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Basketball, commercials, health, health care systems, surgeons... my mind, it wanders a lot May. 27th, 2009 @ 10:15 am
Basketball

I'm watching a basketball game. Cleveland Cavaliers vs Orlando Magic. I am developing a preference for the Magic in this series, because:

1) Orlando Magic wear consistent uniforms that look fine. Cleveland Cavaliers... I've watched three games between these teams. First game, Cavaliers wore a really nice blue. I rooted for them that game, and that may be why. Second game, they wore a dark red I disliked, I found myself preferring the Magic. This game, they're wearing navy blue with red stripes. PICK A COLOUR.

2) Orlando Magic do not have Lebron James, who a) seems like kind of a jerk b) keeps getting bad decisions in his favour because he's a STAR c) okay, this one isn't his fault, but seriously, one of the commentators is totally doodling MR LEBRON JAMES in the margins of his notebook, because he can not shut up with the OMG Lebron James is so awesome he's the dreamiest OMG OMG.

3) The Orlando Magic's coach is kind of adorable. He's so wee! He's short even compared to normal people, let alone the basketball players, so standing amid the basketball players he looks like a moustached, shouty munchkin. So tiny! So shouty!

Watching American sports, I have very little personal stake in what's going on, but I like having a side I vaguely want to win. So I pick a side on an incredibly arbitrary basis.

Commercials

There's a commercial for Maltesers that comes up periodically. My brother-out-law Chas observed yesterday: "That ad always makes you smile." I hadn't realised, but it's true, I do really like it. It's 'Rollers', for Maltesers, which the YouTube blurb claims was so successful Mars had to build a whole new factory to cope with the demand. (The version we see has been dubbed with voices in Australian accents, but the dialogue is all the same.)

The thing is, it's a genuinely good ad. It doesn't treat eating chocolate as a "guilty pleasure", or some kind of overwhelming experience that's just stupidly unrealistic, or anything like that... it's, hey, chocolate is nice. And the friend's reaction of "I can see what you're doing!" and the fact that this is a cause for laughter, not any kind of why-would-people-do-that argument based on getting overly invested in a bag of chocolates, that's... nice. And the way the song on the radio gets to a cool bit and they both join in singing.

It's the kind of thing that, for me, is just... hey, this is friendship. I've had those moments. You're driving with a friend, you're laughing, being a little silly, including being silly about something like a pack of snacks, where the point isn't exactly eating the snacks (although they're tasty), it's also the game of sneaking them and getting caught and both of you finding it funny. A good song comes on, you both interrupt the conversation to sing along. These are the little, mundane moments of love and laughter that, in a very literal sense, I live for.

So yeah, that commercial makes me smile. Because it's a commercial that speaks to everyday joy - not pretending Maltesers are anything other than, you know, chocolate snacks.

Honestly, if Maltesers were gluten-free, I would probably have been buying them more since I saw this ad, because I like the taste, and it would make me think of happy, random moments with my friends.

Advertising: Just for a change, you're doing it right.

Something that's come up in my head recently:

I've been reading a lot of blogging (from the science-based, pro-vaccination side) about anti-vaccination activism.

I've also been reminded by various events that my own immunisations are either coming up to due for boosters, or possibly way overdue.

When I see my new doctor next week, I'm going to mention this, in the expectation that she will send me on to the clinic nurse to shoot me up with something, and give relevant instructions on how slowly I need to get everything done.

The site of the tetanus shot I got on Saturday is still red and puffy, but I showed it to Dr Paula on Monday, and she said it was a normal localised reaction, and the inflammation was a small enough area not to be concerned (and demonstrated what WOULD be cause for concern). I have reasonable faith in Dr Paula, so I'm not worried.

Faith because: Seriously, she's awesome. She listens, she doesn't tell me all my problems would be solved if I lost weight, when I went in near-fainting from fear about getting a pap smear she listened and she was sympathetic and very, very gentle. I had this localised skin problem. Doctor before her, Doctor D, when I said, look, I've got this, and my previous doctor told me it was a fungal thing, so I've been using anti-fungal cream for nearly a month now and it's just not getting better, glanced at it, said, "That's a fungal infection." like I didn't have any idea that was a possibility and told me to get a different anti-fungal cream.

Doctor Paula's reaction, to my telling her that that one hadn't worked either? "Well, it's probably not fungal, then." *writes prescription for steroid cream* "Try that." Visible improvement by the following morning.

Doctor Paula is awesome because when I tell her something, she listens, and integrates that into her plans for my treatment. I tell her, look, this is really scary for me, because X, she's gentle and reassuring and sympathetic and promises me that if it's too hard, we can stop, and we'll work out another way to do this.

Also, Doctor Paula is at the uni medical centre, which bulk-bills students, so it doesn't cost me money to see her, which seeing Doctor Peter, who's been my family doctor since I was about three, does. He recently moved to a new practice that's actually bothersomely expensive.

Explanation for non-Australians: Medicare pays a set fee for doctor's visits. Doctors are not required to charge that amount for their services, and most charge more. Usual practice is that the doctor will charge the fee for their services to the patient, who can claim a rebate from Medicare. However, if the doctor only charges the Medicare-refunded fee, what they will usually do is skip charging the patient altogether. Instead, the patient signs a form, and the practice bills Medicare directly. This is known as bulk-billing, because they bill Medicare in bulk. The university medical centre charges a fee for university staff and local community members who use their services, but bulk-bills students.

