NURSE JEREMY RESPONDS TO WASHINGTON POST LETTER OF 8/23/09

Attacking Dr. Jain's premise hardly changes the truth about healthcare in America. American Insurance do far more to 'ration care' or deny care as it is, than worrying about long wait times. I had nurses not give my dying grandfather pain medicine to keep him comfortable. So my mom and her sisters, and my grandma had to watch him die in pain over several days. I had to take care of a patient who was brain dead for days, but the family was stupid, uniformed, and wanted everything done, (didn't want him to be a tissue or organ donor either).

Comparing Canadian healthcare with American is a mistake for several reasons. The most obvious is the huge difference in population between the countries. over 300,000,000 to 35,000,000. Why would you even expect their resources to rival ours? I know plenty of Canadians who are satisfied with their healthcare. To say something like that about getting an MRI being harder for a person than a dog is patently false. Canadian's don't have nearly the high rate of heart disease that fat sedentary Americans do, so why would they need the same amount of access? Access to a cath lab means you need close access to open heart surgeons, if they aren't at the same hospital. These statistics don't impress me, and I find them to be misleading to the uninformed. I have seen and taken care of plenty of open heart patients who shouldn't of had the surgery, but did because someone paid for it. They had poor outcomes because of their co morbidities, and lifestyle choices, but as long as the surgeon gets paid, he'll operate on any bedridden stroke victim with dementia, and tell the family or the legal P.O.A, whatever the case may be, the operation will improve the patient's quality of life. Same goes for interventional cardiologists, putting stents into people, stents that hardly work. I had an old saint with 15 stents!!! If he fell and started bleeding he would die, since he is on 3 anticoagulants. Don't pat yourself on the back because you think we have better technology than Canada. Canada will catch up with us soon enough. We will almost never catch up with Dubai's technology. I am thinking of going overseas to be a nurse actually. A billion dollars? Not much actually, since we are spending over 18% of our GDP on healthcare.

The UK's population is much denser than ours, so again a direct comparison is not that relevant. And I know English people and nurses who worked in the UK. Most people are still satisfied with the level of care given. But I have nurses from India, not believing the level of care they see here. (It's very poor) They give better care in India.

So great, you got your letter published, but America seriously needs healthcare reform. And I am so sick of Republicans, saying no to everything and not even wanting to reform health care. Only 2 or 3 Republicans in Congress (representatives not Senators) have shown any unction for introducing legislation on healthcare reform. Members of Congress have received millions from the healthcare lobby to not reform anything. If a public option does not come out of the healthcare bills being debated in Congress, it will only get worse. Republican senators and pundits are quoting their facts and figures from an insurance think tank group. It disgusts me.

You seem to be focusing on the wrong issue here. I don't care what comparisons Dr. Jain makes if it makes a difference.


Jeremy B., RN, BSN

REPLY FROM JC LEAHY


Woah! Jeremy! Take a deep breath! I feel your passion! I admire you for that! I'm really sorry about your grandfather's death.

I'm sensing that you're pretty down on the health care in America. I respectfully disagree with a lot of what you've said. You made a number of different points, though, so let me attempt to summarize:

Point 1:
American health care sucks big-time compared to Dubai and India.

Point 2:
Plenty of Canadians and Britons are happy with their health care; therefore, you imply, health care in Canada and Britain must be okay.

Point 3:
It is actually easier for Canadians to get MRI's for themselves than for their dogs.

Point 4:
Although you are quick to compare American health care with Dubai and India, I must not compare Canadian or British health care with American because Canada is smaller and Britian is denser.

Point 5:
Republicans just say "no" to everything and don't have any proposals for reform. They get their facts from an insurance think tank. They're disgusting.

Point 6:
Whether a newspaper article is true or untrue does not matter so long as it facilitates "change."

I'm double-checking your e-mail, Jeremy. I believe those are your major points. So let me take them one at a time. Here goes!

POINT 1:
AMERICAN HEALTH CARE SUCKS BIG TIME

You didn't sign your last name to your e-mail, Jeremy -- but aren't you the Jeremy who worked with me in Cardiac Critical Care at Washington Hospital Center? When folks came to our hospital with chest pain plus either EKG changes or cardiac enzyme elevations, how long did it take them to get a cardiac cath and any needed angioplasty and stents? Same day? Next morning at the latest if they presented in the afternoon? How does it get any better than that? Even when folks came to outlying, rural hospitals, how long did it take those hospitals to perform diagnostic caths and helicopter the patient to us for treatment as needed? Same day? Same day, Jeremy!! How in the world does it get any better than that?!! Have you ever worked on Dr. Sugarbaker's gastrointestinal cancer surgical unit? Have you seen the miracles they perform there? How does it get any better than that?!!! Do you know what on the 5th floor of WHC, Jeremy? It's the extra-high-class hospital rooms for all the rich folks who fly in from all over the world to cured by the American health care system!! Honestly, Jeremy! Give me a break!!! American health care is the final resort of the sick people of the whole world!!!

