26 February 2009

a healthcare question

a friend recently asked how i reconcile the idea of accessible health care with the abuse of emergency rooms. my not-so-short answer is copied below, because it took a long time to write.

The longer answer is that the abuse of emergency room services (which is absolutely a problem everywhere, and especially in teaching hospitals) is a symptom of the inaccessibility of health care. In reality, its just the tip of the iceberg.

The first thing to grasp is the number of Americans without insurance. Basically there are a huge swath of people that have no assistance in health care. Depending on the state, VERY low income people (maybe those at 100-150% of the poverty line, which you know is very poor) will have coverage through some social services. This generally applies to women, or people with disabilities, maybe to single fathers, but definitely isn't universal. And people with good jobs and benefits will have coverage through their employers or may be able to buy their own coverage (though at much raised cost). That leaves a huge number (somewhere around 50 million Americans) that have no coverage.

People without insurance generally can't afford the expense of routine preventive well-visit care (primary care). Usually, they won't be able to afford even basic sick visits or a trip to the doctor until their health is very bad and their problems well past the point of easy (and cheap) interventions. (This could mean just that their respiratory infections are much harder to treat, or that their cancer is several stages progressed by the time they're diagnosed.) People coming into the ER with a headache sounds ridiculous, of course, but the ER is often the only option available without a $100 price tag. And people have a right to care, and headaches get old after a while. So the people that flood ERs with hangnails may be a problem, but they are the less heartbreaking of stories, at least.

If we actually had accessible health care for everyone, the people flooding the ERs would have access to preventive medicine services, in the form of a general practitioner. These practitioners would be paid for in some way (pick your candidate's health care plan) that would cushion the individual from the full cost. As for Obama, he's advocating an affordable insurance program that would open the federal insurance pool up to everyone. And the SCHIP bill that thank God just passed expands coverage to all children without insurance. I'm an advocate of moving completely away from private insurance companies, because I think they too often neglect care for the sake of the bottom line. At the very least there needs to be a viable public option (in the way that education provides a public/private choice).

The other important issue to consider is that the prices paid and charged by hospitals and private doctors are completely artificial, and are unfair to people trying to pay out of pocket. If you stay in a hospital and look at your itemized bill, you'll see ridiculous prices for aspirin because the hospital is using their relationship with insurance companies to recoup cash lost elsewhere. If you are paying for services and are not the state or an insurance company, you're getting screwed because the system was not designed for you to be the payer. This is another smack in the face of the uninsured (and underinsured). I won't go into the pharmaceutical industry, but again, the prices aren't fair here for the individual payer.

The creme de la creme of this problem (and the as yet undiscussed) is that very few medical students actually want to be general practitioners. They all want to specialize, because our current health care system rewards specialists with the big bucks and treats GPs like volunteers. An effective revamping of the health care system is going to require redistributing compensation for doctors or finding a way to entice more doctors to pursue being a physician rather than a cardiologist. In Massachusetts, where they granted by state law universal health care, this issue has been their biggest problem, and I'm crossing my fingers it will be addressed in Obama's plan.

If I may take it one step further, I'll point to the fact that medical students are driven to hunt down the big bucks because medical school is far too expensive. The requirements to admission already cater drastically to the affluent, but the cost of medical school itself is a deterrent to future doctors becoming general practitioners. I'll step towards the socialist line and argue that there is an important place for public support of medical schools and students.

I'll stop there. The basic point for me is that health in the United States is now treated as a business. Its a right only in the extreme, final case (life or death). This is a travesty; health care is a right and needs to be provided. There are many, many examples of health care systems from around the globe - each with their own problems, of course, but none as wasteful and slipshod as ours.

24 February 2009

my two cents on tonight's speech

on obama:
1. thank you, mr. president for at least trying to talk over the clapping. members of congress, i hate you. please sit on your hands and control yourself. i'm trying to go to bed eventually.

2. when will preventive medicine and primary care receive their standing ovation? far more important and beneficial than cancer research, i'm still waiting for prevention to get its due.

3. oh my god, obama called out directly to potential high school drop-outs. this is amazing. if you haven't been in a high school lately, you probably don't understand the clout that obama has on these teens. huge, huge, huge. and a call for post-secondary education! huzzah!

4. there's a bit much of the "america is always right and deserves the best of everything" sentiment for my liking. for example, the line about 'this is america and we don't do what's easy, we do what's necessary to move this country forward.' how about 'we do what's right'?

5. no governing out of anger. rock on.

6. carbon control on a market system! yes!

on jindal:
1. i like the man's story, don't get me wrong, but i couldn't stop thinking of troy mcclure (you know, the filmstrip guy from the simpsons).

2. mocking volcano surveillance? this is inappropriate. i imagine mr. jindal would have appreciated some funding for improved hurricaine preparedness a few years ago. natural disaster planning is crucial, and i'm not ok with it being used as a political ploy.

3. on healthcare, i'm tired of republicans warning against government making the decisions for doctors. a government official is a much better option than a for-profit insurance company.

4. i'm down with a call for improved transparency. i wonder what the reviews will be like for recovery.org.

on both:
1. please remind your speechwriters not to end phrases with prepositions.

2. little stories about individual americans are overrated.

