Death be not proud (but it is cost-effective)

Even from my bed on the opposite side of the room it was possible to see the gruesome surgical-steel staples bisecting Miguel's head.

I'd spent three days trying to figure out what had happened to the man who was my roommate at the Cornell Medical Center's Neurosurgical Intensive Care Unit. I watched the nurses run him through the daily regimen of post-op skill tests — if you consider the ability to open your eyes, follow a finger held in front of your face or correctly state your own name a "skill".

I watched Miguel fail many of these tests over and over again: he could barely keep his right eye open, at one point leading the nurses to get creative and use a piece of surgical tape to secure his open eyelid to his forehead; he never spoke in anything above a barely audible mumble.

It wasn't until the day that Miguel's children showed up — when I was forced to sit silently and watch a tragic bit of theatre play out in front of me — that I worked up the courage to ask the nurse just what kind of catastrophe had taken place inside his ruined brain.

He seemed to barely notice his children were there — hardly respond when his wife stroked the palm of his hand. Even someone who had never met this man until a few days ago could tell that he was a mere vapor trail of what he had once been.

The nurse explained that Miguel was recovering from surgery to remove a brain tumor — the exact kind of tumor that had been removed from the same place in my head just three days earlier. He and I were basically the same person.

There was a simple explanation as to why I couldn't recognise myself in the mirror of Miguel's one good eye so to speak. Miguel's operation may as well have been done by Theodoric of York compared to the hyper-advanced microsurgical resection that was performed on me by one of the country's most revered neurosurgeons.

Miguel was left with a massive scar; I had none. Miguel had been in the hospital for well over a week, and would likely be there much longer; I would spend only five days in the ICU, then be discharged.

I'd be back on my feet within weeks, while Miguel likely had years of mental and physical therapy ahead of him. Same medical crisis — different outcomes.

As I sat there just a couple of days after my surgery, I reached the obvious conclusion: there but for the grace of my insurance carrier go I.

I work for one of the largest media conglomerates in the world. I've rarely been employed by a company that wasn't in a position to offer its full-time staff access to the best health care money can buy.

Yet something about this fact has always rubbed me the wrong way: An ironically sickening reminder that in the 21st Century United States there's nothing that's above having a price tag slapped on it.

The parents of 17-year-old Nataline Sarkisyan understand this all too well. On December 20 they laid their daughter to rest in Glendale, California — closing a harrowing three-year fight with bone marrow cancer.

Hundreds were on-hand for Nataline's memorial service, including a few celebrities who had taken up the cause of saving the young girl during her last days. Their appeals hadn't been directed at God or Mother Nature but toward a much more powerful body when it comes to deciding whether a human being lives or dies these days: Cigna Corp, an HMO (health-care insurance provider).

Just before Thanksgiving, Nataline underwent a bone marrow transplant, complications from which caused her liver to fail. Cigna twice refused to authorise a liver transplant, despite a written appeal from her doctors (the company insisted the procedure was "experimental").

It was only after the case began to receive national attention that Cigna capitulated.

The company's chief medical officer issued a public statement that attempted to cast damage control as legitimate concern. He said that Cigna had decided to make an exception for Nataline "given our empathy for the family and the unique circumstances of this situation".

"We volunteered to pay for it out of our own pocket. We decided to bear the risk even though we had no obligation to", the good doctor went on to say.

It's a damn shame Al Gore already got that Nobel Peace Prize.

Nataline died a few hours after the decision was made to grant her the liver transplant.

In 2007 a lot of unnecessary controversy was generated by muckraking filmmaker Michael Moore's excellent indictment of the US health-care system Sicko. "Unnecessary" because, despite whatever feelings one may have about Moore, only the most ruthless capitalist would be unwilling to admit that the way we care for the sick in this country is almost irredeemably screwed up.

We've given an entity as unscrupulous and indifferent as the free market control over whether we live or die. Health care and profit are two thoroughly antithetical concepts. Giving CEOs the authority to stand on the edge of the arena and issue a final thumbs-up or down while we lay incapacitated or dying is like charging a lion with protecting the Christians.

The most shocking and infuriating two minutes of Sicko, and the most effective, provide an irrefutable answer to the question of just how things got this way — how a system that was once predicated on a commitment to good health care for all US people became a cynical money-generating engine willing to let people suffer if it means turning a profit.

Moore plays part of an audiotaped conversation between Richard Nixon and his flunkiesque assistant for domestic affairs, John Ehrlichman. Ehrlichman advises Nixon on a plan to overhaul US health care that's being put forth by industrialist Edgar Kaiser — the founder of Kaiser Permanente. Nixon says to Ehrlichman, "You know I'm not keen on any of these damn medical programs".

Erlichman reassures him by saying the magic words: "This is a private enterprise one. Edgar Kaiser is running his Permanente deal for profit. All incentives are toward less medical care, because the less care they give them the more money they make."

Nixon's reaction? "Well that appeals to me."

Thus were sown the seeds of the modern HMO. The day after that conversation took place, on February 18, 1971, Nixon proposed a new national health strategy based on managed care from private companies.

It worked toward obliterating social medical programs — because "socialised medicine" had long been dirty words, the product of anti-Soviet paranoia — and masked greed under the guise of providing people with the best care money could buy, which was great as long as a patient had money to afford the best care.

Nataline's family had health insurance, and maybe that's the most appalling aspect of her story. She never should have died because she was one of the "lucky ones": the services were in place to save her life.

Her parents fully expected that when their child got sick, there would be no questions, no arguments, no delays — there would just be the care she needed. They lived in the most powerful, wealthy and technologically advanced country in the world after all, and they both had good jobs and did their part to contribute to society.

Now they're left demanding answers — wanting to know why, in this wealthy nation, there was even a question as to whether it was fiscally prudent to save the life of their daughter.

The mammoth company for which I work made sure I had the best possible medical care when I needed it — they paid for it. I never feared coming up with the money to see a doctor, which meant that I discovered the tumor in my head before it grew to the size of a golf-ball. That meant that it could still be removed through a procedure done by only three hospitals in the country.

It's because of all of this that I sit here today able to tell you about it. I'm not sure Miguel could say the same. And I doubt his wife and children believe that my life is worth more than his.

[Abridged from http://www.deusexmalcontent.com. Chez Pazienza is an Emmy-award-winning journalist.]

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