Letter from America (6)

On August 25, 2009, Senator Edward Kennedy at 77 finally passed on. He has been described variously as the “Lion of the Senate”, Senate's “Liberal Lion”, “Senate stalwart”, the last of the “Camelot dynasty”, “an iconic, larger-than-life United States senator whose influence cannot be overstated”, "a liberal icon, a warrior for the less fortunate, a fierce advocate for health-care reform, a champion of social justice here and abroad", and so on. A Freudian slip from me dubs the senator the “Lion King” of Senate! Ted Kennedy was an avowed Liberal of American politics, and he was proud to wear the badge.

President John F. Kennedy is fondly remembered for his “... ask not what your country can do for you - ask what you can do for your country." Bobby Kennedy for his “There are those who look at things the way they are, and ask why... I dream of things that never were, and ask why not?” In his great concession speech Ted Kennedy had this to say, “For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.” In a eulogy at the funeral of a beloved brother, Ted Kennedy had this to say about Robert Kennedy:

“My brother need not be idealized or enlarged in death beyond what he was in life; to be remembered as a good and decent man, who saw wrong and tried to right it, saw suffering and tried to heal it, saw war and tried to stop it.

Those of us who loved him and who take him to his rest today, pray that what he was to us and what he wished for others will some day come to pass for all the world.”

Ted served as senator for over 46 years, and while several major legislative achievements can be credited to him, there is one that must be singled out, which the senator himself described as the “cause of his life”, universal health care!

Today, America is in the throes of a very heated debate on health care and there are many who wish Ted Kennedy the deal maker was around to finally bring about a consensus on a form of universal health care system that has thus far defied several previous Presidents in America.�Here are quotes of Ted Kennedy's speeches from publications that are on the internet, principally put out there by Newsweek (http://www.newsweek.com/id/207406).

“In 1964, I was flying with several companions to the Massachusetts Democratic Convention when our small plane crashed and burned short of the runway. ... the care was expensive, but I didn't have to worry about that. I needed the care and I got it.

“Now I face another medical challenge. Last year, I was diagnosed with a malignant brain tumor. … I've undergone many rounds of chemotherapy and continue to receive treatment. Again, I have enjoyed the best medical care money (and a good insurance policy) can buy.

“But quality care shouldn't depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to.

“This is the cause of my life. It is a key reason that I defied my illness last summer to speak at the Democratic convention in Denver—to support Barack Obama, but also to make sure, as I said, "that we will break the old gridlock and guarantee that every American…will have decent, quality health care as a fundamental right and not just a privilege." For four decades I have carried this cause—from the floor of the United States Senate to every part of this country. It has never been merely a question of policy; it goes to the heart of my belief in a just society. Now the issue has more meaning for me—and more urgency—than ever before. But it's always been deeply personal, because the importance of health care has been a recurrent lesson throughout most of my 77 years.”

Ted went from narrating his personal torment with having to cope with serious medical illness in his family to the burdens that several other families in America had to endure:

“Nothing I'm enduring now can compare to hearing that my children were seriously ill. In 1973, when I was first fighting in the Senate for universal coverage, we learned that my 12-year-old son Teddy had bone cancer. He had to have his right leg amputated above the knee. Even then, the pathology report showed that some of the cancer cells were very aggressive. There were only a few long-shot options to stop it from spreading further. I decided his best chance for survival was a clinical trial involving massive doses of chemotherapy. Every three weeks, at Children's Hospital Boston, he had to lie still for six hours while the fluid dripped into his arm. I remember watching and praying for him, all the while knowing how sick he would be for days afterward.

“During those many hours at the hospital, I came to know other parents whose children had been stricken with the same deadly disease. We all hoped that our child's life would be saved by this experimental treatment. Because we were part of a clinical trial, none of us paid for it. Then the trial was declared a success and terminated before some patients had completed their treatments. That meant families had to have insurance to cover the rest or pay for them out of pocket. Our family had the necessary resources as well as excellent insurance coverage. But other heartbroken parents pleaded with the doctors: What chance does my child have if I can only afford half of the prescribed treatments? Or two thirds? I've sold everything. I've mortgaged as much as possible. No parent should suffer that torment. Not in this country. Not in the richest country in the world.

