I am always caught between a glass door and one that is swinging. I say that in regards to writing about our healthcare system. This weekend, in a family discussion, my brother commented on the inevitability of the health insurance gridlock of medical records, forms, and formats, being replaced by a single repository…which, he went on to say, would be the natural outcome of the powers at be realizing the cost for continuing to do it the way we are doing it. If only I could trust this perspective. I say this because most of us have long known that the cost to physicians and hospitals for mere administration of insurance documents eats of 50% of the healthcare dollar. Nonetheless, the present system has survived all of us knowing the cost.

The other part of this conversation is that when illness hits, whether a broken leg or a maligancy, whether an automobile accident or an aging parent, none of us want to have to worry about whether our insurance company will actually pay for the care that is needed. We just don’t want to have to think about it…at all. The fact that the first words that come are “May I have your Insurance card?” or “Do you have insurance?” That may be exaggerated…especially if a patient is not conscious… The variation is to ask these questions of the family. if you have other variations…that all makes this story more difficult to tell.

Going further into our very chronically ill healthcare system, HIPAA has itself added a layer of complexity totally unintended. I spoke at Harvard last month for the 16th HIPAA Summit and Privacy Symposium. What is clear to me now is that HIPAA is part of our culture more than part of our operations. That the barriers it created are both sophisticated and unintended, honored and used. I say “used” as discussions regarding the difficulty a remote adult child has in getting information about their parent were met with “Yes,” it is a problem and “No,” it is sometimes an excuse to not have to deal with the family on the phone in the middle of understaffed, overworked emergency department operations. This is not my opinion. This is what was reported to me by those wanting to offer some explanation as to why this is happening.

So, what do we do about this? Well, according to Jennifer James, as I wrote a couple of months ago, nothing…since we are so addicted to American exceptionalism we will not learn or take direction from other countries whose systems have worked through some of our mess. According to both Barack Obama and John McCain, the problem is money…and only a problem of the poor. John Edwards had a plan that I really thought would work…and we all know what has happened to his ability to influence the national debate.

I am a healthcare voter…and, for what I see that needs to happen..meaning total universal access to medical services, health services, to a healthy life… no one has come up with a plan that will inevitably include all of us. Our policy…for HHS employees… increased almost 30% this year, and our high deductible increased by 25%. Dallas and I now will pay over $14,000/yr in premiums, plus $5000 in deductible prior to the insurance company paying one penny, a total of $21,000K, not including any services not covered by insurance, like dental, vision, ???

The push for rights for pain management and palliative care is at the crux of the healthcare dilemma. Do each of us have a right to be cared for regardless of any of the factors that now clearly separate us into the deserviing and un-deserving? Does the well regulated water we drink (and that has long been held as a community resource, controlled and regulated) add up to being of greater value and need than the care needed by a child, mother, grandmother, father, husband, …??

As I write this, the questions continue and the answers bypass the patient in the bed, the veteran in pain and angst whose benefits have just run out, the elder whose choice is between medication and food, the parent whose choice is between caring for their infant or working.

This is my rant…what is yours?