Between the Bookends of ‘Living’


President Trump’s latest assault on the Affordable Care Act (ACA) underscores the increasingly divisive tensions associated with our directionless trajectory of healthcare in America. On the heels of Congress’s latest failed attempt to repeal and replace the ACA, the Trump Administration is now taking matters into its own hands in an Executive Branch blunt-instrument-overreach. Its goal is to bypass Congress in an effort to dismantle the current healthcare marketplaces under the ACA. Bipartisan efforts to shore up these marketplaces have sputtered with fits and starts—apparently going nowhere quickly. For the millions of working Americans who are only one emergency away from bankruptcy, the prospect of losing whatever healthcare they can now cobble together has to be excruciatingly unsettling. Nearly all of us know someone who is living with this dysfunctional nightmare.

Meanwhile, as the debate rages on regarding the future of healthcare in the U.S., public policy experts continue their obsessive focus on the facts and data surrounding our health. Most of the discussion centers on things like costs of care, tax implications, care access, healthcare bureaucracy, the pros and cons of competition, over-and-under service utilization metrics, population-based medicine, payment schemes, subsidies, interstate insurance offerings, and downstream federal/state budgetary impacts. And if we’re honest, most of this dialogue comes down to simply ‘following the money’. About the fiscal, profit winners and losers amongst healthcare stakeholders like providers, payers, associations, and governmental entities.

If this weren’t troubling enough, we’re increasingly viewing the healthcare debate as a set of ‘bookends’. In this perverted state of ‘reality’, it’s all about the inputs and the outcomes. About how and where patients enter the healthcare system. Then about the health outcomes and associated costs as the care is delivered and received. When we eventually get around to talking about the patient’s actual experience within the healthcare system, we fixate on technical things such as informed consent, patient records confidentiality, wait times, transparency of communications, right to refuse care, and right to treatment. To be fair, these things do matter because they help to quantify and structure the experience patients actually encounter in the healthcare process. But the technical terminology and jargon only further amplify the lack of humanity in how we deliver healthcare. Furthermore, this all goes on as our country continues to fracture around broader, underlying bookend issues such as how and when life begins and should end. In truth, it’s all quite unhealthy and unspiritual.

What really gets lost, though, is our humanity as participants in our healthcare. And the notion that we, as patients, are the actual reason for healthcare to even exist as a service in the first place. Our dignity as recipients is tossed around like a stack of patient files on an office floor. The working poor are effectively shut out of care by premiums they can’t afford or plans that offer only ‘catastrophic-like’ benefits. And our actual engagement and participation in our own health are undermined by a bureaucratic, mind boggling infrastructure (abetted by a hedonistic consumer/consumption oriented society) that continues to brand itself as an emergency ‘repair shop’ for all the bad stuff that we can possibly do to our bodies everyday. There’s a pill, injection, surgery, treatment regimen, medical device, or hospital for almost anything that ails us. Just turn on the TV and you’ll see. It’s a miracle… Not. Not even close.

What a mess. But here’s a thought: what if we looked at healthcare differently for a change? As a fundamental right to ‘living’. And focused on those things that make life truly livable for us from a health standpoint. With a new, human-centric approach. Then built our healthcare system on this basis. Instead of on the fiscal, political, tax, and other policy foundations that drive healthcare now. What a concept! If we did, we’d be far more concerned with how we can all live together with a far greater quality of health, care, inclusiveness, and dignity. Everyday. Not just when we have an emergency. And with a far higher regard for those currently struggling with the ever-widening gap in healthcare delivery and affordability… for those increasingly left behind to suffer their ‘living’ in silence. For we are only as strong as our most tenuous members of our living society.

Former U.S. Vice President Hubert Humphrey may have said it best:

“The moral test for government is how that government treats those who are at the dawn of life, the children; those who are in the twilight of life, the elderly; and those who are in the shadows of life, the sick, the needy and the handicapped.”

I would add this. It’s not just the moral test for government. It’s a moral test for us all. Each of us. It’s the real human, living test as to whether we’re actually a spiritual, caring people. And not some set of bookends holding a stack of papers or files in place.

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