Monthly Archives: August 2009

Stop and think for a few moments. Have you ever jumped into something without having all the facts? Most people have at one time or another done just that. Here is one example from my own life.

It was a hot summer day in Florida, the ambulance I was working in was dispatched to a vehicle accident. We raced to the scene where there wer 2 fire trucks and 3 rescue vehicles already there. People in uniforms were running around everywhere. I figured it must really be bad. I did notice that everyone was busy grabbing equipment and there wasn’t anyone with the patients. Someone hollered at me that the doors were jammed. The Jaws of Life and Metal Saws were being pulled out and hooked up. I took off for the vehicle and its occupants carrying my jumpkit, oxygen, and cardiac monitor. My partner went to the drivers side, I went to the passenger side. An older male was slumped over the steering wheel on my partner’s side, an older female was on the passenger side. She was conscious and alert, and in a great deal of pain. Fortunately, the windows were down and I could start to work on her right away. I got busy (these things happen in a hurry). Once I saw the damage to her leg, which I couldn’t reach through the window, without thinking, I grabbed the door handle and opened the door to start to stabilize the broken leg.

Of a sudden, there was a great hush to all of the noise that had been going on. I looked up and my partner was staring at me. He looked at the door he was trying to work through, stepped back and opened it. We now had full and complete access to the patients and other emergency responders had a lot of equipment to put up.

Talking about it later we found that a ‘good samaritan’ had stopped shortly before the fire and rescue personnel. He stood by the car yelling at them that the doors were jammed. There first thought, of course, was that they needed to have a way to get access to the patients, so they started getting equipment ready to tear the car apart and get them out. Unfortunately, because they had not checked for themselves, this wasn’t necessary.

It was an emergency situation, and someone gave some bad information that a lot of other people reacted to. Fortunately, there were only moments lost, but the situation could have been worse. Perhaps it was only dumb luck that caused me to try the door.

How this relates to the current issue of health care reform is that:

• We do have an emergency situation. Things are only going to get worse if something doesn’t happen pretty quickly.
• Mis-information is as thick as mosquitos in a swamp.
• People are trying to respond in an urgent manner that sometimes keeps them from checking what they have been told or looking for new facts to address.
• The outcome? That will depend upon how many people try the door by accident and how quickly.

Please take the time to contact your elected officials and ask them for the facts. Speak with your own doctors and see what they have to say. Read the newspapers, watch a variety of news shows on TV so that you are not getting only one opinion. Stop, for just a moment, and ask what is best for our Country.

August 25, 2009: Senator Ted Kennedy, the “Lion of the Senate” passed away. His legacy, however, lives on. Although health care was only one of the issues that this great man tackled during his 40+ years in government, it was one that was obviously very important to him. Some worry that health care reform will simply fade away without this leader helping to guide the way. Others hope that the momentum he gather around the issue will continue to serve to move things forward.

Regardless of whether you agree or disagree with the concept of health care reform, perhaps the example Senator Kennedy presented will lead the way in discussions. Senator Kennedy did not use “Fear Tactics” to get his points across. He used common sense, a large does of facts, and a healthy side portion of compassion.

Fear results in closed minds and closed fists. Perhaps Senator Kennedy’s greatest legacy is that he maintained an open mind and open hand in trying to find ways to serve this Country.

Education of the public, empowering people to make choices that are right for them, and presenting a voice for those who do not have the resources to speak up for themselves. Those are the marks of good leadership.

Thank you Senator Kennedy for raising the bar and setting an example for all good leaders to follow. Whether a person agreed with his views or not, it is clear that he was willing to reach out, to be inclusive, in order to get things done. He knew the importance of service to the public and lived life accordingly. He did not use “fear tactics” in an attempt to frighten people into adherence to a cause he supported. He sought unity rather than divisiveness. He sought to empower rather than to disenfranchise.

Senator Ted Kennedy will be missed. I hope that his legacy, the example that he provided through his years of public service will continue on into the far distant future.

An August 29th, 2006 article on Center on Budget and Policy Priorities web site, The Number Of Uninsured Americans Is At An All-Time High. Shows beyond a doubt that elected officials have been aware of the rapid decline in the number of people who have insurance in America. This report uses information from the Census Bureau and seems to indicate that there is a correlation with the increase in poverty levels and the decrease in insurance coverage. In particualr, paragraph 4 notes that 17 states were facing significant budget shortfalls in the 2007 fiscal year to the tune of $800 million. That, in turn, equals the cost of covering more than 500,000 low-income children. After noting Congress’s failure to act thus far, paragraph 5 offers this quote:

Between 2004 and 2005, 360,000 MORE children were without health insurance.

This article goes on to provide further details: (see Table 1)

• Number of uninsured individuals has steadily increased from 2001 through 2005.
• Medicaid/SCHIP rose slowly during that same time.
• Employer-sponsored Insurance declined during that time period as did indivually-purchased insurance.
• Medicare and Military Health Care both increased.

