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Health Care Wars: Embedded Reporter

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I have a confession to make: I sort of like my insurance company. In the last five years, it has shelled out a lot of money to save my life, which has endeared it to me.

Also, unlike a number of the other major players in the current health-care wars, my insurance company didn't do anything to threaten my life.

When I was 45 years old -- and healthy by all conventional measures -- I was identified as a person at risk. According to my DNA, I inherited a mutant protein from my father (he died when he was forty-four), which can compromise the electrical signals that regulated the beating of my heart. I was told that the first obvious symptom would be my sudden death.
I was persuaded by a team of doctors at one of Boston's most eminent teaching hospitals to pursue what was described as prophylactic therapy -- hospital code for surgery. An ICD -- commonly known as a defibrillator -- was implanted in my chest and hard-wired to the muscle of my heart. My insurance company paid the bill.

Unfortunately, along with that ICD, I was also given a life-threatening staph infection in the hospital. The ICD and wires had to be pulled out, and a central venous catheter had to be inserted so I could shoot myself full of antibiotics for six weeks, under the careful supervision of visiting nurses and technicians. The insurance company picked up the tab again.

A second ICD was inserted and wired though my veins, and the scar tissue healed over the internal and external incisions again. Again, the insurance company paid the bill. And then I read in my morning newspaper that the new wire screwed into the wall of my heart was being recalled by the manufacturer. That faulty wire probably rendered my life-saving device useless, possibly posed a threat to my life, and certainly would prove dicey to remove.

Thanks to a recent Supreme Court ruling, which effectively shields device-manufacturers from liability claims, guess who would be stuck paying the tab? Because the wire was evidently fraying and frazzling in my vein, the manufacturer kindly offered me a new electrical wire and $800 toward the cost of removal and replacement surgery. The hospital bill I received for that surgery was $80,000. My insurance company finally forked over $60,000.

You could call this a win-win-win-win-win. In the impossible math of our present system, those doctors, the hospital, the device manufacturer, the insurance company, and the patient are all apparently thriving.

Or you can use my story to add to the tally of unaccountable losses -- the lives lost or harmed by the shamelessly high rate of hospital-acquired infections in this country; the needless deaths and suffering occasioned by the unholy alliance of device manufacturers and the regulatory agencies that protect them and not patients; the $35 billion taxpayers have been paying annually to hospitals that basically invented a profitable form of socialized medicine with cooperative doctors, drug and device makers, and insurance companies. (And I'm not even counting the $15 billion or so in annual tax-exemptions granted to the 80-plus percent of our hospitals that qualify as nonprofit institutions).

As I see it, the reform legislation just passed by House or Representatives raises a lot of hope and a lot of questions. So far, those questions have been framed to divide Americans and to pit one interest against another. In the aftermath of the vote, I am asking myself three simple questions.

1. What would have happened to me if I didn't have insurance?
2. Was I better off because 30 million uninsured Americans -- teachers, taxi-drivers, plumbers, food-servers, and a lot of people in, around, and on their way to a hospital bed next to mine -- were routinely not screened or treated for communicable and contagious and infectious diseases?
3. Should every Americans, faced with preventable suffering and death, have the same choices I had or not?

We are all embedded reporters in this war. We are all patients. The questions before us are real -- but I really think we know the answers.

Michael Downing's most recent book is Life with Sudden Death: A Tale of Moral Hazard and Medical Misadventure. He teaches creative writing at Tufts University. You can read more about his work at michaeldowningbooks.com.