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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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