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There was an excellent editorial comment in the New York Times yesterday on the nature and the breathtaking scope of our looming crisis in the cost and delivery of health care.

We've forgotten the wisdom contained in aphorisms and nursery rhymes. Ever hear "An ounce of prevention is worth a pound of cure?" "A stitch in time saves nine?" Or of trying to put Humpty-Dumpty back together again? I shudder to think of the kind of world our children and grandchildren, and their children and grandchildren, are facing due to our, and our parents' and grandparents', and their parents' and grandparents', keeping our heads buried so deeply in the sands of denial of so many issues of cataclysmic proportion (medical care and its delivery and financing being only e pluribus unum) almost inconceivably monstrous in their ever faster-approaching impact.

Will we remain asleep at the wheel until the Rubicon is crossed and there is no going back and no longer any possibility of righting the floundering ship? Will we greedily just keep on pushing Humpty-Dumpty from behind like "good Republicans" until we finally tip him off the wall, he shatters on the ground below, and nobody - not even all the king's horses and all the king's men - can put Humpty-Dumpty back together again?

It looks like it. It has looked like it with such outspoken clarity since Inauguration Day in 2001 that only the most ignorant, the most apathetic, the most unengaged, the most slapphappily optimistic, the most ideologically indoctrinated and hidebound, the most dishonest, and the insane (psychosis or insanity, after all, is characterized by extreme denial of reality even when the facts are clearly laid out) among us could have not seen it as it transpired before our eyes.

In order to establish an analogy, a personal story: In the beginning, over four years ago now, after the first big Texas TRAP (Targeted Regulation of Abortion Providers) law was passed and before it took effect, there was much discussion among abortion care providers about exactly how to implement compliance with the law, and this discussion seemed to course through Elisabeth Kübler-Ross's five stages of grief (perhaps better termed "the five stages of cataclysmic change"). Each person involved roughly went through [1] denial ("Oh, don't worry. They’d NEVER go THAT far, but even if they did we wouldn’t REALLY be expected to comply with something THAT draconian and absurd – and they are only trying to scare us and wouldn’t REALLY punish us as severely as the law allows."), [2] anger ("Those %$@#& bastards! They ARE going that far, and they DO plan to force us to comply and punish us if we don’t!"), [3] bargaining ("This is so ridiculous that I’m SURE we can talk some sense into them and get them to just drop it or at least really tone it down a lot."), [4] depression ("They won’t even listen to us; all is lost."), and [5] acceptance ("OK, it's REAL. They REALLY DO mean every bit of it, and all we can do is clear our heads and REALLY get down to doing all the work and making all the changes and adjustments it will take to comply."), and it was not until the final stage was attained, in some cases at virtually five minutes ‘til midnight on the day before the law went into effect, that effective steps to implement compliance could be made.

In every facility and all around the state abortion providers went through harrowing conflicts as individuals fell in and out of alignment with other individuals as the inevitable result of each progressing, often in a step forward, step backward manner, at his or her own pace, through all or most of these stages, so that effective communication became very difficult or even impossible between, e.g., one stuck in [1] denial or [2] anger and one who had progressed to [5] acceptance.

As a non-owner physician I had long since become accustomed in kinder and gentler times to trusting and leaving the administrative details almost completely up to the manager and/or owner of any clinic with which I was associated. I loved the freedom from concern about management details and hassles, and the avoidance of it was one of the main reasons I never established my own clinic (another being not having the guts after a clinic I was working in and negotiating to buy was totally burnt to the ground by an anti-abortion fanatic in 1985 - I guess I've had a bit of PTSD since that). In keeping with this long-ingrained habit, I didn’t give the transition as much thought as I should have prior to that "virtually five minutes ‘til midnight" mentioned above and was shocked into awareness that, as I then saw it and still do, the owners and managers of many clinics in Texas were gambling with their physicians’ lives and livelihoods, as well as the survival of their clinics, by not taking the law seriously enough, i.e., IMHO, stuck in stages [1], [2], and [3], and this awareness struck me at a point when time to resolve differences was too short.  I was forced into a "Sophie’s Choice" of either possibly risking criminal prosecution or resigning from an association that at that time meant a lot to me in terms both of income and personal/professional relationships. I resigned. We abortion care providers have all so far survived and kept our services as available and accessible as the draconian, medically unmerited law allows- both those who gambled and those who did not - by all of us finally settling into stage five and doing what is necessary to comply.

Once such laws are in force or soon inevitably will be, just assume from the outset that it is past time for you to have progressed to stage five: THEY DO MEAN IT and THEY WILL ENFORCE IT.

