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Acute on Chronic


There’s always a lot of background noise in our American culture, situations that most take for granted to be the normal course of things. One of these topics is our absolute and utter lack of universal health care. Much hand-wringing and dismay in regard to this reality has been exhibited by those who still reflect and consider, by that I mean, maybe 5% of the population, but most Americans do not comprehend that this is not the norm for the rest of the industrialized world. Even if they know this to be true, they don’t seem to completely realize what we are lacking. We have a rancid lottery every waking day- and the hope that any unexamined, nagging pain won’t eventually bring us financial ruin.

Imagine becoming ill and simply accessing care because you are a citizen, a valued part of the whole. That’s the dignity that other nations bestow upon their masses. They don’t have that fear of becoming destitute simply by accessing healthcare, as did 62% of American bankruptcy filers in 2007 (all of those from medical bills- and 78% had insurance of some type).

The most common utterance from those who are against a universal coverage (that is, those without a profit motive) is that they do not wish to pay for the existence of others. They view the world as a hostile, winner-take-all battlefield. And I mean that literally; these same individuals never seem to proclaim any desire to deny the funds that are commonly used in an over-kill fashion by our military. As an American you don’t get any “free” healthcare, but you do get the pleasure of knowing that your nation spends as much on defense as the next 17 nations combined. And of course there’s the total absence of things like terrorist caused fatalities in the US from 2003 to 2007 (with just 4 reported efforts)- contrast that with the over one million heart attacks suffered per year. What a bizarre notion of risk most Americans have, however, when they grumble about what their tax dollars actually pay for.

$7, 538 is spent per capita on healthcare that is not provided for all. But that money is coming from somewhere, isn’t it? A nice comparison is Japan, which has a cost of $2, 729 per person to administer their universal program. What do they get for that number? Well, for one thing, an infant mortality about half of what the US owns. And as our costs go up, the indicators of health for the nation are going down.

What is all that money being spent on? The massive corporate giveaways certainly continue unchecked. When prescription drug coverage was added to Medicare a few years ago there was that pesky corporate gift that stipulated there would be no negotiation for lower prices in terms of bulk purchases—that has become a huge factor in increasing expenditures. An example of these runaway costs can be had by looking at a medication like Reclast- it’s administered to treat Osteoporosis and the cost of this medication is in excess of $1,000 for a one time use. Never mind that this medication has been implicated in conditions such as osteonecrosis (a fancy way of saying that your jaw erodes) and can also cause paradoxical fractures of bones not from injury. I guess, you have to break some bones to save them? There is a system in place that rewards the newest and most advertised medications, but like a crappy spring fashion show- the newest isn’t necessarily the best.  At present US Emergency Rooms are often unable to get routine and proven medications like the anti-nausea medication Phenergan, presumably due to there being less profit incentive to turn out these cheaper and less glamorous offerings. And of course, the CEOs need to maintain lifestyles.

This “free market” in regard to healthcare is anything but. It’s more an unholy collaboration of rabid extortionists. The pharmaceutical industry is certainly a major driver in all of this. The very culture that sends out cute 20 somethings who cajole and flirt with physicians in an attempt to encourage the prescribing of new medications- well, that’s kind of disconcerting….and don’t be naïve- it works. Most physicians still have that inner nerd who would love to go back in time and have attention from the hotter of the opposite sex. The nerdy boy from “16 Candles” is now your radiologist. And if you need a reference a decade or so later, then Screech from Saved by the Bell is now your…well- that one wasn’t a good example. Never mind that one.

Mind you, this is an industry that thinks it is appropriate to advance a medication for darkening and extending eyelashes even though the stuff can grow eyelashes on…well anywhere that it lands- not necessarily in the correct spots. This might be attractive in the world of bridge trolls, but not so much for others. And there’s the bacterial conjunctivitis issue, and the skin darkening…… Seems a strange benefit/risk ratio, especially since eyelash length probably comes in about number 532 in male considerations for female beauty. Hence, the dismal sales of the Liza Minelli erotic dvd set.

These are clowns pitching snake oil and we’ve given them an undeserved air of legitimacy. And lots of blank checks. Sometimes the government pays (Medicare and Medicaid) and sometimes they don’t- and of course, it’s not for all. It’s a patchwork of misery for everyone but the profiteers.

And this is but one of the drivers of cost. You will have to deal with many others during important life and death illnesses- just when you’re prepared to make rational decisions, right? The insurance industry will happily see you die to achieve profits.

It’s fitting that the presidential race has come down to a couple of fellows who have in one way or another advanced extremely similar measures to provide even more handsome giveaways to the rackets. Because, of course, universal is “off the table”- as was any means to curb profits.

There’s a common phrase in medicine, “acute on chronic”. Just as it sounds, it reflects when a patient has a violent flare-up of an existing debilitating condition. Sadly our nation is suffering from many acute on chronic ailments, including greed and ignorance. It’s a dangerous time when the patient has a flare up of an acute nature because with that underlying chronic condition….it can be the kiss of death. And our nation has no medications at the ready to combat this situation (but some killer eyelashes might be possible).

Kathleen Peine writes out of the US Midwest and can be contacted at


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