The new norm

I’ve known this mother for a long time. Far from wet behind the ears, she’s raised four other children, mostly on her own after her divorce several years ago. She’s never been one to run to the office for every sneeze and sniffle. If she brings one of her children in to be evaluated, it’s usually for a good reason. more»

Interested readers can peruse my latest JAAPA Musings blog post, newly published in the Journal of the American Academy of Physician Assistants.

5 comments on “The new norm

  1. clare says:

    Hi Brian,

    I am a PA who works in dermatology in Denver. I read your blog about how messed up our health care has become and I wanted to tell you an even bigger problem that is growing fast is senior living and dementia care.

    My father had a rare dementia called frontal temporal lobe dementia. He has had it for four years now and he started falling so my mom could not take care of him so we placed him in a home.

    The average cost of a home for a dementia patient is $7000/month. We are paying $9000/month. My father was a geophysicist and both of my parents saved up for retirement however ALL of her money is going to the home until she qualifies for medicaid and then this home he is in takes medicaid. However, my mother can’t afford her home so my sister and I have to rent her a condo.

    You can’t divorce someone who has dementia and the government will look back at where all of your money has gone for the past 5 years so she cant allocate money to anyone.

    These senior homes do not take insurance, and long term health insurance only pays about $1000/month, if that, and only for a few months.

    I am wondering if you can help me educate more and more people about this and make these homes less of a money making place than a place to take care of loved ones.

    Do you have any suggestions on who I can contact? I have a 4 page letter I have written to Obama but have yet to send it.

    I appreciate your help!!!!


    Clare Wightman

  2. BTM says:

    Hi Clare,

    Thanks for posting.

    The problem which you elucidate – that of assisted living facility care draining family finances – is one that many of us unfortunately will face as we age under the current health care system in this country.

    Those of us who have had the foresight (and the funds) to purchase long-term care insurance find that in the end it is grossly inadequate to cover these costs. In spite of our best efforts to be diligent, we remain victims of the system.

    In my opinion the only hope for change lies in the political arena, and that is a dim hope indeed. Still, I would encourage you to write your congressmen to voice your concerns; submit a letter to the editor of your local news forum. You might consider submitting a letter to the editor of JAAPA on the subject. The more folks who become aware of this issue, the greater the chance for change.

    Your mother is extremely fortunate to have two children with the commitment and financial wherewithal to support her through this ordeal. Give yourself a pat on the back for your efforts.

    Best wishes,


  3. Margaret Houlehan, PA-C says:

    Hi Brian,

    I am new to your blog. I am a PA with 26 years experience. I would like to see more PAs align themselves with Physicians for a National Health Plan. In my humble opinion, all roads lead to Single Payer. The Affordable Care Act does good in that it curbs some of the more predatory practices of Big In$urance, but it does not go far enough. President Obama is a pragmatist who knew he didn’t have the votes for Single Payer or even the public option. One good aspect of “Obamacare” is that it has a loophole which allows states like Vermont to proceed with universal health care.

    I am so disgusted with the misinformation disseminated by “Faux” News and other footsoldiers of Aetna, Cigna, et al. I hear it from my patients on a daily basis. I am also disheartened by the Ayn Randian attitude of some. I have mine, to *hell* with you. Well, guess what? Even Christopher Reeve, a wealthy man, was out of funds near the end of his life.

    We are the only industrialized nation in the world with for-profit health care. Are the systems in the UK, Canada, or France perfect? No. But I will wager you that few people in those countries worry that they are one illness or accident away from bankruptcy. In an ideal world, everyone would receive Cadillac health care. That is not going to happen. Not under Single Payer, and definitely not under our vaunted US system.

    This is American exceptionalism—and not in a good way. Only in this country is it a badge of honor to pay 2K per month for crappy insurance.

    Let’s see more PAs get involved in the movement for health care for all.

  4. BTM says:

    Hello Margaret,

    Several years ago I examined the debate on healthcare reform in a series of Socratic dialogs on this blog. In them I address many of the issues you highlight in your comment.

    In the final Socratic dialog (VII) Hippocrates laments:

    “Alas, the single payer option was defeated in the preliminary debate. The lobbyists for the health insurance industry made certain of that through the influence of much silver coin in the pockets of the politicians. Likewise, the sorcerers bought their influence to insure that the price of pharmaceuticals could not be negotiated in the Agora.”

    Socrates replies:

    “It seems as though that which began as a good and noble idea has been degraded through bribes, trickery and quiet whisperings behind the scenes.”

    While I share your zeal to enact a single-payer system to ensure equal access to health care for all, I fear that it is not in the cards anytime soon. Those who hold the reins of power (third-party payers, the pharmaceutical industry, for-profit hospitals, even members of the medical community in some cases) are poised to block it.

    Perhaps we should take the anthropologist Margaret Mead at her word: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”



  5. td says:

    Insurance is legalized extortion ….

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