An American Death

[McCamy Taylor]

Nobody in Johnny’s farm family smoked. When he was drafted in 1970, he picked up the habit in boot camp. Smoke breaks were one of the few luxuries the new recruits enjoyed. In the jungles of Vietnam, the rations contained name brand cigarettes. Camels, Marlboros, Lucky Strikes to name a few. Another branch of the federal government had already declared “Caution: Cigarette Smoking May be Hazardous to Your Health.” But so were bullets. So were land mines.

Johnny was lucky. He made it out of the jungle alive and returned home, bringing with him a two pack per day habit. Over the next forty years, he would stop and start again numerous times. His bride did not like way his smoking made her hair smell, so he stopped for her---and then, picked up the habit again when their child was born, and he needed an excuse to get out of the house. A bout of bronchitis persuaded him to quit again, until he got laid off during the Reagan-Bush recession. During the boom years of the 1990s, he had his first heart attack, and his doctors told him he had to quit—or die. Nobody in his family had ever suffered a heart attack so young. His relatives lived into their nineties and most of them died of pneumonia or just plain old age. But in the factory where he worked, everyone smoked. And his insurance, which paid for his hospitalization, did not cover smoking cessation. If it was really that important to his health, surely Blue Cross-Blue Shield would pick up the tab.

During the second Bush administration, Johnny began to cough and wheeze. His doctor told him he had COPD. Again, he was advised to quit, and he made an effort---until his company sent their manufacturing plant abroad and he was downsized. His wife got a job at a convenience store making a quarter of what her husband used to earn. There were no benefits. For six years, Johnny only saw a doctor when he was having chest pain. Twice, he was hospitalized. He could never keep the follow up appointments. The doctors wanted cash before they would see him in their office. He started smoking less---cigarettes were so damn expensive. But he never quit entirely. He was too depressed by his unemployment.

Johnny is on Medicare now. Though he does not know it, he is a member of the small group of folks on Medicare---about 5%---- with multiple complicated medical conditions that account for half of the program’s annual spending. These problems---coronary artery disease, COPD, congestive heart failure and end stage renal disease are all directly related to smoking.

Johnny is on Medicare, and Johnny is dying. In the months to come, he will be in and out of the hospital. He will see specialists. He will take a bucket full of drugs. Home health nurses will check on him, to monitor his progression to death. Just turned 65 and too weak to get out of his chair, too short of breath to sleep in the bed beside his wife. His legs will swell until the skin cracks and blisters and his toes turn black. During his last hospitalization, his heart will stop, and they will get it started again. He will be on a breathing machine for a couple of weeks, before the doctors decide that he is not coming back.


Ever wonder why we, in the United States, spend twice as much per person as any other country on earth for health care and yet we have such low life expectancy, such high infant mortality, so much preventable disease? Ever wonder why our public medical expenditures are as high as those of France or Canada, even though the public does not start paying the bills until we are on Medicare (elderly or disabled) or Medicaid (dirt poor)? Ask Johnny. He’ll tell you that when he was young and scared of dying in a jungle on the far side of the earth, his country did not do what was best for him. It did what was best for Phillip Morris.

It was inevitable that the Baby Boomers would age. With a little bit of sensible public health planning and a lot less catering to big business, we could have aged so much more gracefully.

Links: High Cost Medicare Beneficiaries http://www.cbo.gov/ftpdocs/63xx/doc6332/05-03-MediSpending.pdf

Also recommended Unhealthy societies: the afflictions of inequality By Richard G. Wilkinson

[trud]

1. responsibility

People put addictive substances in front of me in my life. Guess what, I turned them down.

