Because my wife works in the Phoenix area on weekends, I often hear of unusual cases. A 60-ish woman developed hemoptysis, coughing up blood. While a strong sign of lung cancer, hemoptysis is also a hallmark of tuberculosis. Now, it is often MAC disease, Mycobacterium aviae complex, a non-contagious cousin to TB, often affecting lungs previously damaged from pneumonia, where the bronchioles, the small airways, dilate, a condition called bronchiectasis, a nidus for such pathogens. We used to say hemoptysis was a manifestation of bronchiectasis; I wonder today how many of those people in retrospect had MAC disease.
MAC can be treated with “triple therapy”–3 antibiotics, many used for TB. If widespread, the antibiotics have to be taken for life. If localized, then part of the lung containing the disease may be taken out, and the disorder cured.
That’s pretty nice, to take somebody who is coughing up maybe a cup of blood periodically, and curing them. Surgery can cure many bad problems. I have three pins in my right hip after a car turned in front of my bicycle in 1999. Without surgery, I’d be limping or not walking at all. Since surgery, I’ve backpacked Alaska five times, climbed mountains, canoed, and traveled all over the world, walking normally. My surgeon gave me back my life.
The downside is that surgery is expensive. So is anesthesia. And hospitalization. There are a lot of people employed in hospitals to check you in, care for you, get your medicines, your meals, get you out of bed, clean your room, and so forth. But what is the price of good health? Until you’ve had bad health, you probably don’t think much about good health’s being worth something. It’s just that we can’t put a price tag on certain important things in life, like no longer having a condition that makes life pretty miserable and limits activity. A lot of people no longer die quickly from conditions that may not be curable, but can be controlled for many years, like COPD, CLL (Chronic Lymphocytic Leukemia), CHF (Congestive Heart Failure), HIV, and many others.
Being poor is both highly correlated and likely causative of ill health. There are a lot of poor people in this country, a whole lot, for whom a lot of medical advances simply are too expensive for them. They hope…..the abdominal pain will go away, the chest pain on exertion isn’t their heart, the recent onset of headache isn’t a brain tumor, or the recent fever isn’t something bad. I hope, too, when I get one of these problems, but I can get it checked out and either be treated or reassured. I don’t know what reassurance is worth, and I don’t think the Republicans in Congress think it is worth much either. I can look up the price of Raytheon stock; I can put no price on my ability to be able to walk normally. Most of us take our health for granted.
Until something bad happens.
The woman with MAC had insurance. What if she didn’t? The antibiotics are expensive in their own right–$60-$100 a month. I know many people who need that money for other things, and not booze and cigs, either. They have kids who need things, their cars break down, they need a new heater in their trailer. Yes, trailer. What if she can’t afford it? She might be a great candidate for surgery, but she doesn’t have $25,000 or more to pay for the diagnostic tests and surgery. So what does she do?
Coughs up blood and hope it goes away. Maybe pray that she doesn’t exsanguinate. There is a place for prayer, but not here. We have the ability to treat these people. Not to do so is betraying the ideals this country was founded upon.
In America, many believe that is the way it should be. If you don’t have insurance, well, you don’t have insurance. The market will deal with you. Maybe you are lazy and on the dole, not doing real work like moving money around, which has been shown not to add value, unlike the minimal wage Nurse’s Aide who has to clean a patient who soiled himself (crapped in bed and was lying in it). I’ve done that, by the way, hundreds of times. As a doctor, too. Some weren’t born to wealth, had bad genes, parents who didn’t read to them, had a husband leave (after fathering a few kids, perhaps), and don’t have “connections”. Or, they are unemployed, because unregulated fools believed in stupid models, made bad bets, got bailed out and were paid nice bonuses for doing it. That is basically why our unemployment rate is so high. You are out of luck, and there are 50 million “you’s” in America today. The thought of insuring somebody, called the Affordable Health Care Act, derided by many as “Obama Care,” is an anathema to many. Let the market take care of it. Really? We aren’t talking pork futures here; we are talking about people’s health.
