Let’s Talk About Breasts
Posted by Michelle Moquin on September 20th, 2009
Good Morning….Did I get your attention?
Yes, we are going to talk about breasts, but in a serious manner because this is a serious and important topic. Breast cancer is a big deal these days. And I mean it is a big deal not because it is a form of cancer, that in itself is obviously a big deal, but because the stats, especially for women, are high. Here are the numbers:
-One in eight women or 12.6% of all women will get breast cancer in her lifetime.
-Breast cancer risk increases with age and every woman is at risk.
-Every 13 minutes a woman dies of breast cancer.
-Seventy-seven percent of women with breast cancer are over 50.
Since 1 in 8 women will get breast cancer, it is no wonder that there have been several women in my life that have been struck with it. Men, you too are vulnerable. But the best way for prevention is to have yourself checked yearly and for those with breast cancer in their family history, two times per year at least is required.
Girls, we all know what it is like to have our yearly feels-like-my-breast-is-being-run-over-by-a-tire-mamogram. Not exactly a thrill is it? Well here’s something fairly new that might excite you. I was sent this article that I think women especially will appreciate. Read on…..
BETTER THAN A MAMMOGRAM?
Till now, I’d only ever encountered ads and information on breast thermography for breast cancer screening in those hippy-dippy newspapers you pick up for free at the health food store. I was interested, therefore, to read a new report from a major academic medical center affirming the efficacy of breast thermography as an early screening tool for cancer detection.
THERMOGRAPHY PICKS UP 97% OF CANCERS
A study published in the October 2008 issue of the American Journal of Surgery by researchers at New York Presbyterian Hospital-Cornell reported a high percentage of success with biopsy plus digital infrared thermal imaging (DITI), the most advanced form of breast thermography, as a follow-up to suspicious mammogram or ultrasound results. Sixty biopsies proved malignant and 34 were benign. The investigators found that DITI correctly identified 58 of the 60 malignancies (97%), and that digital infrared thermal imaging can be a valuable adjunct to mammography or ultrasound in the early detection of breast cancer and that it also has merit for use in the clinical monitoring of breast cancer response to therapy.
HOW DOES THERMOGRAPHY WORK?
Also known as infrared imaging, this screening test detects changes in body heat that may indicate the presence of cancer in an early stage. The technology, used in many forms for a variety of purposes (including airport security), has been used for diagnostic purposes since the 1960s, and was FDA-approved in 1982 as an adjunct for breast cancer diagnosis. In this case, its application is based on the theory that metabolic activity and vascular circulation in pre-cancerous and cancerous tissue is higher than in normal breast tissue, generating heat. Thermography looks for this increase in temperature, highlighting areas with increased blood flow and new blood vessel growth, both possible signs of tumor development.
Daily Health News contributing editor Andrew Rubman, ND, told me that DITI is especially helpful in young women with dense breasts (which tend to have slightly diminished blood flow) and/or those considered at high risk for cancer. He said that women with fibrocystic or large breasts, as well as those who have breast implants, may also benefit from this technology. A key advantage of breast thermography is that no radiation is involved and it’s also non-invasive.
NUTS & BOLTS
It’s a toss-up whether thermographic screening is more or less pleasant than conventional mammography. It’s not exactly comfortable (unless you love cold temperatures) but it doesn’t involve squishing your breasts between cold metal plates. Here are the nuts and bolts of what you need to know…
Before your test: Important precautions — don’t schedule your test during menstruation and avoid prolonged sun exposure for five days prior to testing. Also stay away from caffeine, anti-inflammatory medications and strenuous exercise the day of the scan. All these things may affect your body temperature and/or metabolism.
What will happen: In the office, you will be asked to undress completely to the waist and sit for approximately 10 to 15 minutes. The room will be very cool — uncomfortably so — but this is an important aspect of the test, as your skin needs to adjust to the “cold stress” environment of approximately 66 degrees Fahrenheit for accurate assessment. Next the technician will ask you to plunge your hands into cool water for one full minute. Normal blood vessels will react by constricting, while abnormal vessels typically do not constrict. The technician will then ask you to put your hands on the top of your head, elbows extended outward to lift the breasts (some labs have bars for you to hold on to). After 60 seconds have passed, the technician will take a series of breast scans that reveal any differentiation between healthy and unhealthy (or “hot”) blood vessels on the computer screen. Typically, two sets of images are taken, before and after cold exposure.
