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                                                        THE FUTURE OF HEALTH?
 Right after the 4th of July, Terry McAuliffe took a campaign tour of INOVA Alexandria Hospital, including a stop in its ER, stressing that expansion of Medicaid in Virginia, covering up to an additional 400,000 under the Affordable Care Act, would improve the health of the Commonwealth's residents, and its economy, by creating approximately 33,000 jobs by 2021, in addition to making "the system" more efficient.
     About a month earlier, I was in that same ER, twice, on two consecutive days, a card carrying member of BCBS Federal. I feel fortunate to have made it out alive.
     It started on a Friday morning, as I got up from a chair. I felt a sharp pain in my mid to lower right back. It got progressively worse instead of subsiding, coincidentally my bowels became increasingly inoperable, so two days later, bright and early, I went to the ER. There I was seen by a doctor - and the nurse from hell. I pointed out to the former that I knew the thoracic spine was somehow connected to movement of the colon - she shook her head "NO." I have a year long recent history with staphlicoccus aurelius which morphed into MRSA - another medical horror story for another time - which left me with a depressed immune system, so at my suggestion, to stave off any possible infection, I asked for a prophylactic antibiotic. The nurse brought me generic cleocin - although I told her I could not take it and the medication was in fact on the very long list of drugs on their computer so indicating - and sassed me back repeatedly with the phrase "that's not how we do it here," meaning the physician dictates, right or wrong. Far from "compassion." Despite her rude insistence, I did not swallow the pill, however, it showed up as charged on the itemized statement. They also did a vaginal culture - which left me bleeding, as did the Fleet enema they gave me, or should I say, jammed into my anus, right before they sent me packing, dribbling all the way, prepped by them, ready for any "bug" to take hold. Although I requested it, not a picture was taken - of anything!
     One day later, back again. This time I was attended to by a physician's assistant who ordered a CAT scan - of my digestive organs. Nothing there except clog - and the nurse that day attempted to convince me that what I was feeling in my back was from the bloated bowel, not my thoracic spine. At this point, I could smell the stench of feces emanating from my skin - and was told that was "impossible." I was given a suppository which moved NOTHING - and was sent home with sparking Magnesium Citrate, and an encouraging invitation that I could always come back for more IV Ketorolac which they had administered on both days, although I told them it had provided relief for only about eight hours. So far, very little that I could not have "accomplished" on my own with a trip or two to the drug store. Far from "advanced."
     The Magnesium Citrate worked slowly, but after about two days of ingesting nothing but water, I was cleaned out of four days of back up. While I was going through that process, I called around to spine specialists' offices and found one where I could be seen on Friday, with most admonishing me to go immediately to the ER! I was prescribed Medrol, which contrary to its reputation, did not make me testy - and a muscle relaxer which ironically made me incontinent! An MRI of my thoracic spine was ordered and done on the following Monday. Four fractures at T6-7, T7-8, T4-5, and acute at the T-11 level - confirming what I had "diagnosed" in the ER. Patient knows best. Scary. 
     Soon, the invoices started pouring in, and after I related my story, first to the Patient Relations Representative, and then to the Chief of the Department of Emergency Medicine (Alexandria), any balance I owed from the debacle after insurance was quickly erased, thousands of dollars. Part of INOVA's slogan is "...join the future of health..." I sure hope not. I can only imagine what would have happened had this been a public emergency, involving many, instead of private, and concerning only one. Or speculate on whether I would have received any "different" treatment had my "encounter" been on the day of Mr. McAuliffe's visit.
     Expanding Medicaid, and Obamacare in general, will do nothing except dump more patients into an already dysfunctional infrastructure. Federal dictates alone cannot force efficiencies on a local level. Yes, I can sympathize with the arguments concerning the costs of the uninsured and the pain of Medicare reimbursement cuts, but the focus of "the system" should be on value - the health "care," and not volume and velocity of turnover. And as Ken Cuccinelli has pointed out, readmission of too many Medicare patients too soon under the Affordable Care Act will be penalized, a policy I suspect will migrate beyond that program, putting limits on the profitability of multiple visits such as mine. I also have to wonder just what kind of jobs would be created under the expansion - well compensated doctors and nurses, or lower paid, less educated, but medically trained individuals performing essentially most, if not all, of their same functions? - and how many will be eliminated or subjected to a reduction in hours because of the legislation's new requirements.
     In the interests of full disclosure, I favor coverage for all, single payer. In my dreams. My concern is that "the system" is not ready to actually provide services adequate for the "numbers," as well as it now generates procedure codes and dollar amounts - "numbers" on a bill. Much of the talk in the Commonwealth's gubernatorial race has been about scandals and "guilt by association," and whatever issues could be polarized creating a dichotomy between the right to life and the right to personal choice. Health care is one of them. But rather than just sparing about insurance, I invite the candidates to go deeper than partisan platforms and pandering and focus on addressing the underlying flaws in "the system." Citizens should not have as their only resort against waste the risk involved in a refusal to pay outlandish prices for what has been poorly, inappropriately, or wrongly delivered. In the current environment of apathy and disapproval surrounding both the contest and the contestants, whichever one does that first gets my vote! Because in this seminal moment, in this purple and somewhat undecided state, and elsewhere as well, to paraphrase INOVA, it is about "...the future of health..." - yours, mine, and ours.