Oregon has had government involved in health care for quite a few years.  The state electorate also approved the concept of state sanctioned suicide several years ago.

Recently, the board that reviews the medications that are approved for state residents made a determination that was controversial...in my mind if no where else.  The board, in essence, said that, given the cost of a certain medication, it would approve suicide for this patient but would not approve use of the medicine given its relative newness and the lack of convincing data as to the outcome.  It had essentially set a price on the human life involved.

Today I read the story concerning Denver Children's Hospital and heart transplants in infants that use the heart from another infant that died a 'cardiac-related death'.  This differs from a heart harvested from a brain-dead infant in which that heart is beating until removed from the donor body.  A decision has been made that the donor that has been pronounced dead and has been in that state for only 75 seconds, is a valid heart donor for purposes of this new program.  The earlier line that had existed required death be determined only after some five minutes during which time the heart did not re-start itself.  In this instance, the length of time a person had been deemed 'dead' had been reduced to assure that the harvested heart had a decent chance of functioning in the new body.  The three cases in which this approach has been employed resulted in three infants alive today.  The decisions to withdraw life support were made by the parents in all three instances.

We know so much more today than we did a decade ago.  We can do things from a medical perspective that were impossible then, and these procedures have become commonplace now.  We are, in this area, pushing the envelope as it has never before been pushed.

I know there are at least two sides to these issues.  I have good friends whose daughter lives today because of transplanted organs that were available on a timely basis.  I can't even begin to comprehend being placed in the middle of such decisions, and I earnestly hope that never befalls me.

And this leads to my general question:  Is there a line we dare not cross?  If so, where is or was that line?  Am I comfortable with an appointed board making life and death decisions about me?  Who among us can claim the right to make such a decision?  How do medical ethicists deal with these kinds of issues?

I don't profess to have the answers to these questions.  If you do, and you're willing to share, I'd appreciate your comments.

Seemingly everytime we pick up a newspaper or periodical we see that health care costs have risen again.  The only real question anymore is 'How Much?'.  Of course, if we still have health insurance, the premium rates continue to go up and up.  What in the world can we do about this?  Would statewide mandatory insurance coverage do the trick?  Can we somehow legislate lower insurance premiums?  Are the drug companies really the culprits?  Maybe we simply need to move to Canada or Europe.

Recent studies show that our national health care spending increased in 2006 by 6.7% to $2.1 trillion.  That means that one out of every six dollars spent in our national economy goes for health care.  The 'good news' in this staggering number is that this is actually slower growth than we saw for 2005.  Apparently we're going in the right direction, even if too slowly.

Another amazing fact, to me at least, is the amount of 'out-of-pocket' spending each of us averages after insurance premiums, etc.  In 2006, we spent, on average, 12% out-of-pocket for our health care expenses.  Know what we spent out-of-pocket in 1960?  We spent 47% out-of-pocket for health care expenses. 

That means that we are shielded to a much greater degree today from our real health care costs than we were in 1960.  Our out-of-pocket costs have decreased steadily since 1960.  We are often at the point today where we think of the cost of health care as being the $10 or $20 co-pay we have to come up with when we go to see the doctor.  Or, the $20 or $30 dollars we have to cough up for medicines.  Those amounts are very small percentages of the total costs.

Why is this important?  It is important because we need to think about what we're spending if we're ever going to be able to bring this cost spiral under control.  If we come to understand that the real cost of the doctor visit is in the range of $125 to $150 or more, we can begin to understand that maybe we shouldn't be running to the doctor everytime we have a runny nose or a cough.

Another very interesting fact is this:  more than 50% of all health care claims costs in America today are to cover lifestyle-related illnesses.  Those are the things that you and I can control to one degree or another.  But, we can't control them if we don't know about it or if we choose not to do anything about it.  What are 'lifestyle' issues?  Smoking, alcohol use, obesity and simply laying around doing no exercise.

Does this apply to us?  Here are the most current facts:  One in every four Americans eat fast food every day!  Six of ten Americans do not exercise or seldom exercise!  Two of every three Americans are classified as either overweight or obese!

This is the real source of our health care cost crisis.  We have met the enemy and it is us!

No mandatory state programs, or profit controls on drug companies or anything else is going to solve this problem.  The simple truth is that this is up to us.  All the rest of these proposals are simply pablum calculated to make us feel good.

That is why this 'stuff' is flowing from the mouths of politicans.  And it does nothing to solve the problem!

Let your politicians know that you understand this.  If they really want to help us, they'll begin an educational program using some of the 'smoker money' to get the true message out.  And, be sure to tell them we do not want laws banning fast food or drinking or smoking.  We need to take responsibility for ourselves.  No one else can do that for us.  The marketplace will make its own corrections just as you've begun to see with the menu changes going on in the world of fast foods, for example.

Maybe if insurance companies were permitted to charge people what we deserve to be charged based on our lifestyle habits, we'd begin to see these changes occur.  If I smoke, I pay more.  If I'm overweight, I pay a surcharge.  Make me feel my wallet lightening up if I don't take personal responsibility (just don't think this is your new way to raise taxes). 

Don't just continue to blame big health, or big drugs or big insurance!  You are doing nothing but pandering when you resort to this, and we're on to you!