20th Century Woman

Today I spent some time trying to understand why so many people say we in the United States have the best health care in the world.  I looked up some statistics.  First, I checked the adult mortality rate:  your chances of dying between the ages of 15 and 60.  About 25 countries, including Cuba, have us beat on that one.  Then I looked at infant mortality rate.  Same general result.  We are way down the list.  Then deaths from heart disease and cancer.  We are below all the European countries and Canada. 

All the countries that do better than the United States on adult mortality, infant mortality, cance and heart disease have government health care plans. 

Health care reforn without a government option is worse than the status quo.  At least with the present system we have Medicare, a single payer government plan.  That covers those of us over 65.  Without a government option for the rest of our population they will inevitably raid Medicare and Medicaid.

The substitution of the so-called health care cooperative for the government option is simply a slight of hand for the creation of more insurance companies.

I include here part of a post I wrote a few weeks ago about the health care debate that includes an example of how these cooperatives work. It recounts my husband’s experience with Group Health of Puget Sound, a so-called cooperative that has been promoted as an example of how the cooperatives work.

My husband, Jerry, insured his late wife, Susy, with Group Health.  He himself had Medicare, but she was too young.

Group Health is being held up as an example of a model for a “cooperative” health care plan that would be a “compromise” solution to the Republicans’ objection to a government health plan.  There is an article in the New York Times discussing Group Health.  Toward the end of the article it states that “Technically, Group Health was misnamed. . . . . Structured as a not-for-profit corporation, its revenues (2.6 billion last year) are reinvested rather than redistributed among members.  But it is governed like a cooperative – and calls itself one – because its board consists of and is elected by members.”  In fact, according to the article, only seven-tenths of 1 percent of enrollees voted in the last board election.

In fact, Group Health is an insurance company.  Apparently its fees are slightly lower than other insurance companies, supposedly because its records are computerized and its doctors are paid a salary (not fee for service).  Salaries are based on “performance.”  The article does not say who evaluates performance, or what criteria are used in the evaluation.  But I’d be willing to bet my bottom dollar that keeping cost down is a biggie!

At Group Health, according to the Times article, patients are assigned a team of primary care practitioners who are responsible for their health.  Notice that they are assigned practitioners.  What that means is that you don’t choose your own doctor, and you don’t even choose whether or not you see a doctor.  You may see a nurse, and you don’t have a say in which it is. 

Suppose you were a doctor working for Group Health and your salary was based on your performance.  Your performance would be measured by the administrators running the insurance company (Group Health).  These administrators would be very interested in keeping costs down, and probably secondarily, in keeping patients healthy (or perhaps in keeping healthy patients).  You would be disinclined to order tests for patients, especially expensive tests.  You would prefer not to treat the really sick ones.  They would need expensive care and would spoil your record of keeping costs down.

The times article states further: “Medical practices, and insurance coverage decisions, are driven by the company’s own research into which drugs and procedures are most effective.” 

Don’t let them fool you.  It’s an insurance company, pure and simple.

Here’s what happened to Jerry’s wife.  Some years after he took out the insurance she discovered that she had metastasized breast cancer, the same thing Elizabeth Edwards has.  It would eventually kill her, but there were treatments which could significantly prolong her life.  She was given chemotherapy and the cancer went into remission.  The tumors were not gone, but they were no longer growing.  After another year they came back.  Jerry got a letter from Group Health saying they would no longer cover Susy’s cancer.  He read the policy, which had been sold to him by an insurance broker (because Group Health is an insurance company) and it had a lot of language in it that was difficult to understand, but which did seem to indicate that the insurance company could terminate coverage under various conditions.

Is anyone surprised by this story?  Isn’t this standard insurance company practice?  Don’t get really sick because the doctors will get paid less and the insurance company will get less money.

Jerry made a fuss.  The original broker got involved.  (“This is outrageous!” is what he said to Jerry.)  Eventually he got coverage reinstated, and Susy lived another 5 years. 

Jerry and I both have Medicare.  He wouldn’t be paid to have Group Health.  Medicare isn’t perfect, but it is the best health insurance I ever had.  We supplement it with a medigap policy.  That is not cheap, but it allows us to choose our own doctor and to decide when to go.  We can see a specialist when we need to, and the insurance company has nothing to do with the decision.  We decide, with the recommendation of our doctor, which specialists to see.
President Obama said that if we like the insurance we have we can keep it.  I sure hope he keeps that promise, because I really don’t want to be forced into something like Group Health.

I arrived in New York, to be there during my son’s operation on his neck, last Wednesday afternoon.

I flew into grubby Kennedy International Airport.  I stood in line waiting for a cab.  “Where you wanna go?” the dispatcher shouted at me.  I gave her the address on east 46th street.  “Fifty dollars,” she barked.  Ah, yes.  I’m in New York, I thought.

I met my son and his wife at the apartment where we were staying, kindly lent to us by my cousin who was away on vacation.  We decided to go out for dinner.  There were lots of restaurants nearby, and we finally chose one that had “Indian – Latin American fusion” cuisine.  The food was fine.  I had a whole fish spiced with ginger and hot pepper.  I was hungry, having eaten nothing but airplane peanuts all day.

