Saturday, April 30, 2011

On the royal wedding: a note to its cultured despisers

3-year-old Grace van Cutsem is not amused.
Some of my friends apparently identify with the kid on the balcony. The royal wedding? How anachronistic: "Who giveth this woman to be married to this man?" How tiresomely patriotic: all British Empire and military display. How clichéd: "England's green and pleasant land." What a colossal waste of money - a  £50k forest in Westminster Abbey! Some of these critics are even women.

I confess: I hear them, and I more or less agree with them, and still I got up at 4:00 a.m. and watched the wedding, every minute of it, just as I watched Charles and Diana's wedding 30 years ago, hanging on to every word, every image.

In the evening I came back for more, and when I turned on the TV news, I knew why I can't tear myself away. What are the options? Shelling in Syria. Rising death toll from tornadoes in the American South. Libyan civil war spilling over into Tunisia. Endless political bickering. The only happy news came from London.

The romance! the dress! the hats! the horses! the trumpet fanfares! the choir! the queen all in yellow! the gorgeous young couple, so obviously in love! Do I want to turn from that and blog about union bashing or cow bashing or Obama bashing? I don't think so.

I mean, what's the reason some of us get exercised about politics and the economy and international relations, anyway? Isn't it because we have a dream of love and beauty and peace for all? Don't we want to affirm the words spoken by the Bishop of London yesterday, that "every wedding [should be] a royal wedding with the bride and the groom as king and queen of creation, making a new life together so that life can flow through them into the future"?

As "we stand looking forward to a century which is full of promise and full of peril," can't we agree with the bishop that "we shall not be converted to the promise of the future by more knowledge, but rather by an increase of loving wisdom and reverence, for life, for the earth and for one another"?

To be sure, the bishop pointed out that "personal relations alone will [not] supply meaning and happiness in life. This is to load our partner with too great a burden." And royal weddings, of course, will not eliminate poverty or dictators or conspiracy theorists. But when 2 billion people gather around the TV set to watch a wedding (or a funeral or the Summer Olympics), it is not mere escapism - it's a celebration of the things that give life meaning, the values we share that we hope, by our political involvement, to extend to as many people as possible.

Saturday, April 23, 2011


In 1968, 179 east London machinists walked off the job and changed history. The machinists weren't complaining about having to work long days in an airless room that quickly became unbearably hot. They objected to being classified as unskilled workers when  their work - making seat covers for Fords - required a great deal of skill. They also objected to being paid considerably less than fellow workers who were less skilled than they were. And they objected to, year after year, being patronized, lied to, and eventually ignored by union officials. The 179 machinists, of course, were women.

Made in Dagenham is funny, sassy, infuriating, and occasionally moving. Watch it for an evening's entertainment, or watch it to remember - or to learn - what life was like only 43 years ago. 1968 was the year when Martin Luther King and Robert Kennedy were assassinated. It was the year of the Tet offensive and the My Lai massacre in Vietnam. Student protests, especially in France, were huge. The Beatles sang about Lady Madonna ("wonder how she manages to feed the rest?"). They might well wonder - women earned less than 60% of what men earned, and it didn't look like things were going to get better anytime soon.

Of course women should have equal pay, some of the more enlightened men-in-charge told us. But these things take time. You can't expect things to happen overnight. Making demands will get you nowhere. That's what the same enlightened men-in charge-had been saying about civil rights for people of color just a few years earlier. And that's what the weaselly union and business leaders told the women machinists in east London.

Fortunately, the women machinists didn't agree.

In 1968 I taught history and French at a small private high school. The pay scale had three levels: married men earned approximately $7000 a year; single men earned about $6000, and women earned about $5000. The English teacher, the German teacher, and I thought this was not quite fair. All the married men had working wives. We, however, though women, were all married to students and were the sole support of our families. Why shouldn't we earn as much as the married men?

We wrote a polite letter of inquiry to the people responsible for our paychecks. We made no threats; we merely asked for an explanation. Immediately our principal got a terrified phone call from his board chairman. "What's this I hear about a teacher's strike?" the man wanted to know.

Unlike Rita O'Grady, the spunky heroine of Made in Dagenham, we didn't strike. We didn't do anything, in fact: we were nice girls. Those were the days, my friend. I'm glad they finally ended.

Monday, April 18, 2011

Where to get excellent hospital food

Are you looking for a hospital that provides gowns that actually cover your rear, that lets you stay until you feel well enough to return home, and that - get this - gives you excellent food three times a day?

