Potatoes, shots, and valuable health.

Human again! Taking a bit longer to bounce back from the chemoas the doses add up. It is so good to wake up and actual feel normal. And to have an appetite! I was truly hungry for the first time in a while, and I went to Whole Foods an bought Lots of Expensive Food. And then I ate too much, which is not a good idea either, but it felt so good! I had cravings for unexpected things. Like I just wanted potatoes. Potatoes. The golden Yukon buttery kind in chunks and boiled with butter, salt and pepper. Yum. Who knew. And coconut sorbet.

Currently I am minding the farm alone, the family is off for a long weekend in Orlando. I have become the dogs' mama. They follow me everywhere, sit in the chair/couch I am sitting in, and they have mightily tried to come in my bedroom and jump in the bed, but I draw the line there. I would come out of the bedroom and they would be just sitting there waiting for me. I had to bring up their little beds so that they would sleep outside the bedroom and stop trying to sneak in. I would hear little feet and their dogtags and turn on the light.Maggie or Teddy would act shocked that they had been caught, and would slink away after repeatedly being told OUT! They do wear you down, they just want to BE with you. But I can't have an itchy bedroom.

Also getting a look at the medical bills. This is another aspect of being on the "other side" for me. I don't see the bills generated by the care I help deliver; I bill for the services but the rest of it, and the hospital bill part, happens totally separately, and I have to admit I like it this way. I know NICU care is very expensive; but it is enough to keep up with the knowledge and practice in the field. The business part of it definitely never interested me, and the billing part of it is something I must do to justify my position.

So I noted with interest the cost of one of the drugs I get every 2 weeks. In fact, it is the drug that allows me to get treated every two weeks instead of every three weeks. A serious rate-limiting side effect to many chemotherapy regimens is the drop in the white blood cell count, which increases the risk of developing serious infections from almost anything including exotic infections. A drug called pegfilgrastim is a growth factor for white blood cells, and is given as an injection the day after chemotherapy. So, it not only prevents the WBC from getting very low, it also permits the chemo to be given at shorter intervals, called "dose-dense" chemotherapy. These shorter intervals enable the chemo to hit the just barely-recovering fast growing cells when they are more vulnerable in the cell growth cycle, and has been shown to have improved outcomes. Yay! And only available since 2002. This is how fast medicine is changing, exponentially fast.

But, the price tag? $7000.00 a shot!

Now, I am fortunate enough to have medical insurance and the resources, but you can see how this would change the life of someone without insurance completely. And have to make choices. And maybe use up life savings to get the best care. Or go bankrupt. But, the drug costs that much to develop and test. And it turns out that it is cost effective too--one intensive care serious infection hospitalization costs about 50K.

So the answer is...the care is expensive because the care is REALLY GOOD. Better drugs, care, treatment options, outcomes....more expensive. But Americans don't want to pay more for the improved and constantly improving standard of care. I'm not sure people really understand how incredible the care available to us really is. I really don't know what the answers are, but I have seen what's available in most of the world, where you're lucky if the water is clean. The hospital in Uganda where I worked for 3 weeks, a major hospital, ran out of paper one day. The WATER didn't work one day.

Excellent health care costs excellent money. So are we as a society going to accept different standards-of-care based on ability to pay? This would result in stratified outcome measures (% cancer survival, life expectancy, newborn mortality rates)--based on socioeconomic status. That would be a repugnant situation indeed. It is not the kind of society I want to live in. Go to a poverty-stricken 3rd world country and see it for yourself, the poor and sick basically linger outside the hospital begging for help. Clearly there are cost-saving measures to be identified and implemented (duplication, inefficiencies, etc.) that can and will be put in place to decrease the cost of health care, but as a population becomes healthier and lives longer because of better medicine and technology, it will cost more. How will we pay for accessibility to standard excellent state-of- the-art care for Americans? I think we will have to get used to thinking differently about the chunk of our own budget that must go to pay for all of it. And we should be expect to be paying more if they can zap your mother's brain tumor with a gamma-knife laser, or transplant a liver into your little girl, or inject a new drug into grandpa's eyes to prevent a common type of blindness in the elderly, or operate on an unborn baby to correct a birth defect before birth, or have the CDC swoop in to figure out what the hell is going on with the next SARS or Ebola or the next mutant virus to infect humans and wreak havoc, or save your life in a horrible car crash where you are helicoptered from the scene and are on the operating table in less than one hour, or build a bone cell scaffold to implant in a degenerating spine so that your own cells can support a new structure, ad infinitum. This is not cheap. We must get used to paying dearly for our valuable health. And be grateful that it is available to us.

How to solve this problem, I am not smart enough and I never took accounting (clearly). But the citizens of this country cannot have high expectations for the personal availability of the best care in the world, and still expect to pay a relatively mediocre, static, grudging fee.