Imagine George Bush, like Scrooge, visited by spirits who show him the error of his ways.
There was a telling quote in Sunday’s New York Times by George W. Bush:
It turns out this isn’t one of the presidencies where you ride off into the sunset, you know, kind of waving goodbye.
It is not hard to take that quote and see George W. Bush as Scrooge for like Scrooge, Bush up to the very end has maintained that his is the right course no matter what anyone else said.
This quality of self-righteousness is not all George Bush shares with Ebenezer Scrooge. The two also adamantly believe the rich deserve to keep their money because the very act of being rich benefits society. Scrooge would contribute nothing to the annual Christmas charity nor would George Bush ask the rich to contribute to making life less onerous for the less fortunate.
The Bush tax and budget cuts have produced more misery than anything Scrooge himself could have conceived, for far from being the acts of one man they are government policy. Perhaps the most Scrooge-like act of George Bush was his response to Katrina.
Charles Dickens’ Christmas story is still widely misunderstood today, watered down like much else into a story celebrating the customs of Christmas such as parties and giving presents instead of the tale Dickens meant it to be, for he sought to hold up a mirror before his country asking everyone to ponder the fate of the less fortunate.
So what if we imagine George visited by the Spirit of Christmas Present who visited Scrooge. If the Spirit of Christmas Present mysteriously appeared in his White House bedroom, what sights would he show the President? If he truly wanted Bush to see what the Republican Counterrevolution has done to our society he would take us to the one place where sooner or later the real victims of the budget cutting, slash and burn strategy end up – a large urban public hospital.
George Visits the ER
Usually located in parts of town that the affluent do not regularly visit unless they have to, these places are often the last refuge of those who have already been through lives most of us cannot imagine. Some never leave except in a hearse.
If you come in like most patients, you enter through the ER, which is nothing like the television ERs with photogenic actors, fancy sets and soap opera scripts. The only similarity between reality and fantasy is that your first impression is of chaos. The real ER is truly a modern vision of Dante’s Hell, so that one half expects to see a large sign posted on the wall: “Abandon hope all ye who enter here.” Except we might not see the sign through the tangle of people and medical equipment.
This is not to say that those who work in this place do not have hope, for often hope is all they have to offer, hope that is reflected in the eyes of all those patients which have that strange mixture of fear and uncertainty that comes only to those who know the string has played out and now they are about to come face to face with the great unknown.
A fair number of the patients also have a different look, one of anger and resignation after being kicked so many times that they are not sure what they will do the next time it happens and don’t really care. These patients hold sick babies who cry incessantly or sit there coughing with some malady that has gone on too long and now makes each painful hack sound like a death rattle. Others hold bandaged limbs or heads, many of them clotted dark red, some already showing the dreaded signs of infection. The cubicles around the ER often hold the hard cases that already have crossed over to that place where they have become a passive receptacle for enough tubes and wires to qualify them as cyborgs.
The Crisis in the ER Due to the Bush Depression
The Robert Wood Johnson Foundation did a study of these patients in New York City. They found:
There were large differences in patients’ health outcomes depending on which provider they typically used.
Patients who receive their care in hospital outpatient departments or hospital satellite clinics have much worse outcomes than patients obtaining care in private physicians’ offices or other settings.
Low-income patients frequently use emergency rooms for conditions that do not require immediate treatment or for conditions that could be treated in a primary care setting.
But the Bush Depression has had even more impact. A recent survey by AARP found:
About one in five midlife and older adults have had their health negatively affected by the current economic downturn, and about one in six are not confident about being able to afford medical care next year.
When asked about 10 things they may have done because of the current economic situation, about half (51%) of respondents said they have taken a generic or over-the-counter medication instead of a prescription drug. About one-fifth said they have delayed seeing a doctor or other medical professional (22%), cut back on other expenses to be able to afford medical care (21%), or sought assistance in getting prescription drugs at lower cost (21%).
A survey of hospital executives by Computer Sciences Corp. found what most of us intuitively sense–the Bush Depression is forcing more people into the ER:
Of the executives surveyed, 67 percent said they expect more patient volume in their emergency departments.
Another report released earlier this month by the American College of Emergency Physicians put the situation in more desperate terms. Dr. Angela F. Gardner, the president-elect of the ACEP said:
We have no capacity now. There’s no way we have room for any more people to come to the table.
The report gave the nation as a whole a D- for access to emergency care, the spirit would point out to Bush (click the link to see your state’s grade). As usual he would try to find excuses, but the spirit could cite the data from the report:
In a 2006 report, nearly three-quarters (73 percent) of emergency department medical directors surveyed the previous year reported inadequate on-call specialist coverage, compared with two-thirds in 2004. The problem was most pervasive in the southern United States, with 81 percent stating that on-call coverage was inadequate.
