'Look for the helpers'

Name a hospital after this woman already 

“When I was a boy and I would see scary things in the news, my mother would say to me, "Look for the helpers. You will always find people who are helping.” 

- Fred Rogers

While an awful American betrays his country and as other Americans supinely support this ongoing assault on our values, read about the best person you've never heard of (hat tip to Forrest Dillard for passing on the link to this):

It started in 1984, in a hospital hallway. Ruth Coker Burks was 25 and a young mother when she went to University Hospital in Little Rock, Ark., to help care for a friend who had cancer. Her friend eventually went through five surgeries, Burks said, so she spent a lot of time that year parked in hospitals. That’s where she was the day she noticed the door, one with “a big, red bag” over it. It was a patient’s room 

...Whether because of curiosity or — as she believes today — some higher power moving her, Burks eventually disregarded the warnings on the red door and snuck into the room. In the bed was a skeletal young man, wasted away to less than 100 pounds. He told her he wanted to see his mother before he died.

...Burks wrangled a number for the young man’s mother out of one of the nurses, then called. She was able to speak for only a moment before the woman on the line hung up on her. 

“I called her back,” Burks said. “I said, ‘If you hang up on me again, I will put your son’s obituary in your hometown newspaper and I will list his cause of death.’ Then I had her attention.” 

Her son was a sinner, the woman told Burks. She didn’t know what was wrong with him and didn’t care. She wouldn’t come, as he was already dead to her as far as she was concerned. She said she wouldn’t even claim his body when he died. It was a curse Burks would hear again and again over the next decade: sure judgment and yawning hellfire, abandonment on a platter of scripture. Burks estimates she worked with more than 1,000 people dying of AIDS over the years. Of those, she said, only a handful of families didn’t turn their backs on their loved ones.

(Emphasis mine)

Some things worth pondering:

Burks was doing this in the 1980s when most doctors, let alone the general public, had little knowledge about HIV/AIDS outside of rumors of the "gay plague." We know now that she didn't have a significant risk of being infected herself. At the time, she didn't know that. She went through the red door anyway. 

She did this for years, in anonymity. See more below:

After she cared for the dying man at University Hospital, people started calling Burks, asking for her help. “They just started coming,” she said. “Word got out that there was this kind of wacko woman in Hot Springs who wasn’t afraid. They would tell them, ‘Just go to her. Don’t come to me. Here’s the name and number. Go.’...I was their hospice. Their gay friends were their hospice. Their companions were their hospice.” 

Before long, she was getting referrals from rural hospitals all over the state. Financing her work through donations and sometimes out of her own pocket, she’d take patients to their appointments, help them get assistance when they could no longer work, help them get their medicines, and try to cheer them up when the depression was dark as a pit. She said many pharmacies wouldn’t handle prescriptions for AIDS drugs like AZT, and there was fear among even those who would.

She soon stockpiled what she called an “underground pharmacy” in her house. “I didn’t have any narcotics, but I had AZT, I had antibiotics,” she said. “People would die and leave me all of their medicines. I kept it because somebody else might not have any.”

I remember the political climate regarding AIDS in the 1990s. I'm reasonably sure that if word had gotten out too widely in Hot Springs that Burks was illegally redistributing prescription drugs to HIV-positive gay men, she would've ended up doing hard time. 

To recap, Burks did the following:

• Risked her life
• Risked her savings
• Risked her freedom
• Gave selflessly of her love and time for years in what seemed like a hopeless cause

She did this for a sexual minority facing rampant discrimination from everyone from politicians to health care providers to their own families. She did this for men dying slowly and horribly.

I like to remember that so many of our neighbors are much better than we deserve.

Annotating the news: Is there an answer for Obamacare opposition besides 'tribalism'?

From the NYT - "Hospitals in Safety Net Brace for Health Care Law's Repeal"

Before the health law, the hospital had to absorb the cost of caring for many uninsured patients like Mr. Colston. Now, with President-elect Donald J. Trump and the Republican-controlled Congress vowing to dismantle the law, Temple and other hospitals serving the poor are bracing for harsh financial consequences that could have a serious effect on the care they provide.

Hospital financing is a complicated beast but the bottom line is the hospital will be reduced to providing legally required triage care with only rare exceptions, no? Status quo ante Obamacare, so to speak. The upshot is that many more people will suffer and some will die prematurely.

Since the election, hospitals have been among the loudest voices against wholesale repeal of the health law. In a letter to Mr. Trump and congressional leaders this month, the two biggest hospital trade groups warned of “an unprecedented public health crisis” and said hospitals stood to lose $165 billion through 2026 if more than 20 million people lose the insurance they gained under the law. They predicted widespread layoffs, cuts in outpatient care and services for the mentally ill, and even hospital closings.

Twenty million people is a little under the size of the New York City metropolitan area. Imagine what it would be like if that population were limited to emergency room care only for everyone under 65.

***

Republicans have opposed Obamacare since it was proposed (by Obama, not years before when it borrowed heavily from the conservative Heritage Foundation's plan). I've followed the debate for years and still struggle to understand the logic of opposition beyond 1) Obama 2) government and 3) small tax increase on wealthy.

