Let’s imagine the existence of a country where there’s no music. No, make that where there is music, but only a small percentage of the population can afford to listen to music, due to a patchwork of archaic laws, political influence peddling and exorbitant fees collected from folks by private music supply companies for music listening. And of course there are the ever present Music Death Squads.

Come to think of it, make that different than the patchwork of archaic laws, political influence peddling and exorbitant fees collected from folks by private music supply companies for music listening that actually exists today in reality. Music Death Squads is so subjective a term, but a pretty nifty name for a grunge band or a cynical term referring to open mike night at the local Karaoke Bar. You be the judge.

This land of which I write is rather, a place where only the wealthy may partake of, or participate in any form of music, and those less fortunate made to do without music or become impoverished, just to pay the premiums imposed on music listeners. And a disgrace in a leading industrialized country that, while other industrialized countries, including one north of this fictitious country’s boarders, have single payer, music for all systems of National Music Care.

Seems ludicrous doesn’t it? The concept of denying music because of Previously Existing Musicians – that takes nerve. Spend your hard-earned dollars to a Music Maintenance Organization each and every month? Choose between music or household expenses? That would be unconscionable. I can’t afford a dirge to play right here, although it would be the perfect time for one.

Okay – you got me. I was about to go into a tirade about mismanaged healthcare, and the idiotic and draconian system of health (we don’t) care (non) delivery in the United States, preaching much of what you already know about it all anyway. I was feeling preachy. Forgive me. I wish you good health and, as we have come to realize, wishing for good health is about all some of have had to cling to, lo these many years. This is particularly relevant in the case of the not-for-profit musicians among us, and folks who buy our medical records.

We have become sick and tired of it all, some more sick and tired than others. And, as a citizen of this not-so-fictitious country, I became an expert at contorting to follow the malevolent game-of-health-insurance rules while getting laughed at by most of my friends in other industrialized (and third world) countries. Sometimes in different languages, so I can only assume that is the issue about which they are laughing. I’m going to save you all that, I therefore, in deference to you, have deleted a bunch of acerbic paragraphs, along with that dirge. Sorry, I notice that other paragraphs remain.

But, I do have to say, I needed to write it all down, and doing so was somewhat cathartic. I have paid so many thousands of dollars to healthcare insurance companies over the years, often to have claims denied on a range of creative technicalities. I wonder how many great banjos and guitars I might have owned, how that money might have otherwise been allotted. The high-end automobiles I could have motored about town, the good works I might have done, what with all that money coming in from my creative endeavors. Then, something called the Affordable Care Act became law. What good fortune for us. I have just become one of the 7.1 million (correction at time of posting – 8 million) to sign up by the deadline. Thank heavens so many folks will be covered, some for the first time, others, at a reasonable cost. However, my ever present sardonic “good” fortune is somewhat taunting. In lieu of the dirge, bring up the laugh track my friends. You see, the joke is still on me.

A few short months from now, I turn 65 and am eligible for Medicare coverage. I would have been in better spirits if this were all available – oh, before I wrote that first of my hundreds of articles and columns; and the first of my hundreds of checks help make some HMO exec richer. You know the one who gets a bonus for “cost containment,” a euphemism for keeping senior citizens out of hospital beds and wheel chairs, or denying (fill in the blank) on the grounds that a previously existing condition (fill in the blank) may have applied. How will I tirade this all together – music and healthcare? Whilst I make a few points about both? Watch. I’ve gotten reasonably good at this.

Back in 1971, I was a bright eyed (no make that a blurry eyed) innocent biology major about to enter medical school. That’s when I chanced upon and purchased my first banjo. It was hanging on a wall in a music shop in Albany, NY over four decades ago. The store stood a couple of miles from Albany Medical College. “Buy me!” cried the five-string. There is absolutely nothing dirge-like about banjo music. Buy it, I did. I think it saved my life. It certainly changed my life. That purchase, and my playing coincided with classes in anatomy, histology, and developmental biology. Courses I would go on to teach at universities and colleges – nary a one, however, as a medical doctor. No, I never did snag that elusive diploma. And honestly, not that I was a banjo whiz … I was more adept at playing the banjo than I was at attending classes.

At Albany Med, I fell in with a wonderful group of enlightened, politically active left wing classmates, (termed “trouble makers” by the school’s administration), friends who even then, could not believe that this country did not serve all of its citizens with affordable or free healthcare. We were perplexed that no single payer system had replaced our fee for service, capitalistic free for all (poor choice of words, there was nothing free for all or any about it). We did what we could, volunteering at the free clinic. I watched and waited as the years passed.

Managed care took hold. Still I kept rooting for Ted Kennedy to pull something Universal out of Congress’ anal sphincter. Instead, things went from bad to worse. I noted how the system drifted further from the goal of healthcare for all, to a goal of profitability for HMOs. Politicians continued accepting campaign contributions from the managed care folks – why not? Those politicians have really good health insurance plans. The most descent and dedicated of my MD friends were caught in a web of cost containment rules and regulations. Replacing the Hippocratic Oath, were some very resourceful Hypocritical Oafs settling in between patients and doctors.

It didn’t take long before the HMOs were practicing medicine, playing the tune the doctors danced to, dictating rules of practice as doctors were becoming less and less able to be – well, doctors. Had such a grand effort been put into setting up a business model for actually caring for patients, rather than setting up a business model for giving patients the business, I might have been able to look north or south of the border without being embarrassed by my country’s capitalist eco-system and malignant health plans. The Death Squads are in the details.

