The Untold Story of America's Health Care Crisis (Harper-Collins, via AlterNet)

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The Untold Story of America's Health Care Crisis

By Jonathan Cohn, Harper Collins Publishers, Inc.. Posted May 29, 2007.



The U.S. has not had a serious political discussion about health care reform since the early 1990s, and the system is unraveling. In his latest book, Sick, Jonathan Cohn lays bare the consequences any one of us could suffer if we don't replace it.

The following is an excerpt from Jonathan Cohn's latest book Sick: The Untold Story of America's Health Care Crisis -- and the People Who Pay the Price.

April 10, 2007 -- It was 4:43 on a clear November afternoon when the paramedics found Cynthia Kline, pale and short of breath, slumped against a bedpost in her double-decker Cambridge home. Although Kline was in obvious pain, she seemed keenly aware of what was happening inside her 55-year-old body. One of her blood vessels had closed off, blocking the flow of blood to her heart. Minutes before, she had phoned 911, taken the nitroglycerin tablets prescribed for such an emergency, then waited for help to arrive -- an ordeal that stretched out an agonizing extra few seconds while the rescue workers, having found the front door locked, scampered in through an open second-story window. Now, while the paramedics worked busily over her, noting vital signs consistent with cardiac distress, Kline turned to one of them with an anxious plea: "Take me to Mount Auburn Hospital."

Kline, a teacher who worked with special-needs children, had no formal medical training. Yet her instinct about where to go was as sound as a seasoned cardiologist's. Nearby Mount Auburn Hospital, a private teaching facility affiliated with Harvard Medical School, had some of the city's finest doctors and nurses. More important, it had an intensive cardiac care unit that specialized in cases like hers. A few days earlier, staff at Mount Auburn had treated Kline's advanced coronary disease by inserting a balloon into her circulatory system and then expanding it, in order to open up a partially blocked blood vessel. A variant on the very same procedure, "cardiac catheterization," could be used in an emergency like this one, when the flow of blood through a vessel was almost completely cut off. Cardiac catheterization had saved literally thousands of lives across the country.

The procedure had the potential to save Kline's life, too, just as soon as she could get to the hospital and receive it. But getting there was precisely the problem. On the way to Kline's home, the ambulance driver had checked with a dispatcher about hospital availability. Mount Auburn was no-go: the emergency room there was overflowing, with no space to handle new patients. So as the paramedics wheeled Kline into the ambulance, one of them told her they would have to deny her request: "Ma'am, we're going to Cambridge Hospital instead." Kline accepted the news, and maybe for a moment she thought it would be for the best. Although Mount Auburn was less than two miles away, Cambridge Hospital was even closer -- just a short trip through the crooked, disjointed streets that surround Harvard Square. It was also a highly regarded medical facility in its own right, with a top-notch medical staff and a recently renovated emergency area fully capable of handling the majority of trauma cases that came its way. Had Kline's condition remained as it was, it probably could have handled her case, too. But just four blocks into the journey, Kline's condition suddenly deteriorated. The instruments tethered to her arm could no longer detect a blood pressure; her heart rate, seventy beats per minute just moments before, was down to thirty-eight. Kline, strapped into a stretcher, was conscious through all of this-and increasingly agitated. At her side one of the paramedics, a kind-looking thirty-year-old, tried to calm her, explaining that the hospital was just seconds away. But as the ambulance made a right turn around one final corner, bringing the tall redbrick facade of Cambridge Hospital into view, Kline began to cry out: "I'm going to die. I'm going to die."

...(snip)...

It's a system of public and private insurance programs, supplemented by private charity, that dates back to the late 1920s-the time, not coincidentally, when medical care first became so expensive that large numbers of Americans literally could not afford to get sick. And it's a system that has survived for as long as it has because, by the late twentieth century, it had financed a massive industry dedicated to medical care while putting its services within reach of the majority of Americans. As critics have repeatedly noted, these arrangements have never met everybody's needs; the poor, in particular, have frequently struggled to find medical care either through doctors or through safety-net hospitals. But the U.S. health care system has generally worked well enough -- or, more precisely, it has worked well for enough people -- to withstand efforts at redesigning it.

Probably never was this more conspicuous than in the early 1990s, when President Bill Clinton proposed his now infamous reform plan. Under Clinton's proposal, the government would have made certain everybody had insurance coverage and, along the way, refashioned the whole health care industry -- doing for Americans what the Canadian, Japanese, and western European governments have long done for their citizens. But Clinton's gambit failed. And while many critics would later blame its demise on either Clinton himself or the special interests that fought him, a more crucial impediment to reform may have been public ambivalence. Most Americans, after all, still had health insurance in the early 1990s and rather liked it the way it was. When they needed medical care, they got it. To these people, the possibility of losing insurance and the consequences that might follow just didn't seem real enough to warrant such a sweeping overhaul -- particularly if it would be at the hands of the government, an institution few people believed was capable of such a massive and complicated undertaking. "I've got pretty good health care and 80 percent of the country has pretty good health care," said one caller on a CNN show in August 1994, summing up a national mood that had turned decidedly against comprehensive reform. "Why are we doing the wholesale changes?" And yet if Americans truly believed they had rejected radical change with Clinton's health care plan, they were in for a surprise. The arrangements for financing medical care, from the private insurance workers got on the job to the public insurance programs that provided for retirees, were already faltering, because they could neither control nor keep up with the rising cost of medical care. The strain was building not just on emergency rooms, but also on charity clinics and public hospitals. Sooner or later, something was going to give. .....(more)

The complete piece is at: http://www.alternet.org/healthwellness/52448/?page=1