My mother had simple remedies for all my troubles. “Eat,” she would say. “I fixa da chicka soup to make you good. If you don eat you gonna die. I kill you if I see you wid dat Americano junky food. You eat da soup and go sleep. Domani you feel gooda, ma-sure.”
Midwest wind could cause fatalities. Did I want to get sick and die? All I had to do was work up a sweat and take it outside into a cool evening breeze. A cool evening breeze brushing against bare shoulders caused colds. Minnesota winters caused pneumonia. Ma-sure.
All pills, prescriptions, and medicines were suspect, taken only as a last resort–when chicken soup, fruits, dandelion greens, nuts, tap water, and a steady stream of pasta failed.
My mother died at 89 of mesothelioma, a cancer that results when asbestos secretes its vileness into the lungs. My father died just weeks short of 99, from a heart attack. His heart checked out fine just a few months earlier when he began a regime of anti-arthritis pills, a new wonder drug later proven to cause heart attacks. To the very end my parents insisted on chicken soup, fruits, dandelion greens, nuts, tap water, a steady stream of pasta, and, in my father’s case, lots of beans and an occasional dose of prune juice.
Good genes, we hear ourselves saying, as if to confirm our dread that even good things can’t be helped.
I grew up confused and careless about cause and effect, and I’m still as confused about them as I am about why some marriages work. When I get sick I see remedies stabbing at ills lurking in the dark. The ills often stab back. As both sides stab they retreat, regroup, and rethink their ways and means. When the problems don’t magically disappear there is always something, or someone, to blame. I’ve never been one to surrender to unpleasant inevitabilities, hoping new research, technology or my dead mother will intervene. When we don’t feel well we sometimes just want to muddle through, maybe get back to work next week, if we have a job. When solutions take too much time or fail we take to drink. Or we pray, especially if we don’t have medical insurance or a job. Or we kick the cat, giving no thought to the scapegoat it represents.
When we’re jobless and hurting it gives us less quality time to wonder about who should pay how much, and for what. I think of myself as a good enough American, but can’t help asking if troubling questions about the nation’s welfare (narrowly understood to mean its solvency) are more important than the health and welfare (“wellness faring”) of its citizens. I’m told that forty million Americans are uninsured. If I’m very sick because I can’t afford medical insurance, a doctor, surgery, or drug, should I make a patriotic sacrifice of myself in order to balance the nation’s checkbook? Should I salute the flag, suck it up, drive myself to the cemetery rather than hospital, and be the loyal unknown citizen who dies?
We like to think of the U.S. as “exceptional,” the world’s superpower, God’s chosen nation and guiding light. But the health care numbers, as established by the World Health Organization, are alarming and embarrassing. In general health system attainment and performance the U.S. ranks 72nd, well behind Iceland, Turkey and Cuba. France, Italy and Spain are near the top. We rank 14th, behind most Western European nations, in preventable deaths. When life expectancy, educational attainment, and national per capita income are taken into account as indicators of “green” living and quality of life, the U.S. ranks 23rd, well behind Finland, Iceland, Norway, and Sweden–all of them such frigid nations my mother was sure people died young of wind chill factors there. Meanwhile, the U.S. is in second place among the biggest spenders for health care as a percentage of GDP, behind first place Marshall Islands. The cost of our mediocre health care is almost off the charts.
My mother, always a cheapskate, would be very upset to know that Italy spends more on health care (at 27th) than Cuba (50th) and San Marino (62nd). A dose of chicken soup, nuts, dandelion greens, tap water, pasta and an apple a day should be what it costs her to keep the doctor away. She could find some of this stuff in the garden in back and buy the rest with the loose change she kept in a coffee can above the kitchen stove.
She never understood, or really adjusted to, these more complicated and expensive times. A couple years ago my daughter had a somewhat routine surgery that cost somebody $28,000. Recently I had an enzyme injection to correct a problem in one finger. The injection alone cost somebody $7000. I’m very happy to have my daughter healthy again, and when I gaze at my little finger of my right hand I’m overwhelmed at how valuable the rest of me no doubt is.
But I can’t help wondering: Why do such things cost so much? Where does all the money go? And is someone getting too much of it? If we’re being gouged while being fixed, who’s ripping us off? In the old days highway bandits asked the question a lot of people have to face when they get sick: Your money or your life. Luckily only three of my ten fingers are bad. Luckily I have (expensive) medical insurance, Medicare, and the Mayo Clinic nearby. And luckily I don’t have cancer or Parkinson’s or a failing heart.