The inability to access an on-call specialist can have devastating results. For example, 21 percent of patient deaths or permanent injuries related to emergency department treatment delays are attributed to lack of availability of physician specialists.
Think about that last finding for a minute, Mr. Bush. In short your budget cuts and lack of a decent health care system are killing people. There are web sites that have meters recording Iraq War deaths, but none that I know of recording mounting ER deaths.
The Ticking Time Bomb
Amidst all these people sits a ticking time bomb far deadlier than the 9/11 attack, unnoticed by anyone for the threat she represents. On the outside she does not seem all that different from the others, perhaps even a little better dressed than most, outwardly appearing neither as ill or injured. But unknown to us, inside her body microbes so tiny they must be identified by an electron microscope are doing their mysterious, deadly work, multiplying at a furious pace, insinuating themselves into every organ as they cruise the veins and arteries without attracting the attention of any enforcement agent.
It may be the next AIDS, the next SARS, but whatever it is it will be something no current drug will stop. And our hopes and the hopes of all civilization that we will never have a repeat of the 1918 influenza epidemic ride on people who already have lost too much sleep and seen too much suffering and wonder if they can make it through the next hour. To catch those microbes, those treating this patient require the one thing besides money that is in short supply–time, time to assess that patient, time to ponder what they find, time to seek out other opinions, and time to do the right tests and get the right samples to the right technician in the right lab.
Here all the connections and questions of the last half century come to a head. Some might maintain the above scenario could not happen in the vaunted American health care system, but the system is not as vaunted as we believe, for economic injustice means some receive health care no better than they would in a third world backwater. States trying to pinch pennies have cut the benefits of the working poor, so they cut back on primary care that might catch illnesses early.
We all know also how hard it is even for the middle class to afford expensive prescription drugs that might knock out a deadly infection. They also wrestle with the bureaucracy of our wonderful private insurers, where executives fresh out of business school make medical decisions based on charts spewed out by a computer and knowing how much you will eventually pay for a procedure requires a degree in fine-print reading.
Meanwhile ER staff are overworked, underpaid and understaffed due to cuts that have driven many public inner city hospitals to the brink of bankruptcy. The rich do not come to these places except in extreme circumstances where a few minutes might mean the difference between life and death. As for the poor, they get shaken down with all the skill of a back-alley mugger.
The research that might have identified the threat of this still unknown disease also has been the subject of GOP cuts and blatantly political decisions made with a Bible not a medical textbook. None other than Newt Gingrich, of all people, wrote an op ed piece a year ago about the impact of the Bush budget cuts in medical research:
NIH funding has been flat since 2004, undermining the gains earned through the doubling of the budget and slowing the pace of progress in biomedical research. The Bush administration’s proposed fiscal year 2008 budget would cut $329 million from last year’s allocation of $28.6 billion. Biomedical inflation significantly compounds the impact of this reduction. This is exactly the wrong course for the country. Investment in the NIH should be expanded, not cut.
The Systemic Impact
As for the patients, the budget cuts have a systemic impact. Lack of adequate funding for education–especially in inner city schools–means the patients may have little of the knowledge they need to understand or communicate what ails them (translators are another group that has suffered cutbacks). Reductions in college loans mean fewer students can afford the long, costly road they must follow to become a physician or the even more expensive path to certification in a specialty. Public school cuts have affected areas such as wellness education while ideological rigidity over AIDS and sex education have weakened these programs.
The lack of media fairness probably means what little knowledge many patients have comes from commercials. A media susceptible to government payola plus partisan commentary and network cut backs on long, complex news stories mean the possibility of such an event has registered neither with the public nor policy makers. Some no longer trust what they hear after years of false scares and biased reports. And if the event really occurred, it would entangle in partisan rhetoric that causes people to deny the threat as they have with global warming. Just recall the coverage of smoking or obesity and you already have the templates.
Voting rights may not seem to impact an inner city ER, but they represent an often overlooked problem. Redistricting aided by cluster research already has diminished the clout of urban legislators who now fight for hospital funds with the suburban mediplexes that have become the direct counterparts of mega schools and strip malls.
In a section titled “Congress Favors the Organized,” the American Political Science Association report “Inequality and American Democracy” observes that Congressional pork now feeds relatively narrow factions:
Members of Congress have directed government funds coming into their districts to specific geographic areas that vote at higher rates and provide their greatest support.”
We know who those are. Moreover, since many in the underclass no longer vote, have become cynical about the results or are deliberately prevented from voting, their desperate voices crying for help with those most basic of needs–their health and nutrition–have little impact. At a national level we need only see what drug and insurance companies have done to health care and prescription drug reform.
The deaths that might result from the ER scenario are at this point imaginary, but the spiritual death that is already occurring as the playing field continues to tilt is not. As the Bush Depression worsens in America, something wild and uncontrollable has been let loose, and no one knows where the future will take us.
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