It is significant to note that the data also shows that “Insurance coverage declined in the South and the West in 2005, while remaining steady in the Northeast and Midwest. Unfortunately, the South and the West already had poorer health insurance coverage than the other two regions in earlier years, so this further widened the gap between regions. Further information is provided showing 8 states showed significant increases in the number of people with coverage when the data from 2004 & 2005 are compared.

If you look at the data comparing 2000-2001 to 2004-2005, the facts are even scariers as 31 states had higher rates of uninsured.

The declining numbers of those Americans with private health insurance are attributed to the cost of premiums. These increased costs have also resulted in increased Medicaid enrollment.

If you need further information before you are willing to believe that health care is the most significant issue today, go to the 2008 version of this same report: Poverty and Share of Americans Without Health Insurance Were Higher in 2007 – And Median Income from Working-Age Households Was Lower-Than at the Botom of Last Recession.

This second article clearly shows the impact of poverty on healthcare. The worse the economy has gotten, the greater has been the problem with healthcare coverage.

While noting that the number of Americans without insurance dropped slightly from 2006 to 2007 (0.5%), this was due to increased enrollment in Medicare, Medicaid and other public programs. This increased enrollment serves to offset the losses that have resulted from the continuing decrease in the number of people with employer-sponsored coverage. (Lots and lots of part time jobs and the increasing number of small businesses that simply cannot afford the current premiums.)

Further along in this report you will find information to show that the economic growth from 2001 through 2007 was growth for a very small portion of the population but was of such a magnitute that when it is averaged out, it just looks like a reasonable gain across the board. What comes through when you look at the numbers is that the very rich got even richer and poverty enveloped a large portion of the population. When you are looking at overall numbers it looks like the economy overall was doing better. It only takes a few $25,000,000.00 increases in income to make those losses of people in lower income brackets vanish to all but those who are affected by those losses.

The Census data also shows that the increase in poverty was not a result of immigrants. Between 2001-2007, the number of Americans living in poverty increased by 4.4 MILLION. It is specifically noted that “…84 percent of the increase due to an increase in the number of citizens in poverty (and 78 percent due to an increase in the number of poor native-born citizens).

Keeping in mind that the above data only covers through 2007 and the economy has hit quite a few bumps in the road since then, is it any wonder that predictions for the immediate and near future are so dire?

The health-care problem is not a problem of the services delivered by our outstanding medical personnel. Indeed, we have some of the best in the world. Many people from other countries come here for the opportunity to learn specifically for the reason that our doctors and nurses are the best. The health-care problem is one of reasonable access. Reasonable access has been compromised by unbridled greed. A system that was originally designed to help make health care available to all (Blue Cross was the original health care cooperative) became a “big business” where bottom-line became more important than caring about people.

Can we afford to continue to push to get what is best for ME rather than what is best for WE? I wonder what people like Clara Barton, Florence Nightengale, and the family physician that took care of 4 generations of my family would say about the current state of affairs.

A very, very special thank you to all of you medical professionals who go out of your way to help those without insurance. I am sorry that you also lose under the current system. Hopefully, this recent surge in health care reform (an ongoing issue for decades) will help to provide the types of coverage that you obviously feel everyone is entitled to…thank you.

After reading information until my eyes are crossing, I set all of that aside to do my usual approach to understanding an issue. That means I quit looking at the answers that were being thrown at me and started asking my own questions about the health care crisis and exactly why it is so important to make sure that something is done…quickly!

Here’s what I have put together in my little mind:

Health care costs have risen.

Of course it has. Over the last 20 to 30 years a lot of research has been done that has lead to new techniques in treatment and in medications. Each one of those advances has cost tremendous amounts in research and development. Typically, the costs of research and development falls upon the American citizens despite the fact that these technologies and medications are marketed world-wide. (That is why you can buy the same medication in Canada for a low price than you can here. It is also why some procedures are performed in other counties at lower rates than in the United States.)

Because of all that new technology, people are living longer and requiring more health care. People are not suddenly just deciding to live longer. It is through all  of those medications and procedures that people are able to live longer. (Sometimes this becomes a big issue with making a choice of quality vs quantity of life.)

That same technology means that children that would have died 20-30 years ago, are now living much longer lives. A million dollars invested in the first year or two can insure a child lives a relatively normal life when that same child, 20-30 years ago would have died.

More and more of the medication and technology is used for fairly rare conditions and you then run into the issue of how can a rural area afford the same level of care for the 1 or 2 people who may need the advanced technology as compared to the 500 or 1000 who may need that same technology within a highly urbanized area?

Now, add to those issues the fact that a goodly chunk of your insurance premiums is used to support lobbyists, contribute to political campaigns, and more recently be spent on rabid attacks on anyone that dares to suggest that health care should be reasonable and fair for all.

I have to admit that I have a hard time understanding how anyone could be against providing fair and accessible options for health care to everyone. Maybe I am naive but I feel that having viable health care available to everyone is just the right thing to do. I really do not understand arguments against it.

