Trying Something Different

The more I listen/read what's going on in this country (the US in case you live somewhere less prone to shouting), the more I'm concerned that the focus on what separates us is blinding us to what holds us together. I firmly believe that the people in this country are not as divisive, are not as far apart on many issues as the media, politicians, and those who seek to manipulate us would like us to believe.

I think most of us, in many walks of life, of varying degrees and forms of faith, of different political flavors, of different educational, cultural and geographical backgrounds as well as different social and economical status, still have a great deal in common, other than the fact we are all, more or less, human beings.

I think we generally want others, even strangers to succeed, be happy and prosper. I think most of us don't want others hurt unnecessarily. I think we generally believe we are stronger as a nation than we would be as an anarchy. I suspect we largely (with a few polarizing exceptions) generally want the same thing for this nation, even if we don't all agree on the best way to get there.

I also believe (because, hey, I'm a dreamer) that there isn't just one way to get there. And, in the interest of moving away from divisiveness, I'd like to focus some attention on what we have in common, ways diverse individuals with vastly contrasting viewpoints are moving down the same path, working toward the same goals.

This week, my goal is to showcase an example every day, at least until Saturday. I've already found three.

Today, I'm going to start with my good friend but frequent critic, especially when it comes to politics, Relax Max. Now Max and I have gone round and round on the healthcare debate. There are many points on reform that we just don't agree with each other on. However, it was brought home to me that that's mostly details. The other day, he wrote a post about what we need in healthcare reform. Reading his bulleted list, I realized that, fundamentally, we both wanted exactly the same thing. We just need to figure out a way to get there. And, neither way we envision it is necessarily wrong. In fact, either one is a vast improvement on where we are now.

How do I know this? Because there are dozens of countries with universal healthcare and they run the spectrum from the government owning everything down to the q-tips to having groups of private insurance provide the services that everyone has to have. There's more than one way to get this done. Whether my way is "best" or RM's way is "best," either way (and probably a dozen more) will get us where we need to be. We've just got to get off our butts and do it.

And stop using our differences as an excuse to do nothing when so many of us agree that something needs to be done.

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Sunday Soapbox: Finding a Scapegoat

*Steps on the soapbox*

One of the side conversations I note during any discussion on health care is the villification of fat people. *Sigh*

Alcoholics, smokers, people with stupid (and/or) dangerous sexual habits, people with poor eating habits (which may not be reflected in appearance), exercise habits (which may not be reflected in appearance), people exposed to unhealthy environments, and people who are dangerously thin (and yes, that is possible) - none of them are called out as the scapegoats for the healthcare crisis.

It's the fat people.

True, obesity is prevalent and prevalent to a degree not seen in the past. And it can be a factor in a number of diseases - but to talk about the amount of money spent on obesity is misleading since much of it is spent - millions, even billions - on people trying not to be fat. But to listen/read the blogs and news now, ONLY fat people get heart disease or diabetes or any other major cause of death or disease.

It might be noted that people lump those who are obese, morbidly obese and being overweight in the same pot, even though the repercussions and issues are not the same. In fact, I'm not sure we have clinical evidence that being overweight alone threatens your health.

You want to know what I think (and you ought to or you shouldn't be reading this), one reason obesity is being singled out as THE factor, the cause of ALL of the growth in healthcare costs, is because people can judge someone by appearance. Just a glance and one can smugly judge, calmly blame all the struggles and pain of healthcare issues on an individual. And, since everyone assumes it's a lifestyle choice, they are comfortable in thinking fat people get what's coming to them or are bringing the rest of the country down.

I don't get that. I'd never take it upon myself to judge a smoker, what kind of person they must be to take up the habit or continue it. How would I know how that happened or why they haven't overcome it? Or a drinker? Or a prostitute? I've never walked in their shoes. How do I know what I might have done if faced with the same choices? As long as they don't endanger others with their behaviors, such as drinking and driving or continuing with unprotected sex even if HIV positive, it's not any of my business what they do to themselves. As for health issues, there are plenty of people who suffer the consequences of life-threatening diseases without doing anything "wrong" and many who do nothing right and yet remain healthy.

