Some Facts on Health Care in the U.S.

Uninsurance: Currently, about 47 million Americans are uninsured.

Underinsurance: Millions more are underinsured, meaning they are just a car accident, heart attack, diabetes diagnosis, or baseball-to-the-face away from a financial meltdown. As one reader recently commented, losing one's job also puts you just two steps away from that catastrophe. 

Death by denial: Every year 10,000 Americans die preventable deaths because they were denied care by insurance companies. To clarify, these deaths are DIRECTLY caused by denial of claims, e.g. a patient needs cancer drugs and the insurance company says "no, your policy doesn't cover those drugs because they aren't approved by our administrative board" or "we've discovered you have a gene that predisposes you to this type of cancer, so we are canceling your policy for failure to disclose a pre-existing condition."

Insurance company practices: Currently, what insurance companies do is "cherry-pick," meaning they only insure the young and healthy who won't need much medical care, and deny insurance to older people and those with pre-existing conditions.  This can include people who are otherwise quite healthy, but weigh too much, or have a gene that could cause disease in the future.  The thing with genes is they don't always turn into disease.  Genes are like words in a dictionary.  They might be in the book, but that doesn't mean that every word gets looked up in the lifetime of that book.  Similarly, not every gene is expressed in a person.  In fact, many genes don't get expressed.  So denying insurance to someone simply because they have a particular gene is very shady.  But that's all par for the course because insurance companies make their profits by denying medical care, not by paying for it.

Insurance company costs: When the sick but uninsured finally get sick enough to need care, where do they go? The ER. Emergency care costs way more than preventative care. And guess who pays the ER doctors and hospitals to treat people who don't have insurance? You. It's called taxes. It's also called "out of the ER doctor's paycheck" because they never get paid for the services they render. And insurance companies get away with not covering those expensive individuals by pawning them off to the ERs-->ER doctors/taxpayers. Even the insurance that is supposedly paid for by employers, do you think they are really paying extra? No, they're taking it out of money that would otherwise be included in your paycheck. Let's not kid ourselves. Employers don't pay for our health insurance, they merely play middleman. Covering all Americans under a Universal Health Care plan would widen the pool and spread the risk/cost of insuring the very sick onto everyone, so each person's health spending burden is decreased. That's more money in your pocket from (the cost of insurance your company no longer has to pay for you) + (the money in taxes you no longer have to pay toward emergency care for other people). And let us note: insurance companies' administrative costs run 31 cents to every dollar you spend buying a policy from them. If a family is paying $1000 a month in premiums, that's $310 that goes toward hiring people to fill out a dizzying number of forms, put you on hold for half an hour before hanging up on you, or mailing you cryptic "coverage checks."  Why not choose a system that puts that 31%, or at least a good portion of it, toward paying for your medical care?

World rankings: Even though the U.S. is ranked #1 in money spent on medical costs, we rank #37 in the world - between Ukraine and Costa Rica - in terms of overall health, measured by several standard variables. Our infant mortality rates are the highest, and our life expectancy is lowest of any developed country. We are the only developed country that doesn't have a universal health plan for all its citizens. To be sure, American medicine has amazing drugs, technology and procedures. But guess who gets that great care? It certainly is not the uninsured or even the underinsured.

Other systems: Some of the best systems in the world - Britain, Japan, France - perform much better on most, if not all, heath indicators for less expenditure per capita.  They cover everyone.  And last I checked, they were not scary communist or socialist countries like many are afraid we'll turn into if we insure everyone.

Match Day

On one day every March, thousands of medical students across the country gather 'round for Match Day.  Yesterday was that day.  

Match Day is when 4th year med students find out what residency programs they matched to.  This is important information, because even when you graduate from medical school and are technically an MD, your training is really only beginning.  Without a completed residency, no one in their right mind would hire you as a doctor (you could work as a consultant for a biotech company, but most med students actually want to be doctors).  Around January or February, you create your "match list" where you rank various residency programs you want to go to.  Each residency program does the same for its medical student applicants.  Everyone submits their list, and the day before Match Day, a central computer uses an algorithm to spit out nationwide match results that pair up students and residencies who have ranked each other high on their respective lists.  It's a lot like pledging a fraternity or sorority, only obviously waaaaay more respectable.

