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6615. alistairconnor - 1/10/2006 10:57:38 AM Winter makes you SAD? Lighten up
According to the company which installed the boxes, all the average Sad sufferer needs is up to an hour a day under one of its light boxes. "Sad is believed to be due to the brain and body not getting enough light," says Kat Nilsson, the centre's programmes manager. "We wanted to not only debate the issue but offer people who may be suffering from Sad the chance to test one of the most popular treatments."
The science is well known: lack of light causes an increase in melatonin (the hormone that makes us sleepy at night), and a reduction of serotonin, which regulates our happy moods. But experts differ as to whether Sad, which is usually accompanied by lethargy and cravings for carbohydrates, is a severe form of winter blues or a separate disorder. According to a new theory it may be linked to hibernation patterns and a once-valuable evolutionary adaptation that prepared women for pregnancy. 6616. jexster - 1/28/2006 12:59:33 AM HEADLINE: Health Care Confidential
BYLINE: By PAUL KRUGMAN
BODY:
American health care is desperately in need of reform. But what form should change take? Are there any useful examples we can turn to for guidance?
Well, I know about a health care system that has been highly successful in containing costs, yet provides excellent care. And the story of this system's success provides a helpful corrective to anti-government ideology. For the government doesn't just pay the bills in this system -- it runs the hospitals and clinics.
No, I'm not talking about some faraway country. The system in question is our very own Veterans Health Administration, whose success story is one of the best-kept secrets in the American policy debate.
In the 1980's and early 1990's, says an article in The American Journal of Managed Care, the V.H.A. ''had a tarnished reputation of bureaucracy, inefficiency and mediocre care.'' But reforms beginning in the mid-1990's transformed the system, and ''the V.A.'s success in improving quality, safety and value,'' the article says, ''have allowed it to emerge as an increasingly recognized leader in health care.''
Last year customer satisfaction with the veterans' health system, as measured by an annual survey conducted by the National Quality Research Center, exceeded that for private health care for the sixth year in a row. This high level of quality (which is also verified by objective measures of performance) was achieved without big budget increases. In fact, the veterans' system has managed to avoid much of the huge cost surge that has plagued the rest of U.S. medicine.
How does the V.H.A. do it?
The secret of its success is the fact that it's a universal, integrated system. Because it covers all veterans, the system doesn't need to employ legions of administrative staff to check patients' coverage and demand payment from their insurance companies. Because it covers all aspects of medical care, it has been able to take the lead in electronic record-keeping and other innovations that reduce costs, ensure effective treatment and help prevent medical errors.
Moreover, the V.H.A., as Phillip Longman put it in The Washington Monthly, ''has nearly a lifetime relationship with its patients.'' As a result, it ''actually has an incentive to invest in prevention and more effective disease management. When it does so, it isn't just saving money for somebody else. It's maximizing its own resources. In short, it can do what the rest of the health care sector can't seem to, which is to pursue quality systematically without threatening its own financial viability.''
Oh, and one more thing: the veterans' health system bargains hard with medical suppliers, and pays far less for drugs than most private insurers.
I don't want to idealize the veterans' system. In fact, there's reason to be concerned about its future: will it be given the resources it needs to cope with the flood of wounded and traumatized veterans from Iraq? But the transformation of the V.H.A. is clearly the most encouraging health policy story of the past decade. So why haven't you heard about it?
The answer, I believe, is that pundits and policy makers don't talk about the veterans' system because they can't handle the cognitive dissonance. (One prominent commentator started yelling at me when I tried to describe the system's successes in a private conversation.) For the lesson of the V.H.A.'s success story -- that a government agency can deliver better care at lower cost than the private sector -- runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today's Washington.
The dissonance between the dominant ideology and the realities of health care is one reason the Medicare drug legislation looks as if someone went down a checklist of things that the veterans' system does right, and in each case did the opposite. For example, the V.H.A. avoids dealing with insurance companies; the drug bill shoehorns insurance companies into the program even though they serve no real function. The V.H.A. bargains effectively on drug prices; the drug bill forbids Medicare from doing the same.
Still, ideology can't hold out against reality forever. Cries of ''socialized medicine'' didn't, in the end, succeed in blocking the creation of Medicare. And farsighted thinkers are already suggesting that the Veterans Health Administration, not President Bush's unrealistic vision of a system in which people go ''comparative shopping'' for medical care the way they do when buying tile (his example, not mine), represents the true future of American health care. 6617. arkymalarky - 1/28/2006 1:40:43 AM For the lesson of the V.H.A.'s success story -- that a government agency can deliver better care at lower cost than the private sector -- runs completely counter to the pro-privatization, anti-government conventional wisdom that dominates today's Washington.
This is the bottom line of almost all the bullshit that's been trotted out since well before Bush took office, and it hasn't shown to be true in a single instance where it's been applied. Costs are higher, quality is lower, outcomes are less desirable when private corporations run government services. 6618. wonkers2 - 1/28/2006 7:14:58 AM For profit health care is just what it sounds like! And most of U.S. health care is of the for profit variety--for the profit of the drug companies, the medical equipment makers, the insurance companies and the doctors. Why it's so expensive is no mystery. Recent articles show that the money spent on our lawmakers at the federal and state levels is peanuts compared to what the drug and medical equipment makers shower on doctors in order to get them to prescribe or use their products. 6619. judithathome - 1/28/2006 8:09:20 AM compared to what the drug and medical equipment makers shower on doctors in order to get them to prescribe or use their products.
