Health Care Reform? We Haven't Even Started...

For months we've been inundated by what the media refers to as the 'Health Care Debate'; politicians, lobbyists, tea-party protesters, and media pundits trying to influence how we're going to achieve health care reform. Well, we haven't even scratched the surface. To be honest we haven't even begun talking about true health care reform, merely health insurance reform. And while there have been some modest proposals and a bit of discussion outside the realm of health insurance, the real debate that needs to occur has largely been relegated to the sideline.

With both houses of congress actually making moves to get bills out of committee and onto the floor, it is crucial to remember that when a health insurance reform bill passes, and one will, the job is not yet done. While we may actually see some fairly meaningful insurance reform occurring by 2013, the real change that needs to take place will take decades and will depend not on the commitment of the Obama administration, Harry Reid, Nancy Pelosi, or any other individual or group of politicians, it will depend on the public's ability to continue to demand the change that the majority of population knows is necessary.

So what really needs to occur in order for this painstaking health insurance reform push to mean anything? I'm going to break it down from my perspective across a series of posts in the next few days. In my opinion, true health care reform needs to occur in three ways: (1) health insurance reform, (2) health care delivery reform, (3) food reform.

Health Insurance Reform Includes...

• Universal Coverage and no exemptions based on pre-existing conditions
• A robust public option and state-based experiments in single-payer systems
• An inclusive, national insurance exchange
  
• Personal and employer mandates
• Death panels
  
• Subsidies for low-income populations and tax-exemptions for small businesses
• Reduction in insurance overhead costs and cost-saving measures to Medicare

Health Delivery Reform Includes...

• Reduction in prescription drug costs and greater incentives towards use of generics
• Payment method alterations and the elimination of 'fee-for-service'
• Movement towards group practice and local/regional coordination of care
• Increase in and incentives for primary care doctors and nurse practitioners; reduction in specialists
• Socialist-Fascist bureaucrats to the staff the death panels
• Effective use of deductibles to control unnecessary spending
• Tort reform and medical courts to reduce 'defensive' medicine
  

Food Reform Includes...

• Increase in food labeling measures for nutrition facts and ingredients
  
• Tighter quality controls, greater transparency, and decentralization of the meat-processing industry
• Experimental taxes on sugary drinks and other unhealthy foods
• Greater nutrition education and other measures to counteract the obesity epidemic
• Higher taxes on the overweight and obese (that's 2/3 of the population you know)
  

Can you spot the outliers in each set of reforms? In my next three posts I'll attempt to break down and expand upon each step in the process. We'll also ponder how it is that Fox News can manage be such stalwart defenders of the public's interest... a truly amazing news organization they are.

The Higgs-Boson Particle & the Future Dictating the Present

Wow... I've always enjoyed theoretical physics, partly due to the sheer impossibility of wrapping one's head around some of the concepts, and partly due to my former roommate's willingness to translate the more basic theories into remedial English for me to more easily ponder. Also, Carl Sagan, that guy is great.

The most audacious experiment in all of modern physics is known as the 'Large Hadron Collider' (LHC), an 18-mile diameter ring buried underneath the border between France and Switzerland. The purpose of this $9 billion behemoth, operated by the European Organization for Nuclear Research, known by the acronym CERN, is to essentially smash protons into one another at just shy of the speed of light. At certain points within the machine, the proton beams will be allowed to cross and smash into each other. Scientists hope to study the potential new particles that arise from these collisions. The most prized of these theoretical particles is called the Higgs-Boson particle, also known as the 'God Particle', which is theorized to imbue all things with mass.

Well it turns out that God doesn't want us playing with his particle. The project has been beset by various delays over the past 9 years of its construction, the most recent coming in the form of the connection between to magnets being destroyed shortly after the machine was switched on. Oh, and a French particle physicist employed by CERN was recently arrested for potential ties to the North African wing of Al-Qaeda. Nevermind that the lunatic fringe has repeatedly warned that such a colossal machine working on the edge of our scientific knowledge could inadvertently create a black hole and destroy the world.

Now, two highly-regarded physicists, Dr. Holger Bech Nielsen and Dr. Masao Ninomya have postulated that these various hurdles and delays may not simply be coincidence. Rather, they propose that the existence of a Higgs particle is so 'abhorrent' to nature, that the future may in fact be attempting correct the past and prevent a Higgs from forming.

I'll give you a moment to read that over again...

"It must be our prediction that all Higgs producing machines shall have bad luck,” Dr. Nielsen said in an e-mail message quoted in this recent NYT essay. Further evidence can be found in the fact that in 1993 the United State Superconducting Supercollider project, also designed to find the Higgs, was cancelled, even after billion of dollars had been spent, he argues. So yes, they are basically saying that the future is correcting the past.

