While this month is the 17th anniversary of the C.A.R.E. Channel and Healing HealthCare Systems, it is also the 17th anniversary of the last best effort to reform a healthcare system that was then declared broken. Although the critics have analyzed Hillary Clinton’s errors in process and have tried to lay singular blame for why nothing happened, the reality is that all debates about economic process in relationship to healthcare are major distractions from the issue of providing healthcare to every man, woman, child, elder, rich and poor, old and young, employed or otherwise.

Personally, I am familiar with the ways distractions disrail debate. Anything to end the discussion in ways that prevent in depth conversation and accountability. That seems to be what is going on right now. I am hopeful, however, that the situation has become dire enough to push through the rhetorical wall. A system that does not provide care, kills. This healthcare system, as it stands, is lethal.

Nonetheless, in the 17 years since Dallas and I dreamed up a way serve patients at the bedside, healthcare has certainly reformed, transformed, moved closer to looking at the patient as a human experience rather than a diagnosis. Far from perfect or consistent, the fact that our work is now serving patients and families in close to 500 hospitals is evidence of this profound change. When we started, it was clear that there was no money, no budget, no understanding of why nature and music were as needed as clean water, clean air. While Florence Nightingale had long ago identified the human needs, her words and policies has been buried beneath progressive science, antibiotics, and what is called “modern medicine.” Nonetheless, we persevered knowing that, as we were told, the challenges for patients are at three in the morning, when the lights are out, the staff is less, when the world is sleeping, and when the patient is most alone.

So, here we are 2009. 17 years later and feeling as driven and passionate and committed as we did in 1992. I have no words to express how grateful I am to have a mission incomplete. I love the work and the work will never be done. I love the people I work with, the hospitals who take on this challenge, and the other missionaries who walk as nurses, physicians, therapists, chaplains, volunteers…who know that serving patients is so much more than treating them.

If there is any truth that can be claimed regarding healthcare and the costs it may be that we can neither afford to have it or not have it. That we cannot afford to pay the current tab on the wages or profits being made by most Americans (not counting the most wealthy whose healthcare will never be dependent on cost).

Yes, we are going through most difficult times for so many, but not all. The insurance and health care issue, however, long predates this recession. It is at least 17 years old and getting older. It is actually as old as the first patient and family that were denied care, were turned away from a hospital or emergency room, and as old as the first infant who died because the mother could not afford prenatal care.

I remain hopeful and grateful and driven and passionate.

The original lyrics come from Pete Seeger’s song…Where have all the flowers gone…etc. At that time, it was about war. However, the same question can be asked regarding health, poverty, and education. When will we all learn that hand washing, preventive care and cleanliness, education are as requisite for good health as poverty and health illiteracy is a threat? During this recent threat from the H1N1 virus, it was not surprising that other countries had more serious outbreaks than those in the US…and that those whose lives are at a subsitence level are as much at risk today as those who lived prior to antibiotics and other medical miracles.

Florence Nightingale asked the same question: When we will ever learn that pauperism (poverty), lack of good hygiene and clean water, toxic air, and lack of good diet is why patients die who would otherwise live?

Barack Obama’s hint to wash our hands and cover our mouths remains so boringly low tech. The push is for vaccines so that we no longer have to wash our hands. My sarcasm may not be appreciated. However, there is more truth in my observation than even I am comfortable with.

Give me anything but don’t tell me to change what I am doing, how I am doing it, or when! This has become the mantra of patients, the profit margin of pharmaceutical companies, and the job description of clinicians: Diagnose and prescribe, but don’t look beyond the symptom. OR, if one looks, still do everything that can be done other than tell the patient what kind of decisions would ensure their best shot at improving their health, if not protecting it.

I am personally invested in healthcare reform. Our company rates for 8 healthy people increased 33% this year. This includes an increase in our deductible by 20%, to $2500.

