During the last few months I was forced to abandon my blog because we in my family were living a new episode of the tragedy, which resulted from the senseless shooting of my son almost five years ago and the disappointments and frustrations with the nature and quality of the care he is receiving here since our arrival in this country.  On top all of this was, what has been happening to my wife for the last eight months who has been in and out of hospitals with a medical problem which we were told in the beginning was a fairly simple problem, but in spite of dozens of tests and investigations the problem is still undiagnosed and she is still in hospital.  The other reason for this update is the debate which is going on here about the state of the health care system which is in a very bad shape, one of the issues candidate Obama made it very clear during the presidential campaign that it is going to be on the top of his priorities if he was elected. In a recent poll by TIME, a thousand Americans were questioned about the state of the health care system in this country, a very big majority of those polled thought it rated between only fair and very poor, a smaller number thought it was good, a much smaller number said it was excellent.  In the end most of the interviewees thought that the health care system in this county in its current state needs major changes, large adjustments rather than few minor reforms.

The United States spends thousands of billions of dollars on providing health care and medical help to the people, this system devours almost 20% of the country’s yearly revenue which is about  two trillion dollars, and in spite of  those thousands of billions the system has become a black hole, this country states spends more to get less than just about every other industrialized country.  The United States spends more than any other industrialized nations in medically preventable diseases yet it ranks 18 behind those countries and in spite of all those billions this country is far down the list in other categories including the number of years its citizens live a healthy life, it has a very high incidence of infant mortality rate more than about every other industrialized country, each year about 30,000 American babies die before their first birthday a rate three times as high as in Singapore which has the world’s  best infant survival a denominator long considered a very good indicator of a nation’s overall level of health.  So what is happening and why things are are so bad in the health care system and why had it deteriorated into this moral and fiscal mess?

President Obama told CBS in June, the status quo is untenable, our health care system is rife with skewed incentives, it gives us a whole bunch of care that may or may not be making us happier, it generates too many specialists and not enough primary care physicians, it is bankrupting families, bankrupting business and bankrupting our government a the state and federal levels, things are going to have to change.  In late July he said, obviously the system is not working too well for too many people and that we ought to be doing much better, this sort of diplomatic language is what one would expect from the President, but it did not conceal the fact that the system is not only not working as it should but it is actually deteriorating.  But before I go into the why and how did this happen I am going to tell you about my family’s experience with the American health care system.   

A lot of people I am sure are familiar with the tragedy of my son Nazar who was shot at by an American soldier in Baghdad on March 2004, after the shooting the boy underwent a long and very tricky operation, after which he suffered from a series of complications which left him in a state of a very advanced brain damage, the hospital were unable to help so we took him home and started the nursing, the feeding and the nonstop observation he is going to need and that was what we did for almost four years first in Baghdad and then in Amman.  On the 14th of November, 2007 we brought him to US hoping for a better care than what we were providing, but it was not always the case, we [my wife and myself] are still staying at his bedside and delivering ourselves most of the care he needs, which has exerted a huge toll on my wife’s health which has been very bad and extremely worrying for the last eight months.

Now I am going to try and explain why and how did  the health care system became the mess it has became, but before that I would like to make it very clear that there are in this country some excellent health care centers and institutions which are absolutely unique who are providing a first class care, but there is only a very small number of these and they are very expensive and not always within the financial means and income of the average individual who is almost always forced to accept what the system can provide in its current state.  The system has developed into a truly monstrous size, a multi headed creature which is very difficult to discuss with the limitations an update of this length usually imposes, so I am going concentrate on what are the big players in this drama, the doctors the hospitals and the insurers who are mostly keen on their own interests and what they might reap out of the system and with the passage of time these interests have grown more entrenched and the groups becoming increasingly dedicated to their own specific needs at the expense of the broader interests of the society as a whole, which is creating an atmosphere of doing nothing is the best thing.

The doctors practice what might be described as a defensive medicine, they are always under the threat of malpractice lawsuits which compels them to seek very expensive insurance which tempts them to perform more tests and rather more than less procedures to avoid lawsuits, and that the system encourages the generation of more specialists rather than primary care providers which are in an acute shortage nationwide.  They would like loan forgiveness programs for medical students who got no primary care would ease the shortage there, reimbursement programs that could reward doctors for keeping patints healthy rather than paying them on the basis of services provided.  The hospitals especially the smaller suburban ones operate on thin margins in part because of below costs Medicaid reimbursements and the expense of treating the uninsured.  Emergency rooms are overflowing and many hospitals are struggling to deal with outdated record keeping systems, these would like federal investments in information technology which could help them modernize medical record keeping.  Getting coverage of more of the uninsured would mean hospitals could cut down on charity care.  The insurers are making healthy profits, but the will lose when new ones are going to move into the system, they actually make the money by setting rates based on the health of the individual accepting ones with no pre-existing medical problems, these would be very happy if all Americans are going to be covered, this will give them a huge pool potential new customers.  These three are only a very small group of a very complex system which is not functioning as it should which needs changing.

Change is imperative and urgent, but every thing else is negotiable, like, is the whole system going to be tackled at once or is it going to be done step by step?  What is the nature and degree of the reforms which have to be introduced?  How are these changes going to be financed?  All these questions and many others are open to discussion that is why a debate about them is necessary, but the debate  has to be conducted in an objective and a civilized way and not in anger or violently and for ulterior reasons.

Najeeb Hanoudi
Southfield/Michigan
Friday, August 21, 2009
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