Results: Some facilities will give you findings on the spot followed by a written report — others will send a written report later.
IT’S NOT PERFECT
Because it has some deficits, breast thermography should not be considered a replacement for mammography, but it does have utility as an adjunct therapy, Dr. Rubman said. For one thing, there is some debate about how early it is able to detect cancer. Another issue is that thermography is still relatively uncommon and may not be easy to find in your area.
If you opt for DITI, Dr. Rubman recommends that you consult a technician who is trained in performing and interpreting thermography. He/she should be certified by the International Academy of Clinical Thermology, International Thermographic Society, American Academy of Medical Infrared Imaging or the American Academy of Thermology. The cost may be as high as $200 or more, and in most cases is not covered by health insurance.
Breast cancer screening guidelines are based on your age and degree of risk. Women at average risk should begin having annual mammograms at age 40. But if you are at high risk (e.g., for genetic reasons or due to family history), you may want to ask your doctor about adding breast thermography as a valuable form of adjunct screening. It can provide useful information that may turn out to make a big difference to your health.
Readers: Comments? Blog me.
Still at the beach enjoying the sunshine, so I’ll catch up with your comments tomorrow. Enjoy yourself whatever you do….
Gratefully your blog host,
michelle
Aka BABE: Your Bad Ass Bitch Editor
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September 20th, 2009 at 3:45 pm
CANCER NEWS SO URGENT, WE’RE GIVING IT AWAY!!!
Baltimore, MD — As unbelievable as it seems, the key to stopping many cancers has been around for over 30 years. Yet it has been banned. Blocked. And kept out of your medicine cabinet by the very agency designed to protect your health — the FDA.
In 1966, the senior oncologist at a prominent New York hospital rocked the medical world when he developed a serum that “shrank cancer tumors in 45 minutes!” Headlines hit every major paper around the world. Scientists and researchers applauded.
Time and again this life-saving treatment worked miracles, but the FDA ignored the research and shut him down.
You read that right! That was over 39 years ago. How many other treatments have they been allowed to hide?
Click here to find out.
PROPER TIMING MAKES MEDICAL TREATMENTS MORE POTENT
There’s an old saying that timing is everything — which turns out to have important applications with regard to medical treatment and drug dosing. It’s not as simple as merely following dosing instructions that tell you to take a medication two or three times per day, with or without food, however.
I’m talking about a field of study called chronotherapy, which is rooted in Traditional Chinese Medicine. Chronotherapy considers your individual biological rhythms, sleep patterns, menstrual cycles and hormonal changes, and harnesses the daily, monthly, seasonal and yearly biological clocks of human beings to optimize the power of drugs, even surgery. Modern-day doctors began to tune in to the importance of timing as they started to track trends of when symptoms of certain diseases were most likely to arise and be severe.
The concept has expanded to include a variety of ailments and treatments leading to such innovations as bedtime doses of asthma medications to avert nighttime attacks… scheduling of breast cancer surgery for a specific time in a woman’s menstrual cycle… and development of insulin medications that adjust to the varying needs of patients over a 24-hour period, including while asleep.
To learn more about chronotherapy, I spoke with Michael H. Smolensky, PhD, professor of environmental physiology at the University of Texas Health Science Center at Houston.
Dr. Smolensky has spent his academic career studying the importance of biological rhythms in the diagnosis and treatment of a broad spectrum of diseases, including allergy, asthma, hypertension (high blood pressure), heart disease, cancer and certain sleep disorders.
He explained to me that belief in homeostasis, the theory that biological functions are more or less constant, has long dominated medicine.
But research in chronobiology, the field of science dedicated to the research of biological rhythms and the biological clocks that drive them, has demonstrated that numerous rhythms and cycles are “programmed” into human functioning, some as short as a millisecond and others spanning a year. Of greatest importance to clinical medicine today is the circadian cycle — the fluctuations that take place over a 24-hour span. Dr. Smolensky told me that in the hypothalamus is a master brain clock (it’s called the suprachiasmatic nuclei) that serves to control and orchestrate the circadian rhythms and clocks present in all our cell tissues and organs.
