Half Changed World

I don’t have a lot of energy to post tonight, but I wanted to be sure to share Families USA’s website on how to contact your representatives to urge them to support the bipartisan SCHIP reauthorization against Bush’s veto threat.

Or call tollfree: 1-866-544-7573 — thanks to SEIU.

Some quick points:

• In a country as rich as this one, no one should have to choose between taking their kid to the doctor and having enough to eat, or having the heat turned off.
• Kids with insurance are more likely to get preventative care, more likely to be seen when sick before something minor becomes something big.
• Families with insurance are more likely to get to make doctor’s appointments, rather than have to wait to be seen in a clinic or ER.  That means their parents don’t lose as much pay.
• Covering children is actually remarkably cheap as good public policies go, on the order of $2,000 per child per year.
• In the states that are covering higher income families, they’re requiring families to put up copays and premiums.  It’s not a free ride.
• As far as I can tell, the Bush Adminstration’s main complaint about SCHIP is that it works, and that other people might start asking why they can’t buy into public health insurance pools.
• On the radio this evening, Dennis Smith was claiming that the problem with expanding SCHIP is that it would create adverse selection against private insurance programs, by making the insured pool older and sicker.   Funny, the Administration doesn’t seem to worry about adverse selection when it comes to their proposed tax subsidy solution to uninsurance.
• When the Administration starts talking about crowd-out, they never talk about the quality of the private health insurance plans that people are abandoning.  In many cases, they’re insurance in name only, with overly high deductibles — or worse, ridiculously low annual limits.  In some cases that’s because the employers are being stingy, but just as often, it’s because they’re desperately trying to find a way to keep offering health insurance in the face of constantly rising prices.
• In a country as rich as this one, no one should have to choose between
  taking their kid to the doctor and having enough to eat, or having the
  heat turned off.  Yeah, I know I said it before, but it’s worth repeating.

Update: go read Cecily’s post on health insurance

Point of evidence #1: The Cho family speaks out.

Point of evidence #2: David writes about his brother.

Point of evidence #3: One in four children in Virginia’s foster care system are there because it’s the only way to for them to get mental health treatment.

My mother in-law is getting a new car, and she very kindly offered to give us her old one.  It’s 4 years newer than our second car, and was a much nicer car in the first place.  The catch is that it’s a stick shift, and I haven’t driven one in approximately 11 years.  Ok, everyone promises it will come back to me.  I spent some time practicing in an empty parking lot, and then last week I started using it to drive to the metro station.

Overall, it’s gone pretty well.  Yes, I’ve stalled out at stop lights a few times, but overall the drivers around me have been remarkably gracious about waiting for me to get the car moving again.  After a week and a half, I’m doing a lot better, and am no longer terrified.

Or at least my conscious mind is no longer terrified.  My body seems to have a different opinion.  Every day last week, I needed to use the bathroom pretty much nonstop from when I woke up until I left for work, and by Friday, I felt sick pretty much all day.  I was fine over the weekend (when I drove our automatic transmission minivan) and then my gut acted up again Monday morning.  Not fun.

So, I spent some time on Monday googling, and wound up downloading two MP3s from this hypnosis site, one on stopping irritable bowel syndrome,* and one on overcoming fear of driving.  Since the problem was clearly originating in the mind-body
link, it seemed logical that was a good place to start trying to fix
it.  And telling myself that I was being ridiculous didn’t seem to be
helping.  I’m pretty sure that hypnosis can’t hurt, and the downloads are cheap enough that it was worth a try.  I listened to them on both Monday and Tuesday, and yesterday my gut was better and today was better yet.

I told T, and he said he was glad it was helping, even if it was the placebo effect.  My response was "what exactly do you think is the difference between hypnosis and the placebo effect?"  As far as I can tell, hypnosis is essentially a way of harnessing the power of mind over body that makes the placebo effect work.  I suppose you could test whether hypnosis directed at a specific goal was more effective than just putting someone in a trance and not making specific suggestions, but that would only work if you were able to get people into enough of a trance that they didn’t know what you had said.  (I  personally have no idea what’s on either MP3 I listened to between the introductory section and the ending, but I’ve had that happen in meetings too.)

* The MP3 begins with a disclaimer that only a doctor can diagnose IBS and that you should seek medical treatment, etc. etc.

If you want to send a note to Elizabeth Edwards, the campaign has set up a page for people to write to her.  I know she’ll be in my thoughts and prayers. 

My guess is that John would have suspended his campaign (as was inaccurately reported this morning), but that Elizabeth told him no way.  I hope she stays in good health for as long as possible.  That family has certainly had its share of heartbreak. 

