By Kelly Jean Cogswell
The world might be coming to an end. Not just because the Large Hadron Collider is back in action, or was, accelerating particles in 17 miles of track and potentially generating teensy-weensy black holes capable of swallowing up the earth in a single gulp, but because Obama actually got that health care reform bill passed.
I'd jump up and down and throw a party except I'm still a little miffed at whoever's bright idea it was to get fence-sitting Democrats on board by promising an Executive Order banning federal funding of abortion health care services. Keep the pompoms in the closet when poor women are getting screwed again.
Then there's the ongoing stranglehold of insurance companies brought in to lobby from the very start behind closed White House doors. I haven't forgotten that either. But as they say, better something than nothing in terms of health reform. It's a start. Things can be improved later. Though this Pablum would be considerably more believable if the Democrats had a backbone made of steel, rather than Silly Putty.
If I'm satisfied at all it's because a defeat would have given the Tea Party folks a whomping burst of momentum and shoved the Obama administration even further into the quicksand of caution and bipartisanship (cowardice, endless concessions) pretty much dooming to failure all his promises of change. I never really believed them, but what the heck? I can hope with the best of them.
What has impressed me lately is how in the midst of the hoo-ha about health care reform, the rest of the Obama administration managed to function at all. There were two wars to think about, Israel to chide, and they actually negotiated a treaty with Russia to reduce nukes. Obama will probably face much bigger hurdles than the ex-commies when it comes to getting the treaty approved. Right-wing Democrats and Republican politicians will no doubt continue to say No to everything like a bunch of terrible two-year-olds with a load in their pants.
I was also surprised to see Obama make a foray to Afghanistan to twist Hamid Karzai's arm in person. Meanwhile, Secretary of State Clinton visited Mexico with half the U.S. government in tow to show a commitment to a state that's been brought practically to its knees by the drug wars. So yes, I'm glad health care reform passed, giving a little oomph to Obama instead of the hateful Tea Party mob, and showing folks his administration can take care of business. If they want to. Or if they're forced into a corner where they have to bare their little rat teeth.
Which raises the question of just what exactly queers would have to do to see some progress on any federal front like Don't Ask Don't Tell or the Defense of Marriage Act. Have a cappuccino or maybe Molotov cocktail party? Stage demonstrations where we foam from the mouth and all behave badly?
Our national organizations don't seem to cut it, especially compared to individual baby dykes in southern states. In Alabama in 2009, Tharptown High School student Cynthia Stewart successfully fought to bring her girlfriend to prom. The school initially decided to cancel its event, but reversed their decision after Stewart's case made headlines.
Itawamba Agricultural High School in Fulton, Mississippi followed suit, canceling its prom rather than allowing Constance McMillen to wear a tuxedo and arrive with her girlfriend, Ashli Pass, who also goes to Itawamba. Just afterwards McMillen told the Clarion-Ledger: "That's really messed up because the message they are sending is that if they have to let gay people go to prom that they are not going to have one." If only they would do that with marriage.
McMillen was tempted not to return to school because she was afraid everyone was going to hate her, but her family came through. "My daddy told me that I needed to show them that I am still proud of who I am. I want other kids to know that it's not right for schools to do that."
She went to court backed by the ACLU, and last week federal Judge Glen H. Davidson ruled that McMillen’s constitutional rights had been violated. He didn't force the school to hold a prom because parents are organizing one everyone can attend.
While she probably would have preferred a quicker resolution, it's been great seeing McMillen appear in photos with her family and girlfriend. The new faces of lesbian visibility are mighty cute. And if proms are what spur change in the South, I say more power to them.
It's not abstractions like equal rights that get under the skin of most people and force them to act. It's wanting to be like everybody else. Go to proms, get married. There's room for a more radical agenda, but interesting things often start small. With random collisions. Then big bangs.
Showing posts with label health care. Show all posts
Showing posts with label health care. Show all posts
Tuesday, March 30, 2010
Tuesday, September 01, 2009
Two Cents on Health Care
By Kelly Jean Cogswell
When I drop in on the American health care debate my only response is "Freaks!" Seriously. Universal health care = death panels? Communism? Armageddon? On the other hand, who on earth believes access and regulation will fix it all?
I'm an unexpected skeptic. I'm living in France where the value of universal coverage is self-evident. Despite their complaints about the high cost of care, middle-class French people pay very little, poor people pay nothing, and even outsiders like me benefit from government regulation, subsidies, and a system among the best in the world.
To give you an idea of what it means in financial terms, last year I had an ovarian cyst that involved a lot of doctor visits and eventually surgery. I paid full price for everything before my insurance returned the bulk of it. Sixty euros ($86) covered one visit to a private gynecologist, 28 euros for a visit to a public clinic. A sonogram was eighty euros. An MRI ran 454 euros. Surgery with three whole nights in the hospital was 4450 euros ($6367) including hospital bed, surgeons' fees, anesthesiologist, medication, bed pan, coffee and croissants. And I waited less than a month for this non-emergency surgery to be scheduled.
The most important thing, though, is that at every stage the care was competent and professional. Hell, it was the best I've ever had. Unsurprisingly, the World Health Organization as well as the Commonwealth Fund rank France, along with Switzerland, Britain, Canada, and Japan, as having the best health care system in the world, not just in access, but in having the best outcomes in all age categories for cancer, heart disease, diabetes, and rates of other chronic diseases.
For me the question is, even if the flying pig of universal health coverage manages to get past the increasingly powerful lobbyists and their congressional lackeys to give every American insurance, can the United States actually transform its medical culture enough to make universal health care work? Access aside, America's existing health care system stinks. You can pay a lot, or pay a little, you're still in a country rated a pathetic 37th on results.
