Sporadic update: Healthcare

Healthcare has been on my mind a lot lately. Over the last couple of months, I’ve had to get surgery. I will likely need another in the next year (then, hopefully, I will be cured knock on wood).  If it weren’t for Obamacare, I wouldn’t have been able to get that surgery. Right now I’d still be in so much pain I can’t walk. In fact, I’d probably need to move back to Taiwan just to have treatment. It would actually be cheaper for me to do that. Wild.

On the metro today, I went through my usual list of podcasts to entertain myself on the hour long commute to DC.  In between the news and the pop science, an interview with Naomi Klein came up. She’d be invited by W.  Kamau Bell and Hari Kondabolu to appear on their show “Politically Re-Active” which blends comedy, news and cultural analysis. Klein, who gained acclaim for her book “The Shock Doctrine” (though perhaps that’s disingenuous as I believe she was well known before), joined to speak about her new book:  No is Not Enough.

During the interview, she spoke at length about the new shocks we might endure, about how they signal systemic failings and about how we must respond. In the coming days, weeks, months even, god forbid, years we will need to mobilize and respond a lot. We will be saying “No” a lot, but “no” has less motivational power than “yes”, Klein says. No can exhaust you, especially when the red of Nos are drowned out by the stacks of green Yeses. Moreover, Klein says ‘No’ is not enough. We need to identify Yes policies; we need to prepare for them.

The Healthcare bill, which spread like a noxious gas through Capitol Hill, has inspired in me more than dread.  It’s made me curious about what a solution could look like. I feel inspired to better explore my own Yes, and others.

For the duration of my time in DC, I am being housed by a friend’s family.  This morning I heard his father, a doctor, lament what he referred to as changes in the medical system. When I asked him how he might design the ideal healthcare system he did not bring up single-payer or privatization or any of the typical words.  Instead, he said “Education”.

He had noticed a shift in culture within the medical world of his thirty years of practice. “I was trained to believe my duty was to the patient,” he said. “Younger people are trained to worship at the altar” of reducing costs regardless of how it affects the person they are helping. That means prescribing the cheapest medication, regardless of side effect. That means not questioning a CEO “pocketing 22 million” at the expense of broad healthcare coverage.

Not just that, but the average adult lacks basic knowledge of healthcare systems, according to the doctor. They cannot identify what constitutes an injury needing urgent care; they put off visiting and a problem which might have been inexpensive to treat weeks before now incurs high costs to the system and, more importantly, the patient.

After thirty years, this shift has been wearing him down. He’s considering a career change. “Do you know I have to give out dozens of denials a week?” he asked me. “It’s tiring.” Saying No to people who need care, but cannot access it so a wealthier tier can purchase another car, another watch, another thing weighs heavy on his mind.

He’s not sure what Yes looks like for him personally now, but he believes it starts with education and a fundamental shift in the culture. They’re good people, these new doctors, he added at the end. They’ve just been trained wrong.

Yes feels good when it’s identified, but can also be daunting. Klein spoke of how daunting, and a little scary, it was to speak aloud what she’d, and a group of other women, been formulating in their minds. Yes can be risky– not least because you can’t know the effects of a hypothetical completely, but also others might circumscribe your ideas or punish you for having them.

Klein has spent years thinking about and developing her Yeses, and I think she’s worth listening to. As for me, like the doctor, my Yes is guided by my ethics. I can identify pieces of a system which includes intersectionality,  but as for the specifics? Well, I have some work to do. Let’s hope some day I’m brave enough to articulate them aloud with the force of Naomi Klein.

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