Tuesday, August 18, 2009

Your representative is waiting for your call

Do not give up on serious health care reform. Your senators and representatives are waiting, begging even to hear from you before Congress reconvenes. Many of their jobs may rightly depend on how they vote, so they need to know what you want them to do. I just made three calls to voice my support (particularly for saving the public plan) and it took about 5 minutes. Here is a link that will help you call and/or email (calling is better) the president, your senators and your local representatives: http://www.usa.gov/Contact/Elected.shtml

Everyone needs and deserves basic health care coverage, prevention and education. The physical, spiritual and economic health of our country depends on it.

Doctor's and patients need access to unbiased research and information comparing treatment options and pharmaceuticals. This is a job for someone like the NIH, not drug companies or insurance companies or politically appointees who have vested interests.

Drug rationing already exists so let's not fear it. Doctors and patients are told everyday by insurance companies what they can and cannot do. What we are talking about is taking the rationing out of the hands of people who have a financial incentive to order more or less tests--often doctors and hospitals in the first case and insurance companies in the latter. Whatever the system, here or in Canada, socialized, nationalized or just plain old Americanized, people with money (like you?) will always be able to afford paying for the doctor, procedure or drug that you want or believe you need, so let's not ruin it for all the people who can't afford to pay and currently get what my Dad calls "bupkiss".

Dying with dignity, in comfort and without a bankrupting ICU bill is a right that we should all be encouraged to exercise. It's very personal, but if you do not have a health care proxy, living will, DNR etc., then the hospital will be making the decisions for you--which will involve putting you on every machine and ventilator known to man whether there is any hope of recovery or not and regardless of how uncomfortable it may be. Not being able to speak or move and living in an ICU with an artificial respirator is both painful and expensive. There are times where it could save your life, but there are times where it cannot, and only prolongs it, assuming you consider that a life. These are the situations where you need a living will or health care proxy to help you have the end of life that you want. This isn't death camps, but it does involve taking some time to consider these important end of life decisions and then making them known to your family and physicians. Here is a simple website that can help you create a health care proxy or living will: http://www.doyourproxy.org/

A co-op is not a reliable alternative to a public health option. This New York Times article does a great job of describing the potential risks and benefits of co-ops: http://prescriptions.blogs.nytimes.com/2009/08/17/so-whats-a-health-insurance-coop-anyway/?ref=health

Finally...

7 Reasons We Need Health Insurance Reform Now

1. Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/denied_coverage/index.html

2. Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job. Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html

3. Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes

4. Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline

5. The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction

6. Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov/reports/inaction/diminishing/index.html

7. The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf

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Dave Barry: a journey into my colon--and yours!

OK. You turned 50. You know you're supposed to get a colonoscopy. But you haven't. Here are your reasons:

1. You've been busy.
2. You don't have a history of cancer in your family.
3. You haven't noticed any problems.
4. You don't want a doctor to stick a tube 17,000 feet up your butt.

Let's examine these reasons one at a time. No, wait, let's not. Because you and I both know that the only real reason is No. 4. This is natural. The idea of having another human, even a medical human, becoming deeply involved in what is technically known as your 'behindular zone' gives you the creeping willies.

I know this because I am like you, except worse. I yield to nobody in the field of being a pathetic weenie medical coward. I become faint and nauseous during even very minor medical procedures, such as making an appointment by phone. It's much worse when I come into physical contact with the medical profession. More than one doctor's office has a dent in the floor caused by my forehead striking it seconds after I got a shot.

In 1997, when I turned 50, everybody told me I should get a colonoscopy. I agreed that I definitely should, but not right away. By following this policy, I reached age 55 without having had a colonoscopy. Then I did something so pathetic and embarrassing that I am frankly ashamed to tell you about it.

What happened was, a giant 40-foot replica of a human colon came to Miami Beach. Really. It's an educational exhibit called the Colossal Colon, and it was on a nationwide tour to promote awareness of colo-rectal cancer. The idea is, you crawl through the Colossal Colon, and you encounter various educational items in there, such as polyps, cancer and hemorrhoids the size of regulation volleyballs, and you go, "Whoa, I better find out if I contain any of these things," and you get a colonoscopy.

If you are as a professional humor writer, and there is a giant colon within a 200-mile radius, you are legally obligated to go see it. So I went to Miami Beach and crawled through the Colossal Colon. I wrote a column about it, making tasteless colon jokes. But I also urged everyone to get a colonoscopy. I even, when I emerged from the Colossal Colon, signed a pledge stating that I would get one. But I didn't get one. I was a fraud, a hypocrite, a liar. I was practically a member of Congress.

