Crowdfunding As Socialized Healthcare

Charity, ostensibly a central moral and social American institution, is alive and flourishing–online, on crowdfunding sites, as thousands and thousands of perfect strangers and sometimes acquaintances and friends and family, line up to donate to the latest plea for help. (Perhaps someone needs a vital organ transplant, extended chemotherapy and radiation, or a new, life-saving alternative therapy; or perhaps, like most Americans, they went into a hospital hoping to emerge healthier, and instead, found themselves facing a foreclosure-inducing medical bill.) As Bloomberg reports in an article unironically titled ‘America’s Healthcare Crisis Is a Gold Mine For Crowdfunding–later changed to ‘American Health Care Tragedies Are Taking Over Crowdfunding’:

Crowdfunding platforms such as GoFundMe and YouCaring have turned sympathy for Americans drowning in medical expenses into a cottage industry….Business is already booming, and its leaders expect the rapid growth to continue no matter what happens on the Hill. “Whether it’s Obamacare or Trumpcare, the weight of health-care costs on consumers will only increase,” said Dan Saper, chief executive officer of YouCaring. “It will drive more people to try and figure out how to pay health-care needs, and crowdfunding is in its early days as a way to help those people.”

Indeed:

Growth has been rapid….one million campaigns set up over the previous year had raised $1 billion from nearly 12 million donors. By February 2016, the total was $2 billion. In October 2016, it was $3 billion, from 25 million donors….GoFundMe had indicated that $930 million of the $2 billion raised in the period the study analyzed was from medical campaigns….medical fundraisers made up 70 percent of GiveForward’s campaigns. The combined companies have 8 million donors who have contributed $800 million to a wide range of campaigns. A big part…was donated to medical campaigns…It was approaching 50 percent of all fundraisers at YouCaring before the acquisition, and the growth rate is set to triple this year.

Indeed, no matter what the flavor of the current healthcare system, it will not take care of most Americans, and neither will it do anything to drive down the rising costs of healthcare. Short of progressive taxation, a national single-payer system, and extensive structural reform to bring the American healthcare system into line with the ‘best practices’–both financial and clinical–of the best national healthcare systems in the world, Americans look destined to continue pay the highest rates for healthcare in the world, while receiving outcomes that can be described, at best, as ‘mediocre.’ In these conditions, the success of crowdfunding campaigns is entirely unexpected and unsurprising; ‘look to private resources’ is the fairly explicit message of the current healthcare system, and it is there that Americans have turned. ‘Private resources’ are normally taken to mean financial support from family; Americans seem to have found a much larger family of sorts; a blessing of a kind, one supposes.

But mostly, reactions to this state of affairs can hardly afford to be sanguine. Such methods of paying for healthcare costs suffer from too much contingency; some campaigns succeed, yet others fail. Perhaps your pitch was not ‘moving’ enough; perhaps you did not include the right pictures of cute families; perhaps potential donors were financially exhausted. The health of the citizens of any country, let alone one with pretensions to greatness, should not be riven by so much uncertainty, so much dependence on the unpredictable largesse of others.

The Plain, ‘Popular’ Speaking Of Bernie Sanders And Jeremy Corbyn

One of the highlights of the recent Bernie Sanders and Jeremy Corbyn campaigns–one, a failed attempt to secure the nomination to become the Democratic Party’s presidential candidate, and the other a comparatively successful attempt by the Labour Party to derail the Tories in the United Kingdom–has been their plain speaking. Both Sanders and Corbyn relied on straightforward ‘messaging’; they spoke unapologetically about their political views and vision; they did not back down from supposedly ‘can’t-win’ electoral platforms; they did not waffle about or ‘triangulate. Wonder of wonders, they seemed perfectly cognizant of the fact that they would face political opposition, but that did not deter them from continuing to discuss and defend, in unvarnished terms, the democratic socialist and populist ‘agenda’ that was the centerpiece of their claim to become President or Prime Minister. If asked ‘Are you really saying that X?’–where X might be ‘taxing the rich’ or ‘supporting the Palestinian cause’ or ‘socialized healthcare’–the Sanders or Corbyn response, quite typically, was, “Why yes, that’s exactly what I meant, and here’s why.” (In sporting terms, Sanders and Corbyn decided to swing for the fences–rather than sitting on them. Perhaps they would lose; but they would only lose an election, not their integrity. They appeared prepared to pay that price.)

