Healthcare

Bostonians pride themselves on having some of the best healthcare in the world... if you can afford it, if you can find it, if you can understand it.

We're lucky. We have a healthcare package mediated by Nathan's employer. It only costs us $800 a month. (I find it difficult to write that sentence - the use of 'only' is ironic, the figure seems to have too many zeros). It's not the best of policies: one of Nathan's colleagues pays over $1000 a month, but we have a health care package at least. Our next step is to find a doctor who is taking on new patients to their practice, who is approved by our health care provider, who is listed on our health care provider's website (a virtual place in which the casual visitor can become lost for several hours at a time). When we find a doctor, we are expected to interview them and to research their practice (a range of quality markers are made available by the district and the state, the health care providers' own league tables of listed practitioners, through heated discussions between parents at the school gates). The amount of data and the sense of choice is overwhelming. I don't know how to navigate this but I feel a tremendous sense of responsibility for making the right decision. I want a roadmap for the health care provider's website, a script that I can adapt for interviews with prospective doctors, a list of basic instructions for successfully navigating this entire process.

Our neighbour's nanny is a politics student at Harvard. She recently described to us a class that she is taking on the American Healthcare System. Not one of the students attending this class fully understands the health care system, she tells us. It is too complex, too fragmented, too incoherent. It isn't possible to understand.

On a Tuesday, I volunteer at a soup kitchen in Cambridge. It's a big venture: the kitchen provides sit-down meals to 100-150 people. I've worked with homeless and socially excluded groups in England and Scotland. Some of the issues are generic to both sides of the Atlantic: there are the story-telling streetdrinkers and the drug-users whose addictions don't leave them with money enough for food; the people whose struggles with mental health problems have knocked them out of the mainstream and the people whose quirks and ways of living have meant that they don't want to fit into the mainstream anyway; there are the ones who have lost too much and the ones who have never had enough to lose. I thought that it would be familiar, and in many ways it is.

But I have never before seen so many people with no teeth, because they can't afford dental care. I have never before seen people taking turns with a broken down old wheelchair because that's all that they had been able to beg, borrow or steal. I've never before looked across a table and seen rows of eyes rheumy with infection or blue-ing with cataracts. I have never before seen old men who have only stumps on their hands because they have lost their fingers to frostbite over a series of winters. When I asked one man whose two remaining fingers were blackened with infection if he had been to the doctor, he shrugged. My question was nonsensical. A doctor volunteers at the soup kitchen. She does what she can. What she can do, in a few hours for over a hundred people on a Tuesday evening, will often be the most that these people can hope for.

As a mother, I want the best possible doctor for my children and I'm trying to find a way to do that. As a citizen (although not yet eligible to vote), I commend the politicians and activists who want the best possible medical system for the people of America and who are currently trying to find a way to do that (even when some of the brightest young people in the country, working with their professors, struggle to understand what is already there).  As a human, I am disgusted to live in a time and place where some people just need, desperately need, a doctor.