Senior Editor

ehealthMD.com

An intriguing new study published in the journal Pediatrics suggests that messages about SIDS prevention might not be getting to parents, despite millions of “back to sleep” and stop-smoking brochures. SIDS (Sudden Infant Death Syndrome) is the unexplained death, usually during sleep, of a seemingly healthy infant, most frequently between two and four months of age. The incidence of SIDS deaths has decreased dramatically in the United States since 1983, starting at 1.4 deaths per 1,000 live births and decreasing to .056 by 2001. But the decrease pretty much levels off after that, hovering around .5 per 1,000 live births through 2006, the last year for which the CDC has data. SIDS claimed 2,234 infants lives in 2006 (the last year for which the CDC has data), making it the third leading cause of death in this age group.

One reason for the decline is heightened awareness of risk factors for SIDS. Rates dropped most dramatically in the early 1990s, correlating with the American Association of Pediatrics “Back to Sleep” campaign, which began in 1992. The National Institutes of Health (NIH) followed suit in 1994.  The campaign is straightforward, its core advice being to place infants on their backs when putting them to sleep. And the evidence is substantial: Infants who sleep on their tummies are 12.9 more likely to die in their sleep than are those who sleep on their backs. The campaign adds a few other pieces of advice, like not smoking around your little ones and avoiding pillows, heavy blankets, and soft bedding, and it’s obviously had an effect. After all, a 50 percent drop isn’t bad.

But why the plateau? There are a number of other important risk factors for SIDS, usually categorized as “non-modifiable,” meaning they can’t be changed. For instance, being male or being born during the fall or winter months both increase the risk of dying from SIDS.  Other risk factors include happening to be born Hispanic or African-American, or happening to be born poor (two factors that, in the United States at least, all too often go hand in hand). We also know that some infants, risk factors or no, are simply more likely to stop breathing and be unable to start up again. Recent studies suggest that abnormalities in the brainstem may prevent infants from responding to breathing challenges.  But those physiological abnormalities are much more likely to occur in infants exposed to risk factors — for instance, an infant whose mother smoked cigarettes while she was pregnant.

In the study published this week, researchers focused on those modifiable risk factors. Study authors Barbara M. Ostfeld, PhD and Thomas Hegyi, MD, professors in the Department of Pediatrics at UMDNJ-Robert Wood Johnson Medical School, found that more than 96 percent of infants who died of SIDS in 2006 were exposed to known modifiable risk factors, including sleeping on their side or stomach or exposure to tobacco smoke. More than three-fourths (78 percent) of SIDS cases involved multiple risk factors. Rightly, they conclude that there’s a lot of potential for improvement in communication between health-care providers and parents, especially parents-to-be: “The study provides evidence that despite a decline in SIDS, a continuing effort should be made by health-care providers to educate parents and other caregivers and to do so with attention to all identified risk factors, as recommended by the American Academy of Pediatrics (AAP).” In other words, they suggest that the decline in SIDS deaths has plateaued because there’s a failure in communication between health-care providers and parents.

But it’s more than a failure of communication and education that’s leading to excess SIDS deaths in the United States. It’s a failure to recognize that parents and families live in complex networks of interpersonal relationships, communities, media advertising, cultural histories, and more. Each of these factors influences people’s choices about whether to adopt known risk reduction practices, whether it be reducing the risk of SIDS for their infants or heart disease for themselves.  What pregnant teen do you know who’s going to outvote grandma when she insists that her new grandbaby will sleep more soundly on his tummy (she’s right… and that’s the problem. Baby is likely to sleep so soundly that he won’t wake up if he stops breathing). I think of a young mom who took a CPR class from me recently. When I announced a smoking cessation class to be held in our rural community, she groaned, “Oh… my uncle is going to make me go!” This was after she enthusiastically affirmed my inclusion of smoking on a list of SIDS risk factors: “Oh, yes. Smoking is the biggest problem.”

