Hmmm, Rob, were the docs lying to me? I always look at the ultrasounds (I've been involved in the science of ultrasonics) and I saw what they called stenosis. It's supposedly a result of valve defects (maybe a bicuspid valve). I figure I could have done a three hour marathon if my valve had been normal, but it took me almost four hours. Anyway that was 25 years ago, when I was about 50, and if anything my problem has gotten better. I haven't had an ultrasound in over five years. When I go in I'll quiz the doc.

Walter: we seem to disagree on what constitutes unnecessary treatment. I would say that my wifes six or so friends who elected to the glucophage route are getting unnecessary treatment. I believe that it costs about $150 a month for the drug and probably at least that in doctor visits and diagnostics. Each of them is costing the system at least $3600 a year. In Europe the drug might be far less than that, but that might induce more people to take the treatment route instead of lifestyle change. If each of these women had a major med of $5000 and had to pay the $3600 out of their HSA they just might ask the doc if there was an alternative. Or they might just do a little research on their own. Of course the recommendations on the diabetes association website are designed to produce chronic patients, with the low fat high carb diet they recommend. So that is not a good resource.

Anyway, my definition of unnecessary is any treatment for a condition that could be alleviated with lifestyle change.

I believe that if all of us had to bear some degree of the costs of our problems, to the extent that it would be a little painful, many of us would choose lower cost and likely more beneficial approaches.

What if half of the people who now take glucophage got off it? The drug pusher might just lower his price to get back some of the business. (Not my idea of a good outcome, however.)

Rob, the purpose of insurance is to prevent financial catastrophe, not to control us. In a socialized system I might have been forced to take the bureaucratically acceptable treatment.

Maybe we should socialize home insurance so I could subsidize those who like to live where there are floods and hurricanes, although it already seems I am, thanks to the federally partially socialized system.

My wife was the wedding (or reception) planner for both our daughters. The oldest ran off to Las Vegas in a sudden fit and got married in a "wedding chapel". We, and the grooms parents, hurriedly got involved and made it a little more traditional. But it cost only a few hundred bucks. Those mass production "wedding chapels" are pretty low cost, but a little tacky. The next one wanted a wedding on a lake shore in a national park, where she would canoe in and out. But the park service didn't want a horde partying on the shore, so we switched to a mountain top wedding at a ski area. She wore a $100 dress, and the most expensive part was renting a local restaurant for the afternoon festivities. The restaurant was in a beautiful location with great mountain views. The whole thing cost less than five grand, which included my paying for three nights at an expensive lodge in the park for the newlyweds. We had a reception at our church for the older one after the "chapel" business. The church ladies supplied the refreshments, and entertainment was provided by our talented friends. Cost: essentially zero.

We recognized that the wedding business is a suckers game and with a little imagination can be more fun, and less stressful, at far less cost if you gird up your loins and do it yourself. The thousands we saved then went to the newlyweds to help them get started in their married life.

My wifes brother did it the expensive way, and he went bankrupt as a result; that $2500 dress was an absolute necessity, although I couldn't tell it from our daughters $100 one.

Take your choice. The feds have very low administrative costs, but there is rampant fraud. The insurance companies have high administrative costs, because they analyze every expense, but there is probably not much fraud. The biggest fraud of them all is the prescription drug plan, except that the Congress legalized it. If it was the law that no one paying for his own treatment could be charged more than the lowest price to anyone else, it would be much less necessary for most of us to have low deductible insurance. Of course, it was my experience when I managed a small company and provided my employees with a $5000 deductible major med, that they got the lowest price. After all it was in the insurance companies interest for the employee not the hit the deductible, so their negotiated price was the one my employees got. Before any of you call me an ogre, I'll point out that I put $5000 into each employees HSA every year.

Making the healthy subsidize the unhealthy through "community pricing" or whatever you want to call it is a hugely regressive tax on the middle class. If we are to have some sort of socialized health care, the huge costs for the unfortunate should be borne by the general fund, and the rest of us should pay an actuarially sound amount. Cost studies for decades have shown that most chronic sickness is a result of life style choice. That should be factored into the price we pay for insurance.

For those of you who think that the use of prescription drugs is a positive good-PRESCRIPTION DRUGS ARE POISONS THAT HAVE OCCASIONAL THERAPEUTIC VALUE. User beware.