btw2.net

The part worth noodling on:

…The U.S. health-care system has two distinct parts — financing and delivery. The financing system is how we pay for health-care services. It is composed of employer-based insurance, the individual insurance market, Medicare, Medicaid, SCHIP, the veterans health system and other programs. Today, the private part — employer-based coverage and individual insurance — accounts for just under 55 percent of all payments for health care, while government contributes about 45 percent.

The delivery system consists of about 850,000 doctors, 5,000 acute-care hospitals, 39,000 pharmacies and 8,100 home health agencies, as well as hospices, surgical centers, radiological centers, laboratories and other outlets that provide the actual health-care services Americans need.

To the extent that any health insurance scheme involves spreading among members of society the financial risk of getting sick, all insurance “socializes” the risk. This is, of course, not what people mean when they level charges of “socialized medicine.” This term is never used in reference to police protection, fire departments or highways — all of which are provided by government.

Properly speaking, socialism is when the state owns or controls the means of production. Thus “socialized medicine” is when the doctors are state employees; when the hospitals, drugstores, home health agencies and other facilities are owned and controlled by the government.

Only one part of the U.S. system really is socialized medicine: the veterans’ health-care system, which is wholly owned and operated by the federal government. Veterans love the system and vigorously oppose any suggestions of dismantling it and integrating them into civilian health care. By many measures, this bastion of socialized medicine may constitute the highest-quality and most efficient part of American health care….

It is absurd to call an expansion of government payments for health care in the existing private delivery system socialized medicine. Politics may be full of hype, exaggeration or partisan bickering, but there should be no place for overt deception. A serious debate about whether and how to reform the American health-care system requires that we eliminate comments whose only purpose is to mischaracterize and misinform….

‘Socialized Medicine’ Quackery
By Ezekiel J. Emanuel, The Washington Post, October 8, 2007
Ezekiel J. Emanuel, an oncologist and
the author of “No Margin, No Mission: Health Care Organizations and the Quest for Ethical Excellence,”
chairs the Department of Bioethics at the National Institutes of Health.
The views expressed here are his own.

There’s an article on CNN about Rethinking Retirement that mentions:

…”The baby boomers were the first generation to have a lot more career freedom, but it seems like [for] at least some of them, that ended up not being the case,” Randall Hansen, a career advice writer for the Web site Quintessential Careers, said.

“They fell into a job that they kind of hated or didn’t get as much satisfaction from but stayed in because of first mortgages, and then college tuitions, and now that their kids are out of college, now they finally feel like they have the freedom to change careers.”…

It isn’t retirement, its a career change. Freedom for one. Some freedom for one.

Ok, shall we the people get involved
or shall we leave it to the experts,
the insurance companies, the drug companies, the health care giants and politicians?

Cancer Society Takes on Health Care Policy
from the New York Times via Newser, Published Aug 31, 07

The American Cancer Society’s next ad campaign won’t tackle the tobacco wars or advocate mammograms, the Times reports. Instead, the group will devote its entire $15 million ad budget to the nation’s health care crisis. The move follows recent research linking detection delays with lack of coverage, which “will be a bigger cancer killer than tobacco,” the society predicts….

notes from the field

Suffering Differently
By Ethan Watters, The New York Times Magazine, August 12, 2007

After the 2004 tsunami in Asia, many mental-health experts agreed that a “second tsunami” of mental illness in the form of post-traumatic stress disorder would strike the region. Like doctors rushing to the outbreak of an epidemic, American counselors and trauma researchers soon arrived on the scene hoping to pass on useful knowledge about PTSD. A few years on, however, their efforts have raised a troublesome question: Were they bringing the wrong treatment to the wrong people?

At issue is not whether tragic events like the tsunami trigger debilitating psychological distress and even mental illness — everyone agrees that they can. The question is over the extent to which survivors’ cultural beliefs shape their symptoms. If culture has the impact that some researchers suggest, the PTSD diagnosis may be of little help (and even do potential harm) when applied wholesale in other countries.

In the last 25 years, PTSD has had a remarkable ascendancy in American psychiatry and in public consciousness. Proponents of the diagnosis assert that experiences of fear or horror often spark a cluster of 17 broad symptoms, including intrusive thoughts, memory avoidance and uncontrollable anxiety. The concept of PTSD also encompasses notions of how best to overcome the disorder, usually through measured re-exposure to the original trauma supervised by a counselor. PTSD, many Americans assume, describes the way that all humans react to trauma.

