Beer as "vitally essential"

While the U.S. Supreme Court pretends to deliberate on whether or not to deny health care coverage to some 40 million Americans (we all know how this is going to turn out, don’t we?), a Lithuanian court has ruled that beer is “vitally essential” to that nation’s interests, blocking a strike of workers at a Carlsberg brewery, declaring the making and selling of beer to be an “essential service.” The ruling puts beer in the same class as medical supplies and drinking water. One has to wonder if it wouldn’t have been better for the Obama administration to bring in the Lithuanian lawyers to argue the case for health care insurance being “vitally essential” to our nation’s interests. Or at least they might have been able to raise beer to that stature for our country.

My Colonoscopy

My discharge instructions include: YOU SHOULD HAVE A REPEAT COLONOSCOPY IN 10 YEARS. That’s not likely to happen. It might, should I have some specific reason to have it done. But I’m not going to do it just because that’s what our goliath healthcare industry deems a good thing to do. My doctor first suggested I have a colonoscopy 12 years ago, when I turned 50. That’s the age when all men are supposed to undergo the procedure. I had my doubts. I wasn’t all that concerned, as many men apparently are, about having a roto rooter shoved up my butt. I knew I’d be sedated, and besides, I’ve been through much more painful procedures (sinus and knee replacement surgery come to mind, as do hemorrhoid surgery and a vasectomy). I was more anxious about the day before, when you have to drink 32 ounces of a foul concoction (sodium sulfate, potassium sulfate, and magnesium sulfate), followed by more than twice as much water, and then sit on the toilet as everything in your body that isn’t attached goes shooting like a fire hose into the commode. Oh, and you can’t have any solid food that day, only clear liquids (vodka’s a clear liquid, isn’t it?). Actually, that day went all right; it was uncomfortable, a hassle, but there were no embarrassing accidents or any of the side effects listed on the expunging solution package (seizures and death struck me as most worrisome; vomiting, nausea, bloating, and dizziness seemed almost tame). It was the morning of the procedure that turned out to be the worst part of the experience. The purging of my body of solids and liquids the day before had left me dehydrated and weak. I’d slept nine hours. My mouth was dry, but I wasn’t supposed to drink anything. I took a shower, shakily making my way down the stairs, but had to lie on the bed for a few minutes afterward to regain some strength. Walking into the hospital, I felt like the old man I guess I am. The procedure itself was routine; I was another widget on a colonoscopy conveyor belt (my doctor was doing nine that morning). Everything went smoothly. There was no pain, no real discomfort. Thankfully, when it was over, the nurses gave me three cans of orange juice, and that, combined with the IV that had been stuck in me for an hour, helped with both my dehydration and strength. The doctor deemed me “very healthy,” and I left the hospital for a late, large breakfast of scrambled eggs, hash browns, ham, an English muffin, and two cups of very welcomed coffee – the first solid food I’d had in 40 hours.

So if the whole process went pretty much as I’d expected, without problem or pain, why would I balk at doing it again in 10 years? Aren’t I relieved to know that I don’t have colon cancer? (That’s the rationalization for the majority of us who go through the procedure in the clear.)

Well, I pretty much knew going in that I didn’t have colon cancer. I’m relatively healthy. I eat well. I exercise regularly. I have no history of colon cancer on either side of my family. I’m all for preventive medicine. I go to the dentist twice a year. I see my eye doctor once a year. I go to my dermatologist at least once a year. But I go regularly to my dentist, my eye doctor, and my dermatologist because I have a history of tooth, eye, and skin problems (including skin cancer). Also, all of those visits probably wouldn’t add up in ten years to what this colonoscopy is going to cost (my insurance company, not me). Our health care system is one of the most sophisticated, technologically advanced in the world. But the working philosophy seems to be, use it if you’ve got it. We test because we can. But I’ve tried, and I can’t find the cost-benefit ratio of testing the entire population over the age of 50 for colon cancer – how many cases of colon cancer are found and treated by colonoscopies that wouldn’t have been found and treated at some point down the road from symptoms? Are we being tested because it’s efficient and effective, or because all the technology is in place and so is there to be used (and often owned by the doctors who order the tests)? Couldn’t there be less complicated (and less expensive) screening tests to determine the degree of propensity to any disease or condition before moving to expensive procedures like colonoscopies? That’s how I’m looking at the next 10 years. If someone in my family is diagnosed with colon cancer, then yes, I’ll have another colonoscopy. If my doctor has good reason to believe, through some more simple screening test, that I might be susceptible to colon cancer, then yes, I’ll have another colonoscopy. But I’m not going to have another colonoscopy just because it’s what everyone over the age of 50 is supposed to do every 10 years. That’s the kind of waste that has made our health care system the most expensive, yet one of the least effective, in the developed world.

Myth of Equality

Here’s the problem with both education and health care in this country (and maybe other things as well): We want to provide the very best for everyone — everyone gets a college degree, everyone gets MRIs, CAT scans, knee replacements, etc. But those are unrealistic goals, the Lake Woebegon effect, where everyone is above average, everyone gets what they need. The reality is that that’s not reality. Perhaps it’s an ambition, a goal that we would like to achieve. But policy should face the fact that not everyone can (or should) get a college degree, that not everyone can receive the high-tech, high-priced health care that’s now available to a few. It would be nice to live in an egalitarian society where all are equal and all have equal access to all. It would be nice to live in Shagri-La. But we really need to drop the bar for everyone — if we want all to have equal access — or admit that that is not a possibility and we live, for better or worse, in a culture (like all cultures) of class and that we should make things as good as we can for everyone in whatever class they migrate to (or be stuck in). “Equality may perhaps be a right, but no power on earth can ever turn it into a fact.” — Balzac