Health care debate

Health care debate
By Carlos T mock, MD
August 16, 2009

I read today’s Chicago Tribune where Steve Chapman alleges: “A 2006 poll found that 89 percent were happy with the medical care they get.” (No reference). He continues with a statement of: “ President Barack Obama and his allies in Congress don't seem to realize how good we have it.”

Mr. Chapman acknowledges that “It's true that the United States spends more on health care than anyone else, and it's true that we rank below a lot of other advanced countries in life expectancy.” (Please note that the US is behind in life expectancy to all socialized medicine countries and even Cuba.) He rationalizes the lower mortality on the fact that: “One big reason our life expectancy lags is that Americans have an unusual tendency to perish in homicides or accidents.”

Crime and accidents are not a unique experience to Americans. This is a subject that has been studied by the medical profession for many years. The fact is not that we have more accidents and gun violence than anyone else in the world—a fact that is impossible to corroborate and mostly untrue—the problem lies in the fact that as American have not been taught how to end life; when to say enough!!! While it is true that actor Heath Ledger didn't die at age 28 because the American health-care system failed him, he died of a drug overdose, many car accident results in brain dead people that families can’t let go. Or an elderly person, who suffers from terminal cancer or end organ disease and no one can’t unplug them from the respirator.

The perfect example is the Terri Schiavo case. This was a successful seven-year long legal effort by Michael Schiavo to have his wife, Terri Schiavo — diagnosed as being in a persistent vegetative state (PVS) for several years — disconnected from her life-sustaining feeding tube, which subsequently resulted in her death by dehydration. As early as 1993, Michael, as Terri's guardian, had entered a do not resuscitate order for her but was convinced by the nursing home staff to have it rescinded; in 1998 he petitioned the Sixth Circuit Court of Florida (Pinellas County) to remove her feeding tube under Florida Statutes Section 765.401. He was opposed by Terri's parents, Robert and Mary Schindler, who argued that Terri was conscious. Michael later transferred his authority over the matter to the court, which determined that Terri would not wish to continue life-prolonging measures.

Next year we'll spend $17 billion in Medicare money on an oxymoron: preventing inevitable death. So forget for a moment the plans coming out of Washington. Curing health care is not a question of Obama's blue pill or Obama's red pill. The answer may be no pill at all. At the end of our long and increasingly longer lives, when we are terminally ill and in the last months of life, we must accept our body's decline, face our own mortality, gather our family and say goodbye. Say no to feeding tubes, ventilators, resuscitators, the isolation of the intensive-care unit. End-of-life care eats up 12 percent of U.S. health-care dollars. That's not money spent getting well and extending life, that's money spent preventing and easing death in terminally ill patients. Indeed, 30 percent of Medicare's costs are spent in the last year of life.

One aspect Mr. Chapman failed to document is infant mortality.

Infant mortality is defined as the number of deaths of infants (one year of age or younger) per 1000 live births. The most common cause of infant mortality worldwide has traditionally been dehydration from diarrhea. Because of the success of spreading information about Oral Rehydration Solution (a mixture of salts, sugar, and water) to mothers around the world, the rate of children dying from dehydration has been decreasing and has become the second most common cause in the late 1990s. Currently the most common cause is pneumonia. Other causes of infant mortality include congenital malformation, infection and SIDS, and prematurity

The USA ranks number 46, behind to all socialized medicine countries and even Cuba in infant mortality. (Source: CIA - The World Factbook -- Country Comparison :: Infant mortality rates)

In the USA Premature Birth Rate in U.S. Reaches Historic High; Now Up 29 Percent Since 1981. (Source – March of Dimes). And yet, Medical Costs for One Premature Baby Could Cover A Dozen Healthy Births. The average medical cost for healthy full-term babies from birth through their first birthday was $4,551 in 2007 dollars, of which more than $3,800 is paid for by health plans, according to the new data. For premature and/or low birth weight babies (less than 37 completed weeks gestation and/or less than 2500 grams), the average cost was nearly $50,000, of which more than $46,000 was borne by the health plan.

Not to ,mention that prematurity is responsible for fifty percent of all cerebral palsy cases, which also add to the health care bill—not only in health care costs, but also in litigation. Cerebral Palsy is responsible for the largest awards against obstetricians in litigation. On Feb. 24, 2008, a Stamford, CT jury's decision to award a record $38.5 million to the parents of a boy born with cerebral palsy reignited debates over medical malpractice rates, insurance company tactics and the cause of cerebral palsy. Obstetricians statewide were shocked by the verdict against a Harvard-trained obstetrician from Stamford who, in the jury's view, took too long to decide to do an emergency Cesarean section. The result of this case was higher malpractice premiums and forcing quality doctors to stop practicing Obstetrics.

The truth is the US is the richest country in the world, and even though has the best tools to fight disease than anyone else in the world, it spends one half of its health care budget in the first year of life and in the last year of life, thus leaving almost 60% of Americans unable to afford adequate health care insurance.

Dr. Mock has published four books with Floricanto Press, Berklety, CA. His articles have appeared on publications like The Chicago Tribune and several gay and lesbian newspapers. He was inducted in The Chicago GLBT Hall of Fame in 2007. He can be reached at: www.carlostmock.com