How about an MRI for that headache?

While out to lunch with some co-workers the other day, our talk gradually shifted to health care. Actually, first it was about pregnancy (for some bizarre reason, I seem to find myself in some sort of unitiated baby/maternity/pregnancy conversation about once every day or two these days) which then led to us talking about rising health care costs. One co-worker who gave birth a couple of years ago told us that she needed a C-section and their medical bill totaled almost $40,000. Fortunately, of course, her insurance picked up the tab. A normal pregnancy, I learned, was itself about $15,000 about a year and a half ago. And this from a guy whose wife had a natural childbirth! No drugs or anything, all they did was stand there, yell for her to push, and be there to catch. Thirty years ago, however, my other colleague had been billed $257 for her entire delivery, of which her insurance paid $200. Is it really that much more to bring a baby into the world now? What are doctors doing differently these days anyway? Did some sort of new technology make the whole childbirth process less of a pain in the ass?

Since then, the topic of health has been a bit on my mind. Not surprising, I suppose, seeing as how its a frequent news topic these days. Obama just spoke before the AMA and basically told them that any health care reform bill will result in doctors having to be be paid less money. I hear they took it reasonably well, as in, there wasn't any booing or shoe-throwing. Not a bad start. The Obama administration, of course, is in favor of some sort of affordable public insurance plan like Medicare. And this makes sense. The whole idea of health insurance being tied to employment is completely strange to me. Who suddenly decided that it was the employer's role to pay for health care anyway? And how unfair is it that you can get better or worse (or no) health care just depending on where you work?

So definitely the idea of public insurance is a GREAT idea and long overdue. But I was listening to NPR the other day, and they did a profile on a county in Massachusettes (Howard County) that offered a low cost ($50-70 a month) to its residents. The goal of the plan was to promote prevention, healthier habits, etc. and catch issues sooner rather than in an emergency room (thereby keeping costs down). But while its been super successful with those individuals that participate, one of the biggest problems they have run across is that most people (as in something like 95% of those eligible) don't even enroll.

And anyway, I'm not convinced that changing who pays for the health care (the govt vs. health insurance companies) really changes the problem. What I want to know is why health care is so expensive to begin with. A few weeks ago, I read this fascinating article in the New Yorker that attempts to address this very question. Its a long article but definitely worth reading if you have the time. The author, Atul Gawande (awesome surgeon and writer), is trying to find out why one county in TX spends thousands more in Medicare funds per person than anywhere else in the US. And the answer, he determines, is that the doctors there perform more tests, surgical procedures, etc. Procedures that don't necessarily lead to better health care or provide more satisfying medical experiences for patients. That is, more is better. But in medicine, that's not always the case. Gawande argues that where medicine has proved to be the most successful are places like Mayo and Kaiser, where doctors of different specialities work together to treat patients, where doctors are paid a monthly salary rather than by test performed. Or, as an another example, he cites Grand Junction, CO, where physicians and HMOs have created a medical community that works together to look at each patient and root out problems, resulting in health care that is comprehensive, low-cost, collaborative, and accountable.

A few weeks ago, while we were in Napa, we were chatting with one of the pourers at a winery we were at. He told us it was his first day back at work after his appendix had ruptured. A young guy, he was without health insurance when it happened. While he was recovering at home, he received his bill for the procedure and hospital stay: $91,000! Now if that's not a reason to look at health care prices, I don't know what it is.

Any docs or med students out there that have some insight on the whole issue? I'd be curious to get your take on it.

one last push . . .

This year, I've received more emails and seen more blog posts about political issues than ever before, and I love it. I hope this isn't just me and my circle of friends. I hope that its indicative of the entire country. Because whatever your thoughts or beliefs, the most important thing any of us can do is go out, get informed, and vote.

In 2004, approximately 64% of voting-age citizens turned out to vote. I guess its not bad compared to some years, but it still appalls me to realize how many people don't take advantage of their opportunity to have a say in the political process. Whatever the reasons are for not voting, believe me, I've been there -- too busy, totally indifferent about the candidates, hate standing in line, forgot to register. I don't believe there's been single election where I haven't felt one of these. Last time, I forgot to re-register when I moved and was just thankful it wasn't a presidential election year. But I didn't get to make the difficult choice between Obama and Hilary!

I wonder if our general abysmal record when it comes to voting isn't indicative of a larger problem -- is it just me or as a society, do we just not discuss politics? I rarely engage in political discussions with friends. While I tend to have strong opinions, I don't really go around talking about them. And (maybe as a result), I actually don't really like having prolonged conversations with people that disagree with me politically. I'm not sure its like this world wide. Traveling around, I feel like I've encountered much more animated political chatter in other countries. In India, for example, at least in my family, sounding off on politics is an almost daily occurrence. And it seems that no matter what the level of education or socio-economic background, people are enthusiastic about having an opinion and making it known. They recognize the value of being part of the process and take advantage of the opportunity.

I don't know what the numbers are in other countries so I might be totally off base. But whatever -- there's no reason why we can't have a 100% voter turnout in our country. I'd love to see everyone get excited about politics. And more than that, to see everyone really get informed and vote for the right reasons, rather than what a 2 minute commercial tells them. My biggest fear this year is that too many people will get in that voter box, where no one else can see them, and give into that little racist voice in their heads that says a black man can't be president. Or, in California, that people won't recognize that Prop 8 isn't about a moral values but denying a minority group certain fundamental constitutional rights.

So I'm off now to vote for Obama and NO on Prop 8. I hope you do the same, of course. :) But more than that, I hope you take the time to read about the candidates' positions, the arguments for and against the ballots, and vote. Its not too late!!

Please VOTE!!

EVERYONE seems to have an opinion about Sarah Palin. Honestly, I feel like I barely noticed when Obama picked his VP candidate. But then along comes Palin and she's got even Pink running "terrified." Crazy conservatives (and I mean CRAZY) like Dr. Laura seem to have a problem with the choice, too -- taking us back to the 20s, she asks why McCain couldn't have chosen a female candidate with grown children. Because we all know what's gonna happen now -- Palin's gonna be all torn between her kids' runny noses and nuclear arms deals with Russia, and we're can't trust her to prioritize appropriately. On a lighter note, Slate.com asked their readers to send in any Sarah Palin dreams they might be having. And you'd be amazed to read just how many dream worlds Palin's been visiting lately. . . . come on, really? This is what people dream about? http://www.slate.com/id/2200015/

Personally, I like knowing that the only thing standing between me and the vice presidency is American citizenship, a couple of years on my local city council, and a Miss Alaska title. I take comfort knowing that when my kids go to the school, they'll have choices. They don't have to buy into the whole evolution myth if they don't want to.

Man, who knew I'd be agreeing with Pink?