Is Our High-Tech Health Care System Better Than War-Ravaged Sudan's?
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Four men were carrying someone down the road in a bed.
I had encountered some strange things in southern Sudan -- seen malnourished children; nearly stepped on a large snake the color of pinkly opalescent milk -- but nothing more compelling than this.
What impressed me as I struggled to catch up, was the speed at which they were moving, each man carrying a leg of the bed, which was constructed of rough-cut wood and a lattice of rope. I could see its occupant was a woman. The little procession walked with fierce determination, despite the sweltering heat and the mud.
Akon is a market town and a county seat in South Sudan, and this was the main road, but the rains had turned the red clay into a sea of braided puddles.
Finally they stopped and I was able to meet with them. I learned that the woman lived in an outlying village. Her husband and brother-in-law and other members of her extended family had carried her like that for two hours to get to a clinic here in Akon that consisted of a big shade tree and a meager stash of medicines -- on the chance that someone could save her.
She was gaunt and feverish, suffering from abdominal pains. She told her story in Dinka and someone translated. She'd gone into labor, and after two days of contractions, the traditional midwife had determined that the birth canal was too narrow, and had cut the baby up and withdrawn the pieces.
I wondered if something was left in her uterus or maybe she'd been cut. They looked to me hopefully. Lacking any medical training, I felt helpless. But I sent for my Dinka colleague, Chris Koor Garang, a "Lost Boy" who had become a U.S. citizen and a certified nurse. He'd brought medicines with him. Chris gave the woman an oral antibiotic and instructions for taking the remaining doses.
This was her sixth pregnancy; all had ended badly. The pills, condoms, and other birth control options that we take for granted in the industrial world were not available to her. Nor were the anti-diarrheal medications and routine vaccinations that save infant lives. South Sudan, torn by decades of colonialism and decades of war, has an estimated sixty percent infant mortality rate, about the highest in the world. Maternal mortality is also high: one in ten women dies giving birth.
Miraculously, this woman lived.
Now fast-forward two years, to last March. I was visiting my son in Vermont -- which was fortunate, because when I experienced stomach pain and nausea, I could get to a local ER, and then be taken by ambulance to one of New England's top-notch hospitals. There I underwent emergency removal of eighteen inches of small intestine that had become twisted and gangrenous.
I was lucky. Had I been traveling in South Sudan, we might have assumed I had some parasite. I never would have made it to an airport for transport to Nairobi in time for surgery. I wouldn't be alive to write these words.
As I lay in the Intensive Care Unit, emerging from a five-day medically induced coma, attached to various life-support systems -- attended by a bevy of surgeons, anesthesiologists, pulmonologists, radiologists, and nurses -- I experienced a string of hallucinations. When my mind was finally clear, one image kept surfacing.
It was that woman being carried down the road in the bed.
We were fortunate, each in our own way. She had become for me an emblem of survival.
Our beds could not have been more different. Mine contained computer-driven air-pouches that pulsed in a manner designed to preserve muscle tone and prevent bedsores. It weighed probably 800 pounds.
Was I grateful for the technology that saved my own life?
But my point in recounting theses two stories is not to contrast a failed or non-existent healthcare delivery system with a successful one. On the contrary, that woman and I both represent failed systems. They've simply failed in different ways -- the one from poverty, the other from profits.
My own treatment was commodified, under the dictates of U.S. hyper-capitalism, to an extent that comparable treatment under socialized medicine is not. The total price for my surgery and related expenses came to $144,000, or eight thousand dollars per inch of intestine removed.
Fortunately my expenses were covered -- under Medicare, supplemented by the excellent private healthcare insurance my wife gets as a retired University of Connecticut professor. Our private plan is almost as good as that enjoyed by members of Congress. I was out hardly a dime.
My son in Vermont has no such coverage. He works as a chef in a small restaurant and is one of the estimated 47 million uninsured Americans. Like most, he’s in debt. Too young for Medicare, and struggling to make ends meet, he lost his private healthcare coverage last June by failing to make a monthly payment on time.
Others among our fellow citizens are denied coverage by private insurers because they are sick. Cancer, diabetes, or heart conditions make them "poor risks" for profit-driven companies. Still others have coverage tied to their employment, marital status, parents, or tuition payments. And finally, others are too poor to do more than put food on the table.
In other words, it's a completely insane system that makes sense only to those who reap profits from it.
Is this any less bizarre than that woman being carried down the road to a clinic that barely exists?
In short, it seems that we in the U.S. have shaped our technology, or allowed it to shape us, into a system which at its very essence is less humane than one ravaged by colonialism and war.
This is why a "public option" must be central to any healthcare reform. It offers an alternative for the uninsured, while serving as a yardstick to measure the performance of a private healthcare industry notorious for its greed and runaway costs.
This public option is precisely what Republicans and conservative Democrats want to strip from the reform package. Republican Senator Charles E. Grassley argues that a government-run plan "will ultimately force private insurers out of business," and that its supporters are "trying to open a back door toward a fully government-run, or single-payer, health system like those in Canada or England." Even as polls indicate that most Americans favor a public option, the Senate shows itself a rich man’s club whose members are all too indebted to the healthcare industry.
Two statistics are often quoted by President Obama in arguing the case for healthcare reform. One is that Americans pay one and a half times as much as citizens of other industrial nations, and have a lower life expectancy. The other: our spending on healthcare accounts for one sixth of our national economy.
However, neither statistic adequately reflects what we do not spend individually because we can't afford it -- the inequity that translates into life or death for millions of Americans who, like my son, might not feel they had the luxury of going to the hospital.
In my own mind, the image of that woman being carried down the road in such a determined fashion, despite the mud and heat, has taken on special meaning in the context of the present debate. It was the urgency that surrounded her. We could learn from that. We who may carelessly assume that our own system is somehow more "civilized," simply because our resources are more abundant and our technology more sophisticated, need to rediscover our collective caring -- to understand access to healthcare as a basic human right.