Healthcare from where I sit (in the waiting room)

     It is my privilege to have lived long enough, and fully enough, to have developed some close relationships with various medical professionals. That's a positive spin on the situation; I've been spending a lot of time lately in doctor's offices, testing labs, rehab, and rooms full of large machines that buzz, bang and whirl away to look at the mess I've made of my body.
    Apparently, I have had a good time with life. Too much of good things, like fine food, and too little of nuisances, like exercise. As I have come to know, it's not the age, it's the mileage.
     In any case, I have a great vantage point from which to experience, see, hear and discuss the issues of the day regarding health care in the United States.  Empirical knowledge, more than the product of formal research, but then I now know that such is my most fundamental American right -- I don't have to be correct to be entitled to my opinions.
     What I have learned is this: The issue is not whether we have good medicine in America, but rather who is in charge of administering it to those who need care.
     Generally, conservatives think they are in charge of their medical care, but they are wrong. Liberals think the government is, or should be, in charge of providing medical care, but they miss the point, too. Doctors want to be in charge, but lawyers and insurance companies and the stockholders of every business that earns or spends money on health care is out in front.
     Patients are in the back. Doctors are in the middle.
     What should be simple is now complicated. What should be complicated is beyond frustrating. Blame some of it on bureaucracy -- and whether it's insurance company bureaucrats or government bureaucrats is a matter of your personal political point of view. Republicans prefer that their insurance companies mess up the paperwork and fail to pay for tests, or dictate what treatments and medicines are permitted. Democrats like to have the government in charge of losing forms, denying coverage, or requiring additional documentation.
     When I was a kid, there was one doctor in town and if you got sick, you went to his office and sat in one of about 20 hard, straight-back chairs lining the walls, waiting your turn.  No appointments. If you were REALLY sick, the doctor came to see you when he made his daily house calls. Yes, house calls.
     He would take your temperature, look up your nose, down your throat, in your ears, and shine a light in your eyes. He'd listen to your chest for lungs and heart function, take your pulse, and send you home with some pills to take to see if things improved. If you were lucky, there was a pharmacy within five miles. If you were rich, you'd get the prescription filled.
     Most people didn't have insurance. You paid your bills when you got the money. They knew where you lived.
     Okay, that was back in the dark ages. But we survived, and medical care improved. People were offered health insurance as part of their job benefits, and began using credit cards to pay their bills. You called in and got an appointment, which the doctor almost never kept, but you had a general idea when you'd see him. The paperwork increased, so instead of having a nurse to help in the exam room and double as the billing clerk, you saw an increase in the staff required to keep and file records, make reports to insurance companies, the government, deal with pharmaceutical reps, answer phones, make referrals, schedule lab and hospital tests and so on. The old doc and his nurse grew to half a dozen doctors, nurse practitioners, RNs, phlebotomists, and billing clerks.
     Things have improved to the point where you now get a recording when you call the doctor's office, asking you to leave your name and number and a message, and they will call you back, probably today. If you're taking out the trash or getting the mail when the call comes in, they leave a message on your machine, and you have to start all over.
     In spite of all this, medical care is better than ever. But there's room for improvement. And everybody who has anything to do with it knows it, and is in favor of reforms. Cost controls and efficiencies are needed, because it's getting out of hand. So some people are looking at ways to make some positive changes.
     Insurance companies are all for it, so long as they continue to make profits and sell malpractice policies. Lawyers are all for it, so long as they can continue to sue and kick in the clauses in the settlement phases of the malpractice policies that doctors have to pay for. Politicians are all for it, so long as they don't have to vote for changes that will offend lobbyists for insurance companies, the trial lawyers' association, the American Medical Association, The American Association for Retired Persons, conservative political action committees, liberal advocates for free medical care, bankers or -- let's see, who else?
     Oh, yeah -- Patients. Folks. The ones who have moved from the waiting rooms of yesteryear to waiting at home for the insurance company to call back and explain why they aren't covering the MRI.