POINT 2:
CANADIANS AND BRITONS LIKE THEIR HEALTH CARE SO IT MUST BE OKAY

I have a good story to tell about this, but in the interest of brevity, I'll save it for another day. Here's the basic deal. Only about 2% of people are acutely sick. 98% aren't. No, I didn't make those numbers up. Based on the US experience, that 2% of the population consumes 41% of all health care expenditures, and 10% consumes 72% of health care expenditures. The point is that sick folks are really expensive to cure. I know this firsthand because 3 years ago I had an 80% chance of dying and it cost about $80,000 for me to pull back from the drain hole.. Sick folks are very expensive to cure. Your average healthy person, on the other hand, can be satisfied with relatively little -- perhaps an annual checkup and a free pair of eyeglasses, for example. Relatively speaking, healthy people are just a whole lot cheaper to satisfy. So --- forgive me, I'm going to be cynically frank here --- faced with a need to "buy" votes, the prudent politician will allocate resources towards pleasing the healthy 98% of the population at the expense of curing the sick. ( I didn't just make that up by the way. There's a whole school of study called "public choice theory" aimed at predicting how politicians will act. To read a good summary of public choice theory, see chapter 21 of Lives at Risk, Goodman, Musgrave, et al.) When you place health care expenditures in the hands of politicians, they become political just as sure as the night is dark. I'm sure you must understand that, Jeremy. That is why Britons have no difficulty visiting their personal physician, or getting a free health club memberships -- but can't get renal dialysis to save their lives, literally. It's sad, but most Britons are happy with this. Canadians likewise. For cultural reasons and because of familiarity with the Internet, I think American consumers are a little more sophisticated than that, and less docile. Hence, the current uproar over President Obama's health care proposals.




POINT 3
IT'S ACTUALLY EASIER FOR CANADIANS TO OBTAIN MRI'S FOR THEMSELVES THAN FOR THEIR DOGS

No, Jeremy, I didn't just make up the part about MRI's in Canada being easier to get for pets than for people. Goodman, Musgrave & Herrick point out that, "While Canadian pet owners can purchase an MRI scan for their cat or dog, purchasing a scan for themselves is illegal." ( Lives at Risk, page 16.) We also know that in Canada there are only 2.5 MRI units per million people -- which is pretty darn few even compared to Britain. Here are some links to Canadian newspaper articles about pet care in Canada that you might want to read.


http://www.angelfire.com/pa/sergeman/issues/healthcare/pets.html



Canadians can simply buy an MRI scan for their dog. For themselves, however, it's pretty darn hard to get one -- except by driving into the US where they can purchase a full body scan in some shopping malls and many outpatient centers for around $1,000.


POINT 4:
WE MUST NOT COMPARE CANADIAN OR BRITISH HEALTH CARE WITH AMERICAN BECAUSE CANADA IS SMALLER AND BRITAIN IS DENSER.

Well, we really need to evaluate and compare findings to be able to draw conclusions and learn. We must learn!! If there are differences between countries, we must seek a way to adjust for those differences to make comparisons more valid. For example, when we say that Canada ranks dead-last in availability of medical technology among developed nations, we take the different population sizes into account by counting the number of MRI units per million Canadians and per million Americans. The number of lithotripsy units per million Canadians (0.2) and per million Americans (1.5). Or the number of CT scanners per million Canadians (6.5) and per million Americans (13.6). Really, though, those comparisons don't tell the whole picture. We should also note that a great proportion of medical equipment in Canada is severely outdated. This includes 63% of general x-ray equipment and half of all diagnostic imaging equipment.

Point 5:
REPUBLICANS JUST SAY "NO" TO EVERYTHING AND DON'T HAVE ANY PROPOSALS FOR REFORM. THEY GET THEIR FACTS FROM AN INSURANCE THINK TANK. THEY'RE DISGUSTING.

Let's do try to not rant on about "Republicans" or "Democrats", shall we? Health care financing is way, way too important for that. It's important because, obviously, our health is at stake. Some of our lives are at stake, too. Additionally, it's important for a less obvious reason: We may very well be traveling on what Hayek, in his seminal tome, called "the road to serfdom." I personally believe we are, in fact, speeding along on that road, and if we are, we had better discover it pronto. Otherwise, we shall find ourselves to be plantation workers in a big system designed to benefit drug companies, insurance companies, big labor unions, doctors, hospital operators, bureaucrats, and career politicians -- at the expense of us little people, who will slave away to pay for it all. So let's you and I be allies in a quest for change, Jeremy. Okay?

By the way, one little correction of fact: Republicans do have proposals for change. Here are links to 3 bills introduced during 2009. You don't hear much about them in the press.

Putting Patients First Act:
http://rsc.tomprice.house.gov/Solutions/EmpoweringPatientsFirstAct.htm

Patients Choice Act of 2009:
Summary: http://www.house.gov/ryan/PCA/PCAsummary15p.pdf
Full Text: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h2520ih.txt.pdf

The Health Care Freedom Plan
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:s1324is.txt.pdf


Point 6:
WHETHER A NEWSPAPER ARTICLE IS TRUE OR UNTRUE DOES NOT MATTER SO LONG AS IT FACILITATES "CHANGE."

This sounds like the old "ends justifies the means" argument. I thought we put that argument to rest at Nuremberg. The problem here is that the wrong kind of "change" would be catastrophic. Continuing along the road towards a Canadian/British-style single-payer system looks like the wrong kind of change.. And so, President Obama's health care plan looks like a really bad idea that needs to be just scrapped, now. NOW, NOW, NOW!!!

If all you want is an annual checkup and a free pair of eyeglasses, I'm sorry, I don't want to be part of that system. You and I and all of us need to get interested and get together at a grassroots level to find a better way without the advice of our Republican or Democrat politicians. Then we can tell them what we want. They will only listen if WE tell THEM what we want, loud and clear!!!!

So let's talk. Sign up to "follow" this web site. And/or leave a "comment" on the here on the site. And/or e-mail me at jcleahy@jaitoday.com

JC Leahy
RN, BSN, MA, ACLS
"100 Most Extraordinary Nurses" Award, Washington, DC