Stateside with Rosalea: Maltese Blue

There was welcome relief this week from the steady stream of US, Israeli and Palestinian ambulances that have populated TV's local and international news since September 11. Un-PC as the Maltese Cross (late of Jerusalem and Rhodes, and now based in Rome) may be, it was sweet to see a St John's ambulance whizzing away from Auckland airport midweek in the news items here about the San Francisco-bound flight that turned back after hitting clear-air turbulence.

If I took ill in the city where I now live, the ambulance would have the fire department's insignia and a fire engine would come along for good measure. So I've been told by someone who had just exactly that happen to her, and I don't believe she dialed 911 because of a spontaneous combustion problem. It's just the way things are. Along with entire BART stations being painted purple to encourage people pester their doctor for a particular purple pill, and relentless advertising by pharmaceutical companies imploring viewers, readers and listeners to insist on a free trial of one of their products.

It is the golden age for pharmaceutical companies, what with all the baby boomers hearing their knees creak when they bend, and waking up in the middle of the night to go potty more often than they used to, to say nothing of experiencing hot flashes and an ever-present feeling of impending doom. One particularly insidious commercial even goes so far as to second guess the naysayers like me by baldly stating that a certain set of symptoms is not just the natural consequence of ageing but the sign of a medical problem for which their product is the cure.

You need to understand I'm not talking about over-the-counter drugs here.These are prescription drugs, and no doubt the pharmaceutical companies time their ad campaigns to coincide with distribution of free samples to physicians. Softening up both sides of the health equation doubles the chances that their product will get used, either at the request of the patient or the insistence of the doctor for whom a ready-to-go pack of a month's supply of anti-depressant means no prescription-writing and is the equivalent of handing out a burger at a drive-through.

I know this because at the end of last year, just when the commercials for such a drug had returned to the screen (modified to take advantage of the very real sense of unease people had about the possibility of more 911-style terrorism), I went to the doctor for my yearly check-up. I had made the appointment three months earlier but just before Christmas was the earliest I could get in for the longer time it takes to do a check-up. I turned up for my appointment at the clinic where my health insurance is valid, and waited in the crowded waiting room for the practice nurse to call my name, weigh me, and put me in an examination room. Where I waited again. A long time. The room was hot. The air was stuffy.

The doctor walked in. She wasn't the one I saw last year, who had since thought better of being part of a system that reduces doctors to the equivalent of a biscuit packer on a conveyer belt. She asked why I was there, and when I said I'd come for my annual check-up she said she couldn't possibly do that because I'd been given only the usual short appointment. "Anything in particular worrying you?" she asked, as I wrung my hands in frustration at the clinic's incompetence. "I feel stressed," I said for want of a better word - or two of them, actually, as in "pissed off". "Yes, you look it," she said brightly, and then debated out loud with herself which of the two free samples of anti-depressants she would give me. Having decided on the one that didn't have the weight-gain side effect, she left the room and came back 10 minutes later - probably seeing another patient in that time - with the free sample of the anti-depressants that DID have the weight-gain side effect. Naturally I threw the drugs away - not because of the likely weight-gain, but because I knew I was righteously stressed and could righteously get myself un-stressed without the help of drug pushers.

Maybe I'm with the wrong health plan. But it occurs to me that for all the money my employer and I have put into health insurance over the past two years I could have taken leave without pay, flown to Wellington to see my old GP for a half-hour (or more) check-up, stopped over in the most expensive hotel suite in town, and still not be out of pocket, even at a dollar for dollar exchange rate. Sure it cost me only $10 for an appointment, but you call that an appointment?

There is something seriously wrong with the healthcare system in the United States, and that something's name is 'greed'. Listen to this from a representative of Blue Cross insurance who appeared with other healthcare professionals on a televised "town hall meeting" last March. When asked what one thing he would spend money on to improve health care he replied that he'd put the money into a public service campaign to tell the rich uninsured that they should be in the system. His buddy out in the audience concurred - getting more people insured would solve the problems.

In a sense they are right. For insurance to work efficiently the risk needs to be spread among as many people as possible, and all the people who opt out of getting that insurance, but still need to use the services of healthcare professionals and institutions, are bludgers who push the premiums up for the people who do pay. The poor, the old, and the disabled have federal or state-funded insurance plans like Medicare and Medicaid to act as their safety net - if they know how to enrol in them. The people who don't qualify for such aid but who don't earn enough to pay the premiums being pushed up by the "uninsured rich" are the people who suffer the most.

That's market forces for you, I suppose. When Clinton tried to implement his healthcare plan during his first term as president - a plan founded on the concepts of universal coverage, managed competition among healthcare providers, an employer mandate to provide insurance coverage, and health alliances between small businesses and individual consumers so they could negotiate for high-quality healthcare at an affordable price - it was shot down in flames.

In his 1995 speech accepting the Paul White Award at the Radio Television News Directors Association awards, ABC news anchor Peter Jennings had this to say of the role of the media at that time: "On policy issues we sometimes show a need to anoint or condemn. Prior to President Clinton's election we did story after story on how messed up health care in the country was. Once he proposed his plan, we turned around and did stories on how change would do us so much harm, egged on, I might add, by the widest imaginable array of lobbyists."

Now that's something to get cross about.

Lea Barker
California
Sunday, 5 May 2002

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