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Tom Daschle, former U.S. Senator and Senate Majority Leader from South Dakota. He is President-elect Barack Obama's nominee to serve as the Secretary of Health and Human Services in Obama's Cabinet
News and Opinion

Advocating for Universal Healthcare

-- DocJess

Since Senator Obama became President-elect Obama, there has been a lot of movement in terms of naming his Economic team and his National Security team. There have been only whispers about Health Care, but by the time you read this, the following is likely:

  • Tom Daschle will have been named Secretary of Health and Human Services (HHS), and will be in charge of shepherding the Administration side of Health Care through Congress.
  • The Baucus Plan will be modified with input from health care plans previously fought for by Ted Kennedy.

Some background: Max Baucus (D – MT, Chair Senate Finance Committee) proposed what we basically call “Universal Health Care.” His plan is interim to Universal Health, but is likely a necessary starting point to get us where we need to be.

I am a big fan of Mr. Daschle, I had the privilege of hearing him speak on the issue last spring, in a forum with Tommy Thompson at the Constitution Center. My brother and I were able to speak with him after the program, and I know that HHS could not be placed in better hands. You can read my write-up of the program here. The thing that most struck me was how completely and succinctly Mr. Daschle understood the fundamental problem of health care in America.

Daschle framed the problem by saying that everywhere else in the world, health care is like a triangle, where the bottom: the most money, the most care; is spent on preventive care, and you spend up the triangle to the most specialized care until you run out of money. Here in the US, he said, the reverse is true, we spend first on high tech. I could go on for 3,000 words on how right he is, and why that leads to fully 50% of all American adults dying of some form of cardiovascular disease, but I digress.

To pass Universal Care will require that Americans change some fundamental beliefs in how health care is defined, assessed and delivered. It will not be the easiest thing, but will be critical in the long run. The other thing is that having National Health Care is a necessary part of making American industry, especially manufacturing, competitive worldwide. It isn't the only thing, but it's critical. Many people will not be happy about change in general, and what will be necessary for them to do. I am going to first lay out an example of how this changes under Daschle’s inversion of the triangle, and then present a personal anecdote of why the changes are so important.

Changing beliefs:

Currently, if you are a middle-aged American diagnosed with high blood pressure, high cholesterol and a borderline diabetic, standard treatment is a bunch of drugs, and a few printed pages related to diet and exercise. Sure, there are doctors who take a more holistic and whole-person approach, but that's not Standard of Care. And SOC is codified in many states, and by most insurance companies.

Another approach, which has to do with Daschle's triangle-righting, would be different. When you get the diagnosis, care costs would be front-ended to the end of decreasing secondary complications. While certainly you would get drugs to solve any immediacy problems, initial care would instead focus on taking more control over the causes that led to the problem.

For example, a normal person has about a teaspoon of sugar in his blood, a diabetic has about a teaspoon and a quarter. It doesn't seem like much, but it's the difference between whether or not one's cells can utilize insulin to be able to process glucose and indirectly glycogen. You don't need to understand the cellular process to understand that left untreated, diabetics can end up blind, with kidney failure, needing digits or limbs amputated, and with severe cardiovascular problems. So, if an undiagnosed diabetic walks into an Emergency Room with blood sugar of 650 (normal is 70 - 110), it's necessary to use drugs to get that number down. However, if someone has blood sugar of 150, there are better ways of getting it down and keeping it down without the necessity of life-long drugs, and the complications related to the drugs themselves.

Back to our middle-aged American. The front-end load would likely mean that the person sees a nutritionist or dietician weekly, keeps a food journal, and gets weighed and counseled. In addition, the person would be put on an exercise program. Adjunctive programs, as necessary, for stress reduction, smoking cessation, and alcohol awareness would be available. This costs a lot more for the first year than a handfull of statins, ACE inhibitors, beta blockers, sulfonylureas, meglitinides, biguanides, thiazolidinediones, and alpha-glucosidase inhibitors. However, over the long run, for most people, losing some weight, improving cardio-vascular abilities, and eating right will cost less to the person AND the health care system (whether nationalized or in its current for-profit form).

To wit: if you get a bunch of drugs, the disease still progresses, and the drugs have side effects. A year of intervention is much less costly than leg amuptation, kidney dialysis and transplant, heart attack, stroke, or death, to name a few.

Still, most Americans will say "NO -- give me drugs!" People tend to hate change and want an easy way out. So the beliefs have to be changed, the approach needs to change.

A Personal Anecdote:

I have a friend. She is as close to me as a sister. Pretend her name is Glenda.

Last January, on a Saturday night, Glenda, her boyfriend, and I went to all-you-can-eat-pancake night at the local IHOP. On the way over, she and I had a good natured fight in the car about hair dye. At the restaurant, her boyfriend attempted to have a conversation with me about the upcoming election: 58 years old and he’d never been registered to vote. (It’s a long aside, but on November 4th 2008, he voted for the first time, and that January night at the IHOP, he made me list out all the states, and their capitols, because he didn’t believe anyone actually knew either of those two lists.)

On Sunday, she called me, complaining about how sick she felt. I pointed out that if I had eaten four plates of pancakes with butter, syrup and more butter, I’d be sick too. She made fun of the fact that I’d rather do anything than eat, we laughed, and I recommended she eat some peppermints, and I’d see her the next day.

Monday night, I took her to the emergency room. She was in terrible pain, and there was just something very, very wrong. By Tuesday afternoon, they had diagnosed ovarian cancer. On Friday, they operated. She has never done anything “wrong” – she never smoked, never drank to excess, eats low on the food chain, exercises, and has always lived a healthy life. At the time of diagnosis, she was between jobs and on COBRA. The surgery was extensive, and it was followed by chemo.