Monday, the New York Times stated “Signers of the letter (of commitment) said that large amounts could be saved by aggressive efforts to prevent obesity, coordinate care, manage chronic illnesses and curtail unnecessary tests and procedures; by standardizing insurance claim forms; and by increasing the use of information technology, like electronic medical records.” This is a start, but will not help you and I in paying for our insurance or guaranteeing that when and if we really need it, our insurance will cover what we need when we need it. The question, however, is whether we will do our part in staying healthy.

I am not going to enter the debate of whether the players now willing to participate are wolves in sheep’s clothing. Rather, I am going to offer that the healthcare system, as an institution, has created a codependent relationship with all of us, making us feel like we cannot take care of ourselves. There is clearly too much profit in sickness and hardly any in wellness. Too many make too much on the sick, those of us who fear being sick, and those of us who have come to believe that cures are there to forgive our indulgences.

I am not blaming any of us for this. However, as Dr. Leland Kaiser said years ago, if we do not begin to re-frame our healthcare systems to invest in health rather than illness, offering another sickness-based system in any form will be rearranging the chairs on the deck of the Titanic.

When will we ever learn that have had health care rationing ever since doctor’s treated for money, that most vaccines will fail if we fail to use them; that the miracle of the antibiotic died at the age of 40 with the advent of HIV; that the current spread of the H1N1 virus points to the need for us to own our collective health as being all of our business. We live globally if one child in Mexico can get a virus and within days it spreads to many countries.

Florence Nightingale would have told us all to wash our hands, clean our sick homes and offices, and that the best way to deal with illness is prevention. Clearly, how this one young child in Mexico is, so how the world is.

Coming from the Aging in America conference in Las Vegas last month, I am again struck by the good news and other news about how life progresses. The word ‘aging’ is one with mixed meaning: to age may mean become richer, more seasoned, and certainly better over time (such as in wine, in wood, in personhood…). However, in the current western way of looking at it, longevity has a point of diminishing return: we climb the mountain only to have to go down the mountain… We are an ageist culture, valuing youth over age, valuing new over old, valuing innovation over experience. We are also out of balance with ourselves and, as many of have seen, are doomed to repeat a sordid past if we do not balance innovation with knowledge.

I would say to anyone who looks back over history, that we are the first to live this long, to celebrate good health longer and, to create a whole economy around this new stage of life that was never lived before.

At the Aging in American conference last month, I heard Debbie Reynolds speak, saw her dance and sing, heard her stories of youth and marriage(s), declare that aging with only about one word: perseverance. She was beautiful and articulate. She almost fainted…she had had pneumonia only a month earlier. But, she did not. She just said, “Things like that happen.” We all laughed at ourselves, with Debbie, in her descriptions of how life plays out as an older person.

The new issue for me is age related hearing impairment…it is pandemic, it is isolating, it is a major quality-of-life impairment. Yet, even at this amazing conference, there was a certain level of denial about how pervasive the issue is. This is the second conference dealing with aging where I have presented on this specific issue. I feel like I have to build a case for dealing with it each time. The continuing level of shame and embarrassment around wearing a hearing aid and the unwillingness to invest in the technology that can remedy (to a high degree) the challenges remains the great barrier. Remember, we dealt with the presbyopia…loss of nearsighted-ness…with line-free transitional glasses, hiding the obvious. Even if we spend a few thousand dollars on in-ear hearing aids, complete with remote control, this hiding has not really made the grade in how nursing homes, long-term care organizations manage a population whom collectively and individually cannot respond appropriately because they cannot hear. Certainly a topic for another blog…one that will arise over and over.

On my end, I am not waiting until I am old to do anything, nor do I think I will want to do everything when I am old. When I am old, I will wear not only purple…but also, hopefully, will wear my experience and wisdom in ways I could not possibly wear them now. Yes, I will always avoid the persistent graying of my hair; I am starting a separate hearing-aid acct for Dallas and I so we can get the best; I will always wear makeup; I will always want to engage in the present and put the past in perspective. But, most importantly, I will seek to be treated for who I am in the moment, rather than the numerical measure of my age.

