Monday, June 15, 2009


I began writing this in the ICU unit of children's hospital in Florida. Ten feet away, my wife was sleeping in a hospital bed, curled around my five year-old daughter Riley. Riley was hooked to two IVs - one for steroids and one for blood pressure medication - so she had to sleep with her arms straightened at her sides.
Riley had been diagnosed with something called Nephrotic Syndrome. Her blood pressure was high - within the stroke range even for an adult - and the doctors and nurses had been trying different medications in the hope that her blood pressure would go down to normal. At around 2 a.m. in the morning, they would find the right medicine.
But at that moment, we didn't know that.
I thought about different things there in the dark ICU room, as one of Riley's favorite Scooby Doo DVDs played over an over. I thought about a ritual that Riley performs when I pick her up from pre-school on Mondays. As soon as I walk through the gate to her school yard, she backs up, plants her feet and races toward me. Then she jumps. My only job is to catch this lanky, golden juggernaut girl and then stagger back - as if she has almost knocked me over. Riley doesn't like it as much if I don't stagger. The purpose of her leap is to overwhelm me.
And she does.
That night I also thought about health insurance. What if we didn't have it? Riley didn't seem that sick at first, but we took her to the doctor's office just in case. What if we had waited because we didn't have the money?

Two weeks after Riley left the hospital, I was repairing a computer at customer's house when the customer began talking politics. In general, he felt that President Obama was going to bankrupt the country. I've heard this stuff before, sometimes from friends, and I try to keep my responses measured. I do this because it's the polite thing to do, but I also do this because even though I voted for Obama, I have no idea how this is going to turn out. I'm not an economist.
But then the customer started talking about socialized medicine. I tried to steer him away from the conversation.
"My daughter just got out of the hospital," I said. "Every time I see something about universal coverage on the news, I think about her. I'm probably not the most rational about the subject."
The man persisted. "You're living proof, though. You've got a job and you've got medical coverage. Almost everyone can afford medical coverage. The problem is that you've got people who would rather spend the premium on other things..."
I flinched because I thought he might be the kind of person to end that sentence with " spinners and rims."
But he didn't. He seemed to sincerely believe that our medical system was in great shape.
I didn't try to change his mind. I'm not a preacher, either.

Riley is doing better now. Her medicine costs, thanks to health insurance, only about $300 a month. We're happy to pay this. The money is not the tough part for us.
Riley's medicine gives her something called "moonface" - meaning that her thin, sweet face has become almost round. Her cheeks are hard to the touch and her stomach swells out, too. And for the first time in my five year-old's life, she is afraid to be seen in a bathing suit. She is like Eve just after she was thrown out of the Garden of Eden - only Riley never stole an apple. We think she might be able to stop the medicine in a few weeks.

I've written this column for something like five years now. I try to keep it humorous; I exaggerate a little here; I poke a little fun there. Every now and then I make a pee pee joke for the kids and husbands. But this thing with Riley has changed me. I can't stand the national conversation about health coverage.
Most of the debate is generated by interest groups with something to sell. The purpose of their talk is not to inform us or educate us; their purpose is to overwhelm us - and they do.
So, I'm not an economist, but I'm gonna say a few things about the economy. Nor am I a preacher; but I'm gonna fucking preach a few things.
Someone you know - someone you like and admire - is going to tell you in the next few months that America doesn't need "socialized" medicine. They might even be an actual doctor. They're going to spout talking points about how it will affect job growth in a faltering economy. They might talk about how doctors will actually leave the field of medicine because they can't pay their bills. This is what you should say:
Almost nine million kids don't have health insurance, part of the almost 45 million people in the United States without any kind of health coverage. It's estimated that at least 18,000 people die each year because they lack medical insurance.
If your friend talks about America becoming Socialist - whatever that means - appeal to their rationality and point out that our libraries, police departments and fire departments are already socialized. They have been since the beginning of our country. Tell your friend that our medical infrastructure needs to be exactly like a fire department - because the health of America is dangerously close to being on fire. Appeal also to their common sense. When the next pandemic rolls through, do we really want nearly 20% of America avoiding a doctor's office?
I don't. But then, I'm not an epidemiologist. I could be wrong.
I'm just a father haunted by the thought of all the uninsured families out there that have a daughter like Riley with an undiagnosed problem. The girl is feeling a little sick, but is otherwise okay.
I wonder how long they wait.


