Last weekend we had a nice visit from my brother Paul and his wife Brenda. Paul is a paramedic with many years of experience and Brenda is an experienced Physician's Assistant, so naturally, one evening our discussions turned to the medical system in the United States. Hearing things from the professional medical side has convinced me that our system is more screwed up than even I ever believed.

Everyone knows that there are major problems with medicine in this country: many low-income people can't afford even basic medical care, much less treatment for major illnesses. Doctors and dentists don't always get fully reimbursed for their expenses, yet health care insurance is expensive and getting worse. I'll write more about this in a future blog entry, but here are some of the key points I see in the health care debate:

* Doctors undergo very long and very expensive training before they can practice, and they must continue to update their training each year, generally at their own expense.

* Malpractice insurance premiums are huge and, to me, represent a significant reason that medical care is as expensive as it is.

* Jury awards in malpractice suits are enormous. You don't have to be a rocket scientist to see a direct link between these awards and the skyrocketing cost of malpractice insurance.

* In order to avoid costly malpractice suits, doctors tend to be extremely conservative in courses of treatment, prescribing tests and examinations that may not be necessary for the sole purpose of being able to prove that they have done everything that can be done.

* The process of developing, testing, and approving new medicines is very long and very expensive; as a result, drugs tend to be extremely expensive (and the issue of huge jury awards in malpractice suits related to drugs applies, too).

* The ability of drug companies to advertise their new medicines leads patients to expect and demand prescriptions of new drugs from their doctors, whether or not these are the right treatment. The same applies to very expensive new diagnostic machines and treatments.

* The cost of medical care appears to be influenced greatly by the various lobbies that have a voice in the treatment we receive: the AMA (for the personal, professional, and financial interests of medical professionals); the legal profession (whose members have a vested financial interest in securing huge jury awards; and the drug industry (which spends huge amounts of money on developing new drugs and wishes to recoup its costs and make a profit). The expectations of patients can also be considered as a lobby of sorts as well.

* Courses of treatment for many illnesses, and even for routine care, appear to be based as much (or more) on what the insurance company will pay for as on what the patient needs.

* And there are many ethical issues as well. These include: decisions on how long to sustain life when the patient suffers from critical injury or terminal illness; whether a doctor has an obilgation to treat patients who cannot pay for the treatment (doctors have bills to pay and a living to earn, too); what is a reasonable level of profit for a medical professional or a drug company; and whether it is better to promote routine health maintenance care than to wait until a problem arises and grows expensive, and then treat it.

So...given all of the above (and this is only a very short list of the issues that bear on the problem), what do we do to help resolve this absolutely critical issue? As you might suspect, I have some ideas. Unfortunately, you'll have to wait for my next post to hear about them. In the meantime, read widely and think critically about the problem so that you can ask the right questions and make the right decisions...and so you can decide whether my coming suggestions are right.

This is - truly - a life or death issue.

Have a good day. We'll continue this discussion in my next post.

Bilbo

If you aren't a lawyer, chances are that you don't spend much time reading court opinions. However, it's a good idea to do so from time to time, if only to understand what's going on with your rights and your responsibilities as a citizen.

There have been a number of recent decisions at the local and national level that are worthy of your reading. First is, obviously, yesterday's Supreme Court ruling in Hudson v. Michgan (#04-1360, June 15, 2006), which allows the police to enter your home without knocking or announcing themselves, as long as they have a search warrant. To me, this is a somewhat disturbing ruling, because it violates our rights of privacy and freedom from unreasonable search as defined in the Constitution, not to mention many years of previous legal reasoning. You can read the ruling, and the vigorous dissent written by Justice Breyer, here: http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=US&vol=000&invol=04-1360.

Another ruling worth the reading is that of Judge John Jones in Kitzmiller v. Dover Area School District (Case # 04cv2688), which decisively shot down the mandatory teaching of, or reference to, "Intelligent Design" as an alternative to the theory of evolution. Judge Jones' eloquent, thoroughly-reasoned, and heavily footnoted decision clearly revealed Intelligent Design for what it is: a thinly-veiled effort to push a religious agenda in public schools in violation of the Constitution. As the judge makes clear, there are those who hold deeply held religious beliefs concerning Intelligent Design, and they are free to share those beliefs with themselves and others; nevertheless, as it is clearly an opinion rooted in religion, not science, it must therefore not be taught in public schools as if it were a tested and accepted scientific theory. No matter which side of the argument you come down on, this is an important ruling and very much worth your time in reading.