The Times articles gives a more thorough account of the two physicists and their theories, more fully described in this publication, and followed up by this paper. As far as most others involved with the project are concerned, it will be moving forward soon, when they begin to inject particle beams into the machine in November.

Regardless of the outcome (and sure hope its not a world-ending black hole) isn't it exciting to live in a time where we can recreate the Big Bang in a hole in the ground, realistically postulate about time-travel, and have so many options on the 99-cent value menu?

Timeout: I Win!

I'm sure most people would say this has nothing to do with public health, but the success of my fantasy football team has a lot to do with my personal health, so I thought I'd point out that I totally beat Yahoo! Sports blogger Andy Behrens to the punch when I proclaimed that Steve Smith of the New York Giants was now the #1 Steve Smith in the league, supplanting Steve Smith of the Panthers.

I made my claim in this post, on Sunday October 4th. It took Behrens until Wednesday to make the same obvious realization... This guy gets paid to write about sports, and I blog about public health in my spare time. I think Yahoo! should hire me instead.

Adam - 1, Yahoo! Sports - 0

Also, Yahoo's weekly point projections for fantasy players is awful.

In The Kitchen with Shark Eyes

The following is a contribution to my blog from my friend Rob White. While he may have trouble using a telephone, he's a great guitar player and fantastic cook. I love cooking, and eating, so I asked him to contribute a recipe. It probably won't be the last. Soon I'll delve into the abyss that is the nexus of food and public health... But for now, here's Robbie, aka 'Shark Eyes'...

I was recently asked to make a contribution to the Woolsey Street Digest, I assume in the interest of rounding out the publication’s flourishing readership. Specifically, I have been contracted to talk about the world of food and why not? I can’t imagine any better combination than one man’s musings on the politics of public health and infectious disease followed by a self indulgent foray into the world of amateur gastronomy. I know nothing makes my tummy grumble like a rousing story about humanity’s inevitable destruction at the hand of some pandemic de jour.

Despite my cynicism, I have recently had few people ask me to share some of my recipes with them and this might be a good venue to slake their, presumably, unquenchable hunger for my secrets.

The first recipe I would like to share is one which I had a tremendous amount of trouble with and only finally got working recently. People's opinions regarding the process of making French bread, as I have found, can be extremely divisive. There are innumerable recipes available, all of which insist that they constitute the perfect loaf of French bread. I’m not sure that my recipe is perfect but I can say that it has worked for me consistently where others have failed. I don’t have pictures for this recipe, but in the future I’ll try to provide some visual aids.

Shark Eyes' Perfect French Bread

-4 cups white flour (You can substitute as much as half with wheat flour if you would like)

-1 tbs. salt

-1.5 cups water (warm but not uncomfortably hot to touch)

-1.75 tbs. active dry yeast

-a pinch of sugar

Add sugar and yeast to water and mix in a large bowl. Let sit for about 10 minutes until the yeast activates and bubbles on top of the water. Mix salt into 3 cups of four and slowly add to the yeast mixture, constantly stirring, to incorporate the flour. Once the first 3 cups of flour are added, cover and let sit for about a half hour.

Uncover and add the last cup of flour (1/4 cup at a time) and mix with your hands until it forms a soft dough. It may only take ¾ of a cup but that is okay. Pull your dough ball out of the bowl and knead for 5 minutes on a clean floured surface then let it rest for about 7 minutes (use that time to wash and dry the mixing bowl and coat it with olive oil) and then knead for 5 more minutes. Form the dough into a ball and put it into the oiled bowl. Roll the ball around and make sure to coat it on all sides with the oil. Cover the bowl with a damp towel and let rise in a warm place for at least an hour and a half and until the dough at least doubles in size (often times I’ll let the dough rise for up to three hours and it fills a rather large mixing bowl).

Once the dough has risen, punch it down in the bowl then bring it back out onto your flowered work surface. Knead for a few more minutes. Cut the dough in half and make them into balls again. This recipe will make to large baguettes so I usually save one half in a plastic bag, in the refrigerator (it will last at least 4 or 5 days and it makes really good pizza dough). Let the dough that you are using sit for a few minutes longer then, with a rolling pin make the dough into something that resembles a rectangle that is about 8” by 12”. It might look more like an oval and that is okay. The key is that it is fairly even. Next, tightly roll the dough in on itself so that it is starting to look like a loaf of bread. Pinch the dough along the seam to seal then, with the seal facing up, pull the dough from the bottom on both ends up and incorporate it into the seam. This process is difficult to describe and I am making it sound more complicated than it is. The objective is to seal up the loaf so that there are no holes. Use your common sense and it will be fine.

Now prepare a baking sheet. The best way to do this is to use a high sided baking sheet upside-down. Oil the bottom of the pan and, if you have it, sprinkle some corn meal on. Then lay your loaf out on the pan seam side down. Let it sit and rise a bit more while you ready the oven.