[McCamy Taylor]

3. Congrats. Read Wilkinson's work about the health effects of disparity.

Wealth disparity (such as that which occurs when you are chronically unemployed) increases the risk of many diseases, including substance abuse, depression and suicide. Wealth disparity is the problem, not absolute poverty. A young man in Harlem has a shorter life expectancy than a young man in Bangladesh. Black women in Memphis have higher rates of infant mortality than Black women in Jamaica. Since the people who are poor have no health care, they are in a double jam. They can not get treatment for the illnesses they would get anyway, just for being people, and they can not get treatment for the extra illness they get, because of the diseases caused by their poverty. Then comes the third whammy---they are told that their illness is their "own damn fault." Just like in Japan, when a minister got on TV and declared that strong people do not get radiation poisoning. Here, we have people telling them that if they let their anger, despair and self loathing turn into depression or substance abuse, they are weak. Presumably, they are supposed to be like the "happy slaves" of "Gone With the Wind" or "Brave New World's" Betas (who were so happy not to be alphas). Try being called a "Welfare Queen" over and over while your kids go to school hungry and staying upbeat. It's hard to do.

[The Magistrate]

4. And What A Special Little Gal You Must Be,Ma'am

Think you can put it into bottles and fix everybody up right by tomorrow?

[Raster]

42. Oh Snap! Most awesome response, Sir!

[xocet]

21. Here is a compassion-free gold star for your worksheet.

For extra credit, complete the phrase "There but...."

[jwirr]

25. How much of that lifetime did you spend in one of our wars?

[chervilant]

32. hmm...

Insufferably condescending... Is this the type of response we should expect from you?

[Hissyspit]

38. Astonishingly ignorant reaction.

[Newest Reality]

2. There are people who live to advanced years beyond

ours and they did not live lives of purity or healthy living.

We are all going to die from something. We can deal with and play with how we can leave a good looking corpse or worry about what we do in order to prevent the inevitable.

Considering just how much pollution, radiation, (both nuclear and electromagnetic) we are now being subject to from all directions, why bother to focus on a personal substance or habit when we are not at all ready or capable of collectively dealing with a total and massive onslaught on our home planet by a massive onslaught of inflicted poisons being injected into into our biosphere only because power and control and profit are officially and dominantly more important than the sustainability of life itself.

That's right. Blame the victims and focus on their inevitable results form the system they were taught to believe in.

Our system is sick and it is in a terminal condition that requires us all to pay attention and join together in a more equitable and cooperative and generative way to find a cure so that we all may be more healthy, secure and able to survive together, rather than as manipulated competitors who exist simply to empower and enrich our dominant controllers who create, anticipate and provide for our needs. We need to learn to find power in providing in realistic, non-corporate ways, for our selves and those around us.

[Demeter]

5. My family lost a whole generation to smoking

and their ancestors lived into their 90's, too. It's a horrible lingering way to die.

Yes, our government is corrupt and our economy has borne the brunt of it. The rule of law has been abandoned for the rule of profits at any cost. It's just worse than it's ever been...perhaps in the end stages before a complete change of everything occurs, as it inevitably must. That which cannot continue, will not continue.

[trotsky]

6. Why do you continue to post fictional stories to bash Medicare?

http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=222&topic_id=107066&mesg_id=107066

[The Magistrate]

7. That Does Not seem The Point To Me,Sir

The stories are well written, and while fictional, do illustrate well real problems in our health-cart system, which includes Medi-Care. One of the points seems to be that,without a single change in regulations for Medi-Care, its costs could be reduced if the total system for delivering health care provided more preventive and early-stage care, and if society as a whole were more equally ordered in economic terms, since the stress of uncertainty and even down-right hardship in penury many are subjected to does promote ill health, which neglect aggravates. These costs do tend to concentrate in treatments that will certainly be unavailing in the last few months of a person's life,though that person has not been well for years, and received no treatment at all over that span of time.

[trotsky]

9. Oh, I completely agree with problems facing our health care system and Medicare itself, sir.

But I do not like the approach of making up stories to deal with those problems. It is the Republicans who are the master of the fictional anecdote, from the Cadillac-driving welfare queen to the "death panels" who will make our health care decision for us. We should be able to face these issues with truth and honesty.

[The Magistrate]

10. Fictive Personification,Though, Sir, Has Its Uses

Books like 'Grapes of Wrath' and 'The Jungle' were fiction, after all.