At UCI, Match Day is such a big deal that everyone in the School of Medicine gets the day off, all the deans come out, they serve breakfast in the courtyard, set out chairs for the family and friends, have balloons everywhere, and put up a podium where the dean calls off a student's name from a randomly ordered list.  When the student approaches, he or she hands the dean a dollar.  The dollar goes into a pile for the person who gets their name called last, because it's such a stressful event that no one wants to be at the end!  Then the student gets his or her envelope, takes the podium, opens the envelope and reads the result to the crowd.  It's kind of like the Oscars.  Watching the 4th years yesterday, there were a lot of smiles, shrieks, and joyful dances as most people matched to their #1 choices.   But one girl opened her envelope, then silently left the stage in tears.  Her husband caught her as she ran off, and led her away as she buried her face in her hands.  It turned out that she had matched to the best orthopedic residency in the country, but it was not her #1 choice because her husband was already a maxillofacial surgery resident somewhere else.  

This sobering scene illuminated the sacrifice that med students make in order to become doctors.  They give up their childhoods, their young adulthoods, their comfortable surroundings, networks, friends, all that potential free time, their childbearing years, and sometimes their families and significant others to pursue the doctor dream.  Is it worth it?  Many primary care physicians say no, they would not repeat their career if they could go back and do it over again.  They get paid so little in relation to their sacrifices: the insurmountable educational debt, mounting costs to practice, dwindling Medicare reimbursement rates, minimal patient-care time, and unbelievable malpractice premiums.  It's no wonder physicians in America are trending toward high-paid (read: costly) specialists just so they can recoup in their adulthood all the sacrifices they made earlier in their lives.  However, that just leaves the rest of the populace with ever-decreasing access to primary care physicians and ever-increasing costs of health care.

Match Day.  Luckily it's a joyful occasion for many.  But it's also a time to reflect on the 4th years' achievements and sacrifices, wish them much luck in their residencies, and strengthen one's resolve to overhaul America's broken healthcare system.

Positively Black

My friend Nancy sometimes gives me blogging inspiration, as you see in a recent post. Here's the latest, thanks to her blog. I actually wrote this over a week ago and saved it in my draft collection for release during my own inner Writer's Strikes.  But now that Barack Obama has made his speech on race, it's serendipitously relevant to current politics!

Sometimes people say "dark" or "black" are associated with negative things. Here are some positives:

• What is oil known as?  Black gold. 
  
• The universal desirable male type?  Tall, dark and handsome. 
  
• Quality chocolate?  Dark.
• Time when people spontaneously get lovey-dovey?  Blackout. 
• Necessary item in every tasteful woman's wardrobe?  Little black dress.
• Most well-loved children's horse book?   Black Beauty. 
  
• Attire associated with power or achievement?  Dark suits, black gowns (graduation, judges).
• Symbol of highest achievement in martial arts?  Black belt.
  
• Color you want your finances to be in?   The black.

May the racial healing begin.

Health Care

It's been over a month since Lobby Day. So, what was Lobby Day all about?

Lobby Day was held to support the health care bill (SB840) that Senator Sheila Kuehl (D-Santa Monica) hopes to pass. Not all of us present that day necessarily believe that a Single Payer Universal Health Care system is the way to go about achieving affordable health care in CA or the U.S. But all of us know that the current system has to change.

I could quote a bunch of facts about health care, but all the argument over facts won't change the opinions of someone whose basic values are different from mine. As a doctor-wannabe, I may be a sucker for suffering and death, but I think health care should be a right. If one is sick, one is not free to pursue liberty or happiness or much of anything else. But some people think health care isn't a right. They think it's just fine for us to attack the rest of the world, tooting our righteous horns about democracy and liberty, while we stand by and let our own people die of simple, treatable diseases in our own streets. People recoil in horror and stick their noses in the air when they see a photo of a dead Afghan/Kenyan/Brazilian kid on the side of the road, and think, "Oh my God, how barbaric! How indecent! I'm glad *I* live in a civilized country!" And the kid in their own town dying of athsma? Not a thought about that. It's not catchy news. The Republican Senator (or Assemblyman?) for North San Diego told our med students he flat-out thought health care isn't a right. If you are poor, stupid, lazy, unfortunate or old enough to get sick, then gosh darn it, you better pick yourself up by your bootstraps and get a job to pay for your medical bills. Otherwise you don't deserve health care, and can die in a gutter for all he cares. And guess who's paying HIS ample medical insurance bills? WE are! The taxpayers! Irony knows no bounds. I wonder what he would think if a person who was refused medical care, due to his politics, coughed on him at the neighborhood Starbucks and gave him drug-resistant, incurable tuberculosis. You think he might have wished he'd invested a little of his politics into helping others be healthy?