I think the same dynamics of the five stages of cataclysmic change are afoot in regard to many other cataclysmic changes that are inevitable over the not-nearly-distant-enough horizon (global climate change, economic insolvency of the world's one "superpower," the mushrooming need of dramatic restructuring of the nation's health-care system, etc.). This era might be known in the future (assuming for the sake of argument that there will be one) as "The Age of Cataclysmic Change." Either enough of us will wake up and come together to cataclysmically change and adapt our antiquated beliefs and systems (if Humpty-Dumpty has not already lost his balance and there is still time) or the troubled world of human religious/political/economic conflict and the forces of nature will cataclysmically change it for us in ways that are unthinkable. At this point in time my greatest fear is that too many of us are stuck in stages one, two, and three, stitching nothing in time and intent upon pushing Humpty-Dumpty off the wall.

STAGE FIVE = Wake up! It's upon us! We gotta DO something! At least stop pushing! ASAP!

Based upon their clearly maladaptive record and persistent championing of unreason, hypocrisy, dishonesty, and frank delusion, I can't see any hope of adapting and righting our floundering ship if the contemporary Republican Party retains power in this country. Or if the Democratic Party wins only by becoming Republican-Lite. None.

There has never been an election as important to the survival of this nation as the one coming up in 2008. Never.

I do not know with what weapons World War III will be fought, but World War IV will be fought with sticks and stones. - Albert Einstein

My grandfather rode a camel. My father rode in a car. I fly a jet airplane. My grandson will ride a camel." - Saudi saying

Originally posted to Beket on Mon Nov 26, 2007 at 02:44 PM PST.


Which stage are you in?

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Comment Preferences

  •  I am awake and alert. (9+ / 0-)

    Unlike you I had read enough and also read the PNAC doc. before Bush was slected. When they declared Bush, part of me died. I agree we must win this election. If we lose, democracy will be only one of the things read about in History Books.

    "Though the Mills of the Gods grind slowly,Yet they grind exceeding small."

    by Owllwoman on Mon Nov 26, 2007 at 03:09:35 PM PST

  •  Democrats must bite the bullet... (5+ / 0-)
    Recommended by:
    SarahLee, annrose, moiv, Beket, Jain

    and be ruthlessly honest about the difficulty and choices that must be made if, and the key word is if, we are to transition to universal health care.

    This editorial, which I read yesterday, was notable in that it was not partisan, not blaming one side, just looking at the immense difficulties that must be faced.

    One sentence stood out, since I am aware of it, have diaries on it, yet it is not acknowledged by any of the candidates.

    Prevention. Everyone seems to be hoping that preventive medicine — like weight control, exercise, better nutrition, smoking cessation, regular checkups, aggressive screening and judicious use of drugs to reduce risks — will not only improve health but also lower costs in the long run. Preventive medicine actually costs money — somebody has to spend time counseling patients and screening them for disease — and it is not clear how soon, or even whether, substantial savings will show up.

    Even this long sentence is self contradictory.  "Will lower costs in the long run" and then "It is not clear...even whether substantial savings will show up."

    The Times can't quite let go of the myth so it contridicts itself in a single sentence.  No, prevention, based on all evidence, may, that is may, increase health, but it will cost more, not less money.

    The Times had an extensive article describing the reasons which I can look up if there is interest.

    But, universal health care, as this editorial points out is difficult.  And if done wrong, if it fails, it will be the last time we will try it in this generation, and maybe the century.

  •  Whoops, Times didn't contradict themselves...n/t (2+ / 0-)
    Recommended by:
    annrose, Beket
    •  Nope, because (4+ / 0-)
      Recommended by:
      SarahLee, annrose, moiv, Womantrust

      the Times merely reported that lowering costs is hoped for. Is that your meaning?

      It (UHC, if attempted)will be such an overwhelmingly complex and enormous, powerfully resisted, undertaking that I fear it will just continue to be ignored. The same for global climate change and a long list of other gargantuan crises edging toward tipping points.

      No matter how fervently you believe that you know what you merely believe, you merely believe it, and you might be wrong - very wrong.

      by Beket on Mon Nov 26, 2007 at 03:43:09 PM PST

      [ Parent ]

      •  The thing is that OTHER countries (4+ / 0-)
        Recommended by:
        annrose, Beket, Womantrust, Tennessee Dave

        Seem to be able to at least get a handle on some of these issues. What has happened to us?

        Could it be the religious fervor taking over too much, to the point where too many people just turn off their ability to think, reason and plan?