So is the SIDS communication gap really because health-care providers need to provide more education to parents? I say no. We can educate all we want, but that’s not going to change people’s health behaviors — even when it comes to our kids. Maybe the real SIDS communication gap lies not in what health-care providers aren’t telling parents, but in what they’re not asking them.

This post is to get technorati to list blog.ehealthmd.com

But in the world of health and health-care reform, my bet is on Michelle.

Why? Health-care reform is desperately needed in the United States. We need to rein in health-care spending and ensure that everyone has access to affordable health-care. You’ve heard it before, and I’ll say it again: We Americans spend more money on health care, and we have poorer health, than any other developed nation. And kudos to Barak Obama for taking it on. Whether the current initiative succeeds or not, the issue has finally become the national discussion that it needs to be. But no matter how effectively or efficiently we rein in health-care costs, and no matter how equitably we disperse health-care resources, we’re fighting a losing battle unless we address obesity.

Health problems associated with obesity are going to overwhelm our health-care systems, our families, our communities, and our economic stability unless we do something about it, and do it now. Obesity costs us far more than we know, not only because of its immediate effects but its effects on chronic diseases. People who are overweight or obese are much more likely to experience heart and blood vessel disease including sudden cardiac death and stroke, hypertension, high blood cholesterol, diabetes, cancer, asthma and other breathing problems, difficulty sleeping, orthopedic injuries, depression, and more.  In 2003, we spent $75 billion of our health-care dollars on obesity, about half of which came from public sources. By 2018, we can expect to spend $343 billion on health-care costs related to obesity. That’s $1425 per person, compared to $316  per person in 2008. And we’re not even talking about lost productivity or other indirect costs associated with obesity, nor the costs to the health-care workforce in  back injuries and more as they try to move those obese patients around.

We Americans are fat — and getting fatter. Two-thirds of adults in the United States are overweight or obese. Even more troubling, the proportion of those who are obese appears to be on the rise. The prevalence of obesity in the United States increased from 19.4 percent in 1997 to 27.6 percent in 2009; the rate was highest among people ages 40 to 59 (31.8 percent). For a striking visual look at obesity trends, take a look at the Centers for Disease Control and Prevention (CDC) graphic representation of their data at http://www.cdc.gov/obesity/data/trends.html. And just in case you Brits are chuckling, take a look at the Foresight Report’s predictions: by 2050, 60 percent of adult men, 50 percent of adult women, and 25 percent of children in the U.K. could be obese.

Right now, the bulk of our spending on obesity-related illnesses is among older adults. You know anyone who hit their 40s, 50’s, or 60’s who suddenly put on a few pounds? The negative effects of obesity on those people’s general health didn’t start until their middles began to spread in middle age.  But a whole new generation of kids is coming up the pipeline — and they’re fat already. The prevalence of obesity among children as young as two years of age increased dramatically between 1980 and 2004. By 2004, nearly one out of ten children between aged two to five were obese.  By the time they reach adolescence,  one-third (33.3 percent) of U.S. kids are overweight or obese.  The chance that those children will make it to adulthood without serious health problems are slim indeed. A recent CDC study (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5902a1.htm) suggests that they might not even have to wait that long.  When researchers analyzed results from the National Health and Nutrition Examination Survey (NHANES) for 1999–2006, they found 20 percent — that’s one out of five — adolescents in the United States already had abnormal blood lipids (translate: high total cholesterol levels and/or high levels of “bad” cholesterol and triglycerides). In other words, they already have heart and blood vessel disease.

So will Michelle Obama’s “Let’s Move” initiative really address the problem? I’ve only taken a quick look, but it’s heading in the right direction by recognizing that overweight and obesity are caused as much by community factors — such as the distance to grocery stores versus fast food outlets — as by individual choices. Even more fundamentally, the initiative seems to recognize that individual choices are themselves the result of community factors. That’s a topic for another post.

