Health care reform is incredibly complex. I’ve talked to doctors and others in the health care field who worry that the politicians will get it wrong. But it’s rare to meet one who thinks what we have today works.

On Monday, I met Dave Gans, a vice president of the Medical Group Management Association, which represents doctors’ practices. We were at a gathering at St. Joseph Hospital where U.S. Sen. Michael Bennet was talking health care.

Gans had worked on a study showing that doctors spend an average of approximately $60,000 a year dealing with insurance companies. That would be approximately insane. You know why costs are so high. It’s not only inefficiency and paperwork. It’s that insurance companies make money by making it hard for doctors to make successful claims.

I’ve seen numbers that show insurers turn down as many as 30 percent of claims. I heard doctors explain to me what it’s like to be in a small practice. Say you have a $100 claim and say it costs you $25 to file a claim, another $25 to appeal when it’s turned down, another $25 to appeal a second time and so on. How long before you decide not to appeal at all? And that’s before we even get to the issues of reimbursement for Medicare.

And, of course, there’s more here at work than cost. If you lose your job, you lose your insurance. If you have a pre-existing condition, you can’t get insurance. If you have an expensive disease, you can run into a lifetime cap. If you have an expensive disease, your insurer may spend many person-hours looking for a way to exclude you (including the now-infamous case of the nurse with breast cancer denied care because she failed to tell her insurers she had once been treated for — I know I’ve used this one before — acne).

“We have the best health care in the world,” Gans said. “And we have one of the worst health care systems.”

It seems like a paradox, but it isn’t. It’s how we can spend so much — much more than those peer countries with universal health care — and yet have outcomes that rank us well below those same countries.

“We have a dysfunctional system,” Gans said. “No one would have designed this system. We have excellent providers. We have excellent institutions. We have a system that wants to work.”

He pauses. “But doesn’t work.”

Update: Alternet has a good article on why our health care system sucks, including some interesting stats:

• The WHO ranks the US health care system 37th in the world, behind Portugal and Columbia;
• The US ranks 44th in the world in infant mortality;
• Out of 30 developed nations, life expectancy in the United States ranks 21st; and
• More than 50% of Americans have medical debt problems.

Marquez’s 3,500-soldier unit — now called the 4th Infantry Division’s 4th Brigade Combat Team — fought in some of the bloodiest places in Iraq, taking the most casualties of any Fort Carson unit by far.

Back home, 10 of its infantrymen have been arrested and accused of murder, attempted murder or manslaughter since 2006. Others have committed suicide, or tried to.

Almost all those soldiers were kids, too young to buy a beer, when they volunteered for one of the most dangerous jobs in the world. Almost none had serious criminal backgrounds. Many were awarded medals for good conduct.

But in the vicious confusion of battle in Iraq and with no clear enemy, many said training went out the window. Slaughter became a part of life. Soldiers in body armor went back for round after round of battle that would have killed warriors a generation ago. Discipline deteriorated. Soldiers say the torture and killing of Iraqi civilians lurked in the ranks. And when these soldiers came home to Colorado Springs suffering the emotional wounds of combat, soldiers say, some were ignored, some were neglected, some were thrown away and some were punished.

Some kept killing — this time in Colorado Springs.

Sobering stuff, especially the audio interviews with prison inmate Kenneth Eastridge.

It all came about at a meeting in 1879, when residents and property owners in the area at the convergence of Cottonwood Creek and the Arkansas River held a meeting to create a formal community.

They had been told that would help attract a railroad line, said Kathi Perry, assistant director of the Buena Vista Area Chamber of Commerce and a member of the Buena Vista Heritage board. She drew her information from the book The History of Chaffee County and her own research.

Two names were proposed by attendees: Collegiate Peaks, after the mountains in the area, and Buena Vista, which means “beautiful view” in Spanish, certainly an appropriate description.

Alsina Dearheimer, the resident and property owner who suggested the name Buena Vista, certainly knew how the Spanish words were pronounced, her first husband having been a language and music professor. But she insisted that the pronunciation for the town name be Americanized into “BEW-na,” borrowing the first syllable of the English word beautiful.

Her suggestion carried the day. An interesting anomaly was born, and Dearheimer became known as the Mother of BEW-na Vista.