Five more years passed. I turned 60, and I still hadn't gotten a colonoscopy. Then, a couple of weeks ago, I got an e-mail from my brother Sam, who is 10 years younger than I am, but more mature. The email was addressed to me and my middle brother, Phil. It said:

"Dear Brothers,

"I went in for a routine colonoscopy and got the dreaded diagnosis: cancer. We're told it's early and that there is a good prognosis that they can get it all out, so, fingers crossed, knock on wood, and all that. And of course they told me to tell my siblings to get screened. I imagine you both have."

Um. Well.

First I called Sam. He was hopeful, but scared. We talked for a while, and when we hung up, I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy. A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis. Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner. I nodded thoughtfully, but I didn't really hear anything he said, because my brain was shrieking, quote, "HE'S GOING TO STICK A TUBE 17,000 FEET UP YOUR BUTT!"

I left Andy's office with some written instructions, and a prescription for a product called 'MoviPrep,' which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America's enemies.

I spent the next several days productively sitting around being nervous. Then, on the day before my colonoscopy, I began my preparation. In accordance with my instructions, I didn't eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor. Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-liter plastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons.) Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes -- and here I am being kind -- like a mixture of goat spit and urinal cleanser, with just a hint of lemon.

The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, "a loose watery bowel movement may result." This is kind of like saying that after you jump off your roof, you may experience contact with the ground.

MoviPrep is a nuclear laxative. I don't want to be too graphic, here, but: Have you ever seen a space shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.
After an action-packed evening, I finally got to sleep. The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, "What if I spurt on Andy?" How do you apologize to a friend for something like that? Flowers would not be enough.

At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the hell the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked.

Then a nurse named Eddie put a little needle in a vein in my left hand. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep. At first I was ticked off that I hadn't thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house.

When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point. Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand. There was music playing in the room, and I realized that the song was Dancing Queen by Abba. I remarked to Andy that, of all the songs that could be playing during this particular procedure, Dancing Queen has to be the least appropriate.

"You want me to turn it up?" said Andy, from somewhere behind me.

"Ha ha," I said.

And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.

I have no idea. Really. I slept through it. One moment, Abba was shrieking Dancing Queen! Feel the beat from the tambourine... and the next moment, I was back in the other room, waking up in a very mellow mood. Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that it was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.

But my point is this: In addition to being a pathetic medical weenie, I was a complete moron. For more than a decade I avoided getting a procedure that was, essentially, nothing. There was no pain and, except for the MoviPrep, no discomfort. I was risking my life for nothing.

If my brother Sam had been as stupid as I was -- if, when he turned 50, he had ignored all the medical advice and avoided getting screened -- he still would have had cancer. He just wouldn't have known. And by the time he did know -- by the time he felt symptoms -- his situation would have been much, much more serious. But because he was a grown-up, the doctors caught the cancer early, and they operated and took it out. Sam is now recovering and eating what he describes as "really, really boring food." His prognosis is good, and everybody is optimistic, fingers crossed, knock on wood, and all that.

Which brings us to you, Mr. or Mrs. or Miss or Ms. Over-50-And-Hasn't-Had-a-Colonoscopy. Here's the deal: You either have colo-rectal cancer, or you don't. If you do, a colonoscopy will enable doctors to find it and do something about it. And if you don't have cancer, believe me, it's very reassuring to know you don't. There is no sane reason for you not to have it done.

I am so eager for you to do this that I am going to induce you with an Exclusive Limited Time Offer. If you, after reading this, get a colonoscopy, let me know by sending a self-addressed stamped envelope to Dave Barry Colonoscopy Inducement, The Miami Herald, 1 Herald Plaza, Miami, FL 33132. I will send you back a certificate, signed by me and suitable for framing if you don't mind framing a cheesy certificate, stating that you are a grown-up who got a colonoscopy. Accompanying this certificate will be a square of limited-edition custom-printed toilet paper with an image of Miss Paris Hilton on it. You may frame this also, or use it in whatever other way you deem fit.

But even if you don't want this inducement, please get a colonoscopy. If I can do it, you can do it. Don't put it off. Just do it.

Be sure to stress that you want the non-Abba version.

Colonoscopies are no joke, but these comments during the exam were quite humorous... A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:

1. Take it easy, Doc. You're boldly going where no man has gone before!

2. Find Amelia Earhart yet?

3. Can you hear me NOW?

4. Are we there yet? Are we there yet? Are we there yet?

5. You know, in Arkansas , we'd now be legally married.

6. Any sign of the trapped miners, Chief?

7. You put your left hand in, you take your left hand out...

8. Hey! Now I know how a Muppet feels!

9. If your hand doesn't fit, you must quit!

10. Hey Doc, let me know if you find my dignity.

11. You used to be an executive at Enron, didn't you?

And the best one of all.
12. Could you write a note for my wife saying that my head is not up there!

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