Steve and Michelle

The apartment we stayed in was a penthouse, so-called (though it had no balcony) because it was on the top floor – about the 27th.  The views were panoramic.

Penthouse view

Tall buildings

We had a full day in New York before my son’s operation.  We walked the streets and planned the next day and shopped for dinner which I was to cook. 

I was astonished at how many nail salons there were.  I think about one in every block.  New Yorkers must spend a lot of time and money on their finger nails.  There were lots of flower stands and fruit stands.

Sidewalk flowers

Sidewalk fruit

Michelle and I stopped for a drink at a sidewalk café. It was a treat just to watch the variety of people passing.       

There were lots of babies in strollers and carriages.  Many of them were pushed by nannies.  Many were pushed by daddies.  I saw only a few stroller pushers who could be suspected of being mommies.  How things change.  When I was young a man would be laughed at for pushing a baby stroller in the daytime when he should be at work.  We saw quite a few twins in carriages in the short time we sat there.  “Must be something in the water,” Michelle said.

The number of dogs on the streets was a wonder too.  And they all looked so squeaky clean and groomed.  I thought there should be as many dog groomers as nail salons.

All sizes and shapes

There were old people too out walking in the sunshine; old men alone and old women with companions and helpers. 

Oh, and the young women!  On a warm day there was so much to be seen.  Gowns, some long, some so short as to hardly rate the name of gown, clung to the curves, barely covered the bosom and were held up with the thinnest wisps of straps.  Some were strapless.  Jerry would have loved it, though he claims to dislike all cities.

We didn’t know until Thursday afternoon at what time the next day Steve’s operation would take place, and that made him tense all day.  The operation has significant risks: risks to life, and risks to mental function, because the area of the surgery is full of major blood vessels and nerves to the brain.  He was supposed to call at 3 o’clock to find out the time. It took three calls but at last he was told to appear at 10:30 the next morning. 

He had expected to be discharged the same day as the operation, but discovered that the admissions people mistakenly thought it was to be a shoulder operation, not a neck one.  When the doctor came into the prep room to write his initials on the left side of Steve’s neck with ball point pen – so everyone was clear about which side was to be fixed, he said Steve would have to stay in the hospital overnight.  Steve finally walked to the operating room, wheeling his IV’s beside him, at about 1 o’clock.

Michelle and I, both nervous as cats, went to get some lunch in the hospital cafeteria.  We shared a table with a nice nurse who knew Steve’s surgeon well and she told us that he is the team doctor to the New York Giants.  The time seemed to drag, and I kept thinking of the time I spent sitting in a waiting room when he was 8 years old and was having his ruptured spleen removed.

We had been told that the operation would take about an hour and a half, but it was nearly 4 o’clock when the doctor came out to see us.  He explained that the operation had gone well, and drew a little picture of how he had installed the ligament of a cadaver to tie up the dislocated collar bone.  Then he said, “I’ll need to see him for a follow-up in about 2 weeks.”

I said, “But how can they, they live in Charleston, South Carolina?”

He gave me a long look and said, “People come from all over the world to see me.”

By 5 o’clock they had Steve in a bed in the hospital.  Michelle and I stayed with him until visiting hours were over at 8.

The next day his neck was swollen, and it soon was clear that he would not go home that day.  The swelling had to go down first.  We came and went most of the day, and in the afternoon set out to get him some non-hospital food, specifically, some sushi.  And to get some additional undershorts that he wanted.  For that we stopped at Banana Republic, and I was astonished to see elegant ladies with elegant dogs on leashes right in the store trying on clothes.

Michelle’s cell phone rang.  It was Steve.  He said we were not to worry, but something had been seen on an x-ray taken after the operation (air where it should not be) and they wanted to do another x-ray and an MRI.  When we got back to the hospital he was back from x-ray, looked really upset, and couldn’t eat the sushi.  By 7:30 there still was no news from radiology.  Since he is a doctor himself, he understood well all the unpleasant possibilities, and was scared.  But it was the weekend, and things were moving slowly.  Finally he called the nurse and said, “I want to see the resident, NOW.”

Then we got the news that the air seen on x-ray had not been in a region of vital blood vessels, but in overlying tissues.  We all sighed with relief.  By this time the swelling was down, and he was to be discharged the next day.  I said goodbye, since my plane left early Sunday morning.

On the road to recovery

Sunday was Jerry’s and my third wedding anniversary.  I was so glad to see him.  We still hold hands across the table in restaurants.  It has been a good 3 years.

Here are two things that made me happy since I came home.  I saw the frog while I was watering.  The baby to come will be my first great grandchild.

Garden Frog

Baby to come

A lot has happened since I came home.

