Health Care: The Change We Need
December 03, 2008
Today's post is from Patricia Harman, author of The Blue Cotton Gown: A Midwife's Memoir. Harman got her start as a lay-midwife on the rural communes where she lived in the '60s and '70s, going on to become a nurse-midwife on the faculty of Ohio State University, Case Western Reserve University, and West Virginia University. She lives and works near Morgantown, West Virginia, and has three sons. In the interest of privacy, the names and some identifying details of the women she discusses in this post have been changed.
Willa Burr, a forty-eight-year-old West Virginian, was a housekeeper and a darn fine one. She made good money too; a little over $14.00 an hour on Mondays, Thursdays, and Fridays for two doctors' families and a single middle-aged teacher. The rest of the week, she stayed home with her three-year-old granddaughter.
Darrell, her husband, had retired early, when the shirt factory at the edge of town closed. He worked on an addition to their house on Taylor Mountain, a little at a time, when they could afford lumber. He had diabetes and took the medication he got at the free clinic. When the snow was too bad, he drove Willa down the steep mountain, in his four-wheel-drive truck, into the suburbs for her cleaning jobs.
Life was pretty good on their two acres, what with Willa's pay and Darrell's Social Security, until Willa's knees gave out. First Mrs. Haddock let her go. That's the urologist's wife. She said Willa was missing too much work, but there was only that once when Willa and Dave had to go to South Carolina for two weeks to help their son, and the other time when Willa had the flu.
The real reason Mrs. Haddock fired Willa was she couldn't get down on knees on the tile floors anymore, and the dusting was deteriorating too. Then Dr. Kepler said he didn't need her either. That left Miss Robinson, the second grade teacher, and when Willa noticed her hands were shaking and walking was difficult, she gave up cleaning altogether and just stayed home. Maybe she'd been working too hard, was what Darrell said.
After that things went downhill. Willa's daughter, Tina, a secretary in an accountant's office, took her mom down to the low-income clinic, staffed by students, residents, and faculty from a nearby medical school, but they couldn't find anything wrong. Then, even though the Burr's couldn't afford it, Willa and Darrell made an appointment at the Patterson Family Health Center to see a young Doc who wore a gold cross around his neck and a cashmere sweater. He wasn't much help.
The medical bill, from the clinic was $565, counting lab work. The doctor with the gold cross said he was pretty sure Willa had Parkinson's disease and wanted to order more tests, maybe a CAT scan of her brain, but Willa refused. She didn't have the money. And she couldn't pay for a trial of medication either.
After that, Willa took to sitting in front of the TV and gained another thirty pounds. She refused to go out. Neither her daughter nor Darrell could get her up from that chair, not even with a walker they purchased through the used medical equipment section in the Traders Bulletin. Nothing would move her.
Three hundred miles away on the out skirts of Windsor, Ontario, Canada, Molly McGregor, a thirty-five year old, pregnant landscaper had her own business. She made a fair living cutting lawns in the summer, digging out flowerbeds in the spring, blowing leaves in the fall, and plowing driveways in the winter. Despite the down turn of the economy, she and her husband, Lester, a commercial fisherman on Lake Erie, did all right. Then Molly began to have back pain.
Les drove her down town to the Ontario Family Medicine Clinic on Talbot, where she saw a nurse practitioner who ordered lab work, got a urinalysis and told the patient to rest for a week. The pregnancy was fine and a fetal monitor strip showed the absence of uterine contractions. A week later, when the pain was no better, Molly was admitted directly to the Windsor Regional Hospital. She had an x-ray and a CT scan that demonstrated a slipped disc. The tests were billed to her Ontario Health Card.
For five months, Molly couldn't work, but her Canadian Disability Insurance kicked in. Les did her snow plowing in the winter. (Fishing was impossible when the ice came in anyway.) By spring, Molly was on her feet and gave birth to a healthy boy. The Ontario Universal Health Insurance Program paid for all medical expenses. Her Canadian maternity leave was for fifty weeks. Her brother-in-law kept up with the mowing.
Willa and Darrell's story is all too common in the United States. The uninsured are everywhere from my small town in West Virginia to the suburbs of Boston. The proportion of people who have health insurance paid by their employer is dropping, while those who do have coverage face ever-higher deductibles. Always in the shadow, are the more than forty million US citizens who have no health coverage at all.
I hear it often said, with sarcasm, about the possibility of universal health care in the United States, "Oh sure, get the government involved, that will really help things!" A few years ago, my physician husband and I said the same thing but we've changed. It helps that we own a cottage in Canada and frequently talk to our neighbors and friends there. I know Molly in West Virginia but I also know Willa in Canada and I see who is thriving and who is not.
A single payer system is better for patients and better for doctors because in the private insurance bureaucracy the paperwork consumes 31 cents of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.
Canada spends $1000 less per capita on health care than the U.S., yet delivers more care and provides greater choice for patients. Canadians get more doctor visits and procedures, more hospital days, and even more bone marrow, liver and lung transplants than Americans.
Surveys show that Canadian doctors are far happier with their system than we are with ours. Fewer than 300 out of Canada's 50,000 physicians emigrate to the U.S. each year, and doctors who have practiced in both nations show a clear preference for the Canadian system. Surveys also show very high rates of patient satisfaction with their health care by Canadian citizens.
U.S. physicians and other providers know that our health care system is in crisis. In our private women's health practice, we see pregnant women for free if they don't have health insurance, hoping they will eventually qualify for a state medical card. We write scripts for pain medicine because the patients cannot afford a hysterectomy. We scrounge for samples of antibiotics and birth control pills from our friendly drug reps to give to women with no prescription coverage.
Interestingly, the tide in the US medical establishment is turning. Except for monolithic insurance companies, huge HMO's and the wealthy, no one gains from our private health care system. According to recent research, in which more than 2,000 doctors were surveyed, 59 percent say they now support legislation to establish a national health insurance program, while 32 percent say they opposed it.
Willa Burr, 47-year-old former housekeeper, is still waiting, on Taylor Mountain, in one of the wealthiest nations in the world, to be declared disabled so that she can get a Medicare card and eventually surgery on one of her knees. She's already been denied twice. Her health continues to deteriorate. She and Darrell now receive food stamps, but she still can't afford the medication for Parkinson's Disease. Molly and Les, in Ontario, take turns caring for their young son and are both back to work.