But, as I said, I had other plans. No pun. These plans fell into place, ever since finding that banjo and attending Med School. I carried Gray’s Anatomy in one hand, John Burke’s Book of Old-Time Fiddle Tunes for Banjo in the other. I would become involved in my own practice, the practice of banjo, guitar, singing and songwriting. You’d think I could play better! I also recall playing The Beer’s Family and Fox Hollow recordings in my dorm room while incredulous medical students stopped by my door to listen, smirk, and comment on my bizarre choice of fiddler Bob Beer’s “psaltery” music made with his deal Evelyn and family. I studied as well, but of course, these were the “salty” times too.

Which I might remember had it not been for the many hours spent drinking (at and around the appropriately named Fountain) and attending nursing school parties. Then there was the grand tradition of urinating on the Law School front steps on the walk back to the dorm. The Law School being strategically and conveniently situated between the taverns and my dorm. We med students were a tad put off by the fact that our lives seemed more onerous, while the law students appeared happy most of the year having all sorts of free time. We were pissed (pissing?) because we studied for exams administered almost daily, while the Law School students, had their only exams at the end of the year.

Come to think of it, they started to appear grim at year’s end. But, no Law Maintenance Organizations ever dogged them in their careers! Also, Albany Medical College and I never saw eye to eye – I had/have keratoconus, a blurry eyed corneal ailment that prevented me (still does) from reading for very long or seeing print clearly. Including the print upon which I now gaze. So, the pitcher of beer in front of me was blurry even before pouring the first mug. I could, however, clearly read the handwriting on the wall back then. Not that anyone reads handwriting today.

Monthly new spectacle prescriptions, new glasses, eye tests, hard contact lenses I could wear once every few days, the others days, looking as if I had gone three rounds with Mohammed Ali. The medical community was not concerned; too few possessed the ailment to make R&D profitable. The administration was angry I had failed to mention on my application that I did not possess happy eyes. My ears, listening to folk music, were ecstatic! Thank god I had that banjo to hold and play between classes and studies, to allay the woes of eyestrain headaches. But, let me get back to nursing school parties before I lose my eyes-train of thought.

I was going to stay in one Friday night to study (right) or maybe sleep (no, I did that in class), or have a brew, but instead, I was coaxed to attend a nursing school party. And, I was encouraged by a mate to bring my banjo along. Nursing school parties were a feeding frenzy. All those eligible unhitched medical students, and all those lovely nurses. Each group was ever stalking the other. This one was a nice party, most of the folks there were known to me. Some of the nursing students had just arrived from another school on a study rotation, always a good thing for a student with my stellar reputation. “Hey Roger, Play us a few banjo tunes!” shouted a few colleagues. Well, if you insist. I took the banjo out of its case. This is where I signed up for my lifetime healthcare policy. Or was it a marriage license?

Although I could barely finger a few chords, I let it fly. A funny thing about banjo music, not only has it the power to cheer folks up, it sounds as if so much more is going on, to the general listener. It is like dazzling slight of hand. Lord forgive me, I killed, sorry, in show business terms. The music performance was quite persuasive with one particular nursing student. We’ll call her the future Mrs. Deitz.

Her career as a Director of Nursing at nursing homes was her contribution to bettering the lives of others. I guess I figured having a personal nurse might be a good idea. But a lifetime of caring for her and my family’s laundry list of ills was on-the-job training in hand’s on medical care and frustrating insurance dealings. You never think of these things are laying in wait when you are young, and the stuff you learn along the way includes the names of maladies one would never have thought to run across. In my family alone I became adept at dealing with strokes, retinal detachments, Central Nervous System Vasculitis, pancreatic cancer, diabetes of both types, brain tumors, breast cancer and on and on. This stuff happens to people – and those of us in the line of fire have to help others overcome and deal with their illnesses. There is no turning your back on those in need, especially when they are family members.

I would also like to think that my work consulting at Pharmaceutical companies and teaching pre-med and pre-dental biology students at colleges and universities also contributed to the overall karma of my absence from the profession of medicine. That along with the fact that, many of my advanced biology college and university students became doctors, dentists, research scientists and chiropractors – my favorite histology student, a brilliant young coed who became the dean of a dental school in Florida. But, from a pure healthcare standpoint, I wager my banjo has done more good than a battery of tests and team of physicians.

I am grateful that millions of folks will benefit from finally having affordable healthcare, but it still is a far cry from the dream I had back in medical school; that in time we would all find the ailing system a thing of the past. I can also reflect on the countless lives saved resulting from my not practicing medicine. Perhaps you or someone you know is alive today because of my altered career path. Playing the banjo saved at least my life. I am certain my performing never (directly) caused the demise of even one listener. (That guy in the audience in Cleveland was already dead before I started to play. I swear!)

I rather liked the idea of characterizing myself as a Primary Care Musician. May I “Perhaps” here, just a little? Perhaps, those in the business of making the least out of our healthcare system have done a great deal for Primary Care Morticians. Perhaps, had politicians and health care execs banjo lessons instead of MBAs and Law degrees, we might have gotten to a better place in the last four decades, ever since my med school colleagues and I hoped for a healthier and happier future. Perhaps we should start handing out banjos along with diplomas. One of my physicians keeps his Pete Seeger long neck Vega under his bed. He says he acquired it when he was in the military service. He says he feels the positive energy radiate up through his mattress. It helps him sleep away the hardships of the day. It certainly couldn’t hurt.

Questions you will not find on the MCATs: “What do you call a medical student who graduated last in his class?” Answer: “Doctor.” Question: “What do you call a medical student who did not graduate with his class?” Answer: 1. A “RagTag” columnist for Sing Out! magazine. 2. A fair to middling banjo player. 3. A squinty-eyed advocate for better healthcare. 4. Grateful. 5. All of the above.