20 February 2009

my sister's keeper - jodi picoult

jodi picoult || my sister's keeper || 3.5/5.0

i used to work at a bookstore. my opinion about people who read jodi picoult can therefore be considered informed, i think, and summed up in one word: saps!

and yet, thanks to book club i found myself checking out ms. picoult's most well-known novel, my sister's keeper. for those of you not in the know, the story is about a 13-year old girl, who was genetically engineered to serve as a donor match to her older, cancer-ravaged sister.

its full of medical ethics, courthouse tension, and a healthy serving of cheese. i have to admit i had a hard time sympathizing with several of the characters, most notably the 13-year old who drives the drama by suing for medical emancipation. a couple of the side-stories felt a bit contrived, and a bit unresolved.

...and yet. i have to confess that despite my ambivalence towards the story and the writing, i found myself on the verge of tears at the ending. this, i'm afraid, falls into the category of crying when i watch extreme makeover: home edition, despite my dislike of the show's premise and hokey interviews. i guess inside every hardened cynic, there's a bleeding heart yearning to be free.

a quick, entertaining read. i'd recommend it, but don't expect too much.

virginia passes a smoking ban?!

virginia recently passed a partial ban on smoking. (a big shock for us, as virginia loves her tobacco industry). the new ban isn't complete, but requires that private establishments have separate ventilation systems for smoking and non-smoking sections. since this in most cases would involve quite an infrastructure overall, it will effectively remove smoking sections from most restaurants.

this is a great success for the public health community, restaurant workers, non-smoking consumers, and the health of virginians in general.

you can read about the bill and its history here. (at least this year's history... the effort has been going for many, many years). as a general plug, richmondsunlight is a great resource for tracking the progress of bills in the general assembly. its informed, interactive, and user-friendly. hooray!

15 February 2009

wuthering heights - emily bronte

emily bronte || wuthering heights || 3.5/5.0

i was named for emily bronte. wuthering heights is her only novel, as she died at the young age of 30. having known nothing about the bronte sisters, i have to confess wuthering heights was not what i was expecting. i'd placed it in the same category as the austen novels, and that assumption is terribly off-base.

the novel is pretty depressing, and the characters for the most part are all messed up and cruel. i suppose the most basic story line is technically a love story, but its pretty dark. heathcliff is certainly no darcy.

the set-up of the book is interesting and rather unique - a set of stacked first-person dialogues. at any given point, it can be difficult to keep up who is speaking, who is quoting, who is listening, and so forth.

not my favorite classic, but definitely glad i finally got around to reading it. love that classic english voice.

09 February 2009

good news for vaccines

the sunday times reported yesterday that the author of the study linking autism to the mmr vaccine deliberately altered the data used.

even though the study involved only 12 cases and lacked any scientific credibility, its been widely cited by the likes of jenny mccarthy and is largely responsible for the innoculation rate for mmr falling well over 10% in the ten years since the study was published.

i can only pray that this discovery gets as much attention as the phony study did, because falling rates of vaccine coverage is terrifying and incredibly dangerous.

will people listen?

flight of the conchords - the humans are dead

07 February 2009

the zahir - paolo coelho

paolo coelho || the zahir || 2.5/5.0

i picked up the alchemist last year, and while i wasn't completely amazed by the book as so many were, i enjoyed the story well enough. so when a very good friend recommended the zahir as a story of finding life's meaning, i was eager to pick it up, too.

unfortunately, the zahir didn't do it for me. for one, i was a bit confused by the classification of the book. its supposed to be a work of fiction, but the book reads as an autobiography. as an autobiography, its pretty self-absorbed - and self-pitying.

i get the feeling that the book is a godsend for people that really found deep meaning in the alchemist. i guess i missed the message. if you thought that the alchemist opened your eyes to the world, i'm sure you'll enjoy the more straight-forward message of the zahir. if you're looking for another quaint parable, though, spare yourself the troubles of coelho's inner consciousness.

the twilight saga - stephanie meyer

stephanie meyer || the twilight saga || -4.5/5.0

did you know my rating scale goes into the negatives? neither did i, until i read the twlight series. never one to pass up a good fantasy series (see: harry potter, the lord of the rings, his dark materials, a wrinkle in time, etc.), i was pretty pumped when my good friend vpm lent me these four books. i should have known better - she loved the inauguration poem.

if you haven't read these books, please spare yourself. just pick up harry once more and revel in the world of hogwarts, a place with prose and character development thrive. twilight is wildly popular, but certainly not for its literary quality. for a hilarious list of what is most wrong about these books, i direct you to fricknits. hilarious.

granted, i did read all four books in under a week. so, meyer does have a bit of that addictive fantasy charm... though mid-fourth book, it was actually painful to continue. the laugh-out-loud quality kept me going. these books are actually that bad.

for those you have made it through the muck, the first half of meyer's unpublished (and unfinished) fifth book is available as a pdf online. apparently she was so upset by the leak that she's decided not to finish the book. its so sappy, i can't help but feel a twinge incomplete.

a man without a country - kurt vonnegut

kurt vonnegut ||a man without a country || 3.5/5.0

this surprisingly short book, one of vonnegut’s last, was written in 2004. its much more of a commentary on recent politics and american society than i was expecting when i picked it up. it is of course, both funny and sad, as is the style of the author.

he jumps all over, but the meat of the book is in his criticism of george w. bush and the iraq war. mixed in are some heart-wrenching stories from his experience in dresden, and some rather hilarious one-liners on homosexuality, mathematics, and the profession of writing.

the book is clearly meant for a partisan audience, but worth a read if you fall on the blue side of things. its so short it fits onto just two audio cd’s, so put it on your list if you want to feel like you’re knocking out books by famous authors.just don’t expect too much.