White House Chronicle

News Analysis With a Sense of Humor

I Had a Fall in Paris and Got Amazing Emergency Care

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The dog wasn’t to blame. The lovely Paris night wasn’t to blame. The charming 7th arrondissement wasn’t to blame.

No. It was my old enemy, gravity, that caused the blameless sidewalk to rise up and smite me.

I had thought I was done with gravity. It had frequently interjected itself into my well-being when I was riding horses. Mercifully, it had held its peace when I was flying single-engine aircraft.

However, gravity came back for me, vengefully, I might say, in Paris on Sept. 12.

My wife, Linda Gasparello, and I traveled to France for a meeting on aspects of the future of Europe at the lovely Jean Monnet House, just outside Paris. On the day of our arrival, we checked into our Paris hotel. We were scheduled for a meeting at the French Foreign Ministry the next day, after which we would be transported to the Jean Monnet House in Houjarray.

We were guests at the house because a few years ago, we had filmed a television program about another delightful Monnet house: the one on leafy Foxhall Road in Washington, where Monnet lived during World War II.

Monnet, who worked from an office at the Willard Hotel, was a central figure in the American arms supply operation vital to the Allied effort — and some say he shortened the war by at least a year. After the war, Monnet and French Foreign Minister Robert Schuman became the two principal fathers of what became the European Union.

Back to Paris, where my wife and I were taking a stroll after a snack in the evening. I have been walking with a cane for several years, so I was not too steady to start.

Then came the blameless dog. I leaned over to pet this fine Parisian pooch, and over I went, my head hitting the sidewalk hard. Blood everywhere. The young couple who owned the dog and two young couples visiting from Corsica offered immediate assistance and called an ambulance.

Years earlier, during one of the many attempts to overhaul the U.S. healthcare system. I wrote about the French emergency medical services called Services d’Aide Médicale Urgente (SAMU). I said it was considered the best in Europe. Little did I know that I would investigate it in so personal a way.

I hasten to say that I have built up a huge respect for emergency responders, whether they are part of a volunteer fire department in rural Virginia or the ambulance service in London, where I was a reporter long ago.

But France’s SAMU takes it to another level.

It begins with the first telephone call, where the dispatcher learns what the injury or illness may be, and an ambulance is sent with the appropriate equipment and personnel. Often, a doctor rides in the ambulance.

The trick is that the ambulance is an emergency room, well-equipped and with the right staff. The ambulance that scooped me up had four technicians — I don’t know if one of them was a doctor.

They went to work immediately, taking health information, cleaning the wound, and constantly checking my vital signs.

The result of this spacious emergency-room-on-wheels is that when you get to the hospital, the trauma staff is ready for you. Under the French medical system, there is no producing proof of insurance, no upfront mention of payment, just care.

For me, it felt like checking into a luxury hotel. The trauma center was airy and well-staffed, and although people were being wheeled around on gurneys, there was no sense of this being a place of the sick and suffering, though it was.

Everyone spoke some English, and as my wife speaks French, we had no language barrier — my French falls away the farther I am from a menu.

The doctor, a young woman, spent more than half an hour with me and my wife. Then, I was wheeled into a room for a head scan, and there was no waiting. Indeed, the nurses and technicians were waiting for me.

The doctor explained the scan and gave prescriptions for dressing the wound and pain relief. Amazingly, she walked us to the discharge area and then to a waiting taxi.

France is criticized in the EU for having one of the most expensive medical systems of the 27 countries. I looked up that cost — medicine is a birthright in France — and the result is: Presently, France spends about 12.3 percent of its GDP on health. We spend about 17.3 of our GDP on it. 

A Plea to Start Again on the Whole Issue of Health Care

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The process now underway in Congress to repeal and replace the Affordable Care Act (Obamacare) reminds me of what would happen if you tried to thread a small darning needle with a strand of bulky yarn: It won’t go through the eye. The more you try to pull the strand through the eye, the less useful the yarn coming through it will be.

Therefore, isn’t it time to reconsider the whole proposition as though there were no Obamacare, no House version of its replacement, and no preconceived objective beyond affordable care for all?

Also, there should be no pre-established conditions, such as single-payer and multiple-payer; no pre-established goals, such as preserving particular insurance practices and expectations that employers will always be part of the deal; and no expectation that the health-care bill should also be a tax bill or a welfare bill.

Its simple goal should be to free people from fear of medical catastrophe and enable physicians and hospitals to care for the sick without commercial pressure.

