What the Hell is Topsy? And What Does it Have to Do With Healthcare?

Since all the furor over Obamacare seems to have settled to a dull rumble, now may be a good time to raise the issue here.  Affordable health care has very much been a part of my life for the past few years, between Bunny’s cancer and the treatments and my cervical spine fusion back in 2010. 

For years, we had insurance coverage through Bunny’s job, and a very small amount of his salary went toward the group premium.  No sweat.  We had access to the best doctors we could find.  Once Bunny ran out of FMLA time and his employer terminated him, we were in COBRA territory.  COBRA is supposed to provide health insurance without a gap—you pay the premium, and your coverage continues until the insurance at your next job kicks in.  Sounds good, right? Ha!

I was acquainted with COBRA from changing jobs many years ago—it’s expensive.   Very expensive.  For the exact same coverage we had before, we now paid as much for health insurance as we did for our monthly mortgage payment.  I don’t consider it “affordable” when you pay as much for the roof over your head as you do for health insurance.

Not paying for COBRA wasn’t even an option: Bunny needed chemo and blood transfusions.  He got desperately ill with the least provocation.  Worrying about the extra expense added to his already-anxious demeanor.  I assured him that everything would be okay, but he worried nonetheless: if we spent all our money on medical care, there’d be nothing left for me once he was gone.  At the time, we didn’t realize how little time he had left, and he was prepared to continue treatment as long as there was hope.

Finally, he hit upon a solution, borrowing a page from some of our friends who’d done the same thing years earlier: if things got too bad, we would divorce, and he could qualify for Medicaid and get medical care that way.   Knowing how much the whole situation upset him, I agreed, but I thought to myself: how fucked up is it that people would be so worried about having health care that they would dissolve an otherwise happy marriage?  Then I started hearing stories from every corner of the country about people who had done the exact same thing.

I’ve been on board for universal health care since way before Hilary’s plan.  I’ve always believed that health care is a basic necessity that everyone should have.  Socialized medicine?  That label doesn’t bother me.  When people need it, they should have access to it, and it should truly be affordable.

I’d never discussed the issue with my daddy, other than in passing.  My daddy has worked in health care his whole adult life, so he knows more about it than the average dad.  He’s also maddeningly logical in his thinking—kind of like Mr. Spock on Star Trek.  E-mails from him never took up more than a few lines, so I was surprised a few weeks ago when he sent me a draft of an e-mail he was sending to a friend who was losing her mind over Obamacare.  With his permission, I’m reprinting it here:

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"It growed like Topsy”

I can remember the late 40s & early 50s, when the only wonder drugs were the sulfa drugs (developed in the 30s), newly released penicillin (if your doctor trusted it) and of course the patent medicine spectrum (Hadacol) . Immunizations were the most visible sign of medical research. These were affordable to even the poorest people.

Surgical procedures were primitive compared with those performed today on a daily basis. In Louisiana, the Charity Hospital System (taxpayer supported) provided care to anyone who could not afford (or was unafraid of the "charity" stigma) and was willing to be treated. Most of the private physicians in the state interned or completed residences in these facilities.

"Clinics" which were generally named for the physicians in the practice and reflected their personal training and attitudes had become available after the 30s as a result of the advent of medical-hospital insurance schemes, which were participated in by union members, state governments, enlightened employers and some individuals.

Transplants, implants and chemo were experimental and not available except to the wealthiest.

Generally, outside of state-supported hospitals, if you could not afford a specific treatment, you did not get it.

In sum, standardized medical care was a commodity which was not available to everyone and 'Nature abhors a vacuum'

Thus, the impact of Medicare $ on this system brought forth research, enhanced medical care, fraud, unnecessary treatment, unintended consequences, etc. (another vacuum waiting to be filled).

Now we have "Obama Care" which will have both good and ill consequences which are awaiting discovery.

Until we as a society are willing to honestly address the fundamental issues (medical ethics - an oxymoron?), the cycle will continue.

How much medical care for everyone do we really want?

Although I am willing to drive a clunker rather than a Maserati, am I willing to receive the same medical care as the poorest member of society? Should there be an available difference?

How much morality do we want to inject into the issue? birth control? abortions? pacemakers for 85 year olds regardless of mental/physical condition, CAT Scans and MRIs for someone obviously about to die?

Do I want a friend on the "Death Panel"?

I'm sure you can add a few others, but as usual it all comes back to $$, and a way to administer the system in such a way so as to please everyone.

­vox populi, vox dei

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Thought-provoking, for sure—the issues he raises could spark endless debates.  I was astonished that he could write so well!  My e-mail back complimented him on the content, and asked the burning questions: What the hell is Topsy?  And what does it have to do with healthcare?

“It growed like Topsy,” it turns out, is an arcane saying that developed after Uncle Tom’s Cabin was published.  Topsy was a character in the novel, and in the years following, "it growed like Topsy" became a popular saying to describe something that grew or increased by itself, without apparent design or intention.   Daddy had been introduced to the saying by his north-Louisiana cousins during childhood.  It was a new one on me, and on my (well-read) step-mother and (English professor) step-sister, as well.

Maybe Obamacare isn’t perfect, but it’s a step in the right direction.  I’m sure it will evolve over time as the bugs get worked out.  I don’t have all the answers, but I do know one thing: people should be able to pay a reasonable amount for the opportunity to access health care.