The Euphrates is drying up. Strangled by the water policies of Iraq’s neighbors, Turkey and Syria; a two-year drought; and years of misuse by Iraq and its farmers, the river is significantly smaller than it was just a few years ago. Some officials worry that it could soon be half of what it is now.

The shrinking of the Euphrates, a river so crucial to the birth of civilization that the Book of Revelation prophesied its drying up as a sign of the end times, has decimated farms along its banks, has left fishermen impoverished and has depleted riverside towns as farmers flee to the cities looking for work.

And…

At a conference in Baghdad — where participants drank bottled water from Saudi Arabia, a country with a fraction of Iraq’s fresh water — officials spoke of disaster.

“We have a real thirst in Iraq,” said Ali Baban, the minister of planning. “Our agriculture is going to die, our cities are going to wilt, and no state can keep quiet in such a situation.”

Forecasters have long warned that water will become an increasing source of tension in the world, and lack of it has the potential to contribute to growing instability and violence.

In this somewhat-academic TED talk, Jared Diamond talks about why societies collapse, calling water a “ticking time bomb”.

He notes that “an unsustainable course will get resolved one way or another in a few decades”.

Whales, we now know, teach and learn. They scheme. They cooperate, and they grieve. They recognize themselves and their friends. They know and fight back against their enemies. And perhaps most stunningly, given all of our transgressions against them, they may even, in certain circumstances, have learned to trust us again.

In discussing strandings, Siebert cites evidence that noisier oceans and sonar tests by the military and seismic surveys contribute to whale deaths.

It is nearly impossible to pinpoint the precise cause of a whale’s stranding. Theories invariably include factors like the straying of a sick and dying whale leader, faithfully followed by the members of his pod, or sudden shallows along the shores of a migratory route. The two strandings in September 2002, however, did have something intriguing in common. It was noted by the Canary Islands rescuers that naval vessels were carrying out exercises that day not far offshore, a situation that had accompanied four other mass whale strandings on Canary Islands beaches since 1985. And while no such military exercises were being conducted off the beaches of Isla San José, the vessel that the scientists radioed turned out to be a research ship dragging an array of powerful underwater air guns that were repeatedly set off the previous morning in the course of seismic tests of the region’s ocean floor.

The suspicion of a causal relationship between whale strandings and either seismic tests or the use of new high-tech sonar tracking devices in military-training exercises had been mounting for some time. Similar coincidences had been noted off the coasts of Brazil, the Bahamas, the Galápagos Islands, the U.S. Virgin Islands and Japan, as well as in the waters off Italy and Greece. Necropsies performed on a number of the whales revealed lesions about their brains and ears. The results of the examinations performed on the Canary Islands whales, however, added a whole other, darker dimension to the whale-stranding mystery. In addition to bleeding around the whales’ brains and ears, scientists found lesions in their livers, lungs and kidneys, as well as nitrogen bubbles in their organs and tissue, all classic symptoms of a sickness that scientists had naturally assumed whales would be immune to: the bends.

It might sound like something out of a bad sci-fi film: whales sent into suicidal dashes toward the ocean’s surface to escape the madness-inducing echo chamber that we humans have made of their sound-sensitive habitat. But since the Canary Islands stranding in 2002, similar necropsy results have turned up with a number of beached whales, and the deleterious effects of sonar and other human-generated sounds on ocean ecosystems have been firmly established.

Siebert notes that similarities exist between human and whale brain structure and describe the peculiar affinity humans feel for these aquatic counterparts.

Somehow the more we learn about whales, the more we’re coming to appreciate the sublimely discomfiting reality that a kind of parallel “us” has long been out there roaming the oceans’ depths, succumbing to our assaults.

Charles Siebert was also featured on NPR’s Fresh Air: The Surprisingly Social Gray Whale.

Hat tip: Kottke

As seen in an introduction to his interview with Bill Moyers that is well worth watching, Potter testified before Congress:

Recently it became abundantly clear to me that the industry’s charm offensive, which is the most visible part of a duplicitous and well-financed PR and lobbying campaign, may well shape reform in a way that benefits Wall Street far more than average Americans.

