Editor's Notes

Home hospice care has come a long way
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tredmond@sfbg.com

My father died June 15, in Philadelphia. He was 82. He hated doctors (who kept telling him to quit smoking and drinking) and hospitals (which he alternately described as prisons and torture chambers, depending on how charitable he felt that day). When he realized that the emphysema had gotten the best of him and his days were numbered, he made it clear that all he wanted was to stay at home, so I and my siblings took time off, and for several weeks we helped my mother take care of him, keeping him as comfortable as we could until his lungs finally gave out and he stopped breathing. I gave the eulogy at his memorial service.

So I'm about tapped out on the emotional stuff, and I've said all I have to say about what a wonderful guy he was. But along the way I learned a couple of things that are worth thinking about.

Home hospice care has come a long way. When my friend Paulo died of AIDS in 1995, you had to be in a hospital to get easy access to drugs like morphine and Haldol, and if you were at home and woke up in horrible pain in the middle of the night, your friends had to take you to the emergency room and wait until a doctor could find time to give you a shot. The hospice program we had was awesome; the nurses gave us big jars of medicine, taught us how to administer the doses to relieve my dad's pain, and told us that we shouldn't worry if he asked for a cigarette (it was a bit late for lifestyle changes).

The insurance providing us with all of that top-rate care, and the remarkable social services that went along with it, came through a government program called Medicare. It has an overhead rate of about 3 percent, which makes it about five times as efficient as most private insurers. It's not perfect — all health insurance in the United States is a bureaucratic nightmare, and even this coverage required intervention on the part of my family to keep things on the right track. But it's available to seniors who don't have much money, and it works.

While my dad was dying, I read some of the early reviews of Michael Moore's Sicko in the East Coast media. I think my favorite was in the New York Post, which accused Moore of demanding that everyone in the United States get their health care from Fidel Castro. The critical reviews played up the fact that Moore fairly gushes about medical care in countries like Canada and France (along with Cuba) while people who live in such places with government-run health care systems complain about long waits for nonemergency treatment.

Perhaps so. I can't argue the facts one way or another. I could argue that a system covering everyone at the cost of a bit of waiting for all is better than one that dumps all of the waiting, getting sicker, and dying on the poor and uninsured. But I will also argue that Moore is right (see Cheryl Eddy's piece on page 64). This is the richest country in world history. We can have a public health system that works. We just need to get the private insurers the hell out of it.*