Health care: January 2008 Archives

As my wife, The Fair Helenkela, lays in the recovery room, after receiving a new bionic knee, I am meditating (if in a somewhat agitated state) on the subject modern aging. I am also wondering why my wife, whose weight is appropriate, who works out three days a week, who has the heart of a 25 year-old has to contemplate a future with a hip replacement, hand surgery for arthritis and the other knee?

When I think of our parents’ generation, I am clear that we are in much better shape. We are not nearly as old as our parents were at our age. They were over weight, out of shape and in terrible cardio-vascular condition. Many were even dead.

We, on the other hand, have been into health for decades. Sometime after the excesses of the infamous 60s, when we turned 30, we gave up one set of drugs, stopped smoking cigarettes and started running—even without being prompted by cops with tear gas and batons. We went on hikes with the Sierra Club. We swam in Masters competitions. We joined gyms—and occasionally showed up, sometimes got past the café and actually worked out. We played golf, did aerobics, yoga and Tai Chi. We meditated. We got personal trainers.

We worked diligently at not becoming our parents. We went so far as to actually put on leotards. We bought Lycra for biking and skiing. We dressed, not in the grown up clothing of our successful elders, but in the style and fashion of our children. If any generation could fool mortality, it would be ours. Such was our vanity.

We gave up red meat. We force-fed ourselves fiber. We eschewed the chewing of fatty and deep fat fried foods. We are now buying organic. I do ask myself what an inorganic apple might be.

In order to follow up these healthy ways of trying to stay the aging process (which acts more like a processor—chewing us up) we got our faces lifted, our tummies tucked and our fat sucked.

The problem is that in trying to stay young and healthy, we’ve wrecked ourselves. Our moving parts aren’t moving so well and are in need of replacement. Part of the crisis in healthcare is that my cohort is worn out and out of warranty.

As one of the balladeers of my generation, Leonard Cohen, wrote/lamented, “Well my friends are gone and my head is gray. I ache in the places where I used to play.”

The philosopher Richard Cumberland wrote, “It is better to wear away than to rust out.” I think this is true. G-d knows we’re doing our best not to get rusty, but our maintenance and up-keep are becoming both fiscally expensive and physically painful. Still, my wife is looking forward to returning to the gym, getting back on our tandem bicycle and remaining active in life.

No, we won’t succeed in staying aging permanently. We will do our best to slow it down. Nor will we fool death with our beautiful bodies, youthfully lifted faces or even the inner health of aerobically exercised hearts and lungs. We will not live forever. We will, however, try our best to live fully as long as we’re alive.

Note: The Fair Helenkela came out of surgery wonderfully and is resting comfortably in the arms of Morpheus.

Well, we knew the earlier presidential primary would elevate California's importance in this year's elections, and now we're seeing the fruits. The California Nurses Association has been running this radio spot, ostensibly aimed at the Schwarzenegger-Nunez health plan, that just so happens to feature ... Barack Obama.

That's clever. The ad serves two purposes at the same time -- opposing the health-care reform and boosting the Illinois senator's presidential bid, yet the former purpose inoculates it from federal campaign-finance regulations. This way, the union can effectively make unlimited contributions to the Obama campaign. Smart.

Meanwhile, Obama has received the endorsement of State Sen. "One Bill" Gil Cedillo. Which is curious, seeing that Cedillo's singular concern is getting driver's licenses for illegal immigrants -- a policy Obama (says he) opposes. You'd think Cedillo would have backed Hillary, who supports the licenses, at least when she doesn't oppose them.

All the while, Los Angeles Mayor Antonio Villaraigosa is flitting around the state and the nation campaigning for Hillary. I guess the Clinton campaign figures between Hillary's appeal to put-upon women and Antonio's appeal to cheating men, they've got all their bases covered.

That's politics -- and we're about to get a massive dose of it.

So Delta Dental originally refused to pay for my wisdom teeth removal, somehow suggesting that the experience was recreational and not absolutely completely necessary. My oral surgeon sent Delta x-rays and a narrative explaining that, yes, it was necessary. So Delta finally paid -- but only for the cost of removing the teeth. They didn't cover any anesthesia, which in my case was cheesy, inadequate novocaine because they couldn't find a vein on my zombie-esqe body to use IV sedation. Who knew that in the world of dental insurance we have to bring our own bottles of brandy to surgery to try to numb the pain?

In today's Daily News, Geri Jenkins of the California Nurses Association takes a page from John Edwards, and uses the death of Nataline Sarkisyan to make the case for socialized medicine:

Every politician who thinks the solution to our health-care crisis is to mandate everyone purchase insurance products should stop and think about Nataline Sarkisyan. Her family was "covered" and "insured." And it didn't matter. They were denied care in the interest of Cigna profits. They deserved health care but got Cigna-care.

The California Senate, which will consider the Schwarzenegger-Nuñez bill later this month, has a variety of serious issues to consider, including the uncertain funding for the bill at a time when the state is facing a $14 billion deficit and the administration is already talking about cuts in current health programs.

Still it's important to know there is an alternative bill, one that has already passed the Senate, and will be considered in the Assembly in the coming months: Senate Bill 840, authored by state Sen. Sheila Kuehl, D-Los Angeles. It's similar to the system that exists in every other industrialized country and looks a lot like what we have with Medicare, only expanded and improved and covering everyone.

Under SB 840, doctors - not insurance companies - decide what medical treatment patients need. The profit motive to delay or deny is eliminated.

Isn't that the health-care system Nataline deserved and that all Californians should have?

Well, maybe, but it's not the health-care system SB 840 would deliver. Jenkins operates under the myth of the free lunch -- the erroneous belief that when a "single payer" (read every taxpayer in the state) is paying for health care, health care becomes unlimited, and every patient gets whatever treatment his or her doctor recommends.

But real-life socialized medicine doesn't work that way. Instead of insurance companies deciding who gets what care, government boards do it. (Indeed, when devising her national health plan, Hillary Clinton convened a whole panel of philosophers to discuss how best to ration medical treatment.) And in the place of the profit motive, we get the politics motive, the ideology motive, the special-interest motive, the inept bureaucracy motive, and the who-has-the-best-connections motive.

One can argue, I suppose, that this is an improvement over what we have now, but let's not pretend that scarcity, tough choices, and harsh denials would cease to exist under the socialized model. Far from it. In "every other industrialized country," there are also guidelines as to which treatments get covered, and which ones get denied, regardless of what the physician recommends. There are also often major shortages and long waits for basic medical treatment.

Horrific and tragic though the Nataline Sarkisyan story is, there's no guarantee that under a socialized system her liver transplant would have been approved. And even if it were, she likely wouldn't have survived the long wait for a surgeon.

When it comes to health care, there are no easy answers -- and there are always trade-offs.