happy new year

Wishing all of us good health, good tidings and an abundance of love and joy in 2008.

The Blue Cloud of Medical Home Wonderfulness

Psst.....

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Want to increase the likelihood of success for your funding/operations/research/department's proposal?

Here's how:

Download this soft, friendly, fluffy quality increasing and cost saving image and paste it onto several pages, liberally and repeatedly add the words "Advanced Medical Home" or "The Chronic Care Model," lather, rinse and repeat.

Introduction, RAND and DMAA

Welcome to the Disease Management Care blog.

This is not only a chance to keep up with news and events in that growing segment of the health care industry called "disease management" aka care coordination aka population health, but a place for readers to share comments.

Speaking of which, the latest news of some note is another publication casting some doubt on the effectiveness of disease management. Drawing on a wellspring of 317 studies, Dr. Mattke and colleagues at RAND were only able to find evidence of reductions of hospitalizations in chronic heart failure and increases in outpatient care among persons with depression. While there was evidence that DM can improve processes of care, the long term impact on outcomes in other diseases (for example, diabetes mellitus) was unknown. Except for depression (ruh roh, costs increased), there was inconclusive or insufficient evidence of any impact. Not only did RAND post this on their web site, the news spilled over into the lay media.

Think DMAA will take that lying down? Not when their members have a $1.8 billion revenue stream at stake and the folks at Medicare are pondering just what they're going to do about this disease management thingy.

Among the DMAA responses: purchasers, unlike academics, are forced to make seasoned judgments without the benefit of conclusive evidence, that findings from peer review may not apply to their settings and what's more, other swaths of health care are also lacking in evidence. What do the very smart Medical Directors, Operations VPs, CEOs and CFOs in the commercial insurance industry know that the peer review literature doesn't?

If I may say so, waiting for conclusive proof before instituting a needed intervention also has its downsides (like unopposed gravity).

Let the games continue.

10 lb terrorist

This is Eli.

He is asleep on the dog bed that J-Dog got for Christmas.

J-Dog really likes his bed but Eli really, really likes it, too.

Eli weighs 10 lbs.

J-Dog weighs more than 50 lbs.

But J-Dog always defers to Eli, who I recently decided is related to the Fishing Cat.

things i can count on: boys will be boys and a dog will have dinner

My spouse left the kids in the back yard while he went to shovel the front walk. When he returned, D. was digging and shovelling looking focused and determined. Nine year old S. was nowhere to be seen.

Turns out he was completely buried in snow.

I am choosing not to be disturbed by this (although D. did look like he was really enjoying himself) and instead, to be pleased that they were playing together without fighting.

This is another rare sighting of my children playing together.

And this is where it all falls apart.

And this? It's a picture of my dog having his Christmas dinner with all the trimmings. Except cranberry sauce. Because that would be excessive.

when do my children go back to school?

Just asking.

California Insurers Lose a Big Court Case In the Health Insurance Policy Rescission Controversy

Here's one for a Harvard Business School case study: A few months before voters in the state are going to decide the future of your industry get into a losing battle about retroactively canceling sick peoples' health insurance policies.A unanimous California Appeals Court decision has decided that California health insurers have a responsibility to check the accuracy of applications for health

The First Year For This Blog

This month marks the first anniversary for this blog.As of today, folks have visited 95,558 times. From less than a thousand visitors that first month, 14,000 a month now visit and that number continues to grow briskly.As long as you keep reading it, I'll keep writing it.

A November Ballot Initiative Over California Health Reform Would Be The Biggest Thing Ever To Happen In The Debate

With news that California Governor Arnold Schwarzenegger (R) and the Democratic controlled General Assembly have agreed on a health reform proposal we may be on the cusp of a huge referendum on the Democratic version of health care reform.The next step is for the State Senate to approve the plan. The Assembly approved it earlier this month on a party-line vote with Republicans in opposition. The

Why Couldn't CIGNA Make the Right Decision In the First Place?