And every single drug rep I've seen is a leggy bleached blond with very expensive clothes and veneered teeth and they all seem to show up when it's time for my appointment with the doc. 6620. arkymalarky - 1/28/2006 7:43:08 PM Right Wonk. I try to explain that to people who want to privatize public schools. The first motive is profit, not educating kids, and it's actually more expensive with less benefit for teachers, even in private schools where the first priority is education rather than profit.
I think states should pass laws that drug reps aren't allowed to visit doctor's office during appointment hours. 6621. wonkers2 - 2/8/2006 5:24:25 PM Now they tell us!Here. 6622. thoughtful - 2/8/2006 9:29:19 PM Yup, just as I had learned from schwarzbein. The low-fat diet thing is a myth. The first study that put them onto it was a poorly designed study that included having people quit smoking in addition to following a low-fat diet. Results for whatever reason created this false paradigm that it was the diet that did it when in fact it was the smoking.
Latest thinking is that transfats are the bad fats and having a balance of fats in the diet is best including the omega-3s and 6s and 9s.
Also that the syndrome x including diabetes, high bp and abdominal fat is a result of excess carbs in the diet and the insulin rush that that requires.
So do the schwarzbein for best health: every meal consists of protein, carb, fat and nonstarchy vegetable. Drink lots of water. Moderate exercise. Sleep well and lower stress. Eat sufficient protein for your body (6-8 oz per day for women 8-12 oz per day for men) don't worry about fat as your body won't let you overeat it, and control the intake of carbs to control your weight. Opt for healthy carbs (from starchy vegetables, whole grains) over empty carbs (cakes and pies). Eat real food with minimal processing and without chemicals. Avoid alcohol and artificial sweeteners.
All pretty basic, sound advice. 6623. Ulgine Barrows - 3/3/2006 1:26:18 PM Moderation! 6624. anomie - 3/4/2006 11:56:37 AM IV sedation works well for dental work. I had been stressing about "going under" and getting a wisdom tooth and moler removed for about a month now. I had the fight or flight, or approach/avoidance turmoil going on right up to when they started the IV yesterday. But then I woke up and it was over. I had no awareness at all of what was going on or even of time passing. Residual pain is very mild and I can look forward to fewer head and ear aches. Best of all I can finally stop obsessing about the procedure. 6625. arkymalarky - 3/4/2006 6:47:21 PM I had an epidural for my hysterectomy last spring. I just couldn't get beyond being stressed about "going under" either. I wasn't even worried about the surgery, even though they had to do a cesarian-type incision. I hadn't been under anesthesia since I had my tonsils out when I was 8. 6626. wonkers2 - 3/4/2006 7:29:08 PM "The Health Care Crisis and How to Fix It" by Paul Krugman and Robin Wells in "The New York Review of Books," March 23, 2006 Here. 6627. anomie - 3/4/2006 8:25:48 PM Arky,
Most of my anxiety was caused by thinking about what they would actually be doing while I was out, amd worse, what if I woke up in the middle of it. 6628. wonkers2 - 3/4/2006 8:29:36 PM One of my best friends had a quintuple bypass yesterday. During the several days when he was in the hospital before the surgery they put him on Xanax to reduce his anxiety. 6629. anomie - 3/4/2006 8:32:40 PM We'd better fix the health care system before the economy makes the choices for us.
Some people piss me off. I met a guy while traveling once - right wing, etc - who boasted about how he payed his own way for health care and everything else and didn't need ANY help from the government. I asked him how much he paid to prevent himself from getting polio and smallpox, and how much for his doctor's education. I don't think he got the point. 6630. arkymalarky - 3/4/2006 11:02:40 PM Wonk, I do that for mammograms every year. I've had several abnormal ones, and though all have been fine, I get increasingly stressed about them from one year to the next.
6631. arkymalarky - 3/4/2006 11:04:16 PM I did for the week or two before my surgery last spring too, come to think of it. 6632. wonkers2 - 3/4/2006 11:37:52 PM Cap'n Dirty sez, "I can't handle more'n two abnormal ones!" 6633. anomie - 3/5/2006 12:16:22 AM I've used Valium for other dentist visits, but this guy said he wanted my system clean for the IV. Just as well too as long as you can get yourself to the office and in the chair. 6634. judithathome - 3/5/2006 3:13:26 AM Well, I know exactly what that stress is like, Arky...I read the MRI report yesterday when I picked it up to take to the specialist next Thursday.
Now, I know doctors and those who read MRIs and X-rays have to cover their asses these days...I know that intellectually but emotionally, that all goes out the window when you see words like "malignant" and "metastasis" and "cannot be ruled out at this time". It's one thing to know they have to put that in there to avoid liability but it's a whole 'nother thing to be hurting like bloody hell for almost 4 weeks and taking vicodan like it was candy and reading those words.
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