9/16/14 My Anniversary

This month is the 6th anniversary of the unknown infection that put me in the hospital for a week. Mainmost (one of my long-time physicians) failed to find any specific thing wrong, but after a week of non-stop testing and IV antibiotics, I improved enough for them to let me go home, having had, they said, an unknown viral infection. Two weeks later a still blistering high white blood cell count revealed during a follow-up visit to Mainmost, and his looking at a blood smear under a microscope sent me the same day to Hemosapien, who also looked at my blood under a microscope and did a bone marrow biopsy (my first!). Thus the Leukemia diagnosis.

I still remember Mainmost’s slight shake of his head as he was peering down into the microscope. I don’t think he meant to do that so I could see it, but he did and it was worrisome. The urgent need to see a Hematologist right away was worrisome. Hemosapien was brand new, fresh out of the University of Mississippi Medical School and a residency in Hematology and Oncology at UMMC in Jackson. He also gave a slight shake of his head as he peered at my blood on the microscope’s slide. He didn’t mean to do that either. Mainmost shook his head because what he saw did not portend well for a long-time patient and friend. Hemosapien did not like what he saw because it was simply what it was, which it was whether one liked it or not. Hemosapien didn’t know me yet; I was simply another new patient handed over to the new guy at the oncology clinic.

The headshake was unmistakeable, though. “Uh-uh. Tough titty said the kitty,” the first headshake seemed to say to me both times, but more so the second, seemingly because a new strange doctor was looking at it, but in reality because it was an unspoken corroboration of what Mainmost had seen in my blood, whatever that was. It couldn’t be good.

Now, I know what they saw: immature white blood cell blasts, and far more of them in a given sample than there should have been. Now, I could take a microscope and look at your blood and see what they saw if what they saw in mine is there to be seen in yours, and I am not a physician of any kind…I just know immature white blood cells when I see them; from that I may not be able to determine what is wrong with you, but I sure could give a slight headshake knowing that something is indeed wrong.

But then…those headshakes then . . . those headshakes seemed to be like a 180 grain bullet fired at muzzle velocity of 3,000 feet per second striking me right between my eyes.

Hemosapien’s urgency to do a bone marrow biopsy was unsettling, too, though at that time he had the time, and so did I. Six years later, he would likely schedule one as a special appointment rather than have the time to do one off the cuff, on the spur of the moment, at his whimsy, for his practice has grown. I suppose he is glad for the business, but I think in his heart of hearts he’d rather not have new clients, really. It’s a hard business, that of an oncologist. I’m glad it’s him doing it and not me. I suppose physicians never really want new patients, they just want to help those who need help. Of course this is not true with all physicians, for the highest paid among them are surgeons who sometimes, occasionally, recommend surgery for all the wrong reasons. I don’t have any of those people as physicians. I’d fire them if I thought they were.

Hemosapien and I have discussed the state of health insurance. He is well paid for what he does, as he should be since he made many sacrifices to get where he is, besides having the extremely unpleasant task of telling some people and their families that they have terminal cancers, or they have very aggressive cancers that will require surgery and drastic chemotherapy…some of them will make it…some of them won’t. Some of them he painfully has to tell that there is nothing they can do…go directly to hospice…do not pass Go…do not collect $200. He has to make sure patient relationships stays all numbers with him, else he have no mind to use to treat his patients. Like I said, it is a hard business. When and if my CLL finally gets me, it will get to him, too, though he will not have time for it. He will mourn in his professional way of mourning, rely on his training, and both of us, he and I, being Christians, have the promise of a trouble-free reunion one day. It could be that something gets him before something gets me. There are no guarantees here. If it gets him, I will get a new doctor. If it gets me, he will have room for a new patient.

“One monkey don’t stop no show,” senior show management once said to a disgruntled and very young me.

Hemosapien and his clinic don’t participate in any plan in Mississippi that is offered under the health-care exchange run by the government. None of my physicians do, though it is going to be difficult for them to resist, since the government is going to find a way to make them participate. Medicare will be that way.

