...to let things get out of hand, past the point of no return, etc...in the long-term, it's much cheaper to fund Head Start (through high school, that is), provide parenting classes, intensive counseling and support to kids in troubled families, etc, etc, etc...than it is to build a prison and warehouse people...but hell, this is America! Why pay to prevent the social disaster? Just let kids suffer in hellish families, then drop out in high school, get involved in drugs, go to prison...have a few kids of their own on the way...it's just easier...

...so, why should Americans concern themselves with preventive medicine, taking care of ourselves, eating better, etc? Hell, it's the American way to eat junk food for lunch, stop by Dairy Queen for some gigantic sundae after work, pizza, snacks, sit on the couch, watch skinny Paris Hilton types with their little dogs in little purses...

I thought low back pain was commonly brought on by WEAK ABDOMINAL MUSCLES...people are getting enough exercise to strengthen their midsection (core, trunk, whatever you want to call it), they overdo it, reach the wrong way, and there goes the back!

Again, it's the American way!!!! Wreck your back from lack of exercise!

(Of course, I am being sarcastic. But things are ridiculous on all fronts in the US at the moment - McCain wants to build 54 nuclear power plants...and shorten the review period by HALF???? Has the man never heard of Chernobyl????)

yes, you'd better take care of yourself because absolutely no one else is going to. Eating right and exercising, they're just great. But what if at the age of 14 (34 years ago for me) you start having seizures every month around your period? Should you have an apple? I took medication for seizures for 34 years that made me tired, depressed, weakened my bones and dehydrated me causing upper respiratory infections, dry mouth, sinus infections, bladder infections, kidney stones. For all of these conditions doctors prescribed different antibiotics, antidepressants (making seizures worse) and steroid inhalers which aggravate rosacea. Now I take Keppra instead of Tegretol or mebaral and I am much better. I haven't taken anything but an antacid in more than a year, and I don't have seizures either.

People aren't perfect by any means but neither are doctors, hospitals or drug companies. I also haven't had insurance in more than two years, and I still see a doctor and get my meds. Instead of waiting to get dumped by your insurance company, drop them. It would be interesting to see the whole population dump the insurance industry. I know no one will do that, it's risky. But really, how much worse could it get? We're paying for those stupid drug commercials.

We spend more in the U.S., per capita, on healthcare than any other industrialized nation--and have the worst outcomes to show for it (i.e., infant mortality, life expectancy).

So, let's try insurance 101 again. Insurance is intended to protect you against the risk of a costly outcome--a meteor striking your home, a semi smashing your car, someone slipping on your icy front step and breaking their neck. It's NOT intended to cover little things like loose doorknobs, broken taillights, or guest's bruises. Insurers "bet" that they'll take in more premiums than they'll pay out. In most cases (since they design the product), short of Katrina-esque disasters, they do quite well for themselves & shareholders.

Our "system" of care (and I use that term VERY loosely, since it's truly more of a chaotic mess) with HMOs now "insures" everything--except for the weasel factor, well-covered in Sicko. But insurance is the WRONG business model for most healthcare, which can be broken down into 3 categories:

-- Acute illness/accident (Motorcycle crashes, cancer...)

-- Preventive care (Checkups, nutrition planning...)

-- Chronic disease care (Education, self-care training, follow-up, coordination between specialists...)

Chronic disease in the U.S. causes 70% of all deaths and 75% of all healthcare costs. Preventive care may help prevent some chronic disease. These two categories of care should be provided by a SINGLE PAYER (Govt), with the option for upgrades by those who can afford to opt out. Before y'all jump down my throat about how horrible Medicare is, their admin costs are just 2%. Health insurance companies spend more like ten times that on admin. Those dollars are wasted for healthcare. (Don't believe me? Check out http://www.cahi.org/cahi_contents/resources/pdf/CAHIMedicareTechnicalPaper.pdf)

Would I put all the health insurance companies out of business? Nope--they'd cover acute costly illnesses/accidents, AND could supply upgrade policies for chronic & preventive care.

Dr. Parikh says our "system" is "driven by illness." Yup--by acute illness. The Western medicine paradigm is built on the miraculous cures for infectious disease. Magic bullets! Antibiotics! Yay! In acute disease, the "job" of the patient is to seek good care and do as he's told. There's no need--or even time--for education. But most illness is chronic. The acute medical model does a very bad job of caring for chronic disease, educating patients about day-to-day life and symptom management with chronic disease, but a pretty darn good job of blaming those who have it for not doing "their" part. Unfortunately, patients are trained in the same culture as doctors. NOBODY realizes they have a job to care for and educate themselves with a chronic disease until they bump up against that reality the hard way, usually by getting lousy care.

It's facile to talk about how most of our healthcare choices "aren't good ones", as if obesity, heart disease, diabetes, etc. are solely a result of poor personal choice--while not considering government subsidies on high fructose corn syrup, ubiquitous trans fats in the food supply, and a lobbyist-driven government emphasis on grains (they fatten cattle--and us!).

We DO need a new paradigm for healthcare that's based on aligning all of the incentives--not just doctors and health plans.

Too bad we can't penalize people for poor choices. Breast cancer at 35? You get treated. Heart disease at 40, and you weigh 300 pounds? Well what did you expect? Too large a portion of what we call health care in the U.S. is actually rescue care. Saving people who haven't had access to medical care, or who just plain said "screw it, they'll fix me later". As the article implied, too many people don't want to take any responsibility for their health. And these are the same people who will cry the loudest if you try to take some of their benefits, because giving more to someone else might mean less for them. In the end it's about the greater good, and we're all going to have to understand that we can't do every thing for some people and nothing for others, but we might be able to something for everyone. Change won't come easy, we're putting responsibility for change in the hands of politicians, and we know they hate to have anyone mad at them, better to do nothing.

And please, every Republican politician, and free-market booster who thinks that competition will fix everything in health care; come to a large urban hospital and have some real health care workers show you around for a day or two. We'll show you the waste, greed, and just plain stupidity, that keep the costs of health care high.