Draining the Medical Swamp

Making Health Care Great Again

I have a good friend, let’s call him Arnie the Hapless because he has a medical issue, and we must be careful to protect his privacy. He’s a bit of a right winger, Arnie is, but we manage to remain friends because there are qualities that we admire in each other. He’s loaded, so he can take me to exclusive venues that I would otherwise not be welcomed in. I’m a doctor, and Arnie’s an accomplished hypochondriac, so he appreciates to have reliable medical opinions at the drop of a hat. It works out well.

We met because our children went to school together, and our wives got to know each other while they waited in line to pick the kids up in the afternoon. Soon they became fast friends. A cup of coffee in the morning progressed to membership in the same gym and a common interest in yoga. They read every book that came out on how to raise children. They almost always agreed on what they thought were the right approaches.

I don’t recall who extended the first invitation. Maybe it was us, taking them to a Cardinals game. These are always tense moments. It’s easy enough for two people to get along. Once you add two spouses, instead of dealing with one relationship you must handle four. In math they teach us how to deal with permutations. These are the variables: husband and wife A have to get along with each other; husband and wife B likewise; husband A must like wife B and husband B; same for wife A; same for husband and wife B. Unlike in math, there can be times where husband A likes wife B and she secretly despises him in return. It can get complicated.

We had several things going for us. Our kids were fast friends. At a young age they spoke of getting married to each other. My wife and Arnie’s wife are severely apolitical. They had enough to worry about and they never talked about money or policy. I’m easygoing and I try, very hard, to find something positive to say about anyone that I meet.

We hit it off. Arnie’s a bit of a loudmouth and a braggart, but it came through loud and clear that he was proud of his family and would do anything for them. I also got the notion that he would tear off his right arm if it would help a friend. Over the years we’ve traveled, dined, and just sat and talked. It has always been good, despite our very obvious political differences.

Of late two additional variables have threatened the relationship. Despite having strong reservations about the Trump candidacy, Arnie embraced it and donated money. He told me that anyone would be better than the alternative. I countered that by asking if he literally meant anyone, because that was what he was voting for. He told me that I should give other viewpoints a chance. He thought that Trump would drain the swamp. He also hoped that he’d get some relief from the onerous government regulations that he had to deal with.

The second issue is that Arnie has developed health problems. Real; not imagined. I have steered him through the proper channels in our hopelessly complicated health care system, for which he’s grateful. But being in constant pain is hard, and it becomes intolerable for a person who’s so used to be in total control of his life. Or so he thought. He has been very difficult to get along with. His wife, who’s an angel if there ever was one, has suffered through tantrums and humiliations. I resent Arnie for that.

So: Arnie’s having a hard time accepting his disease and his political choice. He’s falling all over himself trying to justify the incompetent cabinet appointees. “Just give them a chance,” he says. He always adds something about draining the swamp. It has been sad to see him in physical and emotional pain. I wish that I could help more.

A few weeks ago it became clear that Arnie would need surgery. I did my research. I found what I felt was the best place for him to be operated on.

The date was set. I agreed to be with him.

When we walked into the hospital outpatient surgery department there was a long line to check in. At five thirty in the morning. I was puzzled. I knew this place. It was usually very efficient. I recognized one of the supervisors.

I motioned to her to come talk to me.

What’s going on?

“It’s the hiring freeze. Two of our employees left. One moved out of town; the other got another job. We cannot hire any new ones.”

I thought that was only in government. And not for health care or the military anyway.

“We have a new hospital president. Big Trump fan. He wanted our institution to express support for the government any way it can. We froze hiring.”

Her eyes rolled up in her head. But now your surgeries will be delayed. It’s so inefficient!

She shrugged and placed her palms up around her shoulders, in the universal sign of helplessness.

I went back to Arnie. I knew better than to tell him he’d be taken care of by a short staff who’d be in a hurry.

They had an emergency. We may have to wait a bit.

He was in no hurry to get operated on. Plus, he had been given a sedative by his doctor. He nodded.

