The Price of Health

By Kelly Jean Cogswell

Thursday, I bought a bathrobe and pajamas, packed a bag, and took the metro to the hospital where I handed over both my credit card and a check so they would accept my 59.2 kilos of flesh to be depilated, disinfected, knocked unconscious, pierced with holes, de-cysted, and released.

Even paying full price, it was a bargain by American standards. In Paris, doctors will make a house call for about $85. A visit to a gynecological clinic costs $40. A sonogram is about $100. And a prescription of Xanax runs three bucks. Laparoscopic surgery with three nights in the hospital is a mere $5,800, surgeons' fees and morphine included. In New York, that'd barely cover a bed pan.

For most French folks, the government covers two-thirds of health care costs, and they often have a supplementary insurance that gets the rest. For the poor and unemployed, the state picks up the whole tab. The best thing is, French doctors are competent. Even in the public sphere. The hospital I was going to was more highly rated than the private clinic a friend of mine used that cost an extra 600 bucks a day.

I checked it out, did price comparisons. That's the American way. To focus on dollars and cysts. When the radiologist said I had a big clump in an ovary and needed an MRI, I freaked out more about the cost and whether my insurance would reimburse me than that my body was growing strange fruit. After all, it's medical bills that metastasize into crippling debt. And money that shapes our experience of medicine, even health.

Health for the rich means well-being, every part of the body on track, clear skin, good feet, all systems go. The poor are often grateful just for mobility and generally being intact. You can have rotten teeth, and a bad back, and still proclaim when you lose your job, "At least I have my health."

We don't have the time or money for more. In the New York public health system, you wait months for appointments, then wait for hours and days in waiting rooms with all the other marginal folks, new immigrants, working poor, the crazies who apparently don't deserve better. And rarely get it.

The doctors seem to hate us, and secretaries sneer behind our backs. Bring a list of questions to an appointment, you'll be dismissed as a hypochondriac. Admit a pelvic exam was painful, maybe the nurse practitioner will suggest early childhood abuse and abuse you verbally if you dissent. Wake in the middle of a colonoscopy, they'll continue without anesthesia because they're too incompetent to deal with dropping blood pressure, can't give you more drugs, and pleas to stop, stop, stop from a Medicaid patient are like whispers in deaf ears.

Good luck with that universal health care thing. Access isn't enough for anything resembling care. For that, the enormous gap between the salaries of Madison Avenue doctors and the ones at public clinics has to end, along with segregation of patients. In fact, class and race themselves would probably have to go, along with the culture of scorn as deeply rooted in American medicine as shame and fury are buried in people like me.

Inequality's in the very nature of the medical beast. On the one side, there's the patient as supplicant, asking for help. On the other, some white-coated god free to give or withhold. And charge you for it either way. When money or race or sex or sexual identity is added to the picture, the balance is increasingly skewed.

I'm wary, even in Paris, where the care is good and cost is less a factor. Handing over my body still feels like a kind of fourth dimension prostitution in which I lose both my money and my flesh. All I own is a computer, the clothes on my back, and everything under them until you arrive at my beating heart. Now, even that's yours.

And laying there, a day later, with my dragon breath and scars and IV drip, I was tempted to tell her so. Explain to the young surgeon smiling shyly at the American patient all the effort I've put into protecting this shell. All the male hands on my female ass in high school that I had to shove away. The bottles dodged from cars because I was a dyke and on the street. These sudden waves of hate in the media that sweep you off your feet. The walls I've built against what homophobes do to you in their brains. What doctors have done in the flesh.

How I defend what I want to relinquish. How I want to be saved. And though she had done this thing, cut a miraculous door into a world I kept for myself, and pulled out death, I needed more.

Bush Screws Women Globally: Still Gagging on the Rules

By Kelly Jean Cogswell

802 words

Now that Gore's got his Oscar, and Barbara Boxer's in charge of the Environment and Public Works Committee, a safer home for those cute little arctic seals is practically in the bag. But what about that other endangered category: women?

