A Confederacy of Dunces…or Angels…Take Your Pick (posted July 21, 2011)

It was a grand conference in a grand hotel in a grand city. I was there to learn; to engage in a national debate over the future of healthcare. Thousands of attendees milling like cattle with their badges placed in colorful lanyards and hanging neatly around their neck. Celebrity speakers motivated and challenging, pitched their latest books. Breakout sessions ~ with all manner of topics ~ adult forms of show-and-tell. One went so far as to speak for thirty-five minutes about all of their industry accolades and devoted less than fifteen to what they were doing to affect patient care.

I politely walked out prior to the wrap-up in silent protest.

We began early and ended late. The wisdom-thirsty few (me among them) listened for insight, solutions, nuggets of innovation and possibility. There was precious little of any of it. More questions that answers. Perhaps that is where we begin though, with dialogue. I felt lost in a sea of self interest in an industry so desperately seeking selflessness. There was more discussion of margin that mission; more debate over partisan agenda that patients; more selling of goods than challenge of what might actually create value for the sick, diseased, and struggling. Expensive suits, expensive rooms, and expensive meals and nights on the town seemed to have more attraction than the agenda so much in need of attention.

All the while I thought of my daughter. During these same days she is volunteering at a hospital in the mountains of Nepal. A hospital devoted primarily to leprosy patients. A condition, highly treatable and even curable, but not so among those living in ignorance and poverty. She spends her days providing wound care to an outcast segment of society. Those with little to no means. She spends her hours assisting a staff of physicians and nurses with precious few resources to treat the condition of their calling. They are grateful for the most basic and crude of medicine, supplies, skills, and those with a sense of humanity in a place people go to die or, at best, survive. I thought how the price of one attendee at this mega conference would likely fund the hospital’s operations for a month, maybe more.

I thought of how providers and insurers and operators and the legislators fight and jockey for political position and debate and joust just to create paper trails of speeches and the illusion of a campaign promise honored or a protection of an element of “liberty.” It made me sick (pun intended).

We have much to do in this country to make healthcare something that is offered with equity and dignity and good evidence and compassion. We have miles and miles to go in offering healthcare that is WITHOUT judgement, disparity, extraordinary waste, and harm. We can do this, but it will come at a cost. The cost of ridding ourselves of the idea that healthcare is a source of profit without dividends paid out to society. Our technological, pharmaceutical, informational, and human innovations may not be producing a healthier planet. Granted, we know more and can treat more than ever before in history; but are we healthier?compassion

Today, in a southern California city, executives and providers alike are leaving sessions early to attend group galas and local shows. Today, in Nepal and in the urban and rural and even suburban pockets of this great country patients are arriving with hopes for care that is offered without motive other than to return quality of life for the patient.

I expressed my internal struggle to a new colleague during a Vendor Sponsored Continental Breakfast prior to listening to the keynote session from a speaker known to draw $20K for a speech. His response: “You must be a socialist.”

The response in my head was a mash up of Jesus and what I imagine Jon Stewart of the Daily Show might offer: “Forgive him, for he knows not what an ignorant moron he really is.” Yes, I get angry at this. I watch the debate in congress ~ a form of self torture ~ and wonder if there might be a drug or protocol for the symptoms I experience: nausea, dizziness, brain cell dilution, spontaneous laughter coupled spontaneous crying, and the strange feeling that I am actually living as Bill Murray’s character in the movie Groundhog Day.

I am here to create change. There are days when I wonder if my DNA was even present. There are days when I feel I facilitated a proverbial dent in the rusted steel of a system that is failing, but has such possibility. This week, I found purpose again. Not because I was inspired, but because I was disgusted at what I saw among my peers. My revolutionary self is riding a treacherous and beautiful path. I am surrounded by a posse of gifted, equally committed and passionate humans who show up every day to make a difference.

God and Jon Stewart help me.


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