Paying For Health Care And Humanistic Medicine

   

If Humanistic Medicine (HM) is showing care and concern for the individual patient, certainly the way we pay for care has implications for HM. Should a patient worry about getting care because of financial implications, be it copays, deductibles, medical debt or medical bankruptcy, choosing between medical care or food or housing, or other consequences? If one believes that health care is like any other good or service in life, like buying a new television or deciding on a vacation, then one can justify financial consequences, including possible avoidance of care or medicines and choosing inferior treatments. But if one believes that health care is special, like having food to eat or housing to live in or education to get, then one is likely to be persuaded that facing more than small financial consequences of seeking care is inhumane.

If one thinks that removing financial consequences for a portion of the population (the middle of the population, because Medicaid applies to the lower income population and high wealth families and those with adequate health insurance will not face significant consequences) is essential to moderate demand, then one should remember that the main culprits for high costs in health care are prices and administrative overhead, not high utilization. In addition, if one really wants to use patient choice to put pressure on prices, it is far better to find an agent for patient choice, such as the primary care provider (PCP) for the patient to do the searching and choosing, since they are the ones with the requisite knowledge.

HM demands that financial implications for health care remain a minor issue for patients, and that medical decisions by families not have to take finances into account.

This should be the goal of all payment schemes for medical care.

Connie

  

I have to admit it, I have always liked blonds. When I was in high school and expressed admiration for Diana Crocheron – blond, wifty a bit, really pretty to my eyes – my mother, who was a redhead, I’d say, maybe chestnut, those shades always confused me, said – Boys always like blonds. Such a know it all, such an observer. Last night I was rewatching Silver Lining Playbook, and Jennifer Lawrence says in exasperation, stop referring to me in the third person! I could relate to that. They watched me, they loved me, but really, this third person stuff? And by the way, she’s not a blond, but who could resist Jennifer Lawrence? Here I am, 85 years old, and it sounds like I’m still looking for love. Isn’t that for young girls, looking for love? Jesus.

So, I think it was in second grade at the Henry C. Lea Elementary School at 47^th and Spruce Streets in West Philadelphia, where I was a student from kindergarten to fourth grade. What was I in second grade, eight years old, maybe? Or was it a year later? Eight sounds pretty young. But I’m pretty sure we were in Mrs. Anderson’s class. She was tall, spare, angular, alert, animated. Maybe a character. A teacher who took teaching seriously. I think most of the teachers I met in school took teaching seriously. Teaching can be a calling. You’re facing all those kids, those sincere and eager kids, those bright faces, not knowing what to do with their hands as they sit at their desks, some folding their hands and pursing their lips, like that girl in my class, Patricia, or John Lewis, the somewhat effeminate light brown haired fair skinned kid who ran like a girl with his arms stiffly by his side, who had a nice, naive, gentle smile. He and Patricia, who was heavier, both folded their hands and looked attentively at Mrs. Anderson when it was time to pay attention.

Those were great days. Prepubertal days. What made them so great? Security – I was lucky to have loving parents, stable parents, and by then I had three younger siblings, Bobby, Kathy, and Emily. But being prepubertal, there was school, which I was lucky enough to be good at, and sports, which I was also lucky enough to be good at. There was a well-regulated household and a well-regulated life, and we were all healthy. I had a mother at home – not like my new friend Trinh, who as a little kid was a Vietnamese boat person who eventually wound up with her mother and sister in the Tenderloin section of San Francisco with no material support, who came home from school as a latchkey kid who stepped over people on the street to get to her house and lock herself in, imagine that. But who was first in her class at Lowell and got full boat to Harvard. I had no idea of anything like that, of course, I lived in West Philadelphia and we had a nice class and school, not overly demanding, and I didn’t worry about girls, I was prepubertal. Best time of my life, in some respects. Talk about living in the present.

But, I did have a girl friend. A blond girl friend. Connie. She was the most beautiful girl in the world, according to me. She had straight hair that came down just below her jaw. I never understood this curly hair craze – her straight hair was just perfect. She had a little mole at the right corner of her mouth. She had kind of dark skin, I’d say, just a little, but I would look at her and I just loved her, I thought. Not tall, not short, but just lovely. I remember her eyes especially, brown, looked directly at me. I can’t remember talking to her very much, but there was something, and it just was clear that we were boyfriend and girlfriend. Prepubertally. Which was great. Just kind of happened.

And here’s how I know for sure. It must have been springtime, because you wouldn’t have ice cream in the winter. Somehow, the whole class was having ice cream from Dixie Cups. Do you remember them? Those little round cardboard cups with a round top that just fit right down below the rim and had a tab on the edge to pry the top off, and there was half of it vanilla and half of it chocolate. Dixie Cups. Way before ice cream got fancy. So, we were all sitting there at our desks, probably about 20 of us, I’d think, and we were very involved in eating this treat. At least I was, I remember the enthusiasm I had in having this treat. I’ve always been intense, I think.