Since George W. Bush took office in 2001 imposing his global gag rule, we've been crushed between the rock and the hard place with no end in sight.

The gag rule cuts off U.S. funds to any foreign organization making any mention of abortion for any reason, no matter where the funding for those services came from. So even mention abortion among a hundred other things, and women in developing countries can kiss goodbye prenatal care and cancer screening and open their arms wide to the half a million women that will die this year during pregnancy or childbirth -- from largely preventable causes.

That's the rock. The hard place is the President's Emergency Plan for AIDS Relief (PEPFAR), which does do some good in providing money for treatment and prevention of AIDS in developing countries, but again has a crushing provision that a full one-third of the prevention money go to programs preaching only abstinence.

For Bush, sex workers are garbage. Girls that aren't given the chance to say "no" are crap along the side of the road. Girls forced to marry young are what you scrape off your shoe. Women that already have HIV and have no means to prevent transmitting it aren't even on the map.

When are we going to roll that back?

Is it even on the agenda of the macho Dems when the bad news from Iraq takes half the newspaper every day, and the other half is consumed by presidential wannabees grunting at each other while garden variety torture cases barely get a mention. If another Abu Ghraib was uncovered now, or even if anyone wanted to follow-up on the old one, they'd have to wait in line behind whatever Hillar-Ama brainfart hits the stands next.

There's been little coverage of that lug José Padilla, the "enemy combatant" from Chicago that could barely spell his own name, but was nabbed in 2002 and thrown in an army brig for supposedly coordinating more deadly attacks. He's finally come up for trial and it turns out they tortured him so much he's almost completely insane. Forget poor women dying slowly of AIDS, or during deliveries.

I even resent all the coverage of Academy Awards, though Helen Mirren won best actress and I've had a crush on her for ages, except during her recent incarnation as the pin-curled, blue-rinsed Queen.

If I had my druthers it would other women on the front page this morning, all the forgotten ones dying and at risk, and the handful trying to do something about them.

As it turns out, overturning the gag rule is on the Democratic agenda, kinda, just not far up enough to make it to most newspapers. On January 22, Democratic Representative Nita Lowey from New York re-introduced the timeworn Global Democracy Promotion Act expressly devoted to overturning the gag rule. A couple of weeks ago, California's Rep. Barbara Lee, re-introduced the Pathways Act, which would remove the requirement that one-third of PEPFAR AIDS prevention programs be abstinence-based.

The problem is neither bill will go anywhere this time either. Even if the new clench-fisted, testosterone stoked Dems suddenly admitted sympathy for the problems of women, Bush would veto the bills anyway.

Pressure probably won't come from outside, either. Dr. Margaret Chan, the new director-general of the World Health Organization has announced that women's health is one of her top priorities, but she also seems to be courting America's Big Pharma in recent comments in Bangkok criticizing Thailand for challenging intellectual property laws to develop generic AIDS and cardiac drugs.

Will she turn a blind eye to the United States' global gag rule and PEPFAR policies that are based on moral crusades than good science and public interest? WHO knows?

Sexual and reproductive health worldwide is a mess. According to a global study published in the British medical journal the Lancet last November, international aid for family planning dropped from $560 million in 1995 to $460 million in 2003.

We need Helen Mirren to return, not as queen, but President, a kind of unsmiling, childless, tough-as-nails Inspector Tennyson to defend the rights of women.

Hillary is tough, and Pelosi, too, but I don't like seeing the speaker of the U.S. House of Representatives doing photo shoots with a grandkid on her hip. She's being the dog that rolls over to expose her belly and show how non-threatening she is to all the male voters out there. Yeah, I understand the game, but it creeps me out.

Show your soft side long enough, some wolf'll rip it to shreds.

Visit Kelly Sans Culotte at http://kellyatlarge.blogspot.com.