The Christmas weekend was full of news stories about a 17 year-old girl who was denied a liver transplant by CIGNA.The insurer ultimately reversed its decision but the girl died a short time later.I have no idea if the outcome would have been different had CIGNA made the decision to approve the transplant in the first place.Health insurance contracts--and government plans like Medicare and

"Health Care Quote of the Year"

Brian Klepper joins us again today with his nomination for the "Health Care Quote of the Year."Health Care Quote of the Yearby Brian KlepperI was reading through some other peoples’ blog posts yesterday and came across this straightforward statement by Paul Levy, the CEO of Beth Israel Deaconess Medical Center in Boston. Paul made news by establishing a blog called "Running a Hospital."I think

kingston women get down

Taken this morning, under the influence of coffee with Baileys.

Whatever you're doing, whatever you celebrate, wishing you love and laughter this holiday season.

Washington Post: McCain "Has Some Good Ideas on Health Care"

The Washington Post is not known for favoring Republican prescriptions for health care reform. That is why their editorial today calling the McCain health care reform proposal, "the most detailed and thoughtful of the Republican proposals," caught my eye.McCain has gone further in some respects than his Republican opponents on health care. Instead of providing people with a tax deduction, McCain

The State of Primary Care--How Much Responsibility Do Specialty Physicians Bear?

Our good friend Brian Klepper, posting over at "The Health Care Blog," has some provocative things to say about the state of primary care and the role the specialties, and even the American Medical Association, have had in getting us to where we are.Among Brian's points:"American primary care is a shambles, and it is now clear that it will not be viable in the future unless significant changes

serendipity

Sometimes the most amazing things happen.

Or are done by amazing people.

Two weeks ago we had nineteen people to our house for a family Chanukah party. The cooking was shared (my spouse refers to Chanukah as "the festival of fried things"), the cleanup was shared and everyone had a great time.

After the meal, the children in the family exchanged presents.

There was also a package with my name on it. As I started to protest that this was against the rules, I was told that it was something special from my oldest niece (she'll be twelve this year).

It turned out that she had knit me a hat. It was her first non-scarf project and it is perfect. It's the most beautiful shade of turquoise, fits beautifully and just happens to be the exact same colour as the turquoise flecks in the scarf that I wear every day. And it looks great on me.

Just that week, I had tried to knit myself a hat but there was something wrong with my yarn or the pattern and it hadn't worked out. Just that day, I had been thinking how much I love it when people knit things for me and that I wish it would happen more often.

I love that hat with a passion because it is perfect and because it was so thoughtfully and carefully made, just for me.

And I have another example of an amazing thing.

I have been feeling kind of down lately. Part post-NY and Chanukah let-down, part grief for my old life and part chemotherapy blues, I've been feeling the dogs of depression nipping at my ankles. I've been fighting them off (and figuring out how to be healthier) but it has been a bit of a struggle (and of course the sadness is compounded by the guilt of a recovering Catholic: "I should be ashamed to be feeling so sorry for myself when I have responded to treatment so well, have good insurance and such great support!").

Two days ago, I wrote about feeling uninspired.

Yesterday, a book appeared in my mailbox, bound with a ribbon, on which was written the following:

"I like reading your blog and I find inspiration from it. Here is a book for you, may it bring you inspiration."

(It was from J., an artist friend, with whom I once worked closely and haven't seen in a long time. To think I inspire her means a great deal to me).

You know the expression "my heart lifted"? I now know exactly how that feels.

And how could she possibly have known that I have been scouring the Internet for patterns for knitted bags?

Sometimes, life is very hard. And it's not true that everything happens for a reason.

But sometimes, the right thing happens at exactly the right time. Or good people know to make good things happen.

The picture above was taken yesterday from the my spouse's downtown office window. Perhaps not the brightest woodpecker in the world, but I thought his appearance was pretty amazing, too.

uninspired

Perhaps it's NaBloPoMo burnout.

Also, Chrismukkah craziness and the chemotherapy blues.

Blondie says I shouldn't feel guilty about it, though.

