Better Late (Thankful) than Never

I rolled back into work on Monday, straight into an meeting, followed by an hour conference call and then six and a half hours of a meeting with out of town collaborators. All that talk talk talk makes me thankful for the weekend just past.

I am also thankful for:

• family (mine and Chris's both) - I got so lucky to have all these people to whom I am related by birth or marriage that I liketo be around. Also, my children are more wonderful than insane, though they are certainly a healthy dose of the latter as well. I never get over how good it feels to have three little people come running in at the sound of the opened door, yelling "Mommy's home! YAY! Mommy's home!"
• work - I continue to have a fulfilling job with people I like doing something I care about. Oh, and I have some flexibility in my scheduling too. 
• home - my house is warm and cozy, with a fire often in the fireplace and good smells coming from the kitchen. I live on a fantastic block with thoughtful, generous, fun neighbors, most of whom are good cooks too. My city is easy to love; interesting and filled with cool little discoveries. Plus, it has lots of bridges. The state is beautiful and often progressive despite itself.
• friends - from my closest friends to people we are getting to know, I feel love and acceptance. Often people laugh at my jokes and praise my children. 
• health - My body has continued to let me run without complaining too much, which gives me the emotional and physical balance I have been needing. It even stops raining for long enough now and then to make runs reasonably pleasant. 

What more could I want? Oh right, holidays that remind me how lucky I am to have so much.

Place cards from Thanksgiving dinner, by Ada with help from her aunt and uncle 

The kids' table at Second Thanksgiving dinner this past weekend.

And now a message from the wonk portion of my brain

Over the past few months I have mostly had my fingers in my ears when health reform talk was in the air. This has been hard to do, as health insurance reform has been topic #1 for much of the past six months. It has been in the news for good reason. What other time in my lifetime has there actually been so much change actually likely to happen? Never. So, not a good time for me to be singing "la la la la" instead of listening to the news on this. Also, I am a health policy wonk, professionally, so I have a vested interest in health reform news. But for almost six months I've been a policy wonk on leave, so I have not really paid the attention I would have if I had been working the past six months.

(now that I know my mother reads the blog, I am a little embarrassed to admit this in front of her, policy/research wonk that she is. Oh well. It is still true.)

Even in my news gray zone, certain pieces of the reform process have gotten my attention. I can't help pay attention to news about a potential public plan, after all the discussions we have had here in Oregon on that topic. The idea of a health insurance exchange is also key for me. It looks like I will be doing some work on that when I return to my job in a couple of weeks. And the past week or two, I have been listening to the news about the Stupak Amendment, which would not allow insurers to offer abortion as a covered benefit in the insurance offered to people who access federal financial premium assistance.

This is a sneaky way to limit access to abortion, and not just for low and middle income Americans. Of course, it does limit access to abortion for people who will get federal subsidies for their insurance purchase (by refusing to allow it to be a covered service). But it actually goes further. As people who get help paying for insurance premiums will have to buy through a health insurance exchange, it effectively eliminates abortion as a covered service from any insurance purchased through exchanges, whether or not the purchaser uses a subsidy. Exchanges will be open to people buying coverage on their own, with no financial help from the government. But no insurance company is going to offer one package for people getting subsidies, and another almost-but-not-quite-identical-except-with-abortion-coverage to people paying on their own. Since insurers will have to exclude abortion for some, they aren't going to include abortion in an otherwise identical insurance package for others. It just doesn't make financial sense for the insurance companies.

Proponents of this amendment say that people could always buy a separate insurance rider for abortion. But who is going to do that? How many women think "gee, I'd better plan for the possibility of a catastrophic pregnancy that needs to be terminated at 22 weeks in order to avoid threatening my health or life!"? No one thinks that, and pretty much no one is going to buy this kind of special coverage. (Plus, people who - due to past health issues - know it is likely that they'd need this are going to be high risk, making premiums for such insurance costly, and further dissuading others from buying it.) This rule would shut down abortion coverage for a big chunk of Americans. Given that most Americans who purchase insurance in the individual market have abortion as a covered service, this will be a big change.

Yes, I am annoyed.

I expressed my annoyance by signing a petition sponsored by California Senator Barbara Boxer. Despite what the conservatives say, Boxer is a moderate, not a crazy flaming liberal (not that there is anything wrong with flaming liberals. I and some of my best friends are crazy liberals).

My fellow countrymen and women can sign a petition against the Stupak Amendment here. You can also write or call your legislators to let them know what you think about this. (Click these links for contact info for your senators and representatives.)

