| 02 Mar 2015 | 04:26

    my physical therapist heather case, proprietor of case specialty physical therapy, knows all about alleviating pain in the human body. and she actually reads (i slyly test her) every new yorker article.

    heather was impressed with the recent essay by dr. atul gawande, advising president obama to cobble universal health insurance on top of existing structures, like the french did.

    we desperately need some kind of government-sponsored health insurance for middle-class people. in 2007, 57 million americans were unable to pay medical bills and now-struggling employers are dropping heath plans in order to keep their businesses going.

    in his essay, gawande worries about unforeseen horrors created by sweeping plans. for example, heather's heartbroken over several horrors in ontario: her 79-year-old mother eleanor waited four-and-a-half pain-wracked years for knee surgery, and currently eleanor's suffering horrendous neck pain.

    heather's stymied. it's canada-utopia, no?

    it turns out that ontario's universal health-care delivery system is sluggish as a clogged sink. heather warns obama's health-care planners against ontario's ceilings on doctors' fees and limits on how many patients a doctor can treat, thus worsening a situation in which fewer and fewer people choose to become doctors.

    heather's mom eleanor-ironically a retired hospital dietician-is a victim of ontario's so-called one-tier plan (each province has its own plan). "one-tier" means suffering patients can't avoid waiting lists by paying for treatment. oy.

    heather has read eleanor's x-rays and knows a good osteopath who'd alleviate her mother's agony. so heather called her mom's orthopedist, but he refused to come to the phone, relaying the message: "no osteopathy. wait for her to see the spine surgeon."

    heather explains that eleanor could immediately see a spine surgeon in another ("two-tier") province, or go to a specialist in buffalo, n.y.-both of which would cost a king's ransom. however, heather's mom is scared to go against her doctors. what morale can we new yorkers draw from eleanor's plight?

    1. options are critical in health-care emergencies. if only eleanor were legally allowed to pay a bit more in ontario to see a spine specialist fast.

    2. if only orthopedists knew a little something about soft-tissue injuries.

    3. if only heather's mom didn't fear her doctor.

    4. if only, as in france, we could create health-care plans that didn't reduce doctor's fees.

    lack of options, unforeseen consequences and reduced doctors' fees also muck up medicare, our universal health care for senior citizens.

    friends rejoiced when medicare expanded health insurance to include prescription drugs. but joy turned to confusion. few, if any, of some 25 million people older than 65 understand the jargony descriptions of supplemental drug coverage they must buy from private companies.

    my neighbors also complain that medicare reimbursements to doctors are very low. thus many of our city's best doctors opt out of the plan completely because medicare forbids patients to make up the difference between its low reimbursements and doctors' fees. (younger patients share pricey fees with private health insurers, who reimburse more than medicare does.) thus, doctors "fire" patients when they reach 65.

    jokes one of my neighbors, "it's age-related illness called, 'you're too old.'" phew. this is one complex issue! -- susan braudy is an author and journalist whose last book, the boudins and the aristocracy of the left, was nominated for a pulitzer by publisher alfred knopf.