CHRONOTHERAPY AND CHRONIC DISEASES
Here are some examples of chronotherapy principles in use today, based on the most commonly recognized predictable patterns in chronic disease symptoms:
• Arthritis. People with osteoarthritis are advised to take their pain-relieving medications a full six hours before the time of day they commonly start to hurt — for most, this means taking meds in the morning. Rheumatoid arthritis (RA) patients, on the other hand, do better to take their medications before bedtime.
• Asthma. Doctors now know to take very seriously asthma attacks that strike in the middle of the night — more than three-fourths of asthma attacks occur in the middle or latter stages of night-time sleep, which is when risk of death from asthma is highest.
• Heart attack. Angina pectoris, a symptom of heart disease, is most common in the first few hours of the morning and the risk of heart attack or stroke is greatest from the early morning through noon.
CHRONOTHERAPY IN ACTION
One contemporary focus of chronotherapy is hypertension. In most healthy individuals, blood pressure is higher in the morning — but in people who have hypertension as a complication of other medical conditions (such as diabetes, renal disease, sleep apnea or advanced age), abnormally high blood pressure levels are common during sleep.
Many studies have shown that doses are more effective if adjusted accordingly.
Cancer therapy is another area of application. Some highly effective chemotherapy drugs are incredibly toxic, causing side effects so severe that patients can barely tolerate them. However numerous studies of circadian rhythm cycles in cancer patients have demonstrated that side effects can be mitigated with careful timing of these potent medications.
It is now possible for patients to wear a portable pump programmed to release the drugs at a certain hour. Dr. Smolensky says these devices, called “light-weight programmable-in-time ambulatory drug-delivery infusion devices,” can dramatically improve outcome. They are often used in Europe but not yet commonly available here, he said.
Contemporary chronotherapy also weighs gender differences in how and when people respond to medications. Medical researchers have seen that hypertension drugs are more effective in women when taken at night, but not so for men, and are exploring why.
They are also studying the impact of the menstrual cycle on how women respond to medication, as well as in mammography, breast cancer surgery and even the likelihood of suffering sports injury.
TIME TRAVEL IN MEDICINE
Dr. Smolensky believes that incorporating biological rhythms into medical care will eventually become such an integral part of treatment that we will all someday consider it standard therapy… and the very concept of “chronotherapy” will fade away.
But for now, it’s something to pay attention to and make sure you discuss with your doctor, especially with regard to prescriptive medications.
Source(s): ??Michael H. Smolensky, PhD, professor of environmental physiology, University of Texas Health Science Center at Houston, School of Public Health, Division of Environmental and Occupational Health Sciences.?
September 20th, 2009 at 3:46 pm
Hi Michelle and to all your female readers,
Get your mammograms done regularly. 1 in 8 are not good odds. Detected early, breast cancer is much easier to treat successfully.
I feel bad for those without health care, whatever you gotta do, get it done. Wait in that line, or whatever else you must do.
I know that for some women a mammogram or any other type of health care just is not going to happen, what do I say to them?
Al
September 21st, 2009 at 7:43 am
I received this. I almost hope it isn’t true. The greed by the pharmaceutical industry in this country is evil.
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OUTRAGE!
Billion-dollar drug company hides astounding discovery of a natural cancer killer.
10,000 times stronger than chemo —
but without the side effects!
For seven years a major U.S. pharmaceutical company knew of a true cancer killer — but decided to tell nobody about it…ever!!
Dear Friend,
There isn’t a scarier moment in anyone’s life than when a biopsy comes back positive. It’s cancer…It’s the beginning of a battle in which no holds are barred. Anyone with any sense will do almost anything at all to try and destroy the killer disease…
Imagine one pharmaceutical company had the answer…had it, as it was, for SEVEN FULL YEARS…yet, not only didn’t tell anyone about it — but decided not to tell anyone about it ever!?
The truth is shocking: Deep within the Amazon Rainforest grows a tree that could literally revolutionize what you, your doctor, and the rest of the world thinks about cancer treatment and chances of survival. The future has never looked more promising. Research shows that with extracts from this miraculous tree it now may be possible to…
Attack cancer safely and effectively with an all-natural therapy that does not cause extreme nausea, weight loss and hair loss
Protect your immune system and avoid deadly infections
Feel stronger and healthier throughout the course of the treatment
Boost your energy and improve your outlook on life
The source of this information is just as stunning: It comes from one of America’s largest drug manufacturers, the fruit of over 20 laboratory tests conducted since the 1970s! What those tests revealed was nothing short of mind numbing… Extracts from the tree were shown to:
Effectively target and kill malignant cells in 12 types of cancer, including colon, breast, prostate, lung and pancreatic cancer.