The industry and its backers are using fear tactics, as they did in 1994, to tar a transparent and accountable, publicly accountable health care option as, quote, “government-run health care.” What we have today, Mr. Chairman, is Wall Street-run health care that has proven itself an untrustworthy partner to its customers, to the doctors and hospitals who deliver care and to the state and federal governments that attempt to regulate it.

In the course of his interview with Bill Moyers he talks about his “conversion”, the duplicity of the industry and why we should be surprised if any meaningful change is made by Washington insiders, the Obama administration included.

Check out the second part of the interview on YouTube, the full interview with Bill Moyers, the introduction to the Potter interview, Wendell Potter’s recent article at PR Watch on the health care industry vs. reform, and his bio.

Among other things, Potter explains that the health care industry ran an organized campaign to discredit Michael Moore’s Sicko because they viewed it as dangerous.

BILL MOYERS: Was [Sicko] true? Did you think it contained a great truth?

WENDELL POTTER: Absolutely [it] did.

BILL MOYERS: What was it?

WENDELL POTTER: That we shouldn’t fear government involvement in our health care system. That there is an appropriate role for government and it’s been proven in the countries that were in that movie.

You know, we have more people who are uninsured in this country than the entire population of Canada. And that if you include the people who are underinsured, more people than in the United Kingdom. We have huge numbers of people who are also just a lay-off away from joining the ranks of the uninsured, or being purged by their insurance company, and winding up there.

And another thing is that the advocates of reform or the opponents of reform are those who are saying that we need to be careful about what we do here, because we don’t want the government to take away your choice of a health plan. It’s more likely that your employer and your insurer is going to switch you from a plan that you’re in now to one that you don’t want. You might be in the plan you like now.

But chances are, pretty soon, you’re going to be enrolled in one of these high deductible plans in which you’re going to find that much more of the cost is being shifted to you than you ever imagined.

This is an important point: even if you currently have good coverage and/or benefit from the healthcare system, there is no guarantee that you won’t be ambushed by your insurer in the future.

Also worth reading is Trudy LIeberman’s interview with Wendell Potter in the Columbia Journalism Review, which touches on deficiencies of the media and the ways that corporate PR people manage relationships with journalists to get favorable stories published.

I can’t recall a reporter ever probing how insurers manage to meet Wall Street’s expectations through medical management and claims practices, which are key ways to manipulate the medical loss ratio and dump unprofitable accounts. Not once was I asked by a reporter what happens to people who work for small and mid-sized companies that get “purged” by insurers because their employees’ claims were causing the insurer’s medical loss ratio to move in the wrong direction from an investor’s point of view. No one ever asked me about the human consequences of satisfying Wall Street. Most reporters are happy to do a superficial job.

It seems to me that the business of making money by denying treatment to people is fundamentally flawed and that health insurance should be left to nonprofit organizations or the government, entities which are not directly accountable to Wall Street. This makes me a big fan of the Chaffee People’s Clinic.

From the Pueblo Chieftain:

The petition was submitted by the Xerces Society, Center for Native Ecosystems, WildEarth Guardians and Western Watersheds Project. It asserts that grazing, logging and other activities affect Susan’s purse-making caddisfly habitat.

Potential impacts to the insect and its importance will be examined during the status review. Following the review, federal experts could propose adding the species to the federal list of threatened and endangered wildlife.

Read the petition [PDF]. Comments may be submitted submitted electronically via the Federal eRulemaking Portal and are due by September 7.

Hat tip: Coyote Gulch

“The company has been looking to extract water locally, bottle it in Sydney and bring it back here to sell it,” he said.

“It made people look at the environmental impact of bottled water and the community has been quite vocal about it.”

While other cities like Seattle and San Francisco have prohibited city departments from purchasing bottled water, proponents of the ban suggest that Bundanoon may be the first city to enact an ordinance which bans the sale of bottled water outright.

“We believe Bundanoon is the world’s first town that has got its retailers to ban bottled water,” said Mr Dee. “We haven’t found it anywhere else.”

New South Wales Premier Nathan Rees has backed the cause, ordering government departments to stop buying bottled water and use tap water instead.

Mr Rees says it will save taxpayers money and help the environment.