It’s also a reminder that often it is in the personal sphere that we are most effective at creating real change. I’m reminded of those famous remarks delivered by First Lady Obama’s predecessor, Eleanor Roosevelt, at the United Nations in March 1 953: “Where after all do universal human rights begin? In small places, close to home – so close and so small that they cannot be seen on any map of the world. Yet they are the world of the individual person: The neighborhood he lives in; the school or college he attends; the factory, farm or office where he works. Such are the places where every man, woman, and child seeks equal justice, equal opportunity, equal dignity without discrimination. Unless these rights have meaning there, they have little meaning anywhere. Without concerted citizen action to uphold them close to home, we shall look in vain for progress in the larger world.”

Add health as one of those fundamental human rights to be found in our neighborhoods, schools, and workplaces, and you’ll understand why my bet is on Michelle.

Second, Anthem Blue Cross of California, a division of WellPoint, announced that it’s ready to take the lead in that increase in health-care coverage costs. The company received a scolding from Department of Health and Human Services Secretary Kathleen Sebelius after it announced a whopping increase in the prices of its policies next month — as much as 39 percent on individual policies. The rate hike, Secretary Sebelius pointed out, is more than 15 times the rate of inflation. Nor is WellPoint suffering. The company posted a $2.7  billion profit in the last quarter of 2009. She admonished the company that the premium increase will make health insurance coverage unaffordable for “hundreds of thousands of Californians, many of whom are already struggling to make ends meet in a difficult economy.”

Back in July 2009 when the “public option” (i.e. the creation of a government-sponsored health-care plan) was still on the table, Wellpoint spearheaded a campaign against it. In an email to about 100,000 stakeholders, Wellpoint execs suggested “that President Obama’s idea of adding government competition into the health-care mix is ill-advised” (hat-tip to Ceci Connelly at The Washington Post: http://voices.washingtonpost.com/health-care-reform/2009/07/wellpoint_launches_battle_agai.html).

And now, in a marvelously circular argument, WellPoint executives are defending their rate hike as follows: Economic woes have lead many of the healthier people in their insurance pool to cancel their policies and take their chances, leaving only the sickest people in the pool — hence, the cost per person has increased.

I can’t think of a better option for a government-sponsored health-care plan. Can you?

ehealthMD Senior Editor

I breathe a sigh of relief when I read headlines like the one at the top of The Lancet’s home page this week: “Retraction—Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.” In (somewhat) plain English, that means the editors of The Lancet, a leading medical journal, have retracted an article published in 1998 that purported to establish a causal link between vaccines – specifically the mumps, measles, and rubella (MMR) vaccine – autism, and gastrointestinal disorders.  After the study was published, parents began to abandon the vaccine in droves — leading to outbreaks of measles in Great Britain and the United States and fueling the general anti-vaccine fire.

Although The Lancet had previously said it shouldn’t have published the research, it wasn’t until the British Medical Council gave a stinging slap to the paper’s lead author — Andrew Wakefield — that the Lancet editors finally retracted the paper in its entirety. Last week, the Council found that Dr. Wakefield had acted unethically, showing a “callous disregard” for the children in his study. For the study, Dr. Wakefield took blood samples from children at his son’s birthday party. Each child was paid 5 pounds sterling ($8) for their contributions, and Wakefield was said to joke about the incident afterward.

The story of the Lancet’s retraction hit the airwaves yesterday with a small explosion  But if you read beyond the first few paragraphs in most of the media’s coverage, you’ll find that the reporters filing the story found it necessary to quote from the “other side.” Enmeshed in all those stories are quotes from parents and anti-vaccine activists who remain convinced that the connection between autism and vaccines is irrefutable.

I know, it’s “balanced” journalism. But where’s the balance? There really is no debate about autism and vaccines. Study after study, including studies of studies, and reviews of those studies of studies, have failed to establish any causal link. So why did reporters from CNN feel like they needed to interview  people like Rebecca Estepp, a spokeswoman for Talk About Curing Autism?

“Estepp said her son has autism and bowel problems. She said she remains convinced that he had a vaccine reaction and that Wakefield’s research helped doctors identify how to help her son.

“I guess the GMC can say whatever they want to say for the rest of their existence, but I know that my son got better because of Dr. Wakefield,” she said” (http://www.cnn.com/2010/HEALTH/02/02/lancet.retraction.autism/index.html).