Maybe I am ready to go back to work after all.

It bears repeating

Two years ago I wrote a post about a friend, and why you should do breast self-exams. Last year I linked to the post, and wrote about friends I'd made who were living with and living through cancer. This year I thought I might mention a resource, in case you take my advice to do self-exams and then end up needing insurance to deal with something you found. Oh, how I hope you will find nothing wrong and need no assistance. I also hope you have good health insurance. But if any of that is not true, there are resources available, including the U.S. Center for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program. The NBCCEDP helps low-income, uninsured, and underinsured women gain access to breast and cervical cancer screening and diagnostic services. These services include:

• Clinical breast examinations.
• Mammograms.
• Pap tests.
• Pelvic examinations.
• Diagnostic testing if results are abnormal.
• Referrals to treatment.

In Oregon, you can contact the state's Breast and Cervical Cancer Program. For resources in other states, check out CDC's NBCCEDP web site.

In the mean time, here is my friend Stephanie's story.

When I moved to Rhode Island in 2000, I left a job I loved and a close group of friends, in a city I'd come to see as home. Chris is an academic, so he made friends at work, but I struggled to meet people in a place where most of the residents are natives. Almost everyone I met had lived in Rhode Island their entire lives, had the same friends they'd had since before kindergarten, and though they were kind, it was clear that they were not looking to make new friends. I really struggled to find friends, and in the end one of my favorite people in Rhode Island did not even live in the state.

Stephanie Williams was the girlfriend of Dan, one of Chris's colleagues. Every other weekend she would take the train from New York City to visit Dan. A journalist, Stephanie was interesting, funny and smart. Some of my favorite moments in Rhode Island were spent in the company of Stephanie and Dan. Chris and I liked them enough that we we saw them in New York too. We went to NYC regularly to see family, and we'd meet up for brunch or pizza.

Shortly before we met, Stephanie was diagnosed with breast cancer. She was 30. One of the things that impressed me about Stephanie was that despite dealing with cancer (surgeries, chemotherapy, radiation), she was always interested in other people. Maybe because she was a journalist, she tended to look out into the world rather than retreat into her own pain.

Stephanie fought her cancer for three years. She ultimately died, but not before fulfilling a dream to write a novel. Her book, Enter Sandman was published in 2004, the summer she died. Stephanie's story, including her struggle with cancer and her decision to use her limited time to write a book, was featured in a number of national and local publications. She herself wrote an article for Glamour that was published after her death. Her alma mater wrote a a very nice article about her.

It is terrible that Stephanie died so young, but you can do something to help ensure that you and your loved ones do not. Please do monthly self breast exams, and please get an annual exam every year. This is a great start for young women, especially those of us who are generally healthy and do not see ourselves at being at risk for cancer. If you do not know how to do a monthly exam, click here. Most insurance covers annual exams with either a very low or no copayment. It is more than worth the $10 doctor fee and an hour of your time. I know you are busy, but really, this seems like a good use of time. I hope the men in my readership will urge their loved ones to do these exams as well.

I thought to tell you this because October is National Breast Cancer Awareness Month, but you should do an exam every month. Even though I admit that I have not been so good about this in the past, I'll promise if you do too.

In your face, Slovenia!

My mom sent me this video about the USA's rank (37) in the World Health Organization's ranking of countries' health systems. Sigh. Guess there is still work to be done, huh?

(To my British and Canadian friends: STOP LAUGHING. Some of us are trying, really.)

Help for a Little Guy

I don't know this woman. Until this week I had never visited her blog or heard of her. But through another blog I saw a plea for help for her son Ike and her family. Ike was born 13 weeks early, which meant a lot of work and expense when he arrived. He did better than expected, but then his father was laid off and the family's health insurance was terminated with no warning. You can read about it here.

It touched a nerve for me, both because twin pregnancies are automatically on pre-term delivery watch, and because at work I am engaged in efforts to reform the health care system so that this kind of thing does not happen to people. (Well, that the loss of insurance doesn't happen and doesn't keep people from getting needed health care. Someone else is working on pre-term birth, I imagine.) Personally, every time I am gripped by a strong series of contractions I worry that the twins will show up before we or they are ready for them to be on the outside. I have read a lot about twins and NICUs and the scary process of parenting in the hospital. But yes, it was the loss of health insurance that pushed me over the edge. I am not an advocate for a "single payer" health care system - as nice as it might be, I think it is too late for the United States to go down that path. (for the wonks in the crowd, please see the great article by Atul Gawande in the January 26 New Yorker.) I do think that people should have access to health insurance and health care whether or not they are employed, and that people who lose their jobs should have an easy way to get connected to continuing coverage. (I will admit I am not sure what the situation is like for workers in Texas, where this family lives, but even with technical "access" via COBRA, that can be a prohibitively expensive proposition, especially for a family that just lost a wage earner.)

