One of the problems with a blog as opposed to a paper journal is that you can’t write about some of the important stuff. Personal stuff that happens that has no business being shared with others, but is still incredibly important.

Like how our health care system has become a nightmare, both in the ridiculousness of the paperwork, and the way that some of those within the system treat those who use its services.

What insane invertebrate designed this system?

The most frustrating problem is that reform is held up on all sides, and those who are for true reform can’t manage to say the right things to let people know how serious the problems are, and how reform is a good thing.

Let’s take Medicare and health care costs are our example, shall we? One (of the many) charges leveled against a national health care system is that the bureaucracy is inefficient and would only inflate the costs of services. I’m sure everyone has heard that charge, yes? That is patently untrue.

Medicare overhead costs: 2%
Private Insurance overhead costs: 14%

Fourteen percent as opposed to two percent. Just consider how much of your monthly premium is going to pay some paper pusher as opposed to going to pay actual health care costs.

Then there is the canard about quality of service. Canada has significantly lower national health care spending with its national health care system, yet the quality of care is the same as or better than health care in the US.

Then there is my favorite, the bit where people complain about not wanting to pay for health care for the poor and undeserving (And we have the audacity to call ourselves a Christian nation? Please. But that’s another rant entirely.) Guess what. We’re paying for that health care already. Unfortunately, what we’re paying for is emergency care and hospitalization, which is incredibly more expensive than preventive care.

How we pay for the care is in one of two ways: Higher costs for products and services, and higher costs for medical services.

Higher costs for services come because companies that provide health insurance for their employees and then pass those costs along to the customer in the form of higher prices. (I heard earlier this week that the percentage of the cost of a new car that is employee’s benefits is higher than the cost of the steel) The problem with this set-up is that companies (obviously) find it cheaper to not provide benefits to employees, and so we are finding a rising percentage of Americans who are working, yet still lack health insurance.

If you have never had the misfortune of going without health insurance, let me tell you, it’s frightening.

The second way that we pay for the health care of the uninsured is through increased medical and hospital bills. When someone lacks health insurance, and cannot afford routine medical care, all their medical treatment occurs in the emergency room, where doctors are bound by law to treat patients who need care. And if the situation is grave enough, the patients then entire the hospital. There are two points here. These are huge expenses that the hospital or medical facility has to absorb, and the only way to do it is to pass the costs along to other patients–patients who can pay.

What makes the situation even worse is that many of these situations could have been resolved with routine medical care that costs next to nothing when compared to emergency care and hospitalization. Treating high blood pressure reduces the incidence of strokes. Treating diabetes reduces a whole host of medical problems, going to the doctor to be treated for a cold for the flu, keeps a patient out of the hospital with pneumonia.

But people don’t see this. They don’t get it.

Health care should not be a luxury. A healthy population is one that is better able to work (increasing productivity!) and one that has lower across the board medical costs, as use of emergency services and hospitals decreases.

But that’s okay. You go right along calling yourself a devout Christian and railing against universal medical care. But keep reading the bible. Perhaps one day you’ll actually get the bits about caring for the needy.

I just hope for the rest of our sakes that day is sooner rather than later.

I have not posted much on health care recently, primiarly because it’s all we talk about in my policy class, so I’m tired of it by the time I’m done with the lectures and all the readings. That’s probably a personal failing, since I am getting my Master’s in Public Health, primiarly because public health is something I think is important.

I was reminded of this failing on my part, in an excellent post by S-Train on the state of the health care system in the US. (Please be aware that S-Train uses strong language and doesn’t apologize for it.) There is further discussion in the comments that is even better.

So go read it. Otherwise I’ll be forced to talk about my Health Policy class, which can be summed up in this way: The Clinton Health Plan failed. Discuss.

One of the reasons I have not been writing a great deal recently, is because I have been working on the paper due in my health policy class. It is a group paper, and the subject is, unsurprisingly, End-of-Life Care Policy, with my portion of the paper/project focused upon hospice.

What I find so disturbing about all this is not that the US lacks a cohesive end of life care policy, because that isn’t it. Yes, there are issues such as euthanasia that have yet to be resolved, but that is only a minor issue in the grand scheme of end-of-life care. What surprise me is that despite the existence of relatively strong policy, so very little has been achieved.

