Tuesday, March 23, 2010

The Health Care Crisis Redux

Calvin Trillin, the great essayist and deadline poet, once remarked that you know you're a grown-up when all the idiots you went to high school with are now the idiots running the country.  Our President, Mister Obama, is a year older than me.  Most of the gaping maws flapping endlessly on about health care, the politicians and the pundits, the liberals and the conservatives, are all more or less my age.  They are indeed the idiots I knew in high school, or at least reasonable facsimiles of them.

The health care bill is a mess.  You know that you are staring at a doomed effort when the supporters are comparing it to Medicaid (a fiscally bankrupt endeavor) and some of the less savory aspects of Lyndon Johnson's Great Society (a morally bankrupt one).

Before you go Keith Olbermann on me, sir, let me explain that last statement.  Daniel Patrick Moynihan was right: the conditions of the ghetto, particularly the Black ghetto were created by "a tangle of pathologies," most of which had their roots in American slavery.  In slavery, Black men were denied the right to lead their families.  In post-slavery America, Black men were denied opportunities to adequately provide for their families, and to improve themselves.  G.K. Chesterton's observation that matriarchy is merely moral anarchy, for in it, men are no more than shadow figures, removed of responsibility and emotionally disengaged, applies here: America institutionalized the notion of the absentee Black father, and thus created a Black subclass.  Unlike the Jewish ghetto or the Polish ghetto or the Italian ghetto, there was no hope of escape from the Black ghetto (and you can make a very strong argument that our benighted immigration policies are creating the same hopelessness in our Latino ghettos, but that's another entry.  Suffice to say: Universal Amnesty Now!  Y Que Vive La Raza!)

The Great Society was an attempt to fix a problem without addressing the root causes -- white racism and white exceptionalism -- that created it.  Head Start is useless, if families are atomized.  Welfare is an insult, when good men are constantly denied opportunities to work.  Subsidized college tuition is pointless for kids who go to substandard public schools, and improved schools are wasted on kids who receive no encouragement, support, or guidance from home.  The Great Society -- and to this day, when I hear Johnson's speech announcing it, promising that "We will build a GREAT SOCIETY..." I get tears in my eyes and chills down my spine -- wasn't about poor people or Black people or fatherless kids.  It was to give people like me, white middle class folks who suffer from a lot of guilt, tears in our eyes and chills down our spines.  It wasn't meant to solve the problems; it was meant to make white folks feel good about themselves. (And when it failed, when, as Moynihan predicted, it made the problems worse, not better, it gave Whites the opportunity to say, "See, you just can't help those people.")

Which brings me to the health care bill.

I just heard a report about the National Health System in England, the universal health care program that affords all citizens essentially free care.  (Incidentally, most British love the NHS and are generally pleased with the quality of care they receive.  It isn't perfect, but, despite the hyperventilations of the Glenn Beck knuckleheads, it's not bad, either.)  The government has released a report saying that NHS is in deep trouble, not because of mismanagement or poor results, but because an inordinate amount of time and resources is being spent on people with routine conditions like mild colds, scratchy throats, and mild stomach upset, things that could easily be treated at home.  In other words, the system is being strangled by patient abuse.

The American system, while far from perfect, is being strangled, too, by patient vanity.  And no law will correct that ill.

It was not that long ago that if you were sick enough to end up in a hospital, you would most likely spend time on a ward, a big room with fifteen or twenty beds.  And because the nurses had a lot of patients to see, a family member would most likely spent a lot of time at your side, fetching you ice and plumping your pillows.  This was a perfectly acceptable system, cheap, efficient, and egalitarian (now there's a word we don't use much anymore!)

Doctors made house calls, mainly because they lived in the neighborhood.  They sent their kids to the local school.  They went to church with the people they treated, shopped where they shopped, vacationed where they vacationed.  They were respected members of the community -- no one begrudged them a slightly bigger house or a slightly newer car -- but they were of the community.   And everyone understood that you didn't abuse the privilege of the house call: when I accidentally dropped a pair of scissors while stepping over my brother, and they hit him right between the eyes and there was blood gushing like a geyser and we thought I had blinded him, we called Doctor Barnett.  If I had just punctured his cheek, it would have been "apply pressure and check it in the morning."  

Today, doctors live in gated enclaves, psychologically and economically removed from the bulk of their clients.  And they specialize.  You make more money that way.  

Specialization is a hallmark of the era.  Years ago, Fred Dean was a star defensive lineman for the San Francisco 49ers.  In 1983, he played primarily in obvious passing situations, the ultimate defensive specialist.  He recorded 17.5 sacks, and made All-Pro (and eventually was elected to the Hall of Fame), in that limited role.  Twenty years before, Philadelphia Eagles star Chuck Bednarik played center on offense, middle linebacker on defense, and covered kicks on special teams,  playing every down of every game.  He's in the Hall of Fame, too.  But nobody wants Chuck Bednarik anymore.  We want specialists.

We've come to expect depersonalized care; it's the price you pay for what seems to be more specialized care.  And we demand our privacy: wards are the stuff of sappy 30's melodramas and war movies.  Well, private rooms and round the clock nursing and a team of experts costs money, lots of money.

We also want magic.  God is dead, or so we seem to think, and with Him, personal accountability is dead, too.  We choose to live like tract home Caligulas, eating to excess our rich and fatty foods, drinking and drugging to our desire, frolicking with abandon, contracting whatever social disease is in season, and then, fat and blighted, our arteries sclerotic, our muscles atrophied, our tender bits cankered, we ride our Rascals into the physician's office and demand the pill, the potion, the procedure that will restore us, no matter the price.

No health care bill is going to heal our hubris.

If any Obama is doing anything promote improved health in America, it's Michelle, with her efforts to combat childhood obesity.

What Mr. Obama should have done is get up and say, "Folks, you don't eat right.  You don't exercise.  You watch too much teevee.  You smoke and drink and consume way too many mocha grandes.  You want better health?  Quit going to McDonald's.  Throw away that Pappa John's home delivery refrigerator magnet.  Eat your vegetables.  Take a walk.  Read a book.  You'll feel better.  Understand that some of you can't afford top notch care; you'll have to settle for really good care.  Maybe that's not fair, but life's not fair.  Some of us drive a brand-new Lincoln, some of us drive a 1994 Taurus.  And accept the fact that you can't live the way you live and expect to see your 100th birthday."   Sure, he'd be a one-term president, but he'd be a one-term president I could respect.


  1. Spoken like a man who never really had to worry about whether he could pay for a loved one's sickness.

    Also, our care is not good, and it has nothing to do with our desire for fancy hospital rooms.

    Just because the guy is the same age as you does not mean he is a a dope -- how about the nuclear reduction last week?

    Who are you confucious?

  2. The first comment is so insulting, it doesn't deserve response.

    Health care in this country is bloated. It is bloated because of the ridiculous amounts of money that are poured into it. It is bloated because we have unreasonable expectations.

    Obama is not a dope, not as far as I can tell. That doesn't make him equal to the tasks before him.

    He reminds me of a kid who's 6'2" in third grade, who can't tie his own shoes: maybe he'll be a great basketball player one day, but for now, his motor skills haven't kept up with his body.

    His handling of most issues has shown callowness, and frankly, the people who constitute his brain trust belie his lack of self-confidence: he's surrounded himself with hacks and Old Hands, hardly the Hope and Change he promised.

    Yes, I am Confucius. Plus, I know how to spell his name!