The tree compounds proved to be up to 10,000 times stronger in slowing the growth of cancer than Adriamycin, a commonly used chemotherapeutic drug!
What’s more, unlike chemotherapy, the compound extracted from the Graviola tree selectively hunts down and kills only cancer cells. It does not harm healthy cells!
The amazing anti-cancer properties of the Graviola tree have been extensively researched — so why haven’t you heard anything about it? If Graviola extract is as half as promising as it appears to be — why doesn’t every single oncologist at every major hospital insist on using it on all his or her patients?
The spine-chilling answer illustrates just how easily our health — and for many, our very lives(!) — are controlled by money and power.
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September 21st, 2009 at 7:49 am
Michelle
I know that it isn’t your fault but I have been having a terrible time posting to your blog. My attempts keep getting the message “you already said that.” I am trying again.
Chamorros on the mainland we may need some of you to return to your Island. It seems that the population of Guam is about to explode. Who will vote for the Chamorro candidate? We could lose control of our Island.
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Guam anticipating a population boom
PHOTO
Guam – expecting a surge in the population.
Last Updated: 22 hours 37 minutes ago
Guam’s government is calling for its census to be held more regularly.
The census is currently conducted every ten years.
The next one is due to take place in 2010 and it’s expected to show Guam’s population has increased significantly.
Shawn Gumataotao. a spokesman for the governor, has told Radio Australia’s Pacific Beat program, that Guam is anticipating a further population boom as a result of the planned U-S military build-up.
“We are working with the census bureau on a mid-decade survey, as with the build up, the numbers will change,” said Mr Gumataotao.
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Hafa adai
September 21st, 2009 at 7:53 am
Michelle, I hope you don’t mind me making a second post so soon. This is one of the ones I tried to enter earlier. This is to us still on our Island.
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Green machine takes pressure off Guam dump
The Ecoti Company has brought a revolutionary green machine, called the ecovim to Guam, with the hopes of easing the burden on our beleaguered dump site. Meet Hannah Jang, whose family invested in the innovative technology behind this automatic food waste recycling machine that magically breaks down everyday table scraps and turns it into this high quality organic soil.
“It utilizes food waste and recycles it so that the product can be used for food forage as live stock feed or as fertilizer for our plants and the environment,” she said.
Members of the military, restaurant owners and food chain businesses were glued to the presentation of just how the eco-vim technology works of grinding down the food to a finely ground rich soil that you can use. She said, “Basically, the food is inputted into the machine, it goes through a grinding process and through this process high heat is involved. The high heat converts the food waste and compacts it down so that the products will be water and turned to fertilizer.”
And believe it or not, the machine also eliminates the usual foul odor and harmful bacteria that’s associated with decomposing food. “It breaks down this process without additives or enzymes and it also gets rid of the foul odor because through the catalyst and the processes in the machine, the smell is completely gone,” said Jang.
Higher end models for restaurants cost about $27,000 but can decompose up to 220 pounds of food and green waste each day. But lower-end models are about $19,000, and in time kitchen models will be available for those wanting to use the ecovim at home.
The Jang family is eager to show the ecovim to other green worthy companies at their office in the Harmon Industrial Park or you can call them at 689-7774.
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Okay, we have it so let’s all of us make an effort to keep our Island clean. Recycle responsibly Please
Hafa adai
Anna
September 21st, 2009 at 7:55 am
Business Travel Loopholes
Edward Mendlowitz, CPA
WithumSmith+Brown
Business travelers who plan carefully can trim the costs of their trips. Generally, “ordinary and necessary” business expenses are deductible while you’re traveling, if you keep proper records.
Examples: Costs for transportation… hotels and lodging… tips… meals… laundry and dry cleaning… baggage handling… trip insurance and other related costs.