“That experience with Teddy made it clear to me, as never before, that health care must be affordable and available for every mother or father who hears a sick child cry in the night and worries about the deductibles and copays if they go to the doctor. But that was just one medical crisis. My family, like every other, has faced many—at every stage of life. I think of my parents and the medical care they needed after their strokes. I think of my son Patrick, who suffered serious asthma as a child and sometimes had to be rushed to the hospital for treatment. (For this reason, we had no dogs in the house when Patrick was young.) I think of my daughter, Kara, diagnosed with lung cancer in 2002. Few doctors were willing to try an operation. One did—and after that surgery and arduous rounds of chemotherapy and radiation, she's alive and healthy today. My family has had the care it needed. Other families have not, simply because they could not afford it.

“I have seen letters and e-mails from many of these less fortunate Americans. In their pleas, there's always dignity, but too often desperation. "Our school is closing in June of 2010, which means that I will be losing my job and my health insurance," writes Mary Dunn, a 58-year-old schoolteacher in Eden, S.D. "I am a Type I diabetic, and I had heart bypass surgery in 2005. My husband is also a teacher [here], so we will both be losing insurance. I am exploring options and have been told that I cannot stay on our group policy or transfer to another policy after our jobs cease because of my medical condition. What am I to do after 39 years of teaching to acquire adequate health coverage?" Dunn also serves as mayor of Eden, for which she is paid $45 a month with no health benefits.

“How will we, as a nation, answer her? I've heard countless such stories, including one from the family of Cassandra Wilson, a 14-year-old who once was a competitive ice skater. She's uninsured because she has petit mal seizures, often 200 times a day. Her parents have run up $30,000 on their credit cards. They've sold her skating equipment on eBay to pay for her care.

“These two cases represent only those patients who lack coverage. We also need to find answers for the increasing number of Americans whose insurance costs too much, covers too little, and can be too easily revoked when they face the most serious illnesses.

“Our response to these challenges will define our character as a country. But the challenges themselves—and the demands for reform—are not new. In 1912, when Theodore Roosevelt ran for a third term as president, the platform of his newly created Progressive Party called for national health insurance. Harry Truman proposed it again more than 30 years after Roosevelt was defeated. The plan was attacked, not for the last time, as "socialized medicine," and members of Truman's White House staff were branded "followers of the Moscow party line."…”

If anyone has made an unassailable case for universal health care in America, Ted Kennedy was that person. His case for universal health care is as well reasoned as it is passionate.�Why then has the debate on reforming health care in America become so heated and unhealthy?

Many years ago when I attended a Government Secondary School in Nigeria, we had a Principal named Mr. Patient. Mr. Patient came to be known as Mr. “Everything costs money.” Faced with dwindling resources from the Government, the Principal's recurring refrain was “Everything costs money, water costs money, electricity costs money …” Needless to say, the Principal was not popular with the students.

There is a law of thermodynamics called the first law. I frequently paraphrase the law this way; “there is no free lunch; either you pay for it, or someone else does!”

The current health care reform debate in America has a lot to do with money, who pays, who makes profits (large or small), and who carries a disproportionate burden of the expenses? The USA tops the list when it comes to expenditure per capita on healthcare; the estimate stands at $7,290 per capita compared with $4,763 per capita in Norway. Canada next door to the USA spends $3,895 per capita, while Mexico to the South spends a mere $823 per capita. In Nigeria, total expenditure on healthcare is less than $100 per capita. Practically all wealthy nations except USA and South Africa have universal health care for their citizens.

The standard and quality of health care in the USA is undeniably among the best in the world.�A visitor to the hospitals and clinics will be surprised to find most of them looking like 4- or 5- star hotels. Anecdotally, I have known of hospital patients with near-fatal heart conditions, some victims of auto accidents that left them in coma and with several broken bones, who not only made it to hospital, but were kind of miraculously made whole and put together piece by piece to the way they used to be. Sometimes it feels and looks like miracles of modern medicine.

By way of contrast, one is sadden by the myriads of preventable deaths that ordinary citizens in a developing country like Nigeria suffer simply because the facilities are lacking to provide the needed medical care. In Nigeria today, the University Teaching Hospitals and top-grade Private Clinics and Hospitals are the best hope anyone has for receiving a semblance of good medical care, but even these institutions are plagued with drug shortages, and lack of up-to-date equipment for doctors to carry out the necessary medical procedures. Like most industries in Nigeria, the hospitals have to do without a stable energy infrastructure that is needed for successful delivery of health care. I have been to hospitals that do not have running water, no stable supply of electricity for lighting, for operating fans (let alone air conditioners) in a hot and humid environment, hardly any stable power supply for needed medical procedures. The situation is really pathetic. No wonder that the more affluent Nigerians and leaders in government frequently travel overseas to obtain medical care for themselves and their families.

