THE HEALTH CARE SYSTEM: AN INTRODUCTION

Let's take a break from your personal health for a bit, and look at the broader "Health Care System." This term is a misnomer, because there actually is no "Health Care System." There are multiple systems. A few of the major players are as follows:

1. The Federal Government Health System: this includes Medicare (the health care system for people over 65), the Veterans Administration Service for veterans, the Indian Health Service which covers Native Americans, and various insurance systems that contract with other systems, providing coverage for government employees and helping the individual states.

2. The State Government Health System: each state has its own "Medicaid" system to cover the poor and uninsured, funded by both the federal government and the state. States also fund some state-run and county-run facilities for the uninsured. Some states are getting into the business of providing insurance to cover more people (Massachusetts is the primary example).

3. The Private, For-Profit Health System: this system is run by for-profit, large insurers, who sell health insurance to employers. This system is probably the system you're familiar with, if you have health insurance. Your employer pays a premium for you every month to an insurance provider, such as Aetna, Cignal, or United Health, and that insurer in turn contracts with groups of doctors and hospitals to provide you with health care. You pay a small part of the cost via "copays" for various services. You probably notice that these "copays" are getting higher, but you have no idea what a tiny fraction of the health care cost you're paying. You can purchase this kind of insurance yourself, if you don't have an employer. You will be surprised how expensive it is.

4. The Private, Non-Profit Health System: this system is one of the options for some employers, and it works very much like the For-Profit Private System. It's just that the insurance provider is a non-profit, so they don't have to pay money to company shareholders. Geisenger Healthcare in the East and Kaiser Permanente in the West are two examples of non-profit insurance providers. Like for-profit insurance, you can buy this kind of insurance yourself if you don't have an employer buying it for you. But it's not cheap.

Most people have government health insurance, employer based for- or non-profit private insurance, or no health insurance. There are more complicated hybrid products, "catastrophic" plans, and various charity-funded insurance-like plans. But they aren't as common. Chances are, you're familiar with one or more of the above systems. If you've ever had a decent job, you've probably had private for-profit, or non-profit, health insurance that your employer paid for. If you're over 65, you probably have Medicare. If you've served in the military, you might have insurance and health care through the VA system. If your family was or is low-income, you might have gotten some of your childhood immunizations or medications through state-funded Medicaid. And if you're uninsured, you might need to seek treatment at some point in a state-funded county hospital or clinic.

One way or another, these various health-care "systems" supply some degree of health insurance and health care to a majority of Americans, the exception being the 50-60 million "uninsured Americans." Yes, there are a lot of uninsured Americans- but they still make up only 1/6 of the population. That might be why not much has been accomplished when it comes to dealing with their health-care situation.

MAJOR PROBLEMS WITH HEALTH CARE IN AMERICA:

1. It's expensive.

2. There is NOT ENOUGH MONEY even to keep providing the current level of health care to the current population of people who have insurance.

3. There are a lot of uninsured Americans. Providing them health care = more money.

4. There aren't enough doctors, especially in "primary care," the first line of care for most Americans.

5. People are living longer. That's good for them, but bad for health care, because more years = more health care needs = more money.

6. The quality is not as good as it should be, for the amount of money it costs in America.

IN SHORT:

What you can expect over the coming years is the following: you may have a harder time finding health insurance, and when you do have it you will have a hard time finding a primary care doctor, and you will wait longer to see that doctor. Your share of the cost of doctor's visits, medications, and hospitalizations will continue to increase. And when you are older and retired, you will spend much more of your retirement savings than you ever dreamed of. We'll probably see quite a few changes in how people get health care in the next few years. Some of these changes ain't going to be pretty.

A BITE-SIZED BLOG YOU CAN DIGEST

     Sometimes it takes a long time to read one of my blog entries.  Too long, perhaps.  Back when I was trying to review a "Food of the Day," every day, I think the topics were more short and sweet.  But I was researching them every day, blogging every night, losing sleep, and becoming exhausted.    So less frequent, more well-thought topics are the result.    However, I still would like people to be able to tune in quickly now and then and get a fresh, short, and useful little bit of knowledge.   So here's one, or ten, of those little bits.   They are all things I learned from other health professionals, and most of them have "science" behind them:

10 EASY THINGS YOU CAN DO TO IMPROVE YOUR HEALTH

1. Use toothpicks after you eat.   Dentists all seem to agree on this one.

2. Eat breakfast every day, even if it's just a "Zone Bar" or something.

3. If you're fatigued after lunch and you can manage it, take a short nap.

4. Replace beat-up old shoes, or at least stick some padded arch supports in them.

5. Keep some sunscreen in the medicine cabinet, and get in the habit of putting it on your face on most days.   SPF 15 is fine and it won't make you look like you just got back from clown camp.

6. Wash all fruits and vegetables before eating them, EVEN IF they are organic.  Remember: salmonella is organic, too.

7. Wear a helmet when you bike, ski, or snowboard.

8. If you hate the gym, invest in a treadmill or stationary bike, or whatever will get you an easy 30 minutes of exercise on most days.

9. Wash your hands any time you even talk to someone with a cold.

10. Bring a quart of water with you to work every day.  Try to finish it before going home.   Stop giving worrying about peeing so much.

