Failure to thrive

One day your mom takes you to see the doctor, squeezes your hand, and tells you it’ll be OK; then suddenly it’s you taking her, squeezing her hand, and filling out all the papers she feels too lousy to complete. One day you lean into your mother’s chest during church, rest your ear hard to hear the steady thump of her heart beating; and in what seems the blink of an eye you’re watching that same heart beat on the echocardiogram monitor.

Because the space between the time your mom takes care of you and you suddenly find yourself taking care of her can squeeze down into the merest measure, how we take care of one another when we are sick is preeminently important. Those trips to the emergency room, the broken bones and internal bleeding (mine, 1969), the raging infection and shortness of breath (hers, 2013) take us captive, seize us with the uncertainty and the brevity of this life. Our whole lives flash before us, and all our choices rise up to confound and perhaps condemn us. There’s a reason Jesus took physical healing so seriously.

So I found myself in a busy emergency room on a late Sunday evening, my mom quiet about our sudden situation amid the beeps of IV pumps and the sound of vomiting down the hall. Don’t talk to me about Medicare protocols or healthcare budget battles. In that moment what matters is my mom receiving the kind of attention that will correctly diagnose what’s wrong, the kind of care that will make her well again. I don’t mean overabundance of care, useless motions of care, I mean the right care—knowledgeable, compassionate professionals giving their best advice and applying it with the best medicine. Because Jesus did make healing His business, and the human body is a wonder: Even at its most broken it’s striving and ready to be healed.

Lyndon Johnson was breakfasting with congressmen to win passage of Medicare and Medicaid about the time I was making a habit of falling asleep to the soft thumping of my mom’s chest during long sermons. In 1965 the American Medical Association warned against the dangers of “socialized medicine,” but LBJ told lawmakers, “I’ll take care of [the money],” and dismissed constitutional objections with, “What’s the Constitution between friends?” (see “Gospel dignity”).

Two generations later, Medicare hospital insurance faces a $32 billion shortfall—and overall long-term unfunded liabilities of $37 trillion. Absent reform, the Congressional Budget Office estimates that Medicare spending will skyrocket from $560 billion in 2012 to $1.041 trillion in 2022. The utopian dream in a matter of decades has become a dystopian nightmare underlying all Washington budget battles.

While costs soar, compassion for the sick falters. In the hospitals of America, Medicare rules rule. Medicare dictated that my mother be released on the third day of hospitalization—even though her very mysterious but potent infection had not fully been cultured and her doctors readily admitted they couldn’t provide a full diagnosis. We discovered specialized outpatient care she needed was prohibitively expensive—and not covered by Medicare. Like many elderly, my mother is a widow of just over 10 years who worked past retirement age but now watches as her net worth plummets. Medicare and Medicaid encourage this, requiring low-income and elderly patients to give up assets and personal property to qualify for care.

We must assume these trends are forerunners to what government healthcare for all ages will be like once it is universal.

I saw valiant examples of compassion by caregivers toward my mom. After learning Medicare would not cover her services, one specialist agreed to do an exam anyway. She submitted a handwritten report “to avoid the system.”

Our third-party payer system—government subsidized care and corporate health insurance alike—is making war on this bond between patient and care provider, essential to making sick people well. Until we address this fundamental flaw, and recognize the warped effect it’s having on the content of care as well as the cost, we cannot treat so-called healthcare reform.

Email mbelz@worldmag.com