Boreal B[l]og

“The difficult we do immediately. The impossible takes a little longer.” (Seabees)

Years ago, as a young neurologist, I made a midnight call to Detroit to tell a mother her beautiful 21 year-old daughter would not survive a rollover accident.  I can still hear the screaming “NOOOOOOO”. I treated uninsured young men who were severely brain-damaged from motorcycle accidents, some existing years in nursing homes.  I saw families torn apart by conflicts over what an elderly member with irreversible brain injury would have wanted.  Preventable deaths, high cost care without insurance and too few people with living wills are among the many flaws of our medical system.

It’s shameful.

The most important function I had as a physician was not curing patients but knowing when it was time to stop treatment and to allow people–including my parents– to die with dignity. If the Supreme Court or Congress overturn what is best called “Romney-Obamacare,” these issues–insufficient preventive care, uninsured young people, not enough advance directives– will return in full force.

Health insurance has been far from optimal: pre-existing conditions, lack of portability, lack of choice, changing rules, and a pharmaceutical morass come to mind.  Yet, without it, care is unaffordable for almost any significant condition.  Why should a 25 year-old become bankrupt if he develops appendicitis?  How does a single mother pay for her child with meningitis?  What about the unlucky young father with metastatic cancer?  Do we let them suffer or die in pain? Do we allow uninsured motorcycle accident victims to die at roadside?   Without doubt, we waste money in medical care: executive salaries, not learning from errors, and not applying current knowledge are just three examples.  Expansion of Medicare to cover pregnancy and children under 10 would be a good investment, and the bill would be a lot fewer than 2700 pages.

This years’ election is about all 3 branches of government.  We can choose to keep defense well funded and cut decades-old safety nets.  We can make changes to health care unconstitutional for the next half century, for the next presidential term will likely see 2 or 3 Supreme Court vacancies. I’m hoping we will find a Steve Jobs for medical care: someone who will push us to do great things we never thought possible.  Will fixing the system be expensive?  Yes. So was Iraq.  Will some think it not fair?  Yes.  But remember this:  each of us is one aneurysm, one drunk driver, one blocked vessel, one virus, and one malignant cell away from medical catastrophe.  Insurance is about all of us, for we are all, at varying levels of non-zero probability, at risk.  I am fortunate to so far have been healthy.  Most of the less fortunate are not lazy.  Many are women and children, unlucky, poor, and ill.  Each of us is a catastrophe away from joining them.

If we elect those who take us backward, suicide by poverty or suicide by ill health will join suicide by cop as part of the lexicon.  Perhaps, as Scrooge said, that will decrease the surplus population.