Last October, in a one-hour special commentary on health care reform, Keith Olbermann discussed his father’s illness in personal and graphic detail. Last night he provided an update that began: “Last Friday night my father asked me to kill him.”
Four-month-old Baby Isaiah suffered irreversible brain damage at birth when his umbilical cord wrapped around his neck. Medical authorities recommended that the child be disconnected from the ventilator that keeps him alive. Isaiah’s parents have sought to keep their child on life support through the legal system. See here and here for previous posts on Baby Isaiah.
A medical expert had agreed to give his opinion on the case on February 19. The upshot of last week’s court proceedings, however, was another delay. The medical expect requested an additional MRI and more time to confer with specialists. A new court date has been set for March 11.
Constance A. Nathanson is an American historian of public health. She recently wrote an essay for The Lancet that explains why the public option is such a hot button – one that threatens to confront us with the underlying issue of health inequality.
Early in the twentieth century, industrialized nations – with the glaring exception of the US – acknowledged that national governments had a responsibility to protect the health of the poor. In practice, this took the form of health insurance, wholly or partially paid for by the state. The motivation was primarily self-interest. Contagious diseases don’t distinguish between the rich and the poor. Also, there was a fear that poverty would provide a breeding ground for social revolution. Read more
If statistical analysis shows conclusively that morbidity and mortality are directly related to income, what should a (presumably) enlightened government do with this information? One approach, consistently popular throughout history, is to blame the victims.
In the Reagan/Thatcher years we saw an enthusiastic promotion of taking personal responsibility for one’s health. Personal responsibility follows naturally from a neoliberal agenda: Deregulation, privatization, a free market economy. Neoliberalism champions the autonomous individual, whose responsible or irresponsible behavior relieves the state of any responsibility.
This theme is vigorously echoed today by Sarah Palin. You can even buy her “personal responsibility” bumper stickers, mugs, and t-shirts to promote the cause.
Personal responsibility is the conservative answer to public ownership of the structural inequities in society. As a political position, it has deep roots. Just as health inequalities are timeless, so is resistance to improving the health and welfare of the poor.
Whenever there are disparities in income, inequities in health are inevitable. Today in the US, the gap between the rich and the poor is much greater than in most other highly developed democratic countries, and so are the health inequities. The roots of this inequality lie deep in the histories of developed nations.
When children in impoverished countries die of famine, dehydration, and HIV/AIDS, the images are shocking and unacceptable, but somehow not unexpected. We understand that there will be health differences between rich and poor countries. It was not that long ago, however, that the gap between the rich and the poor within highly developed nations – Britain, France, Germany, the US — was as appalling as what we now see in third world countries.
During last year’s immersion in matters of health care, the US system was frequently compared to those of Canada, the UK, Japan, Australia, and Western European countries. Whether the comparison involved infant mortality, lifespan, or comprehensive coverage, the US fell far behind these other developed countries.
The lack of universal coverage is perhaps the most disturbing difference. There are clearly economic advantages to universal health care: Diseases cost less in the long run when they’re prevented or caught early; insurance costs less when it draws from a pool that includes both the healthy and the less healthy.
Universal coverage is an ethical issue. The US claims to be a country that values equal opportunity. If you lack adequate health care from the time you’re conceived, however, your opportunities will never be equal.
Continuing with Abigail Trafford’s analysis of health care reform, the next comparison between the Obama and Clinton failures is the ongoing empathy gap.
Trafford describes an experience she had with supporters of Clinton’s health reform. In 1994 she traveled with the Health Security Express, a busload of individuals who suffered from a variety of illnesses and who were willing to trek around the country making a case for universal health care.
The riders became a target for attacks against the Clintons. At each stop, small but vocal crowds were organized to protest “BillaryCare” and “socialized medicine.” One protester yelled at a woman in a wheelchair: “Go back to Russia!” I was stunned by the vitriol and nastiness of protesters.
President Obama was determined to avoid the mistakes of Bill Clinton’s attempt at health care reform. He made sure Congress was heavily involved. He courted the major interest groups – the insurance industry, the pharmaceutical industry, hospitals. And yet it appears reform has failed once again.
Abigail Trafford, author and former Washington Post editor, has written an analysis of the failure that includes an historical perspective on the Clinton years.
It took too long and seemed too big
Although the Clinton and Obama strategies were polar opposites in many ways, one thing they had in common was how long it took to create legislation.
[B]oth strategies were undermined by fatal delays. Bill and Hillary Clinton waited almost a year to unveil their plan. With the Obama initiative, Congress has been the laggard. Administration lieutenants hoped to get something passed quickly; then they would sell the plan to the public. But the delay frittered away the public’s post-election enthusiasm for reform while allowing opponents to mount a counterattack.
February has been American Heart Month since 1963, and it’s surely no coincidence that February features Valentine’s Day. For the American Heart Association, it’s a month devoted to increasing public awareness of heart health and raising money.
In support of such a good cause, a gentleman from Ohio (Jeff Ondash) raised money for heart health by giving away free hugs outside a Las Vegas casino. After 7,777 hugs in 24 hours, he had surpassed the previous Guinness record of 5,000. Mr. Ondash, who is 51, was motivated by the memory of his father and brother, who died prematurely of heart problems.
When Texas nurse Anne Mitchell accused a doctor of unethical conduct, she had no idea how much trouble was in store. First of all, her complaint was anonymous, and second, she believed she was doing the right thing. When she was accused of harassment and faced a ten-year prison term, her reaction, according to the New York Times, was: “It was surreal. … I said how can this be? You can’t go to prison for doing the right thing.”
The relationship between nurses – a predominantly female occupation – and doctors – still dominated by males in the more highly paid specialties – has not always been an easy one. Nurses have less power, not to mention fewer financial resources, which makes it less safe to blow the whistle.
It takes courage to blow the whistle on a fellow employee. The workplace is a social community. When we stand up and accuse someone of wrongdoing, we alienate ourselves from that community. The whistle blower, of course, also faces very concrete fears: job and income loss, the threat of retaliatory prosecution, and the expense of defending oneself against such retaliation.
In a recent case in Texas, a nurse, Anne Mitchell, was prosecuted after she submitted a complaint about the unethical conduct of a doctor at her hospital. The doctor claimed that Ms. Mitchell and a fellow nurse, Vickilyn Galle, were harassing him. The nurses’ complaint was submitted anonymously, but authorities searched Ms. Mitchell’s computer and found a copy of the letter. The two nurses, who had worked at the hospital for a total of 47 years, were fired last June and faced up to ten years in prison. The New York Timesquotes Ms. Galle:
“It has derailed our careers, and we’re probably not going to be able to get them back on track again. … We’re just in disbelief that you could be arrested for doing something you had been told your whole career was an obligation.”
Following the 2008 discovery in China of melamine-laced milk – an event that left six babies dead, 300,000 sickened, and over 50,000 hospitalized — the Chinese government ordered all contaminated products to be burned or buried. The government was not directly involved in the destruction, however. That was left to those who had produced and distributed the tainted products.