Yet, few hesitate to judge a fat person. One glance and one assumes they know the eating habits, exercise habits, reasons they're fat, everything they need to know about someone. Just a little effort and it could all be undone. Is it true in some cases? You bet. Just like some people kick the cigarette easily.

For many others, overcoming obesity can involve years of constant diligence, tiny meals, exercise and sacrifice - even life-altering surgery.

But people would rather judge. Now, most will admit that there are some people fat through circumstance beyond their control - but those same will be quick to admit that that doesn't apply to the vast majority of obese individuals. All well and good, even if undoing it is almost universally challenging.

Can you tell which one's which by looking?

And that, boys and girls, is the problem with prejudice. Prejudice is all about deciding what a person is by their appearance, whether it's having dark skin, wearing a burka, or being fat, instead of who they are. I'm far from convinced that the obsession with weight is a healthier thing than the obesity problem - I could be wrong, but I don't think I am. Most of the fat people I know are quite aware of the problem and have already taken steps, even repeatedly, to try to eradicate it. Telling us we're losers hardly fixes anything. And treating people based on what they are rather than who they are, hating them (as fat people still are even in our otherwise politically correct world) though they hurt no one else, well... that's a step that historically has always lead to bad things.

In the end, in my opinion, judging someone by their appearance alone says a great deal more about what kind of person the one judging is than it says the person being judged. And healthcare's issues are bigger (if you'll forgive the expression) than weight control.

Just sayin'.

*Steps off soapbox*

I've decided to limit my rants to once a week and Sunday is often a good day for this sort of thing, so I'm making it a new feature. I expect I'll be getting a lot of flack on these topics. That's OK. If you've really considered something, disagreeing is fine. But I think, far too often, people react in a kneejerk way, insensitive to the effect on others.

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Here's to Our Health

I've made no secret about where I stand on healthcare reform. I know we're not all in agreement on the issue and many people are scared to death about where the reforms (both those actually proposed and those described) will lead us, often speculating on the worst case extrapolation with little or no reference to past history or reality.

I don't feel that way, for two reasons. First, I think we're already IN the worst case situation with regards to healthcare barring ONLY continuing on the trends we're currently on. People, through no fault of their own, are not able to take even minimum preventive care because healthcare has become so expensive it's all but impossible to address without help - even nominal heathcare. And because insurance companies (and their huge profits) add to the cost (without actually providing a benefit), it makes us all poorer. It hurts people without insurance so that they can only get care when they are in a crisis (which is more expensive for all of us) because of the ridiculous cost. It hurts those of us with insurance because the cost of the profits for doctors, hospitals and insurance companies ALL come out of our pockets - as well as that emergency care. It hurts businesses as they spend more and more money on healthcare for their employees and it hurts employees because they can't make decisions that help their families without taking that healthcare as a consideration.

And, yet, for all this money and effort, all the high end hospitals and doctors, our care is not first rate. People die who don't have to. Decisions are made depending on the insurance, tests run or not run, doctors chosen based on who's with what company. Communication and error are frequent.

And, if that weren't bad enough, if facing a terminal or life-altering disease weren't stressful and miserable enough on its own, if the morass of insurance loopholes and disallowed reimbursements, correct codes and paperwork weren't enough, even doing everything right doesn't preclude financial ruin for an ugly diagnosis for dementia, a hard battle against cancer, or a baby born six weeks early. Financial ruin for not just the individual involved, but often a whole family - lost wages, lost savings, lost retirement, lost legacies.

It would be one thing if the system we have now worked worth a damn. It doesn't. I understand not wanting to make something so useless it sets us back, but doing nothing isn't working and it's what we've done to date.

The second reason is that the fear, that government will fail to do something the market can do better is bogus and has been disproved time and time again. Skip the hype and the hyperbole. Spare yourself the nonsense that making sure everyone has health care is putting us on the path to Nazi-ism. There are any number of things that were never got better until the government stepped in (at the impetus of the people): environmental regulation, financial regulation, minimum wage, civil rights. In all of these cases, the government had to step in where capitalism and society did not - for the good of all the people. And, even though I'll be the first to say government is often fumbling and irksome, they've done some damn fine things, too. Things I, for one, am happy to pay for with my taxes. I know a lot of good people doing the right thing in government. My grandfather was one. So was my father. They made it better for all of us with their quiet and unsung dedication.