Steph said...

first let me say that I'm sorry for what Riley (and all of you) have been going through. It scares me, too, to think of what would happen to my daughter if we didn't have health insurance.
Second, just this weekend, a Latino friend of mine was joking around (but not really), calling the US "Obama-stan." Then he says in the next breath that O is going to turn this country into a Socialist nation. The real kicker to me wasn't that my Latino, 30-something friend was a McCain supporter, but that this young man has a daughter and still couldn't see why real education and health care reform are so important. Maybe that's because his little girl is being raised by her mom, in a different state. Okay, rant over.
Thank you very much for writing this. As usual, I am touched.

Anonymous said...

Beautiful story and well said. I dispair whenever I hear that American provides free healthcare for anyone who needs it. Sean Hannity and the right wing say this because our not-for-profit hospitals are required to take patients regardless of the ability to pay. Ignoring for the moment that we all pay for that care whether we like it or not, like we subsidize shoplifting at our grocery stores, you pointed out the very real fact that when you don't have healthcare, you often don't seek help. I have two examples. One, my sister-in-law, got stung by a bee on her calf. It ballooned from an allergic reaction, and she sent me pictures of the discoloration moved up her leg toward her heart as the poison travelled in her blood system. I begged her to go to the hospital to seek treatment, but she and her husband refused because going to get that "free" healthcare meant that they would be saddled with unpayable bills against their credit history for years and years. Luckily, it didn't kill her, but things like this can easily be fatal. Second, my stepson works for a large, well known do-it-yourself home supply company. He's worked there for years, averaging 60 hours per week. He worked there during high-school, stopped working for a year, and then went back. He had been back around 11 months when he accidentally dropped boiling cooking oil on his stomach. He suffered 2nd degree burns. His company only offered medical insurance after he had been back a year, so he was a month short in qualifying. Like my sister-in-law, no amount of begging could get him to go to the ER even though he was in an immense amount of pain and could have turned worse. In both these cases, things could have been life threatening. And in both these cases the individuals involved decided to avoid the hospital "if they didn't have to go". Our healthcare system is the most expensive in the world, yet we don't provide the best care (by far). We pay the most of any country, yet we are the only industralized national not to offer coverage to all citizens. I'm a libertarian in political philosophy, but I can't understand how something so basic to human goodness, healthcare, could be rationed based upon ability to pay.

Richard, thanks for writing this story.

Anonymous said...

as we speak, i'm sitting at the director's chair to the ER, helping guide frantic friends and family to the ones they love. myspace was blocked; i'm happy i was instead able to read your blog. i've been volunteering in the ER for almost a month now, and i can certainly say it has changed my thought process. i'm lucky enought that my mother is a nurse and makes a steady income. i'm also lucky because she knows how to diagnose whatever symptoms i may have. because i wont legally be considered an adult volunteer for another 4 days, i mostly help out by organizing and re-stocking. despite the lack of excitement in my tasks, i get to witness it all. the people that come into the ER often lack medical insurance. i too, cannot imagine what that worry must be like. i didn't want to volunteer at the hospital when my mom said it was my only option, but i'm really glad i did. it's made me really thankful.
a lot of my friends in high school are children of republicans and before the election one of my friends asked me why i supported obama when my class outnumbered me 21-2 (mccaine majority). the first thing i said was that he supported that everyone get health insurance. he refuted by saying that some of that money would come from doctors paychecks. i told him that could bery well affect my own family's income, but that it makes me really sad when a country as strong as ours cannot provide health coverage for everyone. he was stunned. i'm not the most informed when it comes to politics, but i'm old enough to back up my opinions. i can't say that for a lot of the kids in my high school who choose to support whichever candidate their parents support.

don't worry, i'll help spread the word =]


DeeMomma said...

Richard, we knew each other in high school. What an amazing writer you have turned out to be! This piece "Overwhelm" particularly affected me. My 4 yr old son was born with a brain injury. He spent a month in the NICU. He has cerebral palsy (CP) and a whole host of other acronyms as his diagnosis. We do have private insurance, but we are still just getting by when it comes to his medical and living necessities. Thank you for this thoughtful piece.
Denise (nee Elliott)

Anonymous said...

My little girl is now 20 - she was born premature with only 1 kidney and had 6 fingers on her right (dominant) hand.

Without significant healthcare to get her life started she never would have made it.

It should be a national goal to preserve as much human potential as possible. It is reasonable to commit to a system that ensures that care is available to all who need it without them having to priorities bills in order to determine when or if they will seek out the help that is required.

