A new study of mortality in 16 countries offers reasons why Americans are less healthy and die younger than people in other wealthy countries: We eat more poorly, get fatter and have less access to health care.
The 404-page report, done by the Institute of Medicine and the National Research Council also found that even though we are a so-called wealthy country, we have more people living in poverty.
In too many cases, out health care system contributes to that poverty.
We tallied up lower scores than these other nations on infant mortality, injury and homicide rates, teen pregnancy and sexually transmitted illnesses, HIV/AIDS, drug addiction, obesity and diabetes, heart disease, lung disease and disabilities.
So, what's the problem here?
Well, for one thing, out food supply is contaminated by chemicals and it's less nutritious than it could be because of our industrialized agriculture. 
Why is it that many glucose-intolerant people can eat wheat in Europe but not here? It's because they're not reacting to the glucose but to something else -- likely some chemical we're adding that Europeans are not.
 We add high fructose corn syrup to everything because it's cheaper than sugar, and our bodies do  know the difference, despite what the corn industry's ads say. High fructose corn syrup is metabolized differently, leaving our bodies unable to use insulin the way they should, leading to a higher likelihood of type 2 diabetes. Corn sugar also makes our bodies feel hungrier, leading to overeating and obesity. The "epidemic" of obesity and diabetes began in the 1970s, which is exactly when we started using so much high fructose corn syrup in our food.
Americans spend less on food as a portion of our income than any other wealthy nation, but we get what we pay for -- lousy nutrition. These contaminated, compromised foods are what's making us sick, but we continue to belly up to fast food counters and wolf down the crap they dish out. We continue to eat processed food because it's more "convenient."
The food industry is as powerful as Wall Street when it comes to fending off regulation, so we have to be smarter consumers. We have to buy locally from small farms whenever we can, organic, when we can't get local. Know our farmers. Most places have tailgate markets and farmer's markets now. There's really no reason to eat antibiotic- and hormone-laden meats. Yes, local, humanely raised meat is more expensive, but what is your health worth? Eat less meat.
Our food system is leaving us open to so many illnesses and millions of us are lacking full access to health care. We get  sick and fat and we either don't have insurance or our deductibles and co-pays are so high we can't get the care we need for our high blood pressure, high cholesterol and diabetes, so our condition gets worse until we have a heart attack or stroke, go into renal failure or lose a limb. Then we go deep into debt from the cost of crisis care. In right-to-work states, people lose their jobs because of illness, leaving them sick, in debt and uninsured.
Our poverty levels are only partly caused by health care costs, although that is a contributing factor. The real problem is that we are paid less than we were a generation or two ago. There has been a steady erosion of workers' wages and rights since 1980 as the power of unions has eroded. We work harder, make less and are less secure in our jobs than any time since the 1930s.  As poorer people, we are less able to afford decent nutrition and we have less access to quality health care. We live in less safe neighborhoods and we are exposed to more dangerous pathogens because of the lack of food regulation.
Our children are at higher risk of STDs and teen pregnancy because rather than teach them about safe sex, we pretend they won't become sexually active until their wedding nights and they wind up pregnant or worse. We pretend that talking to them will make them want to experiment so they begin to experiment anyway with little or no education.
Overall, we're a mess and the causes are easy to identify but difficult to fix with our current political polarization and the control huge corporations have over our government. 
We have to make the changes we can and lobby for changes at a higher level. We need real regulation of our food supply and real access to health care.

According to an article in Sunday's New York Times, health insurance companies are raising their rates by double digits again, despite the promise of some 30 million new customers in the coming year.
It's not big businesses that are getting hit with these 20-percent increases, but individual customers and small businesses; big companies are seeing rate increases of about 4 or 5 percent.
In California, where the request by Anthem Blue Cross Blue Shield to raise rates by 39 percent in 2010 helped put the Affordable Care Act over the top, companies once again are seeking rate increases of up to 26 percent.