I feel for Ms. Estepp — and all of the other parents whose children have autism or other pervasive developmental disorders. But there’s no justification for medical journalists to continue to perpetuate a harmful myth that has led to unnecessary disease, disability, and even death, especially when the real story is that the myth has finally been busted.

On the other hand, kudos to ABC news, who didn’t succumb to the temptation to “balance” the story but instead emphasized the negative effects of the paper, many of which will never be undone:

“Dr. Gregory Poland, editor-in-chief of the journal VACCINE and director of the Mayo Vaccine Research Group in Rochester, Minn., called the Lancet’s action merely ‘procedural.’

‘What is more important is that an investigator, on the basis of false pretenses, published a paper and propelled a controversial hypothesis forward that led to decisions among individuals and groups to reject vaccination, with resultant outbreaks of these diseases,’ he said. ‘The results are highly significant: millions spent needlessly, hundreds of thousands — maybe even millions — unimmunized, and a fog of suspicion cast upon vaccines.’” (http://abcnews.go.com/Health/AutismNews/lancet-retracts-controversial-autism-paper/story?id=9730805&page=1)

February is the month of hearts. You only have to walk into a store to be bombarded with a veritable avalanche of chocolate candy hearts, heart-shaped cards, tiny little pastel candies imprinted with “be mine” messages, heart-shaped cookies, and more. But despite all the attention to hearts, few people take the time to send an “I love you” message to the hearts beating inside their chests.

Cardiovascular diseases are diseases of the heart and blood vessels. They include hypertension (high blood pressure), coronary heart disease (heart attack), cerebrovascular disease (stroke), peripheral vascular disease, heart failure, rheumatic heart disease, congenital heart disease, and cardiomyopathies.

Since 1980, scientists have made tremendous strides in understanding and treating cardiovascular diseases. In the United States, the death rate due to cardiovascular disease decreased by almost 30 percent between 1996 and 2006 (AHA, 2010). Yet cardiovascular disease remains the number one cause of death in the United States, directly causing one out of every three deaths.

Cardiovascular disease is mentioned on a full 56 percent of death certificates. That means that although cardiovascular disease may not have been the primary reason that person died, it probably contributed to it.
Cardiovascular disease not only causes death – it also causes a tremendous amount of disability. More than 81 million Americans – more than one third of the U.S. population are living with cardiovascular disease. More than half of those living with cardiovascular disease are younger than 60 years of age. Many of those people can’t even walk up a set of stairs.

New research from the American Heart Association (AHA) and the Centers for Disease Control (CDC) affirms just how important it is to take care of your heart – before heart disease develops. Just a few weeks ago, the American Heart Association updated its goals for cardiovascular health. The new framework emphasizes the need to start prevention efforts early – during childhood, adolescence, and young adulthood – long before most people even start to think about the potential for heart disease.

It’s a whole new way of looking at heart disease. While the focus remains on risk factors – conditions or behaviors that increase the chance that you’ll develop heart disease – it’s shifted in two important ways. First, researchers are changing their focus from simply saying “well, your heart doesn’t look too bad” to a goal of “your heart looks really strong and healthy, and you’re doing the things you need to keep it that way.” In other words, the new definition of a healthy heart includes not only as the absence of disease, but whether you’re taking the steps to keep it healthy.

Risk factors for heart disease fall into two categories: those you can’t do anything about, and those you can. Things you can’t do anything about are your age, gender, family history, and race/ethnicity. The older you are, the more likely you are to have heart problems. While men are still more likely to have heart disease than women, women are rapidly catching up – heart disease is still the most common killer of women. Post-menopausal women are at equal or greater risk. If there’s a history of heart disease in your family, you know you’re at risk. Cardiovascular disease is also more prevalent among black Americans and Hispanics, although there’s no clear evidence that the higher prevalence is due to genetics – social and economic factors may play a role in increased prevalence for these groups.

If you fall into one or more of these groups, it’s all the more important for you to address the other category of risk factors: those you can do something about.