This plain-speaking, this directness, this unapologetic standing by and behind their political convictions, a rare species of political fearlessness, did not go unnoticed. Both Sanders and Corbyn attracted many young folk disenchanted–or just plain bored–by politics; they attracted many older folks turned off by the endlessly vacillating, weaselly language of conventional politics. By keeping their platforms simple, Sanders and Corbyn were not just comprehensible, they also managed to be inspiring. Years and years of being subjected to the inanity and indirection of political discourse has produced a diverse electorate that yearns for plain speaking and a kind of transparent, even if occasionally bumbling, sincerity. Sanders and Corbyn both ‘delivered’; neither are inspiring speakers; their prose is not lofty; they do not appear to have taken classes in oratory or rhetoric; but importantly, they did not appear ‘coached’ and bland and inoffensive either. They knew they would cause offense; they accepted such a cost as part of the price of doing politics, of trying to get a certain kind of message out and about. They also knew the rhetorical value of their manner of speaking.

It will remain an enduring scandal that the Democratic Party in the US could not quite see the wisdom of such plain speaking during the 2016 election season, and instead decided to throw its weight behind a candidate who could not bring herself to drop a language that appeared too cautious, too timid, too ready to compromise. Neither could the Labour Party in the United Kingdom; many of its members and leaders attacked Corbyn relentlessly in the lead-up to the election. In the US, we are left saddled with the dysfunctional presidency of Donald Trump; in the United Kingdom, a second election to resolve the uncertainty created by the unstable Tory-DUP coalition seems quite likely. One can only wonder what the political landscape would look like today if these candidates had not been sabotaged by their own parties.

There are lessons to be learned here; the politician who makes the effort to do so knows an attentive audience–and participants in political action–awaits.

The United Kingdom Sends Political Driving Directions To The US

Democracy’s biggest problem–without exaggeration–is the contempt politicians feel for those who elect them. The electors, the people, the voters; the heart of electoral democracies. One crystalline manifestation of this attitude occurs during those events that are designed to remind us, by their periodic occurrence, that we live in electoral democracies: elections. Then, the people’s opinions are presumed and assumed–under the guise of ‘interpreting’ their ‘responses’ to ‘surveys and ‘polls,’ all infected with their own methodological biases. They are treated as generic entities, their preferences and passions turned into quantitative assessments that terminate in gnomic pronouncements like, ‘Candidate X is unelectable.’  Or, even worse, much worse, the electors’ minds will be read, and similar presumptions and assumptions are made; these are ignorant and ahistorical and made from isolated and insular positions, infected with their ideological biases, and they result in identical assessments: ‘Candidate X can never win; his or her platform is unworkable and out of step.’ Management consultants and political experts rule the roost, while those who actually wield power–if only they knew it–are systematically ignored.

The disastrous consequences of this attitude were only too clearly on display in the 2016 US elections. The Democratic Party ran a disastrous campaign from start to finish; it ran a candidate deeply unpopular with huge swathes of the electorate; it undermined a candidate who had actually brought ‘new blood’ to the party, and embodied the best chance of maintaining and sustaining a voter coalition that had put a black man with a Muslim middle name into the Oval Office in consecutive elections; it refused to believe that a populist platform that actively sought to roll back economic inequality, which had mobilized millions of new voters, was ‘practical’ or ‘viable.’ The Democratic Party paid for its hubris; but even worse, so did we.

Across the pond, the British electorate have just shown the Democratic Party the errors of its ways. The Labour Party, led by Jeremy Corbyn, laid out an uncompromisingly populist, democratic socialist platform; they did not attempt triangulation or limp centrism; they spoke to clearly expressed needs; they, in short, listened to their potential voters, they articulated a clear vision, unapologetically; and wonder of wonders, miracle of miracles, they succeeded at the ballot box, disrupting a supposedly global triumph of rightwing populism. The Tory Party lives on, as does the Theresa May administration, but only just; a no-confidence vote in their hastily cobbled together coalition with the DUP is almost certain.

