[R-P] [En inglés] El rostro real de la desregulación de las obras sociales

[Néstor Gorojovsky]

[No he traducido lo que sigue. No por falta de tiempo (siempre falta
el tiempo) sino porque fue demasiado desgarrador. Pero si alguien
tiene alguna duda aún sobre lo que significa la desregulación y
mercantilización de la medicina social, y si tiene ganas de superar
sus prejuicios, que lo lea o que consiga quien lo traduzca.

Aviso: es duro de leer, como siempre es dura de ver la realidad del
mercado de salud.

Esto que se cuenta aquí sucedió en el Primer Mundo. Nada debería
hacernos pensar que va a ser distinto aquí. Si de algo estoy seguro es
de que si Miguel, uno de los personajes en esta historia, hubiera sido
empleado municipal en Buenos Aires, habría preferido toda la vida la
pésima administración de Genta y Datarmini antes que la posibilidad de
elegir qué obra social le tocaba...

Claro está que el protagonista en primera persona podía pensar, en
cambio, que para él todo estaba muy bien. Sin ideologismos...]

Gentileza de la lista Marxmail

http://www.deusexmalcontent.com/2007/12/death-be-not-proud-but-it-is-cost.html

Sunday, December 30, 2007
Death Be Not Proud (But It Is Cost-Effective)


Even from where I was, in the bed on the opposite side of the room, it
was possible to see the gruesome surgical-steel staples bisecting
Miguel's head. They ran like a set of corroded train-tracks from
ear-to-ear, just beyond the hairline which framed the top of his face.

I'd spent three days trying to figure out exactly what had happened to
the man who was my roommate at the Cornell Medical Center
Neurosurgical ICU. I watched the nurses run him through the daily
regimen of post-op skill tests -- if you consider the ability to open
your eyes, follow a finger held in front of your face or correctly
state your own name a "skill." Likewise I watched Miguel fail many of
these tests over and over again: He could barely keep his right eye
open, at one point leading the nurses to get creative and use a piece
of surgical tape to secure his open eyelid to his forehead; he never
spoke in anything above a barely-audible mumble; his movements were
languid and sluggish, as if his bed were sitting at the bottom of an
invisible tank of water.

It wasn't until the day that Miguel's children showed up -- when I was
forced to sit silently on the other side of the room and watch a
tragic bit of theater play out in front of me -- that I finally worked
up the courage to ask the nurse just what kind of catastrophe had
taken place inside his ruined brain. Watching Miguel interact with his
little boy and girl, or at least attempt to, was utterly
heartbreaking. He seemed to barely notice they were there -- hardly
respond when his wife, a short Hispanic woman who spoke little English
and looked like she'd spent the past month sleeping on broken glass,
stroked the palm of his hand. The nurses had been kind enough to put a
patch over Miguel's dead eye and a Yankees cap on his head in the hope
of hiding the most obvious scars of the surgery from his children, but
even someone who had never met this man until a few days ago could
tell that he was a mere vapor trail of what he had once been. Whoever
or whatever had shredded his mind, it had done so with all the
subtlety of a sledgehammer. Where Miguel had once lived, there simply
wasn't anyone home anymore.

I wasn't even looking at the nurse when she explained Miguel's
situation to me; I couldn't pull my eyes away from the sad scene
unfolding directly opposite my hospital bed. In hindsight, it was the
juxtaposition -- the image of the shadow man across from me set to the
weight of the nurse's words -- that left me feeling as if someone had
suddenly sucked all the air out of the room.

Miguel, as it turned out, was recovering from surgery to remove a
brain tumor -- the exact kind of tumor that had been removed from the
same place in my head just three days earlier.

He and I were basically the same person.

And yet there we were: One of us reduced to the mental and motor
skills of a child, the other able to watch him intently and try to
analyze why.

There was a simple explanation actually as to why I couldn't recognize
myself in the mirror of Miguel's one good eye so to speak -- why the
layman would never guess that he and I had once shared the same
diagnosis. It was because everything that happened after that point
had apparently been drastically different, all of it culminating in
two forms of surgery which, despite having the same goal, went about
achieving it in ways that were light years apart. The operation that
Miguel underwent may as well have been done by Theodoric of York
compared to the hyper-advanced microsurgical resection that was
performed on me by one of the country's most revered neurosurgeons.

Miguel was left with a massive scar; I had none.

Miguel had been in the hospital for well over a week, and would likely
be there much longer; I would spend only five days in the ICU, then be
disgharged.

Miguel likely had years of mental and physical therapy ahead of him;
In spite of a few problematic after-effects and a steady diet of
medication that my body and brain would require for some time to come,
I'd be back on my feet and feeling relatively normal within weeks.
Right now, if I didn't tell you I had undergone surgery just a
year-and-a-half ago to remove a tumor the size of a pinball from my
brain, you'd probably never guess that anything had happened to me.

Same medical crisis -- completely different outcomes.

And as I sat there just a couple of days after my surgery, staring at
Miguel -- at the mess his brain had become and the hardships he was
now facing -- I reached one conclusion that seemed to be as obvious as
it was offensive.

There but for the grace of my insurance carrier go I.

I work for one of the largest media conglomorates in the world. In
fact, throughout the length of my career, I've rarely been employed by
a company that wasn't wealthy, multi-national and in a position to
offer its full-time staff access to the best healthcare money can buy.
Yet something about this fact has always rubbed me the wrong way.

"The best healthcare money can buy."

An ironically sickening reminder that in the early days of 21st
century America, there's nothing that's above having a price tag
slapped on it -- not even your life.


