Vic Socotra

01 March 2009

Painfully Fair

(The Patriotic Nurse)

It is Sunday, and the cars are white with snow. Earlier in the season this would be a cause for panic, but the ground is warm enough that only the cold metal of the vehicles gathers the chill enough to show the temporary purity of the white stuff.

The rest is gray, the white melting and mixing gray on the black of the asphalt. The VD (visiting dog) is gone but I started stumbling around early, thinking I had to go take a circuit around the building.

I realized with a start that I didn't, so I curled up with the long-deferred stack of professional and social magazines that arrive with irritating regularity.

It has been long enough since I tried to work on the stack that if people were still paying for advertising it would have been tall enough to bury me if it fell over. The recession is good for something, I suppose, and I picked up the latest issue of the FASEB Journal, which are the chronicles of the Federation of American Societies for Experimental Biology Scientists.

I used to have to sign an oath, annually, I think, that promised I would not conduct medical experiments on anyone other than myself. Now that I am in private life again, I don’t have the time to embark on any interesting clinical trials on my fellow citizens, but I do like to stay current on the literature just in case.

This issue had a bombshell article that explained why hair goes gray. All along, I thought it was stress, and I might be right. But the scientists have clicked on the actual physiology. It appears that a chemical chain reaction causes the hair strands to bleach themselves from the inside out.

It is awesome. The process starts when there is a dip in levels of an enzyme called catalase, which in the normal course of affairs breaks down the body’s naturally-produced hydrogen peroxide. The chemical builds up in the and since other enzymes that would repair the damage are also in short supply, the hair goes gray. It is the same deal with testosterone, which is more depressing a matter than I want to deal with this morning. There are treatments, but they are expensive and could make me want to punch out the pharmacist.

The process of adding hydrogen peroxide to our hair poolside at Big Pink to get that blonde look is actually inevitable. All we have to really do it wait for time to triumph. I assume there will be huge implications in home health care, we being a terminally vain society, which will result in more advertising and thicker magazines, which could collapse and cause injuries to inattentive readers.

That would mean queuing up at the ER, which is a painful process I try to avoid. You have you’re your own scheme for health care, so you know. We all have a scheme, even if we are not covered at all.

The bottom of the barrel, of course, is using the ER for non-emergency purposes, or suffering in silence. You would think this would all be much easier than it is. There are perfectly rational countries that have universal care.

You know how we got into this particular mess, don’t you? The long hand of FDR reaches out from the grave on this one, too. During the Great War Against Fascism, the government imposed wage caps on the work force to prevent the market for labor from soaring into the stratosphere for the workers who had not been drafted. The hand of the market will always find a way around the government, after all.

The way the companies secured advantage in recruiting was to provide ever more elaborate health benefits as a fringe benefit.

Something that never should have contained in the pay envelope thus became inextricably linked. The financial trouble with the Car Companies is in no small part linked to the legacy of the Arsenal of Democracy, since after the good times came back the unions were never going to give up that important fringe once secured.

It is ironic seeing the Democratic Party so committed to universal health care, since it means destroying one of the most significant victories of organized labor. It is easy to understand why, though, since Big Labor is not so big, and the voters without coverage are so much more numerous.

I know a little bit about what is coming, since I have been a participant in a version of universal care for the last thirty-odd years. I could take advantage of the Company health care plan, of course, but when I had the option, offered in “open season” once a year, it was more expensive than I could really afford, what with the circling lawyers.

I had a fall-back in the form of the TriCare health plan. It is available to qualified veterans and their angry ex-spouses at a nominal cost. It is portable, and so long as you are current on the premiums, they can’t take it away from you until you hit 65 and are booted out into the MediCare stack with everyone else.

I am healthy as a horse, anyway, or at least as healthy as an aging racehorse with bad knees. Sometimes the pain from the joints is more than inconvenient, but the peril of the military health care system is that we retirees leverage the infrastructure that exists to serve the active force. Time and conflict being what they are, we don’t compete very well.

I could not get an appointment with the pain management people at the Navy hospital at Bethesda, which is my designated primary health care facility. It only took two runs by the Doc, who is credentialed on the inside, to get a referral to a civilian physician in my own state. It then took about eight weeks to get an actual appointment.

I had to hand it to the Doc: he proved that the system could be forced to work with only a modicum of effort and influence. The civilian doctor checked me out, and recommended three courses of care, short of going the opiate route. I know my limits on that, and while sitting around in a drug-induced haze is appealing enough, I would lose my job in short order and be on the dole.

I trundled over to the Rader Clinic, the Fort Myer medical facility just down the road. It used to have an urgent care facility and real doctors, but those were lost to budget cuts a few years ago. They still have a pharmacy, and I took a number to get the prescriptions filled. The system is a lot like the Department of Motor Vehicles, and I took my place in a room filled with people whose hydrogen peroxide had won the battle with their hair a long time ago.

In only an hour or so I was summoned to one of the windows, where a harried civilian contractor told me briskly that the Defense System did not stock those drugs, and I ought to go the CVS pharmacy and pay for it myself.

This isn’t a problem unique to military medicine. It is the way socialized systems all work. It is that way in Canada, and Britain, and any other country with universal care. You take a number, and the system eventually gives you an answer that may or may not address your needs.

I recall the case of my friend Lee, who died last year. He had an immune condition brought on by exposure to Agent Orange in Vietnam. He had a claim for complete disability with the VA, which fought him over the issue more fiercely than the VC right up the day he died. When his family asked if the Department was satisfied that Lee was really disabled- like REALLY disabled- the Government caseworker agreed, but sadly had to close the case without recourse since he was dead.

See, socialized medicine is a very expensive thing. It costs the US around 16% of GDP, and most of us hate the care we get. In Britain, there was just an uproar about a cancer patient who tried to get an appointment with an oncologist, only to have it cancelled 48 times.

They say that more than a million Britons are on waiting lists for some type of care, with 200,000 in line for longer than six months. In France, the supply of doctors is so limited that the brutal heat-wave of August, 2003 killed nearly 15,000 mostly elderly citizens for lack of care. There are horror stories from Canada and Sweden and every place that has a single-payer universal system just as they are from our patch-work hodge-podge here in the States.

If you have a decent health plan, associated with your employment, or the money to pay for your own, this is a world-class place to be sick. It is awful if you are not, which is why the Progressives are so intent on this issue. It does not seem right that people who can pay should get care, while those who can’t do not.

The deal with socialized medicine is that it is about fairness, or the perception of fairness, not medicine. It is about metering out what is available on a free and equal basis. The Administration plan- one of them, there are many- is to tax your health care plan at the office as ordinary income in the interest of fairness. If there is more demand for the services in the infrastructure associated with increased access, then someone will have to decide how it is allocated. Obviously, that should be in Washington, right?

In my case, I had to call the civilian doctor about my knees and tell him that I had done the cost-benefit analysis of the treatment based on drugs I had to pay for out of pocket. Regretfully, I told him, it appeared a to be a lot cheaper to live with the pain.

Welcome to socialized medicine. I think you will find it to be painfully fair.

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