I’ve come to the belief that big, new ideas are needed from my own experience as an employer-provider. For more than 30 years, as a small Washington publisher, I provided health insurance for my staff of 25. It was a nightmare that got worse as medicine got more expensive.

Of many strange situations, none was worse than the employee who developed nasopharyngeal cancer, a rare type of head and neck cancer. The insurance paid for chemotherapy and radiation, but refused to pay for expensive painkillers. These had to be brought in from France by a family member.

Maybe the most discouraging was a printing-press operator who wanted the premiums given to him, as he refused to see the point of insurance, although he was married with three small children. “We don’t use insurance,” he declared. “When the kids are sick we go to the emergency room and tell them we have no money.” When pressed, he said they did this because they didn’t want the bother of filling out forms.

If you think, as I do, that the system we have is less than perfect, one is immediately thought to be a believer in British-type national health insurance. Not necessarily so.

As a former citizen, I know something about Britain’s National Health Service and I think it is better than what is happening in the United States. I’ve received treatment in Britain under the system and members of my family in England are devoted to it. There is good treatment for major procedures. However for lesser ailments, there are long waiting lists. Bureaucracy is everywhere.

Worse, can you imagine a health-care system dependent on the budget cycle in Congress?

In Switzerland there is a totally private system, which looks like improved Obamacare. Everyone is obliged to buy insurance, just as everyone has to pay taxes. There are no limits on troublesome things like preexisting conditions. The government regulates the insurers. In a referendum, the Swiss rejected a switch to a single-payer system by 60-40 percent.

There also are mixed systems in Germany and Holland. The commonality is that everyone is covered and the governments regulate. That way, insurance pools are large and have the correct mix of old and young — otherwise the old will overwhelm any system.

Unless we devise a structure that caters to all, we will continue with overburdened emergency rooms, preposterous hospital charges and doctors who will pick and choose their patients.

No one on a gurney being wheeled down a hospital corridor should be thinking, “How will I pay for this?”

The chances are that when Congress has finished trying to thread the unthreadable needle, there will be a groundswell on the left for single-payer — better, possibly, but not a fit in the United States.

Meanwhile, there are too many pre-existing conditions in congressional thinking. We need a new prescription, a bigger needle and a finer thread.

Photo: CALDWELL, IDAHO – NOVEMBER 9 2016: at healthcare.gov getting ready to start an application. txking / Shutterstock.com

CFS: One Disease and Its Costs

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What would happen to health care if a million new patients with just one of many now incurable and largely untreated diseases flooded the system, relying on medicine that could cost $70,000?

It might happen. Actually, it’s more than desirable that it should happen.

In one instance, a million or more patients who suffer from the devastating, life-robbing disease known as Chronic Fatigue Syndrome (CFS), or myalgic encephalomyelitis, struggle through days of almost total incapacitation, disorientation, pain and despair, clinging to hope that science will rescue them. All that’s known is that like AIDS, it’s a disease of the immune system.

The horror of this affliction is almost indescribable. I’ve been writing and broadcasting about these patients for several years and never have I seen such extended suffering, lives hollowed out, every tomorrow to be feared, the slightest departure from strict routines of inactivity to be met with punishing suffering.

The mother of an afflicted teenager told me that for New Year, her daughter went out for amid celebration. That exertion cost her two weeks in bed.

My friend and colleague (we host a YouTube channel, mecfsalert), Deborah Waroff, a New York-based writer, has been afflicted for 23 years and has seen her life confiscated. Like other patients she lives in a prison of her body with painful memories of when she was well. The body hurts, the memory tortures. Sleep does not refresh and long hours in bed do not heal.

Sufferers, held together in their pain by the Internet, trade sad notes. Going the rounds now is Winston Churchill’s statement in old age his life was finished but not ended. One sufferer e-mails me that she prays every night that she won’t wake up in the morning.

Patients groups say suicide rates are high. Determining the morbidity rate is a challenge because sufferers die from opportunistic infections rather than from CFS. In this, and other ways, it resembles AIDS and diabetes.

So far, the burden has been carried more by families and loved ones than by the health care industry. This is because there is no diagnosis per se for CFS, and no cure.

Dr. Andreas Kogelnik of the Open Medicine Institute in Mountain View, Calif., says there are no “markers” for the disease. There is nothing in the blood, marrow or soft tissue that identifies the disease.