Eventually we were taken into the staging suite. A nurse introduced herself.

An IV was started; Arnie was asked to empty his bladder. He was barely awake. I suspected that he had overmedicated himself, but I wasn’t about to ask him. He would have denied it.

“Everything is ready,” she said. “Doctor Hopefully will be in soon.”

Who is doctor Hopefully?

“He’s the anesthesiologist.”

I asked for doctor Brandname.

“He no longer works here. Doctor Hopefully does all of the anesthesia now.”

When was there a change? I checked on everything three days ago!

“Today is his first day.”

Who is he? Where did he go to school? What kind of training does he have?

“They haven’t told us. I’m sure that our new president wouldn’t have hired him if he wasn’t good.”

Alarm bells began to ring in my ears. Loudly.

Is all the medical staff new? What about doctor Surehands?

“He has also been replaced. We now have doctor Iffy.”

Why weren’t we told?

I noticed, with some regret, that I had raised my voice. The nurse had nothing to do with any of this.

Never mind. Can we get the OR supervisor here?

“He’s also new.”

Of course. Tell him that we’d like to talk to him.

Through all of this Arnie was barely awake. I could tell that he wanted to react to the news, but his brain was not engaged. He just looked out into space. I could sense a vague glimmer of concern in his gaze.

Don’t worry. No one is touching you until I say it’s OK.

He nodded and smiled.

A half hour later an elderly man who wore thick glasses walked into Arnie’s room. He introduced himself as being the new OR supervisor. I expressed my concern about the wait for registration, and the replacement doctors.

“No need to worry. Your friend will be in excellent hands.”

I want to believe you. But please understand that this comes as a surprise.

Rather profound changes have been made in this place.

“I know. It was necessary to drain the swamp.”

By getting rid of good doctors?

“Expenses were out of hand. New management was needed.”

I see. It just seems so radical. Has this ever worked when you’ve tried it in the past?

He smiled.

“I ran a venture capital firm until recently. Worth billions of dollars. You could say that I know something about administering dollars and cents.”

You mean you’ve never run an operating room before?

“It’s all administration. Paper clips get pushed; people get reassigned… Not that complicated.”

But you have no medical training?

“There are very capable people that I can turn to if I need a particular form of expertise.”

Then why not let them run the show?

“They haven’t drained swamps before.”

How about doctor Surehands? We want him to be the surgeon.

“Doctor Surehands’s costs were very high. Doctor Iffy has a master’s degree in business. She will be the new surgeon.”

Has she done this procedure in the past?

“Today will be her first one. But there are very capable people that she can turn to if she needs a particular form of expertise.”

Why not let Dr. Surehands do it?

“You need to give Dr. Iffy a chance. The whole new system a chance.”

And risk my friend’s life in the process? Are you actually serious?

“I have a commitment to lower costs and drain the swamp. This will be done. You seem to be stuck in the old ways. Are you a liberal democrat, by any chance?”

I got ready to scream. My good guardian angel convinced me to remain quiet.

Let’s go home, Arnie.

My friend had listened to this conversation with increasing levels of alertness. He vigorously nodded his consent.

“I wouldn’t do that if I were you,” said the administrator.

What! Did you do away with informed consent also?

“Of course not. Not yet. But every insurance company in the state has agreed to cooperate with us. Costs will be cut in half; they’re very keen to get on board. It will be the same story everywhere you go.”

That’s OK. My friend here is loaded. We’ll go to Canada for the surgery. He can pay cash.

Arnie vigorously nodded again.

“We have the best health care system in the world. Canadians line up for miles to come to this country for surgery. You have your countries mixed up.”

My dear sir! You have just come up with the latest alternative fact. This is still our country, and we will never stop reminding you of THAT fact. Please have the nurse unhook my friend from the IV. We’re going home.

The supervisor walked out, befuddled, not understanding why these ignorant people couldn’t fathom his perfect logic. He couldn’t wait to tell all his friends at the country club about how rude and unpleasantly obstinate some families of patients could be.