DEYAN RANKO BRASHICH was born in Belgrade, former Yugoslavia, and is an Op-Ed columnist for Connecticut's Litchfield County Times.  He writes the monthly Letter From America column for Romania’s Scrisul Romanesc, a literary magazine and is the Editor-at-Large for  The Country and Abroad, another literary/art magazine where he authors the Dispatch from Abroad column. He is a frequent contributor to Pecat, the Belgrade, Serbia weekly news magazine, Britić, a magazine published in the United Kingdom, Ekurd Daily, a multinational Kurdish news portal and Passport, a lifestyle quarterly. He resides in New York City and Washington, Connecticut.







Otto von Bismarck, Germany’s Iron Chancellor, instituted universal health care in 1884. Most civilized industrial nations, Canada, England, France, have universal health care that works. Others such as former Eastern bloc countries, Romania, Serbia, Croatia have universal health care that works, after a fashion. Others, many ending in “a”, Somalia, Ethiopia, Syria and India do not.

The United States has been in the throes of establishing a viable health care system, not necessarily universal, for the last two decades. This last decade has seen the passage of Obama’s Affordable Care Act and more than 60 separate votes in the House of Representatives to repeal it. Last month witnessed the defeat of the Ryan/Trump repeal and replace by the American Health Care Act fiasco.

I will not debate the merits of the two pieces of legislation:  one, Obamacare is 960 pages long with 2,000 pages of regulations appended which I have not read; the other, the proposed Ryan/Trump replacement only has the initial part on paper, with phases 2 and 3 yet to be written. It also remains unread and so I cannot compare the two.   

But I can tell you about the care I just received at New York’s Mount Sinai Hospital for “cervical cord compression with mysiopathy and stenosis of cervical spine with mysiopathy” or what you and I would call old age.

I am 76, retired and I collect Social Security. $273.00 is deducted from my monthly benefit for Medicare Part B coverage, adjusted for my family’s income. I have an AARP wrap-around medical insurance plan costing $230.50 a month and Silver Scrip drug coverage at $38.40 a month. The cost of medical insurance totals 41% of my Social Security benefits.

November 30, 2016: During a visit to Mount Sinai for an unrelated medical issue the examining physician noticed my uneven walking gait. He recommended that I see a neurologist. The portion of that visit dealing with this issue had me interact with two individuals, the doctor and a nurse. The number of individual interactions [hereafter “NIIS”] was two. NIIS is 2.

December 23, 2016: Initial consultation with neurologist. Arrived at Mount Sinai Hospital campus, a multi block behemoth complex of building. Directed by receptionist/guard to neurology department. Met by receptionist who directed the completion of information forms. Examined by nurse for vital signs and other base line measurements. Examined by neurologist and nurse-practioner. Directed to blood laboratory - met by receptionist and technician. Directed to x-ray facility and received by receptionist and x-rays taken by 2 technicians. NIIS is 10

December 31, 2016: Arrived for an MRI on New Year’s Eve. Met with receptionist and technician administering MRI. NIIS is 2

January 25, 2017: Examination by neurologist, repeat of initial December 23 visit. After examination referred to spine surgeon for evaluation and possible surgical intervention. NIIS is 4

March 16, 2017: Examination and evaluation by spine surgeon. Receptionist, surgeon, nurse, nurse-practioner, visiting surgeons – one from Brazil the other from China – sent for additional blood work, seen by receptionist and technician. Directed to undergo pre-operation clearance. NIIS is 7

March 22, 2017: Pre-op evaluation. Receptionist, 1 nurse-practioner, cardiologist, 3 technicians. NIIS is 6

March 24, 2017: Chemical stress and associated test. Receptionist, 2 technicians and cardiologist. NIIS is 5

March 29, 2017: Introduction to research fellow, see next entry. NIIS is 1

March 30, 2017: Meeting and evaluation outpatient at my home by research fellow in a government sponsored longitudinal study of effect of anesthesia on the cognitive function in persons over 65, two-hour session. NIIS is 1

