United States Health Care Has a Price Problem

The third article in a new series by Elisabeth Rosenthal in the NY Times is about joint replacement. In short, if you need a joint replaced, don't do it in the United States. There is an excellent interview on NPR with the author about this article as well.

In the US most of us have a feeling that our healthcare is more expensive than it needs to be. How many fountains are there in hospitals? Yet having only had one small experience with healthcare in a foreign country (Costa Rica, and my friend basically had the flu) I do not really have anything to compare to, until I read the article and heard the interview. This is a problem. I look at even my health care costs, $340 a month, and I wonder, how in the world those 15 malarone malaria pills, that I paid $115 for anyway, warrant that kind of monthly payment when in the year I have no other medical costs to date? Last year I only had a doctor visit and x-ray, which cost me about $150.

It makes me wonder, if I opted out of insurance, saved the $4000 per year after a few years I would have enough to really self-insure myself for nearly everything. Not cancer, or a paralyzing accident, but in those cases at my young age I might be able to sue someone. The point being, $4000 is a lot of money for the slight chance that a healthy young person like myself will need $4000 in medical car in a given year.

What are some solutions?

• Transparent prices for products and services. Open the price information up to a market so that people can clearly see the costs before the procedures. 
• Less administration, we have reduced the person count in manufacturing, why not in healthcare? It is not only the fact that there is so much administration, it is that each person or company has a profit on top of the salaries required to sell the pills and plastics. I am all for increased employment, but when that quintuples the cost of the service provided compared to other countries, like Belgium, we have just gone too far.
• Accurate information about procedure outcomes, such as percent of people with X type of cancer and Y type of treatment that were cancer free five and ten years later. I have been offered an MRI for an issue that was visible, although only slightly, on an x-ray. No thank you, that is $1000+ I do not need to spend.

All of those negatives being said, we have a price problem, not a value problem. It is still very possible to get great health care in this country from many of the best doctors and nurses and medical product companies in the world. Despite the fact it is overpriced, it is still a high value product. 

Only Three People Cared to Hear About Africa

Since returning to Dubuque from Africa I have had the opportunity to tell a number of people, maybe close to 100 by now a little of my adventure. However, only three people so far have been interested in more than a very superficial overview. That is an oversimplification, the only presentation I did was to a group of high school students and they asked more questions than anyone else, but due to time constraints we didn't have time for a long discussion.

The point is, most adults are so comfortable in their lives here that the thought of a difficult life in a far away land makes people uncomfortable. Besides, we worked hard for our 2500 square foot house and new cars, we deserve these things. No, we do not deserve to be born in the USA. We do not deserve to have the opportunity to go to college, even if that means taking out massive loans. We do not deserve any sort of government social safety net. Yet for some reason, we can afford these luxuries. Do these safety nets become a privilege we are now responsible for maintaining? Yes, with great power (wealth) comes great responsibility. We do not like to hear that when it means we are the rich one with the responsibility. Yet often the uncomfortable truths are the ones we need to hear the most.

I Live in Iowa: Week 117

Another week, working moderately. I think we in the US like to think of ourselves as hard workers, all the time, but real hard work is not sustainable.

Engineering went well, I cycled through a few iterations of the project I am working and took a two day "Working with China" class. The class was very good, I learned quite a bit. For example, even though China is communist it is a very hierarchical society. Your status is an important aspect of you in that culture. That is a stark contrast to our western perception of communists being equals. Another aspect of the Chinese culture, and most of Asia, is that relationships are more important than the task at hand. Again, that is different than the argumentative goal orientated culture of the west. The concept of "Face" is important too. "Face" is like one's reputation, or quite literally, one's face to the world. The more status someone has the more face that person has too. The implication is that the boss can yell at people, even though he is wrong, if it means he can save face in front of a third party. The concept of a verbal "yes" is interesting too, maybe a whole blog post interesting.

I ran 84 miles including a 24 mile long run and some strides and a couple hard hills, though no formal workout. I need to do some quality, and I would like some running partners to help push me through workouts.

How is being vegan? Expensive. Who pays $6.59 for a loaf of bread? This guy. How about $3 for half a gallon of soy, almond or coconut milk? The upside is I am discovering new foods, like coconut milk, new mushrooms, brown rice, wild rice, quinoa and tahini. I have had some before, but never tried to cook them myself.

I am tired, between working, running, and making food, there is not a lot of time left over. I realized recently that I have not had cable, satellite, or even a home Internet connection in over two years! Considering that means I have probably saved close to $2000 by now, I would say it was a good choice.

I Can't Do Everything

The weekly update is coming. I had a long weekend and well, other thing had my time and attention today and yesterday. Sometimes it is good to realize we cannot do everything all the time.

The Vegan Experience: Lessons Learned after Two Days

A few lessons have been learning in a very short amount of time. That is another point of doing unique things, to learn. I have had more quinoa, black beans and rice in the last two weeks than in the rest of 2013. That's not really a lesson learned, eating more of a food, but it's about learning how I like my quinoa or rice. Here are the major things I have learned thus far. 