What we're doing today isn't working. Seriously.

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Stirring the Pot

Talking about healthcare is a big deal right now. I think it's a conversation that needs to happen. When Obama says, we need to do something about healthcare and their costs. Every day, people die needlessly because of inadequate care, because of poor preventive care because of lack or inadequate insurance.

We spend more than most industrialized nations per capita for healthcare yet we have a lower life expectancy and infant mortality. There are a lot of things I think might help (doesn't everyone) and I don't pretend I'm an expert. But I'm a potential patient and I know things will not get better unless I demand better. But I don't want to make doctors into assembly lines or to put them in a position where they can't make a living. In fact, pretty much none of my ideas are designed to do that.

But, my friend, the Mother told me that to talk about making a real difference in the cost of healthcare is going to address some of the big cost drains that skirt some ethical lines. She's right.

So, here's the question: is it always the right thing to fight for life no matter what? And, if not, where does one draw the line? You might be confused by the question - what does she mean? I'll explain. I'll also add that I'm not sure where to draw the line, whether there are two many variables to determine it legislatively or if that's something that needs to be determined by expert (i.e. medical - NOT insurance) opinion, but I do think the line exists. I personally think the answer to the first question is no.

Now, I said I'd explain what I mean. In some people's idea of a perfect world, everybody's have a monitor that would pop and say "Your liver is failing. Schedule liver transplant? Y/N" Then you'd stop by on your way home from work and get a new one and still make it in time for your three martini dinner engagement. But effective medicine isn't like that. Many times, a disease or a condition takes time and effort to overcome. It's painful and and requires sacrifice from the patient as well as time and care from the doctor. And sometimes, all that time and care and sacrifice will do nothing to change the end outcome except make the intervening time horrific.

So, here are some questions.

How much time and effort (and cost) should be considered necessary when there is no hope of doing more than prolonging the inevitable? Is it reasonable to spend, say, a million dollars to prolong someone's life for a year in the hospital on life support when that same million dollars might mean the difference between a productive life or an early grave for someone else. Or several someones?

What if that someone doesn't WANT that last painful and undignified year in the hospital?

How much should be spent providing care to someone who refuses to change their habits so that it has no chance of success. Does someone who drank his liver away deserve another one? Does someone who refuses to lose weight or rein in other habits has heart attack after heart attack? Should he get first dibs on a replacement because his is so much more damaged than another? This is actually a question that applies to me. I'm overweight and have several significant risk factors for type II diabetes. If I don't take steps now to address my weight and eating habits, should someone else be responsible for helping pay for my care?

Here's a hard one. What about children too malformed, too tiny, too underdeveloped to be truly viable. Children who are likely to be on full life support for months if not years if they live that long. Children with tubes and needles in them, children so delicate they can't be handled, who many never even know the comfort of a human touch. Or children born without brains or so severely damage they face years of surgery so they can limp through the remainder of their lives just severely handicapped.

It's not an easy question for me to ask as a mother, a situation that's heartbreaking. But is less hearbreaking to see your child only through a glass wall when there is no hope that the child will ever go home with you?

I don't know the answers to the questions and I suspect the answers depend on a variety of variables not here. But I'm not sure we're making these decisions today the right way. I know my father, who was a healthy man in his sixties when he was diagnosed with stage 4 colon cancer, would have preferred to just go home and spend his last days with his family. He fought at their insistence until his liver gave out and, though the doctors encouraged him to come back for more treatment, he went home. That was hard for me, but I respected his decision, understood his decision, admired the way he saw it.

Perhaps some people would choose to have herculean efforts in place to keep them alive until the last possible minute, no matter the pain, no matter the discomfort, no matter the financial burden on the system and on their families.

But many, I think, would happily trade those months or years of pain for a peaceful escape, would trade losing that family and their memories to Alzeimer's for a loving goodbye with the faces they know and love, would trade a few months in the hospital for years of working through debt for the people left behind.

So, once last question. In many states, people don't have the choice to decide to live or die when they face nothing but pain with an inevitable conclusion. Should they have it?

You know, it occurs to me I just don't stir up controversy as often as I should. I expect this will, hmm, stir something up.

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