        "A common mistake people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools." Douglas Adams

        by splashy on Mon Nov 26, 2007 at 04:37:20 PM PST

        [ Parent ]

        •  Undoubtedly (2+ / 0-)
          Recommended by:
          annrose, moiv

          Could it be the religious fervor taking over too much, to the point where too many people just turn off their ability to think, reason and plan?

          This plays a big role in the denial and resistance.

          Let us pray...and Jesus will take care of us.

          No matter how fervently you believe that you know what you merely believe, you merely believe it, and you might be wrong - very wrong.

          by Beket on Mon Nov 26, 2007 at 05:18:08 PM PST

          [ Parent ]

      •  In some ways UHC is more difficult than climate.. (3+ / 0-)
        Recommended by:
        moiv, Beket, JG in MD

        change.  At least we can measure CO2 and polutants, and there are few unanticipated consequences.

        Health Care is an industry, with some aspects doing good and others doing harm.  And the problem of third party payment will be even more accentuated when the third party is the government.

        Read the NYTimes article by a psychiatrist who pushed an anti depressant during lunch, and the subtle way that the books were cooked.  Government is designed to respond to perceptions, not evidence based medicine.

        I just don't know how, or even if, we can get there from here.  

        •  I understand and share (3+ / 0-)
          Recommended by:
          annrose, moiv, Tennessee Dave

          I just don't know how, or even if, we can get there from here.

          It may be that the hole has just been dug too deep for us to escape, but if we don't change directions, whatever the price, we will wind up where we are headed, and I wouldn't wish that upon my worst enemy, much less my grandchildren.

          No matter how fervently you believe that you know what you merely believe, you merely believe it, and you might be wrong - very wrong.

          by Beket on Mon Nov 26, 2007 at 05:23:06 PM PST

          [ Parent ]

      •  And in 2008, Medicare cuts it allowable (4+ / 0-)
        Recommended by:
        annrose, moiv, Beket, JG in MD

        payments to docs by 10%, while the cost for Part B (physician's care) increases.  That means some docs will not be able to afford to continue to be Medicare providers and we the patients (Medicare participants) will pay more.
        Makes the reality of UHC look more bleak.
        Anyway Beket, thanks for a good diary and good analogies.  Please keep writing.

        •  Price controls are a major reason (2+ / 0-)
          Recommended by:
          Lefty Mama, JG in MD

          that health care in 25 other highly developed countries costs 40 to 60% less than the $7130 a year per capita we spend in the US -- and their clinical outcomes are as good or better.  And when all or almost all residents are covered by the same public plan, there is very little market incentive to stop serving 95% or more of the population.  Instead, everyone, including a provider, has an incentive to make the public payment system work.

  •  Problem is... (5+ / 0-)
    Recommended by:
    SarahLee, moiv, Beket, Jain, Womantrust

    these Republican assholes don't compromise at all.  With Bush, it's his way or the highway.  Every time I think he's got a chance to be reasonable, he's gone over the top and been as unreasonable as possible.  They want to kill Democracy by putting the most unqualified people in power to steward it and "drown it in it's own bathtub".

    The Dems, on the other hand, insist on being nice.  Playing fair.  Compromising.  And that doesn't work with these bastards.  They have no sense of shame in being unfair themselves, then accusing the Dems of being unfair too for doing something better than they were willing to do.  They are the bullies in the schoolyard.

    You can't give these Republicans even an inch.  They'll take a mile.  And they've taken it because the spineless Democrats have let them.

    HotFlashReport - Opinionated liberal views of the wrongs of the right

    by annrose on Mon Nov 26, 2007 at 04:15:35 PM PST

  •  If Democrats fought half as hard (2+ / 0-)
    Recommended by:
    annrose, Beket

    for what is right and true as the Republicans fight for their Simultaneous Parallel Backwards World theories, our side would be winning.  

  •  Beket Excellent diary. (2+ / 0-)
    Recommended by:
    annrose, Beket

    I am afraid Hump fell off the wall when the Decider decided to invade Iraq and to make all the myriad of baadddd decisions he made over the rest of his two terms.  I heard a speach that Joe Biden made to the National Press Club back in August yesterday afternoon on CSpan 2 in which he said that who ever is the next president, there will be no room for error.  That just one more miscue might well lead to a catastrophic event that destroys any future healing that the Hump might reasonably expect to follow the removal of TGDSOBGWB from office.

    A private gyn office offering full gyn services including abortion care to 18 weeks.

    by william f harrison on Mon Nov 26, 2007 at 07:12:31 PM PST

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