My friend Lilliam Hurst is currently being treated at the Clinique Générale-Beaulieu, which not only does all of the above, but also offers breathtaking mountain views from her window. Here's a sample of what Lilliam has been eating:

Breakfast: whole grain bread, yogurt, freshly squeezed grapefruit juice, coffee

Salad: arugula with pine nuts

Another salad - and the flower is edible

Feuilleté d'asperges vertes

Parmentier de canard au céleri

Dessert: Canary Island bananas with berries and caramel sauce

Dessert: terrine de mangues et framboises

Lilliam's hospital is in Switzerland, a country where health care is 12.5% less expensive, per capita, than in the United States - and where every citizen is insured. She is allowed 10 days in hospital for a procedure that in the United States is usually performed as outpatient surgery. Despite the fine food, however, she plans to leave sooner. She says she sees no reason to contribute to rising health-care costs.

Here's a glimpse at this week's menu:



Saturday, April 2, 2011

The Medicaid card: a useless piece of plastic?

Quotation of the Day from "Today's Headlines," an e-newsletter from the New York Times:
"My Medicaid card is useless for me right now. It's a useless piece of plastic. I can't find an orthopedic surgeon or a pain management doctor who will accept Medicaid."
--NICOLE R. DARDEAU, a nurse in Opelousas, La.,
who needs surgery for herniated discs in her neck.
I found this especially interesting since just yesterday I learned that the highest-salaried doctors in the United States are orthopedic surgeons who specialize in the spine.

The problem is not limited to orthopods, of course. As the linked article by Robert Pear, "Cuts Leave Patients with Medicaid Cards, but No Specialists to See," points out, physicians across the board are turning away patients enrolled in the Medicaid program, which is supposed to assure health care to our poorest citizens.

To compound the problem, as states cut Medicaid payment rates for doctors - 20 states did so last year, 16 more states propose doing so in 2011 - people are swarming onto the Medicaid rolls. "Medicaid will soon be the nation’s largest insurer," Pear writes. "It accounts for almost half of the increase in coverage expected under Mr. Obama’s health law."

It's easy to throw blame around for our country's health-care problems: we've been doing it for years, to no appreciable effect. Democrats blame Republicans for doing nothing, and Republicans blame Democrats for doing the wrong thing. Consumers blame greedy doctors, hospitals, insurance companies, and pharmaceutical companies. Doctors blame greedy lawyers, the high cost of medical education, and inadequate reimbursement.

Hold your blame, folks, no matter how certain you are of your opinions. Blame could justifiably be attached to any or all of the above. The underlying problem, though, is neither greed nor bad law nor a broken system.

The underlying problem is that the United States, unlike all other developed nations, has no system at all. Nor do we have the non-system of a genuinely free market with open pricing, vigorous competition, and informed consumers. And until we get some sort of unified approach to health care, prices will continue to rise, accessibility will continue to fall, and Americans will continue to die younger than we need to.

At last count, people of 27 other nations live longer than we do. All 27 pay considerably less per capita for health care.

Friday, April 1, 2011

Health care: a simple solution for April Fool's Day

Kathy Magliato belongs to one of America's tiniest and most elite groups: she is a female heart surgeon.

It's been exactly 50 years since Nina Braunwald, Ann McKiel, and Nermin Tutunju became the first women certified by the American Board of Thoracic Surgery. Since that time, writes Magliato, only about 180 additional women have been certified. None of them, I discovered, are practicing at the nation's three top-ranked cardiac hospitals (see my review of Magliato's book at The Neff Review). Magliato, still in her 40s and the married mother of two small children, is a genuine pioneer.

So when she wrote, "I am uncertain that the health care system, in its current state, can survive much longer," I readily agreed. And when she added, "It is such a shame, really, that no one can figure out what is wrong when the problem is very simple," I thought, She's going to propose a revolutionary solution that will finally restore sanity to our health-care morass! After all, the woman is not only a surgeon, but also an MBA.

But when I read her proposal, I expected her to pop up and shout "April Fool!"
If the insurance companies would simply pay what they are billed rather than just choosing to pay whatever they feel like paying, the health care system will stabilize and there will be plenty for all.
Say what?

Hey, I'm no fan of the way America's for-profit insurance companies do business. But let's take a quick look at what hospitals bill vs. what insurance companies pay. This winter my husband had outpatient hernia surgery. According to Blue Cross Blue Shield's estimation of benefits forms, the total billed (from doctors, labs, and hospital) was $10,313. BCBS negotiated a discount of $6,646, or 64%, so the total paid came to only $3,667. Of that, the insurance company paid $2,526 and we paid $1,141.

