To cheer ya'll up on a Monday morning, I give you this:





(The end credits to my favorite movie about a physicist-neurosurgeon-rock star-samurai-astronaut-superhero)

"Rationing" has become a big negative buzzword in the current health care debate. As in, "we don't want any rationing of our medical services." We already have horrible rationing, and anyone who thinks we don't isn't paying attention.

Repeatedly I've heard tales of the rationing present in the Canadian system. Often I've heard the specific example of long waiting lists for joint replacements, or patients being denied knee replacements because of factors like age.

I have had plenty of real-life patients with bad knees and demanding jobs. The following case is an amalgamation of 3 or 4 cases I've seen.

Two patients both have jobs in the housing industry, and both of them need to go up and down ladders. These bad knees make it really hard to go up the ladders. Both have been hit by the lagging construction industry, sharply reduced demand for new homes, and have had to cut back on hours. We'll call them Bob the Builder, and Chris the Constructor.

Bob works for a large company, and has standard private insurance. He got a knee replacement pretty quickly. After recovery, he feels much better. He can't go up the ladders like he used to, but because of the reduced hours, he's working OK at the moment.

Chris is a self-employed small business owner. He used to have 1-3 part time employees, but he doesn't have work for them. I think he used to have insurance, but he had to drop it, because his business is not making any money. He doesn't qualify for Medicaid because of his assets. He's not getting a knee replacement anytime soon. Potentially he could sell his business, and get a job for a company, tough it out on the ladders until he gets insurance, and then get the surgery, but nobody's hiring. It's possible the economy could recover before he is unable to work, and he could get insurance or pay cash for the surgery. Best-case scenario, he gets a knee replacement in a year or two. Worst-case scenario, he never gets the knee replacement, blows through all his assets, ends up on state support with Social Security Disability, Medicare, and Medicaid and (maybe) gets his knee replacement in 2-4 years. By that time, he will probably never re-enter the work-force. Or maybe the worst-case scenario is that he ends up homeless on the street. That happens too.

This is how health care is rationed in this country. In Canada, both Chris and Bob would get knee replacements in say, 3-6 months. I don't want us to end up with an exact copy of the Canadian system.  We spend about 16-18% of our GDP on health care, and Canada spends 9-10%. So we should get something better, because we pay more.

I think it's actually reasonable, at a level of 17% of our GDP, that we could pay for all necessary health care for all Americans. That's a lot of money, and it should go a long way. If an American pays twice as much per capita than a Briton, it stands to reason our product should be twice as good. But health care in the US is currently so inefficient, fails to cover 12% of our citizens.  There need to be major changes in the entire delivery system before we can get the maximum bang for our buck. I suspect this would probably be with a single-payer system,
similar to Canada's. Or we could end up with something closer to Germany's. (It seems to be the country closest to the Democrats' model) That's going to take a concerted effort, and probably a decade or two.

But in the short term I doubt we can provide health care for everybody without some form of rationing. Currently we ration on factors (employment status, size of employer, student status, parental employment status) that make no sense.

P.S.
Most of the current debate is on the "public option." In Germany, 87.5% of people choose the public option. The private insurance companies seem afraid to compete with the U.S. Government, and for good reason: they suck. I can't think of another industry with worse customer service. Large portions of their business model consist of denying or delaying reimbursement for services paid for by their customers. If the Government offered a viable alternative, people would run from the private insurers in droves, and they know it.

P.P.S.
All this assumes that you (like most bloggers and talking heads) consider short waiting lists to be a major health indicator, rather than infant mortality and life expectancy (like most public health experts).

We got a new (used) car today. A 2005 Ford Focus Station Wagon. I'm not sure if I mentioned this, but I managed to total the Sonata in an 8mph fender bender.

We settled on the Focus because it is surprisingly comfortable for someone 6'4". The seat scoots all the way back, it has a telescoping steering wheel, adjustable seat height, and my knees don't hit the console. We got the station wagon because we're in Portland, and if don't have roof racks full of bikes, snowboards, and kayaks, you're doing it wrong. We think we're going to be able to do a lot of adventures on the tandem once we can get it mounted on the car.

The color is white, we may have pictures up soon.

I've posted some photos from the Starlight Parade to Flickr. I'm sorry that the quality is so low, but they were taken on my phone. But at least it gives an idea of some of the things we saw.

