What a Drag it is Getting Old
"What a drag it is getting old"
—Mick Jagger, The Rolling Stonest
It’s sucks getting old. I guess it sucks more for my mom and dad—who have now both passed after enduring long battles with age, dementia, Parkinson’s Disease (in my mom’s case) and heart disease (in my dad’s case). They were 89 and 91 respectively so nothing overtly tragic about their passing as we had plenty of advanced warning and had said goodbye countless times. My dad had planned well for these things, or so he thought. Not wanting to put the burden of his age on his children he paid many thousands of dollars into a “long-term care” health insurance plan. I never did the math to determine how much his monthly premiums actually cost compared to the insurance that eventually paid out. Suffice to say his plan defrayed the cost of long term care up to the paltry about of $120 per day. In both his and my mom’s cases 24-hour care costs significantly more than $120 per day. Quite easily most 24-hour care lands somewhere between $500 and $600 per day regardless whether you use the services of a nursing home or try to do it by yourself with in-home care givers. Since my dad had purchased $500K of insurance (half a million dollars) for both him and my mom one might think they were nicely covered and could use all that insurance money as necessary. Sadly, if you read the fine print, the restrictions on the use of that money can only describe that policy as not worth the paper it was printed on.
This is a big problem and part of the huge dysfunction that is health care in the United States.
It’s sucks getting old. Almost in parallel, my own health deteriorated. When you turn 40 you take a hit. When you turn 50 you take a hit. And when you turn 60 you take yet another hit. Three hits and you’re out . I just turned 60. I can definitely tell you providing in-home care for two parents over the last decade took its toll on the children (my sister and I). The impact, both mentally, physically, and financially cannot be understated. We both got old. Is there a correlation to the addition of this three-way work load? Or are our bodies just aging out per the grand design? Last year I was hospitalized, wheelchair bound, and unable to walk for two months. In the two years leading up to the hospitalization I had undergone two surgeries. The first one, an emergency surgery, to fix an appendicitis. And a second surgery to fix a hernia. Then, to add insult to injury, I had spinal surgery to fix two herniated discs at my L3/4 and L4/5 vertebrae. It was the double herniation that exasperated the situation and left me unable to walk. A more common single disc herniation, while painful, typically (or never as I was told countless times by the medical experts) does not result loss of ambulation (the ability to walk). Should this have been a clue to investigate further what was wrong, or a licensee to gaslight me to the point where I lost confidence in my own judgement? Maybe I was faking it.
This is a big problem and part of the huge dysfunction that is health care in the United States.
During all of this time, I had the ability to observe those implications including the goods and bads of the health care system in the United States. One might argue the emergency appendectomy saved my life. Having gone to the emergency room for what I thought was pain associated with the known hernia, I was whisked off for emergency surgery in the middle of the night. A protocol which has been set up for just this sort of discovery. There are surgeons, on standby both day and night, ready to remove your appendix if it shows signs of bursting. Our health care system seems set up nicely for these repeated things that don’t require much thinking. The surgery to repair my hernia came a few months later and was performed with the same adept hands of the surgeon who saved my life on the middle of the night. Seemingly on the road to recovery, all of this medical action had most likely weakened me even more. When I landed in the hospital for something that fell outside of the category of “repeated things” getting advocacy, finding a doctor who cared enough to diagnose my problem, and getting the health insurance to pay the bills, all became something that was far from straight forward. At this point navigating the complexities requires either a heroic amount of trust in the system or a Herculean amount of strength to push back on things that don’t seem right. Hard to do when you are the afflicted and the institutions set up to care for you chose to gaslight instead. Regardless, I can assure you I have neither heroic or Herculean strength on a good day. And if I don’t possess those characteristics, while I am arguably at the top of the privilege stack in the United States, how is anyone less fortunate in our Country supposed to do it? Horror stories abound; just strike up a conversation about health care with anyone you see on the street.
