Wednesday, May 17, 2017
Insights into Health Care
Even occasional readers of this blog will be aware of its improvisational nature. I am often constrained—mainly by ignoble sloth but on occasion by actual disruptive circumstance—to throw something together in rather a hurry and without benefit of the technical resources really required. I am not so bad as Doctor Johnson, Prince of Bloggers, who might not even begin writing one of his essays until the printer’s devil was at his door demanding copy. Unfortunately, I am not nearly so good as Doctor Johnson either. It’s usually a question of hoping that things will come together.
One genre of coming together is the historical congruence. Historical congruences can be happy or sad, sometimes both. Thomas Jefferson and John Adams—American Founders, presidents, and political antagonists—both died on July 4, 1826. That day, by the providential scheme, happened to be the fiftieth anniversary of Independence Day, when the Declaration was first proclaimed in Philadelphia. Both men were pretty prolific writers, but not so famous in literary history as William Shakespeare and Miguel de Cervantes, both of whom died on April 23, 1616. That one involves a little historical leger-de-main concerning time zones and variant calendars and that sort of thing; but it’s too good to give up without a struggle. Cervantes was so fanatical about deadlines as to take them rather literally. His dedication of his last novel, Los Trabajos de Persiles and Sigismundo, is dated April 19, 1616. He wrote it on his literal death bed.
What makes these congruences congruent for my particular circumstances is that as I write I find myself temporarily confined to a bed in a hospital in Philadelphia, city of the Declaration. My circumstances are by no means so urgent as those of Cervantes, and there is not the slightest hope of their stimulating another Persiles. But they do invite serious thought about two topics near the top of the current American political agenda: health care and immigration.
A very old and dear friend from Oxford days, a man who has appeared more than once in my blog posts over the years, was supposed to be visiting us in Princeton yesterday before going on to Boston, where one of his sons is in temporary residence, and thence to California, where he has business interests. Most people, arriving at Newark Airport only to face the Case of the Disappearing Host, would utter a few awkward words of formulaic absolution and encouragement (“Not at all, old man; don’t give it another thought; just concentrate on getting well”, etc., etc.) and then move on north. But not Andrew. He came down to Princeton, where Joan was able to give overnight room and board. Then they both jumped into his rented car and drove to Philadelphia, where we spent an entire long afternoon conducting an orgy of reminiscence and a probing seminar on the state of the world in a 150-square-foot room full of blinking and beeping machines, our debates fuelled by bad tea in paper cups supplied by friendly nurses, and punctuated by intermittent blood-lettings and takings of vital signs.
Our topics included Brexit, the French election, and the rapidly changing latest Trumpiana. But the setting of our conversation, together with some of Andrew’s own recent experiences, naturally raised the large subject of health care in a comparative context. Something like sixteen percent of the American GDP is related to health care. In Britain the figure is closer to six percent. Anecdotes are not the same thing as big data, even if data is the gathering together of anecdote. But my current, personal, anecdotal experience is that as a consumer of Medicare I have in general received services of extremely high quality. The scientific and technological aspects of medicine in a university hospital, as this layman has observed them, are remarkably impressive. The American health care system, as I am experiencing it, is anything but “failing”.
I shall not attempt to draw from this experience any comprehensive generalization on the topic of health care. On the topic of immigration, however, I will make so bold as to do so. Most of a hospital stay is boredom alleviated by observing the variety of one’s fellow human beings. I conclude on the basis of observation that of the most highly trained professionals I have encountered here—the superb physicians, chief nurses, and registered nurses—at least a third are not native speakers of the English language. These are the people who have just fixed me up and plan to send me home today. When one broadens the census of hospital workers to include what usually would be regarded as non-professionals, the proportion of the foreign-born would perhaps be even higher. There are certain nativist attitudes to immigration in the air, and they don’t strike me as particularly conducive to the health of American health care.
There are some advantages to last minute blog composition. I just had the opportunity to test some of my impressions with the Asian-American medical student assigned to my case. When I asked him whether the Hospital of the University of Pennsylvania could operate without immigrants he simply laughed. But he thought that the hospitals would probably have a better chance than general and family practices throughout the country.