Do we have the backbone to confront the problem of the aging spine?

We should all be happy that through advances in science, health-care and personal health management more and more Americans are living into their 80's and 90's and even reaching 100. The best news about this extension of life expectancy is that more and more of our "super" seniors continue to lead active life-styles. We have been very good at managing heart disease and vascular disease. Lung disease has significantly diminished as smoking has become much less common. Diabetes is more well-controlled and the treatment of cancers improves every day. What has not improved and, in fact, has yet to be addressed is degenerative disease of the spine. It is inevitable that everyone experiences some degeneration of the spine as we age. For many the degeneration can become severe with pain secondary to nerve compression and pain secondary to spinal deformity. These infirmities lead to profound life-style changes. Chronic pain leads to depression and limited mobility. No one wants to live their lives afflicted by pain, unable to participate in the normal activities of daily living, let alone unable to play sports, take walks with family and friends, go to the movies, go out for dinner or play with grandchildren . So as these individuals start to become intolerant of their pain and limitations they seek out help within our health-care system. There are certainly non-surgical approaches that can help, especially if treatment is instituted before the structural abnormalities become too severe. These include chiropractic, physical therapy, acupuncture, massage, Alexander training, injection therapy, and many more. All cost money and stress the finances of our health-care system but these treatments are relatively inexpensive and there are a large number of practitioners who offer these treatment. However, many individuals will require surgery to alleviate symptoms. This is were things become very confounding. Bigger, more complex surgeries have higher risks. Should "super" seniors be allowed to subject themselves to these increased risks which can add substantially to health-care costs when complications do occur? Furthermore, there are relatively few spine surgeons with the capability of performing complex spine procedures in the elderly. It will become more difficult for those who are prepared to go through extensive operations to even find a surgeon who can place them on their operative schedule. What greatly compounds this problem is that medicare payments for these procedures are exceedingly low. These operations also take many hours to perform. It will be very difficult to encourage surgeons to perform more of these procedures when they take up a large amount of their work time with very limited reimbursement. From a practical business point of view it is simply impractical and unaffordable. Those surgeons receiving a salary have little motivation to perform these extensive operations when they could in the same amount of surgical time be performing more operations with less risk, helping more individuals. So those suffering from severe spine problems may well need to find surgeons who do not participate in medicare and who will perform the surgery for an appropriate usual and customary fee. Even with a limited number of seniors able to proceed with a surgical option, the costs to the health-care system will be high. Do those controlling the health-care dollars want to spend them on seniors with bad backs? There is no question that the criteria for proceeding with this kind of surgery will be so extensive that few will ultimately be able to meet those criteria. What are possible solutions? First of all, individuals need, from an early age, to be taught how to take care of their spine, including exercise, body mechanics and weight control. We need to put money into research that can lead to treatments in the early stages of spinal disease such as stem cell injections to regenerate damaged discs. However, there will always be those who will fail all non-surgical treatments. For them, spine surgery may indeed be life-saving. New surgical techniques are being developed that are less risky. Minimal access spine surgery now is able to correct spine disorders with less trauma to the spine and surrounding tissues and less risk in general. Most importantly, the specific problem that is causing the pain and limitation needs to be identified and addressed with minimal access techniques. The entire spine does not need to be rebuilt. It doesn't matter what the spine looks like on an MRI or xray as long as the individual does not suffer from incapacitating pain and neurological dysfunction. More spine surgeons will be needed who are able to assess these problems accurately and perform these focused minimal access techniques. Finally, patients should be able to see surgeons who do not participate in medicare and receive the allowable medicare reimbursement that they can apply to their out-of-pocket costs, which currently is not allowed by federal law. Spine disorders in an aging population needs to be an issue that is carefully analyzed by our politicians, our health-care pundits and the medical community. We are currently very much behind the eight ball.

I say, tax the insomniacs!