Not all states are subject to the whims of Big Insurance, though. New York, for example, has a commission that must approve rate hikes, and insurance companies must prove they need the revenue to get the raise. So far, 37 states allow regulators to reject or reduce increases of 10 percent or more.
Under the Affordable Care Act, regulators are required to review any request for a rate increase of 10 percent or more; the requests are posted on the federal Web site,healthcare.gov, along with regulators’ evaluations.
Historically, Big Insurance has gotten its way almost every time it has wanted something. Its lobbyists were able to gut the plan for a public option in the Affordable Care Act, which would have made the industry face some competition.
Now, the industry has a monopoly with nowhere near enough regulation, and we the consumers have nowhere to turn if we're treated unfairly, overcharged, denied coverage.
Yes, the Affordable Care Act provides for appeals, but the states will set the specific rules for those appeals. In the law passed by the NC House in 2011, the consumer protections were minimal at best and the insurance company protections were strong as steel. Fortunately, that law never made it through the state Senate and North Carolina will partner with the federal government in its insurance marketplace.
The proposed NC law for its marketplace also allowed oversight of the Benefits Exchange by insurance companies and health care business associations, making the chances for successful challenges even tougher. It seems no one understands the meaning -- or the danger -- of conflict of interest anymore.
So, perhaps it's time to change tactics -- maybe we should start making a lot of noise about getting a public option added to the Affordable Care Act so we can have a real choice.
Let me buy into Medicare.
Let me escape the greedy grasp of the insurance companies.

Dear Gov. McCrory,
I didn't vote for you, partly because I didn't believe you were a moderate Republican. You can prove me wrong.
Soon now, you will announce whether North Carolina will expand Medicaid to about a half-million people in the state. The action won't cost the state a dime in the first three years, and then we'll pay just 10 percent of the cost each year after that.
I urge you to stand up to people who for ideological reasons alone would allow 500,000 people to be denied basic health care.
People who make less than 133 percent of the federal poverty level can't afford even the most basic care, so they don't get checkups and they can't manage chronic illnesses. 
So, let's look at the logic here. If we deny them care, we will pay a whole lot more down the road as people show up in the emergency room in renal failure or with a massive stroke or heart attack, or with cancer that has progressed beyond the point of any hope for a cure.
People who don't have access to care are much sicker by the time anything is done for them, and by then it may be too late to save their lives.
That's what happened to my son, Governor. He couldn't get insurance because a birth defect was a pre-existing condition, and without it, he couldn't get the screening tests he needed. He got sick and he got sicker and was finally admitted to the hospital weighing just 110 pounds (he was 6 feet tall). He was so sick it took them five days to stabilize him, and his cancer was stage 3. He had to leave his wife to get Medicaid, and his chemo cost about $600,000. That's just the chemo, not the two surgeries, the radiation, the other medications and the loss of his tax revenues. So, by cheaping out on his care, we probably spent more than $1 million.
My son would be an attorney now, making decent money and paying his fair share in taxes.
Multiply that by 500,000 people, and I'm just talking about the financial cost. 
How about the emotional cost? How about the cost to our souls as human beings?
Have you ever lost a child, especially one who shouldn't have died? I wished my own heart would stop when his did, and many days I still do.
You have the chance to save thousands of lives of people in this state. I know your buddy, Art Pope, is advising  you to let those poor people fend for themselves, but I hold out hope that you have more character and compassion than that.
Make no mistake about it, Governor, we are talking about letting people die just to make a political point.
If that isn't evil, what is?

Several states have chosen to opt out of the expansion of Medicaid, and it is not in the best interests of their people or their health care businesses, especially hospitals.
The Affordable Care Act cuts the amount of money hospitals receive to compensate them for the care they provide to people who can't pay. The logic was that the expansion of insurance coverage, especially the expansion of Medicaid, would cut down on the amount of uncompensated care hospitals need to give.
