Diana Cirillo Wilson RN, BSN, PHN

  Do we realize what comes into play the moment we step into a doctor’s office?

  We arrive, remembering how it was growing up. Our ‘family doctor’ is still mom and dad’s doctor. He took care of        grandma too. We all lived walking distance to Doc’s office; even our cousins went to him. Doc was always  accommodating;  all we had to do is call his receptionist and make an appointment. His fee for the office visit was  negotiable. He knew our  family and if we were in a difficult situation he had a small installment plan.

  Our pharmacist owned the drugstore on the corner. There was a soda fountain where we drank ‘egg creams’ his wife  made for us. Doc Pharmacist filled our prescriptions explaining how and when to take it. Not infrequently, Doc Pharm  could be consulted for other minor aches, pains, illnesses, and conditions. He would give a customized remedy:  sometimes a prescription medicine, other times he would give a concoction he developed himself. All his remedies  were purposefully simple. Simple to use. Simple to take. He had one stipulation, we had to report back to him in two or  three days so he could progress or lack of progress. He kept track himself, an early statistician, watching how his  remedy worked. He dispensed his concoctions at little or no charge.

  The small fifty bed hospital in our neighborhood had semi-private rooms, usually shared with a neighbor from down the  street. Local, intimate, specifically ethnic, it was in the neighborhood.  Our small hospital was the place all our family  went to and got better or had babies.  We accepted treatment without questions believing the medical care received  was the best that could be done by a caring physician and nurses who we knew.

  Today, looking at the advances in medicine, chemistry, technologies and care delivery systems confounding to  understand we wonder where is the simplicity we had just a single generation ago? Healthcare is no longer the  neighborhood caring for its’ own. Healthcare has become a mega complex with an identity and life of its’ own requiring  us to find a way to fit in.

  American healthcare “is the sixth largest economy in the world”, spending “three trillion dollars a year”.* American  Healthcare has become “The Healthcare Industrial Complex”.

  Occupied with the responsibilities of daily living, consumers have little time to collect yada data amid the thousands  of pieces of information, frequently contradictory, often incomplete, to select and make sound health care decisions,  while everybody is yelling at us at the same time in a hundred different voices---just watch the never ending  pharmaceutical ads on television. We have to choose a health plan: one that covers what we need to be covered, at  a price we can afford. We ask for something simple. We discover not enough information is on the surface, in the  public domain, and yet we are responsible to evaluate the insurance plans offered once a year, as they subtly change  coverage and price. This is a complex corporate wilderness.  Navigating is like a maze. The reality: nothing is simple--  -nothing will ever be simple.  We do not realize how complex the healthcare industry actually is. We can’t image  what a microcosm the doctor’s office really is today and how it is magnetically attached to everything else. 

  This is not a neighborhood where the individual might have a voice; instead it is a conglomerate where the consumer  is screened and profiled into an algorithm defining treatment plan of care based on running the statistical numbers,  potential outcomes, and the costs involved.  This could be good, a guide for quality care. This could be not good; an  algorithm could be rational to deny care, restrain treatment, prohibit coverage, cause individual bankruptcy.
 The system framework, “group purchased health insurance coverage” is allowing ordinary Americans to put their  monies together in various health contracts thereby allowing each “member” to use their portion, when one becomes  sick or injured to pay for all medical costs to regain health and be restored. Invest, Share, and Share Alike.

  No, that is not the way it works. 

  Examine the chart, (I)“THE HEALTHCARE INDUSTRIAL COMPLEX: TABLE OF ORGANIZATION FOR THE  DELIVERY OF CARE TO A PATIENT AND PATIENT FAMILY/SIGNIFICANT OTHER”. Consider all involved in the  T.O.O.---ALL INVOLVED. Each entity is manufacturing a ‘product’ or providing a service. Do we have the correct  image of the healthcare processes? Aren’t we living in an illusion of the behavior of those involved in this complex?
 Do we have knowledge of how much healthcare actually costs, who gets paid, who doesn’t get paid, who does the  paying, who is making a profit, how much of a profit? What are the realities?

   The illness, availability of coverage, and expense of health care for Steve Jobs and Ted Kennedy demonstrate the  extraordinary demands required to save their lives and provide examples how ordinary Americans have no such  access. It is Senator Ted Kennedy who believed his care must be available to every American citizen and worked in  the Senate to make healthcare legislation to cover all Americans.
   Sharon Begly from “The Daily Beast” reported Steve Jobs had a “modified Whipple Procedure”.  This is a long and  complicated surgery involving the removal of the head of the pancreas, a portion of the stomach and small intestine,  and the gall bladder residing under the liver. Begly states this was done after the failure of a “special diet”, because his  tumor continued to grow. Back in March 2009, Steve Jobs received a liver transplant. Transplant recipients require  serious on going monitoring and medication to prevent organ rejection. All of this and any other treatment Jobs  decided to pursue, on his own, is beyond ‘expensive’, it is the path of a ‘catastrophic illness’. Using current industry  health insurance, Steve Jobs would have reached ‘maximum insurance coverage’ early, even as his treatment helped  him continue to live. Steve Jobs died October 5, 2011.
  As he struggled with the brain cancer consuming his life, Senator Ted Kennedy wrote in TIME MAGAZINE, July  2009, “The Cause Of My Life”: “In 1964, I was flying with several companions to the Massachusetts Democratic  Convention when our small plane crashed and burned short of the runway. My friend and colleague in the Senate,  Birch Bayh, risked his life to pull me from the wreckage. Our pilot, Edwin Zinny, and my administrative assistant, Ed  Moss, didn’t survive. With crushed vertebrae, broken ribs, and collapsed lung, I spent a month in New England Baptist  Hospital in Boston. To prevent paralysis, I was strapped into a bed that immobilizers a patient between two canvas  slings. Nurses would regularly turn me over so my lungs didn’t fill with fluid. I knew the care was expensive, but I  didn’t have to worry about that. I needed the care and I got it. “...quality care shouldn’t depend on your financial  resources, or the type of job you have, or the medical condition you face. Every American should be able to get the  same treatment that the U.S. Senators are entitled to.”

  TODAY: If you don’t have private health insurance,
 If you are not a subscriber to a government or state insurance plan (Medicaid, Medicare)
 If you are not receiving social security or disability insurance,
 If you are not a veteran,
 If you cannot pay cash or have poor credit,
 THEN you can be refused at the Emergency Room door for treatment.