Of course, there are and always will be issues that will need to be addressed to fine tune the process. Personally, I have more concerns about this ‘cooperative’ concept than I do about a ‘public option’. It was the ‘cooperative’ concept that led to the birth of Blue Cross decades ago. That was the beginning of the current health insurance crisis that we are currently embroiled in….will more of the same fix the issues? Will stepping back in time, help deal with the problems of a future that has far different problems to deal with.

I would like to have the choice of a public option. I do not have to take it. If I like another insurer’s package better I can take it. I think that is why it is called an OPTION!! Of course, I also believe that simply coming up with standardized forms would reduce the costs of health care. Ask a health care provider how much money is spent simply on processing insurance claims. Each claim requires your time, the time of medical office/hospital staff, time of insurance company staff, possible review board staff time, cost of all the above for appeals when needed.

I must note here that there is a lot of information that you can find via google search to show that often much of this ‘data management’ is handled by companies in other countries. Outsourcing does have a place in the Insurance industry. Maybe a public option would make a requirement that there would be no outsourcing of those functions thus creating more jobs at the same time you expand health care coverage. This really got my paranoid side going. Sure we are told that our files are confidential, but what level of control is really exerted where that data is being sent overseas? Do they have the same or higher levels of security? Can people ‘buy’ the information from them when it would not be allowed to be sold here? A lot of things are possible in today’s world. I do hope that a Public Option for health care is one that becomes real.

“Pulling the plug on grandma????” Please! Give me a break. What is being discussed is a process that most good physicians already do as part of patient care. The issue is not about ‘pulling any plug’. It is an issue about pride, dignity, choices, and the rights of patients to know the condition of their health and the pros and cons of treatment options. The part of the health care bill that is alleged to give this “pull the plug” scenario life is one in which the doctors that are doing this can get paid for the time they spend.

For the patient and family, it means that they will have an opportunity to choose to obtain information as to various treatment options available and how it will affect them. Then, the patient and family can make decisions based upon knowledge rather than guessing.

Many years ago, while working as a paramedic, I responded to a call where an elderly woman had fallen. She couldn’t get up and her spouse was unable to help her do so. Although she was not seriously injured, we patched up a few scrapes and transported her to the hospital for a thorough checkup. The spouse spoke with me for a few minutes before we transported his wife and the words he spoke have been etched into my brain. With tears running down his face he said: “This ain’t living, they’re just keeping us alive with all this medicine, but it ain’t living. This is Hell.”

I sat with him at the Emergency Room for a minutes before I had to get back on the road. He spoke to me of his concern that despite having living wills, if something happened to them someone might ignore it or fight to have extraordinary measures that neither he nor his wife wanted to have used on them. He said that he had lived his life with pride and he wished to leave it the same way. He added that neither of them wanted to be stuck on a bunch of machines and be just lumps. Nor, did he want to be filled with medicines that kept him breathing but unaware of what was going on around him.

Over the years, I met other patients that wanted to hang on to every possibility in hopes that something would change. They did not care what medications, machines, or anything else was needed to keep them alive.

What the bill being discussed offers is an opportunity to make sure that people with terminal illnesses have an opportunity to understand exactly what the process holds for them and allows them to make choices about both quality and quantity of life. It does not promote one of those over the other, rather it provides an opportunity for patients and families to work with physicians to make sure that the wishes of the patient are known, and family members will be aware of what to expect.

In the decades since I went on the ambulance call noted above, I have had friends and family members where these discussions with health care providers have occurred and decisions have been reached. Although the choices have varied, the ultimate outcome was consistent. The patient and/or family members were provided with information that helped them to understand the process and to have realistic expectations. Decisions were made, removing unnecessary stress, and creating an environment where a loved one’s last days, weeks, months, or years were as comfortable and productive as possible.

Other situations have arisen where these discussion did not occur and people were not prepared to deal with situations. Stress and frustration grew and became the dominating force for those whose lives were involved in the process. Later, there was regret for time lost feeling fearful or helpless that could have been quality time spent with a loved one if they had better understood what would be happening.

This really isn’t about pulling the plug on anyone. It is about the right to make choices in treatment. It is about the right to have the knowledge necessary to make conscious decisions about how you wish to spend the last of your life. Where the patient is unable to make that decision, those loved ones who will make the decisions need to have every bit of knowledge available in order to honor the wishes of the patient and to make decisions that they will have to live with. The process is about informing…..the deciding remains in the hands of the patient or (where the patient is unable to make such decision) in the hands of loved ones.

Something so personal and private should not be used as a tool by politicians or insurance companies to try to instill fear. It is not something that should be used as a weapon, generating the type of anger and abuse that is being shown on almost every news cast. Something that should be faced with grace and dignity should not be distorted as it has been during these discussions. This type of psychological abuse, promoting and encouraging fear, is just wrong.

If you want to know more about this topic, don’t go to politicians or insurance company representatives for information. Take the time to call someone at a local hospice center or give your own physician a call, or ask a social worker. Talk to those with the experience and the knowledge to give you an answer that will be influenced by the experiences they have had with patients.

For some additional information on the Health Care issue, you might want to check out the League of Women Voters of the United States.