The Democratic Party, of course, very closely resembles a death cult these days, obsessed with a relentless drive towards rendering itself both irrelevant and politically extinct; the election for the chair of the DNC revealed this quite clearly, as does its refusal to put the Clintons behind it, and pay attention the clamoring voices of the millions of voters it stands to gain if only it would give them what they want: affordable, single-payer healthcare, housing and education for all, clean drinking water and air, a chance for their children to do better than their parents did before them. It should heed the political driving instructions conveyed to it by the British electorate: stop pulling right, turn left.

The Doctor And The Silenced Patient

In Confessions of a Medicine Man: An Essay in Popular Philosophy (MIT Press, Cambridge, MA, 2000, pp. 109-110) Alfred I. Tauber writes:

Health care providers have to listen, respond, and generally account for the subjective experience of a patient’s complaint. So much of our discontent can be traced to the too little time the physician spends with a client, and how poorly a true dialogue develops. Focusing upon the clinical narrative, the patient’s rendition of the disease experience offers crucial insight to the physician, both as scientist and empathetic, that is, ethical, healer. Beyond obtaining information that may be important in tending to the patient’s particular physical needs, a patient’s own description of the illness presents the physician with the problem of suffering, and the profound disruption, uncertainty, and pain that disease imposes. To ignore this aspect of illness is to deny the patient’s fundamental humanity and relegate them to the status of object.

In an older post titled Taylorism and the Doctor’s Office I had complained about the slavish devotion to efficiency and throughput maximization visible in the work of the physician; an important component of the dissatisfaction I felt then, one not fully articulated, was that my physicians, my healers, were simply not listening to me:

The patient, meanwhile, many of his questions unanswered, his possible inputs to the diagnostic process ignored, returns home, disquieted by the experience, disillusioned by the wonders of face-to-face contact with a fellow human being, and supposedly a healer at that.

This is a real frustration with serious consequences. As a patient, I have a great deal to tell my doctor about my personal experience of the illness: this is how it feels on the ‘inside’; this is how it affects the way I move, the way I relate to my body; these are the kinds of things I want to do and cannot do; this is how I now see myself in relation to the world and my body. I see these as important inputs into the healing process; I see them as descriptions of my dis-ease, a tabulation of the ways in which I am no longer whole and long to put back together again. My illness is not just a set of physical markers; it is an impairment of my being in this world, and I am best placed to report on a very particular aspect of that fractured relationship.

Because I consider myself a good observer, and a good reporter, I come to each doctor’s visit with a sense of anticipation: I will place these reports and descriptions at the service of my doctor, and he will combine them with his expert physiological, medical, and scientific knowledge to produce the optimum healing package. Together, doctor and patient, interacting with each other, will move to a new co-anchored state of being: the doctor becomes a better doctor by healing, by having his skills honed on this new ‘challenge’; I will return to good health.

But my doctor has no time for such niceties; he cannot be bothered to listen to his partner; he cannot wait to hear the ‘other side’ of the story; he is only concerned with test parameters, visible observations, and quick slotting into categories (and the submission of an insurance claim for payment.) To listen to a patient will interfere with the most efficient ‘best practice,’ the one recommended by the management consultant group in charge of his clinic or hospital.

The patient’s experience of the illness falls by the wayside; it is the least important part of the modern ‘healing’ process. And with that assessment, the patient becomes just as marginal, ready to be objectified.

Ben Jonson on Doctors

A few weeks ago, I had made note here of a brief excerpt from Molière’s Love’s the Best Doctor, which rather pungently satirized doctors. Today, here is another master of comedy–Ben Jonson–on doctors. (A personal reminiscence follows.) As an added bonus there is some skepticism directed at the cost of medicine, the products of the pharmaceutical industry, and the legal system. (Sort of.)

From Volpone, Act One:

CORBACCIO: How does your patron?

MOSCA: Troth, as he did sir; no amends

CORBACCIO [deaf]: What? Mends he?

MOSCA: [shouting]: No, sir. He is rather worse.

