Health Care: Why It Will Still Suck After They "Fix" It

I admit I am getting annoyed. I tried to be patient with this process, but as the days and the weeks and the months tick by, it becomes more and more clear that 300 million Americans are about to get a giant Congressional rectal exam.

I'm not one to join the Teabaggers (and really, with a name like that, how can you take yourself seriously?), and I'm certainly not one to take my AR-15 to an angry town hall meeting. But I think I have read enough on the subject of the health care reform fiasco to realize that we're not going to get the change we've been promised. What we will get is a piece of crap legislation that protects the interests of Big Insurance and Big Pharma and does nothing to improve access to and the quality of our healthcare.

We know that what we have now isn't working. The oft-quoted figure is 47 million Americans are uninsured, and the truth is that millions more are underinsured. In this country, we provide more "care" at greater expense and at worse outcomes than any other industrialized nation. The insurance industry and Medicare have a whole lot of influence how physicians practice. Insurers and Medicare set reimbursement rates for procedures. Basic care has a low reimbursement rate. But the more tests and procedures a doctor orders, the higher the reimbursement. As a result, they often provide more, often unnecessary care. I don't blame doctors for trying to make a living. They go through years of study and rigorous training to practice medicine. But we've created a system that incentivizes quantity over quality.

In the endless, exceedingly tedious debate about healthcare, a few major items have been discussed.

1) A single-payer system. Often compared to Canada and the UK, opponents argue that it will "ration" healthcare. And send your grandparents to the death panel. Certainly those systems have their drawbacks. It is true that some people have long waits for treatment, though my understanding is that those are "nonemergency" cases. If you're having a heart attack, it's not like they send you to wait in line. I also just want to point out that WE ALREADY RATION HEALTHCARE IN THE U.S.. Every time an insurance company denies a claim or refuses to cover a test, treatment, or procedure, they are RATIONING. And if they deny someone a treatment that could or would be lifesaving, well, that sounds an awful lot like a death panel to me. A uniquely American single-payer system (with salaried doctors and coverage for everyone) could be made workable if anyone cared to try. But try getting that past the insurance companies who have bought off Congress. This option is completely off the table at the moment, maybe forevermore.

2) "Universal mandates." Everyone has to be covered, no ifs, ands, or buts. Employers must offer coverage to employees. Those who are unemployed or otherwise don't have coverage through an employer are required to buy into insurance cooperatives (see #3) and/or a government-run plan (see #4). Sure, sounds great in theory. But small businesses will be hard-pressed to provide insurance to their employees, even if there are cooperatives to buy into. And large businesses could choose to cut costs by scaling back their plans- and if employees opt-out, so be it, they'll save even more money. So there is no reason for companies to provide anything but a bare-bones plan with minimal coverage. Employees can choose the lousy plan their employer offers, or pay more to the government plan or a cooperative. Which means we'd be in no better position than we are now. Furthermore, without underwriting reform (see #5) to ensure that no one can be denied insurance or be required to pay astronomical premiums due to pre-existing conditions, requiring everyone to be covered could put a lot of strain on a lot of family budgets.

3) Insurance cooperatives. This is an idea with some potential, but also with some pitfalls. The basic idea is that doctors, hospitals, and businesses band together to offer services to members. The model would likely be Group Health of Seattle, which covers about half a million members. The benefit is that co-ops are non-profit and member-run, with the goal of keeping costs low. In theory, such co-ops would compete directly with private insurers and force insurers to lower their own prices. However, co-ops have a less than stellar history, and there is no guarantee that they would be successful in significantly reducing premium costs to members. (Just for kicks, I went to Group Health's site and got quotes based on my own family of 5... They don't have a plan that matches our current health insurance. The co-pays are higher, they all have some kind of deductible, and all have at least 10% coinsurance. The closest plan to ours is $888 a month, which is more than what we currently pay out of our pocket, but my husband's employer picks up part of the tab. My guess is that the total cost is fairly similar, but Group Health's plan covers less.)

4) Government-run plan, aka "the public option." Sort of a third alternative to Medicare and Medicaid. The government obviously has the negotiating power to keep costs low. But would it just be Medicrap? Hard to say. The insurance lobby has been crying like a bunch of little girls whose kitten died about this one. They complain that they couldn't compete with the government keeping prices low. Well, they could start by not paying gazillion-dollar salaries and bonuses to their company officers. There are questions to be answered about any public option, such as who would be eligible and what kind of financial assistance would be provided to those at lower income levels. But what once was a mainstay of Obama's call for reform has been all but ditched.