I'll have more to say on other recent court decisions in later posts. In the meantime, gird your mental loins, wade through the legalese, and read key court decisions, which are easy to find on the Internet. They establish the law under which you live.

Have a great weekend. More thoughts later.

Bilbo

It's been more than a week since I last posted, and quite a bit has happened in my life and in the world. Let's talk about the world.

Two big things have happened recently - that worthless, murdering snake Abu Musab al Zarqawi is running around hell looking for the virgins he thinks are waiting for him; and some 17 men in Canada have been arrested and charged with planning major terrorist attacks in that country. Let's look at these events in a little more detail.

The death of Zarqawi won't end the insurgency in Iraq and won't convince die-hard Islamic fanatics that they are on a dead-end road. If anything, it may make things worse in the short run by bringing more of the lunatics who believe in his twisted philosophy of out of the woodwork. But it does send a useful message to those people: that it may take a while, but we will eventually track you down and let you learn first-hand that there are no virgins waiting to serve you in hell. I think it says a lot about the nature of this war that so much effort was expended on our part to kill Zarkawi without killing innocent people around him. I don't think this was ever something he worried about when planning his outrages.

As for the people arrested in Canada, you could have easily predicted the response: rather than condemning the evident existence of a deadly terror plot cooked up by twisted religious fanatics, the Canadian Islamic community has pulled together to trot out the same old stuff about Islam being a religion of peace, Muslims are being picked on, blah, blah, blah. This is the true message of this event: that Muslims are living in a state of denial, unwilling to admit that the world has left their religion in the dust of the seventh-century Arabian desert, and equally unwilling to admit the fact that - while they loudly curse at the Western "crusaders," the last crusade took place centuries ago...and it's Islam that believes to this day in spreading its message of "peace and understanding" through murder and intimidation.

There are a few books you should read to understand the bizarre mindset of the fevered Islamic mind: The End of Faith, by Sam Harris; Why People Believe Weird Things, by Michael Shermer; and When Religion Becomes Evil, by Charles Kimball. You will probably not agree with everything these authors write (and I wouldn't trust you if you did), but they do provide some very interesting insights and points of departure for thinking about blind adherence to illogical and violent belief systems.

I'd rather write about grandchildren, herbs, good books, music, and the joy of dancing with beautiful ladies in beautiful clothes. Unfortunately, there are those who believe it is their mission in life to remove all these sources of joy and force me to live in the same joyless world they do...or kill me if I fail to see the correctness of their beliefs. They're out there, and we'd better deal with them soon. They aren't waiting for us to wring our hands and worry about legal and moral niceties.

Have a good week. More thoughts are coming...hopefully, more regularly.

Bilbo

Ah, it's Friday again, and I've been thinking since last night about what to write in today's post. There are, after all, so many things that need critical commentary that it's hard to choose and equally hard to keep my thoughts down to a length people will actually take the time to read and ponder.

So...

Today, we won't deal in heavy topics. Today, we'll talk about my modest little herb garden.

In three large pots in front of the house, I'm growing rosemary, thyme, chives, tarragon, and basil...lots and lots of basil. There's nothing quite like fresh herbs for good cooking, but if you buy those herbs in little plastic packages at the grocery, they'll cost you an arm and a leg, so it's much better to grow them yourself. Our basil is shooting up and bushing out nicely, and I can't walk past the pots without rubbing the leaves to enjoy the wonderful smell. Soon, we'll have enough basil for good tomato-mozzarella-basil salads. The thyme is growing well, too - and it will soon find its way into soups and rice pilafs. The rosemary, which is a perennial, is marvelously fragrant and growing like mad; the tarragon is also growing very well, but for some reason doesn't seem to smell at all...I guess we'll have to harvest some and try it out to see if the plants are okay. That leaves the chives, which are growing and spreading well...no flowers yet, but they aren't far off.

There's something deeply satisfying about growing our own herbs. If nothing else, it's a good feeling to just be able to step outside, pick the fragrant leaves you grew yourself, and toss them right into your recipe...without having to wrestle open a plastic box.

Have a good weekend. More thoughts are coming.

Bilbo