This is a BIG problem and part of the HUGE dysfunction that is health care in the United States, to say it again with emphasis.
In 1961, our U.S. President, Dwight D. Eisenhower left office and highlighted what he saw was a looming danger to the Country he loved. He phrased his warning in his farewell address as the rise of the “Military Industrial Complex” . It centered on the armed forces, the defense industry, and our political system. He warned against such things as unwarranted influence whereby the players could shape policy ahead of national interest. He added the fear of economic distortion whereby restraint could not be exercised without creating additional problems which would force bad decisions to be made regardless. And perhaps most insidious, the erosion in democratic control, whereby the people and our representatives could never fully understand the complexity of the system and thus become wholly unable to make good decisions.
What I have observed over the past few years is that there is this similar thing, far more insidious in our daily lives, that we can call, thanks to Ike, the Medical Industrial Complex. It has all the similar features that force bad decisions and a few more. Rest assured it was also here in 1961, but back then it was never identified as anything close to the same level of threat it currently poses to our Country. In fact, one might argue it was the opposite and we had a model for health care in the United States that you could write home about. Unfortunately, since that time, the problems, conflicts, and complexities of this new threat have risen strikingly more confusing with more issues, more fuckery, and more things in heaven and earth, President Eisenhower, than were dreamt of in your initial philosophy on the Military Industrial Complex.
This is the BIGGEST problem and why we have a HUGE dysfunction in our health care in the United States. It’s not the lack of universal health care.
In any mystery scenario trying to be understood, most of the clues can be found simply by following the money. If we believe some of the numbers that exist regarding how much money we spend within the Military Industrial Complex and how much we spend on the Medical Industrial Complex annually the scope of the problem is apparent. Depending upon what we include in military related expenditures it ranges from about $1 trillion to about $1.1 trillion, if we include intelligence related expenditures, annually. The money we pay our veterans would increase this by another $400 billion annually but I would argue that we keep the veteran’s expenses out of this math because a lot of the VA money would also cross over into health care.
On the medical side of the coin, we are looking at $5.3 trillion annually. So, if the Military Industrial Complex is a problem, the Medical Industrial Complex is 5 times that problem. The genie has left the bottle. The tooth paste has left the tube. The shit has left the horse. Is it possible to reverse this chaos? The 2nd Law of Thermodynamics says no. Everything is moving from a state of order to a state of disorder. Things are becoming far more complex. Thus, we now refer to these very large creations, or institutions, of human society, using multiple definitions of the same word “complex”. A complex thing is something that is very complicated, such as a DNA sequence. A complex can also be a group of buildings serving a similar function, such as a college campus. In mental health, a complex is an unconscious collection of ideas that influence behavior, such as a guilt complex. In math, a complex number denotes a number that has an imaginary component—which I personally never understood, since all of math is imaginary from the point of view that humans created it. Finally, we arrive at this all too human use, of an overused word, to denote this inter-related connection of human institutions, the Military Industrial complex and now the Medical Industrial Complex. They are indeed both complex collections of complexity arranged as a complex of institutions that when confronted by a human seeking health care gives all of us a mental complex as we try to imagine if health care is actually real.
The Military Industrial Complex only consists of the industry that builds weapons, the Services (Army, Navy, Air Force, Marine Corps, Space Force) that organize, train, and equip forces for employment. And the political organization at the top—both the Executive and Legislative branches of our government. If we add veterans, Eisenhower left the veterans out, that does include some of the people in the US population.