Does my good fortune in life make me guilty of greed? I confess: Greed is one of the masks my insecurity wears. I feel most insecure when I’m an unrestricted free agent all on my own, without knowing how best to ward off what’s ailing or threatening me. That’s when I’m almost tempted to shore up my defenses by getting uppity about my right to defend and take care of myself–by flailing away at what ails me with uplifted arms, for example, or by insisting on my right to rake in enough money to get all ten of my fingers fixed, just in case, and to hide the money I don’t need in a Bahamas bank so the IRS can’t get to it. I’ll survive on my own, I tell myself, and everyone else can go to hell with the world going down the drain. By pulling myself up by the straps I don’t have on the workboots I wouldn’t think of wearing–I’ll escape the drain.
Greed, once broadcast as one of the Seven Deadly Sins, leads a quiet life as a cottage industry these days. Pure profits, and impure ones, like cancer cells, are easily secreted away, often far from doctors’ offices and hospitals where people actually do the work. Nurses, known to do a lot of actual work, maybe know this best.
I’m numbered among those who have managed to avoid going down the drain, though scientific evidence is inconclusive about whether we are the most fit to survive. Those masses going down the drain also have certain strengths–resentment, for example, and anger–that have their ways of asserting themselves as survival skills. Resentment tends to be drifty and careless as it gnaws away at what it abhors, and anger is untidy too, even when it achieves the focal point sharp enough to cause it to explode big-time. An outspoken wellness professor, untenured, once told me that resentment can swell like a tumor into a social illness that only cauterization by hot fire can remove. It seems like a very painful way to make things right.
As I keep waiting for greed’s benefits to trickle up into the body of society I wonder how much waste is going down the drain. I see my mother smiling up at me from Purgatory for asking this. Her heart was guilty as hell of cursing when she saw waste. Her suspicion of all doctors and psychiatrists was as unfair as it was deep, maybe because they never developed a chicken soup pill. But her suspicion was grounded in part on the fact that in her eighty-nine years she had endured twin miscarriages and eight surgeries, most of them “exploratory” and for the removal of benign lumps. She spent the worst part of a lifetime failing to understand the source of her troubles, and her own chicken soup did little to heal the unease she felt as woman and immigrant. Are there medical cures for these afflictions, and for the lonely, the homeless, the jobless, those frustrated by language, gender, skin color liabilities, and mental and physical disabilities? How carefully do we study and do anything to diminish the various forms of social unease that may lie at the root of actual disease? Can such diseases be amputated by budget cuts? Or will the cuts cause deeper long-term ills?
If my mother had stayed in the Old Country she might have died from a chill, from a miscarriage or from one of her lumps. Or she might have lived happily ever after until she turned 99. The World Health Organization’s rankings suggest that health has something to do with place. What also seems reasonable is that health has something to do with how we think and believe.
A couple of decades ago I clipped an article from the Minneapolis Star Tribune and tucked it away for future reference. That piece of newspaper looks almost as old as I am today, but it still rings the bell in me that says the past is never really past and the future is now. Lynn Payer, author of the book Medicine and Culture, argues that, “Medicine is not quite the international science that the medical community would have us believe.” A disease in one culture is not a disease in another, and there are very different ways of treating the same ailment in different cultures. A doctor’s best practice in one place is malpractice across the border. “Looking at medicine abroad can…show that…aspects of American medicine are not the inevitable result of medical progress but of choices–conscious or not–made on the basis of our own cultural biases.”
In England, for example, aggressive and exuberant free enterprisers run the risk of being diagnosed as mentally ill. In a culture that values self-control and restraint, “symptoms such as ‘agitation,’ ‘irritability,’ and ‘elation'” might be indicators of profound pathology. “British doctors,” says Payer, “in fact prefer inactivity to mindless activity not only in their patients but in themselves. British doctors do less of everything: less complete examinations, fewer diagnostic tests, fewer prescriptions and less surgery.” The English also recommend lower doses of vitamin C.
My mother might have been happier with English doctors. She might have avoided some of her exploratory surgeries, and happily would have saved the money spent on vitamin C pills.
Payer cites John Fry, a general practitioner who has compared medical systems worldwide: “The British health service is based in the conservative, critical questioning and cynicism of doctors….It’s highly self-critical. You are trained to think what is really necessary…[and to ask] does technology do any good? Is it better than not doing anything?”
The U.K.’s health care system ranks 18th worldwide, compared to the U.S. at 37th, with the U.K’s health performance weighing in at 24th compared to the U.S. at 72nd. The U.K. also tops us in preventable deaths, though (with apologies to Ireland) it ranks as a less “green” and livable place.