Gaithri Fernando, an expert on trauma from California State University, questions that assumption. “Researchers and counselors who came to Sri Lanka after the tsunami did find some PTSD symptoms,” Fernando says. “But it was not the nightmares or flashbacks that most of the population was concerned with. The deepest psychological wounds for Sri Lankans were not on the PTSD checklists; they were the loss of or the disturbance of one’s role in the group.”…

Eye on DNA Headlines for 12 August 2007
by Dr. Hsien-Hsien Lei, Posted August 12, 2007
includes:

Matt Ridley writes in The Agile Gene:

If personality is created by parents, peers, or society at large, then it is still determined; it is not free.

In some ways the news that our genes are important contributors to our personality should be reassuring: the imperviousness of individual human nature to outside influences provides a bulwark against brainwashing. At least we are determined by our own intrinsic forces rather than somebody else’s.

A more non-trauma, non-DNA US culture view at: Culture, Counterculture #1

Dr. Val and The Voice of Reason posts Revolution Rounds: Part 2, 7.27.07
Subheadings:

Healthy Debates

For Your Information

This prosthesis is made for walking
cnet news.com

Researchers at the Massachusetts Institute of Technology’s Media Lab say they’ve developed the first powered foot-and-ankle prosthesis.

Unlike traditional prostheses, the device varies in stiffness, which allows wearers to handle irregular terrain with a more natural, humanlike gait….

Because walking with conventional prostheses is harder work, amputees tend to walk 30 to 40 percent more slowly than able-bodied people, according to the team. And the abnormal gait caused by an older prosthesis can lead to injury in the hip, knee and ankle of an amputee’s unaffected leg.

Business Owner Welcomes Bush, But Not His Ideas on Health Care
By Christopher Lee, Washington Post Staff Writer, Tuesday, July 24, 2007

Following Doctor’s Orders Isn’t Hard, if You Can Read
By ERIN N. MARCUS, M.D., The New York Times, Published: July 24, 2007

Medicine, Constantly Redefined and Redefining Lives
By ELISSA ELY, M.D., The New York Times, Published: July 24, 2007

Who Invented The Idea of Midlife Crisis?

Greg on August 7, 2006 - 4:51pm.

The idea of midlife crisis has been around for seven hundred years, for Dante’s first lines of The Divine Comedy are:… 

[mentions Jung]
In the early 1960’s, Canadian psychologist Elliott Jaques was researching the careers of composers and artists — including Dante — and discerned that many went through a period of midlife turmoil, frequently accompanied by major shifts in style and worsening productivity (Jung could have been included on this list!). In 1965 he published a paper in the International Journal of Psycho-Analysis on this pattern, and when “Death and the Mid-Life Crisis” appeared, midlife crisis had a name.

Jaques’ work was academic. It took the 1976 publication of Gail Sheehy’s Passages: Predictable Crises of Adult Life for the idea of midlife crisis — and the accompanying cliches — to pass into popular culture….

I hadn’t thought about Sheehy’s book in years. But I went googling for Passages: Predictable Crises of Adult Life more to see how “modern life” has changed - how to explore the new issues.

And, of course, the old “midlife crisis” is the primary context.

But there are other stages in her book. And I think they are more complex now.

For one thing, we can begin to expect to live longer. Worry about our aging health? Absolutely!

But we can also build healthy routines into our life so we have a better opportunity (no guaranty, opportunity) to live long and active.

And, more searching and I find - The Human Odyssey: Navigating the 12 Stages of Life by Thomas Armstrong.
There’s even a blog about it - prebirth, birth, infancy, early childhood, middle childhood, late childhood, adolescence, early adulthood, midlife, late adulthood, late adulthood, death & dying.

They cite “research from the McArthur Foundation Research Network on Successful Midlife Development (MIDMAC) suggests that most people go through midlife without any great hoo-hah.  ‘Almost everyone over 40 claims to have it, or knows someone who surely has it, but I do not think more than one person in ten is experiencing a genuine midlife crisis,’ says Orville Gilbert Brim, director of the MIDMAC project.  The findings from this research study suggests that for most people, midlife is not a crisis at all, but rather a series of gentler incremental changes that occur emotionally, socially, and physically over the course of several years.”

We’ll circle this a few times.