So even if you think people should earn things in life (which I generally agree with), it still makes sense to cover everyone so they don't spread disease around or drain the rest of our pockets by getting very high cost emergency care as their only form of health care. Prevention is so much more economical than reactionary interventions, but as a nation, we're not getting it. Cutting insurance companies out of the picture is the only solution. They are only in it to make a profit, and they make profits by denying care. Single Payer Universal Health Care makes the most sense because it does just the opposite - it replaces all insurance companies with a government agency that reimburses private doctors and private hospitals. This is not Socialized Medicine that everyone is so afraid of. Even if it were (and it's NOT), let's think about the effects of a socialized agency. We currently have socialized firefighters, police officers, highways, EPA, Medicare, schools, and libraries, to name a few "Scary Socialized Institutions." They aren't so scary. But I digress. Single Payer Health Care ISN'T socialized medicine; doctors and hospitals would still remain private. Single Payer health care would simply cut out insurance companies, because corporate greed just has to go.

Coming soon:
1) For you business types to mull over and comment on - why the "free market" won't improve the American health care system.
2) Some facts about the state of health care in the U.S.

Little Things

I read an article about a person who impulsively bought a cute little purse that her oversized life had no use for, and suddenly she found herself unloading all the unnecessary stuff she'd been hauling around. It began with having to think about what she truly needed that day and what could fit into the tiny handbag. One day, she realized she had become more organized and productive - all stemming from that impulse purchase. She somehow had made a large positive change in her life without even knowing it. The point of the article was that it's the little shifts in our everyday habits that eventually beget large changes; changes that we ordinarily fail to achieve when we set out to achieve them in one fell swoop, like "losing weight" or "becoming happy." One little change causes another, then another, then another, until eventually something big and positive has happened and it was no effort at all!

Reflecting upon this, I discovered that I've done a couple of things like this. The first: I spent last summer keeping busy, and I didn't study at all. A week before school started again, I looked up something I couldn't remember. Once I'd brought out the ol' textbook, I read a little bit each day until classes began. I actually enjoyed looking at old material because it wasn't as confusing in posterity. And now that second year is coming to a close, I find that I've gamely, if not eagerly, studied nearly every day this year. Last year there were many times when I was unable to make myself sit down and study, but this year I haven't been fighting it. Even though there's more material and the testing schedule is harder, I strangely enjoy the process a little bit. My grades show it, too.

The second thing is my cloth bag. A couple months ago, I bought one to haul groceries in so I won't have to use those plastic bags. Unlike other similar efforts I've made before, I actually remember to bring it into the store with me now. This is probably because I'm pleased with my bag and I think it looks cute, regardless of any environmental good it does. It has an understated, tasteful logo (just the fruit/clock part, no words) from a new grocery chain called Fresh & Easy. The bag has since started conversations with checkers as they load my food into it, and I even had a woman stop me in the parking lot to ask where I got it! So I think my little change is already having a bigger impact than I set out to make. Actually, I must attribute the origins of my cloth bag change to Darron's dad. He gave me something a few months ago in a heavy-plastic Fresh 'n Easy bag, and commented that it was built to reuse. So when I saw an ad for "a new Fresh 'n Easy coming to your neighborhood," it caught my eye. I noticed the cloth bags they had for sale in the picture of the new store, and had been wanting one ever since. So this change is actually a little shift that Freeman started - see how nicely that works??

So (to take a page from Nancy's book - or blog, rather), let's hear it in the comments section: What little thing have you changed in your life recently that works for you?

Cardiac Petrification Disease

There was recently a report that medical students have a hardening of the heart during medical school, particularly after the first/second years. It seems medical school sucks away their human spirit, rendering them less empathetic and more cynical. I just finished taking my umpteenth set of exams today, and I certainly feel like an empty shell of a person. Or maybe that's just because allergy season is now fully upon us, and I'm just feeling empty because I've blown all my contents into tissues. Still, I wonder what happens if one is already jaded before even hopping onto the bottom rung for the long climb up the prestigious medical ladder? Does it get worse?

Blue Cross Encourages Doctors to Snitch

Blue Cross encourages physicians to snitch on patients about their pre-existing medical conditions so they can deny even more people insurance.