The Medical Industrial Complex, on the other hand, includes all-of-us right off the bat. Or at least all-of-us who desire health care. Much larger than it’s military cousin, the Medical Industrial Complex also includes academia, large medical schools, and the universities dedicated to training our corps of medical professionals as well as countless areas of science and research. The Medical Industrial Complex includes the medical industry which is comprised of all the companies that build all the equipment used in modern medicine from the exquisite MRI machines that weigh six tons and diagnosed my condition, to the simple tubes (catheters) used for drawing blood, including the catheters that were used to save my daughter’s life when she was born prematurely at 1 pound 9 ounces. I still cannot comprehend a catheter that is small enough to thread inside the tiny veins of an infant, even one of normal size. Prenatal emergency room doctors, have to thread a thread through a thread. The medical industry has to conceive, design, manufacture, and test all of this equipment, and hope that it does more harm than good. The medical industry also includes the research, testing, and manufacturing of all the medicine and supplements we consume to make us better, from the exotic formulations that are now curing cancer, to these new weight loss medicines targeting specific hormones in our body. We call these companies Big Pharma and they carry half of the ire that we feel when we attack this seemingly monolithic wall of a Medical Industrial Complex. We have to have a bad guy. I think we attack Big Pharma unfairly. The other half of our ire is directed at the health insurance industry. For the most part, I agree with that discontent. Health insurance companies, I will perhaps unfairly suggest, have no mission they can hide behind like curing cancer. Big Pharma can pretend they are not in it for the money. Health insurance companies cannot pretend. They are in it for the money and the only way they can make money is if they pay out less money for health care cost then for the health care premiums they take in. The point I just made about my father’s non-existent, long-term care policy. But we are not done yet.
The Medical Industrial Complex clearly includes the actual health care providers. Those who we pin responsibility on for mystically and magically knowing what is wrong with us, trying to divine a cure, and helping us feel better. We wish every EMT, or first responder to be Kevin Tighe as Roy DeSoto in the hit TV show EMERGECY I watched sitting next to my father in the 70s. We want every trauma center doctor to be George Clooney as Doug Ross in the Emergency Room (ER) . We want every specialist to be Hugh Laurie as Dr. Greg House in the hit TV show “House” , to find the cure for our incurable ailment. We want every primary care physician to be Robert Young playing, “Marcus Welby, MD” . Whereas we don’t want every nurse to be Edie Falco as “Nurse Jackie” , we do want every nurse to be Florance Nightengale. And of course, we want a competent administrator at the hospital to make everything run smoothly for us. Fat chance people, TV isn’t real, it’s imaginary.
Finally, just as with its cousin on the military side the Medical Industrial Complex wouldn’t exist without the governance and regulation that come with it. The President and his team at Health and Human Services (HHS), the agencies that are run, including the Food and Drug Administration (FDA), Centers for Disease Control (CDC), Congress and the laws and regulate all of our care, the industry, our insurance. International concerns such as the World Health Organization (WHO), and the private reference organizations such as the America Medical Association (AMA). The list goes on and on forever, it’s infinite, another imaginary construct. In addition to the institutions Eisenhower also warned about a “scientific-technological elite” dominating public policy if citizens abdicated oversight—this also makes sense since we can’t read our own lab reports anymore without an interpreter. One trick is to throw our medical reports into CHAT-GPT. This is a powerful and freighting method. I would be preferred for our care provides, to actually take the time to explain these things to us. Alas, that time is never available. CHAT-GPT however, can now do it in less time than it takes me to finish writing this sentence.
Aside from the terror all medical professionals will now face with every patient becoming their own Dr. House, with CHAT-GPT in their hands, what follows is one person’s account of a hospitalization scenario I experienced firsthand. It is no more dramatic in nature than anyone else’s encounter with healthcare in the United States, but in this case, I documented in my blog what was happening. It’s more than 65,000 words of observation—laying in my hospital bed I had time on my hands. My apologies, if I had even more time, this essay would be shorter . I was bearing witness, in real time, to what was happening around me. Most of it quite incredible. It’s only my story but I think it digs sufficiently enough to tell the story for everyone. It asks the right questions to probes the depth of our dysfunctional system. I don’t think I provide any answers but I think I do have a few recommendations for how each of us can potentially get more from the system if we understand it a little bit better.