• Dump the tobacco. You’ve heard it before, and you’re going to hear it again here: Quit smoking. Smoking is the biggest risk factor for sudden cardiac death. Smoking any type of tobacco product (including cigarettes, pipes and cigars) more than doubles the risk of heart attack. Why? Smoking increases the buildup of fatty acids and plaques in blood vessels, called atherosclerosis.
• Stay away from other people’s smoke. Exposure to second-hand smoke increases the risk of cardiovascular disease. The AHA estimates that 37,000 to 40,000 people in the United States die because of cardiovascular disease caused by exposure to environmental tobacco smoke (“second-hand smoke”). The “stay away from smoke” rule includes not exposing your kids to second-hand smoke. Children are especially vulnerable, because their lungs and hearts are still developing. If you have kids or grandkids, don’t allow anyone to smoke in your home or car. Moving to another room is not enough – they need to go outside if they insist on smoking.
• Manage your weight. Overweight and obesity are key risk factors not only for cardiovascular disease in general, but for physiological risk factors – hypertension, high blood cholesterol, and diabetes. In a vicious circle, poor diet and physical inactivity may lead to overweight and obesity, which in turn may reduce the likelihood that a person will eat well and get adequate exercise. So shed those extra pounds. Yes you can. You don’t need a fad diet or a subscription to one of those overpriced “diet” packages or yet another diet book. All you need to do is burn more calories than you eat
• Eat real, heart-healthy food.
  • Know what you’re eating and drinking. Learn about the nutrient content of the foods you eat and the drinks your consume. Read labels and learn to estimate the calories you consume in a given meal, including the breakdown of fats, proteins, and carbohydrates.
  • Focus on whole foods. Fruits, vegetables, and whole grains should form the basis of your diet. Eat five or more servings of fruits (two cups) and vegetables (two and a half cups) and at least three servings of whole grains each day. Pay attention to serving sizes: one grain serving is one slice of whole wheat bread, one-half cup of cooked pasta or rice (about the amount that would fit in a cupcake wrapper). A good rule of thumb: Shop mostly in the outer perimeter aisle of your grocery store, where most stores sell fresh fruits, vegetables, and other unprocessed foods.
  • Pick your fights – and your fats. Use fats sparingly, and when you do, use heart-healthy fats. Generally, that means using liquid vegetable oils such as olive or canola oil. Avoid transfats (found in margarine, vegetable shortening, most purchased baked goods, and almost all processed foods).
  • Go fish. Eat at least 2 servings of fish or another source of essential fatty oils (omega-3s) per week. Good vegetarian sources are flaxseed and evening primrose oil.
  • Go a little nuts. A growing body of research suggests that adding a handful of nuts to your diet every day can help your heart. Nuts contain a host of heart-friendly nutrients, including fiber, unsaturated fats, omega-3 fatty acids, plant sterols, Vitamin E, and L-arginine. Both separately and in combination, these nutrients have been shown to lower cholesterol, help control blood sugar, and even increase the flexibility of arteries. But be aware: Nuts are an “energy-dense” food. , containing a lot of calories (especially from fats)
  • “B” on top of things. Take a daily multivitamin that contains B-complex vitamins, especially folic acid. Several of the B vitamins, especially folic acid (Vitamin B6) and B12 help to lower the level of homocysteine, a sulfur-containing amino acid, in the body. High levels of homocysteine have been linked with cardiovascular disease, including sudden cardiac death and stroke.
  • Spill the salt. Consume no more than 1500 milligrams of salt per day, especially if you have high blood pressure or if it runs in your family.
  • Sip a little. The evidence is mixed, but moderate consumption of red wine – defined as no more than one glass per day for women and two glasses per day for men – may help your heart and blood vessels. Researchers aren’t exactly sure why red wine seems to be beneficial, but most evidence points toward substances called antioxidants. Antioxidants are thought to help the body’s cells resist damage caused by free radicals, which are charged particles created by normal bodily processes such as breathing or environmental contaminants like exhaust. Free radicals can damage blood vessels, leading to increases in LDL-cholesterol oxidation and plaque formation on arterial walls. Antioxidants found in red wine include flavonoids and reseveratol.
  • Have a cuppa. A growing body of research on tea (black, oolong, and green tea from the Camillia sinensis plant, not herbal infusions), suggests that tea may help your heart and blood vessels. Tea is especially high in antioxidants called polyphenols. A 2001 study from Boston University showed that consumption of black tea helped increase the flexibility of blood vessels in people with existing coronary artery disease.
  • Slip in some (dark) chocolate. Like red wine and tea, chocolate – especially dark chocolate – is rich in antioxidants called flavonoids. Stick with a pure, dark chocolate – skip the chocolate-covered-caramel-marshmallow-nougat versions – and enjoy a bit of chocolate.
  • Get off your butt. Get at least 30 minutes of aerobic exercise daily. That means activity that keeps your heart rate up for a sustained period of time – walking, running, swimming, bicycling, etc. Getting more exercise doesn’t necessarily mean you need the latest fashion and a $100-a-month subscription to a gym. Add just a little extra motion to your everyday activities. Park at the far end of the parking lot, or better yet, walk or bicycle to the grocery store if you can. Take the stairs instead of the elevator. Walk to school and back with the kids: Not only will you benefit, it will set a good example for them.
• Know your numbers. The AHA recommends that everyone aged 20 years and older get the following screening tests:
  • At least every two years:
    • Overweight/obesity. You may not even realize that you’re overweight or obese – or that your kids are. Get on the scale, get out the tape measure, and have your doctor calculate your body mass index (BMI).
    • Blood pressure. If it’s borderline high, your doctor may want you to monitor it regularly.
  • At least every five years (or every two years if you are at risk):
    • Blood cholesterol levels. The numbers you need are: total cholesterol, “good” (HDL) cholesterol, bad (LDL) (“bad”) cholesterol, and triglycerides.
    • Blood glucose (sugar) level. A reading higher than 100 suggests you may be at risk of developing diabetes, and you need to take steps now to stop the progression.

