Some folks that know me, or follow me on Twitter or Facebook know by now that my Dad has been in the hospital for what is now going on 13 days.
It started, as many of these kind of cases do I have learned, with what seemed to be a cold, then a bad cold, then a fall at home, then a call to 911, and finally a diagnosis of pneumonia (along with some other assorted issues that have popped up).
As this process has unfolded, his condition has gone up and down, probably a bit more down, as additional issues and complications have arisen in the past few days. In the course of his care, the doctors (and there have been at least five, specialists for infectious diseases, neurology, endocrinology, cardiology, and psychiatry), and nurses have been very professional and have done their best to help both my Dad and us stay informed of what is going on in what has proven to be a complex, challenging case.
And as the number of doctors, nurses, clinicians, specialists, and other professionals has multiplied, so have the number and frequency of tests, procedures, and medications that have been involved in his care. There have been really too many to count among the MRIs, CT scans, X-rays, blood tests, and more in the last 13 days. In truth, my Dad's case has been extremely complex, and at times they have not been completely sure what is going on, and as such, several of the tests have been perhaps a bit speculative.
But as this process continues on, I can't help but wonder a few things:
One - had my Dad not had health insurance coverage in the form of some combination of Medicare and insurance from his former employer, just exactly how would all of this played out? Would any of the decisions and approaches to his treatment actually been any different? Does everyone in his situation get the same comprehensive, and I am sure incredibly expensive care?
Two - Is it entirely normal and expected that the actual costs of treatment are really never discussed with the patient and family? As each test, procedure, medication, etc. have been ordered, they have been discussed with us in detail. The goals, steps, process, potential complications are all carefully described. But not one time has the subject of cost ever been discussed. Should the cost of care, of each additional test or procedure be a part of the decision making process? I imagine that the Doctors or the hospital administrators take the costs into account, but to have what has amounted to zero discussion of cost between service provider and service recipient is certainly unusual (at least to me).
Three - These last two weeks, as the US health care reform debate, compromise, and vote has played out on the news, in the blogs, and in social networking, most of the (limited) information that I saw was primarily focused on the macro level. The many millions of uninsured people that would now get coverage, or depending on which cable news network you prefer, the billions of dollars that would be saved, or squandered as a result of these reforms. Big picture discussion on percentage of GDP and national obesity rates.
But to me, what is clear as a result of what my Dad and our family is going through, is that any talk of health care reform really starts and stops at the micro level. It is about what happens when Dad or Grandma gets sick and needs intensive, expensive care, (and rehab). It is about what happens if the new baby is born weeks and weeks early. It is about making a decision, as many people do, to stick it out in a dead-end and soul crushing job in order to cling on to a marginally decent benefits plan, because your spouse has been sick for a long time, the kind of sick that insurance types like to call a 'pre-existing condition'.
I have been really distracted the last two weeks, talking about ventilators, CT scans, catheters, spinal taps, and blood work. So perhaps I simply have not had the time or attention to think about the big picture, and what these reforms mean to the country, the economy, the workforce, and the next generation. For me, at least right now, these concepts are too vague, elusive, and certainly contentious to fully grasp.
Right now, for me, the only thing in 'reform' that I care about, is whether reform will affect my Dad's ability (and you can insert your own loved one's here), to get the needed treatment, and walk out of the hospital one day soon.
And I suppose any reform that makes that kind of positive outcome more likely for my Dad, and your Mom, Grandpa, daughter, husband, or friend, is the kind that we can all support.