I did not write this essay to complain. If your patience has not been annoyed by my navel gazing, you understand my point: I have no complaints. I was coddled by friends, their rides and dinners, I willfully dismissed one well-regarded cardiologist for another. I was treated royally in a heart palace. Thirty six sessions of therapy, after home visits, were thrust into my arms by rebel medical workers who should be fired for undermining medicine’s cash cows: surgery and pharmacy.

I am one properly insured (and let me be frank) privileged white guy with enough income to afford Medicare. Nevertheless, I say here, this system is flawed.

American health care is rationed. The National Coalition on Health Care reports on the complexity of a society where the number of uninsured grows: [http://www.nchc.org/facts/coverage.shtml]

Americans receive a range of unequal protection, from expensive elected care (fat, wrinkles and nose jobs) to no care at all:

• The paraplegic dumped (yes, dumped) by the hospital driver on a sidewalk; he crawls to the homeless shelter, carrying belongings in a bag held by his teeth. [http://www-scf.usc.edu/~desola/primary.html]

• Sickly woman avoids medical care for tuberculosis because authorities might learn that her love has no immigration papers.

• Injured vet waits months to get care for war wounds - rationed care of our wounded under the nose of our President.

• Millions of uninsured. Why is no insurance company marketing this huge crop of customers? If the free market is not imploding perhaps it is correcting itself? And, may I ask, who is paying?

• Folks having what the bean counters call the “preexisting condition” are carrying the insurance industry on their backs with high fees or exclusions. Hopefully there’s a special corner of hell for the “Scrooge” who thought this up.

• The drugs, rationed. The manufacturers make the preposterous claim that they own these pills exclusively - never mind the thousands of citizens upon whom these drugs are tested. Sometimes with their lives. Every drug you take is still being tested; testing is never done. Remember VIOXX! You and I are, by this arrangement, health care providers. We invest our health into their factory. They profit. We pay twice.

The symptoms of rationing are becoming more ominous, suggestive that we need to define a term before we find ourselves down the road without the ability to reverse: what is class warfare? And at what point do we understand that this fight has started? Dividing “customers” into competing units for the life blood of health care is an attack on the community heart.

Even as rationing cuts expensive patients out of the system, it raises the rates for everyone who struggles to remain inside. Fewer customers, more profits.

I am a witness: Before the age of 65, successive insurance companies would raise my rates to the boiling point and thereby force me to hop into a different pot, even though they knew this salient fact: since 1976 I never used insurance to pay any medical bills. I was deemed unprofitable.

Broadening Medicare to a younger market would enlarge the population with people who use less insurance while increasing revenue. A lower entrance age would reduce rationing. This is not a handout or another government “giveaway”; Medicare rights are earned by work. And you pay to keep this insurance. Medicare gives the individual a chance to take care of herself.

But with abundant resources in this powerful nation, why is the citizen’s stake in health care so fragile?

We built America’s health care system through our jobs, taxes, insurance premiums, and the incessant testing on a ready supply of patients. You should understand that I have a haunting memory of inappropriate care - my father’s final surgery. Had it benefited future patients, his tortured last three weeks would be of some comfort to us. We don’t know. The surgeon did not face the family after the calamity. Hopefully his confidence in his craft was sobered by what he had done. If he cared to learn, I don’t know, but my family has blood and bone in his career. Hopefully some nurse or resident visiting Dad took notes and brought them to a classroom somewhere. Because tests, gambles and risks are essential to medical progress, I do not suggest their cessation. But can we cease the “free market” blather that patients “consume” health care? It also happens to be clear how the health care industry consumes patients.

American medicine is strong because it is our system; it belongs to us. It should be a crime to single out and deprive individuals who present ill and broke at the same time. Everyone has worked. The health care system that ignores this and deprives a member of our community of care is an affront to the wider community. If they can dump a paraplegic on the street, just what would they tell an uninsured who flunks the stress test? Come back next week with $10,000 for a procedure that might lead to a $100,000 surgery? Or say good bye with a month’s supply of Lipitor?

My health insurance was not for me alone, my ride on my gurney. What was done to me was done for my loves, friends, and relatives who coaxed me into the hospital and maintained their watch after.

Health is not a private mortgage you make with insurance gods on a mountain. Health is written by forces larger than technology and institutions. Health is written by parents, genes, friends, and lovers. Katrina is proof writ large that these ties, not the insurance premiums, are the strongest - individuals dying can take down cities and presidents.

I was listening to Judy Collins discuss her recent book on suicide. If you’ve been there with her, you know that community finds itself lost for explanations and feeling guilty; survivors torture themselves over what they believe they might have done but did not do. Suicide crashes the fabric of community care. The survivors feel failure and the caregivers are turned into patients.

Finally, to nourish the community of caregivers where we can foster the potential of each human life, we must abandon the language of privatization. The “fountain of youth” promise of extra years is an historic distraction from the opportunity to make best use of the years we have. Privatization of illness isolates the sick from the sick, and the well from each other. We are not “health care consumers” - that language of “choices” is a wretched twisting of illness to promote a sense of scarcity, raising the fees but also suggesting we can select an insurance policy that is “tailored” to our needs. Rubbish! We all own the whole system, and no human being has ever been given the power to predict all of their personal medical challenges. Insurance should not be a board game stacked in favor of the moneyed, the clever or the lucky.

We need to turn the system inside out so that our natural instincts to care for each other are integral to the rules of fair play, not just the penalty box. Care is our historic response, not merely a package waiting for us at Walgreens.

We want technical medical care at hand to help us see our loves to the end, which we hope will come no earlier than when life seems complete.

We want the best for everyone because it makes us who we are, a caring people. Or not.

My friends are. And this is what I know.

At the funeral of her mother, my dear friend said “happily we were there, through the night, until the end.”

“Millions of uninsured. Why is no insurance company marketing this huge crop of customers? If the free market is not imploding perhaps it is correcting itself? And, may I ask, who is paying?”