Saturday, January 13, 2007

Deus ex machina

deus ex machina: an agent who appears unexpectedly to solve an apparently insoluble difficulty.

Healthcare in this country is in crisis. Rising drug costs, millions of uninsured Americans, bankrupt hospitals, Big Pharma run amok---the most powerful and influential nation in the world still cannot care well enough for all of its citizens. While Senators and members of Congress have health coverage to die for (pun intended), so many of the working poor are denied even the most minimal of coverage. Seniors are forced to choose between paying for prescriptions or groceries, and insurance companies continue to deny certain types of care as costs skyrocket out of control.

Enter the deus ex machina, or at least the hope for some solution which will fall out of the sky and save us. Is it Canadian-style universal healthcare? Is it a market system? (Oh wait, that already failed miserably, right?) Where will we find our panacea of preventive medicine and cost containment?

In Massachusetts and California, governors and legislatures grapple with critical universal coverage mandates which could break the bank, but may just be one answer which could be followed by other states around the country if they succeed. I would never have imagined that Arnold Schwarzenegger, that movie-star playing a politician, would be the one who could actually pull it off. If he does, I'll gladly eat my hat. And here in New England, in Massachusetts specifically, perhaps Deval Patrick---the first African-American governor of that state, and only the second in all of U.S. history---is also poised to tackle universal healthcare which is mandated by law to swing into action on July 1st of this year. And who knows, maybe Nancy Pelosi will perform the miraculous, only to be thwarted by a cantankerous and staid Senate. (Talk about The Bride Stripped Bare By Her Bachelors, even.)

My patients are relatively lucky, receiving the benefits of a cutting-edge program which provides that with high quality care, timely follow-up, and personalized service. Still, drugs are denied, certain procedures and equipment are not covered, and certain specialties are becoming almost impossible to refer patients to as those provider groups stop accepting Medicaid all together. Something has to give, and usually the first thing to go is quality and equality.

So is there a deus ex machina? Will someone or something save us? Will Arnold's proclamations bear fruit, his iconic super-hero status actually managing to be the springboard to bring healthcare to the disenfranchised? Or will Deval Patrick, a descendant of the disenfranchised himself, turn a tide that has been carrying the poor out to sea for decades? Both of these scenarios are possible, and still others are yet to be born, or are now being hatched in minds around the country. But the rest of us cannot necessarily sit on our laurels and wait for others to solve the dilemma. Letters to the editor, calls to legislators, op-ed pieces, dreams and meditations, or even water-cooler chat---all are potential places for the birth of a kernel of an idea that could turn the tide. So, where is the deus ex machina? Apparently it is us.

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