The Shadegg Bill––A “Health-Insurance Solution” That Is a Waste of Time

Merrill Mathews, writing on yesterday’s Wall Street Journal op-ed page, asks why Representative John Shadegg’s (R-AZ) “Health Care Choice Act” isn’t a “no-brainer” for the Congress to pass.Shadegg’s proposal would enable consumers to buy a health insurance policy in any state thereby bypassing the states with the most costly benefit mandates. At the top of his costly mandate list are state “

Health Wonk Review Is Up!

David Harlow over at the "HealthBlawg" has a particularly entertaining holiday edition of Health Wonk Review up. It covers some of the best posts in recent weeks from the world of health blogs.

Republican Candidates Wouldn't Have Been Able To Get Coverage Under Their Own Health Reform Plans

Republican presidential candidates have called for a greater reliance upon the individual health insurance market. But many of these same candidates have had cancer and wouldn't have been able to get individual coverage under their own health reform plans at the time of their treatment.Ricardo Alonso-Zaldivar had a great story in the Los Angeles Times recently.Ricardo points out that Rudy

a very short post

The last couple of weeks have been unbelievably busy.

Off to chemo shortly.

More time to blog, as I recover.

Go read Jacqueline's account of my trip to New York. She made me a little weepy. And she pretty much said exactly what I would have about our time together.

Kindred spirits, indeed.

Mike Huckabee's Health Care Plan

Mike Huckabee is now among the front runners for the Republican nomination. So, what is his health care plan?First, he doesn't have a plan so much as a set of principles that would have to be detailed. On the surface he seems to want a lot of it both ways--no more government but lots of new program ideas. For example, he calls for tax credits to help low-income people purchase health insurance

december 6, 1989: why i am a feminist

Eighteen years ago today, a gunman walked into the engineering school of the Ecole Polytechnique in Montreal, separated out the women and opened fire after declaring his hatred of "feminists."

I remember exactly where I was at the moment I found out, how I felt as the details emerged. I also remember the outrage and pain I felt in the aftermath, when mainstream Canada refused to accept that these women were killed because they were women, aspiring to work in a male dominated field.

No one disputes that fact now.

They call it the Montreal Massacre and the killer has achieved the kind of recognition posthumously that he sought in life.

I will not re-print his name here.

I will, however, name each of the young women who died that day. Twelve of them were engineering students, one an administrator and one a nursing student. They would all be my age (or very close to it right now). When I think of all I have lived since December 6, 1989, I am reminded that these women and those who loved them were robbed of a very great deal.


Geneviève Bergeron.

Hélène Colgan.

Nathalie Croteau.

Barbara Daigneault.

Anne-Marie Edward.

Maude Haviernick.

Maryse Laganière.

Maryse Leclair.

Anne-Marie Lemay.

Sonia Pelletier.

Michèle Richard.

Annie St-Arneault.

Annie Turcotte.

Barbara Klucznik-Widajewicz.

More People Think Health Care Is An Urgent Issue Than Think The Iraq War Is

A recent Wall Street Journal poll caught my eye.The poll found that 52% said the economy and health care are most important to them in choosing a new president compared to 34% that said terrorism and social and moral issues were most important.That is the opposite of what people thought at the time of the 2004 election.Here's the surprise for me. The poll also showed, "health care eclipsing the

busted!

Just because we're paranoid, doesn't mean they aren't out to get us.

Undercover officer hit riot squad member at Montebello: filmmaker

wonderful wonderful, wonderful

It's as though I didn't know any other adjective, I've used it so much over the last few days.

But it really is the best possible way to describe my long week end in New York with Jacqueline.

I now own two Rebel 1 in 8 designs. Click here and here for pics. Don't I look happy? She made me feel so beautiful.

Jacqueline also made me my very own Rebel necklace, something I have wanted for a long time.

But the joy is about more than the stuff I got (although I do love the stuff I got). It's about kindred spirits, never running out of things to talk about, experiencing unfathomable kindness and being inspired by people and place, touch, taste and sound.

I have been back since late last night and I am still all aglow.

Wonderful, wonderful, wonderful.

Pete Stark Regrets the Stark "Self-Referral" Laws!