I keep meaning to learn more about proposed systems for American health care reform. I see people talking about a "single payer system", which I kind of don't get, but then I don't understand the current system at all, with the thing where different doctors will accept different insurance providers, and... it all sounds so weird and complicated.

Possibly it would make more sense if I lived with it. Possibly it wouldn't. I grew up with Australia's. Nobody worries about eligibility for Medicare - everyone is covered by Medicare. Medicare covers various things - GP visits to a set level, and most diagnostic procedures completely. I'm used to blood tests and X-rays and the like being things you don't pay for.

On the other hand, everyone also knows that for non-urgent treatments, there tends to be a waiting list, and so on... so you can also get private health cover, which insures you for more stuff, and lets you get things like non-urgent surgery quickly and at your own convenience for timing. Private health insurance contributes to orthodonture, and glasses (Medicare covers eye tests, but not treatment), and so on.

I have private health insurance. It costs me a little under $45 a month, I believe. I think of that as being a lot of money, actually, but I have the solace of knowing it's there if I need it, and that, since I've been with the same health insurance company since infancy (and have no complaints about their service, actually), as far as they're concerned there's no such thing as a "pre-existing condition".

And of course, I personally have yet to pay them enough to cover the money they spent on my braces when I was a teenager still under my parents' family plan - and my parents have yet to pay them enough in premiums to cover the hundreds of thousands of dollars they paid on my mother's care when I was a teenager. On the public health system, my mother almost certainly would have died - they don't have all the resources that are available on private. They don't have the staff or the money.

One year, my mother was fifth on the list of payees for our insurance company. (They publish a top ten - they don't identify patients by name, only by condition. Open heart surgery usually tops the list.) I think that year they'd paid out over half a million dollars on her.

My family, not rich. Without that cover we wouldn't have had the money to keep her alive.

At the time, my father was a contractor. Technically self-employed. In America I doubt we'd have had health insurance, and from what I've heard, even if we did, they would have stalled at least some of the unbelievably expensive treatment Mum got and she would have died.

Certainly, subsequent things would play out differently.

The surgeon Mum ended up at is arguably the best in the state, definitely among the best in the country. (Oddly, despite his utter brilliance at the most delicate of surgeries, he's absolutely useless at applying a wound dressing more complicated than a bandaid. He once removed a dressing to check something while visiting my mother in the ward, and then decided to replace it himself. This involved a mass of the dressing stuff, in an awkward lumpy wodge, held in place with about ten feet of tape. The first nurse to see this rolled her eyes so hard she nearly sprained something, called a couple of other nurses in to show them how hilariously bad it was, and then changed the dressing early.)

As might be expected of someone of his gifts, he's not someone you tend to get referred to directly. Mum had other surgeons before him. This is the man you get sent to when other surgeons decide your case is beyond them. It's like a filtering system - if you don't need him, you don't get him.

Despite the filtering system, by the way, this guy works insane hours. He'd regularly come to check on my mother, making his rounds, as late as 9pm on a weekday; he'd get there earlier on weekends, but he'd still be working. Sometimes he'd operate on her and the surgery would last until nearly midnight - and he'd be checking on her on his morning rounds at 7 the next morning.

His fees are high, and he doesn't bother with trivialities. I suspect my mother's was the first appendectomy he'd done in years - and he only took out her appendix because he happened to be passing, more-or-less.

He was doing other things around her abdomen, saw her appendix, and observed that:

1) It was, in fact, fine.

2) But it quite possibly would cease to be fine, given other things that had been going wrong lately.

3) A separate surgery to remove it if it went wrong could kill her.

4) He might as well take it then and there, since he had her on the table and open.

Hilariously, he didn't charge for this (it was unplanned, and it was a few seconds' work since it was just THERE), but the anaesthetist did.

Anyway, the thing is, despite the fact that he is, as a rule, reluctant to be concerned with surgical trivialities, when my mother finally recovered, he gave instructions that, should anyone need to do anything with her abdomen EVER again, she either come to him, or, if she preferred someone else, she make sure that her new surgeon contact his office so he could speak to the new surgeon and give a detailed briefing on the ways in which he'd rearranged things, because in order to save her life, he'd had to get somewhat creative, and not all of my mother's internal organs are where they're supposed to be.

When, a few years later, she did require some minor abdominal surgery, she went back to him. It turned out it was just as well. Part of her previous treatment had included implanting a mesh in her belly to reinforce her abdominal wall, which, apart from anything else, had been severaly compromised by many, many surgeries.

What they thought had gone wrong: A corner of the mesh had rucked up a little, causing a mild infection and needing to be straightened out.

What it turned out had happened: A corner of the mesh had pierced her small intestine. This too would have been fine, except that in fixing this, he discovered some other problems, which threatened to restart the whole trouble (my mother: defying all medical reason since about 1996), and he was able to intervene then and there to fix it before it got serious. Of course, this blew out a one-hour-estimate operation to over six.

I'm not sure an American insurance company would actually support "go to this really expensive surgeon, who already has a very high caseload and does not normally accept patients who could be handled by another general surgeon, for something that doesn't technically need his brilliance," even if the surgeon and patient would both prefer he handle the case because of the patient's special history. And so my mother would, probably, have been much sicker, maybe died if the problems had really kicked off again.

So we have multiple payers, and the system is far from perfect, but... for the most part, it copes.
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