CORBACCIO: That’s well. Where is he?

MOSCA: Upon his couch, sir, newly fall’n asleep.

CORBACCIO: Does he sleep well?

MOSCA: No wink, sir, all this night.  Nor yesterday, but slumbers.

CORBACCIO: Good! He should take

Some counsel of physicians. I have brought him

An opiate here, from mine own doctor –

MOSCA: He will not hear of drugs.

CORBACCIO: Why? I myself

Stood by while ‘t was made, saw all th’ ingredients,

And know it cannot but most gently work.

My life for his, ’tis but to make him sleep.

VOLPONE: [aside]: Ay, his last sleep, if he would take it.

MOSCA: He has no faith in physic.

CORBACCIO: Say you, say you?

MOSCA: He has no faith in physic: he does think

Most of your doctors are the greatest danger,

And worse disease t’ escape. I often have

Heard him protest that your physician

Should never be his heir.

CORBACCIO: Not I his heir?

MOSCA: Not your physician, sir.

CORBACCIO: O, no, no, no,

I do not mean it.

MOSCA: No, sir, nor their fees.

He cannot brook; he says they flay a man

Before they kill him.

CORBACCIO: Right, I do conceive you.

MOSCA: And then, they do it by experiment,

For which the law not only doth absolve ’em

But gives them great reward; as he is loath

To hire his death so.

CORBACCIO: It is true, they kill

With as much license as a judge.

MOSCA: Nay, more;

For he but kills, sir, where the law condemns,

And these can kill him too.

Possibly irrelevant aside: In my time here in the US, I have been misdiagnosed precisely twice. These occasions still remain the only two such instances in my life thus far. In the first case, I was living in Harlem and sought treatment at a doctor’s office that promised walk-in consultations. A brusque, cursory check-up later, I was presented with a diagnosis that seemed wildly off-base. Despite my protestations, I was quickly shown the door. Shaken at this treatment, I made an appointment with an Upper West Side physician who was on the money. In the second case, I was living in Fort Greene, Brooklyn, and desperate to secure a doctor’s appointment quickly, wandered over to Myrtle Avenue and sauntered into a rather dingy looking clinic. I was only a few blocks away from the considerably more well-heeled DeKalb Avenue. The doctor conducted a rushed examination, pronounced his diagnosis, and once again, I was ushered out the door quickly. I was diagnosed correctly a week or so later after I had sought a second opinion.  The common element to these encounters was that in each case I was seeking medical help in what might be termed a ‘not-so-fortunate’ neighborhood.

Excerpt from: Ben Jonson, Three Comedies, Penguin Classics, London, 1985. (ed. Michael Jamieson) pp. 60-61

Molière on the Modern Healthcare System

There are times, when overcome by irritation at our modern medical system, which is expensive, run by insurance companies and all too often, populated by doctors who seemingly aspire to ever greater heights of corporate efficiency even as they resolutely neglect their bedside manners and care little about outcomes while ordering an array of expensive and unnecessary diagnostic tests, I descend into bitterness, muttering dark imprecations about how far the two professions that I admired as a child–journalism and medicine–have fallen.

At moments like those it is best to comfort oneself with a little Molière on doctors; he seems to have anticipated the modern, insurance-company run medical system too.

From Love’s the Best Doctor, Scene Two:

LISETTE. What do you want with four doctors, master? Isn’t one enough to kill the girl off?

SGANARELLE. Be quiet. Four opinions are better than one.

LISETTE. Can’t your daughter be allowed to die without the help of all those fellows?

SGANARELLE. You don’t mean to suggest that doctors do people in?

LISETTE. Of course they do. I knew a man who used to maintain that you should never say such and such a person perished of a fever or pleurisy but that he died of four doctors and two apothecaries.

SGANARELLE. Be quiet! We mustn’t offend these gentlemen.

LISETTE. Upon my word, master, our cat fell from the housetop into the street a while back and yet he got better. He ate nothing for three days and never moved a muscle. It was lucky for him that there aren’t any cat doctors or they would have soon finished him off. They would have purged him and bled him and –

SGANARELLE. Oh, be quiet, I tell you! I never heard such nonsense. Here they come.