[trotsky]

12. But written and published as fiction, good Sir.

The poster's previous attempt at this was much more disturbing - it made up this person who received a new hip despite not being in a condition to be mobile anyway, blaming the system for wasting money on that person when we have no documentation that such an incident actually occurred. Yes, the case of a life-long smoker is far more realistic and more likely to be true, but still attempts to use the same tactic to undercut support for Medicare.

[The Magistrate]

13. But Things Like That Hip Replacement Do happen, Sir

A good deal of money is mulcted out of the Medi-Care system by unscrupulous providers.Sometimes the bills are wholly fiction, but sometimes they take the form,safer for the thieves,of unnecessary procedures that can be billed at a high price. There have certainly been recent actions against kick-backs paid doctors by companies manufacturing hip replacements, whose implantation was then billed to Medi-Care. Medi-Care pays for more than two-thirds of all hip replacements, and the odds against some 'padding' seem poor to me.

[trotsky]

15. I will still disagree with the need to make up anecdotes, Sir.

When there exist plenty of real world stories that serve our purpose better - stories that encourage us to improve the system rather than scrap it.

[The Magistrate]

17. Fair Enough,Sir

To me, anyway, these pieces do tend to argue for improvement of the Medi-Care,rather than scrapping it.

And good writing goes a long way with me....

[Divernan]

30. Kudos and thanks to The Magistrate and Trotsky for a civilized, thoughtful exchange of opinions.

No four letter words; no snark; no flaming; no rude, crude & socially unacceptable language of any kind.

How refreshingly adult & intelligent.

Thank you both for setting a good example - one which is much needed on DU of late.

[madamesilverspurs]

19. As to those "real world stories" --

I've shared a couple on these boards and was stunned by some of the contentious and sometimes unkind responses from people who had no clue as to the depth and breadth of my experience. Some people just have to argue, I guess, but in so doing they very much detract from any meaningfulness in the conversation.

Nothing at all wrong with a good parable, however.

[trotsky]

20. Rather difficult to distinguish between truth and a good story on the Internet.

That doesn't mean we should treat them as equivalent, however.

[McCamy Taylor]

31. You have a valid argument. Here is my response. I try to give a voice to the voiceless.

There is no difference between fiction and nonfiction. Everything we write from the heart is true, because we wrote it. And every piece of so called nonfiction that we write is false---again, because we wrote it. The writer is a filter that changes the "facts" either subtly or broadly, depending upon his intention.

There is a genre of writing that calls itself "nonfiction". It tells the world "I am more true, more important, because I am real." However, this type of writing almost always has an agenda, and the agenda makes it fiction--even though the folks who write it would shout "No! It's real." Consider the different way that biographers can approach the same subject. The biographer colors the portrait, much the same way that the singer in "The Idea of Order at Key West" colors her world with her song. The desire to remove the author as a impediment towards conveying "the truth" is a noble one. We all know from Barthes that this is the era of "The Death of the Author". However, there is almost always an author lurking somewhere behind the scenes, unless you are reading a phone book (and even that can tell a story). Unless you realize that there is an author (or bias) behind the supposedly "real" nonfiction, you can make the mistake that Barthes describes in "Mythologies" of turning history into nature. I.e. because it has happened this way before, it must happen this way again and forever. Like the so called Bradley effect in voting. This type of propaganda is used by religions, governments and the rich to ensure their own survival and crush dissent---only a fool goes against nature.

One of the peculiarities of politics nowadays is the right wing's determination to cast as false or fiction any story that is told that goes against the best interest of capital. Consider the way that Al Gore and Hillary Clinton were mauled. Think of the way that the press would track down people Clinton talked about, to prove that some detail was off---and this was used to discredit her whole story, which (generally) was meant to illustrate a social ill. The result----since one detail was off, the social ill did not exist.

