Humanizing the System

Highway Scribe is a political activist who lives in Southern California and blogs at HighwayScribery.

Two years ago at health-care conference in Los Angeles the Scribe heard U.S. Rep. Javier Becerra refer to the American health care system as a, "flashy and well-built car; a six-seater that only holds five. "It’s too expensive and it’s not working," the congressman said.

Too expensive.

Market driven, the health-care system has followed the upward drift of the country’s wealth. The system is going where the money is.

To illustrate: While you are in the hospital the chances are your temperature will be taken with a computerized thing-a-ma-jig that has a digital panel, knobs and buttons.

The apparatus costs more money than the old-fashioned thermometer, which had an excellent track record where taking temperatures was concerned.

You can have the cheap one, but you have to ask. Today, when you enter a hospital, you enter a giant medical store where, if you don’t exercise your consumer’s prerogative, the hospital will be glad to do so for you.

And you will get the best medical health care your money can’t buy. And then it will be your problem.

At the root of the health care debate is an issue yet to be truly resolved in the political arena: Does every American have a right to health care or not? Maybe they don’t, but we have to state it so there’s a direction and an end to the counterclaims of partisans on both sides.

And then we’ll have to get used to all those terribly ironic juxtapositions of people dying with the richest country in the world as backdrop. the scribe doesn’t think it’s possible.

Everybody expects to be saved in a health-care crisis and, democratically speaking, it’s tough for anyone to draw a cut-off line for that kind of treatment.

Even in the light of all our recent experiments with institutionalized inhumanity, that is still what sets us apart from others; the value we place upon each and every life.

If you decide health care is a right, then you have to accept a public system because that’s where the rights business plies its trade – in the public arena – through legislation. And the money must go to an accountable public entity, not a private concern seeking to enrich itself.

The horror stories about "waiting" must be properly devalued. You’re covering everybody, naturally there will be some waiting.

Perhaps a series of smaller public medical systems addressing specific types of illnesses might be in order, so as to avoid lumbering, oversized bureaucracies, realize economies of scale, and make delivery and exchange less complex.

Let’s say a system for the deathly ill, a community center network handling those with stable conditions requiring constant care or treatment, a system of walk-in pharmacies and first-aid stations for people that fall in the street and need a bandage or diagnosis.

In Spain they are called "Houses of Assistance" and are recognizable by a signature green neon cross.

To accept a single-payer government system is to require a spreading out of the care through a series of filters limiting the crush at the doors of the emergency room, which hardly what it claims anymore.

At the very front line, a return to house visits would serve the under-emphasized disciplines of prevention and early treatment, take pressure off hospitals busier with bigger problems, and leave some of the knowledge and medicine in the hands of an informed family member.

If it sounds complicated, go fill out some forms under the current system.

Before we run folks through the great medicine factories bristling with new technologies we might try things homier and more comfortable.

A few years ago, working as an editor, the Scribe was approached by a certain Dr. Gloria Mayer looking to build momentum for a concept she called the "hospitalette."

Mayer, by the way, was at the time employed at a think-tank called Institute for Health Care Advancement. How do you get those think-tank jobs?

Anyway, as the name suggests, the hospitalette would be a smaller hospital.

Here are some quotes from the resulting article in the "Los Angeles Downtown News":

In lieu of a fuller range of treatments, the hospitalette would offer more of less. That is to say, the reduced number of medical services it did provide would be done in greater doses and with more accessibility.

Mayer said the most significant difference between the hospital and hospitalette would be the role of the family and patient in treatment. She said hospitals currently treat family members as, "second class citizens, an appendage, not an integral part of the process."

Indeed, barriers should not be thrown up between families and the ill as is now the case once the gurney is loaded and the first pair of swinging doors traversed. The family will be footing the bill and feeling the pain.

In the end, whatever system we choose should be one that is de-industrialized, decentralized so that care is more local, more individual and less prone to the errors of broad stroke policies, processes and procedures determined from on high, with a stockholders’ representative looking over their shoulders.

We should not treat the ill in factories for the ill. You get more attention at a $200-a-cut hair salon in Los Angeles than you do in most medical establishments.

The focus should be on healing and shrinking the care system through betterment of the country’s health, lowering profit through decreased visits and more self-responsibility for what we put into our bodies. In the hands of businesspeople, how can you possible achieve that reverse dynamic?