1. Really this was the warmup challenge, finding vegan bread. Between Trader Joes Sprouted Wheat Bread found in Madison, WI and Ezekiel 4:9 at The Food Store in Dubuque it looks like I shall survive. I eat a loaf of bread about every five or six days, because I eat 2-3 sandwiches per day at work most days, plus bread with olive oil and vinegar. Point being, I cannot envision going without bread. That seems more drastic to me than being vegan.
2. Sometimes I feel like an idiot for the length of time it takes me to learn something. For example, [anecdotally] vegans always seem to be really skinny, so if I am a vegan I will probably get really skinny. Not once did I try to reason why vegans are skinny. I thought for some reason they didn't eat as much or something. On day one of my vegan month (August 1st) I discovered why in the evening: I had a craving for ice cream. Vegans cannot eat ice cream, custard, or gelato because all contain dairy products. Suddenly I knew why vegans are skinny. It's not for lack of eating, already two and a half days into the month the volume of food I eat has gone up. The reason vegans are skinny is that many of the vegetarian friendly foods like doughnuts, brownies, pizza, and most baked goods are off limits. Many of the high sugar foods are also high in milk, cream or butter, which tends to contain more fat and often saturated fat. It's as simple as that. Forget meat as a source of high fat and salt, which are not always conducive to weight loss, what about milk and related cream products as a source of fat and sugar? How many calories of that subway sandwich are in the cheese?
3. Always carry food wherever I go. Often there is one ingredient that makes an entire food inedible to a vegan, like honey or an egg in bread. In short a vegan has to read a lot of labels, which is not a huge change for me because I have been on the lookout for high fructose corn syrup and sugar in foods for some time. This just takes that to a whole other level, instead of eating something I have a craving for, like ice cream, I have to find soy or almond milk to satisfy the craving. The point of this lesson is that leftover pizza and doughnuts are something that might be in my best interest to avoid regardless of my diet, and having my own chosen more healthy food available I am less likely to eat the junk food.
4. We are not meant to be vegan, because of B12. It's a huge issue for vegans. It basically only comes from animals, really from bacteria, but in a symbiotic relationship with animals. What this means for me is that a vegan diet, even if I stay on it for years, is temporary for me. I like steak, salmon, cheese of course, and especially the occasional sea bass.

On a side note I have been tired all of August. I think that is from passing 300,000 miles on my van, talking to my parents of Africa, traveling to Moline two days in a row, and running over 50 miles in three days. So I don't think it's tiredness from an inadequate diet. 

The Hills Are Steep in Rwanda

We take for granted that agriculture in the US is on level ground. In Rwanda, and what I have seen of Indonesia and China, that is not the case for most of the arable land in the world. The United States is very fortunate to have the farm land we have. Honestly, we should import some people to bring the population density on arable land at least remotely close to that of other countries.

Our Host's House, Cut into the Hillside

In the panorama above you can see our host's house and compound. Also, notice the UN tarp that I mentioned a few days ago to the lower left of the house. The platform is cut into the clay hillside, by hand and with only three feet of space between the hill and the house, at the top the land cut away is taller than the house!

The Front of our Host's Compound

Similarly, the platform is also built up in front of the house, and this is what results. Those are banana trees in most of the picture and the fence is made of bamboo vertical pieces and wood horizontal pieces. This is all recent construction, that's why the lawn hasn't come in yet.

Tractors just will not work here. Besides the fact that most plots of land are less than a quarter acre, the hills are too steep for machinery anyway. There is some terracing, but it varies by region and even a terraced field may still be on a 15 degree slope with a 50 degree slope between fields. While that sounds inefficient to us, during the rainy season the last thing they probably want is a giant pond where their crops are. So the challenge is: how to make the land more agriculturally productive? Short answer, I do not know. Long and uncomfortable ecologically incorrect answer, terraform the country to make it less steep.

A tangent on all this is that if other parts of Africa are this hilly, and the Africans ever decided to go into the mountains to run trails or hike serious mountains, they shall utterly destroy the speed records.

Running to Congo

It's funny how we don't realize the significance of something until it is over. I had no idea how close I was to Congo (Democratic Republic of Congo) and specifically the fighting near Goma until I was back in the US and uploaded my GPS tracked runs to my running log. Thus, I want to share this with you.

Running Toward the Gorillas and Guerrillas

This first run was just up a long low angle road toward the mountains that were somewhat masked by haze, smog, and dust. I knew that we were in the general region of the DRC and Uganda, but when I actually look at it on the map... Wow, it's just another five miles away, I was halfway there!

Running Toward Goma

For those that do not know, Goma, or north of Goma, DRC is where the M23 rebels are fighting and UN peacekeepers have moved into the area. This was a shorter run, but this is clearly the main road from the city of Ruhengeri to Goma, with a population up to even one million. I look at this map and I think, while fighting still exists there, and the city was captured by M23 rebels in late 2012, I could have run there! Sure it would be 20-25 miles or so, but the road was pretty good. 

The strange thing about this whole experience is that the two days spent in this area no one ever mentioned anything about the fighting in the Congo just 15 miles strait away. It's like Platteville, Wisconsin was having a war and in Dubuque no one talked about it.

Interesting to say the least. This highlights an idea that I had after Pakistan, the world is more day to day than we understand. I think in the US we still think wars are fought on battlefield in far away destinations, because we have not had anything up close and personal on our land in a long time. Yet in much of the rest of the world, wars are fought next to uncle Jim's fruit stand and behind aunt Margret's house. By far, most people do not participate in the fighting, thus the issue of refugees. Yet these struggles are so close to their daily lives that there is not a choice of stopping until the conflict ends. If a country or place wants to develop and have something economic, life and work must continue.

By the way, DRC, doesn't that sound scary? I keep thinking, 'Demilitarized Zone' because of all the fighting that has happened and the connotations of demilitarized zone in Korea.