For starters: An employee who is fully reimbursed for business travel expenses by his/her employer does not need to account for these payments on his tax return. However, if you receive an expense allowance for which you don’t need to account to your employer, the amounts paid must be reported to you on your W-2 wage statement as income. You then can claim your business travel expenses on your tax return on Schedule A as a miscellaneous deduction. The total of your miscellaneous deductions is deductible to the extent that it exceeds 2% of your adjusted gross income.
Here are some travel tax-savers…
Loophole: You do not need receipts for the IRS for expenses of $75 or less if the expenses are properly recorded in a business diary contemporaneous with the activity.
Required information: Business purpose… time… place and date… names of people involved… what was purchased… how much was paid.
Exception: A receipt is required for lodging costing any amount.
Loophole: For out-of-town travel (or outside the country), ask your employer to give you the standard IRS meal allowance rather than to reimburse your actual expenses.
These amounts are not taxable income even if you spend less than the full allowance — so, if you keep your meal expenses low, you’ll actually be earning extra tax-free income. The rates, which are set by the IRS, vary by area. Domestic travel per diem rates are listed in IRS Publication 1542, Per Diem Rates, available online from http://www.irs.gov. Foreign travel per diem rates are available from http://www.gsa.gov.
Note: Cruise ship travel deductions are limited to twice the domestic per diem rate.
Loophole: Consider attending a business conference on a cruise ship.
You can deduct up to $2,000 annually for such conferences if all the ports are in the US and the ship is registered in the US — the per diem rules (see above) do not apply to conferences. Strict tax reporting requirements apply, so check with your tax adviser before embarking.
Loophole: Out-of-town “commuting” costs are fully deductible.
While commuting costs generally are not deductible, business travelers can deduct such expenses (including car rental, cab fare, limo, and mass transit) as the cost of “commuting” from a hotel to their place of business.
Loophole: Consider establishing an official “tax home” if you regularly travel to work in multiple locations.
Your tax home is the location of your principal place of business. Without one, you cannot deduct any travel and meal costs.
Note: A “tax home” cannot be merely a mailing address or the local library or Starbucks — it must be a legitimate location where you conduct business.
Loophole: Even if you work at a temporary business location for many months, if the period is less than a year, all travel and lodging costs are deducted by the business and not taxed to the employee.
After one year, the government considers this a “permanent” business location and travel costs are not deductible… or alternatively, they are deducted by the business and taxed to the employee.
Loophole: Married couples who work in different cities during the workweek can maintain separate “tax homes” for travel deduction purposes.
However, once the one-year threshold is exceeded, even legitimate expenses are not deductible.
Loophole: Meal costs, which generally are not deductible by employees, are fully deductible on trips of at least one overnight stay.
The deduction for meals is limited to 50% of their cost.
Loophole: Domestic business travel combined with some vacation activities is deductible if business is the primary purpose of the travel.
If the primary purpose is vacation, but you do some incidental business, you can deduct the business costs, but not transportation and lodging.
Strategy: Extending a business trip to a weekend to benefit from lower airfares, and using the time for vacation, does not alter the primary business nature of the trip.
Loophole: Business travel outside the US plus vacation activities may be deductible.
The primary purpose of the travel must be for business. And, as opposed to the domestic travel rules, you also must have no control over the purpose or timing of the trip.
Loophole: Expenses of spouses who help entertain business associates on a trip can be fully deducted. The entertainment must be immediately before, during, or after the business meeting or activity. You also must demonstrate that your spouse was helpful to the business relationship.
Loophole: Frequent-flier miles received for business travel but used for personal travel are not taxed.
Exception: Miles that are converted into cash are taxed as compensation.
Tax Hotline interviewed Edward Mendlowitz, CPA, partner in the CPA firm WithumSmith+Brown, One Spring St., New Brunswick, New Jersey 08901. He is author of The Adviser’s Guide to Family Business Succession Planning (American Institute of Certified Public Accountants).
September 21st, 2009 at 7:57 am
Welcome! Denver and the “Eastern Slope” are great places even though we refer to this area as “West Kansas”. Just kidding.
I am , obviously, severely biased in favor of the “Western Slope” and Southwest Colorado. The San Juan Mountains are real mountains. If a “hill” has trees on it, it is not a mountain.
