About a month ago, I felt some scaling on my cheek, saw abnormal skin, and realized it was time to see the dermatologist long before my annual appointment.  Here in Oregon, I get annual appointments; in Arizona, I was seen every six months, which I needed, because I had lived there for decades, the sun angle is higher and there is more sun exposure in general.  Arizona is a hotbed of skin disease.  Worse, I grew up spending a lot of time outdoors, where my parents told me to go outside and play in the sun (along Route 20, I think the pediatrician told them).  Vitamin D was good: we all heard that. I developed many actinic keratoses as a result of all that “good” sun. The four basal cell carcinomas I had were more dangerous, but at least somebody found them in time and cured them with chemotherapy ointment.

Skin cancer is not a big deal if one has periodic checks and gets treated early.  That costs money, requiring insurance and access to dermatologists.  Unfortunately, in the scheme of needed body care, dermatology and dental are not high priorities. If one doesn’t have insurance or access—either one—there is a risk that a melanoma will be missed until it presents with a seizure perhaps, meaning it has metastasized to the brain, or a basal cell cancer presents by eroding deep into skin and bone, treatable only by extensive disfiguring surgery.  The father of a friend of mine died after surgery to try to clear a basal cell cancer that had eroded through his face. My actinic keratosis was treated in twenty seconds of liquid nitrogen therapy.  The blister on my face will be healed in a week.  I won’t discuss dental care other than it is necessary for good health as well as creating a good impression.  Americans are very teeth conscious.

Strep throats are nasty but are easily cured.  Left untreated, because someone cannot afford a doctor’s visit, they will still get better.  Unfortunately, untreated strep throats may have complications as peritonsillar abscess, mastoiditis, retropharyngeal abscess, rheumatic fever with subsequent scarring of the heart valves, and acute glomerulonephritis with kidney failure.  A big reason why I never saw mastoiditis when I practiced medicine was that American children get early treatment for strep.  Take away access to treatment and these diseases will return.  Syphilis has returned to Eugene.  Go to the Third World and you will see people with diseases we Americans never get (polio, tetanus, congenital rubella) and trauma that our “restrictive” safety regulations prevent.  No, we aren’t perfect; every fourth of July, 11 Americans die from mishandled fireworks.  A kid out here blew off his hand last week: “I thought I would have at least two to three seconds.”  He might have had that; people aren’t good judges of time. He now is young with one hand.

We need to ensure people at both ends of the age spectrum have access to affordable, good quality medical care, and then work on those in between.  I had thought we were making progress towards the first until these past few months, when there is now a real possibility we will go backward at least with children on Medicaid.  I would be very naive were I to think Medicare is immune from the chopping block in some form, either.  There are far too many who don’t think they should be taxed to pay for someone else’s medical care, even as these same people are medical care consumers.

I would hope that out of the shooting of Mr. Scalise, there might be an awakening in some circles that each one of us is one bullet away from an unexpected, unforeseen medical catastrophe.  A psychologist I know would have called this being hit with a two by four on the side of the head moment.  I would expand the list from a bullet to one malignant cell, one blood clot, one ruptured vessel in the brainstem, one bacterium, one virus, and one drunk driver.  While some of those have risk factors, virtually none is predictable.  We can screen for cancers, and we can eat right, and that will help, but I, like all doctors and nurses, have seen my share of horror stories: the 29 year-old with aggressive colon cancer, the 24 year-old runner who died after uncomplicated surgery for appendicitis, the 41 year-old man who died from a preventable heart attack, because he couldn’t afford to be screened, a 17 year-old high school student in my class, beautiful, smart, who died after routine thyroid surgery.  Bad stuff can happen to anybody, and not being able to get or to afford care makes a bad situation far worse.

Catastrophes aside, day to day preventive health care gives peace of mind if something isn’t found, and while peace of mind doesn’t have a dollar sign, it has worth: perhaps the pursuit of happiness that is discussed every July fourth.  If something is found early, like a melanoma, an unsuspected heart problem, a small malignancy in the colon, cervix, or prostate, it can be dealt with far more easily, successfully, and yes, cheaply, than waiting until the individual has Stage IV disease and is “found down” or struggles into an emergency department with extensive disease, a bad prognosis, and yes, very expensive, too.

I’m concerned about the 40% of our children covered by Medicaid.  The proportion is not surprisingly higher in the poor, especially in people of color.  A disturbingly large number of children have episodic Medicaid coverage, which is not good for those with chronic diseases, like asthma, who need regular monitoring.  I’m concerned about vaccination status, lead poisoning, and proper nutrition.  If we miss the timeline on these, these children will never catch up and be doomed to a second or lower tier existences.  If we have too many children in this country, which I think we do, then we need more available birth control, not defund Planned Parenthood or take away medical coverage.  What gives?  Let me say it right out:  Paul Ryan is a devout Catholic, and he is going to push the Church’s rules (hopefully not pedophilia, although that is a cheap shot, I admit) down our throats.  Let me keep going.  The Affordable Care Act was signed by a black (half black) president, and that is just too much to tolerate.  In one of my lesser moments in life, my father once accused me of being incredibly irrational.  Yes, I was.  And I learned from it.  (So was my father irrational when it came to the Catastrophic Care Act, which taxed the elderly.)  It’s one thing when I’m irrational.  I hurt the people around me, a very small number.  The Republicans in power are hurting a third of a billion (not counting the rest of the world), because they couldn’t stand a black president and any of his legacy.

What are they thinking?  Do they want more poor people who need more medical care?  Because that is where we are going.  Or do they honestly want to see people die because they aren’t pure in some form?  What is it that they want?  Is it government out of our lives altogether?  Why, when a majority of Americans want Medicare to be left alone, should it be changed?  Why, when a majority of Americans want background checks for firearms, should they not be allowed?  Keeping Medicare is not irrational; wanting background criminal checks before one purchases a weapon is not irrational.

Not making needed preventable and other medical care affordable to every man, woman, and child in this country is irrational.  Not only is it morally right, it will save money in the long run.  Want to save more?  Fund Planned Parenthood and increase family planning.  Wanted children are healthier and will be more productive citizens. It’s necessary, it’s fair.

It’s rational.

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