Now in Magliato's perfect world, the insurance company (or we and the insurance company together) would pay the whole bill. In other words, we would pay nearly three times as much as we actually did pay. This money, of course, would come out of our pockets one way or another.

If Magliato's simple solution were applied, insurance companies would have to nearly triple their rates in order to pay whatever medical providers wish to charge. Instead of today's family average of $13,770 (for families lucky enough to have good coverage at work), the average annual cost would jump to nearly $40,000. If workers continued to pay approximately 30% of the insurance premium out of pocket, we'd all be paying about  $1000/month for coverage (in addition to the $2000-2500 our companies would be paying), and either our salaries would drop or the cost of goods would rise precipitously to allow for such generous benefits.

And, of course, if medical providers knew the insurance companies would pay whatever they were charged, medical cost inflation would outpace anything previously seen in world history.

Dr. Magliato's solution is breathtakingly foolish. But she's right about one thing: our health-care system, with or without the Affordable Care Act, is such a mishmash of ill-considered practices that its very survival is in jeopardy. Because, as author T.R. Reid points out, we don't have a system at all. What we have is a crazy quilt.

HEALING HEARTS by Kathy E. Magliato

The January 2011 paperback
edition is retitled Heart Matters.
There are many good reasons to read Healing Hearts: A Memoir of a Female Heart Surgeon.

Maybe you're inspired by success-against-all-odds stories, especially when the author is a lively straight-shooter with a wry sense of humor.

Maybe you're a fan of House or Grey's Anatomy or other medical dramas, and you'd like to know what really goes on in a hospital. (Hint: it's not as sexy as you might think.)

Maybe you'd like to know more about what it's like to be a woman in a specialty where women are almost nonexistent:
Since 1948 the [American Board of Thoracic Surgery] has awarded approximately 7,400 certificates.... In 1961 the board certified its first woman.... From 1961 to 2008, ... only 180 [certificates] have been awarded to women.
(I just searched the "Find a Doctor" data base for Cleveland Clinic, for years the #1 ranking heart hospital in US News's annual rankings: no female heart surgeons on their Cleveland Campus. So I tried Mayo Clinic, hospital #2: zero in Rochester, MN. Johns Hopkins, #3: zero. Texas Heart Institute / St. Luke's Episcopal, #4: one! Note to my granddaughters: the field is wide open.)

Maybe you're curious about how Magliato - who sometimes works 24-hour days, frequently gives speeches, invented a device to assist heart patients, earned an MBA on the side, and, of course, wrote this book - manages to maintain a good relationship with her husband and their two young sons, as she claims she does:
Life is too short not to have it all.... If I can do it, anyone can.
Yeah, right.

On the other hand, you probably won't want to read Healing Hearts if
you crave sympathy for your own hectic days, or if you're looking for practical ways to balance work and family - unless you, like Magliato, have relentless ambition and energy to burn.

You probably won't want to read it if you have low tolerance for self-promotion: achievement is extremely important to Magliato, and she never neglects an opportunity to mention her accomplishments.

You certainly won't want to read it if you're facing open-chest surgery and need reassurance that nothing can possibly go wrong. Things often go wrong - more things than you might imagine, and Magliato is happy to tell you about them.

And if you're struggling to get by in America's foundering economy, parts of this book may raise your blood pressure to dangerous levels. In an astoundingly tone-deaf chapter, "Where Have All the Good Times Gone?" Magliato complains that her rates are less than her hairdresser's, notes that at age 45 she is still paying off student loans, expresses concern that new medicines and technologies are making surgery less necessary, and takes comfort in the fact that congestive heart failure is on the rise.

If I can't shed a tear for her plight, it's because a recent physician compensation survey shows cardiac and thoracic surgeons to be the fourth-highest-paid U.S. specialty out of the 69 listed. The average salary for a heart surgeon is $533,084; not as high as that of an orthopedic surgeon who does joint replacements ($605,953), but considerably higher than, say, that of a pediatric endocrinologist ($187,957) or a geriatrics specialist ($187,602). Magliato works hard and deserves adequate compensation, but she could have stated her case more tactfully.

Still, Magliato is a genuine pioneer, and pioneers are rarely soft-spoken and cuddly. She has had to summon the strength not only to put herself through decades of higher education, but also to stand up to sexism at every step along the way. She has had to work longer hours under more strenuous conditions than most of us will ever dream of, and at the same time she has had to fend off criticism about how she relates to her husband and children. You need a triple dose of chutzpah to do what she has done, and I applaud her for her success.

But please, Dr. Magliato, stop saying anyone can do it. You may think you're being modest, but really you're just making us normal people feel inadequate.