The Supreme Court of the United States, in a decision written by Chief Justice Roberts has made it clear, if we were yet unaware, that Congress has the right to tax anything it sees fit to tax. Therefore, Congress may tax individuals who fail to purchase health insurance. These scoundrels who are avoiding purchasing health insurance clearly are harming society at large. As best as I understand it, insurance companies won't make enough money to keep sick people in their health plans unless more healthy people join the plans. I suppose the assumption is that people who choose not to buy health insurance are healthier as a group than those who buy insurance. So make the healthy ones pay up for the good of the sick. This is good for society in general, it seems. Well, we need to think about taxing others who are interfering with the general well-being of society. I say, tax the insomniacs (here referred to as "the awake.") Why do such a thing, you may ask. There are several good reasons too-awake members of society should be paying for their sleeplessness ("Sleepless in Seatle"? tax the bum.) First of all, it is a well-know medical fact that people are healthier if they sleep eight hours a night. So those who sleep less are less healthy which means they are sicker which means they use more health-care resources. These resources, as we have been told time and again, are extremely costly to our society. Does it not therefore make sense that these more "awake" individuals need to ante up to cover their less healthy life-style? Secondly, we all know that we can acheive more when we have more energy and that we have more energy the more rested we are. Clearly those with a good eight hours of sleep a night will have more energy thereby being more productive than those sleeping less than eight hours(the"awake") thus less energetic and less productive. Reduced productivity is harmful to society, it lowers our GDP and has lots of other bad consequences such as making the "sleepers" have to work harder and be more productive. It may even push the "sleepers" into the "awake." "The awake" clearly need to cover the cost of this reduction in productivity. Hence, the tax. Thirdly, the "sleepers" use precious few resources when asleep, far less electricity, far less heat and no gasoline at all (unless they are asleep at the wheel). The planet and society are well-served by those using less resources. This clearly reflects well on the "sleepers" and poorly on the "awake." We are paying a heavy price for the resources being used by the "awake."

Will you have your choice of doctors?

The face of medicine in the United States is about to change dramatically. For many years now, individuals have had choices regarding their healthcare insurance, they could choose an HMO plan or a plan that offered out-of-network benefits. The HMO plan requires subscribers to use contracted physicians who are "in plan" or else you have to pay the full doctor's fee yourself. With a PPO plan, one that offers out-of-network benefits you can choose to see a physician who does not contract with the insurance company. The insurance company will pay 70-80% of the usual customary fee for the doctor's services and you will be responsible for the 30-40% difference. You can always still use an "in network" physician to have 90-100% of the fee covered. You have the choice of paying a bit more for the opportunity to be cared for by a non-participating doctor who you may prefer. When insurance companies base their out-of-network reimbursements on usual and customary rates then not only do consumers have choice but physicians have a choice whether to be in-network or out-of-network. This means that insurance companies have to negotiate rates that some physicians will consider acceptable because those physicians otherwise can decide to stay out-of-network. This helps maintains a free market model in medicine, choices for the consumers and choices for the providers. This model is on the verge of changing profoundly. Health insurance companies want to peg out-of-network reimbursement to medicare rates. Physicians, especially surgeons and other proceduralists, can not remain in private practice with reimbursements based on 140-200% of medicare. Private practice physicians will go out-of-business and be forced to either leave medicine or become an employee of a large medical group or hospital. Only a small handful of physicians will remain in private practice and patients who choose to have these physicians care for them will have to pay the lion's share of that doctor's fee out-of-pocket. Those who can afford to do so will still have a choice, the remainder won't so this will immediately create a two-tier medical system. Once the majority of physicians are driven into large groups and hospitals that contract on behalf of the doctors, the insurance companies will ratchet down the reimbursements because physicians will have no option left but to accept whatever payment is offered. The large medical groups and hospitals will, of course, limit the number of physicians they employ to provide enough income for the physicians in their group. In order to make a marginally adequate income these health-care providers will have to see a very high volume of patients. This all translates into long waits for patients and very short visits. The quality you expect just won't be there. The coup de grace is that these clearly inferior insurance policies are still costing the consumers more, the insurance companies aren't lowering the cost of these plans, they are raising them. Make no mistake about it, the money that does not stay in your pocket or go to your health-care providers goes into the pockets of the executives of the health insurance companies and then to the company's shareholders. So if you care more about your investment then your health-care, buy stock in the health insurance companies. If you care more about your health-care, contact your legislators and insist that the private practice of medicine be allowed to flourish in the United States.

