Decoding the Surrealistic Landscape of Health Reform

By this time anyone reads this the arguments in Congress may be over.

Joseph Lieberman et al may have even prevented a vote. My prediction: Leiberman's next incarnation will be as Shining Path Maoist. Based on principle, you know.

Regardless, this whole "health care reform" plan is a travesty. It's a giveaway to private insurance companies, a sop for big pharma, and makes care more complicated for the average person to obtain.

Anyone who thinks about this issue, and does not work or lobby for, the insurance industry, can see that using private insurance and linking it to employment is a recipe for wasteful and inefficient spending.

The solution has been staring us in the face for decades, but particularly in the last few months.

Ready?

What we need is a single payer system.

This does not mean the end of private practice. In fact, it very closely resembles Medicare, which is, pardon the expression, a single payer system that is known to work.

The Veterans Affairs medical programs (some of which are a substandard disgrace) are also single payer, and if Republicans stopped obstructing and obfuscating everything that crosses their desks, Congress would allow an increase in spending for the VA health care system.

Somehow, I am chosen to participate in telephonic town hall meetings. Always happens at dinner time. The phone rings, I answer with typical trepidation, and am informed that I have been selected for this cyber town hall thing.

The first one was for U.S. Rep. Rosa DeLauro, who took many calls, a high percentage tearful, from people begging to know how health reform will help them. Small business owners were also wary.

When my turn finally came to talk, I asked, since most of the previous callers were complaining about medical insurers, why was the single payer option eliminated without serious consideration? Why are we catering to the insurance industry, I asked, and was then placed on "listen only."

I cannot recall was Rep. DeLauro said, but a male aid of hers told me that a single payer system would make workers who receive benefits through their jobs unduly "anxious" about the system.

Right. Workers have no anxieties in Connecticut, do they?

The answer was silly. When 64-year-old Americans become 65, they are eligible for Medicare, and he sky does not fall. The heavens do not darken. The federal government does not grind to a halt.

The 65-year-old receives a Medicare card, and gives the information to his doctor. His doctor probably takes Medicare cases. If not, he finds a doctor who does.

Covering everyone in the country with an expanded Medicare plan would cut billions of dollars in waste by insurance companies whose sole motive is to collect money, and keep money by refusing claims.

Given a choice between arguing with a disinterested government official and an unidentified professional confounder at an insurance company, I know what I would rather choose.

Instead of the simple Medicare for all plan, if health reform pans out, we will be able to keep the plans we're on, or shop for insurance from an exchange, including an anemic public option.

If you remember the complexity of Medicare Part D, the prescription plan with the famous doughnut hole, the coming plethora of plans will seem familiar. Figuring out the best, or least bad, Part D plan was the equivalent of breaking the German enigma enciphering machine.

The insurance companies would not release their formularies, and could change them without notice. There was a substantial penalty for not signing up quickly.

Well, you can imagine what "shopping on the exchange" will be like. You'll get a list of covered items, premiums and deductibles, along with a list of exceptions. Everything will require pre-authorization, I suspect.

One plan I recently saw for mental health requires prior authorization, and does not cover marriage counseling, pervasive developmental disorder, or a bunch of other conditions. You call the company for authorization and talk to someone, clearly not a doctor, with a Mumbai accent, I'm imagining.

If health care is a right, as some people claim, the system we are likely to end up with is a mockery.

Which also points out that regardless of what our elected officials say, our domestic and foreign policy is determined by ExxonMobil, Well Point, Humana, SmithKlineGlaxo, General Dynamics, Boeing Lockheed, and Wall Street.

Each woman is an individual and her breast care is her business

The federal Preventive Service recommendations on mammograms is not about rationing health care, although it does involve economic considerations.

Repeat, the "fewer mammograms" suggestion is not about parsing care, it relates to breast cancer as a public health issue, not a personal one.

Here it is in a nutshell: Do the anxiety, biopsies, surgeries, and expenses of mammograms justify their current use by women, not at any special risk, starting at age 40.