So give yourself and your loved ones a real Valentine’s Day present this year, one that doesn’t involve frilly ribbons and pink candy hearts Wake up to a cup of tea and a bowl of oatmeal, pull out your walking shoes, and tell your heart “I love you!”

Orthopaedic Surgeon

Editor in Chief

www.ehealthMD.com

The healthcare reform debate has begun. Years too late.

One is struck by the acrimonious nature of the healthcare debate. At its heart must be the noble ideal to provide each and every American with medical treatment if they fall ill or if they are ill.

But the heart of this debate it seems is about money, the inability to fund a grand or less grand health scheme, “Where is all this money going to come from?” And it is this seemingly persuasive argument that has condemned Americans to the worst health care system in the civilized world during the past many decades. This is the argument from the right, from the Republicans, from conservative commentators; and they ask (possibly fairly) should the government be responsible for our health care?

Those on the left, the Democrats, clamor for a universal system, a national health system courtesy of the US government.

Those in the middle, most Americans, just simply want the assurance that healthcare is available to them or their loved ones if they need it no matter what their financial circumstance.

In order to appease both sides the president suggested in Congress that he would keep the best of the current system and build upon this to develop a system fit for all.

But is the best of the current system something to really keep and build upon? Is there truly anything good about it?  The problems are well recognized. Hefty monthly insurance premiums barely affordable to most Americans. And they keep rising. People turned down by insurance companies because of past medical history (and therefore can’t get insured), people dropped by the insurance companies when they become chronically ill, and insurance companies unwilling to pay expected costs of hospitalization or costly surgical or investigative procedures.

This is the case simply because the sole aim of health insurance companies is profit. To make money.  Providing health care is simply the medium to generate profit.  Their responsibility is to shareholders and investors. It is not truly to the sick people they insure.