Last year, Landismom wrote that the essence of organizing is to give people anger, hope, and a plan.  In that spirit, I offer these links:

• Anger:  I was filled with fury at this story in today’s Post, about a 12 year boy who died for want of a dentist.  By the time he was seen, the infection in his abscessed tooth had spread to his brain.  My office is opposite the break room at work, and all day I heard my coworkers exclaiming in outrage as they picked up the newspaper.  We work on poverty issues, and so sometimes we get a little jaded, lose a little of our outrage.  But this story hit home.
• Hope:  Via Miriam at Everyday Mom, and Nanci at From the Mom Zone, I read about Wakanheza, a program of the Ramsey County public health office to get people to identify people in stressful situations and reach out with a helping hand.
• A Plan: Campaign for Children’s Health Coverage.  Insuring all children is only a start of a solution — adults need health insurance too.  But kids are relatively cheap to insure, and there’s an existing program — the State Children’s Health Insurance Program — that provides a lot of the framework for doing so.  And it’s up for reauthorization this year.  So sign the petition, and write your Senator and Representative.

I’ve had Ella’s Song stuck in my head for half the day.  I’d like to see as many people learning about the death of Deamonte Driver as about the death of Kyle Miller.  (And yes, I know the odds of dying from an abscessed tooth are probably about as low as the odds of dying from seat belt failure.  But a kid shouldn’t have to walk around with his teeth rotting out of his mouth for months either.)

Today I’m reviewing two books that were sent to me by their publishers.  Both are about health and disease prevention, and have a forward or introduction (what’s the difference?) by the authors of YOU: The Owner’s Manual.  One focuses on kids, while the other is organized decade by decade, from pre-natal to "the eighth decade and beyond."  Both of them basically tell you to exercise regularly, eat your veggies, and wear sunscreen.

First up is the book about kids: Good Kids, Bad Habits: The RealAge Guide to Raising Healthy Children, by Jennifer Trachtenberg, MD.  The email I got offering me the book showed the cover, which has the title spelled out in refrigerator magnets, with a carrot and some broccoli magnets thrown in for good luck, so I knew it was likely to push some buttons for me.  As long-term readers of this blog know, I have some issues around nutritional advice for parents — I know darned well what a healthy diet looks like, and that my older son’s diet isn’t quite making it to Planet Power but have more or less accepted that we can only control what we offer him, not what he eats.

So, when I got the book, I was predictably irritated by the blithe assumptions that involving children in food prep and cutting food into fun shapes would be enough to win over a picky eater.  But I was somewhat surprised (and pleased) to see that the book covers far more than nutrition, covering topics from good hygiene (wash your hands, floss your teeth) to safety (buckle your seatbelt, wear a bike helmet) and emotional well-being (spend one on one time with kids, develop relationships with extended family).  Overall, the book offers pretty solid, standard advice. 

My fundamental concern about the book is who is the audience for it.  It seems to me like the sort of well-educated middle-class parents who are likely to buy this book will generally know almost everything that’s in it already.  Certainly, that seems to be the conclusion of the parentbloggers who have reviewed it.  Anxious new parents might buy it, but relatively little of the book is about babies. Maybe it could be a text for a parenting class?  Or you could give it to grandparents who might listen to a doctor about seat belts more than to their children?  I don’t know.  I find it pretty hard to imagine anyone reading the book cover to cover.

The second book is The Checklist: What you and your family need to know to prevent disease and live a long and healthy life, by "Dr. Manny" Alvarez.  I focused on the chapters for 0-9 (the age of my children) and 30-39 (that would be me). 

The chapter on young children suffers from the problem that they’ve only got 38 pages to cover a huge developmental range.  So Alvarez makes no attempt to discuss the full range of health issues, but rather goes through a checklist of topics that you might have heard about in the news — cord blood, circumcision, vaccines, autism, ADD.

The chapter on 30-something adults has a different problem, that there are very few health problems that are unique to this age group.  So instead you get a bland discussion of nutrition, skin care, and urinary tract infections, and then a laundry list of ailments that (fortunately) relatively few people in this age group are actually likely to experience, from cervical cancer to MS.

Fundamentally, I think the decade by decade organization just doesn’t work.  Good preventative habits don’t really change that much from decade to decade, and the litany of diseases would have worked better in simple alphabetical order.   The only people I could imagine reading this book cover to cover are hypochondriacs looking for new diseases to obsess about.

Also, the writing/editing was sloppy.  For example, from the circumcision discussion: "The AAP also found that the risk of penile cancer in an uncircumcised man is three times more likely than in a circumcised man, though penile cancer is rare in the United States, just one in one hundred thousand males has it."  Someone get this man a semicolon.

When people ask me what aspect of parenting has been the biggest surprise to me, my answer is always that I didn’t realize how much time I would be sick.  I’ve been coughing or sneezing pretty much constantly since the new year.  That’s why I don’t buy the argument that exposure to lots of germs in preschool means that kids won’t get sick later on — if that were true, I should be immune to just about everything by now.