Therefore, diagnosing the disease is by elimination – a time-consuming undertaking that the present medical regime is ill-equipped to provide. “You can’t do much in 10 minutes,” Kolgelnik says, referring to average amount of time allotted to patients by doctors.

So this is a disease that, even without a cure, the medical establishment has already indicated that it cannot afford.

The matter of affordability, for example, has affected diagnosis and treatment severely in the United Kingdom. There the National Health Service, always struggling with budgets, has encouraged doctors to teat CFS as a psychosomatic condition related to depression. The patients hate this and only recently has the British Medical Research Council softened its position.

That other medical nostrum, diet and exercise, is favored in the UK, too, but not by patients. They write to me constantly pointing out that exercise is corporal punishment for them; a recipe for relapse.

With only under-funded research scattered across the country at clinics and universities, the picture is bleak. But there are two pinpricks of light: a Norwegian cancer drug, Rituxan, which has helped patients in Norway and Germany, and a drug that is still in clinical trials in the United States, Ampligen, which rebalances the immune system.

Even those who administer the drugs, like Dr. Derek Enlander in New York and Kogelnik in California, don’t hail them as panaceas but as hopeful pacesetters. Neither is available except to a few patients in trials. And cost? Ampligen costs about $25,000 for a year of treatment, and Rituxan comes in at a whopping $70,000.

A slew of other diseases await expensive cures. In the future health-care costs, no matter what the Supreme Court and the politicians do, are going to go up and up. To the sick and their families, any price is a small one.

For the Hearst-New York Times Syndicate.

The Tea Parties: Add Sympathy

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Let’s pour the tea, and see who’s come to the party. More, let’s see why they came.

What binds these good citizens together in a ramshackle and loud fraternity known as the Tea Party movement? The focal point may be the Democratic health care legislation; but there is, as always with popular movements, a back story that is more complex and more compelling.

Could it be, to use Winston Churchill’s phrase, the sum of all their fears?

Indubitably. These are days of change, massive and irreversible change. Change that is undermining but difficult to characterize, and disturbing to experience.

The nation’s first African-American president, Barack Obama, is the symbol of that change more than he’s its author,

The Tea Party Patriots are people who feel that their lives and their nation is being swept forward to a place they don’t wish to go. They blame Obama and the Democrats for taking them there.

But the administration and the Democratic majorities in Congress have little to do with the buffeting the American image is taking.

Consider these facts:

 

✔ The United States has gone from the richest nation in the world to the biggest debtor.

✔ Our competitor, China, has grown rich in our market. Now China lends us money to cement the entanglement, while it becomes increasingly obstreperous.

✔ We have the largest and most lethal military machine on earth, but we can’t subdue insurgencies in Iraq and Afghanistan, banish pirates in international waters, or prevail in sanctioning Iran.

✔ Our infrastructure, once the envy of the world, crumbles. European trains hurtle at 220 miles an hour; ours crawl at less than a third of that speed.

✔ Broadband in the United States is many times slower than it is in Europe. This is cruel: We invent, they perfect.

✔ More than 10 percent, and possibly nearly double that, are out of work with no chance of employment for years. And new technology has made the skills of many of the unemployed obsolete.

✔ The United States is an English-speaking nation where a second language, Spanish, is creeping towards full recognition. Banks, phone companies and state governments have gone bilingual.

✔ Immigrants, legal and illegal, are changing the culture.

After 43 white, male presidents, there is a black man in the White House and a first family that reminds middle-class white tea partiers that huge changes are afoot.

A general anxiety has crystallized into a particular rage.

In memory, the 1950s have been sanctified as a time when all was well in America–if you were white and not serving in Korea. The United States was strong, the land was fertile and fear was concentrated on the Soviet threat.

As it had been in World War II, the good guys were us and the bad guys were them. The European empires were disappearing and we were the city upon a hill. Tea Party Patriots’ nostalgia for the 1950s is as pretty and disingenuous as a Saturday Evening Post cover.

The tea partiers may not be interested in the new demographics and new realities of the 21st century, but their anger won’t banish reality.

Trouble is the only political home these genuinely worried people can find is on the right: the overstated, overwrought and over-simplistic right. The right of Mark Levin and Glenn Beck.

These polemicists have concentrated the anxiety of tea partiers into a fear of socialism. It’s the undefined dark at the top of the stairs, the threat to liberty, to gun ownership and to private enterprise, according to the fear merchants of the right. Yet, there is precious little government left in the world that can be described as socialist.