(Another version 1) tribalism 2) tribalism and 3) greed)

Sure, one can critique Obamacare's flaws from the left (not Medicare for all!) and right (mandate!), but those who are in wholesale opposition confound me. What was supposed to be done with nearly 16% of the population uninsured before Obamacare? Wasn't the increasing numbers of uninsured (and corresponding cost increases for insuring everyone else) going to capsize the market?

I get the politics of it, but don't understand the inhumanity. Again, from the NYT:

Paul Fabian, who received a double lung transplant at Temple last year after getting a subsidized private insurance policy from the Affordable Care Act marketplace, would not have qualified (for state-provided coverage before Obamacare) at all. Mr. Fabian, who suffered from emphysema and chronic lung failure, said he sold his truck to afford his $262 monthly premiums. 

“If you walk into the E.R. they have to help you,” Mr. Fabian, 61, said. “But if you have a condition like I had (chronic lung failure), what’s the hospital’s obligation?”

Health Care: We Are All Going to Die

From Tyler Cowen at Marginal Revolution:

2. A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor.  Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence.  We need to accept the principle that sometimes poor people will die just because they are poor.  Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree.  We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.

From a New Republic article about Remote Area Medical:

(Robin) Layman and her family offer a stark example of the law’s potential impact. Two years ago, her son, then 16, was hit head-on by a speeding driver high on drugs. Her son’s girlfriend was killed; he suffered severe internal injuries and recently underwent colon surgery. Now 18, he will soon age out of Medicaid coverage. 

And Layman, a gregarious 38-year-old, recently lost coverage for her own considerable problems. She suffers high blood-pressure, for which she takes three medications, purchased at a discount from the county health office. She suffers sciatica stemming from the time eight years ago when a co-worker at a dollar store let slip a heavy box of wrapping paper Layman was handing up to her. Layman lunged for it and badly hurt her back, for which she takes the nerve-pain medication Lyrica.

[Highlighting is mine.]

Q: Guess which one points at a moral failing?
A: Both.

***

We are all going to die.

You, me, Mitch McConnell, John Roberts, Barack Obama, that guy who cut you off, the teenager who chunked a firecracker at me -- all will die. Someday.

Given that, here's what health care does:

Tier 1: Treats illnesses & injuries that would kill you quickly if left untreated -- heart attack is the most common; however, many types of trauma would also fall into this category


Tier 2: Mitigates symptoms for illnesses that will eventually kill you, but will kill you much more slowly if treated -- many forms of cancer & diabetes


Tier 3: Mitigates symptoms for chronic conditions or injuries that severely impact a patient's quality of life -- Parkinson's disease, Crohn's, some types of diabetes, ligament and bone damage, arthritis


Tier 4: Treats or corrects issues that have a mild to moderate impact on a patient's quality life -- nearsightedness, warts, morbid obesity


Tier 5: Corrects cosmetic issues -- nose jobs, liposuction

Note that the top three tiers are diseases or injuries no one wants under any circumstances. Sure, some lifestyle choices accelerate the development of some of these illnesses (tanning leads to skin cancer; a diet of steak and burgers leads to a heart attack; etc...). I can think of no rational person, though, who consciously wants to experience anything in the top three tiers.

Yet, at some point, we are going to experience a deadly and/or debilitating injury or illness. Until then, we will have no need for any of the necessary treatment. (Something no one says: "Let's get a bypass, then top it off with some chemo!")

This is why the normal supply/demand curve is useless when applied to health care. Until I have a need most types of health care, I won't purchase it. Once I have a need, there's nothing I wouldn't spend. A doctor could ask me to go into indentured servitude in order for him to treat me when I'm having a heart attack and I'd have to agree or die. No time to shop around for a better deal.

What is lacking is choice. Most consumers don't choose to enter the health care market and they don't control when they leave. Whatever is trying to kill us will dictate our "consumption" needs -- not our socioeconomic status.

Arguments that we should ration health care according to income, that people should bear a "responsibility" for getting a life-threatening or life-altering illness are morally unacceptable. Even for those who made poor choices -- too many Mountain Dews and cigarettes, too few early morning runs -- should the consequence be an early death because of lack of treatment?

If you believe that, then visit a Remote Area Medical free clinic* when it's in the area. (Heck, visit any local free clinic.) Look at a patient like Robin Layman and all of her dependents in the eyes and tell them that yes, sustained and successful treatment is possible, but you must learn a lesson first.

****

The blown supply/demand curve is why we have health insurance. The status quo has been private insurance for some; decent government insurance for the elderly; lesser government insurance for the young or extremely poor; and pool of 40 to 50 million who are one trip to the ER away from financial ruin.

Today's Supreme Court ruling paved the way for nearly all Americans to be covered for illnesses in the top three tiers list above. It also gave desperately needed consumer protections to us. (Ask Robin Layman how important that is.)

To those who argue against this ruling on the grounds that it infringes on some notion of freedom or that it's a tax increase, again, I invite you to visit a free clinic and make your case.

Look them right in the eyes.

* Some may argue that the very nature of a free clinic is that its services are, well, free. I could offer a long rebuttal about how receiving care at a free clinic is a far cry from the comprehensive treatment afforded by health insurance. Or you could, again, take my advice to visit one and offer that argument. This is what will happen to your logic: