Originally published Friday, October 7, 2011 at 4:14 PM

Guest columnist

Health care: a new civil-rights movement?

Guest columnist and nurse Kathleen Bartholomew writes about the importance of making health care about wellness. She suggests health care might be a civil-rights movement of the 21st century.

Special to The Times

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The patient was stoic and distant as he sat on the edge of the bed waiting for me to give him the bath I had promised an hour earlier. Quickly I gathered my supplies and began by washing the old man's back. But suddenly, he burst out sobbing.

"Did I hurt you?" I asked concerned.

"No, no!" He ordered gruffly, "Go on now."

After several minutes of silence, he softly shared.

"I'm sorry. You see, my wife died 22 years ago and no one has touched my back since that day." In the longest bath I've ever given, he told me why she liked the rain and what she always planted in her garden — but it's nowhere in my charting.

Similarly, a physician I respect sat down and talked for 30 minutes to an elderly woman with high blood pressure. He listened to her story then counseled her to lose weight and take her meds. The current financial structure is so lean that these most fundamental and humanistic interventions are now in peril — because there is no price tag.

What's the billing code for easing an old man's grief, or a healing connection? What's the billing code for holding someone's hand as they lie dying because they have no relatives or visitors?

Or maybe a better question would be, how much would you pay? What's it worth to you not to die alone or be heard rather than given a pill? Like pennies on a convenience-store counter there for the taking, these healing acts of care are free.

Maybe it's time to look at our most fundamental premises in health care by following the money.

The U.S. spends twice as much for half the quality care of other industrialized countries and has poorer outcomes. Hundreds of millions of dollars were squandered lobbying for sacred cows in the 2010 federal health-care-reform law to protect vested interests (our health insurers cost us 20 cents on the dollar versus 3 cents in other countries).

Hospital leaders struggle to cut costs to protect their bottom line, while physicians and nurses try with inadequate time and resources to keep their patients from being one of the 22 who die on average every hour from preventable errors and infections.

Why? Because sick people are only profitable when there are enough of them and someone else pays the bill. "Well" people, on the other hand, generate little, if any, income. From a business perspective, the current structure is a conundrum: we need plenty of sick people to sustain a system supposedly dedicated to health.

It's time to acknowledge the elephant in the room and make a collective decision for the betterment of all society: Is health care a business, or public service? What should it be?

If it is only a business, then acknowledge the obvious: No business can give away its resources for free. There are no billing codes for easing grief or spending time with a patient so we give them a pill. Within the business model, all the free stuff will have to go away — as much of it has already.

If health care is a business, our best hope is to create a billing code for wellness so that hospital leaders can stop focusing on revenue from disease out of dire necessity and redirect their efforts to safety, quality and prevention.

Or perhaps, embedded in the chaos and polarity, passion is an opportunity. Maybe health care is the civil-rights movement of the 21st century. It certainly has the same emotional charge as pushing blacks to the back of the bus, or refusing the vote to women.

The poor don't deserve health care! Let them suffer! Though it is labeled as socialism by the "haves" and virtually unreachable by the "have-nots," we have found our next frontier: improving the wellness of America. And in that quest, maybe the services we give away for free are not worthless after all, but rather the harbingers of a healthier society where every citizen has the inalienable right to be well.

Friday Harbor resident Kathleen Bartholomew is a nurse consultant and an author of books about nursing culture.


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