There But for the Grace of God

                   

Gen. Pinochet, Chilean Dictator

I'd like to tell you a story that spans decades and continents, but begins right here at home. It's sparked by me reading the other day that the OECD (Organization for Economic Cooperation and Development, based in Paris), rates the US's health care (and child poverty and overall poverty by the way) on about the same level as Mexico and Turkey.


So much for US exceptionalism. Last Saturday I went to the pharmacy and picked up a bottle of pills (the copay was $5). This ended a cosmic struggle that started last year but became a crisis 3 weeks ago. Negotiations for approval of this medicine that had been prescribed in November involved two doctors, three nurses, and of course the insurance company and drug store. I made calls, sent emails, and whined - almost daily.


A good buddy of mine, after enduring yet another complaining email from me about this saga, emailed back about her own encounters with the same system:

You need to be patient beyond belief, smarter than the average lawyer, understand medical talk to a level the average person would never suspect, and be prepared that you will probably never get the same person you spoke to last.  Not to mention those who don't document in their system well or don't mind being a liar.   

It has taught me to get hard copy prescriptions in some situations and to start early and call more than once until you can match stories.  And the only thing that works for me is if they can see I will buy from somebody else when I reach the end... I am not having fun yet. 

I have learned all about maintenance drugs, specialty pharmacy options, Custom Authorization options and I'm here to tell ya that I think I may know more than [insurance company's] average associate about all that.  Maddening!   Not to mention I have developed a longing to once again see the top of my kitchen table.  When I get done, I hope to pretty easily know when I need to refill my prescriptions/get a new prescription and from where and under what option or plan it comes under, to get the best price.  But it is work and even after I do it I'm not sure they will do what we have agreed is going to be done. 

For me, the worst of it arises at the intersections created by the Iron Triangle of medical care: my primary care doctor's office, my specialist doctor's office, and my insurance company. No one of them is solely to blame, and no one of them is blameless. The communication mechanisms between them are atrocious. 


I am firmly in the camp of single payer medicine. Yes Newt: socialized medicine would be fine with me. And I want to add something, now that I've gotten today's health care rant off my chest.


Remember at the top of this post, before my friend and I got all wound up about our pills, I mentioned the OECD ranking of the US? Well, even with the chaos, I did get the pills, they cost me five bucks, and in general I really like my doctors and most of the people they employ as helpers. I even hate my insurance company the least of any I've ever dealt with. I have a complicated, difficult to manage chronic illness and I know with lesser care, I could be dead.


So if my health care is kludgy and sketchy, but actually pretty good, our middling OECD ranking must mean that there are a very large number of people in the United States a lot worse off than I am. A lot worse.


So I sit here feeling bad for myself because it took me so long to get my pills, and frankly I was frightened, given the serious health consequences of a failure to score. But I was oblivious to millions of grownups and children in the US who have only the most rudimentary health care, or no health care except in the extremity of the emergency room. Thinking this, I feel sheepish and a bit greedy.


This leads me to the second part of this tale. People reading the blog from the early days may remember my election observing trips to Chile in the late 80's and 1990. Chile, by the way, has health care and poverty indexes very similar to the US, Mexico and Turkey.


I loved visiting Chile. It's a beautiful country with delightful people - energetic, thoughtful, cultured, very political and not too shabby when it comes to having a good time. During my visits I met many people who were taking drastic risks for the sake of liberty and protection of others. Most of them were students and poor people; quite a few were Catholic clergy and activists. I spent many hours in little coffee bars drinking endless glasses of cortado - a kind of coffee plus hot milk drink like a latte - discussing politics, art, love, and more politics. Many of us carried lemons, to use as an antidote to the frequent tear gassings that punctuated our long afternoons.


During one such afternoon, some of the people I was with wanted me to meet a family who lived not too far away. This family had recently become anti-Pinochet. General Augusto Pinochet was the dictator of Chile for 16 years, and my first election observing there was for a simple plebiscite in which people could vote yes or no about having new elections for President.


My Chilean friends were uncharacteristically vague about why they wanted me to meet these nearby people, but I trusted my hosts. The activists dropped me off to enjoy more coffee in a nice second floor apartment in a comfortable neighborhood of Santiago, with a couple and their two teenaged kids.


After about 2 minutes, the word landsman popped into my head. This is a Yiddish word my mother used frequently. Literally of course it means countryman, but really it meant someone familiar on a gut level, intrinsically comfortable - someone from your soul's country, maybe. And these people it soon became clear were in fact a nice middle class Jewish family. Decent, earnest, smart, lots of fun. I was at home, this was where I had grown up.


And for 15 and 1/2 years, they had supported the horrific Pinochet dictatorship. I was astounded, as if I had learned that my socialist grandfather was a closet Republican. How could these people whose most subtle habits and values were my own, have been supporters of a monster?


That half hour coffee with strangers was one of those life pivoting moments. By bringing me to see people who were so much like me, my activist friends helped me to dismount from a high horse. The nice family just didn't know people in the slums 45 minutes away with dirt roads and no running water, I doubt they had ever seen anything like that. They didn't know families of disappeared students. They certainly felt uncomfortable about Pinochet. But after the first rough few years, like most other Chileans, they got used to life under the dictatorship, and its inconveniences and occasional anxiety.


Do you see where I'm going with this? I am exhausted and enraged by the rigamarole I went through to obtain my medicine. But in my daily life, I have little contact with the vast number of people in my country who live in daily fear of hassles by the police, who have no health care, who live with rats and bad heating and no hot water and the entire long list that comes along with poverty. I don't mean to tell you that life under Obama is comparable to life under Pinochet, I will vote again for our President. But I am a well-meaning, safe and insulated guy sitting in the house I own with the heat on and a doctor who looks after me. I've let social class cushion me from the millions of fellow Americans whose miserable lives make sure the OECD pushes our quality of life averages downwards. 


I didn't learn that day in Chile to pretend I'm other than I am or add guilt to my life. Instead, what I took away is a determination to become better aware of parts of society I don't easily see, and to let a broader series of values inform the kinds of decisions I make, the people I vote for, the causes I take up.


And to never forget that I'm one reactionary Republican demagogue away from joining those unfortunates at the bottom of the scale.

My oldest son Jason and I, About 1971