In my case, I am privileged to hear numerous stories about the way that society has let down its members. That is because I am a physician and people who keep their mouths shut about their misery when talking to anyone else will open the flood gates with their doctor. They are dying to tell their stories, they are just afraid of the response they will get. Since their doctor does not judge (or should not judge) he accepts everything he is told and uses it to help treat the total person, not just the disease. Because every person has a right to expect that what he tells the doctor will remain confidential, when physicians write about things they have seen, they always fictionalize. Names and demographics are changed. Non essential details are altered. Since so many of the same ills are described by so many different people, it is easy to create a composite which is not a single person but rather a slice of society.

I am sure that part of what offends some readers is the fact that I attempt to describe the emotions of my subjects. A real journalist would not do that, right? Wrong. Journalists have subtle ways of painting a portrait. They pick out a few physical details to emphasize, knowing the effect that these details will have on the audience. They select a few words to quote, even though the whole story may be so much more complicated. They turn a nation of poor children and their single mothers into the mythical "Welfare Queen" and her misbegotten progeny---and suddenly, children are no longer hungry in this country. No, instead the story becomes women---no, let's be honest, Black women can not keep their legs together and we reward them with steak and Cadillacs and these overfed hussies are the ones who do not feed their children.

As a left wing writer, it is important for me to convey a sense of the humanity of the people who are the basis for what I write. One of society's greatest sins is the pressure it exerts on small children to hide their emotions and conform to some pre-selected identity---like forcing a gay to act like a heterosexual. This leads to a feeling of emptiness or anger or despair. People know that they are not the role that they have been assigned to play, but they are afraid to speak out or act in the way they want to. Writers on the left, when describing their flawed society, will almost always attempt to get the reader under their character's skin. In this way, they give a voice to the voiceless. And, since the human experience contains many shared experiences, the reader will recognize certain situations, certain conflicts and emotions and say "Yes! I've been there! This is my story."

[trotsky]

39. I think you should be up front with your stories, then.

And not attempt to sell them as true incidents.

[maddiemom]

14. Medicare costs

My mother recently passed away at 91. She had spent the last decade in nursing homes, from "assisted living" to totally bedridden with serious loss of her mental facilities. She was fortunate in having retirement benefits which included medical care for much of that time, but eventually ran out of all but Medicare. My brother, who took care of the financial details, often complained about charges to Medicare by the nursing home. These were incurred every time a doctor popped in for a minute, even if not needed, and extended to charges such as "trimming her toenails." This is a "good," and well-regarded facility. As much as the basic costs were, you'd think many of these charges should be included. What did seem to be covered was board and, admittedly some very good attention by the nurses (mostly LPN's). Any special needs beyond that were additional charges. This is where Medicare is taken advantage of: no fault of the individual recipient.

[Name removed]

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[TBF]

35. I don't think that's the point of the stories. nt

[no_hypocrisy]

8. I've never understood why tobacco farmers aren't paid to grow *food* crops.

[The Magistrate]

11. Often, Ma'am, Their Land Will Not Support Anything But Tobacco

In terms of soil fertility, that crop is pretty much the last stage of a rake's progress down to the lowest of dives....

[no_hypocrisy]

16. Thanks. I *never* knew that.

That explains a lot.

[bertman]

18. The soil fertility issue may be a factor in a small percentage of farms but many

could use replenishing techniques that have been in use for millenia to refurbish the soils so they could grow food.

I grew up in an area where tobacco was king. The farmers planted it because it was lucrative. Other farmers in the same area also grew cotton, corn, soybeans, millet, and had large gardens for their families to live off of. Many of our modern (industrial) farmers have no knowledge of sustainable farming techniques. They only know how to fertilize with chemical fertilizers manufactured by agri-businesses and they only know how to spray insecticides and herbicides because that is what has been taught them and what has been most profitable for them. If one crop depletes the soils, they just pump artificial nutrients into the tired soil and grow whatever is paying.

Now in many of those areas there are small farmers who are rejuvenating the soils of those worn out industrial agriculture deserts. They are growing food and raising animals using the 'old' methods supplemented by our labor-saving tools such as tractors, backhoes, etc. that the old timers did not have. Unfortunately this is not a priority for our industrial-agriculture-fixated administration (note the appointment of Tom Vilsack as Sec of Ag), so our government keeps offering incentives to Agriculture Industry farmers while it ignores or tries to kill small, organic farmers through intensive regulation.