HAVE YOU HEARD THE GOOD NEWS? THE TRUTH ABOUT COFFEE

Some dude once came up to me on my college campus, and blurted, "Have you heard the good news?"

I said, "What good news?"

"Christ has risen!" Was his answer.

Who cares? I thought. Isn't that pretty much the oldest news around? It may be "good news" if you're a Christian. But even so, isn't "news" by definition something at least somewhat "new?" If it wasn't, Anderson Cooper wouldn't have to travel the world to find new stories about gorillas or hurricanes now, would he? He could just sit in his air-conditioned office at CNN, going on and on about the great news of the fall of the Tower of Babel or Alexander's victory at Tyre. But no: he works hard to give you the "news" that is "new."

So do I. And this might be old news to you, but to most people I think it's relatively new news: Coffee is GOOD FOR YOU!

For years I've been collecting all the research articles I can find on coffee, tea, and caffeine. In fact, Dr. Tofuhead consumes a lot more coffee than he does tofu. So it was in my own interest to know, is coffee really "good?" I've found research articles demonstrating that coffee reduces asthma symptoms, dissolves bile stones, decreases the risk of developing diabetes, increases alertness and performance on mental tasks- the list goes on and on. I've also found loads of relatively unsubstantiated claims in medical guidelines suggesting that coffee causes heartburn, insomnia, dehydration, anxiety, heart palpitations, migraines, and high blood pressure. So what's the bottom line?

The largest study on coffee that I know of just came out this week, and the results were rather shocking. The study looked at the absolute holy grail in medicine: "all cause mortality." "All cause mortality" basically gets at the question, "does this stuff kill you faster, make you live longer, or neither?" It's the most sought-after statistical phenomenon in studies of drugs, diets, exercise regimes, or any other instrument we might use to alter human health. It's also a phenomenon that is frightfully affected by a huge number of variables, and therefore any study attempting to evaluate the affect of something on "all cause mortality" needs a massive number of subjects, a boatload of high-powered statistical analyses, and some very smart people drawing the conclusions.

Without boring you, let me just say this: the big study published this week showed that coffee, even in large amounts, does not "increase mortality;" in other words, coffee does not kill you faster than no coffee. What was more impressive to me was the fact that the more coffee subjects drank on average, the LOWER their overall mortality. That is to say, coffee appears to make people live longer, especially when consumed in large amounts. The subjects in this study who had the lowest risk of dying were those who drank, on average, 6 OR MORE cups of cofee per day! Shocking!

Some caveats: the authors of the study were merely out to prove that coffee did not kill you faster; so they note that they cannot draw firm conclusions that coffee prolongs life. They note that the study "suggests" this effect, but that the life-prolonging effects of coffee "warrant further investigation." They also demonstrated that coffee is probably good for your lifespan, but they did not examine whether it's good for your life- in other words, they did not study the potentially ill effects of coffee that are not fatal. Can coffee give you a longer life that is fraught with heartburn and insomnia? This study did not get at that, or similar questions.

Now it's time to bust some

MYTHS ABOUT COFFEE

1. Myth #1: Coffee is a diuretic. This is just plain wrong in so many ways. Coffee is not a diuretic. If you were dying of thirst, you could rehydrate yourself with coffee. A diuretic is a substance that causes a "net loss" of water from your body. Fortunately, there are only a handful of true diuretics.

2. Myth #2: Coffee causes migraines. No, the LACK OF coffee can cause a migraine, if you usually have lots of coffee in your system.

3. Myth #3: Coffee causes high blood pressure. Nonsense. It just doesn't. Numerous studies have failed to show any significant effect of coffee on blood pressure.

4. Myth #4: Decaf coffee still has a significant amount of caffeine. The truth is, decaf coffee has a completely insignificant amount of caffeine.

5. Myth #5: Coffee causes heartburn. Even I have a hard time letting go of this one. But gastroenterologists from across the country will tell you, the research simply fails to show that coffee causes, prolongs, or exacerbates heartburn.

6. Myth #6: Coffee can sober you up faster. I'm not sure a ton of people still believe this one- at least, I hope not. Coffee will not make you any less drunk any faster. It can make you into a more slightly AWAKE, but equally impaired, drunk person.

WHY IS COFFEE SO GREAT?

-It is full of antioxidants.

-According to the new study, it may have anti-inflammatory effects.

-It appears to reduce cardiovascular death, i.e. heart attacks.

-In addition to antioxidants, it is a rich source of minerals.

-It may decrease the risk of developing diabetes or gallstones.

-It looks, smells, and tastes wonderful.

-It can wake you up, give you energy, and increase your mental focus or "attention."

-EVEN IF YOU DON'T WANT TO DRINK CAFFEINE, decaffeinated coffee has all the above benefits, except the last one- it can't wake you up or give you energy. But it's true: DECAF COFFEE HAS ALL THE HEALTH BENEFITS OF REGULAR COFFEE!

As I see it, that last fact simply means that coffee really has something to offer everyone. Not everyone likes to be heavily caffeinated all day, like I do: I respect that. I do not in the least frown on people who order massive coffee drinks with decaf coffee or nonfat milk.