Studies show that one case of breast cancer is discovered by mammogram per 1,904 women tested. The problem is that the other 1,903 women may receive false positive results, meaning that they then undergo a biopsy, and possible surgery.

complications in biopsy and surgery are rare, but not unknown. Depending on the skill of the doctor "reading" the mammogram, the x-ray may show benign lesions, cysts, or "artifacts" such as shadows that aren't really there.

Suppose there were an extremely rare fatal disease curable if caught before the age of 5. Say this disease struck 1 person in 1 million. Even if the test were cheap, easy and accurate, a million people would need to take and pay for the test to reveal that single case, on average.

Clearly, for the diseased individuals, these kinds of screening tests can be lifesaving. But what if your doctor recommended the test, even though the chances of it occurring in your child were minuscule?

You might ask your pediatrician if it made sense to test everyone, because the risk is only 1 in 1 million, getting time off from work is a hassle, a doctor bill is a hassle, and putting a toddler through a medical test is emotionally and physically draining.

On the other hand, diseases like measles, mumps and rubella were so common and the vaccines so inexpensive and effective that virtually all children in the U.S. receive them before they are allowed to attend school.

Currently, about 1 in 8 women will develop breast cancer in her lifetime. Breast cancer is not a single disease; there are aggressive, invasive types, and slow growing types. Women with certain genetic mutations are more likely to develop breast cancer.

So undergoing mammograms at age 40 seems reasonable.

The five-year survival rate for breast cancer in women in the U.S. is about 89 percent, which is encouraging.

Here's what puzzles and confounds many men and women. Canadians followed 40,000 women ages 50 to 59 in the 13-year study that concluded in 2000. The women were split into one group who received physical exams and another that were given mammograms.

The Canadians found that though more cancers were detected by mammograms, their death rates were no lower than the physical exam group. The inescapable conclusion is that yearly mammograms did not increase survival rates after cancers were detected.

Can this be true? It makes little sense. The methodology of the test was criticized, including the quality of the mammograms. The age of the participants is another issue. All of the women probably faced an elevated risk, skewing the results.

This is why it is so important to read and understand medical reports and journal articles. Why it is important to study biology and physiology. You don't need to agree with evolution to be a good doctor, though genetics is part of an educated person's knowledge.

Even if the study had been conducted perfectly, epidemiology has to do with large numbers of people. Medicine pertains to the individual.

So when all is said and done, here's what you should do: Consult your own doctor or doctors about whether they think you should get or delay mammograms. Because you're the person at risk for breast cancer.

This is your life, and you should not allow an obscure public health meta-study to dictate what medical tests you choose, and when you choose them.

Leave it the way you found it

For mysterious reasons, many people seem concerned about the moon.

Recently NASA hit a crater on the moon with a bus-sized vehicle to see if there was frozen water under the dust. There was general alarm. Is it ethical to bombard another object in the solar system? Did we have the right? Are we in danger of messing up space?

Some of the people worrying about the moon do not have the same level of concern for global climate change on our own planet. But that's another story.

As anyone with binoculars or a telescope can tell, the moon has been hit hundreds of thousands, if not millions, of times by leftover solar system debris. The only places without craters on top of craters are the "seas" and "lakes" covered with relatively smooth melted and solidified rock. In a few billion years these areas will be just as pocked as the rest of the surface.

Humans have hit the moon repeatedly since the 1960s with jettisoned lunar landers, and probes of various kinds. Humans have left stuff there either because the instruments are impossible to retrieve, or the cars, tools, and all of that other moon landing material were too heavy, cumbersome or useless.

Should we dispose of garbage by sending it to the moon? No, of course not. Even if it were possible. it's just not right to trash a pristine world.

The idea of messing up space is different. Because, if you haven't noticed, most of the sky is space. Or it appears to be. There is a lot of invisible dark matter unaccounted for, not to mention dark energy.

If we ever want to get to another galaxy, scientists will have to figure out a non-destructive, practical way to bend or twist space.

That could make the trip short enough to tolerate. Unfortunately, whatever we beam up to warp space can only travel at the speed of light, so to reach a star 100 light years away, the beam would have to travel 100 years.

