"Growing old is like being increasingly penalized for a crime you haven't committed."
Anthony Powell

Along with a passionate need for Nike running shoes and those inescapable ads for four-wheel drive vehicles that promise glowing vistas from insurmountable mesas, we have come to think of our health as merely another obstacle to be overcome. And overcome it we will, it is the unkept promise of modern medicine and government.

A bankrupting promise, unobtainable on the face of it. Nations committed to such foolishness have reached for the goals of ultimate health before and watched them founder on the shoals of financial and economic reality, high tide leaving behind an unpayable debt to future generations.

Access to health care has always been unequally divided among those who can pay and those who can't. Yet we demand cat-scans for everyone, a lifetime of dialysis for all and damn the expense. The misunderstood logic of democratic equality shudders at inequity, but inequality is as founding a force in this nation as the right to free speech.

The right to die without institutional and governmental intervention is being fiercely argued in the courts and with eminent logic, it is those who wish their lives not to be unnecessarily prolonged, who ask that right. And why? Could it be that we have perverted access to that death that once came in the company of family and and the recognizable comfort of our own beds? I must digress for a moment, because I see in this digression the foundations of our guilt, the long road that has brought us to unrealistic expectation.

The history of human culture until a time within the past fifty years, saw family and tribal continuity, sometimes three generations under one roof. The old sickened and grew weak among their family, in most cases dying in an upstairs bedroom and grandchildren coming to know in this communal event, the thread of lives connected to their own and the ultimate reality of the cycle of life and death. No more. Families are scattered, the elderly are shuttled off to nursing homes, visited occasionally and smiled at with one eye on our watches and the press of more necessary schedules. Ill health among our elderly is an embarrassment, an inconvenience and their days are filled with the steady march of mealtimes and wheelchairs. There is guilt in this and fear as well. Guilt in our impatience and fear that one day we as well will sit and count the endless hours, without so much as a glimpse from our own bedroom window, institutionalized and packed away out of sight.

We compensate for this guilt and fear by demanding every medical possibility, framing our sense of lost conscience in what is best for Dad, what only makes sense for Mom. Guilt and fear are compensated by everything that can be done and the result is lonely people, attached to machines and detached from family, dying by inches in endless days with tubes in their arms. Small wonder they have gone to court. We have been made ashamed to die, embarrassed at sickness, comparing ourselves at every moment with the youthful perfection of advertisement. It won't wash. Guaranteed health care must have limits and we must face those limits.

I would propose that we provide free, state-funded clinics to all who require medical help, be it prenatal care, defensive medicine or emergency services. Without need-testing. All who walk in would be served, the indigent as well as those with means. There's too much bookwork in separating one from the other and the wealthy will always seek private assurances. Above this level, private insurance is available to those who would cover every contingency and can afford to do so. Such clinics might be fashioned after the McDonalds model; clean, efficient, recognizable and offering a standard of performance that takes advantage of every opportunity for cost saving and marketing promotion.

Don't laugh, stay with me on this, at least in concept. McDonalds provides sustenance, agreeable to a huge percentage of the population and its cost base resists deviation from the norm. Those who prefer and can afford fine restaurants are not prevented from them by the existence of McDonalds, yet even they, in a pinch can pull in and get a tasteful simple meal. Our medical providers could learn some excellent lessons from this fast-food chain, dominant throughout the world.

Additionally, I would do away with any system of public insurance. It is a needless and prohibitively expensive middle-man process that adds another layer of profit to a cost already out of control. The same with malpractice insurance within free clinics. The costs of cover-your-ass unnecessary testing would decline and medicine would make choices in the interest of patients rather than lawyers.

Last, I would take advantage of every possibility the system offers in the way of medical technicians under the supervision of doctors. We have the capacity to cross-reference diagnosis infinitely by computer.

Acknowledging the fact that death comes to us all as debilitating illness does to some of us and by admitting that equality of medical access between the rich and poor is not possible, we can extensively improve access to sound basic medical services.

Get out of the Archives and read what Jim's writing today