Looking into the mirror of the present, I wonder what calls from the future?

I write about vision and what I think about is the challenge we each face in designing our own future as we navigate the challenging and changing waters of time, place, and humanity. I recall in my own life as a musician for 25 years that I was so happy to be working, playing every night, loving my work, that thinking of the future was like looking at a short thread that I was trying not to tangle up. It was like the future was NOW…not something yet to happen… Currently, I am old enough to look back in wonder thinking about how the future grabbed me on its own time and forced me to reinvent how I needed to be. In a way, the worn out saying, “had I known I was going to live this long, I would have taken better care of myself” is now much to real and much too demanding an opportunity.

That we have an economic crisis is hardly a surprise to anyone who read the predictions in recent years that the ‘bubble’ had its own life cycle not at all related to immortality: it would burst. And, I think of the youthful years of assumptions of that same immortality so characteristic of being young, strong, and far too distant from issues of health.

The young college students I speak to today are each future driven. The issues are two: Will they have a job and will they make enough money. Whether they will be happy, have meaningful lives and relationships, be able to authentically show up to a world who needs their creativity and drive…that seldom comes up. I am ever grateful each day that my life has been rich. That the many years I performed as a full time musician transformed into these many years in service to patients and families. I am grateful to have had my own bubble burst when it needed to indicate to me that change was knocking at the door.

Life-threatening illness, a traumatic accident, a sudden death of someone we care about…these are each crossroads in life that demand of us what we think we cannot deliver. And, we are forced to transcend our own paralysis. It is the relentless pull of the future and the push of the present that becomes the trajectory to help us get to another place and time…and renews life.

This is how I see the current situation in the world: the collapse of a present caused by the acountability of to future that demands we be different, that calls us to reevaluate who we are to ourselves and each other. I am ever hopeful and optimistic. Opportunity lurks behind every boulder in our way…. And the mirror into which we are forced to look reflects back the possibility and potential to be seen anew if only we can look deep enough….

If I think about the “noise” around me, it screams, “IT’S THE ECONOMY,THE WAR, AND UNEMPLOYMENT, STUPID!” That is all I am hearing. Although we are doing well, not everyone is and I am catching the anxiety. When I become nervous, I also think about my parents…and what advise they might have given me if they were still here.

First of all, in the face of this economic crisis my Father would have said sarcastically: “Not to worry. We can just print more money!” Interestingly enough, that is exactly what we are doing.

My Mom, however, would have been more detailed in her response and I often think of her. She died in 1983, at the top of her game. She was a futurist for teachers, an activist that moved from her 4th grade school room to the negotiating table of school boards, to ensure not only the rights of teachers, but also the education of children. She was an optimist. She had lived through the depression, through World War II, through my Dad’s struggles with having a wife that worked, through the civil rights movement, through more than I can list here…through so very much. And, she had a good life.

So, I think about what would she say now? My mother was on the first board of the first HMO in Detroit. This is now called HAP. She represented the DFT, Detroit Federation of Teachers. The discussion was always about how to provide care…not how to avoid providing care. It was always about ensuring the best medical care to those who needed it; it was not about providing the most cost-effective care, rationed to the best insured.

So, with the economy in ICU and the Federal government poised to perform CPR (again), I do wonder what my Mom would say. Would she be depressed that healthcare has become an economy rather than a service? She would be
stunned. Would she be upset that education has become expendable? I have no way of knowing how upset she would be, but trust me, she had a broad vocabulary and deep commitment to the classroom teachers and students. She would be well into her late 80’s and might still picket again. Would she give up? Never. And, if we look at this crisis like the Plague, we will know that although there was great loss of life, many survived to birth and
nurture following generations.

What would your Mom say?