The Health Care Dilemma

I have given an inside view of my perception of the heath care dilemma. I was motivated by my daily experience with my wife who has suffered from the sudden onset of a stroke. This experience has brought me face-to-face with occurrences and situations which were alien to me as a physician and consultant in physical medicine and rehabilitation. Many events included here were previously disclosed by the press or published by government or private agencies. Some of this information may have escaped the attention of readers. Interpretation and presentation of events, however, are based on experience gained by years of practice in the field of medicine; this is in contrast to the experience of a layman whose spouse has suffered a major medical event. I found myself in a very unique position of being "two persons in one," the experienced physician on one side of the coin and the spouse of the victim of a major medical event-a stroke-on the other side. My task as an author is to present perspectives which I could not envisage as a physician. I have concluded that it was easier as a physician. Many of the events encountered were unthinkable and unknown to the author.

I have now brought into focus two sides of the same coin. The view from inside has revealed that there are many players in the field of health care delivery, all of whom exert some influence in its delivery. What is disconcerting is the fact that none of the players has taken any responsibility for its unbridled and escalating cost; they all believe that it is the responsibility of the other player. Therefore, nothing is done to reduce the cost of health care and the unconscionable burden on Middle America. I have mentioned important players in the field who may be contributors to this dilemma and have cited some of their contributions. The intent here is to be more informative. Ideas presented are not intended as gospel but merely another point of view. Readers may expand their thoughts by reading original manuscripts and reports available for public scrutiny.

Senior care, skilled nursing facilities, independent living facilities, and the role of physical medicine and rehabilitation are all discussed at some length. Issues and concerns obliquely related to health care were also discussed; these include long-term insurance coverage, the immigrants' contributions to health care, and the most precious years of our lives, "the golden years." Finally, an overview of the dilemma in health care was given in the context of a physician.