Cost? We’re almost number one and the Brits weigh in with their pounds at a lightweight 41st.
Though they manage to survive, British doctors, of course, make less money than their U.S. peers.
German doctors, true to the romantics in their midst, tend to think we’d be better off if we paid better mind to our telltale hearts. Payer explains the Germans’ “seemingly promiscuous use of drugs for the heart” (eight times that of England or France) as a function of revering the heart as not just a pumping machine but as “an organ in dynamic balance with the circulation” and core of our emotional lives. Hence Germans are less inclined to do coronary bypass surgeries to unblock a clogged pipe, and more apt to prescribe emotion-altering drugs designed to make us–as parents, friends and lovers–less heartsick.
In both Germany and France infectious diseases tend to be seen as consequences of lowered resistance (not enough chicken soup?) rather than as invasions that have to be zapped by antibiotics. “The 20 most commonly prescribed drugs in Germany,” says Payer, “include no antibiotics.” The advent of MRSA suggests that antibiotic overuse is now a serious problem in the U.S. Dangerous bugs seem to morph into tiny terrorists adept at hiding from the drone-like attacks of brilliant antibiotics too fuzzy-minded to worry about how much collateral damage they do.
American doctors apparently take the most mechanistic view, one perhaps influenced by the past success of its auto industry. If a carburetor is going bad, take it out and put a new one in. In this view the human body is a machine, the doctor a fix-it man. When the heart hurts it’s time to perform surgical strikes on the heart’s parts, or cut it entirely out and put in a used or mechanical one. Emotions and any other mysterious ghosts in the machine muddy the waters for the fix-it man, so an American doctor is inclined to cut to the quick. This attitude supplies us with new plastic knees and hips, new faces, new lips, and implants unmentionable in the company of squeamish Methodists. It makes a lot of old people shine like cars recently purchased from used car lots.
I admit the thought has crossed my mind: How much would it cost to attach three slightly used brand new fingers to my hand? They shouldn’t be hard to find.
As I wonder if there is a better way to fix my fingers, I also find the complexity of our current health care debates rather bewildering. To return to the old unreformed “system” seems to encourage free enterprising promiscuity, with forty million of the uninsured out in the cold. The new plan approved by the last Congress also seems untidy, clanking forward like a new-fangled machine that came off the assembly line with broken parts.
But clanking forward is better than going in reverse. The health care reform plan–like all remedies doctors prescribe–is a model in motion feeling its way as it stabs at the semi-darkness we keep trying to penetrate to improve our lives. A national health care system, like the human race, has to be born before it can crawl, let alone run smoothly. As it evolves it will need our ongoing help for it to find a better way.
We’re not wholly in the dark. We know that European health care systems are more “socialized” than ours, and we’d have to close our eyes tight over our minds to believe that greed and waste are not among the biggest sin twins corrupting a free enterprise approach. I also understand that the World Health Organization’s rankings are rather crude, like school test scores that hide both the angels and devils hiding in the details. I don’t know if German, French and English doctors are better than ours, but I don’t think we should ignore the mediocre rankings we’ve achieved. We have a lot to learn from others, and from our limited standing in the world.
Though I’m convinced that wholesale budget cuts are not likely to heal what ails the body politic, someday I may ask a fix-it doctor to perform a surgical strike on my knee or hip. I am, though I refuse to give up the ghost, in some ways like a machine whose body parts are destined to wear out. So I applaud all honest and carefully considered approaches–and I want new science adequately funded too, especially if I can be sure that it is driven by the pursuit of good remedies rather than big profits. Meanwhile, it seems fair and necessary to keep asking if our health care practices are so expensive because they’re controlled by profit-driven special interest groups. Where does all the money go? What types of enterprises are hogging it? Is greed the leading cause of waste? Are there natural, chicken soup, ways of preventing illnesses that will allow us to avoid very expensive responses to problems that are avoidable?
I’m especially intrigued by the attention Germans give to the heart, and by the new stem cell research implying that the body as machine can also organically renew its defective parts. It makes me think I’ve got growth potential for something other than cancer cells. Maybe that growth potential is why I’m fussy about diet and exercise. Chicken soup doesn’t work for everything that ails me, so maybe minestrone or French onion will. And I’ve heard that those delicious curry dishes from India are a wonderful arthritis cure.
My wife Monica also makes tasty chicken soup and has it ready for us whenever there’s a hint of a cold coming on. She says there’s no secret about the special ingredient she puts in it that makes it work so well. It comes from the heart, free of charge.