Don’t Blame The VA, The Health Care Blog

I never wrote too much about Walter Reed at the time of the scandal. But this week’s resignation of the VA Secretary, reported by the AP as being connected to Walter Reed, is now being used by some on the right to re-attack the concept of universal health care. It’s bad enough that I have to range the web to combat this misinformation. It’s almost worse that it comes from a fellow columnist at my “lay people’s site, Spot-on. So I’m up over there saying, Don’t Blame The VA….

personal note, my dad the WWII vet going on 90, went to his local VA emergency room last week. Back pain for a week, in the general area of where he had compression fractures of three vertebrae three years ago (osteoporosis). They didn’t see anything, thought maybe a new hairline fracture that isn’t visible yet. But they did other tests as well, began to think they saw something with the heart. More scans and his heart and aorta are fine. This was on a busy ER day, all 16 ER beds were in use all day. Through all that he was taken care of. He’s happy with his care. I am too.

The day after I got a 3 minute voice recording of how he learned to drive a Model-T.

also from The Health Care Blog
POLICY: Sicko and Healthcare Reform by Maggie Mahar with UPDATE

Michael Moore’s “Sicko” does two things very well. 

First, the film makes it clear that in the U.S., even if you have health insurance, this does not mean that you are “covered.”  Everyone knows that many Americans are uninsured. But now, millions of middle-class Americans are beginning to realize that they are UNDERinsured, and Moore drives that point home….

Secondly, “Sicko” underlines the signal difference between healthcare in the U.S. and healthcare in other countries: the citizens of other countries take a collective view of the problem.  Or as Moore puts it, they realize that when it comes to sickness and dying, all of us are vulnerable. “In the end, we truly are all in the same boat… they live in a world of ‘we’ not ‘me.’”…

meanwhile,
Healthy Aging - Celebrities In The Spotlight, Dr. Val and The Voice of Reason, July 18, 2007

ABC news created an online photo album of the actors from the movie The Princess Bride.  They display headshots of the actors from 20 years ago (when the film was created) beside a current image.  It was a real eye-opener for me, seeing how these people have changed in appearance over the years - though in all fairness, ABC didn’t choose the most flattering follow up pictures.  Nicer ones are displayed in the link to the movie above. 

Nonetheless, this raises the issue of aging - and what each of us will look like in 20 years.  I think a lot of it depends on the little choices we make each day - what we eat, if we exercise, if we’re stressed, if we have loving relationships in our lives… these little things add up and imprint themselves on our faces and bodies for all to see.  What will your body say about you in 20 years?…

And a moving story unfolds over at U.S. Preventive Medicine.
One learns what motivates someone who’s father died when they were one year and three days old.
And what that person learns as they disinter the father to move him to be next to kin.

If Only We Had Found Out Earlier, June 10, 2007 

As the warm spring air blustered through the Water oaks lining the old barn, I was finally about to meet my father who had died more than 14,000 days and many long nights ago…three days after my first birthday.   Images of childhood dreams of the father who was never there raced through my mind.  He was a war hero, or was he.  He was a dashing executive, or maybe not.  He was a swashbuckling super hero, but in all actuality he was none of these, he was just an ordinary postman.  But in my mind, he was god…always there, in the back of my mind, wondering what he looked like, how he spoke, what was his smell and, most important, why did he have to die in the prime of life?

This one who died way too young, leaving a widow and two fatherless infants, was a victim of the times when technology wasn’t there when he needed it most.  He could only hope and pray that the surgeons who found his disease way too late could cure him none too soon.  But his time ran out.  Today, you would think that wouldn’t be the case.  But is it?

There awesome comments by other doctors on their own similar experiences.

And there is Father’s Day 2007

[Today is both Fathers’ Day and my own father’s birthday, his 101st. He’s been dead for almost 45 years, so I have not celebrated either day with him for a long, long time. I make do with the memories he left me. The following is from my Appalachian Trail memoir.] 

I thought of my father often during my 2002 AT thru-hike. He died in November 1962, so the 40th anniversary of his death was prominent in my mind. As I walked, I frequently recalled memories of him and wondered about his thoughts and feelings in his final months of life. I don’t have a lot to go on. I did not know my father well. He died just before my 15th birthday. What memories I have are those of a pre-adolescent and teenager, so I know nothing from him of his thoughts, feelings, hopes and dreams. Much of what I know (or think I know) of him I learned after the fact….

genbetween writes Her dad is funnier than my dad