My theory is that the key to the success of French medical care is not just access, but access to one standard of care for everyone, not just in terms of how medical recommendations are made, but in terms of class.
I'd heard about it from one of my old neighbors, a medical social worker, who told me how he might spend a morning in a total slum with a recent hospital discharge, and the afternoon visiting a patient whose possible inheritors were squabbling in an adjoining room.
I got a chance to watch it myself last year. In the waiting room at the public hospital, there'd be a student, a middle-class matron, an au pair. The secretaries terrified rich and poor alike with the same French bureaucratic chill. The doctors greeted everyone with the same face of professional interest, the same polite handshake.
Compare that mix of patients and the imposition of the same social conventions to New York, where there's clearly a two-tier system of health. The poor are treated by specialists in the poor, who rarely leave their medical ghettoes to treat the rich. In public clinics, nurses snicker at patients to their faces, make fun of accents even if they have one themselves. Doctors, usually paid less than their peers in private practice, assume that the financial poverty includes moral and intellectual lack, too, and treat you accordingly.
Which is not to say they don't prescribe the expensive procedures and tests. The problem is the staff just don't take the same care with some poor schmuck as they would with the rich.
There was the time I was on Medicaid and having intestinal problems. They recommended a colonoscopy and I was right in the middle when the anesthesia wore off. They couldn't give me more because my blood pressure dropped, which they hadn't prepared for though apparently it's a common side-effect, and despite the fact I was begging them to stop, these medical professionals just went straight on like I wasn't there begging them to please, oh my god, please stop.
No, access isn't everything. I could tell you a dozen stories like that. Only a few of them mine. Should I be happy more people get access to that?
I think this two-tier system is also bad for the middle-class or rich. Aware of the differences in pocket books, the potential for patient lawsuits as much as the payoffs in lucrative tests and prescriptions, I doubt doctors give them the objective, thoughtful care they should. They don't refuse to offer useless treatments, don't take chances when they ought to.
Reform? Hell. Better burn down the house.
When I drop in on the American health care debate my only response is "Freaks!" Seriously. Universal health care = death panels? Communism? Armageddon? On the other hand, who on earth believes access and regulation will fix it all?
I'm an unexpected skeptic. I'm living in France where the value of universal coverage is self-evident. Despite their complaints about the high cost of care, middle-class French people pay very little, poor people pay nothing, and even outsiders like me benefit from government regulation, subsidies, and a system among the best in the world.
To give you an idea of what it means in financial terms, last year I had an ovarian cyst that involved a lot of doctor visits and eventually surgery. I paid full price for everything before my insurance returned the bulk of it. Sixty euros ($86) covered one visit to a private gynecologist, 28 euros for a visit to a public clinic. A sonogram was eighty euros. An MRI ran 454 euros. Surgery with three whole nights in the hospital was 4450 euros ($6367) including hospital bed, surgeons' fees, anesthesiologist, medication, bed pan, coffee and croissants. And I waited less than a month for this non-emergency surgery to be scheduled.
The most important thing, though, is that at every stage the care was competent and professional. Hell, it was the best I've ever had. Unsurprisingly, the World Health Organization as well as the Commonwealth Fund rank France, along with Switzerland, Britain, Canada, and Japan, as having the best health care system in the world, not just in access, but in having the best outcomes in all age categories for cancer, heart disease, diabetes, and rates of other chronic diseases.
For me the question is, even if the flying pig of universal health coverage manages to get past the increasingly powerful lobbyists and their congressional lackeys to give every American insurance, can the United States actually transform its medical culture enough to make universal health care work? Access aside, America's existing health care system stinks. You can pay a lot, or pay a little, you're still in a country rated a pathetic 37th on results.
My theory is that the key to the success of French medical care is not just access, but access to one standard of care for everyone, not just in terms of how medical recommendations are made, but in terms of class.
I'd heard about it from one of my old neighbors, a medical social worker, who told me how he might spend a morning in a total slum with a recent hospital discharge, and the afternoon visiting a patient whose possible inheritors were squabbling in an adjoining room.
I got a chance to watch it myself last year. In the waiting room at the public hospital, there'd be a student, a middle-class matron, an au pair. The secretaries terrified rich and poor alike with the same French bureaucratic chill. The doctors greeted everyone with the same face of professional interest, the same polite handshake.
Compare that mix of patients and the imposition of the same social conventions to New York, where there's clearly a two-tier system of health. The poor are treated by specialists in the poor, who rarely leave their medical ghettoes to treat the rich. In public clinics, nurses snicker at patients to their faces, make fun of accents even if they have one themselves. Doctors, usually paid less than their peers in private practice, assume that the financial poverty includes moral and intellectual lack, too, and treat you accordingly.
Which is not to say they don't prescribe the expensive procedures and tests. The problem is the staff just don't take the same care with some poor schmuck as they would with the rich.
There was the time I was on Medicaid and having intestinal problems. They recommended a colonoscopy and I was right in the middle when the anesthesia wore off. They couldn't give me more because my blood pressure dropped, which they hadn't prepared for though apparently it's a common side-effect, and despite the fact I was begging them to stop, these medical professionals just went straight on like I wasn't there begging them to please, oh my god, please stop.
No, access isn't everything. I could tell you a dozen stories like that. Only a few of them mine. Should I be happy more people get access to that?
I think this two-tier system is also bad for the middle-class or rich. Aware of the differences in pocket books, the potential for patient lawsuits as much as the payoffs in lucrative tests and prescriptions, I doubt doctors give them the objective, thoughtful care they should. They don't refuse to offer useless treatments, don't take chances when they ought to.
Reform? Hell. Better burn down the house.
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