Health Care Debate

Dialysis Machine
Because this blog is about things, and I'm not going to clutter it up with a bunch of yucky sick people.

The Detroit gang dropped a couple of links in my inbox this morning. First, a YouTube video: Jimmy Kimmel Fights Back Against Bill Cassidy, Lindsey Graham & Chris Christie, and second, a Washington Post story. I didn't watch or read either one, because:

This whole medical insurance debate is complete and utter horseshit. (Heh, my new catch phrase.) What we need is real information, but we're not getting it. It might be out there, but digging it out would be a lot of work, and why bother? Nobody in power is listening, they are all listening to each other trying to score political points by telling bullshit stories.

Our healthcare system is built on a fantasy, a fantasy that is carefully nurtured by everyone with a financial interest, like doctors, lawyers, insurance executives and media moguls. This fantasy has doctors curing all diseases, patients recovering fully and leading happy, productive lives. Oh, that happens occasionally, and for common afflictions that are well understood, it might even be the norm. But the more people you have, the more variation you have and the more obscure, inscrutable diseases show up. Life is a terminal disease. People spend their lives trying to be happy. They should spend their time getting ready to die.

Health care is a trillion dollar business in this country. All those people who are engaged in the debate over insurance are just trying to influence the trajectory of that money so that more of the random spray that emanates from such a powerful stream will land on them and make them rich. Because even a single droplet from that trillion dollar stream is worth a million bucks.

Since we don't have any facts (not that they would do us any good), here's a couple of stories.

A guy I know works as a dialysis nurse. He hooks up patients who are in need of dialysis to the machine and monitors the blood cleaning process. One Sunday he gets called in to run the procedure on a patient. The guy is old and in bad shape. He is swollen up like a whale. Joe (our nurse), hooks him up and runs the process for a while, but eventually the guys blood pressure starts falling and eventually it falls so much that he has to stop. The guy is still as big as a whale and still in bad shape, but he's done all he can do. Joe (all male nurses are named Joe, at least in this blog) estimates that the guy only has a few days to live, but his wife is demanding that the doctors do something. Like what, sweety? He's dying. Sad, but life is like that.

A couple of months ago a friend had gone into the hospital for some kind of test. The test involved anesthesia, so after the test we were waiting in a hospital ward for the anesthesia to wear off. While we are waiting a nurse starts talking to another patient (an elderly woman by the sound of it, they were obscured by drapes), getting her medical history, and in particular, a list of the drugs she is taking. So the patient starts telling the nurse all the drugs she is taking. It's not just one or two or even a dozen. I swear there must have been a zillion, she went on and on and on. When she gets near the end, she tells the nurse she is taking Oxycodone. And why are you taking that, asks the nurse? Because I'm addicted is the reply. WTF? I didn't think addiction was a valid medical reason to prescribe narcotics, but then I'm old. Maybe the rules have changed. Or maybe the old lady was just a garden variety addict and the rest of her story was just a cover she was selling in order to get more of that sweet, sweet oxy.

Update six hours later: Here's another story from one of my correspondents.

I don't think anecdotal stories move our knowledge base forward. That being said, my aunt, may she rest in peace, had a lousy rheumatologist. He prescribed so many bad meds to avoid operating on her arthritic knee that she developed serious health issues from the drugs. Ultimately at 80+ years old we had a big conference. The right solution was a morphine patch. She became an addict. We spoke daily and I could tell by her voice when the patch needed to be replaced and she was starting withdrawal. They tried taking her off to no avail. So for the last 15 years of her life she was a morphine addict. She still did volunteer work as a retired licensed clinical social worker. She still worked as a locally renowned stained glass artist, she still traveled, she still...  Looking at her life from the outside, one could wonder at and judge the medical interventions. But she had quality of life and wanted more until the day she called me and said she was ready. 

So the politicos are making a big fuss about the dangers of narcotics, but they aren't telling us the whole story. Meanwhile, here in Oregon simple possession of heroin is now a misdemeanor. Will this put a curb in the fentanyl trade?

On the left, a lethal dose of heroin; on the right, a lethal dose of fentanyl.

“Anyone who is so deep into their addiction that they would use fentanyl is not worried about jail.” - Jordana Goldlist