The Poem

I am blogging once again and expect that I will keep it up on a regular basis for a while. I will, at least, add a poem a week. Today it is a poem entitled,

The Poem

It's always either about death or love
The mundane or the extraordinary
Whether about celestial bodies or earthly matters
The progenitors or the offspring
The sibling, friend or lover
The pet or the beast
The sorrow, the elation
The depravity, the divine
In the end, when all is said and done
With meager understanding
It's about
The word

Ezriel Kornel

I read an article about the rap group Das Rascist today in New York magazine. Das Rascist is a group of three non-pure-white rappers who interject humor about race that is often intended to offend whites. Of course, it ends up working just the opposite and the group is gaining popularity. Their dilemna, is seems, is that they are striving to obliterate rascism, making race an inconsequential issue. Yet they are making a name for themselves by playing on rascism. So, it got me to thinking, is rascism passe? It is indeed becoming more difficult to identify those who are pure white, much to the anger of a few extemist psychopaths and sociopaths. But as "pure white" disappears, fear and anger will not. That is because there will always be "otherness" and it seems to be in the nature of humans to have to distinguish other from self. The more "other" someone appears to be, the more fear it evokes in some. So why is "other" so fear-inducing? It is because "other" challenges our sense of "self." Can an "other" devour us? Can we sustain our personal beliefs, our understanding of how we should behave, of how we should interact with others, who we allow ourselves to love, where we wish to live, how we wish to earn a living, if others approach all of these issues differently, especially if far differently? It is this fear that drives people to cruel acts, whether it is bullying a child in school or taken to the extreme, flying passenger-filled airplanes into occupied buildings. The question that has confounded humanity for millenia is how to erradicate this fear which leads to hatred and violence. The answer may be too simple for many to accept but it may be the answer, none-the-less, one that many great men and women have offered: to respect life above all else and to respect every individual's right to pursue their own happiness without infringing on other's equal right to the same. This is a challenge that requires understanding and compromise and above all, love. It is the foundation upon which every personal relationship is built and upon which this great country was built.

Flora and Fauna

The cactus blossoms
From the parched desert earth
As the seedling stretches blue-ward
From the dank forest floor
In my hand I hold a tooth
Pushed out by the one behind it
A man must grow
Where he has been planted
His pain not penance
But a passing rain

Casey Anthony and Belief

Apparently two thirds of Americans believe that Casey Anthony murdered her daughter. The jury did not believe this to be the case. That is because the jury understood that belief is not a basis on which to make decisions that profoundly affect another person's life. In order to make a judgement about another person, especially when it comes to imprisoning that person, restricting their freedom or even taking their life, belief is insufficient. Fact, or evidence is needed to make a determination as to the validity of a claim. As a matter of fact, no pun intended, this is what science is all about. People wish to believe a whole host of things especially when it is meant to make their life better in some way. When it remains purely personal, each individual can maintain their belief no matter how outlandish but when it comes to imposing it on others, we run into huge problems. The same is true in the healing arts. Lots of people offer remedies and treatments that they say is helpful and often may even try to benefit financially from offering these treatments but most often these are based on beliefs at best. Though it is true that experience may precede scientific proof and anecdotal experience may certainly be true for the one having the experience, offering it to others in a authoritative manner requires science and science is complicated and labor intensive and sometimes excruciatingly time-consuming but it will ultimately offer an answer that goes beyond belief. This is what, in effect, the Casey Anthony jury did in coming to it's verdict. It did not decide that she had not killed her daughter but rather that the evidence was not there to make a truthful determination that she had and it is what most of us would have concluded if we had gone through the same rigorous scientific process. It is a principle we should always apply to things that matter in our lives.