For those who just tuned out because I got all wonky on you: 
The point here is: these people could use some help. Even a few dollars would probably mean a lot. You can donate by Paypal (go here for the link) and in other ways. I sent them a little, and hope that by writing about this a few more people will too. I wish for the best for Ike and his family, and hope that my family will never have to face what they are going through.

Once a Month Is Not Too Much To Ask

Last year I wrote about my friend Stephanie's battle with breast cancer. I hoped that more than a wagging finger demanding people conduct self-exams, Stephanie's story might get a few more women to take  action on a monthly basis. It has helped me remember, and I tend to be terrible about that kind of thing.

This year I want to encourage you to conduct self-exams by telling you something happier. At last summer's Blogher, I met two fantastic women who have become daily reads: Laurie and Susan. These women are articulate, funny and kind. And they have both battled cancer. Both have had good news on that front in recent weeks and months. I so much enjoy reading their blogs and am thrilled by their good health.

I hope my female readers will start or continue to do monthly self-exams. Those of you with blogs bring me a lot of joy, and my readers without also add to my life through your comments and good wishes. (Also, as a health policy wonk, I have a professional as well as personal interest in good health.) Take this small step. Hopefully you'll never find anything, but if you do I hope it is caught early and is but a small bump in your road.

Good health and good wishes to us all!

Lazy Updates - Haiku Edition

Pink eye Saturday
Two hour doctor appointment
No dinner with friends

On birth control pills
Ironic IVF start
Hormones in the mail

Northwest holiday
We should expect rain by now
Living room egg hunt

Work still kicks my ass
Nights to catch up on "The Wire"
Once taxes are done

Ada loves bacon
She likes to wear band-aids too
Two pleasures in one

Self indulgent blog
nonlinear girl dot com
Now belongs to me

If you won't take my advice...

then maybe my friend Stephanie's story will have an impact.

When I moved to Rhode Island in 2000, I left a job I loved and a close group of friends, in a city I'd come to see as home. Chris is an academic, so he made friends at work, but I struggled to meet people in a place where most of the residents are natives. Almost everyone I met had lived in Rhode Island their entire lives, had the same friends they'd had since before kindergarten, and though they were kind, it was clear that they were not looking to make new friends. I really struggled to find friends, and in the end one of my favorite people in Rhode Island did not even live in the state.

Stephanie Williams was the girlfriend of one of Chris's colleagues. Every other weekend she would take the train from New York City to visit him. A journalist, Stephanie was interesting, funny and smart. Some of my favorite moments in Rhode Island were spent in the company of Stephanie and her boyfriend Dan. Chris and I liked them enough that we we saw them in New York too. We went to NYC regularly to see family, and we'd meet up for brunch or pizza.

Shortly before we met, Stephanie was diagnosed with breast cancer. She was 30. One of the things that impressed me about Stephanie was that despite dealing with cancer (surgeries, chemotherapy, radiation), she was always interested in other people. Maybe because she was a journalist, she tended to look out into the world rather than retreat into her own pain.

Stephanie fought her cancer for three years. She ultimately died, but not before fulfilling a dream to write a novel. Her book, Enter Sandman was published in 2004, the summer she died. Stephanie's story, including her struggle with cancer and her decision to use her limited time to write a book, was featured in a number of national and local publications. She herself wrote an article for Glamour that was published after her death. Her alma mater wrote a a very nice article about her.


It is terrible that Stephanie died so young, but you can do something to help ensure that you and your loved ones do not. Please do monthly self breast exams, and please get an annual exam every year. This is a great start for young women, especially those of us who are generally healthy and do not see ourselves at being at risk for cancer. If you do not know how to do a monthly exam, click here. Most insurance covers annual exams with either a very low or no copayment. It is more than worth the $10 doctor fee and an hour of your time. I know you are busy, but really, this seems like a good use of time. I hope the men in my readership will urge their loved ones to do these exams as well.

I thought to tell you this because October is National Breast Cancer Awareness Month, but you should do an exam every month. Even though I admit that I have not been so good about this in the past, I'll promise if you do too.