Capitalism is reasonable for those things for which consuming is a choice - however for those things that are necessary: health, education, safety, basic shelter, and food there is a base-line that should be competently available regardless of one's ability to consume in our capitalist society. Above that threshold of 'decency' consumption/capitalism can again take hold - as in the examples provided by the good GrimRichard - we have libraries - above which we have book sellers, we have fire departments - beyond which we can purchase additional fire protection equipment and devices, we have public education - beyond which we can purchase private education - and so forth.

As a society our goal should be two-fold. We should continue to elevate the base-line, while also continuing to elevate that which is available for purchase above the base-line.

The 'for purchase items' should not so far exceed the base-line simply because that is where the profits are. Such an approach results in a dwindling clientele base over time.

By elevating the base-line generation after generation - we have more people able to purchase more - that is what has sustained and made this country grow great and it should never be forgotten that it has been people – all kinds of people, from all kinds of backgrounds that have contributed to the cause of humanity.

I am sorry that your daughter has experienced adversity and the frailty of life at such an early age – it is my hope that she will survive this time and that it will serve as a positive catalyst in her life – something she can draw on as she continues on the path that she charts for herself.

Anonymous said...

You really need to think LONG AND HARD about your support for govt run health care. The last thing i want to hear when getting surgery is: "Hello sir, i'm from the govt and i'm here to help you"

Govt run education, health, energy, agriculture, transportation, mail, water, fda, fcc, epa has not been efficient nor cheap and it never will be. Its just the most assinine thing to say, that "we need universal health care" .. it makes the person sound like they flunked 1st grade.

The cost of health services would dramatically decrease if we didn't currently have welfarism for the poor and corporatism for the rich. If you want a govt run health insurance, go get on medicare and tell me what you think of it!! no self-respecting human would want medicare.. so why are you pushing for uni-care?? the REASON the health care system is messed up (expensive) is BECAUSE of too much govt, not because we need moreeeeeee govt.

and 300$ per month is a retarded amount to spend for drugs that your daughter probably didnt need.

she wasnt majorly sick till you took her to the hospital, huh?

how about this, the patient pays the doctor for their service?

no corporations that require a profit, no govt which require extra paper work or taxes.. just let it be private.

this is all coming from someone who makes piss-poor wages, no insurance, refuse to obtain govt assistance.

there is no reason why we need a 3rd party between the dr and the patient.

this country is just a buncha pussys that dont want to bite the bullet and get their hands dirty. ie pay their own way.

and you sir, are one to talk. why should we change a system that seems to work just fine for you?

you are a coward, and illiterate, and most of all a scourge to folks who seek information on medical reform.

Anonymous said...

I am not sure why the last person to post thought it was necessary to attack rather than merely make points regarding his or her position and move on.

The simple and clear fact is that the government and the services it provides touch us all every day in meaningful and positive ways.

The education that many of us have received (both basic and advanced) occurred in no small part due to government assistance - the roads we drive are serviced and maintained by our government as are our public buildings and parks.

We live in a relatively free society due to the government's maintenance of a standing military and arsenal that keeps most aggressors at bay.

The government with all of its short comings helps everyone every single day in one way or another - to suggest otherwise is arrogant and absurd. It is akin to suggesting that we can survive without the sun and the earth - no collection of people of any size can survive with out agreement and administration i.e. government for a sustained period of time.

We all get to where we are each day by the grace of those around us - examination of the occasional encounters society experiences with the few "berserkers" that have come and gone in life demonstrates how much social agreement we rely on each and every day merely to get to and from work successfully and without harm.

Many people work very hard and yet do not have the collective bargaining required to have a voice in the system. The government is there to attempt to balance that out. Is it a perfect system - I think not - is anything perfect - I think not.

Johnny said...

I find it to be the very pinnacle of irony that you would be called a coward, by someone who posts anonymously. I'd also like to point out that an illiterate is a person who can neither read nor write. This blog, by it's very nature, immediately puts the lie to that little bit of character assassination. if someone thought you couldn't read, why would they send you a written response? Just asking. You know, I appreciate absurdity as much as the next guy. Seriously, though, why bother giving this goon a voice on your forum? A counter-point to your opinion wasn't necessary..... nor asked for....... especially from some faceless, atavistic lout.
Sorry to hear about your daughter. I hope she's doing well, now. I'll keep a good thought for her.

Steph said...

Well said, Johnny, but I think it's a fine idea to let cowards make fools of themselves.

Grim Richard said...

Honestly, I just thought Nana had been drinking again....