In the United States, hospice is covered by most private insurance companies, as well as by Medicare Part A. The Medicare Hospice Benefit is quite generous, and one assume (perhaps incorrectly I admit) that private insurance coverage would be similar. For instance, Medicare covers: doctor services, nursing care, medical equipment and supplies, drugs for symptom control and pain relief, short-term hospital care including respite care, home health aides and homemaker services, and grief and loss counseling for both the patient and the family. The Medicare hospice benefit was created to make things as easy for patients and their families as possible. Patients pay no more than $5 for their prescription drugs, and 5% of the cost of any respite care they receive.

So, you’re thinking, the benefit is too generous and costly, and that’s why it is under-used! You would be wrong.

Palliative care (emphasized by hospice) can can improve patient quality of life, and decrease costs. In one study palliative care decreased the number of days in intensive care by 75%. Nationally, in 1998 hospital inpatient charges were an average of $2177 per day, while hospice cost only and average of $113 per day. This means that Medicare not only improves the quality of life for dying patients, but reduces the cost of medical treatment. A win-win situation.

Despite this, hospice utilization remains low. Nationally, the average for the year 2000 was 48 days of hospice use per patient; the average in West Virginia was 52 days of hospice use per patient. Although patients are best served by a longer time in hospice, 79.6% of those who enroll in hospice used only one benefit period.

Hospice and palliative care increase patient quality of life, as well as decrease medical costs, yet it is under-utilized. Why is this?

The prime reason, in my opinion, comes down to how people feel about, and deal with, death.

In my personal experience, when a family member was diagnosed with cancer several years ago, despite urging, they did not want to discuss end-of-life care options, or what they wanted to happen to their body if they were to die. Luckily this turned out not to be an issue, as the treatment went well, but I think it does illustrate a common problem in the US, which is a seeming inability to deal rationally with death and age.

We in the US, as a society, glorify youth, health, and beauty, and try our best to ignore or hide signs of aging, illness, and death. Glance through magazines and catalogs. The models are nearly universally young, thin, and attractive. (However two exceptions to this rule are Land’s End and Gardener’s Supply. Both catalogs use older models.) Look at ads–it seems as if every pharmaceutical company out there is advertising products to make you act and feel younger. Not that I blame the companies really, I mean, if beautiful blondes sell product, then so be it, but have we as a society fallen for it hook, line, and sinker?

This is an issue, and one that is going to become increasingly more important as the baby boom generation retires and starts to realize that no, they will not be young forever.

The other realization, and one that deals with the topic at hand, is that few want to admit they are going to die, and hospice is a tacit statement that death will come, and it will come faster than we want. Yet denying that truth does not make it go away, it only makes the end and the passing harder to bear.

WV Center for End-of-Life Care
Hospice Association of America
Hospice Foundation of America
National Hospice and Palliative Care Organization
Centers for Medicare and Medicaid Services
AgingStats.gov

“Birdwatchers from all over Britain who gathered in Grimsby to catch sight of a rare American robin were horrified to see her eaten by a passing sparrowhawk.”

That’ll teach us Americans to leave home and go to Europe.

The article described what a robin looked like (this is the BBC after all), but the description, “a member of the thrush family, with oily-black wings and tail” did not bring a robin to my mind.

Although it has received a death sentence with little hope of reprieve, “the Hubble Space Telescope has now seen to within “a stone’s throw” of the Big Bang itself“.

Hubble spent four months looking at one patch of sky, to come up with some amazing images.

The Hubble Deep Field site has information about the project and pictures.

If you’ve never looked at the images taken by the Hubble, you don’t know what you’re missing. You can go to the HubbleSite and view the Gallery to see some of the pictures.

And remember, this telescope that has taken so many amazing pictures will not be upgraded or repaired, and could cease to function at any time.

Spot the fake smiles

Results: You got 13 out of 20 correct.

This is neat. It does not, however, tell me what the average is, so I don’t know if I did better than average, or worse than average.

Ah well, it was still rather neat. Plus it’s science, so you can say you’re learning something to boot!

And you can also go through a whole slew of tests at the BBC. Rather fun actually.