5) Medical underwriting reform. At present, insurance companies can refuse coverage to, or cancel coverage for, anyone with a "pre-existing condition" or a condition that becomes too expensive to treat. Depending on the insurance company, a pre-existing condition can be almost anything, from seasonal allergies to cancer, from a being beaten by one's spouse to a prior c-section.* And watch out if you get sick: Your insurance company may drop you like a hot potato. This denial of coverage definitely needs to change. In 2007, nearly 2/3 of all bankruptcies were due to medical bills- in 80% of those cases, the folks who filed had health insurance. (Himmelstein, D, E., et al, “Medical Bankruptcy in the United States, 2007: Results of a National Study, American Journal of Medicine, May 2009.)

6) Tort reform. Supposedly our legal climate forces doctors to practice defensive medicine. I say supposedly because it appears that doctors are acting more as a result of the fear of lawsuits than actual litigation. A new report in Business Week asserts that malpractice suits do not add appreciably to the costs of health care. According to the New York Times, frivolous lawsuits and huge jury awards are not burdening the system. Those who favor tort reform point to Texas as a successful model. While it's true that malpractice lawsuits, malpractice judgments, and liability insurance costs have all been lowered in Texas since the reforms were implemented (all good things), Texas still has some of the highest healthcare costs in the nation.

Will any meaningful change actually be made in this reform process? I somehow doubt it. The smoke and mirrors thrown at us so far fail to impress me. I don't pretend to have the answers myself, but I can clearly see that the House and the Senate have done nothing but kill trees with their 1000+ page bill. I am disappointed that Obama has taken a weak and waffling standpoint on the whole issue. He has backpedaled on the public option. And he didn't give any real direction to Congress- a group of folks who have probably the best health care plan in the country and therefore could care less about anything but the campaign contributions they get from Big Insurance and Big Pharma. The bottom line is that as long as healthcare has a profit motive, we will never see any meaningful improvement in costs or in quality. Since there doesn't seem to be any likelihood of making insurance companies non-profit entities, I'm betting that real reform is nothing but an illusion.


*The c-section issue is a double-whammy, because those women who can't get insurance due to a prior c-section also face hospital and physician policies "prohibiting" VBAC . Which means that many of those women will not only essentially be forced to undergo major surgery, but they'll also have to foot the entire bill, to the tune of $15,000 or more.

NYTimes Article: Froot Loops Are Health Food

Link to article

You may soon be seeing the new "Smart Choices" labels on products at your grocery store. Several manufacturers- such as Kellogg's, Kraft, and PepsiCo- have banded together to label certain products as "better for you" options. They formed a committee, including the dean of Tufts University school of nutrition and representatives of each the cooperating corporations, in order to decide which foods would meet their criteria to receive the Smart Choices green checkmark logo.

Now here's the problem. Can we honestly think that giant processed-food manufacturing companies are going to put consumers' best interests ahead of their own financial interests? I'm going to go with, "Uh, no."

So what foods have made the list? You can do a search online for products by brand or by category. It's rather amusing to look at the contradictions. All-Bran and Corn Pops are both Smart Choices? Or as the article points out, both regular AND "light" mayonnaise are Smart Choices too? So, according to the Smart Choices program, it seems there is no substantial nutritional difference between those products. Also included as a Smart Choice: Fruit Roll-Ups. Never mind that in a 14g serving, 7g is pure sugar. A Smart Choice can be made of 50% sugar? Seriously, did a group of 7 year olds put this list together?

By artificially enhancing a food with little to no nutritional value, manufacturers can slap a Smart Choice label on a product. (Coming soon to a store near you: Bacon! Now with added calcium!) And by doing this, they can still claim they are following federal nutrition guidelines. This is a complete scam on the American public and an insult to our intelligence. There's hope though: The FDA has written a letter to the Smart Choices program to put the committee on notice that they'll be facing regulatory scrutiny. Let's hope they're willing to put some muscle behind the criticism. No, it's not easy to altogether avoid processed foods. But as consumers we can learn to read nutrition labels and make better choices without some silly checkmark contrivance.

Medicated Moms

Today I read this article about a mother who decided antidepressants were the answer to her parenting stress. Her anecdote about the kids bickering in the backseat of the car is a story all too familiar- Been there, done that, got the t-shirt.

But... Since when is getting angry and yelling at your kids a condition requiring medication?