It hasn’t been a terrible winter in terms of illness — no one has ended up in the hospital or the ER, which is my primary measure of success — but it hasn’t been a great one.  D’s been on oral steroids twice for his asthma, which doesn’t make me happy, although he seems to be doing much better now that we’ve increased his maintenance dose of Qvar.  We also have an appointment for him to see the allergist next week.  And N’s now on oral antibiotics for an ear infection, as well as a topical antibiotic for impetigo.  I feel kind of guilty about that one — we had assumed that he had just rubbed the skin under his nose raw from the constant drippage, but as soon as the doctor saw it, she said it was an infection.

And N was complaining about an ear ache for several days before we finally brought him in.  We got the memo that many ear infections will go away without antibiotic treatment, so were giving him advil and waiting and seeing.  But when his fever started to come back, I concluded that this wasn’t going away on its own.

I hate having to make these decisions.  This is why the Republican argument that the problem with our health care system is overuse drives me crazy.  I’m smart and well educated, but I didn’t go to medical school.  I probably err on the side of avoiding going to the doctor, because I know that there’s not much they can do for routine colds.  But this means that sometimes with hindsight I wish I had gone sooner.  It’s nuts to make it more expensive to bring a kid in for a doctor or nurse to take a look, just in case.  Because the one night that D spent in the hospital with asthma two years ago cost our insurance company more than all the medical treatment everyone in the family has received put together since.

Update:  N puked in the middle of the night.  Is it the Amoxicillan?  Or another bug?

I’m watching the state of the union address and trying not to grind my teeth. 

I’m expecting that the most interesting part of the speech will be the health care proposal.   Based on the advance info, it’s a terrible proposal, but I think it’s massively significant that Bush feels a need to have a health care proposal.  12 years after the crash and burn of the Clinton health care proposal, the demand for change seems to have outweighed the ghosts of Harry and Louise.

The one part of the Bush proposal that I agree with is that it doesn’t make sense for employer-provided health insurance to be fully tax exempt, with no limit.  It costs the government a huge amount of money, and mostly benefits the wealthy and middle-class.  I’d be happy to limit it if the funds went to something that was actually going to expand coverage.

But it’s nuts to think that everyone is going to buy health insurance on the individual market.  It’s way too expensive for low-income families (and a tax deduction doesn’t help those who don’t owe income taxes) and out of reach for anyone with a pre-existing condition.  One of my friends who lives in Massachusetts says that the plans there are costing 2 -3 times more than estimated when the individual mandate law was passed.  Health insurance has to involve risk pooling or it’s just a way of smoothing out spending over time.

Some links:

• Urban Institute analysis of the plan.
• Ezra Klein at TAPPED on the plan.
• Paul Krugman’s column and further explanation.  (You can find these copied out from the select wall at Economist’s View which also has a roundup of other comments on the plan.)

Ok.  I was wrong.  The proposal to reduce gasoline usage by 20 percent in the next 10 years is more interesting than the health insurance.  I have no idea how he thinks we’re going to achieve this.

This morning, the Census Bureau released the 2005 poverty figures, as well as data on income and health insurance coverage.

• The official poverty rate was 12.6 percent, statistically unchanged from the 2004 level (12.7 percent).  The Administration may try to spin this as good news, but it’s really a sign of how little the benefits of this "recovery" are spreading.  As my friends over at the Center on Budget and Policy Priorities point out, it’s unheard of for poverty to still be higher four years into a recovery that it was at the low point of the recession.
• Median household income increased slightly, even though median earnings of year-round full-time workers, both male and female, fell slightly.  I think that has to mean more people per household were working, or were working more hours.
• I think the biggest story in this release is the decline in health insurance coverage.  46.6 million people in the US didn’t have health insurance, for an uninsurance rate of of 15.9 percent.  And that figure would look much worse if there hadn’t been a big expansion of public insurance for children in the 1990s.  I just don’t see anything turning around the movement away from employer-provided coverage.  I read something recently (in the New Yorker, maybe?) that argued that the campaign to require WalMart to provide health insurance benefits is really a back door way to try to get universal coverage, by getting employers to push for it.  Makes sense to me.

For those of you looking for a Tuesday Book Review, I’ll be posting about The Price of Privilege tomorrow.

D’s been off his asthma medications for a couple of months.  He hasn’t had a real attack since the first one, in February 2005.  Last winter, we treated every cough as if it might be asthma-related.  He’s been totally symptom free since the spring, and his pediatrician agreed that we might as well see how he did without the steroids.  There’s pretty good evidence that long-term use of inhaled steroids retards growth slightly, and lord knows that he could use the extra inches.

He’s got a cold, and a little bit of a cough.  School’s about to start, and I’ve read the study showing the dramatic peak in attacks among school-age kids in September and October.  The doctors quoted in that article argue forcefully that asthma should be treated as a chronic, not episodic disease.  But a lot of kids also grow out of asthma.  No one’s been able to give me an answer as to how to find out of he’s outgrown it other than keeping him off the meds and seeing what happens.