The irony is that once humans get to wherever they are going, it would turn out to be just like it is here, because Earth is a non-exceptional planet orbiting a non-exceptional star, in a non-exceptional galaxy in a non-exceptional universe, among million, billions, or an infinity of other universes.

So, the short answer is, don't worry about the moon.

Fate is full of fat

A recent study found that posting the caloric content of fast food does not make any difference in what people order.

Come on. If you go to a place that fries or deep-fat fries everything on the menu, it's safe to conclude that the food contains a lot of -- yes -- fat.

Double maximize the order with a gallon of sugary soft drink, three or four patties of beef, or whatever that stuff is, top it all off with mayonnaise, or some other equally fattening, oily, condiment, and in one meal you exceed the number of calories you require for a day and a half, you get a month's worth of fat, and more sodium than you can shake a salt shaker at.

The problem with this study, at least as it was explained in a newspaper, is that by "posting," fast food places mean that the numbers are available if you search long enough and with a magnifying glass.

Some franchises list nutritional details in handy take-home folders, that the staff never places in your bag. Others have them on the wall, but the letters and numbers are only visible if you have a step ladder.

What we need is something that is chewy, like meat, that tastes like meat, and that contains something that feels like fat, and something else that tastes salty but isn't. Or foods like french fries could be cooked in highly pressurized and superheated helium.

McDonald's had a non-meat hamburger a few years ago. It wasn't bad, basically because it was slathered with mayo and ketchup, and loaded with pickles, lettuce, and so on. But it disappeared quietly. No one noticed.

Is there not some method to render tofu into an ersatz hamburger, a convincing one? There's got to be a way. Soybeans are certainly less expensive than beef. Do it right and no one would know the difference.

Because, as we now know, no one looks at the ingredients or the calories.

Watson, come here -- look out for that car! -- I need you.

Some of today's teens are "texting" on their cell phones while driving.

This obviously is distracting. But the real question is, physically, how do they do it? Using the microscopic keyboards is difficult for palsied middle aged parents with paws, who are sitting at sitting at a desk, concentrating.

Are the drivers doing the texting with one hand, and steering with the other? Are they holding the electronics in both hands on top of the wheel? Can they touch-type, or touch-thumb, or however they manipulate the keys?

Changing the music on an iPod running through the car's radio is simpler, but still requires averting eyes from the road for about a minute or two, or roughly a mile or two at Interstate speeds. It's terrifying, but if you've been listening to Public Enemy for two hours and want to counterbalance your brain by switching to Schubert (or Schumann) for a while, you have no choice.

That is, unless you pull into a rest area, but who has time for that? And really, if you can keep the vehicle in your lane, what can happen in a mile and a half? Those of you who have experienced automobile collisions know that it's not the mile, the problem is the last 50 or 100 feet. Anyway.

A loony teenager, who was seriously injured texting and driving, was on television recently. She had been writing to a friend when she collided with a truck. After she recovered from a broken leg, broken pelvis, and a few other injuries, she went right back to text-driving, and had another crash. And she's still doing it!

The amount of multi-tasking, coordination, and fearlessness, is fascinating.

Never mind the irony of using a telephone to correspond when you could just talk. That was originally what was so liberating about telephones: Instead of laboriously writing, addressing, and posting letters, , you could just dial a few numbers and talk.

We need people like these driving texters to fly drones over Pakistan and Afghanistan. They might even be able to pilot a drone, fires missiles at the Taliban and drive, simultaneously.

If you're going to risk your life like that, and you can drive, read, write and think about something else, all at the same time, why not "give something back" to your country?

I'm the guy with the apple over his face

Preparing for a recent flight out of Bradley, in Windsor Locks, I was treated to the updated homeland security scan.

Obviously we are not terrorists, nor did we want any on board. So we followed orders.

My family was first directed through a "sniffer," a machine that puffs air at you to detect traces of explosives. No big deal.

Then we had to stand with our arms extended, palms up, while personnel went over us with sensitive metal detectors. It detected the wire embedded in my sternum during heart valve repair surgery, and, of course, the zipper on my pants.