But the Supreme Court threw a wrench into that plan when it decided that states don't have to expand Medicaid. Several states have said they won't expand Medicaid, but the law still provides for cuts to the money the federal government pays to hospitals for uncompensated care.
Although some are calling for an increase in federal money for hospitals in those states that refuse to expand Medicare, others are saying the states that refuse to cover more people under Medicaid shouldn't be rewarded -- especially because the expansion costs states nothing for the first three years and then the costs to the state rise to 10 percent of the total cost of the expansion. In other words, federal money is already available to these states and if they choose not to take it, that's their problem; the government shouldn't reward them with money from somewhere else. Here is the solution. Get on board or not, but those are your only choices.
When Medicaid was enacted in 1965, few states wanted anything to do with it. But eventually, all 50 states saw the advantages of a centralized system to care for people in need.
Those states that refuse to get on board will face a lot of pressure from hospitals, which will be less able to care for the poor, and probably from voters who don't understand why people in their state can't get care when it doesn't cost the
As happens most days, I got a call this morning from someone who needs health care information. She recently lost one son to cancer and another son is ill, was recently injured and now needs rehabilitation services.
Because this son only recently got SSI disability, he has to wait two years for Medicare to kick in. Because he has a 401K savings plan from when he was able to work, he isn't eligible for Medicaid. He was planning to buy a small mobile home with that money, but now he has to spend it down -- even though he can't withdraw it without paying a penalty because he isn't of age yet.
There is no reason to make people who get disability wait two years for health coverage; the reason they get disability is because they can't work, and in this country, health coverage is tied to work.
This is not an unusual situation; thousands of people are caught up in this gap every year. Many lose their savings and their homes and some die. Four years ago I interviewed a family caught in this gap and they received four calls from the bank during the two hours I was there. The woman told me they were getting eight to ten calls every day. Their power had been turned off once and the woman couldn't find a dentist who would take care of her infected teeth, which were damaged by the drugs she was taking for another condition and causing her a great deal of pain.
She had nowhere to turn.
The same is true of this family I spoke with this morning. If they can't pay for the bed in rehab, the man will be sent home, where there is no one to care for him properly.
If someone has Medicaid before getting disability, they often lose eligibility for Medicaid when they begin receiving disability checks because the $400 or $600 a month they get puts them over the income threshold in their state. In Texas, someone making just 12 percent of the poverty level can be kicked off Medicaid. And a single male adult isn't eligible, no matter what.
Congress could fix this easily by making anyone on disability eligible for Medicare immediately instead of making them wait two years.
If states expand Medicaid to over anyone with an income less than 133 percent of the federal poverty level, people won't lose eligibility for Medicaid so easily. But a number of states have said they won't expand Medicaid even though they won't have to pay a cent for it for three years and in the long run will only pay 10 percent of the cost. 
Only Congress can change this, but they haven't been inclined to do so. It seems they haven't been inclined to do much to help people in need in recent years.
It seems to me this family has been through enough, but there are those who would call them moochers because they need help because of circumstances beyond their control

I had an e-mail from a surgeon this morning from a physician who said he wanted some help getting the word out that any woman who has had a mastectomy is covered by insurance for breast reconstruction. The insurance company can't turn you down.
I know people don't know their rights under the Affordable Care Act, but this law was passed 14 years ago. I looked it up.
Nearly 300,000 people (mostly women, but a few men as well) face breast cancer every year. A generation ago, women routinely got a radical mastectomy with their diagnosis. You signed the permission before the biopsy, so you woke up minus a breast and a whole lot of muscle tissue if the pathology lab found cancer. There was no discussion because doctors offered no alternative to this body-mangling surgery.
Studies found that the survival rate was just as good when only the breast was removed, and that just removing the tumor and some surrounding tissue was also adequate in many cases.
Women lobbied to be given the choice of lumpectomy or simple mastectomy. Doctors, mostly male at the time, resisted, but women didn't back down.
