Noise Reduction
quiet reflections on life in a loud worldArchive for May, 2009
Single-Payer Nonsense
Often, people ask me if I miss England. “Not really,” I usually say, and then, after a second’s thought, I add, “Actually, that’s not true. I miss my friends, our flat, the public transportation, and the health care system.”
“The health care system?” most people ask, laughing. “Are you joking?”
“Not at all,” I reply. “In fact, after my friends it is the thing I miss the most.”
What I don’t say, but what is equally true, is that some weeks, I miss the health care system even more than I miss my friends. (Forgive me, friends.) Why, you ask? Well, take this week for example. Take Wednesday even, when just a few hours after suffering through an opinion piece in our local paper by Patrick Buchanan that, with depressingly typical rhetoric, accused Obama of trying to create a health system comprised of “bureaucrats deciding what care each of us shall receive, when we may receive it and whether we even ought to have it” (as if that isn’t what we currently have), I tried to make an appointment with a new doctor and was refused, because I didn’t have all of my insurance details at hand (we have new insurance and the husband, who had the details, was unavailable at the moment I was trying to make the appointment).
And then, as if that wasn’t enough to get me going, I read that congress did not invite even one advocate for a so-called single payer system (i.e., what they have in England) to testify at congressional hearings on health care reform. Not one. Zero. And that several of those that did try to attend were arrested.
Why? Why, why, why? Why are so many Americans – including the friends who laugh when I say I miss the system – so skeptical if not totally dismissive of a single-payer system? (Just consider the tone of this WSJ report on the congressional hearings.) Surely it is related to a general suspicion of all things government, and probably it has something to do with the way we value individual freedom, but let’s face it, we’re talking about health care, and when it comes to that, the freedom we can enjoy is the freedom to be healthy or unhealthy. When we get sick though (and as we try to avoid getting sick) we need health services, and in my experience, the National Health Service delivered health care far more effectively than what we’ve got here. And with plenty of choice, much less hassle from bureaucrats, good quality and good results. (And they say the national systems in France and Germany are even better.)
What was good? Well, how about how absolutely, beautifully simple it was to access it? With our Visas, we got National Health Service (NHS) numbers. With our NHS numbers, we had a choice of neighborhood practices based on our post code. All we had to do was check them out, choose one, fill out a couple of forms and that was that, we were patients, with access to doctors, nurses, prenatal care, postnatal care, lactation consultants, baby clinics, smoking cessation classes, geriatric clinics, STD clinics, travel clinics and so on. Were there more forms to complete than in U.S. practices? Not by a long shot. There were, literally, two or three. Were there more bureaucrats? Hah, now that is funny. Was I number without access to doctors? Not at all. Here’s how it worked if I had a health concern: I could either go to the neighborhood practice or I could call, be put on a triage list, and receive a call back from one of the practice doctors, sometimes within minutes but never in my experience in more than an hour. This was the case at any time, including in the middle of the night, as when the Hobbit was only days old and could not be consoled because I’d run out of breast milk – the doctor on call arranged for the husband to pick up some formula at the nearest hospital to get us through the night, then saw us first thing in the morning.
Then there was being pregnant and having a baby in England, which was great, first of all because there was no concern about getting care: we had a National Health number so we had coverage. Too, we had a choice of local hospitals, each of which gave tours so we could see what we would get. It was great because, throughout the pregnancy, I was seen by a team of midwives at the hospital, and if I’d had any complications would have been seen by physicians. Because, when it came time to give birth, I had a choice of a birthing center (low tech) or a labor ward (high tech). Because I had total confidence in the doctors’ care of the Hobbit in his first check ups. Because within three days of delivery, a community nurse came to the flat to see how things were going and give tips on breastfeeding, avoiding jaundice, etc. (This was followed by two more visits.) And because there was no scramble to get a pediatrician – our neighborhood practice was the Hobbit’s neighborhood practice, and from birth, he and I were welcome to attend weekly clinics where he could be weighed and I could receive new-mom support.
Was it perfect? No. The facilities were not all gleaming; but they had all the necessary equipment and the doctors and nurses were every bit as professional as any I’ve had in the U.S. Also, though we did go outside the system, we did so only for optional treatment – I, for insomnia treatment and the husband for sports injuries when he didn’t want to wait for NHS physical therapy.
Yes, there were budget shortfalls. Yes, there were problems. But, in general, the U.K. system felt healthier in every sense. Take this experience we had with the Hobbit, for example. When he was three months old, we were in the U.S. on vacation and he got sick with a chesty cough and fever. We took him to my parents’ primary care doctor and of course, the first thing we were asked was the very stress-producing, in no-way-related-to-his health question of how we were going to pay. Then, when the doctor saw him, he ordered x-rays and a battery of blood tests. He also told us that the Hobbit’s umbilical hernia was dangerously large and had to be looked at by a pediatric surgeon. In other words, he totally freaked us out and we spent several days chasing down a specialist over New Years only to be told exactly what we’d been told by our GP in England: that all was fine and there was nothing to be done other than monitor it. All told, the U.S. treatment, including the X-rays and tests (which revealed nothing) and the surgical consult cost thousands of dollars and a great deal of agitation and anxiety. In England? Just the cost of one regular health check with the practice doctor. In other words a few hundred dollars, with a much more relaxed baby, mom and dad.