LISETTE. Now you will be well edified. They will tell you in Latin that there is nothing wrong with the girl.

Enter DOCTORS TOMÉS, DES-FONANDRÉS, MACROTIN, BAHYS

….

DR. TOMÉS. Well, while we are talking, what is your opinion of the controversy between Dr. Théopraste and Dr. Artimius? It seems to be dividing the whole faculty into opposing camps.

DR. DES-FONANDRÉS. I’m on Artimius’ side.

DR. TOMÉS. Yes, so am I. Of course his treatment, we know, killed the patient, and Théopraste’s ideas might have saved him, but Théopraste was in the wrong all the same. He shouldn’t have disputed the diagnosis of a senior colleague. Don’t you think so?

DR. DES-FONANDRÉS. No doubt about it! Stick to professional etiquette whatever happens.

DR. TOMÉS. Yes, I’m all for rules – except between friends. Only the other day three of us were called in for consultation with a man outside the faculty. I held up the whole business. I wouldn’t allow anyone to give an opinion at all unless things were done professionally. Of course the people of the house had to do what they could in the meantime, and the patient went from bad to worse, but I wouldn’t give way. The patient died bravely in the course of the argument.

DR. DES-FONANDRÉS. It’s a very good thing to teach people how to behave and make them aware of their ignorance.

DR. TOMÉS. When a man’s dead he’s dead and that’s all it amounts to, but a point of etiquette neglected may seriously prejudice the welfare of the entire medical profession.

Hail to the Mighty Nurse

When I was a mere nine years old, I underwent a tonsillectomy, a minor operation that surprisingly enough, in those days, required general anesthesia. My mother spent as much time as she could with me in the hospital, but my constant companions otherwise were the military hospital’s nurses. I might not have been a teenager, but I was still, mysteriously enough, old enough to develop crushes on many of the nurses who did the rounds and attended to my many needs. They wore impossibly starchy uniforms, as befitting those serving in the armed forces; they were prim and proper; they were firm, kind and efficient. I wasn’t sorry to say goodbye to the hospital ward but I did feel more than just the passing pang on waving goodbye to my merry band of temperature-taking, brow-stroking, bedsheet-smoothing caretakers.

Some thirty-five years on, nurses don’t cease to impress. My daughter’s entry into this world was most proximally brought about by the deft handiwork of an obstetric surgeon, but it was considerably and significantly facilitated by a hardworking and attentive group of nurses. From initial admission to prep work to recovery, a nurse was always there, providing expert, experienced care, offering words of advice, caution, and sometimes gentle reprimand too.

My wife and I spent two nights in a maternity ward after the birth of our daughter, and from the time we entered its rooms to the time we left, we were in the care of its nursing staff. I described my anticipation of my firstborn as a mixture of excitement and terror, and the most active factor in the mitigation of that terror was the maternity ward nurse. I always expected fatherhood to involve a great deal of on the job training; I didn’t realize that my first and most visibly accomplished teachers would be a group of nurses.

They knew how to handle newborns with just the right mix of firmness and gentleness; they were champion swaddlers and they knew how to teach its moves to an utter novice like me (I still haven’t mastered the really, really snug wrap, but I’m getting there, keeping their finished product as an aspirational goal); they knew how to change diapers with ease and minimal fuss (and they expertly shepherded me through my first diaper change disaster too); they were, in all the important ways, my hand-holders through my first trepidatious steps through the valley of fathering.

After we left the hospital to return home (but possibly even before) I wondered about how many families the experienced nurses had seen entering their wards with their newborns in tow, how many lives they had kicked off, how many anxious parents’ queries they had answered, how many anxieties they had smoothed over, how many bumblers they had turned into quasi-competents, able to approach the task of rearing a child with just a little confidence.

The world of medicine has often not taken adequate care of these indispensable components of the medical system; doctors have often not acknowledged how their work would be impossible without their assistance; and more than one reformer of the medical system has sought to underwrite their vision via a diminution of their role. They are often invisible, unacknowledged, and unappreciated. Be nice to one the next time you see one or need one.

Note: Support nurses unionizing!