Check out Ouray and the world famous ….
http://www.ourayicepark.com
September 21st, 2009 at 8:01 am
Burt
Hey Hang on..I do..but have been terribly disappointed in what turns out to be a very conservative bunch of people. Against g/l, gave us Ken Salazar…on and on. It is a beautiful state tho. And yes, the people of washington are too arrogant over what they have. Unfortunately that liberal bias happens only in the Puget Sound area. But please be careful when you try to speak for everybody.
September 21st, 2009 at 8:05 am
House Speaker Nancy Pelosi’s eyes watered Thursday as she called for the rhetorical heat to be turned down across the country, and warned that such words can lead to violence — a phenomenon she witnessed herself in San Francisco.
“I think we all have to take responsibility for our actions and our words. We are a free country and this balance between freedom and safety is one that we have to carefully balance,” she said.
“I saw,” she added, choking up, “I saw this myself in the late seventies in San Francisco. This kind of rhetoric was very frightening and it gave–it created a climate in which violence took place.”
Riots in San Francisco in the seventies were punctuated by police beatings and assassinations, most notably of Mayor George Moscone and Supervisor Harvey Milk in 1978.
Milk was the first openly gay elected official in California and was shot by former supervisor and arch-conservative Dan White.
“I wish that we all again would curb our enthusiasm in some of the statements that are made, with the understanding that some of the ears this is falling on are not as balanced as the person making the statement might assume,” Pelosi said.
She stressed again that people are free to speak out. “But I also think they have to take responsibility for any incitement they may cause,” she said.
Read more at: http://www.huffingtonpost.com/2009/09/17/pelosi-warns-of-violence_n_289999.html
September 21st, 2009 at 8:10 am
Let’s talk about unhappiness.
Specifically, how it’s growing in one segment of our society. And no, it’s not white congressmen from South Carolina, hip-hop artists who feel Beyoncé got slighted, or recipients of ill-timed foot-fault calls.
It’s women.
According to study after study, women across the globe are becoming more and more unhappy. Given all the gains women have made over the last four decades, this raises the vexing question:
What in the world is going on?
September 21st, 2009 at 8:21 am
This post was sent to me. I think it is interesting as it discusses the “R” word. It seems that most of white america thinks that they are free of bigotry and racism. But they believe that OTWs harbor a deep racism against them. HUH?
So I Thought you’d be interested in this article: http://bit.ly/Kkctd
September 21st, 2009 at 8:26 am
One of the major reasons I read this blog is for the health tips. I found this article on the web. It is interesting because one never hears about this surgical risk. : http://bit.ly/wDn5B
Helena
September 21st, 2009 at 8:30 am
Okay here is my contribution to the Health topic. It is a book about one health problem given to 10 different countries.
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BOOKS
One Injury, 10 Countries: A Journey in Health Care
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By ABIGAIL ZUGER, M.D.
Published: September 14, 2009
With all due respect to the seminar room, the boardroom, the hearing room and the Oval Office, a better vantage point than any of them for evaluating and redesigning our health care system is the hospital room (window bed, please).
Enlarge This Image
Katayama Kishin
TRAVELED The author T. R. Reid had his sore shoulder examined around the world.
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Prescriptions: Health Care Abroad: Questions for T.R. Reid
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The chair next to the bed isn’t bad, either.
Some of us perch on one or the other almost every day, observing the tangled mess that is our current system and mentally designing a dozen better alternatives. But for those who wind up in bed or a chair only when tragedy strikes, T. R. Reid’s new book provides an excellent substitute perspective.
Mr. Reid, a veteran foreign correspondent for The Washington Post, knows from personal experience that there are indeed a dozen better alternatives. International postings from London to Japan familiarized him with many of the world’s health care systems. Then a chronic shoulder problem offered the opportunity for an unusually well-controlled experiment: Mr. Reid decided to present his stiff shoulder for treatment around the world.
One shoulder, 10 countries. Admittedly it’s a gimmick, but what saves the book from slumping into a sack of anecdotes like Michael Moore’s 2007 documentary “Sicko” is a steel backbone of health policy analysis that manages to trap immensely complicated concepts in crystalline prose.
“The Healing of America” blends subjective and objective into a seamless indictment of our own disastrous system, an eloquent rebuttal against the arguments used to defend it, and appealing alternatives for fixing it.