Anyway, then I saw out of the corner of my eye Connie walking up to Mrs. Anderson with her Dixie Cup. They talked briefly, and then Mrs. Anderson stood up and addressed the class. Mrs. Anderson was a confident woman, who provoked confidence in her class as she challenged them. One time she asked a question and I think it was John Lewis who gave her the answer, which was right, but then she looked at him closely and said, Are you sure??? John backed off and said no, he wasn’t. Are you sure?she repeated. I guess not, he said, Then she said, John you had it right. You were right! Stick to your guns!

Can you imagine that, Stick to your guns! What a great use of the vernacular. Stick to your guns. So American. That’s great teaching, in my book. I remember it vividly – it was so surprising. She took teaching seriously, a calling.

So Mrs. Anderson addressed the class, with Connie standing right beside her, maybe a Robin to her Batman, but they were definitely a team. So Mrs. Anderson said, Connie doesn’t want her ice cream. Who wants it?

Well, who doesn’t want it? A bunch of eight year old kids at their desks, almost finishing one Dixie Cup, what could be better than a second one? So we all raised our hands. Not only raised them, but flexed ourselves forward in our desks, pushed our hands as far forward as we could at a 45 degree angle, and yelled – MEEEE! ME! ME! Cacophony, delirious cacophony. ME!

So Connie stood there and surveyed the room. And there I was about four or five rows back just to her left, and her eyes settled on me. As everyone cried out ME!, she walked purposefully back to my chair and looked me in the eyes and reached out and gave it to me. I was not actually surprised, or maybe a little, but at that age you don’t think too much about it. I said thanks, and prepared to dig in. She turned around with a smile and walked back to the front of the class and turned left to go back to her seat. I didn’t stop to wonder how come she didn’t want her Dixie Cup.

In fifth grade I transferred out of Henry C. Lea to go to private school, Friends Central, out on City Line Avenue, and in 9^th grade we moved out there to Wynnewood on the Main Line, not like in the Philadelphia Story, but still, the Main Line, and I went to Ardmore Junior High for a year and then to Lower Merion High for three of the best years of my life, even though I was well into puberty and all the complications and excessive intensity that brought to an already intense kid. At Lower Merion we had a great group of kids in our year. We had the smart kids, of which I was one, who were also good athletes and good kids who drank beer and occasionally something harder – no dope in those days – and I continued with school and sports and then dreamed of sex but it would be some time. I didn’t have a girl friend. Several of my friends liked Diana Crocheron, and one actually slept with her, I think. I don’t think many of my friends actually got laid in high school, but who knows?

In a class of 350 there were many groupings, of course. We knew each other, these other groups, and especially through sports, we mixed. There was a crowd that was not the high-achievers, and who acted maybe a little tough, although there was no physicality to it, no one was bullied, there weren’t fights, there was no crime I was aware of. A couple of the guys wore leather or jean jackets, I think there were some motorcycles. David Kirby was a little guy with them, Hughie O’Neal was a blond guy who seemed a little tough, Chipper Poe was with them – he later opened a motorcycle store, I think – maybe John “Apple” Lynch, a big strong guy probably 5’11” 220 lbs, who I played basketball with sometimes, and sometimes had a squint and was soft spoken. And there were the girls who went with them, and I don’t remember them very well, except for one of them, who I became more aware of as time went by and I heard what her name was. She had dark, straight hair, and was voluptuous, as my wife Ann would have described her. My less delicate friends in high school would have said she had big tits. And of course, as you have been thinking, her name was Connie. Back in second grade her last name was too tough for me to remember, but now in high school, I could. Her name was Connie Petropolis. So she was Greek. She still had that little mole at the corner of her mouth. And her eyes. She fussed proprietarily over her boyfriend Hughie. Did I sometimes see her looking at me out of the corner of her eyes? Maybe, I think so. But it took me the longest time to realize that this was my girlfriend Connie. Her hair had darkened. Back then in second grade I didn’t have an intimidated bone in my body, but now, post-pubertal, I couldn’t quite believe it. Too much for me, I thought. She had become a woman.

In fact, I never just went up to her and said, hey, are you Connie? I could have done that. Of course she remembered me. She must have thought, with reason, that I was a dunce. How I had loved her! Now she was more advanced socially than I was, which I took for a permanent state of affairs. Oh, man, what would it have cost me to go up to her, and say, hey, are you Connie? Oh, man. I could have told her that the name Connie has always been special to me. Early love. Idealized love. Love without consequences or complications. Love where she gives you her ice cream. I’ve always looked at women named Connie with some sense of lost, idealized love – they are special to me, and I’m disappointed if they don’t look like Connie. I imagine that I look for love in all the wrong places. Who said that? Puberty changes everything.

She never has even come to the sporadic class reunions, of course. I think I’ll ask Jonny Fish, my LM classmate who lives over in Piedmont, about Connie. He might know. I guess it’s a little late now. I would so like to see those eyes again, and eat some ice cream.