My point is that there are alternatives for farmers who have poor soils but most farmers who go through Ag schools are only taught how to do industrial agriculture. Much to the detriment of our culture, our land, and our environment. Those who choose to farm differently are showing us that it can be done and it can be profitable.

[jwirr]

27. Much of that land could benefit from rotating crops. One crop for

centuries depletes the minerals in the soil. It can be built up again but then who would grow the tobacco they sell to the children in other nations?

[russspeakeasy]

22. You are one hell of a talented writer...

:toast: I tried for years and just didn't have it...so congrats to you..

[jwirr]

24. You would have thought that the military would have learned this

lesson in WWII when rations included both cigarettes and alcohol. Many a WWII vet came home addicted to both for their entire lives. Having been born in 1941 I got to know a lot of them. Bad enough that we risk their lives to war without adding a life sentence.

[bemildred]

26. Yeah, two packs a day and a fifth every night.

And otherwise the best people you could know. I remember a lot of those.

[jwirr]

28. And there were not warning labels on anything back then. They never

were told of the dangers.

[Scruffy1]

29. Excellent. You are the new Upton Sinclair.

The point is so well made that corporate profits always come first, leaving the working class to pay for the clean up.
I do remember cigarettes at the comisary for $1.80 a carton and how the American Legion and VFW magazines always had ads in them for sending tax free cigarettes to overseas GI's. If the tobacco companies didn't make a profit on them then, they certainly made up for that later. In fact World War 1 was there first big marketing coup.
One of the good changes in the health care bill is the for the first time dividends are taxed for Medicare. So maybe having to pay some of the cost it will force some of the uber wealthy to care about results in our health care system.

[InvisibleTouch]

33. The big take-home message in this account, to me...

...is PREVENTIVE CARE. Spending a little bit, early on, in preventive care, nutrition, education, smoking cessation, etc., would save monstrous amounts of money later on - not to mention an untold amount of suffering. But our society never seems inclined to close the barn door until after the horses have already vanished across the horizon.

It's the same with environmental toxins and climate crisis. There won't be an earnest large-scale outcry to do something about the problem until after it's far too late. It may be far too late already.

[digidigido]

34. but then we'd have to pay more in social security cause people would live longer

[TBF]

37. I'd love to have that problem rather than using all our tax money

to kill people in wars.

[TBF]

36. That's what I took from it as well - well care, education, and the over-arching

problem of putting profit before people. That's what I've been taking from the stories. McCamy you write incredibly well.

[bhikkhu]

40. I see it every day too

there's a whole generation just a bit older than me that grew up smoking. Most started as teenagers because it was "cool", or picked it up in the military where it was almost universal, or in blue collar jobs where everyone smoked too. It seems like hardly a month goes by that someone doesn't die here that I knew, and the number of disabled is large, and the number who have lost a whole productive life's earning to medical bills is large too.

In a fair world, you would have the companies responsible pay for programs to help people quit, and pay for the health care costs of those whose lives were wrecked by their products.

I smoked for 10 year, and quit three years ago. Everyone at my job still smokes, as do most of our customers, and my wife smokes as well. I don't have any illusions about how easy it is to kick the addiction, so its no use blaming people for their "choices", though on occasion frustration may lead me to do it anyway...

[dmallind]

41. I'm pretty firmly anti-smoking, but the conclusion here is silly.

We have one of the lower rates of smoking among the rich nations, and are more restrictive than most (not all, but most). Sure he's dying because of it, but our overall longevity as a nation is driven by exorbitant, inaccessible care far more than by smoking rates relative to other countries.

[Taverner]

44. I would argue that it's not smoking

Out here in CA, we have one of the lowest smoking rates in the country. Still, heart disease is a killer here. Blame McDonalds? Hardly - most of the time it isn't junk food but an unhealthy diet, period. And yet if we try to teach nutrition in HS, it gets cut as "non essential"

[Taverner]

43. Sell them the disease, then sell them the cure...

[Name removed]

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