Mr. Reid starts with a methodical clarification of terms. First: universal health care. Far from a single socialized system, the various plans other countries use to cover all their residents are quite distinct. Some are as private as our own, and most offer considerably more in the way of choice.
In Japan, and many European countries, private health insurers — all of them nonprofit — finance visits to private doctors and private hospitals through a system of payroll deductions.
In Canada, South Korea and Taiwan, the insurer is government-run and financed by universal premiums, but doctors and hospitals are private.
In Britain, Italy, Spain and most of Scandinavia, most hospitals are government-owned, and a tax-financed government agency pays doctors’ bills.
In poor countries around the world, private commerce rules: residents pay cash for all health care, which generally means no health care at all.
Similarly, what Americans often consider a single unique system of health care is an illusion: we exist in a sea of not-so-unique alternatives. Like the citizens of Germany and Japan, workers in the United States share insurance premiums with an employer. Like Canadians, our older, destitute and disabled citizens see private providers with the government paying. Like the British, military veterans and Native Americans receive care in government facilities with the government paying the tab. And like the poor around the world, our uninsured pay cash, finagle charity care, or stay home.
Our archipelago of plans means that those safe on a good island with good insurance can be delighted with the system, even as millions of invisible fellow citizens tread water or drown offshore. It means that those on a mediocre island are stuck there. It also means that not one single piece of the infrastructure — like record keeping, drug pricing and administrative costs — can be streamlined across islands in any meaningful way. Hence the expense, the inequity and the tragedy.
When Mr. Reid presents his shoulder to his own orthopedist in Colorado, the doctor is quick to recommend a shoulder replacement. It will cost his insurer tens of thousands of dollars (assuming it agrees to pay), with unknown co-payments for him. Risks include all those of major surgery; benefits include a restored golf swing.
The same shoulder gets substantially different reactions elsewhere in the world.
In France, a general practitioner sends him to an orthopedist (out-of-pocket consultation fee: $10) who recommends physical therapy, suggests an easily available second opinion if Mr. Reid really wants that surgery, and notes that the cost of the operation will be entirely covered by insurance (waiting time about a month).
In Germany, the operation is his for the asking the following week, for an out-of-pocket cost of about $30.
In London, a cheerful general practitioner tells Mr. Reid to learn to live with his shoulder. No joint replacement is done in Britain without disability far more serious than his to justify the expense and the risks, and if his golf game is that important, he can go private and foot the bill himself.
In Japan, the foremost orthopedist in the country (waiting time for an appointment, less than a day) offers a range of possible treatments, from steroid injections to surgery, all covered by insurance. (“Think about it, and call me.”)
In an Ayurvedic hospital in India, a regimen of meditation, rice, lentils and massage paid for entirely out of pocket, $42.85 per night, led to “obvious improvement in my frozen joint,” Mr. Reid writes, adding, “To this day, I don’t know why it happened.”
But the comparative merits of different orthopedic philosophies are secondary here: Mr. Reid’s attention is focused on a meticulous deconstruction of the history and philosophy of the policy decisions behind them.
Among health policy narratives, this book’s clarity, comprehensiveness and readability are exceptional, and its bottom line is a little different from most. Instead of rationalization and hand-wringing, Mr. Reid offers an array of possible solutions for our crisis. As the proverb goes (it is a favorite among policy wonks): “To find your way in the fog, follow the tracks of the oxcart ahead.” We have plenty of reasonable paths to follow.
And plenty of reasons to follow them. Mr. Reid’s underlying message of hope does not preclude an intensely satisfying quotient of moral outrage at the worst casualties of our system as it stands.
One is the uninsured working person, too rich for Medicaid, too poor for a standard insurance policy, at first too proud to acknowledge disability, and then too sick for the process that a formal declaration of disability requires. These are the people who die of treatable illness in our country.
And then there is the insured working person who discovers, with surprise, that health insurance is a for-profit industry, that the industry term for payment is “medical loss” and that the process of extracting payment for a dire health condition can turn into a bizarre game of “catch me if you can.”
A person’s last days can be spent in any number of ways. But on the phone pleading with an insurer, that’s only in America.
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I found it very interesting, the book, I mean.
Toni
September 21st, 2009 at 8:32 am
Sorry, Michelle, I didn’t know it would come out like that. I didn’t mean to take up so much of our space.
Toni