Slaughterhouse 38

Start time: 9:54 PM
End time: 10:42 PM
Word count: 868

“What do you think of this whole Universal Health Care Reform that they are trying to pass? Is something better than nothing and what side are you on?”

I have a philosophy that applies to essentially any problem that we have in this country, and it hasn’t failed me yet. It’s the Pyramid Philosophy, kind of an extension of the corporate maxim about shit rolling downhill.

The Pyramid Philosophy says that when the top of the pyramid is not invested in the success or failure of the middle and bottom of the pyramid, what the rest of the pyramid gets is going to suck. Have you been happy about flying in this country recently? Delayed planes, time wasted on the tarmac, charges for bags and soda? It used to be that the fares that the first class passengers paid – a level of comfort in which the passengers did not travel any faster or with much greater expedience or luxury, but were plied with amenities such as free drinks and meals, slightly larger seats, a nicer blanket or pillow – made the airlines profitable. These things didn’t justify the difference in price, though, and along came the more ubiquitous private jet. Now, there isn’t a CEO who’s angry enough at United Airlines to demand they straighten out or he’ll pull every speck of business his giant corporation has with them, because the CEO doesn’t have to go through TSA screening lines, putting his custom-made London oxfords through the x-ray machine. His jet leaves when he says so. As for the rest of us? They could charge everybody in coach for oxygen and he’ll happily keep billing his company for $28,000 every flight from Vegas to Chicago.

Here in Las Vegas, the Pyramid Philosophy works like this: If you are wealthy and can afford the best medical care anywhere, never mind our hospitals, our cancer center or our new brain institute and outpost of the Cleveland Clinic. The top tier of medicine in Las Vegas is to get the hell out of this city and get yourself over to Cedars-Sinai or UCLA Medical Center and get your treatment there. As for what they could expect back here in town? Google “Las Vegas hepatitis” to find out how 40,000 people were exposed to Hep C during routine medical tests because they reused needles.

So we have a really sweet situation where the top of the pyramid thinks they’ll have to pay for the health care of everybody else; they may be on the hook for this and it’s an outrage, I tell you. But this isn’t a simple Pyramid Problem any more.

The real problem with health care in this country is actually close to what we believe with air travel. Do you want the fully reclining seat, the unlimited bowls of your favorite honey roasted cashews, the boardroom style seating? Of course you do. What are you willing to pay for it? If it’s your money, you may not have a loose 28 large; odds are you’re going to tough it out in coach. If it’s other people’s money, nothing but the best. So when I get cancer, treating my cancer should involve sparing no expense, ensuring I’m involved in the latest experimental treatments, using tools of analysis, expert systems and opinions to ensure that I not only survive, but do so with a minimum of suffering. If it’s your cancer, though, and you need me to pay for it directly, well, I’ll give you a couple bucks and I’ll donate blood, sure, but I’m a little short right now.

In America, we want the Cadillac treatment at Yugo prices, and in many cases we’re bitching about that. We rail and scream at the idea of illegal immigrants actually availing themselves of emergency room services without ever wondering if we could physically throw a dying man back out through emergency room doors. We shout about how much money this will cost us without having to accept that our child couldn’t receive treatment at an emergency room when they’ve stopped breathing because we didn’t have the right insurance card, or do anything for our dying mother except get her one more month with us, one more hour without pain.

And for all of the screaming about death panels, did anyone really understand what that was about? Anyone who’s had a pet understands that a time arrives when you have to make a decision about If It’s Time. We do this because we are imbued with a capacity for moral decision-making that animals are not, a sense of compassion and a desire to alleviate suffering. But ultimately we make the decision at several levels regarding whether or not a pet is leading a fulfilling life and whether you can end their suffering. Are you saying that you can’t have this discussion with someone in advance of this decision being made? An understanding of when it’s time?

Ultimately we have to make the decision of not only choosing death over suffering, but finance over life. I get the feeling this may take a little longer to settle than most anyone would like to acknowledge.