I’m b*tching because it’s inconvenient, but I’ll still take this degree of freedom and choice (I chose this mammo center because they’re really thorough and will read and re-read scans while I wait) over what we’re being “offered” in a New York minute. Doesn’t stop me from wishing for “Tan ‘n’ Wash,” though – get a mammo, shop for shoes, return for the results of the mammo…

Baptist Hospital runs a mammography center tucked away in a corner of Macy’s at Oak Court Mall in Memphis, TN. I used to get my screens there, paid for by my insurance company. According to my EOBs, they did cost around $100. It was damn convenient to just pop in and get my name on the list, and shop and so forth, and show up to get that done, and go on shopping.

Mammography is different because the mortality curve is shifted by early diagnosis. Not everyone believes this. I attended a meeting 25 years ago and heard a well known British cancer surgeon say that breast cancer cannot be cured. That every woman diagnosed with breast cancer will eventually die of the disease if she lives long enough. That is a distinct minority view but it is significant, I believe, that he was British.

A friend of mine invested in a very interesting venture about 20 years ago. He was a radiologist and the venture was to be a chain of small mammography centers that would be placed in shopping malls. The center would be staffed by a nurse and an x-ray tech. The films would be read by a radiologist (him) in a central facility. He figured they could do mammograms for about $100. I don’t think anything came of it because mammography became a covered benefit. The private option couldn’t compete with free.

About 20 years ago, I was one of the first surgeons in our area to do hernia surgery by laparoscopy. One of the equipment reps (They were observing the surgery for ideas on improving the equipment) was the wife of a police sergeant in a neighboring city. They got interested in having us do all the workmen’s comp hernias because they were back to work in a week instead of a month. The only reason they got interested is because they were self insuring and paid for both the medical care and the time off. Most of the time those two functions are separate and there is little incentive to combine them.

There are lots of ways to improve the product of health care but many of them never happen because of the way it is paid for. The Democrats’ bills make this much worse. That’s ignoring the cost, etc.

Yes there is, and it’s called Congress…

OK, so I’m cynical.

Feeling like a number is not likely to make us feel confident about our chances.

Free choice exercises muscles. Planning, choosing, taking responsibility – I could practically feel the burn as muscles grew when I began as an entrepreneur after years in academia.

But it energizes – we do something about our health, we’re happier with the consequences, we accept that there’s no free lunch.

We know damn well there isn’t, but the Senate drones on and we can get mesmerized. But, we suspect it isn’t going to work. Facing it is facing what we know is the truth. That’s energizing, too. What’s more draining than living a lie?