The old socialism, with the nationalization of the means of production at its core is dead, sent to its eternal rest in Europe. Only a few leaders. like Hugo Chavez in Venezuela and Evo Morales in Bolivia, still espouse it.

Already extremists of the right–with death threats and property damage–are undoing the legitimacy of the entire Tea Party movement, and its unlikely members–the well-heeled, well-fed, well-insured but very sympathetic and very fearful activists.

Their fears deserve a hearing individually and in sum. Instead, they’re being exploited and in time they’ll be marginalized, discredited by the company they keep. –For the Hearst-New York Times Syndicate

Disruptive Technologies and the Agenda They Set

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The copper-wire telephone is in danger, traditional advertising is drying up and health care costs are through the roof and rising. What is the villain? Well, it’s technology; particularly, “disruptive technology.”

Disruptive technologies are devastating to established order. And they underlie Congress’s consideration the most wide-ranging legislative challenges it has faced since the New Deal: health care and energy.

Hugely effective but expensive new medical technologies, like magnetic resonance imaging, nuclear therapies and artificial joints, threaten to bankrupt the nation’s health care system. At the heart of the health care debate lie the escalating costs for these new technologies and how to shoulder and control them. The rudimentary solution is to get the well to pay for the sick, in the way that Social Security seeks to get the young to pay for the old.

After health care, Congress has to consider energy and its leitmotif, climate remediation. Here, too, it is faced with new technology forcing the issue. Even as the Senate contemplates taking up the House-passed bill, with its heavy emphasis on renewables, new drilling and discovery technologies are tipping the energy balance towards natural gas and away from other competitors like wind and nuclear power. Ironically, at one time, nuclear power was a disruptive technology that threatened to elbow out coal.

In electricity, Congress can force the market away from the disruptive technology toward something it favors for social and political reasons, like solar or wave power. The cost is simply passed on to the consumer.

As for transportation, the energy imperatives are dictated by the forces of infrastructure and sunk cost. In the long term, there are four options that will keep the wheels turning:

1.plug-in hybrids leading to full electric-powered vehicles;

2. hydrogen fuel-cell vehicles;

3. ethanol-powered vehicles and;

4. compressed natural gas-powered vehicles

These options are not created equal. Hybrids are here but the batteries are expensive, and the plug-in option dictates that the car sits in a garage or a parking lot that is equipped with plugs for charging. Also, the batteries decline with time and cannot be used after they lose about 30 percent of their design capacity. If you live in a high-rise, plugging in your vehicle is not yet an option. Ditto pure electric vehicles.

Hydrogen is a darling technology of the green community, which marvels that it is emission-free except for water. Trouble is, there is hydrogen aplenty in nature but not free-standing; it has to be extracted from hydrocarbons, like natural gas, or from water, with huge electrical input. Why not use the gas or the electricity directly?

General Motors markets a duel-use vehicle that can run on E85 (85-percent corn-derived ethanol). This fuel was a favorite of President George W. Bush; but the environmental impact of putting so much farmland down to corn for fuel and the effect on corn prices has taken the bloom off ethanol.

Natural gas–which can be used in a modified gasoline engine and has been made more abundant by revolutionary horizontal drilling technology–is advocated by T. Boone Pickens and others. It has come late to the transportation fuel wars because of fears of shortage, now proved groundless. Natural gas is not without emissions, but these are about half of those of gasoline. And it may be the big energy disrupter.

Congress, reluctant to pick winners for fear of also creating losers, intends to throw cash at every option in the hope that the market can make the choice later. But the market is not immaculate–and less so in energy than almost any other commodity. Electricity has to move down a finite number of power lines, and transportation fuels depend on the nation’s 160,000 gas stations for market entry. You can expect the gas station infrastructure to, say, provide replacement batteries, charging points, hydrogen terminals or natural gas compressors. But can you expect it to provide all of these?

Maybe the gas station, rather than being the vital element in the new energy regime, will be rendered obsolete by disruptive new technologies that allow gas compressing and electric charging in home garages and commercial parking lots. Maybe the hybrid of the future will have a compressed-gas engine and plug-in capacity, and all this will be achieved without the traditional gas station. Technology enhances, modifies and improves, but it is hell on established order.

Leon Trotsky said: “You may not be interested in war, but war is interested in you.” Congress ought to know that technology, disruptive technology, is interested in it. –For the Hearst/New York Times syndicate