Addendum the First:
Gina got 16!

Not yummy, but useful:

Cod Liver Oil really can slow the onset of osteoarthritis

86% of pre-operative patients with arthritis, who took Cod Liver Oil capsules daily, had absent or significantly reduced levels of the enzymes that cause cartilage damage compared to 26% of those given a placebo oil capsule. In addition, the result showed a marked reduction in some of the enzymes that cause joint pain, in those patients taking the Cod Liver Oil.
…
“To put this into perspective, it is highly likely that if the Queen Mother had taken Cod Liver Oil as a young adult, she may have needed her first hip replacement much later on in life.”

Still, I think I’ll continue to hope that by the time my joints deteriorate that much, they’ll have come up with a better solution.

Lies and Phones

(L)ies made up 14 per cent of emails, 21 per cent of instant messages, 27 per cent of face-to-face interactions and a whopping 37 per cent of phone calls.
…
People are also more likely to lie in real time- in an instant message or phone call, say- than if they have time to think of a response.

Now I have justification for not wanting to talk on the phone!

Nano-origami

A hat, a brooch, a teradactyl….

Unfortunately, that’s not what the article is about.

Scientists have taken some of the first steps towards therapeutic cloning, which means that it is possible that in the future your own cells could be used to treat disease and injury.

The possible benefits of this are tremendous: No longer would transplant patients have to take immune suppressing drugs for the rest of their lives. The shortage of organ donors would not longer be such a problem. Yet there are many more possibilities that have not yet been considered, but will be if this research proves successful.

What I find most interesting in all this, is that it might address some nature-nurture issues. If a disease were entirely due to genetics, then therapeutic cloning would have little benefit for those who suffer from that disease, but if there is an environmental component to the disease, then therapeutic cloning could in some cases be a life-saver. How so? Consider that weight has been linked to maternal nutrition during different stages of pregnancy. If a pregnant woman suffers from malnutrition at one point in the pregnancy, the child is more likely to be heavy. If the malnutrition occurs at a different stage of the pregnancy, the child may be skinny.

What if there is an environmental component to diseases such as diabetes or cancer? This means that doctors could grow a treatment from the patients own body that could be raised to be free of these disease.

Of course this is entirely theoretical, and the potential for abuse is quite high, but assuming that we keep crackpots from abusing the technology, there is much potential for good here. I’m very excited.

You can read more at either the BBC or at CNN or at New Scientist.

Speaking of earworms…

The top ten songs most likely to get stuck in your head:
1. Other. Everyone has his or her own worst earworm.
2. Chili’s “Baby Back Ribs” jingle.
3. “Who Let the Dogs Out”
4. “We Will Rock You”
5. Kit-Kat candy-bar jingle (“Gimme a Break …”)
6. “Mission Impossible” theme
7. “YMCA”
8. “Whoomp, There It Is”
9. “The Lion Sleeps Tonight”
10. “It’s a Small World After All”

For the past two days, my own earworms have been songs from the 60s. (shudder)

Therefore:
All My Exes Live in Texas (Triple Shot version)

I was reading the last issue of US News over the weekend, and their special report was on the obesity epidemic in the US piqued my interest (It also pushed one of my buttons, in that that is a subject about which I have ranted before). The authors make several very good points, the most important of which is that obesity is a disease.

Yes, Americans don’t get enough exercise. Yes, Americans eat too much junk food. Yes, lack of exercise and junk food do contribute to the problem of obesity, but that doesn’t mean they are the entirety of the problem.

In the U.S., weight is seen more as a morality issue than a medical condition, with personal judgment automatically passed upon those who are overweight. Society automatically assumes people are overweight because they can’t control themselves, or because they are lazy. You know what? That’s bullshit. Unfortunately, it’s a bullshit idea that will remain as long as health standards are based upon the narrow ideal of beauty common in the U.S.

Skinny does not automatically equate with healthy any more than being heavy means the person is unhealthy. If someone is heavy, but they exercise and eat right, then I cannot comprehend why society feels that we have the right to look down upon that person. If someone is skinny, they may well be less healthy, yet being too skinny is almost never looked down upon in today’s society, but is instead idealized.

