Wednesday, January 27, 2010

The Healthcare Bullet That Wounds Us All

Mom scrapes by and yet...

I just spent a week in Chicago with my mom. She was diagnosed with cancer in December of 2006, about six months before Marrianne, Brendan and I completed our move from Chicago to DC. Mom will be 85 in May, but considering her age and her disease she's doing all right. She still has all her marbles and she is still living at home on her own.

Her cancer treatment hasn't been debilitating; all along it has been aimed at slowing the spread of the disease and maintaining her quality of life. A chemo assault on the cancer, aimed at eliminating it, might have shortened her life, and almost certainly would have had side effects severe enough to rob her of much of the energy she has invested in living the life she wanted these last three years.

But Mom's had a bad run for the last couple of months. She fell at home and hit her head once, suffered through spells of dizziness and nausea, and through periods of high blood pressure and high anxiety about what was happening to her. Thankfully, the last week was pretty good for her. I don't think that my presence had all that much to do with her gains in strength and appetite; my sisters Dale and Teri and brother Mark had already been on the spot during the more difficult time before I arrived.

Still, it is clear that Mom was still reeling and full of distress while I was there. Ordinarily, she's both a gregarious friend and an intensely private person. When she's feeling good, she's very clear about boundaries. The daytime is for chores and for socializing. The nighttime is private time, rest and recharge time. She likes to see her children, her grandchildren and her toddler great-grandchild, and she loves them all best when the visits are short. Most times when I come in from DC, she gives me a big hug when I arrive and, 48 hours later, begins wondering when I'm going to leave. But this visit I was still somewhat welcome a week after I got there; that's how bad she has been feeling.

There's no question aging is tough. So is being so sick that your life doesn't feel like your own anymore. Mom hates those feelings and hates being dependent, but she's luckier than most people her age and most people with her diagnosis. She's got her problems, but she's financially secure and she has first rate health insurance that doesn't cost her anything. As the widow of an Illinois state legislator who served in that role for 14 years, she has Cadillac healthcare coverage and a decent pension. Of course, she also has Social Security, Medicare (which pretty much guarantees that holes in her healthcare coverage are plugged), and what remains of an originally sizable payment from my dad's life insurance coverage. As a result, there are some things she simply doesn't have to worry about.

But most people her age have only Medicare coverage and, by itself, that has enormous holes. And many people with diagnoses as severe, or worse, live their lives with poor and inadequate healthcare. They may also live in substandard housing and have to scrape by making the choice to pay some bills and ignore others. Some are elderly, sick, homeless and hungry.

I suppose I could do a little research and come up with some estimate of how many millions of people are worse off, in many cases, much worse off than Mom, but I'm just going to say there are millions in that position. And in the best possible scenario, those millions of people are loved and cared for by millions more who undoubtedly are stretched financially, emotionally and physically in the process. These people, dependent on others for basics they cannot themselves provide, and their caregivers, live in communities and neighborhoods where still more millions are witnesses to their need and must themselves decide whether and how much to help.

The social ramifications of witnessing needs and being unable to respond adequately are huge. When such a story is repeated over and over again the social consequences of our collective helplessness in the face of injustice are almost too much to bear. I think those consequences include widespread alienation, shame and anger. We cannot bear to keep looking at what we cannot fix and so we look away. But though we may not acknowledge that we have looked away, we must do something.

One familiar option is blaming the victim. The social desperation around us is, for example, the fault of those who suffer. They were not prudent or wise or diligent or independent; they are or were lazy, unmotivated and otherwise undeserving. It is they who are bankrupting are healthcare system, creating trillion dollar deficits, weakening our country.

Never mind that our healthcare system is what it is, a disaster for some of us, a chronic problem for most of us, because it is a profit opportunity for a very few of us. U.S. healthcare is, currently, just another mechanism for concentrating wealth in the hands of a tiny fraction of Americans. Our trillion dollar plus budget deficit is arguably as connected to rampant American militarism, to annual military spending that exceeds a trillion dollars (Pentagon spending plus spending by other departments plus off-budget spending plus interest on that portion of the debt attributable to past military spending), as it is to any other cause. Congressional leaders, most particularly Republicans, and tea party organizers alike, are better at finding ways to mask our shame and express our frustration at our helplessness than they are at addressing our fundamental problems. Democrats, who this past year have managed to squander every apparent political advantage, now appear ready to abandon healthcare reform altogether. This will not be a tragedy for my mom individually, who will address her own challenges with the relatively mighty set of tools at her disposal, but she will suffer her share of our collective failure, if we cannot pass even a sorry compromise of the separate bills that have already passed the House and Senate.

1 comment:

  1. An important factor in trying to determine how we reshape our health-care system is "how much is good enough?" We're at a peculiar crossroads in our society. A better description might be the peak of a hilltop. After several generations of progressively better living, we likely have to get accustomed to living with what's "good enough." Most people expect to live better than their parents did: more conveniences, less worries, and longer lives. While the topic of living beyond good quality of life is certainly not new (Terri Schiavo), planning on living with less is a new pill for many to swallow. It applies to the economy, the environment, everything. I don't think healthcare reform will pass until more people see this perspective of reality. Many will suffer in the meantime.
    Its good that your mom has the coverage a caring family as you mentioned. I hope that she still experiences good quality of life for the balance of her days. It should all be about quality of life. Good health; loving family; compassionate society.