Sunday, March 22, 2009

My Brush with "Universal" Health Care

A number of people have wondered why Natasha Richardson died of an injury (a slow epidural hemorrhage ) that is relatively easy to treat if caught in time.

I am struck by several other curious facts. It took 2 1/2 hours to drive the stricken actress to the nearest trauma center, in Montreal. Drive? What happened to the medical helicopters I so often see flying overhead here in Oregon, WI? And why did they have to go to a city of several million inhabitants to find a trauma center? I also notice that as part of her treatment she was then flown to New York City. (Hat-tip to Bill Anderson and David Kramer for these facts.) Why did part of her care involve being hustled out of the country in a coma?

Let me tell you another story, from my own experience. It happened two years ago, and I haven't written or even talked much about it because it is upsetting and I didn't want to violate the privacy of certain people. But this morning, thinking about Richardsons's untimely and possibly completely unnecessary death, it seems like a story that I should tell.

I was in Genoa, Italy, staying over after a conference to visit some academic friends. I visited one friend, Flavio Baroncelli, in the hospital, in the company of another (call her Laura). (Laura was formerly a student of Flavio's.) He had been suffering from cancer for years. I am very glad I went there to, in effect, say goodbye to him, but the visit was deeply disturbing in all sorts of ways. Though he was dying they had stuck him in a small, bare, cramped room, and with a roommate. The roommate made it abundantly clear that he resented our presence as Laura and I talked to Flavio and his wife. He kept frowning and rattling his newspaper as he turned the pages. I got the impression he really wished Flavio would die quietly and alone.

Flavio's mental condition was if anything more frightful that his physical state. Though he had suffered month after month of terrible, chronic pain, the doctors still refused to give him morphine. His wonderful mind, battered by this unceasing torment, was a wraithlike shadow of its former self. He had been writing a book about his hospital ordeal on his laptop (I think it would have been his fourth book), but had given it up for lack of ability to concentrate. Chronic pain debilitates the mind, as bleeding wounds do the body. As he sat on the edge of his bed, telling us the the tangled tale of his struggle with his illness, his anguish was palpable. Laura was in tears.

A few years earlier, he had gone to a special clinic in Arkansas. At first I thought I had mis-heard him but, yes, Arkansas has a clinic that is a world leader in treating the sort of cancer he supposedly had. When he went there, though, the American specialists found that his Italian doctors had mis-identified his cancer. It wasn't the sort that they treat so well there. But at least he did manage to write a book about his American trip, a meditation on the US slipping into its neocon madness under Bush II.

To get away from the roommate, we gathered Flavio's IV bottle and I helped him down the hall to a sitting room with rows of hard chairs. The whole facility was bare, ugly and devoid of ornamentation of any sort. It reminded me of jails and state mental hospitals I had visited back in the states. Someone had bashed a hole in the wall in the sitting room for no obvious reason, and no one had bothered to patch it up. Opposite us was an enormous window, apparently without drapes, facing the Mediterranean Sea. The glare of the sun on the water was burning a hole in my brain. In this Hellish place, even the life-giving sun was transformed into a torment.

All this while I kept remembering visits I had recently made to another friend in a hospital, one who had the good fortune to be sick in the United States. Her circumstances where similar to Flavio's -- a professor at a pretty good university with a life-threatening condition (in her case it was a stroke that left her severely brain-damaged) -- but her medical system by comparison treated her like she was royalty. Ensconced in a private room furnished lavishly with medical equipment, in a hospital that was carpeted and decorated like a hotel, she had plenty of medication (twelve prescriptions at one time) and all the care she needed -- above all, she never had to travel to another country, or even leave her mid-sized town, for any part of her treatment.

What really shocked me about the treatment my Italian friend got was the cruelty of failing to properly treat his pain. Laura later explained it to me as the result of a typically Italian attitude. Children who break a leg don't get pain-killers either. "It's a broken leg! It's supposed to hurt!" That, she said, is the attitude their doctors seem to have.

That may well be the attitude, but I suspect that it is an effect and not a cause. As is explained here, in a socialized system, like Italy or Canada, capital goods such as equipment and materials -- morphine, machines such as you find in a trauma center, helicopters -- have a different property status than they do in a private system. In the US, where you are allowed to charge people for using them, they are a source of income. In a socialized system, where you have to pay for them out of your budget but cannot charge anyone else, they are a pure cost. Hence such systems tend to be undercapitalized.* They'll give you morphine, but only when they absolutely have to. A few days after I left, they finally let Flavio have morphine. He died about three weeks later, mercifully out of pain at last.

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* Since the private system merely allows you to charge for use and does not require it, you will have the capital good on hand and available for charitable use, whereas in a pure socialized system the consumer will at times not be able to get it for love nor money. By the way, if you would like to make a brief visit to the World of the Politically Insane, take a look at the WHO ranking of health care systems, which was published around the time I visited Flavio. It ranks the Italian system second in the entire world. That of the US is 37th, two steps above that of Cuba.
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