There is no avoiding the fact that good medical care costs money, and someone or society at large must shoulder the cost of healthcare. Nigeria is blessed with an abundance of human talent. I recently read an article that suggests (I think) that as many as about 21,000 Nigerian doctors currently practice in the USA, about the same number as those practicing in Nigeria. Some of the Nigerians abroad often consider returning to Nigeria to practice. In many instances, the challenge of practicing in Nigeria proves too big a challenge, and like the proverbial “Andrew”, a number of them come roaring back to foreign lands.�The health care of a nation is too big an issue for the leadership of the nation to treat lightly or be casual in addressing. Life expectancy in countries like Japan and the USA is in the 70's to 80's. In much of Africa, on the other hand, life expectancy is often in the low 40's or 50's.

I wish to conclude this article by taking a quick look at the challenges and options that any society must explore to achieve a good health care system. First, what do we mean by universal health care? The following definition is given in Wikipedia: “Universal health care is health carecoverage for all eligible residents of a political region and often covers medical, dental and mental healthcare.” It is often asserted that the United States is the only industrialized country that does not implement universal health care.

Canada's health care system is considered a form of universal health care. It is for the most part publicly funded.�Most of the services are provided by private enterprises or corporations, although most hospitals are public. About 29% of health care in Canada is paid for by the private sector or individuals while the various levels of government pay for the remaining 71% of health care costs.

Public healthcare is provided free (at the point of need) to all UK permanent residents and citizens. It is a public funded (from general taxation) universal health care system. The system is often characterized as “socialized medicine” by critics.

As this article developed, the US House of Representatives passed a historic Health Care Reform Bill that embraces the major principles enunciated by President Obama. Here is a summary of those principles (from http://www.whitehouse.gov/issues/health-care/plan):

"It will provide more security and stability to those who have health insurance. It will provide insurance to those who don't. And it will lower the cost of health care for our families, our businesses, and our government"

· �For those that have Health Insurance, More Stability and Security.

o Ends discrimination against people with pre-existing conditions.

o Limits premium discrimination based on gender and age.

o Prevents insurance companies from dropping coverage when people are sick and need it most.

o Caps out-of pocket expenses so people don't go broke when they get sick.

o Eliminates extra charges for preventive care like mammograms, flu shots and diabetes tests to improve health and save money.

o Protects Medicare for seniors.
o Eliminates the "donut-hole" gap in coverage for prescription drugs.

· �For those that do not have Health Insurance, Quality, Affordable Choices for All Americans.

o Creates a new insurance marketplace – the Exchange – that allows people without insurance and small businesses to compare plans and buy insurance at competitive prices.

o Provides new tax credits to help people buy insurance.

o Provides small businesses tax credits and affordable options for covering employees.

o Offers a public health insurance option to provide the uninsured and those who can't find affordable coverage with a real choice.

o Immediately offers new, low-cost coverage through a national "high risk" pool to protect people with preexisting conditions from financial ruin until the new Exchange is created.

· ���For all Americans, Reins In the Cost of Health Care for Our Families, Our Businesses, and Our Government.

o Won't add a dime to the deficit and is paid for upfront.

o Requires additional cuts if savings are not realized.

o Implements a number of delivery system reforms that begin to rein in health care costs and align incentives for hospitals, physicians, and others to improve quality.

o Creates an independent commission of doctors and medical experts to identify waste, fraud and abuse in the health care system.

o Orders immediate medical malpractice reform projects that could help doctors focus on putting their patients first, not on practicing defensive medicine.

o Requires large employers to cover their employees and individuals who can afford it to buy insurance so everyone shares in the responsibility of reform.

America is deeply divided on the issue of health care reform. As is common even in the most mature democracies across the globe, many of those that have taken positions on health care are brazenly ill-informed and ignorant on the issue. There are even those whose position can best be described by a proverbial opinionated individual who said, “Don't confuse me with facts; my mind is already made up!” Both sides appear to be in agreement on some of the core aspects of the debate. The current health care system in America is broke and needs fixing! A lot of Americans are unable to shoulder the burden of paying for health care.�Today, the USA faces a huge unemployment burden, and sad to say, many of the unemployed have lost or may soon lose health insurance coverage. The situation is dire.

Ted Kennedy made it the cause of his life to champion the cause of the needy and those least able to help themselves. I think know which side he would be on regarding the on-going debate on health care reform! May his soul rest in perfect peace!

George A. Adebiyi, Ph.D.
Professor of Mechanical Engineering
[email protected]
Development / Ghana / Africa / Modernghana.com