When Spot was several weeks old, we went to the beach for our Sunday evening walk, as we did most months of the year in Florida. As I held her squirmy little body to my chest and wrestled with the baby bjorn fastenings, my shoulder dislocated. Because I am a mother, I called Mr. Bennet over and told him to take the baby while I worked on getting my shoulder back in.
That was when I decided to have another go at surgery for fixing my chronic, “non-traumatic” shoulder dislocation problem. My first surgery, in 1999, was a nice little present for my new husband. There we were, in our last year of college, married nine months, and there I was, loopy on percocet and immobilized in my writing arm for the six weeks leading up to graduation. I defended my undergraduate honor’s thesis before I had a chance to wash the iodine off.
My first surgery cost a lot more than we expected, even though we were well-insured. The school-affiliated orthopedic surgeon forgave my share (10%) of his fee. Our out-of-pocket was still a thousand dollars — quite a bit for a student working part-time on the fourth floor of the Harold B. Lee library.
My second surgery ten years later cost about the same, only this time I was conscientious about my physical therapy (figuring $25 copays twice a week for four months was worth a squeeze in the budget) and eighteen months later I go several days without even fearing a dislocation.
T. R. Reid has a new book out about health care, framed around his search for treatment for a “stiff shoulder”; he travels to nine countries and the U.S. to see what a doctor will recommend, on the current assumption that incentives and reimbursement of providers dictates care. The different reactions to his chronic problem (hopefully described more in depth in the book) are fascinating, and supposedly provide a a worthwhile baseline for comparing health care systems.
But I’m not buying it. Reid’s orthopedic surgeon in Colorado is “quick to recommend a shoulder replacement.” Few foreign doctors consider this a wise course of treatment, instead suggesting physical therapy, second opinions, steroid injections, etc, with the obvious conclusion being drawn that the American system is whacked because specialists are so eager to recommend the most invasive, expensive treatment.
And this is why I have a real problem with all the discussions of the American health care system (and many other political issues). Reid’s anecdotal evidence (praised in The New York Times as an “unusually well-controlled experiment”) doesn’t resemble my own experience in any way. What kind of journalism is it to call one man’s self-reported consultations as any kind of “experiment,” let alone a “controlled” one?
And how can I take policy suggestions seriously from someone who is, in direct contradiction to my own experience, so sensationally selective in his analysis?
I saw orthopedic surgeons in New York, Florida, and Utah about my shoulder. Each one said the same thing: that surgery was necessary, that physical therapy afterward was imperative, that I’d never play tennis again.
The orthopedic surgeon I saw in Cairo (reportedly the top guy in Egypt) said the same thing.
But what about the shoulder replacement? Surely one of those money-crazed American orthopedists suggested that? Actually, no. In fact, I begged my last surgeon for a total joint replacement after my grandma’s knee replacement allowed her to hike like a forty-year old again. And (maybe he hadn’t seen the fee schedule comparison recently?) he said it wasn’t a good idea, that joint replacements are last resorts, and that we could expect better outcomes with a new (much cheaper) laproscopic procedure.
And he was right.
So I’m left floundering when it comes to health care reform. Is more government regulation the answer, or less? If wonks and journalists describe a health care system (especially health care providers) I don’t even recognize, why would I trust their analysis of the causes, characteristics, and solutions to the problem? If they misrepresent the American system so egregiously, how can I learn from their (seemingly competent) assessment of how we already incorporate many parts of each country’s system?
If this is the best reporting our “free” press can provide, I think we’re screwed.
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I’ve been planning a post on this for a while now. I guess your post is my motivation.
Jane Reply:
September 15th, 2009 at 5:20 pm
I’ve subscribed to your blog, so I’ll be looking for it. (How’s that for motivation?
)
I heard an interview with the author on Fresh Air. Very interesting.
For me, the diagnostic process was less the point of it than what comes after- the ‘can you afford the help you need?’ part. That seemed to be the point of his book, or at least the interview with Terry Gross.
The Times writer who called that a “well-controlled experiment” must be off his/her rocker. Fascinating, but not scientific.
Jane Reply:
September 15th, 2009 at 5:16 pm
I thought the country comparisons were fascinating too — a different glimpse of cultural differences. Loved the Indian anecdote the best.
I’m sure you’re right that the affordability is more important — my point is that I can’t trust discussions of affordability issues from people who are so unscientific and seemingly-biased in their fact-gathering.
I don’t think we can even consider the change in Health Care until we throw out everyone in our “free press” media. The only “news” I can even watch now is Fox news. Unless I want to listen to a bunch of crap anyway.
Jane Reply:
September 15th, 2009 at 5:18 pm
I am hooked on the New York Times ever since I lived in the city, but it is quite liberal. The funniest is when people point to it as the mainstream media (which they frequently do) when it is quite, quite liberal. (Case in point was Maureen Dowd’s recent article about the Joe Wilson thing during Obama’s speech, and the opinionator of NYT said that if Maureen Dowd thinks that’s racist, then it must be. I like Maureen Dowd, but she is not politically neutral. At all.)
Sharla Reply:
September 15th, 2009 at 7:02 pm
See? I can’t even watch or listen to the liberal media without wanting to throw up. So I just don’t.
amen to your last line — we are screwed.
I heard that some news collating service reported that in the main stream press recently there were 19 stories about the murder of a pro-life person (apparently BECAUSE he was pro-life) whereas a coupla months ago there were 640 news stories about the murder of a pro-abortion person.
RE: health care– see Thomas Sowell’s several columns in which he repeately distinguishes between “health-care” and “medical care.” In America we have freedom to seek both; most socialized medicine countries have the much less freedom, though their medical care, such that it is, is tax supported. Totally ignoring the distinction is the basis of such propaganda as you note from NYT. Freedom is so undervalued.
Jane Reply:
September 15th, 2009 at 5:20 pm
Yes, I remember seeing the pro-life news stories, and it definitely seemed much less reported, and also, reported in a “look at this whacked crazy person who obviously doesn’t reflect the pro-choice movement at all” versus the coverage of Dr. Tillman’s murder which led to immense, broad hand-wringing about how the entire pro-life community is obviously violent and militant.
Charlotte Reply:
September 16th, 2009 at 8:48 pm
Having heard the same stat, I’m pretty sure I know who Capt Kirk is listening to in the day time…
We are screwed. The media is biased. The health care system is broken. And it doesn’t seem like anyone in our government or elsewhere will come together to find a solution.
This happens to be a subject I think a lot about, and, having just sat through a recruiting dinner for my husband’s company, I can tell you the conversation about medical liability is frightening on the doctors side. The practice of defensive medicine is driving up health cost in the US. I actually have a post I am going to write about the doctor’s side of tort reform. And it will even be serious-like.
But even if I think there is too much defensive medicine, I still think (from what I read here) that the book sounds way over biased. And maybe they should start teaching in school the difference between CONTROLLED STUDY and ANECDOTAL EVIDENCE. (That might also help with your last post about judgmental mothers and their whacked out ideas, but I already confessed in those comments about my secret prejudices)