All of my physicians take Medicare. Oncologists, Urologists, Gastroenterologists, and Pulmonologists all have a significant number of over 65 patients. If the government simply tells them, either take exchange patients or no more Medicare, what are they going to do? Are they going to abandon a significant number of their patients for whom they have been caring for years? That is unlikely, though many physicians will retire early rather be forced into compliance, thus we will lose many experienced physicians right at the very time physicians are needed most since more people will have insurance access to them. Indeed, we could see rationing.

It is easy to say that a single payer system is what we need since America is the only advanced nation that does not have one. I am not as sure about that as others are, since some of them seem to be very certain. Britain’s National Health Service is every bit as efficient as the VA is in America. If one wants to look at nationalized healthcare, take a look at the VA. This is what you wind up with when you rely on the government since the government doesn’t do anything very well. It seems to me that government does most things poorly as the number of administrators, regulators, and assistant administrators and regulators, and deputy junior assistant administrators and regulators would multiply as fast as the malignant white blood cells did in my body six years ago and far faster than the number of front-line health care professionals and facilities they would regulate.

Yet I want everyone to have access to the same excellent healthcare that I do…that I have been fortunate to have. But how are we supposed to trust our government to do anything it says since nothing it has said has been so far trustworthy? The figures show that most people are paying more for health insurance, not less as promised. One has to get anecdotal to find the individual case of someone who is paying less, and that because of a complicated subsidy that may or may not be legal in many states (this is still working its way through the courts since the wording of the law only permits subsidies in states that set up their own exchanges, not on federally run exchanges).

I have no answer. What we had before the Affordable Care Act (ACA) was capricious and awkward for millions. What we have now is at least as, if not more capricious and awkward for as many millions. As many people were thrown off their insurance as were put under the exchanges, and what will happen in the insurance marketplace between now and the end of the year is anybody’s guess. My guess is that millions more will lose their insurance, which, I think, is what the government wants.

Yet the insurance companies get a free pass, called loss limits, which were to be paid for with fees that were waived by the administration. I don’t understand this, though there is something the insurance company executives should understand: as any insurance actuary can tell you, you don;t get something for nothing. Before the government gets through embedding its lengthy claws, there will be no health insurance companies. They will have vanished.

It is a remarkable thing to study, though. There is a direct correlation between insurance and health care costs. In former times, one paid for his own health care and purchased a major medical policy that kicked in only when there was otherwise financially ruinous medical expenses. Short of that, everyone paid out of their pocket. Then, employers, mostly pressured by unions, began to offer health care benefits to their employees. The unions themselves offered health insurance to their members. Federal, State, and Local government employees had their own health insurance. Pretty soon, everything was about health insurance, particularly if you were one who lost your job, lost your health insurance, and had a medical condition which no sane insurance company would willingly cover. Eventually, we settled into the 80/20 plan and, lo and behold, the 20 percent was about the same as we used to pay anyway. The 80 percent was the amount that health care costs went up. In other words, health care prices expanded to fit the available supply of money. The exact same thing happened in the housing market. As sub-prime loans were being made under pressure from government and banks learned how to decrease their risks in these sub-prime loans by bundling and selling them, housing prices exaggerated to keep pace with the money supply. As the number and amounts of student loans increased the cost of tuition escalated to keep pace with the money supply. At the same time, the value of our educations has gone down, or at least the value of many fields of study. The value of our homes has dwindled. And the quality of much of our health care has declined, though it is still pretty valuable to someone who is seriously ill. To the young, healthy, and bullet proof, there is no need for health insurance.

“Health insurance is what other people need, not me,” they like to tell themselves.

“Oncologist? Why would I need to see an Oncologist?” I asked. “Cancer is what other people get. Not me.”

Enjoy the rest of your day. Enjoy the rest of your life. Do the best you can with what you have, what you still have, and what you have left. That is all any of us can do.

Happy Anniversary. I plan on having another one next year.

©2014 Mississippi Chris Sharp

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