Reform coming to a vote:
The Black Death and health care in America
By Dr. Stephen R. Keister / The Rag Blog / March 17, 2010
In October of 1347 a ship docked in Messina, Sicily, after picking up cargo at the Black Sea port of Sarai. Many of the crew were found dead and most of those alive were near death.
The Black Death had arrived in Europe and was subsequently to spread throughout the continent, killing thousands.
We in the United States may be facing a similar crisis when we look at the estimated 45,000 deaths a year due to a lack of health insurance -- and the great likelihood that these deaths will increase exponentially in years to come, as our health care system continues to fail and poverty increases.
Complicit in the impending tragedy are the Republican Party and such Democratic religious zealots as Rep. Bart Stupak, who has been doing his best to kill any health care legislation if restrictions on the legal medical procedure of abortion are not included.
Joining in this assault on the health and well being of the American people is the representative from my local Congressional district, who takes his reactionary stance despite this area having the highest poverty rate in the Commonwealth of Pennsylvania.
The matter of caring for our sick, our disabled, and our elderly should not be confused with a centuries-long debate about the viability of a fetus. This controversy, which dates back to the 4th Century CE, has no relevance to the care of the impaired and destitute.
In 380 CE the Apostolic Constitutions allowed abortion if it was done early enough in pregnancy. On the other hand St. Hippolytus, St. Basil the Great, St. Ambrose, and St. John Crysotom taught that life begins at conception, while St. Augustine and St. Thomas Aquinas felt that life in utero only begins with "animation" of a fetus, i.e. the time of “quickening.”
The discussion was terminated by Pope Leo XIII in 1886 when he as ultimate arbitrator prohibited all procedures that directly killed the fetus, even if done to save a woman's life. Of course the papacy has frequently erred, condemning and excommunicating Galileo and Copernicus for example. Errors occur when we deal with theological abstractions rather than scientifically verifiable truths.
I am sure that those folks who feel that the earth is flat and was created 6,000 years ago, that the sun revolves around the earth, that the species did not evolve, and that climate change is a myth, will take exception. So be it; however, we are still facing the problem of creating a health care system in the United States that can compare with those in the rest of the Western world. Where are we with that debate?
For a non-parliamentarian the Kafkaesque maneuvering within the House and Senate can become totally incomprehensible. As our readers know, I am a strict believer in a single payer/universal system as proposed by Physicians for a National Health Plan. I also feel that the Senate bill is a terrible bit of legislation. I am a great admirer of Rep. Dennis Kucinich, and agree with his decision this week to vote for the legislation, if with great reluctance.
I, too, feel that I am forced into supporting the legislation, provided the final version finally puts the health insurance industry under anti-trust legislation, controls insurance costs and the rights of the insured, and provides the right of the individual states to enact their own health care plans, including single payer.
Ezra Klein quoted Sen. Bernie Sanders in The Washington Post: "Quite frankly we don't have the votes for single payer. That is not much of a surprise, but right now we have language in the bill that says that states that want to go forward with single payer can do that."
He is talking about the Waiver for State innovation, which allows states to go their own way if they have a plan that will achieve the goals of the bill at a lower cost. The health care bill will create a basic, near-universal system across the country. If individual states think they can do better, they're welcome to try. And if they succeed, you can imagine those reforms spreading quickly to other states, too.
Happily there is proposed legislation in Pennsylvania designed to institute a single payer system, thus providing universal coverage and reducing costs for individuals, employers, and municipalities. At the same time it will provide malpractice relief for physicians, allow the physician to act as his/her own agent, and offer a long lacking sense of security for Pennsylvania residents. Our governor indicates he will sign it if passed, unlike the Republican governors in California and Connecticut who vetoed single payer bills.
As we enter the home stretch in the Washington debate I found a March 7 New York Times editorial to be very relevant. It provides a useful overview, especially addressing what might lie in store for us if passage fails.
The Springfield News Leader carried an interview with Andy Dalton about his recent trip to Canada where he visited several families and discussed the health care system. Their reactions were unanimously positive. One lady said, “I just don't get it! Why wouldn't you want health care for all of your citizens?"
He had a conversation with a primary care physician who had practiced in the United States and now practices in Canada and is affiliated with a large hospital. She feels the standard of care for patients is much higher in Canada than in the U.S. And her income is better in Canada as well.
Mr, Dalton asked about waiting time for specialist referrals and was informed that it might take 3-4 months for elective surgery, but that necessary or emergency treatment involved no delay. All her patients were extremely satisfied with their single payer system. Mr. Dalton adds that he personally is under a government sponsored system here in the United States, called Medicare, and that it works for him.
Pulitzer Prize winning author Geraldine Brooks was diagnosed with cancer while in Australia. Writing in the Daily Beast, she says that being diagnosed within Australia's "socialized medicine system" saved her life.
I have discussed in prior Rag Blog postings the problems created by the Medicare Advantage programs. Philip Rucker further addresses this issue in an article entitled "The Hidden Costs of Medicare Advantage" in The Washington Post.
Meanwhile, returning to my analogy at the beginning of the article, the following comes from Boswell’s The Life of Samuel Johnson. During a subsequent smaller outbreak of the Black Death a Frenchman visiting in London warned the authorities that they must remove the rats from the city since they were the source the plague. The wise folks in control, realizing that the Frenchman was totally insane, banished him from the city -- since he certainly should have been aware that the plague was carried by the “vapors.” After all, everyone had known this since the time of Galen.
This brings to mind the uninvited guest appearing on the pulpit in Mark Twain's "The War Prayer," and the reaction of the congregation. People do believe what they choose to believe, facts being irrelevant.
[Dr. Stephen R. Keister, a regular contributor to The Rag Blog, lives in Erie, PA. He is a retired physician who is active in health care reform.]
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