A small task for you today, my little fuzzy peaches, at reader request.
Let’s solve the health-care crisis. To quote a well-known public figure: Yes, we can.
I ask because I received an e-mail from a reader last week, with a link to a story with this non-inflammatory headline — Canadian Health Care We So Envy Lies In Ruins, Its Architect Admits. Ahem:
As this presidential campaign continues, the candidates’ comments about health care will continue to include stories of their own experiences and anecdotes of people across the country: the uninsured woman in Ohio, the diabetic in Detroit, the overworked doctor in Orlando, to name a few. But no one will mention Claude Castonguay — perhaps not surprising because this statesman isn’t an American and hasn’t held office in over three decades.
Castonguay is credited as the man who first conceived of Quebec’s provincial single-payer system, which eventually spread across the country and became the Canadian system we know today. In a story that begins by implicitly scorning the anecdote as a public-policy driver, the anecdote of Claude Castonguay (what a wonderful name) is given great weight, although his ideas about how to fix the Canadian system boil down to a pretty tame set of recommendations:
Castonguay advocates contracting out services to the private sector, going so far as suggesting that public hospitals rent space during off-hours to entrepreneurial doctors. He supports co-pays for patients who want to see physicians. Castonguay, the man who championed public health insurance in Canada, now urges for the legalization of private health insurance.
In my night-shift editing I read half a dozen pieces like this a week. Everyone has an idea how to fix American health care, but no one has the idea. Personally, I don’t believe the system is fixable in the state it is now. But I’m always willing to read one more idea. My favorite is the Wall Street Journal, which has some of the best health-care reporting in the world, but a whack editorial page bought and paid for by the American Medical Association. And my single favorite piece on that page in recent months was last year sometime, suggesting we could all learn something from the Amish, who don’t believe in health insurance, and who use such radical cost-containment practices as chipping in for one another and, my personal favorite, dickering.
Oh, how I can’t wait for the day when I dicker with my doctor. I bet he can’t, either. Unmentioned in the admiring WSJ editorial are the other documented Amish health-care cost-containment practices, which include alternative medicine (herbalists, midwives, etc.), bus trips to Mexico for the Third World option and, frequently, quackery. The Fort Wayne Journal Gazette had a pretty good series a few years ago, where a reporter followed one of these caravans. Among the anecdotes was a woman who’d had a serious ankle injury requiring reconstructive orthopedic surgery, and the incision stubbornly refused to heal, with chronic infections. (Dr. Nance would prescribe a hospital stay with heavy antibiotics to knock down the infection, followed by a rigorous home-care program emphasizing keeping the wound clean, with instruction for all her caregivers. Oh, and diabetes testing. This is just off the top of my head.) Her Mexican doctor advised removing all the surgical screws on the theory they were causing her infections, followed by poultices. I don’t know where the Amish woman is now. My guess is either pushing up daisies, or coping with life as a 19th-century amputee.
(A further note, also from the WSJ: Dickering doesn’t solve everything. Also, let’s recall the tragic case of the Amish Cook, who dropped dead at 66 from an aortic aneurysm, diagnosed by her herbalist as an iron deficiency, IIRC.)
I don’t mean to be flip, I really don’t. I’m glad the reader sent the link along. I know there’s no simple answer to this problem, or any answer. But here’s what I know:
A health-care system where a poor kid with asthma has to take three buses and a subway to his clinic doctor, and a doctor’s wife can get spa-level care while recovering from her breast augmentation — is not a good system.
A health-care system that rewards doctors more for choosing dermatology as a specialty (with all those lucrative, pay-out-of-deep-pockets anti-aging patients) than primary care (with all those poor kids with asthma) — is not a good system.
A health-care system where insurance is connected to your job, with no contingency for job loss other than COBRA — is not a good system.
There is no perfect system, and there might not even be a very good one. Life is a terminal disease, and some of us have trouble facing this fact. There may be no way to balance the truly miraculous technological and pharmaceutical advances that are driving the cost of health care into the stratosphere with the fact hardly anyone can pay for it. But maybe there’s a better way. This is your job today, little commenters of mine: Let’s fix it! You know we can!
And if you’re not up to it, in the bloggage, two internet-related stories about the campaign:
From Saturday’s WashPost, a woman offended by the Obama-is-a-Muslim e-mail tries to track it back to its source, with more success than you’d think.
And in Sunday’s NYT, a piece on DIY attack ads by freelancers.
Both worth your time. And just for laughs:
A bunch of white kids fight the “Barack Hussein Obama” thing by taking “Hussein” as their own middle names, an “I am Spartacus” sort of protest. I am Salman Rushdie!