Timothy Kelley
MANAGED CARE June 1997. ©1997 Stezzi Communications

Timothy Kelley

I went last night to my first meeting of an exclusive club. It's a club whose literature offers newcomers an ironic greeting. It tells them: "We're sorry you're here."

I went more out of curiosity than immediate need, for I'd paid my dues a long time ago. The club is Survivors of Suicide, and I paid my dues at 11 a.m. on Sunday, Dec. 7, 1969, when my mother took an intentional overdose of sleeping pills.

The others' losses, of course, were more recent than my own. My heart ached as I heard, for example, about the 1996 suicides of three persons much younger than my mother had been. But I must admit that one of the survivors present got on my nerves.

I won't identify this individual even by gender, because privacy is one of the foundations of groups like S.O.S. But this person's appearance and conversation, heavy on health problems, made me want to shout: "You should be confronted on the dangerous way you're eating and drinking and failing to exercise!"

I've long feared that society's faddish emphasis on health-promoting behavior could turn into a fascistic "blame-the-sick" morality in things like health insurance. And I was alarmed to feel something like that attitude in myself. If I couldn't resist such thinking at a meeting whose purpose was to mourn (if also to honor anger at) loved ones who had destroyed themselves, how could it be battled in society, where we now know that Nonsmoker A must ultimately help pay medical bills for Smoker B?

Blaming is one thing; trying to help is another. Suicide is the extreme that proves that "intention" in self-destructive acts is no excuse for backing away, whatever the libertarians say. As an editor I can't tell you how to treat any condition graver than the typo. But I can tell what it's like to spend a lifetime wishing you could have intervened. As our cover story (page 23) suggests, you will increasingly be asked to love patients and plan members enough to fight them for their very lives. Sometimes you will lose. And I promise you you won't always know why.

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Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

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