David Whelan was kind to point out a great story he just did at Forbes.com on the Stark anti-kickback laws and the bans on provider "self-referral."David writes, "Yet in an interview today the Congressman lamented that he ever made this legislative intrusion into medical practices."Congressman Pete Stark (D-CA) went on to say the laws, "gave every shyster and promoter a loophole" and that he

a few days off

NaBloPoMo is going out with a bit if a whimper this year.

I am off to hang with Jacqueline and take the scissors to some of my clothing.

I won't be back until late Monday night and (are you sitting down?) I am not bringing my computer.

I'll be back next week, though, with lots to blog about.

good kind of frantic

Short post to meet my NaBloPoMo commitment tonight.

Tomorrow, I am off to NY (Brooklyn, actually) to hang out with Jacqueline!

I'm so excited, I can't stand it!!!

If Grady Fails--The Crisis At Atlanta's Grady Health System Is A Symptom Of Bigger Problems In The U.S. Health Care System

Brian Klepper joins us again today this time with a post on Atlanta's Grady Health System. Grady is an inner city safety-net hospital now going to extraordinary lengths to remain open. Brian makes the point that the Grady situation is by no means unique but instead represents a national issue as safety net hospitals struggle to maintain health care for the uninsured while being underpaid by their

i've got nothing

It's November 28 and I nearly forgot about NaBloPoMo.

Go read Sara, she's written an interesting post about, um...penlights. And walking. It's more interesting than I am making it sound. Honest.

"Health Wonk Review" Is Up

The latest edition of "Health Wonk Review" is up over at "Health Care Renewal."I must say it is a very well done and interesting review of some of the best in recent health care posts--this time crafted by Dr. Roy Poses.

The Last One is Gone--CIGNA Buys Great West Life Health Insurance Business

The recent announcement that CIGNA has purchased the U.S. health insurance business of Great West Life for $1.5 billion in cash struck me as more than the minor headline it was back on page C5 of the Wall Street Journal.The last one is now history.Metropolitan, Prudential, John Hancock, Mass Mutual, Hartford, Pacific Life, Phoenix Mutual, and so many more, are all out of the medical business.I

One Heck Of A Budget Mess and Lots of Ugly Consequences--But Watch The Pork

With the Congress set to come back to attempt to break the budget impasse in the few weeks before the holidays, many in this town are ready to see the Congressional Democrats and President Bush agree to disagree and let the budget problems slide for a year under a series of lengthy continuing resolutions (CRs).The problem with CRs is that they only allow the agencies and programs to continue at

a balm for the stressed out, cranky soul

I had lunch today with four very beautiful women, three of whom I had not seen in a very long time.

We laughed.

We vented.

We talked and talked.

When I left the restaurant, my step was much lighter than when I entered it.

And that good feeling stayed with me all day.

I am not letting another year go by before I see them all again.

family pictograms

Tonight, when 4 year old D. was going to bed he said to my spouse:

"I know which door to go into at night because I have a D. on my door. And a hockey player, because I like hockey.

You should have a 'p' for Papa on your door and a butterfly because you like butterflies (last night D. came home and declared that he didn't like butterflies because 'girls like butterflies.' My spouse replied that he liked butterflies. Clearly this made an impression on my young son).

Mama would get an 'm' and a boy because she likes me. No. She loves me. And her picture should be a heart, for love.

And S.(his nine year old brother) should have an 's' and a zombie."

please explain the pedagogy behind the practice

My son has the same French teacher he had last year.

All they seem to do is memorize short stories and put them on as plays. Each time, a significant portion of their mark is based on their costume. Exactly how does it evaluate a child's progress in French, when you mark them on the quality of the costume that their parents are able to put together?

What's more, a classmate of my son's was assigned the role of a girl in one of the plays from last year (there are more boys than girls in my son's class). Since the girl in question was a contemporary eight year old, the boy playing the role told the teacher he would wear a t-shirt and a pair of jeans. He was informed that if he did this, he would be given a failing grade; he needed more of a 'girl costume.'