I absolutely believe that there are legitimate uses for antidepressant and antianxiety medications. There are people who wouldn't be able to get out of bed in the morning without them. But by all indications, use of these medicines has greatly increased. Some would say they are overprescribed- even the author acknowledges it:

"My doctor said he prescribes mood-enhancing medications about 10 times a week... My friend called her doctor to make an appointment and talk about going on Paxil. The nurse said she would just call the script into the pharmacy. No appointment necessary."

No appointment necessary? Are you kidding me? I had to make 3 calls to my doctor, begging her to call in a prescription for antibiotic eyedrops for pinkeye without seeing me first. Why are there doctors handing out powerful psychotropic medications like they are candy?

Here is my biggest problem with the author:

"Maybe moms like me should do more yoga, cut back our responsibilities, see a therapist, exercise more, put duct tape over our mouths every day after 5 p.m. Maybe we should do anything to avoid relying on drugs to become calmer, happier people."

She outright acknowledges that there may have been other (non-pharmacological) ways to handle her stress and anxiety, but did she bother to try them? No, she didn't. It's easier just to pop a pill. Antidepressants have well-documented side effects. As far as I know, yoga and therapy do not.

I reiterate the fact that there are many people for whom antidepressants are nothing short of a godsend. Yet I have to wonder if we, as a society, have come to view any negative emotion as a sign of a mood disorder. Or maybe it's that we think we can use a pill to cure just about anything. Or maybe [conspiratorial whisper] the pharmaceutical companies' marketing tactics have convinced us we are broken and need to be fixed.

And I Didn't Come In Last!

Aflac IronGirl Columbia Women’s Triathlon

Race Report

August 23, 2009

I have Cortney to blame or to thank for this race. She was the one who, fresh off her own first triathlon, said I could “totally do one.” I was in the first trimester of my pregnancy, so maybe it was pregnancy brain that made me think it would be a good idea to do a triathlon at three months postpartum. I registered and then basically forgot all about it for about 3 months. In January, I began taking a lap-swim class at the rec center. I built a lot of confidence in my swimming technique and endurance that way, even though I was the only pregnant woman in the pool. I was also able to continue teaching spin classes up until a few days before Becca was born. And that left only running.

Ah, running. The bane of my existence. I've tried to like running, truly I have. I have made several attempts to become a better runner, starting in high school when I thought I would die doing 10 laps around the courts at tennis practice. The thought of taking it up again with a baby bump was too much to bear, so I put off training for that until Becca was a few weeks old. And it was just as lousy as ever. I have friends who are Runners, yes, with a capital R. I just don’t know how they do it.

So I got a new bike, got some new running shoes, got a new swimsuit, and went about my business. I felt positive that I could tackle the swim, even though I’m not accustomed to open water swimming. I was consistently doing 1k in 23-24 minutes in the pool, without overly tiring myself. On the bike, I could tell that all the spin classes had actually paid off, giving me the endurance to take on longer rides. It was the run that plagued me. Even on “fresh” legs, I never did better than an 11 minute mile. And when I did my bike-run bricks, it was always a 12 minute mile. If you’re doing the math in your head, that is approximately a snail’s pace.

We arrived in Columbia, MD around 1 pm on Saturday. After getting the kids settled into naps, I went to pick up my race packet as well as some goodies from the expo and then over to the park to rack my bike. I didn’t realize how close together the bikes would be on the racks- only about 6 inches apart. Analyzing the space, I realized there wasn’t going to be much room to set up my gear. Luckily, I had a pretty decent spot, in one of the center rows and not far from the main aisle towards the T1 exit. I then walked down to the lake to see the swim course. The lake was as swampy and slimy as I’d imagined.

I also drove the bike course in the pouring rain, and realized it was very hilly, even more than the map had indicated. Up to that point, I was uncertain if I would race in my bike shoes, with feet clipped to the pedals, or in my running shoes. I am nervous riding with my feet attached to the pedals, especially since I’d fallen (twice) when I lost my balance and couldn’t unclip from the pedal in time to put my foot on the ground. But with the hilly terrain, I knew I’d need the added efficiency of the bike shoes, which allow me to pull upward on the pedal instead of just pressing down.

When I got back to the hotel, we all went out to dinner at Clyde’s, still in the pouring rain. I was concerned it would be raining during the race, or at least that the rain would go on long enough to leave the roads wet- and slippery- for the bike ride. Luckily, the rain stopped overnight and the pavement was nearly dry by 6 am on race day. I didn’t get much sleep on Saturday night, between thinking about the race, hotel staff moving trashcans around right outside our window at midnight, and multiple awakenings by Josh, who finally wound up sleeping in bed with Jordan.