Set the racks in your oven so that one rack is near the bottom and the other is in the middle/top. On the bottom rack put an oven-proof dish with water in it. This will create steam which will help make your bread nice and crispy. Turn the oven on to bake at 450 degrees. Once your bread is about the size you want it to be, make perpendicular slits along the top of the bread every couple inches along its entire length. Brush the top of the bread liberally with water and put it into the oven on the upper rack and bake for 15 or 20 minutes. It is ready when the loaf looks golden brown and delicious.

So that is the recipe. It looks more daunting than it actually is. Try it once and you will realize that it is well worth the effort. It is a fun thing to do on a lazy Sunday, especially if you are hung over. Focusing on the recipe will help keep your mind off of that sick feeling and the finished product, along with some hot soup, will help to sop up the alcohol lingering in your stomach.

The Socialist Plot Thickens!

The Greek Socialist party has won the Greek national elections, unseating the conservative New Democracy party. Socialist leader George Papandreou lead his party to victory by advocating a $4.5 billion stimulus package and cracking down on tax-evaders, a crime which costs Greece roughly $30 billion annually.

Sound like anyone you know?

Obviously Papandreou is taking his socialist marching orders directly from the the Obama White House, as evidenced by this press release from the Greek Embassy earlier this year... Soon the entire Medditeranean region will be littered with universal health care, free education, and Nazis. Yes, Nazis. Thank god American conservatives have enlightened us all in revealing that Obama is both a socialist AND the next Hitler. Because Hitler was a socialist... and that makes total sense.

On a totally unrelated note, I remembered reading about this study that conluded that conservatives are more biologically inclined towards fear. Food for thought.

Thus concludes my Sunday Sarcasm post. Thank you Steve Smith #2 for scoring me 24 points in my fantasy league today. I'm officially making a motion that Steve Smith of the Panthers be relegated to #2, and you promoted to #1.

Grad School is Busy

Some quick notes since its been a heavy schoolwork week here at Berkeley...

• I had to finally present my 40-minute research project on potential infectious causes of autism. My verdict: autism is caused by a genetic predisposition triggered by a prenatal environmental insult, most likely a range of infections including congenital rubella, herpes virus, mycobacteria, and lyme disease.
• Principles of Infectious Disease midterm in T-Minus 2 hours, 25 minutes... Did you know that our centralized, industrialized food industry is contributing greatly to diseases such as E. coli, salmonella, and so on? Not to mention all the hormones and antibiotics they use to fatten up our animals contributing to antibiotic resistance. Here's a sweet article from the NYT that shows the intrinsic link between the health insurance industry and food industry and how its all going to get flipped on its head soon. Thank you Ryan Marriott.
  
• Early epidemiological studies in Canada (British Columbia to be precise) indicate a marked increase of H1N1 infections in those who have received the seasonal influenza vaccine. Canada may well be halting all seasonal vaccinations for those under 65 years of age. Read more about it on ProMed.
  
• Speaking of the flu, did you know that Single Malt Scotch is one of the best mediums for protection against the flu? I should have known. Check it out yourself. Thanks Kate Corvese.
• The healthcare debate rages on... yesterday the Senate Finance Committee rejected two amendments to Max Baucus' bill that would have included a public option. The first, introduced by John Rockefeller IV of West Virginia was shot down by the entire cohort of Republicans on the committee, plus 5 Democrats. The second, more palatable (to conservatives at least) option was introduced by Charles Schumer of New York, and was also defeated by the Republicans with the help of 3 Democrats. Let's take a moment out of our busy day to thank the following Democrats for killing the public option that they have all previously publicly endorsed: Max Baucus of Montana, Kent Conrad of North Dakota, and Blanche Lincoln of Arkansas voted against both bills. Thomas Carper of Delaware and Bill Nelson of Florida voted down Rockefeller's but supported Schumer's.
  
• Harry Reid and Chuck Schumer today scrambled to say they would push a public option, though likely watered down, to the full senate. Such a watered down version could resemble a proposal by Olympia Snow (R) of Maine, where a public option would kick in only in states where private insurance is deemed unaffordable. Said Schumer, "there is not one way to Rome, there are lots of ways to Rome." Someone please tell Chuck we're not trying to get to Rome, we're trying to get to the doctor's office.
• Speaking of health care reform: UC Berkeley students, tonight at 6pm, in Boalt Hall there will be a panel discussion among three professors regarding the issue. William Dow (former health economics advisor to W), Helen Halpin (current health care advisor to Obama), and Steve Shortell (Dean of the School of Public Health, health care policy specialist) will debate the merits of all the current proposals. Should be balanced and informative ('What does that mean?' you ask... yes I've almost forgotten as well).