What I find ironic is many who were angry about the AHCA were elderly and retired military, both of whom were getting government subsidized medical care. The military earned it, although how much longer we as a country can afford to pay it remains to be seen. If Medicare is going to be on the table, then so must defense spending.
The millions of poor people here don’t have the loud voices that Bill, Rush, Ann, Mitch, John and Eric have. The Republican Party, who has voted in the House more than 33 times to repeal the Affordable Health Care Act, appears not to realize exactly how many poor people there are It’s easy to forget, when one has insurance and can get any medical condition taken care of without worrying about bankruptcy. But these 50 million are mostly silent, and not in the news. I don’t see that cutting medical safety nets will do these 50 million much good. Indeed, I see that expanding the safety nets to cover these people is a better idea, and I am willing to be taxed to do it, even though I already pay double the percentage of Mitt Romney.
There are conditions I saw as a neurologist that are totally devastating–like an anterior communicating artery aneurysm that blows out the frontal lobes, leaving somebody permanently in a nursing home physically intact but with the judgment of a 6 year-old. That could happy to anybody–Republican, Democrat, rich, poor. I’ve seen devastating strokes, infections, trauma, rapidly aggressive cancers ravage people or kill them outright, often with no warning. A former colleague of mine was practicing cardiovascular surgery and was dead 10 weeks later from leukemia. I can get T-boned by a red-light runner tomorrow, or run over by a distracted driver, when I am out for a walk. I was almost at my Safeway store, the day of the Tucson Massacre. My congresswoman is paralyzed and partially aphasic for life; her replacement was shot that day, too, uses a cane and now has to defend the 2nd amendment to get re-elected. While there are scathing attacks on abortion, I haven’t seen legislation pass to ensure every child under the age of 18 gets covered for medical care. This to me is right to life, which ends at birth. There are those who espouse Christianity who call fetuses children but who are against covering all children’s medical care. Since that passes as Christianity in this country, small wonder I am not religious.
Should people be responsible for themselves? Well, it depends. In the Ayn Rand world, every human does the right thing, and there is no cerebral palsy, no devastation from herpes encephalitis, no people tied to ventilators or oxygen tanks. Ms. Rand was no saint, with a personal life that made Bill Clinton’s look normal. I’ve read her books; they sound fine until you suddenly realize that she writes about a different universe from the one you live in.
To Rand Paul, and the others who think we should just care for ourselves, illness is our problem. According to Mike Huckabee, God is punishing you, just as God punished Newtown. Yes, godlessness in the schools caused Newtown. I wrote Mr. Huckabee about that and never heard back. I’ve seen thousands of lives devastated, families in pain, and many who have gone bankrupt. You? Maybe some day it might be you in the bed looking up at somebody, hoping for relief of your misery, and being able to resume the life you took for granted. That assumes, of course, that your brain is not the source of your being hospitalized, in which case you may not recognize anybody. This stuff happens, you know. I worked for 20 years in a small city caring for people with these things, and I was really, really busy.
Those of you who called paying for end of life decisions, derided as “Death Panels,” might walk a few meters in my shoes (that’s a few yards for Americans who read this), and think about those derogatory comments. Here’s my op-ed four years ago
You see, we can decide to be rugged individualists, which is really romantic, until other rugged individualists assert their rights over ours. That’s a problem. Or until we need help in a hurry, be it a flood, a fire, an earthquake, a horrible illness, or a car wreck where we are trapped in a vehicle with leaking fuel and a hot engine. When that happens, most of the money you’ve got, the gold in your safety deposit box, the few bucks on your money clip, the spare jewelry you think will be worth a lot won’t be worth a tinker’s damn.
And then, just maybe then, you will learn that health insurance, Obama Care, clean nursing homes and freedom to die the way you choose, may be more important than you thought.
Finally, you might understand why it is worth spending taxpayer money on medical care.
Boreal B[l]og 
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