We applied for Social Security Disability for her because here in Pennsylvania, there is no extension to COBRA, and if one qualifies for Disability, and lives long enough, he/she can get Medicare prior to age 65. Stage 3 or 4 ovarian cancer (hers was on the line) is an automatic “yes”. The approval is automatic for her condition, and a list of others, because based on actuarial tables, there is not a huge percentage chance of living 12 months past diagnosis.

The chemo was successful in that she entered remission. “Remission” being perhaps the most cruel word in the entire English language. “Remission” means a lot of expensive tests to find any cancer resurgence as soon as possible. “Remission” means waking up every morning wondering if today will be the day that things go horribly wrong.

She cannot work, because she isn’t healthy enough to hold a job. Her COBRA has run out, so she must buy individual insurance. Most carriers will not accept her, or if they do, they won’t cover any cancer-related charges (including diagnostic CAT and PET scans) for at least a year, in most cases two years. If you have ever tried to find insurance when you have a pre-existing condition, then you know. If not, try to imagine living the book Catch-22.

Which brings us to Friday, three days ago. Glenda ended up back in the hospital in intractable pain. It might be a secondary tumor, it might be a bowel obstruction. The tests, so far, are inconclusive. One thing I have not mentioned, but which is relevant. Over the years, Glenda had a number of silent TIAs, which have caused a certain amount of minor brain death. In simple terms, certain parts of her brain can no longer process certain types of information. That, in combination with ‘chemo-brain’ means that she does not completely understand everything about her condition, nor the treatment options.

She is between insurance carriers. While her COBRA ended on 31 October, she could not get new insurance until the COBRA carrier issued a certain certificate, which they intended to not issue until 30 November. She should have been in the hospital a week earlier, but instead held on hoping she could convince the COBRA people to issue the certificate. She did not truly grasp the importance of treating things as quickly as possible. ears taking pain killers because she is afraid she will get addicted. She hates the side effects of the pain program. She fears if she needs additional surgery, she will end up homeless because if insurance doesn’t pay, the hospital will sue her and they will take her house. There is something morally wrong with this picture. A patient should not have to need to juggle the pain, the illness, and come to grips with dying along with the potential of crushing financial strain.

I am not her doctor, but I am her friend. Because I am a doctor, I understand what the chart says, I understand “medical speak”, and I can translate to regular English. I can look her in the eye and tell her to say the truth: that it’s okay to do so, and make sure she knows that I am speaking truth to her. I can help with palliative care. I can make sure that the small things that bring her an ounce of joy are always available to her; her favourite cookies and hand cream, funny movies, a recap of the news. I can advocate for her. I can call the insurance company on her behalf. The single thing I cannot do is save her life.

I can, however, advocate for universal health care. I can ask you to call you Senators and tell them that the time has come for them to support it. Will the Baucus plan be modified as it goes through process? Sure. Does the plan address everything, including the intricacies of implementation? No, not yet. But it is a step in the right direction.

There are millions of people, right now, here in America who are dying, and putting off care because they cannot afford it. There are people with chronic illnesses like diabetes, high blood pressure, high cholesterol, asthma, and others who are not getting basic care, and will therefore need more expensive and extensive care when secondary problems set in. There are many people with severe mental and emotional limitations, who cannot navigate the current insurance programs, if indeed they qualify.

I could write for miles of column space of patients I have met who suffered terribly because they didn’t get care until it was too late, or almost too late, because they had no money and no insurance. Sometimes, these people died. Back in April, part way through chemo, and it was pure torture, Glenda requested an absentee ballot for the PA primary: she did not know if she’d live until the General, and wanted to vote for Obama because she believed that if he was elected, the world would change enough so that no one who came after her would have to worry about making the decisions she was making in the spring: medical co-pays vs. COBRA payments vs. food vs. mortgage vs. breaking into her 401(k) which, even then, was losing value every month.

As a country, we need to fix our economy, change our standing in the world, re-affirm our Constitution, get out of Iraq, deal with global warming. The likelihood is that the Obama administration will start with the economy. The Baucus plan, coming from the Senate, aims to start fixing health care in 2009, without diverting the attentions of the administration from the economy. Now that Senator Kennedy has resigned his seat on Judiciary to devote his full-time efforts to health care, we will certainly see the kinds of changes he has been fighting for since entering the Senate in 1962 folded into the Baucus Plan. There is no doubt that with Mr. Daschle at HHS, there will be a good working relationship between the Executive and Legislative branches on this issue, and the political will to make it a reality.

For the millions of Glendas, let’s all work together to get this done. Now.

A Final Note, in case you were still on the fence about calling your Senators:

In Iraq, we have lost an average of two Americans a day since the invasion, or about 700 people a year. Here at home, we lose 100,000 Americans a year due to drug errors. This is the equivalent of a 747 crashing every day and a half. Health care is broken.

From Tom Daschle: "If you want a car, you must have auto insurance, if you want to own a home, you must carry homeowners’ insurance, why not health insurance?"

While we can talk about the financial ramifications of uninsured Emergency Room patrons, and monies available for drug research, and a zillion other things, the simple political ramification to ALL of us is that our current health care system is great for those of us who can afford great care, and a death sentence for those who cannot. America is better than that, even if we all have to eat right and exercise.

This article is derived from a series of posts published at DemConWatch, and used by permission. "DocJess" is a retired chiropractic physician living in Chester County

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