Starlight Flickr Set!

My thoughts on the season finale:

( Cut for spoilers )

There is a long, but excellent article in the Atlantic about a study that has followed the physical and psychiatric health of 268 Harvard undergrads from the 1940s to the present. The research, among other things, has tried to define what makes someone happy or successful, or how you would even define that.

It's a fascinating, read and I highly recommend it.

From the article:

In 1946, for example, 34 percent of the Grant Study men who had served in World War II reported having come under enemy fire, and 25 percent said they had killed an enemy. In 1988, the first number climbed to 40 percent—and the second fell to about 14 percent. “As is well known,” Vaillant concluded, “with the passage of years, old wars become more adventurous and less dangerous.”

...


JFK is one of the study subjects, although his data is sealed until 2040.

Of course, Kennedy—the heir to ruthless, ambitious privilege; the philanderer of “Camelot”; the paragon of casual wit and physical vigor who, backstage, suffered from debilitating illness—is no one’s idea of “normal.” And that’s the point. The study began in the spirit of laying lives out on a microscope slide. But it turned out that the lives were too big, too weird, too full of subtleties and contradictions to fit any easy conception of “successful living.”

...

“Their lives were too human for science, too beautiful for numbers, too sad for diagnosis and too immortal for bound journals."

There's also a section on Anna Freud's defense mechanisms, which is an aspect of psychology that I think is the most useful and most overlooked by primary care physicians.

The CDC e-Cards are a blast. Especially the STD ones.

That was a great movie. It surpassed my expectations. Although nowhere near as campy as the original series or Doctor Who, they had just the right amount of goofiness and shameless comedy. It's a hard balance, staying true to the spirit of the original, while making the movie (new continuity?) modern and stand on its own. Somehow, JJ Abrams pulled it off. I felt the tone, visuals, and attitude were perfect.

( Cut for spoilers )

Although I miss the comfortable banter of Kirk, Spock, and Bones the characters didn't really know each other yet. There were little inklings of this, and hopefully their friendship will develop over future movies.

The New York Times has an excellent article on vacationing in Portland

Frugal Portland

From the article:

This joyful stress would begin with the city’s most important meal: breakfast. Despite its laid-back aura, Portland is an early-rising town, and its commuting cyclists need fuel for their morning rides.

...

In its place was a dedication to the things that really matter: hearty food and drink, cultural pursuits both high and low, days in the outdoors and evenings out with friends. It’s the good life, and in Portland it still comes cheap.

...

Today, there are almost 400 carts around Portland, most of them clustered into “pods” that ring parking lots, ... As a New Yorker I was jealous; as the Frugal Traveler, overjoyed at what I could find within a single pod.

The article sums up a lot of what we love about living here. Also, check out the slideshow

There's been a strange reversal this last week. Every year, I spend considerable effort trying to convince people that influenza is a Big Deal. Some people get shots. A lot of people brush it off, making excuses, questioning the shots' effectiveness, and using that classic fallacy "the shot gave me the flu." Most people don't seem to think that influenza is something worth worrying about

Since January First, an estimated 13,000 Americans have died of regular, garden-variety flu. This was a "light" flu season. Influenza killed thousands this year, it will kill thousands next year. Most of those were elderly, who may have died a year or two before their time. Some of those were children. 83 children died in the 2007-08 season. As a doctor, I have to consider most of those deaths preventable, and look at them as a motivation to work harder on prevention next season.

So far, I feel the CDC and my local health department's reactions have been sensible, level-headed and appropriate. Why have they raised the alarm? It's not because swine influenza is a scary superbug that's worthy of our panic. But the prospect of a second flu season truly is something to be concerned about. Influenza deaths are sadly routine. But by sensibly limiting international travel, closing some schools, and encouraging good hygiene, we may have the opportunity to prevent another 13,000 deaths this year. We may save the lives of 100 children.

• We went to a Los Campesinos concert last week
  • They might be the most enjoyable band on tour right now
    
    • Although I haven't seen every band in the world
  • I love the stage in a band's career where they improve with subsequent shows:
    
    • Nickel Creek  1999-2003
    • Dresden Dolls 2004-2008
• We got a new digital camera
  
  • It is smarter than us
  • The zoom is awesome
• Spring is here!
  
