N=1 - R.I.P. Autoimmune cat

We lost our beloved George today. Some of you have asked about him lately, cuz I wrote about him earlier in the year. In short, our 14 year old cat became ill this winter, possibly with an autoimmune type disease, at about the time my PsA was flaring and my husband's Crohn's was acting up. I've been trying to connect the dots between the three of us and our diseases, to no avail. Sadly, this week, he got too frail and dehydrated to have any quality of life anymore, and we took him in this morning to be put down.

My husband and I have had a lot of talks about euthanasia these last few days, as we've had to make this decision. When are you, or your animal, too sick to go on? How much pain is too much pain? What is quality of life? Both of us are looking at a future of increasingly bad health... but we don't want to be "put down" (or at least we can't imagine wanting to be). Why is euthanasia o.k. with an animal and not a human? When is it o.k. with a human?

I have no answers, no strong stance to take today. Just a few tears, and a little clump of white fur, shaved from George's leg before they gave him the injection. I stole it from the procedure table before we left the room - it's sitting forlornly on my desk, in a ziploc. How un-ceremonial.

He'll be missed. He was family.

Getting up to speed on health care reform...

I've been out of the loop for a couple of months - being home with the kids has taken more out of me, mentally and physically, than I expected. School started yesterday and my days are empty again - how can it be that I already I miss the noise, the fighting and the noontime cuddles?

But I've also missed a lot of the health care debate - and it's important for me to get up to speed. Psoriatic Arthritis is a chronic condition... and many of us with PsA are looking at huge medical and drug expenses for the rest of our lives. The decisions being made right now in Washington could deeply influence my health (and many of yours) for the long term.

So, yesterday, at my favorite gluten free cafe, I turned to the conservative writers that every liberal loves to love (Andrew Sullivan and David Brooks). And they both spoke very highly of Atlantic Monthly's cover article, called "How American Healthcare Killed My Father", written by David Goldhill... they both suggested that Obama should read it as he moves forward with health care reform.

So I read it too... and I hope the president reads it. It's long. It's heartbreaking. It's complicated. And it is really good. Goldhill pushes past the current focus on financing health insurance, and digs deep into what is really faulty at many levels with America's health care system, including:

A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing.

And his solution goes much farther than the solution Obama presented last night - he would like to see more consumer-centered health care system which would:

not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.

If you skip to page 6 of this article, you'll find thorough description of his plan for a more consumer driven health care system. It isn't a perfect plan (which he admits) but it is a compelling one. As someone who has huge monthly medical bills, I was first terrified by his plan - what? I'd pay for my Remicade out of my savings? But the more I read, and the more I thought about my year and a half trying tackling treatment for Psoriatic Arthritis, the more his plan made sense. Goldhill calculates that if we took all the money we spend in our lifetimes to pay for health insurance and sock it away, we would have over 1.7 million dollars each, to spend on our own health care. And if we have control over where we spend that money, hospitals and clinics would have to become more competitive (and transparent), raising quality.

Imagine, all of us with Psoriatic Arthritis, with 1.77 million each to spend on our health care. What changes could we make, in the quality of our clinics, our rheumatologists, the drugs we're offered, merely by having more choice? I'm getting all tingly just thinking about it.

Take a look at the article. It's a revolutionary idea, and educational. I liked it.