March 31, 2017: Actual surgical intervention: let me just list the individuals and their titles, as best I can, who participated in my care – receptionist, head of intake, intake clerk, 2 admitting nurses, transporter to holding area, nurse in holding area, 2 anesthesiologists, 2 surgeons, an assistant surgeon, neurological assistant, at least 6 individuals in the operating room that I cannot identify, post-operative nurse, transporter, 2 hospital  nurses and 2 assistants nurses, occupational therapist, rehabilitation therapist, 3 technicians monitoring vital signs, transporter to x-ray and 2 technicians, transporter from x-ray to room, transporter to curbside and a waiting cab. NIIS is at least 35

I have interacted with at least 69 medical care providers during this routine surgical procedure which was not brain or heart surgery, and the care is continuing and counting.

This not include the infrastructure necessary to run Mount Sinai as an institution: administration, human resources, the maintenance of complex machinery, the MRI’s, the x-ray machines, the machines that I can’t even name.  You have the mundane, the changing of lightbulbs and bedsheets, the cleaning of floors and bathrooms. You have the invisible technicians laboring in obscure labs reading those x-rays, those MRI’s, those thousands of other test results and evaluating them according to specialty. I never met them and they are not the NIIS that I interacted with but I am sure number in the hundreds.

As to cost – to date, I have had no out of pocket expense except for two drug prescriptions costing $5.87 - the balance being paid by either Medicare or my supplemental insurance. During registration, I was offered a private room for my overnight stay at a non-covered cost of $553.00, which I declined. That’s it, so far.

Health care is expensive and as Donald Trump just realized “it’s an unbelievably complex subject … [n]obody knew that health care could be so complicated.” I am sure that there is abuse, waste and mismanagement, but that is true of all government that our taxes fund and support, be it Congress, the Department of Motor Vehicles, the Metropolitan Transportation Authority, the Department of Defense and even the National Endowment for the Arts.

The Ryan/Trump Administration American Health Care Act’s stated goal is to reduce the cost of health care. After all, it is a budget bill, legislation that requires only a bare majority to be Senate approved and is filibuster proof. But if cutting costs equates to cutting the amount of health care delivered or making health care unaffordable then it will prove a monumental mistake.

Repeal and replace proponents warn that Obamacare is in a financial death spiral and will implode momentarily - perhaps, maybe, I don’t know. There are reports that premiums have escalated precipitously and that insurance carriers no longer offer coverage. The reason I don’t know is that we have had no debate, no testimony, no evidentiary hearings on the issue. The only thing we have had are dueling talking points exchanges between partisan yahoos.

But I do know that the Navy has just commissioned the USS Zumwalt, a guided missile destroyer, after spending $9.6 billion in research and development. As of 2017 the total cost of this “misguided”, guided missile program of 3 ships is “$22.5 billion with the average cost of $7.5 billion per ship”.

I also know that on March 28, the Trump Administration reported to the Senate Homeland Security and Government Accountability Committee that the projected cost of Mexico’s border wall will be $66.9 billion dollars. Not to be outdone the Air Force has the F-35 Joint Strike Fighter program, “an affordable 5th generation fighter” at $132.2 million a plane which is $200 billion over budget and will cost $1 trillion dollars.

Add to this squandered fortune the cost of the Iraq War, a war based on lies and deception, that is now estimated at $1.7 trillion dollars “with an additional $490 billion in benefits … that could grow to more than $6 trillion over the next four decades counting interest”. That’s a lot of money.

And don’t forget the lost tax revenue on profits held overseas by American businesses now at $3.1 trillion and counting [General Electric $110 billion, Microsoft $76.4 billion, Pfizer $69 billion, Merck $57.1 and Apple $54.4 billion, figures as of 2014] and you have the wherewithal to pay for my health care.

So, I’m sorry when it comes to health care I am going to sing along with my pal Madonna:

Papa don’t preach, I’m in trouble deep

Papa don’t preach, I’ve been losing sleep

But I’ve made up my mind, I’m keeping my Obamacare

Oh, I’m going to keep my Obamacare, mmm.

     Madonna, “Papa Don’t Preach”, True Blue Album [1986]






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