Fewer women today get mastectomies, but it is indicated in many cases, and these women can have reconstruction, either at the time of mastectomy or later. Either way, insurance companies must cover the procedure.
Not all women want to have reconstruction, and no one should have it done without getting all the information available. This document by the American Cancer Society is a good place to start gathering information:
Your decision will depend on your age, the stage of your cancer, whether you have enough extra tissue to construct the new breast (very thin women sometimes don't have enough), even whether you smoke.
Each case is unique. However, if you and your surgeon decide breast reconstruction is best for you, insurance coverage (IF you are insured) is not an issue. It's covered.

An article in Sunday's New York Times reminded me that even with the Affordable Care Act, our system has some pretty serious problems, and one of the worst is the cost of medications. 
The pharmaceutical companies here have free rein when it comes to setting prices on their products. Unlike other countries, we don't cap their profits because the companies claim they won't be able to do research and development of new drugs.
Thing is, they're not doing nearly as much R&D as they did in the past. Their biggest research projects are based on finding a new angle on older drugs before their patents expire. It's about making as much and spending as little as they can get away with.
Look at what happened when the cholesterol-lowering drug Lipitor's patent expired. The company offered the name-brand drug at the same price as the generic to keep people buying Lipitor and not the generic. That's $4 a month for many consumers and Pfizer, the manufacturer, is still making money on it. Before it went off patent, the average cost was $160 per month. 
Insurance companies covered Lipitor as a "tier 2" drug. Tier 1 drugs are usually generics and co-pays might be $10 or $15. Tier 2 drugs are ones that are on the insurance companies' formularies, and they might cost the consumer $25 to $30; tier 3 drugs are generally the newer and more expensive drugs and might cost $75, $80 or more.
When I took Ambien after Mike died, it cost me $85 for a three-month supply, but only if I ordered through the mail; otherwise it was $85 per month. As soon as it went generic, it was $15 for a 3-month supply, and it came from a different manufacturer. I could get it now for $4 a month at my grocery store pharmacy.
What Pfizer did was make the name brand's price competitive with the generic to try and keep market share.
In Sunday's New York Times, Frank Lalli wrote about trying to find out what his cancer drug would cost in the new year, when his insurance plan changes its prescription coverage plan. The drug, Revlimid, which is manufactured by Celgene, retails for $524 a pill, or $132,000 a year.
Lalli didn't know how much of that would be covered by his insurance plan, so he set out to find an answer.
It took him more than a week of calling his insurance provider, the human resources department at his former employer, the drug company and Medicare before he got an answer, which he demanded be in writing because he wasn't certain he could trust it.
My question is this: How much does it cost Celgene to make Revlimid? How much of a profit does its manufacturer make?
All too often, the profit is completely unreasonable.
When Mike needed chemo, he applied for Medicaid, the government plan for low-income people. He discovered he would have to leave his wife to get it. He applied for disability, hoping he would still be able to live on his own and not have to move back in with me. He was denied twice before he was put on the waiting list for a hearing.
In the end, the pharmaceutical companies were paid more than $500,000 for his chemo drugs. He got nothing; his first disability check came nine days after he died. Obviously, we put profit before human life in this society.
The drugs we take are sold at a fraction of the cost in other countries and the pharmaceutical companies are still making money, but those companies have made sure it's illegal for us to buy drugs from Canada. The excuse was that you never know what you're getting if you buy from elsewhere. But those drugs coming from Canada were made here in the United States; it's illegal to re-import them because the pharmaceutical companies want to protect the obscene profits they make from the prices they're allowed to charge here.
It's time to stand up to Big Pharma and regulate its prices. That alone would put a big dent in the rising costs of health care.

We've had a busy couple of weeks. what with the election, Mike's and my birthday and our annual dinner and auction, Eat at Mike's. It was exhausting but worth it. I kind of think of Eat at Mike's as the WNC Health Advocates birthday party. It was our first event, beginning just after we became an official nonprofit in 2009.
