Sunday, February 15, 2015

The Best of Care and the Worst of Care

My father is 87 and is finally at the part of his life where he has huge health expenses and has spent the last several months trapped in the American health system. In the last two years he has had a heart attack, two major strokes (many minor strokes) along two broken hips. The health experiences involved three stays in rehabilitation.

My family members are active and aware of nutrition; so we have had very few health issues until now. The last prolonged illness we experienced was that of my Grandmother who moved in with my parents for three years back in the early 1980s while I was away in college.

My father's experience seems to be the same as many Americans. Our experience with doctors, nurses and physical therapists have been wonderful. Our experience with the health care bureaucracy has been horrible. Our experience with insurance, social workers and fuzzy left wing type therapy has been negative.

While the real medical care has been top notch, the political side health care system kept forcing us into making costly decisions that did not enhance the care.

I should say that it forced bad decisions with one major exception. The insurance forced my father into rehab. If he was paying for his own care he would have insisted on coming directly home after each operation which would have turned my mother's life into a living hell.

The hip surgery involved pinning a fracture in the femur that was just below the hip. The problem with this surgery is that the patient's hip needs to immobile for six weeks after the surgery. But if a person is inactive for six weeks, he will pretty much turn static and die. Hip patients need a trained physical therapist who knows how to keep a patient with an immobile hip active.

Because of insurance, the doctors were able to pull the trick of requiring the physical therapy. Refusal of physical therapy would be against doctor's orders, in which case the insurance company would deny the claim for the surgery. The insurance put my father in a bind that forced him to do what was best and follow doctor's orders.

There is a strong temptation to say that the health care system must be structured in ways that doctors can force patients into making the decisions that are best for the patient.

This was my first direct experience with hip surgery. The orthopedic surgeon, of course, had experience with hundreds of operations and access to literature based on millions of operations.

So while my family were neophytes in the hip surgery arena, the professionals know the choice intimately. One must keep the hip immobile and patient active. Without a trained therapist in the mix, the patient either becomes sedentary and dies or moves in a way that causes extreme pain and requires another expensive surgery.

There are options to pinning a fractured femur. For example a costly complete hip replacement could be done on more of an outpatient basis, or the surgeon could have amputated the entire leg which can be done on an outpatient basis. Although I am applauding the insurance for forcing a good decision, I can see other ways to force the right decision of attending physical therapy after a surgery.

For example, the doctor knew before the surgery that the procedure he was undergoing would require physical therapy. He could have informed us of options before the surgery. In the way it happened, the doctor did the surgery then gave us the ultimatum of attending therapy or paying the full cost of the surgery out of pocket. If my father had the choice between a hip surgery and six weeks of rehab or an amputation; I am pretty sure he would have chosen the surgery with rehab.

Although I am glad that the bind placed on my father by the insurance company forced him into physical therapy, I cannot say that such binds are the best course of action.

Anyway, I thought about blogging about this decision a few months ago. But I have been stuck on a problem. I realized that conservatives are as much a part of the problem as progressives, and I have to come up with an approach to discussing health care to show that the Conservative approach to the subject is as bad as the progressive approach.

The real science based medical care delivered by doctors is part of the classical liberal tradition. Both conservatives and progressives are guilty of piling political garbage on the health care industry. No matter how one goes about it, the politics involved in care generally diminishes the care.

Anyway, I held off on writing any blog posts until I found a good way of showing that both Conservatism and Progressivism hurt care.

The primary problem in American health care is politics. Paul Ryan and Mitt Romney are as bad for our collective health as Barrack Obama and Harry Reid. I fear that my blogging about health issues is feeding the false narrative that conservatives have solutions to health care when conservatism and progressivism are both parasites feeding off the system.