The parents of 17-year-old Nataline Sarkisyan understand this all too
well. On Friday, they laid their daughter to rest in Glendale,
California -- one week after her death, which closed a harrowing
three-year fight with bone marrow cancer. Hundreds were on-hand for
Nataline's memorial service, including a few celebrities who had taken
up the cause of saving the young girl during her last days. Their
appeals hadn't been directed at God or Mother Nature -- two entities
who tend not to listen anyway -- but toward a much more powerful body
when it comes to deciding whether a human being lives or dies these
days: an HMO, specifically Cigna Corp.

Just before Thanksgiving, Nataline underwent a bone marrow transplant,
complications from which caused her liver to fail. Cigna twice refused
to authorize a liver transplant, despite a written appeal from her
doctors (the company insisted the procedure was "experimental"); it
was only after the case began to receive national attention and young
Nataline Sarkisyan's picture began turning up in newspapers directly
above captions calling her "the face of a broken healthcare system"
that Cigna capitulated, reconsidering its death sentence. The
company's chief medical officer issued the most public statement
possible in an attempt to cast damage control as legitimate concern.
He said that Cigna -- in a show of strength-through-mercy humorously
reminiscent of Amon Goeth's decision to spare one life out of a
hundred thousand in Schindler's List -- had decided to make an
exception for Nataline "given our empathy for the family and the
unique circumstances of this situation."

And the angry hordes picketing in front of their Philadelphia headquarters.

"We volunteered to pay for it out of our own pocket. We decided to
bear the risk even though we had no obligation to," the good doctor
went on to say.

It's a damn shame Al Gore already got that Nobel Peace Prize.

Unfortunately, in one of those unforseeable twists of fate, Cigna's
big-hearted largesse came just moments too late. Nataline died a few
hours after the decision was made to grant her the liver transplant
that would've prolonged her life.

Well, as is repeated so often this time of year, it's the thought that counts.


Earlier this year, a lot of unnecessary controversy was generated by
muckraking filmmaker Michael Moore's excellent indictment of the
American healthcare system Sicko. I say unnecessary because, despite
whatever feelings one may have about Moore or his politics, only the
most ruthless capitalist would be unwilling to admit that the way we
care for the sick in this country is almost irredeemably screwed up.
We've given an entity as unscrupulous and indifferent as the free
market control over the single most imperative decision in human
existence -- literally, whether we live or die. Regardless of what Fox
business-creature Neil Cavuto may have to say on the subject,
healthcare and profit are two thoroughly antithetical concepts. Giving
CEOs the authority to stand on the edge of the arena and issue a final
thumbs-up or down while we lay incapacitated or dying is like charging
a lion with protecting the Christians.

The most shocking and infuriating two minutes of Sicko, and the most
effective, as Moore wisely allows the guilty parties to do all the
talking for him, provide an irrefutable answer to the question of just
how things got this way -- how a system that was once predicated on a
commitment to good healthcare for all Americans became a cynical
money-generating engine that's perfectly willing to let people suffer
if it means turning a profit. Moore plays part of an audiotaped
conversation between Richard Nixon and his flunkiesque Assistant for
Domestic Affairs John Ehrlichman. The conversation is staggering
insofar as the complete lack of shame on display (even from two men
whose ignominy was already the stuff of legend). Ehrlichman advises
Nixon on a plan to overhaul American healthcare that's being put forth
by industrialist Edgar Kaiser -- the founder of Kaiser Permanente.
Nixon says to Ehrlichman, in classic insufferable,
who-gives-a-crap-about-the-little-people fashion, "You know I'm not
keen on any of these damn medical programs." Erlichman reassures him
by saying the magic words: "This is a private enterprise one. Edgar
Kaiser is running his Permanente deal for profit. All incentives are
toward less medical care, because the less care they give them the
more money they make."

Nixon's reaction?

"Well that appeals to me."

Thus were sown the seeds of the modern HMO; the day after that
conversation took place, on February 18th, 1971, Nixon proposed a new
National Health Strategy based on managed care from private companies.

It worked toward obliterating social medical programs -- because
"Socialized Medicine" had long been dirty words, the product of
anti-Soviet paranoia -- and masked greed under the guise of providing
Americans with the best care money could buy, which was great as long
as a patient had money to afford the best care.

Nataline Sarkisyan's family had health insurance, and maybe that's the
most appalling aspect of her story. She never should have died because
she was one of the "lucky ones"; the services were in place to save
her life. Her parents fully expected that when their child got sick,
there would be no questions, no arguments, no delays -- there would
just be the care she needed. They lived in the most powerful, wealthy
and technologically-advanced country in the world after all, and they
both had good jobs and did their part to contribute to society. They
were living the American dream. They were part of it.

Now they're left demanding answers -- wanting to know why, in this
wealthy nation, there was even a question as to whether it was
fiscally prudent to save the life of their daughter.

The fact is this: It's always cheaper to refuse care, and when making
money is the motive, believing any consideration other than cost to be
paramount isn't just naïve -- it'll get you killed. It's simply never
a good idea to trust anyone who stands to profit.

The mammoth company for which I work made sure I had the best possible
medical care when I needed it -- they paid for it. I never feared
coming up with the money to see a doctor which meant that I discovered
the tumor in my head before it grew to the size of a golf-ball which
meant that it could still be removed through a procedure done by only
three hospitals in the country.

It's because of all of this that I sit here today able to tell you about it.

I'm not sure Miguel could say the same.

And I doubt his wife and children believe that my life is worth more than his.

--
"The free market is perfectly natural... do you think I am some kind
of dummy?" - Jarvis Cocker

-- 

Néstor Gorojovsky
El texto principal de este correo puede no ser de mi autoría