Monday, December 21, 2009

The Cure

The picture? The window of a tanning salon in France, 2004. The subject of the day? Medical care, medical insurance, reform, cures, old age.

There has been massive talk of 'health care reform' for months. It has mostly been about insurance and not so much about care. Except that to pretend pay for insuring more people they are planning to slash reimbursements for things like Medicare home health. Which will allegedly make the deliverers of this care more efficient. Only it may drive them out of business, drive the elderly into homes and put the people employed by these services out of work. But maybe they'll have insurance. Each little bit of legislation has its consequences. It's a messy machine of moving parts.

I'm unsure what Nebraska has been given to insure one Senator's vote, but I'm pretty sure health care is different in every state but shouldn't be legislated that way.

After almost two months of Dad's latest health crisis I have some opinions about the delivery of health care and Medicare. I think the doctors have done a pretty good job saving Dad's life. The quality of his life is compromised by side effects and old age. But he has come back miraculously to the point of doing a pretty good job of chores, cooking breakfast, reheating other meals. He even worked some laundry although he wanted me to fold. Everyone, though, comes to their job in his recovery from a different angle. Some nurses see a shift at the hospital as a series of chores...start an IV, find another nurse to verify starting a blood unit, etc. Some nurses see a patient and try to anticipate what things they can do to move the patient toward a better outcome. Some doctors edged away from a patient threatening to die despite their best efforts. Others stood up with the patient and hard choices. Everyone involved asked what drugs he took a thousand times. Some nurses would condescend one minute (acting like you knew nothing about the patient or health) and expect the family to perform nursing duties perfectly the next. Home health from Medicare was helpful to a point. The occupational therapy evaluation was unnecessary but by the book. The bathing assistance was very helpful. The home health nurse covered the same ground over and over (by the book). Honestly, my dad is now capable of living alone with intermittent assistance. If the paper boy would put the paper on the porch and someone brought food and supplies occasionally and did a few chores that hurt his back, he would survive between times to be driven to appointments. For now.

What will the 'reform' wending its way through Congress bring for us? Will some of Dad's providers quit seeing Medicare patients? Will home health disappear sending him into a facility should there be another crisis? Will my high deductible insurance that we currently just use to wangle lower prices from providers disappear? Or cost lots more?

I don't know any of these answers. But I do know three things. There is no cure for old age and death will come for all of us. And, for now, my dad is perfectly capable of soldiering on...with a little extra help, not a lot. And this health care reform might get more people insurance but the care they receive? It won't be reformed by this legislation except due to unintended consequences.

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