But now it's time to get back to the work of fighting for access to health care for all Americans.
Already, the lame duck legislature in Ohio is voting to defund Planned Parenthood  the agency that provides affordable health care to millions of low- and moderate-income women. I used it as my main health care provider when my kids were little and I didn't have health insurance.
This isn't about abortion; this is about hurting women and children, who need healthy parents.
Employers, angry at having their candidates lose the election, are firing employees because they don't want to provide health care. The owner of Papa John's Pizza, who lives in a castle surrounded by a moat and can afford to give away 2 million pizzas in a football-related promotion, can't stand the thought of having to pay for health insurance for the people who work for him, so he will cut the hours of people who are already living on the edge rather than allow them to be eligible for coverage.
The corporation that owns Olive Garden and Red Lobster had announced it will do the same thing.
A franchise owner of Applebee's will also cut hours and fir employees.
I wrote to Applebee's about this and they sent me a reply saying it's not their decision because the man has free speech. Well, he's using his free speech to make their corporation look bad, and if that's OK with Applebee's, then I'm OK with never setting foot in one of their restaurants again. Companies can fire people who make them look bad, free speech or not. Their business  depends on their good name.
My solution to all this is to avoid eating in any corporate-owned restaurant. I will eat in locally owned establishments and I will contribute to local economies. With smart phones and GPS devices able to display lists of local restaurants and reviews in any town in the country, I see no need to ever contribute to these greedy corporate types ever again.
Although we didn't get a so-called public option that would have allowed us to buy into a government-paid insurance program like Medicare, we will have an option other than the for-profit insurance companies come 2014.
At least two health plans will be offered in every state, operated under contract to the government as the health benefits exchanges come online. Under the Affordable Care Act, one of the plans must be operated by a nonprofit.
It is an alternative to the public option that so many of us hoped would be included in the law.
The plans will compete with others in the marketplace, but they will have some advantages, including the federal government stamp of approval. I know that means little to some people, but those are people who don't trust anything the government does anyway.
In addition, the premiums and benefits of the policies will be negotiated by the US Office of Personnel Management, the same entity that negotiates the terms of the federal government's benefits.
Right now, no one is certain who will operate the plans, but the most likely candidate is the Government Employees' Health Association, which is the second largest provider of government plans, after Blue Cross Blue Shield.
The GEHA began in 1937 as an association to help railroad employees with their health care expenses and grew from there. Today it has high ratings from its customers, according to an article in the NY Times.
The Obama Administration expects about 750,000 people will enroll in the new plans, but some advocated worry about the plans not having to meet state-by-state standards. Because it is a federal plan, its provisions will override state standards. That could be good or bad. Since the plan hasn't been defined yet, we just don't know. I'm afraid a lot depends on the outcome of next week's election.




So, one minute I'm walking across the family room and the next I'm on the floor holding my foot and groaning.
The culprit was a tennis ball one of the dogs had been playing with a little while earlier.
I know something's broken because I heard and felt it crack, but I didn't go to the ER. That's $150, and they would X-ray the foot and then send me to an orthopedist who would make me wait an hour or more and then charge me $50 to tell me, "Yup, it's broken. We'll need to see you again in a week."
That would be another $50, another long wait and an appointment for the following week ... for the next eight weeks. I know because that's what happened last time and all I broke was my pinkie, and it was a simple fracture. After four weeks I quit going back and there have been no lasting repercussions. 
So, I'm going to see my own doctor, and if it's a simple fracture, I'll use crutches for a couple weeks, wear a boot and be back to normal in a month or so.
That's my way of trying to keep medical costs down.
Now, if I need to see a specialist or if I need surgery, I have insurance so I can do that.
But I'm going to start with my primary care doctor, and if I can save a few hundred dollars, I will.