According to the latest reports, President Obama said he’d go with single-payer if he were starting from scratch. I suppose that’s his way of admitting that they learned from the Clinton experience and they’d rather win some victory than totally lose, and I can’t say I’m surprised. Allow me to be disappointed though, will you? Because I can’t say that covering everyone with the system we have now sounds like a great idea. Not that I want the numbers of uninsured to continue as they are. It’s horrendous. But the thought of living the rest of my life in a place where I can’t make an appointment – just make an appointment! – with a doctor because I don’t have my insurance card in hand…well, that really bums me out. I suppose, if nothing else, I wish people would speak intelligently about the matter and not just swallow all the rhetoric.
End of rant.
Life Going On
Sometimes, when I want to post but can’t think of anything that moves me enough to make me want to write about it, I come back to “Noise Reduction” and spend some time thinking about what that means to me right then. The title, like any good title, is my anchor, and today, as I reflected away, I found that what I was most aware of was a din inside my head that has, for what seems like weeks now (I wrote “Lost in Space” after I’d already been feeling lost, and spacey, for some time), incapable of concentrating on any one thought for long, feeling any one feeling with strength, writing even one sentence with conviction. For a while I thought it was a symptom of seasonal transition; but Spring is well-settled now and I’m still feeling floaty. Sometimes I wonder if it has something to do with the childlike nature of the way I spend much of my time. My Hobbit – he doesn’t do a lot of analyzing or reflecting. He just experiences life, and life, at least his life, is not very complicated. Joyous, hilarious, interesting, sad, maybe confusing, sure – but not complicated. We go to the Top of the World Park and run around on the empty basketball court in the rain. It’s great. We go to the zoo and say “Hi Giraffy!” to a lanky, sunbathing giraffe, visit the gorillas, run over to the monkeys then eat hot dogs while watching flamingos walk back and forth along a path for no reason we can figure. We love it. While folding laundry, we make up a song about the Husband’s abundance of socks and sing it loudly, cracking ourselves right up. We sing our chicken soup song as we make our chicken soup then slurp it up three hours later saying yummmm.
Maybe. Maybe it’s that.
And maybe there is another factor: time. For me, just conceiving of a project takes time, and getting traction on a project takes even more time. They take time and concentration. And so do reflection, and idea-exploration, and the process of massaging reflections and reactions in search of kernels of wisdom and insight. It all takes time, and right now, on average, I have about enough quiet time to begin conceiving of projects. And that’s the way it’s going to be for a while, unless I give up sleep which, as a reformed insomniac, I won’t do.
So, along those lines, here’s something that jumped out at me this week. Something I haven’t quite had time enough to explore as I would like. On Thursday, there were three brief news reports in my paper, each about prison. One, was about Lori Berenson, a woman my age who was put in prison in Peru thirteen years ago after a trial before hooded judges. At the time, she was associating with members of the violent revolutionary group MRTA and was charged with being a leader of the group and therefore a traitor. I’ve watched her story through the years, and even read a book about her written by her mom. I always related to Lori in a way, probably because we are the same age, and because around the time she was arrested, I had many friends who were working for justice for poor people in Latin America. The most recent news? She had a baby in prison.
The second story was about a message found in a bottle buried underground in Poland. In Auschwitz to be precise. The message was written on material torn from a cement bag by six prisoners of Auschwitz who, in 1944, were forced to work building a bunker for the German military. The prisoners were sure they were going to die in the camp and wanted to leave something of themselves behind, so they wrote their names and numbers on the material. Several of them survived the camps, a couple are still alive. You can read about them here.
The third brief was about Roxana Saberi, the American-Iranian reporter who was arrested in Tehran in January and has been in prison since. She is a freelance reporter who works for NPR and the BBC among other outlets, and in a one-hour trial held behind closed doors she was charged with spying for the U.S. The report was about her decision to stop a hunger strike because of health reasons.
What was stirred in me by these stories was an awareness of a paradox of prison life, which is that in prison, life simultaneously stops and keeps going. I have a friend who was a political prisoner in Turkey for a decade. She was arrested when she was 18 and released when she was 28. During those ten years, she was all but completely cut off from the outside world and her life as she knew it simply stopped. Her university years, stopped. A career, nonexistent. Yet, within prison, a strange and usually horrible life went on, and that was what I was reminded of by these three stories.
And that’s that. I’d like to have more to say about it, but I can’t quite get my head focused enough to corral my thoughts into coherence. Maybe another day.
In the meantime, I’ll note that Roxana Saberi’s appeal trial is scheduled for tomorrow. Oh, how I hope that it will go in her favor and that soon she will be free to start her life again. What a glorious mother’s day gift that would be for her mom.
