My father-in-law, Bill, lay dying. He lived a remarkable 92-year life and we wanted to make his last days as comfortable as possible. Unfortunately, the medical insurance complex that combines the worst features of capitalism and socialized medicine did not care about Bill or his family. His final days are a case study on our broken health care system.
Bill resided in a nursing home facility and required simple medical attention, an IV for dehydration and another round of antibiotics. Although the nursing staff could do this, it first required an exam by the on-call doctor, who refused to come in. We were told to take him to an emergency room. This was unacceptable. We had been through that ordeal many times before: basic medical care that required an ambulance ride and to from the hospital, six to 12 hours waiting in a cold examining room as patients stacked up in the hallways and an overworked medical staff that interpreted "Do Not Resuscitate" as "Do Not Provide Care."
A hospice doctor happened to come by. Yes, she could prescribe an IV and antibiotics, but she was not Bill's doctor unless we transferred him to hospice care. We agreed, setting off a bureaucratic tug-of-war between the nursing and hospice care facilities over my father-in-law. The on-call doctor didn't "feel comfortable" letting his nursing staff carry out instructions by the hospice doctor. Cell phones rang and hours rolled by as negotiations and conference calls were held between medical administrators.
All parties finally agreed to the transfer of care. Two nurses came by with a phonebook-size binder with Bill's medical records and started filling out the paperwork for his transfer. An hour went by and these two highly trained health care providers continued to fill out paperwork. I pulled out my laptop and checked for a wireless hot spot and found none. No need for mobile computing in the land of paper and pen. Another hour passed before they finished writing his name on countless forms.
Now we had to wait for the saline solution and antibiotics, across town at the central hospice pharmacy. Compassion and luck reduced that two-hour wait to an hour; a pharmacy worker on the way home swung by and dropped off the prescription. Seven hours after intense efforts of a pro-active, loving family, nurses came in and provided basic medical care by inserting the IV.
This is a story of sympathetic individuals and uncaring institutions. All the nursing staff in the hospice/nursing home provided professional, compassionate care. The hospice pharmacist stayed late to fill the prescription. What I saw was an inefficient and indifferent bureaucratic system that was unable to economically provide basic health care. It is a system that is obsessed with saving pennies, like a centralized pharmacy center, and oblivious to excessive costs, such as having an emergency room provide routine medical care.
I saw a medical staff hampered by institutional boundaries and paperwork. We endured a for-profit health care company unwilling to provide medical care yet unwilling to relinquish control. The medical insurance complex is supported by employers, subsidized by taxpayers and has little interest in reducing costs by increasing efficiencies, and profits are maintained by raising rates and reducing care. Compared to other industrialized countries, we Americans pay twice as much for mediocre care.
Several days later, Bill enjoyed a breakfast of waffles and exchanged "high-fives" with his nurse. That afternoon, he peacefully passed away with his family by his side.