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Tom Baxter

After court speaks, troubling problems remain in U.S. health care

By Tom Baxter

Later, we called him Dr. Margarita.

He was the admitting doctor at the rehab center where they took my brother after his Medicare days ran out at the hospital. Standing bedside on his one room visit in the few days we were there, he cautioned my sister-in-law that no one could tell how long “this” was going to take.

“So you ought to drive down to the beach, get one of those cabanas, order a margarita, and just kick back,” he told her.

We just stood there. My sister-in-law didn’t speak up and say she wasn’t the kind of woman who would leave her husband in the final stages of COPD and go to the beach. She was already battered from weeks of outrages. One exchange back at the hospital had been so bruising that when the doctor left the room, the old black man in the other bed leaned over and said, “If I could get out of this bed, I would have knocked the s**t out of him.” So the depth of Dr. Margarita’s callousness didn’t really sink in at first.

All I could think of was what someone had said, that your hearing was the last faculty to go before you died. I looked down at my brother wondering if he could hear what was being said. My brother had not spoken since they knocked him out on Haldol at the hospital.

Dr. Margarita had briefly seemed an improvement over the care my brother got at the hospital. Looking over the charts while he was being admitted, Dr. Margarita commented to my sister-in-law that his Haldol dosage was triple what it should have been, and cut it back. But as my brother showed more signs of alertness over the next day or so, he began to shake like a junkie coming off dope, and a nurse told me you weren’t supposed to take someone down from a high dosage that quickly.

If I were ever going to say anything directly to Dr. Margarita, that was my last chance. I spent a terrible Friday afternoon after that, desperately trying to get a nurse to reach him at another facility and call in some stronger kind of painkiller as my brother’s spasms started coming by the minute. He refused the request and went home. The nurses finagled some changes in the medication that had a calming effect over the night. My brother died the next evening, a year ago last month.

You can read volumes of analysis about how we are separated by gender or race or social class. But I would submit there may be nothing which separates Americans more than whether or not they’ve met Dr. Margarita.

If you’re fortunate enough to be close to a teaching hospital, as U.S. Rep. Gabrielle Giffords was when she was shot in the head, you might be able to say with legitimate conviction that this is the best health care system in the world. If you live in a big city, have good health insurance, no complicated illnesses in your family and do meticulous research before having any major procedure performed on you, you might be prone to agree.

But if you have met Dr. Margarita – if you’re one of the millions of Americans who don’t have access to the best health care and must make do with the impersonal, confusing, and ineffective system in which Dr. Margarita is one little cog – you wouldn’t say that. You might still be opposed to ObamaCare and the U.S. Supreme Court decision upholding it, but it’s not because you think we’ve got the best system in the world. It’s because you’re afraid it could be worse.

If you’re for ObamaCare and you applauded the decision, your response is also shaped by the encounters you’ve had with the health care system. If they’ve been largely positive, you might dare to hope that a more comprehensive approach, smarter administration and more fairness will fix everything.

But if you’ve met Dr. Margarita, you must understand that ObamaCare is only a halting first step, that if all of it worked like a charm, troubling problems in the U.S. healthcare delivery system would still remain unaddressed. You might even worry, like your conservative cousins, that it could make things even worse.

The vast hospital-rehab center-nursing home complex through which most Americans will pass is already a quasi-governmental system. Or rather, it’s a private system designed to extract the maximum amount of money from the government Medicare and Medicaid programs, and most of that in the last weeks of a citizen’s life.

The term “rehab center” is particularly sardonic. Because they are called that, rehab centers are required to attempt to get people like my brother, or my father after he had a stroke, up and moving around. But in reality, rehab centers are the places where the system gets the last 20 days of Medicare coverage. If you’re not dead by then, you go to a nursing home to empty out the family savings, after which, if you’re still alive, you qualify for Medicaid.

In a nation where the average family’s net worth has dropped to $70,000, these transfers of wealth – the government paying health care providers for a citizen’s terminal care – must now be the largest transactions being conducted on a regular basis in this country.

Within this system there are brilliant doctors, like the one who operated on my wife not long ago, caring nurses, like those at both the hospital and the rehab center who broke the rules to help my brother, sharp-eyed therapists who catch things you wouldn’t. But all too often, they work for somebody like Dr. Margarita. They are good people caught up in a system they can’t change, without a greater collective will to make real changes.

Now that the court has ruled, there will be one more hellacious political fight over ObamaCare. The passions are clearly evident. Within hours of the ruling, one Facebook friend who opposes the administration’s health care plan had posted a picture of Hitler, while another who favors it wrote the words to the first two stanzas of “My Country ‘Tis of Thee.”

But when all that debate is over, there will still be an urgent need to address the problems neither supporters of ObamaCare nor its critics are talking about much these days. Unless you want Dr. Margarita standing over your bed in your final hours, time is running short to begin that conversation.

Tom Baxter

Tom Baxter has written about politics and the South for more than four decades. He was national editor and chief political correspondent at the Atlanta Journal-Constitution, and later edited The Southern Political Report, an online publication, for four years. Tom was the consultant for the 2008 election night coverage sponsored jointly by Current TV, Digg and Twitter, and a 2011 fellow at the Robert J. Dole Institute of Politics at the University of Kansas. He has written about the impact of Georgia’s and Alabama's immigration laws in reports for the Center for American Progress. Tom and his wife, Lili, have three adult children and seven grandchildren.


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