Better Way Through Trust

Lapius demanded that the cab let us out about a block from the house, “to get my circulation going,” he explained.  He was literally fuming.  He resembled a dragon as he stomped angrily on the icy walks, twin jets of frost spiraling from his nostrils.  As we entered the house he started to stumble and reach out for support like a blind man.

“What happened," I asked, trying to balance him.  “Did the brandy go to your head?”

“Don’t be ridiculous.  It’s my eyeglasses,” I reached for my handkerchief and polished the mist from his lenses.  “There, that’s better,” he said.

It took him a few minutes to divest himself of scarves, boots, sweaters, etc. with which he had girded himself against the winter winds.  “I think,” he said when he had finished, “that I need another brandy to settle my temper.”

“Still stinging from that argument with Dr. Hardline?” I asked.

Lapius laughed.  “Hardly.  I’ve known Johnny for a long time.  We have a go at each other every so often.  Keeps me on my toes.  No.  The problem is that although I disagree with his tactics, I can’t disagree with his position.  The government is often quite predatory.  It encourages the private sector to develop a fine resource, then gobbles it up.  But what is worse, in the gobbling, prevents the resource from being expanded and refined.  After all, the trust it has placed in the profession of medicine as well as the pharmaceutical industry has paid off handsomely.  Sure it subsidized some areas but the fact is that the medical profession has exquisite tools with which to fight disease, and the pharmaceutical industry has come up with remarkable medications that afford a longer and happier life (medically speaking) for many of our people.  The fact that much of this is beyond the financial resources of many is not the fault of either the profession or the industry, but of the economic system.  It seems unfair to attack medicine and the pharmaceutical industry for something that is the fault of the government itself.”

“Sure is a problem,” I said hopefully.

“But not insoluble,” said Lapius ignoring the irony.  I had poured him a small liqueur, hoping that after the brandy, he had consumed, the sweet drink would put him to sleep so I could watch a fight on TV, but I had, as always, under-estimated his capacity.

“The problem is, Harry,” Lapius continued, disregarding my television commitment, “that the government has mounted a vicious attack on the medical profession, using the proposed regulations to subvert the image of the doctor in the eyes of the public.  They have done much the same to the pharmaceutical industry.  It is one thing to propose corrective legislation, but quite another to demand utilization review, and to require that before a doctor can admit a patient to a hospital the reason for admission must be screened by committee.  This places in the mind of the public the proposition that no doctor can be trusted.  That he keeps patients in hospitals too long in order to line his own pocket.  They have by these tactics, undermined the people’s faith in the medical profession.  They attack our probity and ethic by so-called remedial laws.  Yet individually they trust us enough to come to us when they are ill.  The pharmaceutical industry has played a large role in health improvement, yet it too is under attack. If the pharmaceutical companies can’t earn money to plow back into research, the research will stop, and the system will groan to a halt.”

“Well,” I interjected, in order to give him time to sip the liqueur, “whom the gods would destroy they first make crazy,”

“The quotation, Harry, is, ‘Whom God wishes to destroy He first deprives of reason,’ ascribed to Euripides.”

“Well, you know what I mean,” I said lamely.

“That’s neither here nor there, Harry.  The fact is that the government could solve a lot of its problems if it would stop being so suspicious.  Not worry about utilization so much, but proceed on the certain knowledge that no patient wants to stay in a hospital longer than necessary.”

“But we have a hospital bed shortage.”

“Then build more hospitals.”

“But that’s expensive.”

“Everything is expensive.  Look how expensive it is to set up bureaucratic watchdog agencies.  They could use that money for better purposes.”

“How?”

“Simple.  If I have a chronically ill patient at home who, because of the illness and nursing needs, is becoming a burden to the family, why can’t I call an agency, recommend that they pay for a nurse or homemaker, and have it done pronto.”

“That’s childish, Simon.  Look how much chiseling and kickback there could be.”

True, it might cost a billion in chiseling, but this way they lose a billion in surveillance.  Let’s make a swap.  My way would create more jobs, give the doctor more flexibility in dealing with difficult social problems.  Place the responsibility for the care of the elderly or family who would accept the responsibility, if only they could get some assistance.  You say I am childish.  Of course, I am.  The problem is that we have been behaving as adults.  Creating slick systems that stifle our initiative to get things done and to help people.  What we need is a return to childhood innocence, where a direct problem is met directly, where a well of trust exists.”

“Ha,” I laughed.  “You want everyone to trust each other.  That is a laugh.”

“It is nothing to laugh about.  If someone has an accident they are invariably picked up out of the road by a first aid squad, people who voluntarily place themselves on call 24 hours a day to help their neighbors in the community.  They are a Godsend, particularly for the unfortunate person who suddenly finds himself tangled in the wreck of a car.  The government now wants to professionalize them, and to do this suggests that the first aid volunteers do not know enough about resuscitation, cardiac arrest, internal injuries, and what have you.  The direct inference to the public is that you can’t trust this remarkable person who volunteers to help you when you are in trouble.  I construe the whole thing as an unwarranted and vicious attack.  There must be a better way to improve health services than to attack the people who established them in the first place.”

“I am sure you have a suggestion to offer.”

“As a matter of fact I do, Harry.  There must be a return to the basic tenets of the founding fathers, that in the long run the divergent interests of a free society will balance out for the common good.  In order for people to have faith in its government, the government must have faith in its people.  Get me some more of that delectable potion, Harry.”

“Do you trust me, Simon?”

“Implicitly, Harry.”

“You’ve had too much to drink.  Go to bed.”

“Nonsense,” said Lapius, as he struggled from his chair to refill his glass, I’ll snooze here.”