My wake-up call was at 5:15. That gave me enough time to get dressed, eat breakfast, and pump a couple of bottles for Becca. Then I grabbed my transition bag and headed out to catch the shuttle bus. At the entrance to the park, I got my body marked and then headed down the muddy incline to the transition area. I arranged and rearranged my gear in the tiny patch of grass next to my bike, trying to figure out where to put it so it wouldn’t be in the way of someone else’s bike or gear. Soon they were calling out just a few minutes to the transition area closing, and I headed out to find Bob and Lauren while I waited for my swim wave to start.

After I met up with Bob and Lauren, we waited at the swim start for Jordan to arrive with the kids. I was in wave 10, so there was plenty of time to stand around and wait. Finally it was time to line up with my wave. I made small talk with a couple of the women standing nearby as we slowly waded into the green water. The bottom was sandy and slimy, and I could feel strings of some kind of seaweed brushing past my legs. “Ew!” I said to no one in particular, “I’m such a girl.” A couple of the women around me laughed. When the water became waist-deep, I decided to swim out closer to the starting line and tread water, rather than keep walking and risk finding out what other unpleasantries the murky depths had in store. I seeded myself near the back of the pack, not knowing how fast the others would be swimming. We counted down to the starting time, and at 1, I pushed the button to turn on my heart-rate monitor and then began my swim.

From land, the swim had seemed so long, much longer than 1k. I guess it’s hard to judge actual distance by doing laps in the pool. I told myself that it was no big deal, just keep moving forward. Though I had practiced sighting in the pool, doing it for real in water that literally didn’t allow me to see 6 inches in front of my face, was totally different. I had practiced primarily freestyle, knowing it would be the fastest stroke. That plan quickly got dumped for a mixture of freestyle and breaststroke in order to stay on course. I remembered to emphasize my arm strokes to save my legs from getting tired. As I rounded the first buoy, I saw a woman from a couple of waves ahead of me hanging on to it (allowed for resting). After the second buoy, I passed several women from the previous wave, which was encouraging. I kept going, drafting off a woman ahead of me for a little while, until she tired and slowed down. One buoy passed, and then another, and another, and suddenly a guy in a canoe said there was less than 300 yards left. Sweet! I plowed forward, rounded the final buoy, and headed for the swim exit. As I ran up the ramp, I glanced at my watch and saw I was in the 24 minute range. I happily ran up the hill to my bike, grabbing a cup of Gatorade on the way.

I got my helmet and shoes on pretty quickly, but fumbled around trying to get my bike off the rack. The bikes on either side of mine were still there, and I caught my handlebars on the front wheel of another bike. Frustrated, I ducked under the rack a couple of spots over where the rack was empty and dragged my bike out from the opposite side. Doing that ate up some time, unfortunately, but I hustled up the ramp out of the transition area and mounted my bike as fast as I could.

I felt good, if a little uncertain, as I pulled out on to the road. There weren’t too many people in front or back of me at that time. Soon a few riders came and passed me. As I started feeling more confident, I passed someone. And then someone else. As I sped up to pass someone at the crest of a small hill, another rider came up behind me and passed me, saying, “nice move!” as I passed the first rider. For awhile it seemed like I kept passing, and being passed by, the same handful of people. As we got to the first really big climb, I saw several women walking their bikes up the hill, some of them huffing pretty hard. I said a few words of encouragement as I rode past them. There were several other hills like that on the ride, with people walking their bikes, but I am proud that I didn’t dismount and walk even once- it was never so difficult that I was even tempted.

All along the way, women were talking to each other, cheering each other on, and cracking jokes. At the turnaround, I grabbed some Gatorade and kept going. I was surprised that I was not feeling tired. My legs would feel fatigued on the climbs, but as soon as I hit the downhills and the flats, they recovered quickly. Race volunteers and local residents were out on the course, clapping and cheering. As I sped along the home stretch, I felt fine, but started mentally preparing for the hardest part to come. Entering the park, I could see Jordan, Bob, Lauren, and the kids on the sidelines waving. I got off at the dismount area and jogged my bike back to the rack. It didn’t take me long to swap my helmet for my hat and my bike shoes for my sneakers, and I was off.