But neither has a universal government system elsewhere been shown to be supremely effective in providing quality health care to each and every citizen. Yet, in most European countries the system does work reasonably well. Anybody who is acutely ill will receive good health care; patients with conditions that are not acute (but not urgent) sometimes (commonly in some countries) have to wait longer periods than one would hope for a surgical procedure. But the system is costly.

Which brings us back to money again. One finds it incredible that the debate on the right (Republicans and conservatives) is so focused on the cost of providing health care, with commentator after commentator thrashing suggested initiatives and adding up the costly dollars to show the non-feasibility of providing universal health care. And yet one never hears such arithmetical acrobatics of cost calculations from these commentators when it comes to accounting for the defense of the nation, policing the nation, drug traffic control, America’s wars around the world etc. And when one sees the bucket loads of money used to bail out the banks ands failed auto companies recently surely an argument can be made to show some care for a sick human being?

A responsible government provides for the defense and policing of its people, the basic education of its people and the healthcare of its people. This is the case of every Western nation, certainly every country in Europe. The USA is alone in neglecting the healthcare needs of its people.

Any debater in healthcare is a function of his or her own personal life experiences. All those vigorously fighting change have surely either never been ill or have been in a position to afford the cost of their healthcare or their medical insurance. Such people had they ever been ‘on the other side’, unable to obtain appropriate treatment for their condition or the condition of a loved one, or rejected from an insurance company for chronic illness, or indeed, just had a family member with a chronic health condition, would long ago have changed sides. That’s why Ted Kennedy so strongly supported healthcare throughout his political career (two of his children had significant health problems). These debaters may have also felt the urge to switch sides when people they care for have lost their home or been made bankrupt simply to pay for medical bills they were unable to pay (which happens far too often).

There is a solution to America’s health care problem. And contrary to all current perceived thinking it is not complex.

This is the suggested the way forward. The bottom line is that every single American should have health cover and should never fear the financial implications of becoming ill.

• For those that can afford it and for those employed there should be a mandatory insurance scheme (paid personally or by the employer). But participating insurance companies must be not for profit organizations, tightly regulated, far from any association with Wall Street. These would be newly established companies. Current insurance companies will initially compete and then fall by the wayside (or adapt). This will keep premiums under control and affordable.

• And for those that cannot afford it, the uninsured, there is already a system in place which needs to be expanded and properly run. This is the current VA (Veterans Administration) Hospital and medical network. There is absolutely no reason why the current VA system should be reserved solely for American military veterans. Soldiers are unselfish heroes. Sure, they should continue to have free use of the system but why should it boil down to the fact that free health care in America is provided only to those who join the military? And while some may balk at treatment in the VA system, there are VA hospitals that are outstanding, with excellent medical personnel. And those VA hospitals that aren’t top notch can easily be upgraded. The time has come to open the gates of the VA medical system to all uninsured Americans. And just like the money was there for the unplanned Iraq war, for the war on drugs and to bail failed banks surely the federal government must show the necessary care for its own citizens.  While currently the VA health care system is totally mismanaged (it costs more to run the VA health system then it does to run the entire national health care system in England yet it provides healthcare to less than a half the amount of people) there is no question that with efficient management this can be rectified.

Doctors too will have the play their part in the new medicine in America. The cost of receiving medical attention, the cost of surgical procedures, the cost of hospitalization, the cost of medical investigations is way way over the top. These costs are unreal and unreasonable, a simple reflection of the greed of American health corporations as well as so many health professionals allied and trusted with the provision of healthcare. With health insurance companies it is blatantly obvious. With the rest of health care it is not so obvious but ever so present. Congress must overhaul the greed in medicine as a matter of urgency. This is the root cause of the spiraling costs.

And of course, illegal migrants. They simply cannot and must not be offered free healthcare. The solution? If working (illegally) then he who pays his salary pays his health costs or must face the law; if an employer takes on an illegal worker the employer must be made fully responsible. If there is no responsible employer then emergency care will need to be rendered as a humanitarian gesture. But on recovery the illegal migrant must be deported. Care that is not considered urgent would not be offered.

Guy Slowik

Editor in Chief

www.ehealthMD.com