Our Fear of Health Care Reform and the Household Vacuum0

“That’s the nice thing about carousels, they always play the same songs.”  The Catcher in the Rye by J.D. Salinger

This article first appeared on the PBS affiliated website This Emotional Life.

It starts with a vacuum.

The sudden, unfamiliar dissonance signals fear in his little mind, which grows quickly, magnified by the sight of an unexpected entanglement between the woman he trusts most and this monstrous machine. As he turns to run (or crawl), I find myself thankful to be just inches away, in perfect position to catch my 10-month old boy as he does his best to flee the frightful scene. His two outstretched arms secure a tight grip around my neck, while a sad face burrows deep into my chest. For one sharp moment I feel like a hero, a wholly necessary, trustworthy entity whose sole purpose is to be relied upon in times of trouble.

Fear is a formidable foe, and the ways in which we as grown ups react to its presence can often be inconsistent. Regardless of its origin, any meaningful cause for alarm typically signifies a commonality of chaos, to be first understood, and then vanquished. Though my son’s safety was obviously never compromised during his run-in with the vacuum cleaner, his reaction illustrates the fact that in the eyes of an infant the world is full of uncertainties. In the mind of a child, laughter and tears coexist every day, yet we seldom stop to consider how these emotions actually resonate. Rather, we tend to focus on the cause, which with luck might lead us to a solution, as a means to restore the calm and save the day. Indeed, some of the most seasoned parents have an entire cache of remedies upon which to rely when a crisis hits, and they wield them like weapons of precision, each one crafted and selected for just the right moment.

But what about the child in the midst of a trauma?  Many parents may fantasize about protecting their children from life’s dangers, both real and imaginary, though few go so far as to spend an entire lifetime catching their kids as they are coming through the rye fields of Burns and Salinger. Even so, there is little harm in focusing on both solution and subject concurrently, a better way to stay ahead of disaster. This is similar to the goal of what the practice of medicine should be.

America’s health care system is in jeopardy, and has no all-protective arms in which to jump. What we once knew as health care reform has begun to feel more like civil war, inflicting casualties on both sides. Without casting blame, opining on the political influences at work, or even speculating on the impact of any decision next year by the United States Supreme Court, it has become increasingly clear that the 2010 Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act, has lost its way. Across the nation, while the federal government prepares for an intervention in health care at a level never before seen in this country, the insurance companies rush to reinforce their trenches and bunkers in an effort to withstand the onslaught. This leaves the hospitals and physicians with the unenviable task of calculating their chances of survival with or without the other. When each faction of our health care system is forced to focus on its own survival, who is left to hear the faint ring of a call button – the sound recognized around the world as an indication that a hospital patient is trying to get someone’s attention, even if only for a simple glass of water?

Today’s health care reform has no choice but to focus more on surviving unrealistic cuts to the Medicare and Medicaid programs and outlasting the debt ceiling super committee than reversing epidemics such as diabetes and obesity that collectively threaten the lives of almost one billion people world-wideThe issues have become so muddled of late that the federal government cannot even agree on where to draw the line regulating the consequences of teenage sex, with one federal agency overruling another’s decision to expand access to emergency contraceptives. While the author expresses no opinion as to the propriety of sex between individuals under the age of 17, he is mindful that this recent debate does little to restore calm in the current health care crisis, and serves no purpose in effecting the ultimate survival of our jeopardized system.

If the day should come when no one is available to aid a hospital patient, what then will be the legacy of President Obama’s health care reform? Make no mistake, the system of give and take between a sovereign nation and its states, when combined with the balancing of power between the federal branches of government, defines the federalism for which our country is known. Even so, as a divided Congress surveys the current landscape of health care reform and tries to scale back the national debt, Republican party leaders call for the program’s outright repeal, the Supreme Court contemplates the law’s constitutionality, and President Obama prepares himself for another round with the electoral college, the resulting noise has become somewhat deafening.

Of course the debate must rage on as we as a nation seek the best way to provide care to our sick and injured. These are the natural growing pains in the evolution of a newly born health care system. And yet true as this may be, I don’t want to be the one to explain it to a thirsty and neglected patient, let alone a 10 month old who has narrowly escaped his first attack from the vacuum cleaner.

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