I jogged along the trail, oh so slowly, as other runners passed me. There were some people walking, but I didn’t want to give in. I made it about a mile and a half, forcing myself up the “Gatorade Hill,” but soon after had to walk a short stretch. I ran the turnaround and then had to make it back up Gatorade Hill. This second time I walked. I ran the downhill part, and then walked one more time for a couple of minutes before running it the rest of the way in. Although most of the course was fairly shady through the wooded areas of the park, the last half-mile or so of the trail was in full sun. I’d had plenty to drink, yet I could feel a little lightheadedness setting in. There was nothing to do but push myself through it. In the last stretch, I was able to use a final burst of energy to get myself into the finishing chute. I heard Jordan call my name and waved at him and Josh and Alex, then went on to cross the finish line.

My final time was 2:35:39, a little more than my goal of 2 ½ hours, but overall not a bad showing for a first-timer. (I did post a better time than the 79 year old woman at least!) Some great lessons learned… for next time? I have some clear ideas on what I could improve, so yes, I think there will be a next time.

What Color Is Your Pee?

Yes, that's right, I just asked you the color of your pee. Go ahead to the bathroom and check. I'll wait right here.

Done? Ok.

Urine color is a great indicator of your hydration, which is important even if your most strenuous activity is couch surfing. The U.S. Navy has a helpful chart to help you determine if you are sufficiently hydrated based on the color of your urine. How did you fare? As the chart notes, sometimes vitamin supplements can affect the color of your urine, particularly B vitamins, which tend to temporarily turn it neon yellow. If that's the case, you can check again in a couple of hours.

Severe dehydration is, of course, a serious condition, and can be fatal. Even mild dehydration can cause symptoms that many people would not associate with fluid loss, such as fatigue, headache, or irritability. Ever just feel "blah"? It could be mild dehydration!

How much fluid do we actually need? Well, the bad news is that it's probably more than you usually drink. The good news is that any liquid, not just water, counts towards your daily intake. Yes, even coffee. Even wine! In general, we need about two quarts of fluid a day- that's the legendary eight 8-0z. glasses of water. But that's just for starters. If you are spending time outside in hot weather, spending time at high altitude, ill, pregnant, or breastfeeding, you'll need to drink two to six cups more per day. And you'll definitely need to drink more during exercise.

The American College of Sports Medicine recommends a fluid replacement approach to hydration during exercise. If you weigh yourself before and after a workout, you can determine how much fluid you've lost. An ounce of water weighs 1 oz., so one pound of weight loss would be 16 oz. of fluid lost. Aim to consume at least that replacement amount during exercise, as well as taking in extra fluids before and after a workout. Unless you are exercising for upwards of an hour, plain water is sufficient for hydration. If you are training for more than an hour at a time, you should consider a sports drink for electrolyte and carbohydrate replacement.

It can be a PITA to make sure you're drinking enough each day. Hence the question, what color is your pee? If it is clear or pale yellow, you can be sure you are getting enough fluids. If not, think about carrying a water bottle with you or keeping a big cup on your desk at work. And the next time you're feeling "blah," reach for some water before you reach for some coffee or a snack-- You might just be dehydrated. Drink up and then go get your pee on!

"Duodecaplets" Are a Hoax

Fox News report

I, for one, am glad this turned out to be untrue.

"Dodecamom" Doesn't Have Quite The Same Ring To It

Tunisian Woman Poised to Give Birth to 12 Babies: Reports
(Also reported here.)

I guess we'll learn in the coming days if this is a true story or a hoax. Stories of "extreme fertility" really get under my skin. I understand wanting to have children. And I can certainly sympathize with those who are unable to get pregnant or stay pregnant. I know from friends who have suffered fertility problems and miscarriage that it is frustrating, heartbreaking, and overwhelming. But the higher the order of multiples, the higher the risk to both mother and babies. Why take chances with your own life, or the lives of the children you so desperately desire? And where are the medical ethics?

It is a known fact that multiple gestations are at greater risk for premature birth and the potential accompanying health problems. Does bleeding in the brain sound like a great start to life? Even with the availability of selective reduction, there are plenty of folks who object to such practice, and others who would reject it based on the fact that it potentially puts all the fetuses at risk. But let's go back even further, to the fertility doctors who create these high order multiples, because 12 spontaneously conceived babies would be so rare as to be impossible.

Several European countries already limit the number of embryos transferred during IVF. While I believe that the majority of fertility specialists practice ethically, perhaps it is time for the law to step in and keep everyone on the same page. Any thoughts?