  • It started rather abruptly
  • I hope I don't see another cloud for 6 months!
  • I'm working on my ability to climb hills on my bike
• Links to funny stuff on the Internet:
  • The 15 stupidest game types Wii invented
  • Star Wars according to a 3 year old

ETA: We were in line next to the lead singer of Everclear today. They're from Portland. Who knew?

Wow! Tonight's Sarah Connor Chronicles was *perfect.* I think I may remember it as one of the best moments in TV science fiction. I'm consistently amazed at how SCC is so much better than anything else in the Terminator universe. They've been methodically building up the story arcs of their two "families," it was gratifying to see them collide so powerfully tonight.

( Cut for spoilers )However it turns out, I haven't been so excited about a show since our late, great Battlestar Galactica

In other news, Dushku didn't lie about Dollhouse picking up mid-season. I'm starting to get pretty wrapped up in that show.

In crappy news, did anybody see the American Life on Mars finale? Missy showed me the last 10 minutes. What a load of crap! Did the producers even watch the original British version past the first episode? Apparently Americans
1. Don't understand the original Life on Mars
2. Don't understand the use of metaphor
3. Don't understand Bowie.

Part of me hopes that the finals scene was just a bitter "@$^& you," made by people angry about getting canceled. But I don't really think that's the case.

I exist in a alternate dimension somewhere between "normal-sized human" and "big and tall."  My choices are generally to shrink, gain 30 more pounds, or wear ill-fitting pants.

On Consumerst.com's daily deals, they showed these undercover police pants with a free belt for $30 bucks. They have them in my size, they are cheap, they look OK, and they have 8 pockets. That could be useful for holding my phone, pens, or wearing a wire.

If I like them, I will probably order pants in all 3 colors. I just hope nobody thinks I'm a Narc.

Last night, I wasted 2 hours of my life on the phone with Sirius. I don't think there's any chance of me buying their stock.


I love the product, but the people running the company seem to have no clue about how to run a company.

Since moving to Oregon, I've had to learn to deal with hills while cycling. Hills were just something we didn't have in Florida. I've finally gotten my road bike in good working condition, and I tackled the hill up Terwilliger Blvd. I got up to 500 feet, with a total climb of 927 feet.

As I have posted before, Missy and I love our Sirius radio. I've been a subscriber for 5 years and it's my personal favorite way to listen to music. We both agree it is the best way to find out about new new bands and trends.

In 2 weeks, their rates will be going up but we still have a chance to lock in today's rates with a 3-year contract. But Sirius has been on the verge of bankruptcy this month. We had been debating if we should get a 1 year plan, because of the chance the company would go kaput before 3 years.

Well, last week the owners of Direct TV (Liberty Media) bought 40% of the company, saving them from bankruptcy. So I think we're going to go with the 3 year plan. This leads me to the question: should we buy a subscription or stock?

Right now, SIRI is trading at 12.8 cents. If I have so much confidence that they will still be around in 3 years that I would be willing to pay $300 for a subscription, should I also be willing to buy 2500 shares of stock? If it ever got back up to a dollar, I'd make a killing. The stock was at $3 a year ago. Missy also has the suggestion that we could buy a one year subscription, and $200 worth of stock. Any profits could be used as a hedge against any price increases.

I wonder what Sirius needs more? My subscription money, or somebody to buy their stock? Probably the cold, hard cash.

Of course, buying the stock would imply some sort of confidence in the people running the company. I have none. They have 20 million subscribers paying them approximately $2 billion a year in steady cash flow, yet they've never turned a profit. They overpay their talk celebrities like Stern, Oprah, and Martha Stewart. They ignore their music listeners in favor of sports fans, and tend to jerk the music stations around. I believe in the product of Satellite Radio, but I'm still not totally convinced that they won't continue to run it into the ground.

Today I got three Martin Van Buren dollar coins

I swear, they should stop the presidential series right now! Martin Van Buren should take his place amongst Lincoln, FDR, Washington, and Jefferson. Not because he's that great of a president, but because he looks damn good on a coin!

I'm about to go totally Portland and take part in the Worst Day of the Year Ride. The weather's perfect!



I'm planning on taking lots of pictures.

I had a 4 day weekend, so we went to Vegas! It's so much fun there. We stayed at the Hilton and had 2 metric tonnes of fun.