Saturday, February 5, 2011

The Eyelids Part Once Again. Oh, Joy!

Good morning. Slept pretty well last night relative to most nights. Didn't seem to get much noise from the person upstairs. Have put in a deposit for another unit in the next building down the hill. Will move on the 19th. Just too noisy here, especially due to stomping and tromping from above. - Picked up the parts for the bed frame last night. Big, heavy, odd shaped boxes - pretty awkward. Had to stop a couple of times with the biggest box. The mattress will be in next week. That place is bigger with a better view. Top floor and the end unit. Am really crossing my fingers it will be quieter. I talked to the neighbor who is a librarian. He said it's pretty quiet. 'Sounds' good so far.

Read the latest Atul Gawande article last night. One of the resident surgeons gave it to me. Atul says the answer to the healthcare dilemma will arise from persons and organizations who are willing to cut healthcare costs where they are worst. 'Hot spots' as he describes them. He likes the idea of holding the hands of and babysitting folks who are provided care yet refuse to care for themselves. As you can see, I don't entirely agree with him. He says using low-level providers to provide regular or even daily follow-up to insure patients comply with lifestyle recommendations and treatment regimens is the key to keeping them from accessing more expensive care as they become less healthy. His best example of a hospital affiliate that does this is run by a gentleman whose "philosophy about primary care is that the only person who has changed anyone's life is their mother. The reason is that she cares about them, and she says the same simple thing over and over." Indeed he emphasizes that one patient only listened to the clinic's assigned "life coach" (and not to her own husband) because the life coach "talks like my mother".

While I love the idea of caring for people, I do it because I choose to. I am personally convinced that we are here to make choices and learn from our mistakes. I believe we have a purpose here that requires our ability to choose freely. I also know it is much harder to change ingrained habits in adults, and I am not convinced that we all should be required to care for all of us. Then we don't get to choose. And, people who listen because the speaker talks like their mother are choosing to behave like children. Paternalistic care was yesterday's paradigm. Atul and I do agree, I think, that the problem is rooted in human selfishness and sloth. But, he and I have different ideas about how to approach the problem. While we both agree that the solution is love, I also agree with the Beatles: money can't buy me love. Love is a selfless act. And, no matter what you pay your Mom, she ain't doin' it for the money.

I think it's laughable that folks keep trying to "prove" healthcare is too expensive. Of course, it is. It's been right in front of our faces for years. People want. People take. And, some people take what they "shouldn't". That includes hospitals, doctors, nurses, patients, government employees, insurance company executives and mailroom workers. Our society is built on improving margin. Yay, capitalism! It's one of the things that spur us to further effort and innovation. But, we all have the propensity to carry it too far. Some of us just can't keep it in check. Anytime you see a giant, monolithic structure - be it a building, a legal entity, or an organization (even a person) - you are witnessing mankind out of control. They result from false self-belief and a desire to control on the part of their leaders and laziness and self-indulgence on the part of their followers. The bigger they are, the worse they are.

It could easily be argued that we necessitate them by our very nature and that we must allow others to protect us from ourselves. The circularity is apparent here, I hope. The answer must lie outside of ourselves - and then within ourselves. If you can tell me where love comes from, I will tell you what the answer is. Maybe you know what I know.