My third husband, Hugh, died in Atlanta.  He would have been 80 on his next birthday. He was having dinner with his girlfriend at his apartment.  They had planned to go out, but he wasn’t feeling well, so she got take-out food.  They had just finished their appetizer when he had a coughing fit, collapsed and apparently suffered a stroke.  I heard about this from his first wife, who was later called to the hospital.  I was married to Hugh for 20 years and we were still friends.  He was a lawyer, a good and honest man; loving to me and to his sons (he had four).  His problem was a life-long struggle with alcohol. I find his sudden absence from the world difficult to think about.

My second daughter, Clare, who is presently in Atlanta, tells me her fiancé has swine flu, complicated by pneumonia.  He has been very sick, but not bad enough to be hospitalized.  Soon they are both going off to Afghanistan to work for an NGO.  It’s a perilous world.   

Since coming home I have played Mah Jongg with friends.  We have an island game going now.  My new playmates learned the game quickly, and there is enthusiasm for it.  The first time we played in my house, next time in the wine tasting studio up the street.  The others played while I was in England, and last week we played at Dianne and Mike’s place in their “tower,” a little room they have recently built as the only second story to their house.  The room serves as a game room and a guest room for their grandchildren.  It has a marvelous view of both sides of the island.  To the east is Hale’s Passage, to the west is Legoe Bay.

Jerry and I walk every night after dinner with the poodles.  We do a circuit, down to Hale’s passage, up past the firehouse, turn to overlook Legoe Bay and then home.  We pass great beauty and lots of grazing animals.  On Friday there was a cow (actually a black steer), loose on the road.  We tried to pass by on the other side of the road, but the steer took an unfriendly interest in the poodles.  The poodles barked.  Jerry stomped at the steer and shooed it back, but for a while it continued to lunge at us.  I walked quickly down to Harmony’s, thinking it was theirs.  They said it had been 5 years since their cattle were in that field, and it belonged to Grangers.  I asked if they would call Grangers. 

As we rounded the corner we saw 4 Grangers, including Earl who is almost 90, swoop down on the steer.  John Granger’s trotter ponies dashed across the field to watch, and about 15 of the llamas stood at rapt attention to see the spectacle of 3 female humans and an old man herding the young black steer back to his home pasture.  There was a lot of hand clapping and shouting, and the animal finally obeyed its masters and joined the other cattle which were calmly munching grass.

On Saturday I went to the island market and I bought some beets and got a free zucchini because it had grown too large.  I talked to friends.  Naomi was selling the jewelry she makes from her big bead collection.  Naomi’s son died this year, and she has had a difficult time.  But she visited a daughter and grandchildren in California and that was a help.  I listened to Jill playing her violin with two other musicians; one had a guitar, the other a banjo.  They were playing soft country music and it sounded lovely.  I saw Lis, whose daughter, Olivia, just graduated from Smith College.  Olivia has a table at the market where she sells delicious baked pastries and cakes that she makes herself.  She always sells out within a half hour of the market opening, well before the county health inspector can come around to shut her down for not having an approved kitchen. By the time I got to the market the table was empty.  I saw Chuck, the island organic farmer, who isn’t farming this year because he has multiple myeloma.  He has been having chemotherapy, and I almost didn’t recognize him without his beard.  He is doing well, though, and has only one more treatment to go.

On Saturday afternoon Jerry and I walked over to wine tasting.  The wines were good as usual and there was lots of lively conversation.  Richard, the host, was holding forth about the wines.  He really talks the talk. He is an educator at heart, and when I said I couldn’t tell the difference between the first two wines we tasted, (both light white wines, cool and refreshing,) he gave me a little of each at the same time.  By sipping first one and then the other I found I learned something and could detect a slight variation.

On Sunday my grandson James and his wife Maria came to get the small baby bed I brought back from England with me.  Next month their baby, Julian, will be born, and he will sleep in that bed which had been his father’s, it seems like yesterday. 

My friend and house sitter Linda came as well.  At dinner Linda told us all about the perfidy of her erstwhile boyfriend.  Apparently he had hundreds of other women and he milked them all, Linda included, for money and possessions.  Linda had gone to the RV he was living in, provided by her father, to reclaim some of her possessions.  He had threatened to call the police.  I called my lawyer daughter for some legal advice.

The weather was beautiful, and I cooked the entire dinner on the grill.  We had steak, the large free zuccini and roasted vegetables (potatoes, beets, carrots, and onions.)  I parboiled the carrots and beets, then tossed all the veggies in chopped garlic, halapenio and olive oil and put them on the grill in foil.  I sliced the zuccini and cooked it on the grill in foil as well.  A salad went with all that.  It was good.

Tomorrow I am off again.  This time to New York, but only for 4 days.  My oldest son, Steve is to have an operation there.  Last fall he had an accident on his bicycle.  His collar bone was dislocated so that it is sticking into his neck.  He has not been able to find a surgeon willing to correct it until now.  He lives in Charleston, and no surgeon there would do it.  The neck is a tricky place to operate because there are so many blood vessels and nerves in it.  The surgeon in New York who will do the operation is the world’s expert on this surgery.  I want to be there. 

I’ll be back with you all next week.