Saturday, September 12, 2009

Nationalized Health Care? Say What?

I have thankfully spent precious little time as a patient in a hospital. I got my tonsils out when I was six years old, and I don’t remember much from the experience other than being in a good bit of pain the morning after the operation. The discomfort was immediately mitigated by getting to eat all the ice cream and Jell-O I wanted.

Other than that, I don’t think I was ever admitted to a hospital until I was forty-nine. That winter, I caught a nasty cold that seemed to stick around longer than usual and even developed into an ear infection, or so I thought. It got to the point where I had difficulty hearing in my right ear, but being the stubborn and clueless male that I am, I ignored it for a couple of months before Susan persuaded me to see an Ear, Nose and Throat Specialist.

On my first visit, the ENT took out a handy little suction hose and pulled out what seemed to be a crusty buildup that had accumulated on my ear drum. When this seemed to provide little or no benefit, he administered an audiogram, which confirmed a hearing loss in the right ear. He then ordered up a multitude of tests, most of which I can’t remember, but there were several tests for meniere's disease. lyme disease or other maladies which might have damaged my cochlear nerves. Already suspecting that this was the case, he put me on steroids in hopes of either stopping or reversing the damage. At the same time, he also ordered up an MRI of the brain, mentioning that in certain very rare instances, such hearing losses are caused by something called a vestibular schwannoma (also known as an acoustic neuroma), which is a tumor wrapped around the auditory nerve between the ear and the brain. The ENT reassured me that such tumors are extremely rare and he highly doubted I had one, but he felt compelled to order the MRI just in case. Long story short, I got a call from the ENT a few days later, asking me to come back into his office and advising that I no longer needed to take the steroids. The MRI was positive.

I was reminded of this recently during the health care debate, with President Obama and his allies contending, among other things, that too many “unnecessary” medical tests are being conducted. It also made me think of countries like Canada, England, Italy and elsewhere where heath care is “free” but patients must wait months for certain medical procedures, including MRIs.

The very next day I was referred to two outstanding surgeons at the University of Maryland Medical Center (UMMC): Dr. David Eisenmann and Dr. Howard Eisenberg. In short order, I discovered that their level of education and experience, skill and expertise were exceeded only by their kindness as they patiently explained my condition and what to expect; they did everything they could to allay my fears.

The surgery lasted over twelve hours as Drs. Eisenmann and Eisenberg painstakingly and meticulously removed the tumor, tiny piece by tiny piece, being extremely careful to not damage my auditory nerve, my balance nerves or my facial nerves. Though the hearing in my right ear had already been damaged beyond recovery prior to the surgery, the procedure was otherwise a complete success. It was rough going for a while, as I spent a week in the hospital navigating a good bit of pain as I worked to regain my strength and balance. But just as with the post-tonsillectomy ice cream four decades earlier, the discomfort was mitigated by a clean, comfortable and well equipped intensive care unit staffed with doctors and nurses who seemed intent on moving heaven and earth to make me feel comfortable and recover quickly. I cannot speak highly enough of the dedicated doctors and nurses, the sophisticated technology and research, and even the insurance companies, who did not bat an eyelid in meeting their obligations. My experience represented everything that is right and good about the U.S. health care system.

But I was not quite out of the woods yet, and shortly afterwards I saw a less pleasant side of the U.S. health care system at the very same hospital. While I was still recovering in the hospital, I was repeatedly asked if I felt or sensed any salty or briny fluid dripping in the back of my throat. The concern after this delicate surgery is that I might start leaking spinal fluid, which would result in an infection. Of course, whenever I was asked the question I immediately started tasting something salty in my mouth, not because I was leaking spinal fluid, but because I am a neurotic worry-wart.

When I was discharged, I was given a number to call immediately if I experienced any difficulties, particularly if I thought I was leaking spinal fluid. And so these imaginary symptoms continued as I recovered at home. After a couple of days, I was convinced I was leaking spinal fluid, so I called. Unfortunately, by that hour of the day, most of the regular staff was gone, so I was told that I should go to their Emergency Room.

The waiting room at the UMMC ER is a night-and-day contrast to the other part of the hospital where I had been an inpatient just two days prior. While I was in the same hospital backed with the same equipment, staff and expertise, it became quickly obvious that I was not going to get the same level of attention, because I was competing for it with a whole host and variety of individuals. I found myriads of people slumped in chairs, seeming like they had been waiting for hours.

I registered at the first triage area and was then told to sit down and wait. After seeing little or no movement for about thirty minutes, I began to worry. I was still recovering from major brain surgery and still feeling quite weak, and certainly not able to sit in an ER-outpatient waiting room into the wee hours of the morning. I returned to the triage nurse and explained my situation. Though I would not be able to see a doctor for a few more hours, she would be able to arrange to have me admitted into the E.R and onto a comfortable bed. As I received this news with a sigh of relief, a disheveled man started complaining loudly, something to the effect of: “Hey, I have been waiting here for hours! This guy just got here and he is going ahead of me!” The nurse reassured me and told me to not pay it any mind, as this was an all too typical case of a street person coming in and complaining of chest pains or some other symptoms in hopes of getting admitted to the hospital and thereby getting a comfortable place to sleep, and perhaps a couple of decent meals.

I think of this often when I hear people clamor for government health care, talking about how the poor do not have access to health care. The fact is that hospitals are not permitted to turn people away for lack of insurance, so much so that people can easily abuse the system, using emergency rooms for something other than their intended purpose, and crowding out those who truly need emergency services. And who pays for these services? We do—either in the form of higher insurance premiums, or higher costs for medical services to make up for the patients who do not pay.

Does our health care system need to be reformed? Sure it does. Should we do so by enacting a government run, single payer system? Absolutely not! To see the fruits of such a system, you don’t even need to go to Canada or England to see their failed experiments in socialized medicine. Just pay a visit to any urban emergency room.

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