Perspectives on Healthcare Reform from A Mountain Top

Sometimes (okay, most of the time) mountains help me see things from a different perspective. I just got back from a week in the beautiful Wallowa mountains in eastern Oregon—an awe inspiring place if there ever was one. The small cabin we stayed in had no email or cell phone coverage or newspapers or headlines. Or blogs. It was a relief to turn off that stream of stress for a week and to slow down to the pace of Mother Nature.


For a brief moment, I almost didn’t make it to the mountains. I called my colleague in our D.C. office about 10 days ago in a panic: “I’m going to cancel my vacation and fly to D.C. instead! This is it, this is the week the Senate Finance bill gets debated, this is our one chance to fix healthcare…I should be in D.C.!”  Wisely, my colleague told me to “calm down” and go on to the mountains because things never move that fast in politics.


As my wife and I sat in a cafe in the small town of Joseph, Oregon last week for breakfast, our waitress, Rose, probably in her early 60s and moving through space with what I can only assume was arthritis by the way she handled the serving tray, unknowingly served me up an epiphany. As I sat admiring the myriad of ways deer, wolves, and elk can be depicted in a painting (this cafe is the place to be if you are looking for any artwork on hunting!), I couldn’t help but hear the conversation between Rose and the folks at one of her regular tables who were on their way to go bow hunting.


“How’s your husband?” asked one of the regulars.


“Jim? Oh, he’s not doing so well. He’s sitting home all bandaged up. And I’ve had to start waiting tables again since he got hurt,” came Rose’s reply. She wasn’t resentful, just resolved to the situation.


“What happened?”


“He doesn’t have a damned thing to do with himself since he got furloughed at the plant. They keep saying he will go back to full time hours soon, but there’s no sign of it. He’s restless—he can’t sit still—he hasn’t been this ‘free’ to do what he wants since he was 14 years old. So he’s been out doing extra chainsaw work before the winter comes to make money—and just do something with his hands.”


The regular (and I) saw where this was going. “Uh oh, did something happen to him?”


“Yes, he split open his knee cap with the chain saw.” About six nearby tables winced in unison as we all tried to pretend we weren’t listening in. Rose continued: “Thank god he wasn’t alone, cause he’s been out there cutting alone at times. But a friend was with him and helped him get back to the truck and to the house. I tried to stop the bleeding and bandage it all up. It didn’t seem that deep. And he didn’t want to go to the doctor cause we don’t have insurance right now while he is part time.”  


She promptly filled our water glasses (with trembling hands that had me ready to dive for a napkin), grabbed a side of bacon for the table next to us, turned on the swamp cooler as it was already heating up in the café, and then sat down at the table of regulars to finish her story. She and her husband Jim had waited for four miserable days trying to get his bleeding to stop and his terrible pain to abate, but it was finally too much for them. She drove him to the tiny urgent care clinic in the town of Enterprise nearby, but the nurse there saw the wound and infection and moaning, feverish, almost delirious patient before her and said they needed to go to La Grande or maybe all the way to Boise.


Rose then drove her husband’s truck (her first time using stick shift) to carry him over the mountains and border to the hospital in Boise because she was worried about the cost of having an ambulance come get him. Long story short: Jim had major surgery, has medications, is in rehab, and they are working out a payment plan with the hospital through a government assistance program. And Rose has been forced back into the diner to help with family finances.


Not surprisingly, Rose then turned to the topic of healthcare reform: “I hope those bastards in Washington just fix this whole damned healthcare system. Just fix it! Cause it’s broken. We don’t need a government takeover, no socialism, but they should just scrap the whole thing and start over. And they better fix it—they better get it right this time. We just need insurance so my family doesn’t get set back for 10 years because of one stupid accident out in the woods.”


And with that, Rose rose…and turned from her regular audience, who were nodding and proclaiming their approval of her wise words, to make another round with the water pitcher.


. . . . . . . . . . . . . . . . . . . . . . . . . . .


As I write this memory of Rose and the restaurant and the pantheon of policy issues that came up in that five minute encounter (the impact of the recession, lack of insurance for part time workers, deferring care which just makes the patient and costs even worse, access to healthcare in rural areas, perceptions about government takeovers and socialism while relying upon the government for survival), I am sitting in a waiting room back in Portland for my own doctor’s appointment. While I’ve been here for an hour waiting, I’m trying not to lose my patience. And I’m trying to remember that I should be thankful that I have a job, coverage, and economic means…that I am not having to wait tables or cut down trees just to pay for one healthcare system encounter…and that I can escape to a vacation to hike in the mountains without one moment of concern about whether or not I can get the care I need should I trip and break my knee while out there.


As I muse on this, one of the nurses who knows me well just came up, somewhat laughing and somewhat serious, and said: “What are you doing here? You’re supposed to be in Washington fixing this broken healthcare system!” She asked me what was happening with all the reform bills and wanted to know if nurses would finally get some relief out of all this “government talk.” She told me what was going on with her daughter at school. And then, just as she turned to walk back to her work, eerily, she ended with almost the exact words Rose had said: “Just make sure they get it right this time.”


As I think more about these episodes—and my own panicked response about postponing my vacation to be in Washington instead—I think we could all benefit from “calming down” and resetting our expectations. We have come to treat healthcare reform itself as some kind of godsend miracle drug to cure the diseased healthcare system. We have built up some pretty high expectations that somehow, some way, Congress will wave a magic wand and fix everything with one stroke of the Presidential pen.


My time in the mountains helped me to see that healthcare can’t be “fixed” or even “figured out” all in one moment, one bill, or one idea. Yes, there is urgency to begin this reform effort now given the precarious economics of healthcare costs, the demographic pressures of the age wave, and the moral imperative to be a healthier nation for all. But healthcare reform is not something we will finish anytime soon, if ever. There are no miracle pills or bills that will suddenly make everything alright. We have to move beyond a simplistic “fix it” mentality for healthcare reform that assumes someone else—the politicians or the doctors—has the responsibility to fix things and to “get it right this time” and to do so immediately. If it is to be successful, healthcare reform will be a slower-paced and ongoing activity—and responsibility—for each of us to tackle for decades to come. We don’t have to get it right. We just have to get it started. And we have to be committed to a long journey of continuous improvement. If we do, then and only then, will we end up moving mountains.


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