I am completely average as far as weight goes, but I’m smart enough to know that my weight has much more to do with genetics than it does with my personal choices. I have a fast metabolism, high energy, and a preference for fruits and vegetables over junk food. I got lucky, and I know it. My weight and body shape are no more a moral issue than my curly hair, but that’s not the impression one gets listening to most discussions and debates about weight and health.

At one point, years ago, I was too skinny. I was smoking too much, I wasn’t eating, and I was running myself into the ground. I felt terrible most of the time, and you could count all my ribs, yet the women with whom I worked would invariably tell me that I looked great, that they wished they were as thin as I was, etc. (Luckily, I had friends who were willing tell me that I was too thin, that I looked terrible, and that if I didn’t eat something there would be Consequences.) The point of this is that I was not healthy, and no one should have looked at me as someone to be admired, but there is was anyway. Society doesn’t have much of a clue as to what healthy looks like, and doesn’t much care. This is terribly wrong, yet nothing is being done to change it.

Yes, if Americans got more exercise and made better food choices, we would not be having the obesity epidemic we are today, but let’s face it, when we go to work, we no longer work, but instead spend our days at desks, or doing other sedentary activity. Foods that are readily available, such as the fast food, tend to be unhealthy. American society has changed to a society where activity and time are limited, and this encourages neither an active or a healthy life style.

Yet we continue to act as if obesity were a moral failing, instead of a symptom of the changes inherent to our technological white collar society.

Can we change these things? Probably, but it’s going to take more than suing some fast food companies. To really change things we’d need to rebuild some things from the ground up. Make schools within walking distance of where kids live, and make sure that the walk to and from school is safe. More physical education, more going outside and playing, less TV and fewer video games. Make healthy food as easy to get and eat as junk food. (Next time you’re in a restaurant, compare the prices of milk or juice to that of soda, and then remember that you get free refills on the soda.) Encourage people to get out of their cars and walk places, which means not just building and repairing sidewalks, but making sure those sidewalks are cleared in bad weather.

If we as a society are unwilling to make those changes, then I do not see how we can look down upon those who are heavy and blame their problems upon their unwillingness to make changes. Especially when those changes may have very little to do with personal choice, and everything to do with they genetic hand they were dealt.

(T)he first study ever to analyze genes from all the living families of lizards has revealed that snakes made their debut on the land, not in the ocean. The discovery resolves a long-smoldering debate among biologists about whether snakes had a terrestrial or a marine origin roughly 150 million years ago.

Call me a geek, but I think this is really interesting. (Of course if you’re in the bothered by not enough legs as opposed to too many legs category, this is probably more disturbing than interesting.)

The paper also identifies the relationship between dachshund and snakes:

(T)he burrowing lifestyle of many other species, including legless lizards, is correlated with the complete loss of limbs or the evolution of very small limbs.

The best survival rate is experienced by people who sleep 7 hours, rather than 8 or more, or less than 4.5 hours

Great. Here I was happy that I was finally getting enough sleep, now they tell us it’s better to get less sleep.

Not that I really know how much sleep I get, since I read until I fall asleep, which doesn’t give me a clear idea as to what time I actually fall asleep.

Guess this means I no longer have an excuse to quit doing my homework so early in the evening.

New research found that Transition to Adulthood Delayed, Marriage and Family Postponed.

Okay, how can I get a grant to study stuff that everyone already knows?

There has long been intense debate over the role that alcohol plays in human health. Obviously, severe alcoholism is unhealthy, but research has found that light alcohol intake (drinking a little on a regular basis, not drinking lite beer) seems to have a health promoting effect on people.

A new study done on rats, found that rats who are genetically predisposed to drink alcohol actually live longer than rats who are genetically predisposed to avoid alcohol, regardless of alcohol intake, and they also discovered that in rats drinking did not effect longevity.

Now as rats are different from humans, this research does not mean that binge drinking and alcoholism are, in fact healthy, for research has show that they are now, but it does reinforce the view that moderate intake of alcohol is not only not harmful, but may in fact be healthy.

It also, unfortunately, may mean that the reason the French are healthier may have less to do with lifestyle and more to do with genetics.

But only time and research will tell.