GO FORTH AND DIE QUICKLY

My mother nearly died last week and if she had I wouldn't have been able to do anything over her medical establishment's lack of health care (pun intended).

Here's what happened: she'd been feeling poorly over the last several weeks, causing several calls to 9-1-1 and runs to the emergency rooms of Kaiser (which provides her coverage) as well as the local hospital (which is nearer to our house). When she ends up at the local hospital, as I understand it, Kaiser will have to reimburse that hospital for the health care costs WHICH IS WHY Kaiser wants -- and it's success indeed depends on being able to -- bring nearly all health treatment in-house.

But what's even more cost-effective to an institution like Kaiser, of course, is if its members don't get sick or (and it's not the same thing) don't get treated.

So, last Thursday, my mother called Kaiser for a check-up as she'd been feeling poorly all week. When she was received for said check-up, that doctor immediately referred her to their emergency room. Later in the day, I was told by Mom that Kaiser expected to keep her for overnight observation. All well and good as I had been watching her suffer for the past few weeks. Except that later that evening, the emergency room nurse called and said they wanted to discharge her as there seemed nothing wrong with her then.

Ridiculous, but the nurse wasn't interested in hearing my description of her recent ills. Much to her disgruntlement, I insisted then on talking with the doctor. I would come to have very interesting conversations with that doctor (he kept mentioning his 20-year experience and disgruntlement with emergency rooms becoming geriatric care facilities). But despite my warning him that I was sure that if they discharged Mom, I'd only be calling 9-1-1 within another 24 hours, he said she was "stable" and there was no other medical treatment to give her. That probably was true at the time, but I thought it'd be a good idea if Mom was further observed as there's obviously something wrong with her.

He said a lot of her conditions could be because of her age (Mom is nearly 80). I agreed over the distinct possibility of such, but also said that I wasn't convinced we were doing everything medically possible for her. Nonetheless, I couldn't persuade them to keep her and she came home after midnight (right, they couldn't spring for a bed for a few hours to prevent a near 80-year-old from traveling).

Well, it happened. Mom got poorly the following day, I called 9-1-1, and the ambulance took her to the local hospital. At the local hospital -- check it out: they immediately installed a temporary, then the next day, a permanent pacemaker. Absent that pacemaker, Mom would have died.

Kaiser sucks. And this incident of course reminded me of how Kaiser had treated my father in southern California. At one point, Kaiser discharged him from emergency room. My brother picked him up...and while driving home, Dad took a turn for the worse and my brother ended up driving to another Kaiser's emergency room! At that second Kaiser, a doctor asked, "Gee. Why did the other hospital discharged him?" (This incident is raised in the book I wrote for my father, The Light Sang As It Left Your Eyes -- google yourself Kaiser and buy my book!) Kaiser's approach is to stabilize patients, then get them out. What this overall approach means is the disincentive to take a deep look at an individual's health situation and try to come up with a large-picture diagnosis -- not to say that there aren't Kaiser doctors who care enough to do this, but the institutional approach disincentivizes this more caring medical approach. In my mother's case, for example, she had been suffering for a while from a combination of diabetes, blood pressure problems and fatigue -- what did it take for a doctor to step back and assess proactively, before an "emergency", that she needs a pacemaker?

The only good thing that came out of this recent incident with Mom -- because this Kaiser management of her has been about cost! -- is that because they discharged her, they ended up losing the pacemaker business and will have to spend money reimbursing the local hospital.

So, I wasn't sure I'd be blogging about this but the news this morning carried this bit of hoo-haa of Democrat Alan Grayson of Florida castigating Republicans for their health care proposals that presumably can be summed up as "The Republicans want you to die quickly if you get sick."

What Grayson is talking about is the Republicans' supposed lack of sympathy for the uninsured. I don't know enough about this particular hoo-haa to take sides, but what I note in this health care debate is the focus on the uninsured vs the insured. That's key, of course. But here's what I learned during this debacle with Mom which also caused me to have several conversations with health care professionals who are right there at ground zero of the debate.

What one doctor is hearing is that health care is moving towards the Kaiser model. I suppose the Kaiser model is more efficient than many other alternative models. But an exponentially high percentage of health care treatment occurs for a person when said person becomes a senior citizen. This is where the model breaks down. Death is inevitable and Kaiser is quite aware of that, and there's no economic incentive to keep prolonging life. Kaiser may be quite effective and fully capable when it comes to treating curable diseases or one-off issues (like cataract surgery), but not when it comes to prolonging life.

I hope my mother can survive being a Kaiser patient. My father didn't.

Meanwhile, any health care plan that doesn't adjust for the difference between geriatric care and other health care is inherently short-sighted (and perhaps that's why there's a generational gap in the amount of support, or lack thereof, for Obama's plan, with senior citizens not as supportive as the younger generations). But watch out, ye politicians: there's a difference between senior citizens whose health care is at risk, and, say, children whose education is also being harmed by political policies. Senior Citizens are more than old enough to vote.

DIGNITY

would be Grace
when the
ancient

body is rejected
from the
Emergency

Room because death
is, not
inevitable

but, uneconomic, thus
always ill-timed.
Grace--

a white flower
poking through
that

sidewalk crack everyone
avoids when
Bad

Timing is always
Bad Luck.
Approaching

is not that
hooded guy
wielding

a scythe. Approaching
are the
pencil-pushers

whose erasers always
transform the
perfume

of white roses
into antiseptic
septic.

UPDATE: Of course the above doesn't come near to addressing the complexity of health care. But I agree with one Peep who wrote in:

I am concerned that the insistence on getting some kind of health care bill done this year is the wrong thing to do because speed is not allowing for a rational debate. I’d rather it get done next year and some real thought go into it — [though] I realize I am one of the lucky ones who is not facing the loss of a loved one or a home because of lack of insurance so I have the luxury of not needing urgent action....

All of this reminds me of Winston Churchill’s statement about Americans when he was frustrated about FDR’s slowness in joining WW2. He said that Americans can always be relied upon to do the right thing, but only after they’ve tried everything else. Applying it to the health care dilemma, we will get a heath care bill passed, it will be a mess and will not provide a public option thereby allowing insurers to find loopholes on pricing and coverage, and we’ll have to go back in a few years and do the right thing in the right way — and since the Democrats do not have the balls to do the right thing by going it alone (or because a number of them are in the pockets of insurers and pharmacopia) they will end up being blamed for the ultimate failure of this year’s model.