The security guy declined an offer to view my sternum scar, which I would have happily shown him. I did have to turn my belt buckle and pants over, to make sure, I'm not sure what for.

Again, no problem. Seemed like standard stuff.

Then, I was in front of a counter, behind which stood a woman, who had all of my personal items: my key ring and pill case, my wallet, my cell phone, pens, change, and a few other odds and ends.

The woman started to chat with me, as if to pass the time pleasantly. That's a pill case. What kind of pills? she asked. Prescription pills from home that I use to quell my claustrophobia inside airliners, I said. Alprazolam. Xanax.

In a hushed voice she said she knew someone who got hooked on Ambien. "So sad," she said. I declined to explain to her that Ambien and Xanax are not similar or similarly used. What was going on?

It began to dawn on me that she was interviewing me, looking for signs of something. Maybe I seemed nervous, or not nervous enough.

Then we came to my wallet, which she opened without concern. She leafed through some family photos, my insurance card, and an ancient press card I'd never bothered to remove. "Oh, you work at a newspaper," she said. How nice!

Used to, I replied.

Then she pulled out a pack of assorted do-it-yourself business cards, including a version containing a Magritte painting of a man's face obscured by an apple. "Is this you?" she asked, laughing.

No.

Then she pulled out a battery powered, credit card-sized magnifying glass that I had stuck in there and never used. This was what they suspected was a calculator. What's wrong with a calculator? Not sure.

Having answered that question, she gave my possessions back to me and we flew to Chicago on an Embraer jet.

No one I've spoken to has ever had his or her wallet opened and explored. Maybe she was new and extra zealous? I don't think so. Maybe she wanted to see my reaction to her pawing through my most personnel papers, doctor's numbers, bank statements from ATMs, a card of assorted passwords.

She crammed the looking glass thing back in the wallet and we were on our way, but the whole business left me with an uneasy feeling that would not lift. We were told that our family had been chosen at random for special attention.

Which is the dumbest, least effective way to catch would-be terrorists. Perhaps the random checks are intended to be a deterrent. That doesn't seem to make sense either.

The trip back to Bradley was uneventful.

But I still can't shake that feeling.

A Few Simple Steps to Happiness

Scan the "health" magazines at Wal-Mart and you will recognize that versions of the same articles are published over and over.

There is always a story on how to quickly obtain a flat abdomen; the best way to lose weight; and the keys to higher quality sex. Freud famously wondered what women want, and apparently to this day no one knows.

Not even women. Especially not women.

The same holds for men, whom the magazines always portray as sleek, competitive business types obsessed with sports, sex with women, alcohol and adventure. But most men are not like that, just as few women achieve the weird look that marks the American female ideal.

Lists on the cover sell magazines, so you see "10 ways to trim fat," "12 days to six-pack abs," "26 ways to drive him wild in bed," "100 ways to get any woman you want," and so on. Have your cake and eat it too, in five easy steps.

All of the articles repeat the same advice, which everyone already knows: eat less, exercise more, and improve communications with your partner.

These adolescent issues coagulate in a new HBO series called "Hung," which features an impoverished man with a large penis who becomes a male prostitute for straight women. His pimp, a sensitive woman, has to keep reminding him not to behave like a Neanderthal.

The series is very amusing, and is sure to increase orders for cockeyed "penis enlarging" pills. These pills are sold in spam that you probably automatically discard. Yet these products are out there and even advertised on television.

This whole industry is an exercise in the placebo effect, because biologically speaking, there is no nostrum that will enlarge a specific part of the anatomy. Usually, things that make body parts bigger are bad.

Steroids increase muscle mass while destroying the liver and causing other unpleasant effects.

A steady diet of alcohol will enlarge one's liver to the point that it is a mass of fatty cells that no longer function. And, of course, no one wants to bulk up with cancerous cells. Bigger lymph nodes, larger eyeballs, enlarged gallbladders, swollen appendixes, growing prostates, thickened airways -- all bad, very bad.

Add it all up and neither men nor women take any prizes for brains, health or emotional well-being.

Maybe Freud was asking the wrong question.