I went to the presentation. We saw the same short story presented several times. The boy who had wanted to wear a t-shirt and jeans was wearing a poncho and a headband. The other boys playing girls wore frilly dresses, ridiculous wigs and hats, spoke in high-pitched voices and flounced around like the worst possible 'girly' stereotype.

If the message that this teacher, a woman, had wanted to convey was that being a girl is to be the object of ridicule, then she succeeded.

There are four girls in the class. I wonder how all this made them feel.

And, how exactly is all this helping these children to become bilingual?

Tonight we scrambled to pull together an opera singer's costume. Don't opera singers perform in the costume of the opera in which they are performing?

We just tied a silk scarf around his neck and grabbed a flouncy velvet jacket from the dress-up box.

It will have to do.

in this for the long (hopefully very long) haul

A few random facts about my life as a cancer patient:

I have treatments on Tuesdays (two weeks on, two weeks off).

I always feel better by Saturday. Much better. Almost as if I'd never had treatment at all.

The chemo regimen I am currently on makes me feel crappy but is NOTHING like "make you bald and bloated and unable to tolerate light, sound or motion, so sick you cannot ever imagine feeling well" first six rounds that I went through back when I was first diagnosed (and we were still going for a cure).

I will be in treatment for the rest of my life. This is (hopefully) not a short term thing.

Going over posts from this time last year has served to remind me just how scary things were then. And how much better they are now.

And if you ask me on a Saturday, I will almost always tell you that life is really very good, indeed.

i bore myself to tears

As a deadline approaches rapidly (and I fit writing around parenting, recovering from chemo and oh, procrastination), I have become convinced that everything I have ever written is trite babble that no one would ever want to read outside the context of this blog.

Please don't try to convince me otherwise.

If blog content is especially lacking in depth these past few weeks, it's because I have been busy staring at the computer screen and not writing.

Perhaps I will really torture myself and do NaNoWriMo next year.

the view from here

J-Dog was not impressed with me taking pictures through the back door as he waited to come in.

Pretty boy.

Pretty snow.

I could have waited a few more weeks for the white stuff, though.

one of my heroes

From today's Globe and Mail:

South Africa's retired archbishop Desmond Tutu last week told the BBC he was ashamed of the church for its attitude toward homosexuals and blamed Archbishop Rowan Williams for not demonstrating the attributes of a "welcoming God."

"If God as they say is homophobic, I wouldn't worship that God," he said.

I do not believe in a god. I do however, believe in the power of very good people to effect change in the world. Bishop Tutu is one of those people, a man who believes that human rights should apply equally, to everyone.

"Cavalcade of Risk" Is Up

The latest edition of the "Cavalcade of Risk" is up over at "Colorado Health Insurance Insider." This edition includes some of the best posts from the last couple of weeks in insurance, finance, and investing.

the evil in the necessary

A few hours ago I felt wonderful.

Chemotherapy sucks.

I know it's saving my life but I don't have to love it.

what jacqueline said that made it better

Recently, someone who ought to know better, a professional to whom I had turned for tools to deal with fear and anxiety, said to me, "People who spend their lives saying that everything is a 'pain in the neck' often find that that is where they get cancer."

My eyes widened. My tone sharpened. I asked, "Are you telling me that I got breast cancer because I had negative feelings about my body?"

"Well, I am not talking about blame here. But many people who grow up hearing negative things or thinking negatively about a particular body part, end up, years later, getting cancer in exactly that part of their body."

Excuse me? What young woman doesn't grow up thinking at least somewhat negatively about her body, especially one who goes through puberty as young as I did? And yeah, I did hear lots of negative comments about my body when I was young. And yes, I have hated both my breasts and my belly at times.

But I repeat, what woman doesn't feel at least some ambivalence about her body?

He kept saying that he got this idea from Bernie Siegel, in Love Medicine and Miracles. I haven't read that book but I did read another by him (Peace, Love and Healing) and I suspect that his words were distorted by this so-called therapist.

The whole session with this man was appalling. He rambled, said a number of inappropriate and irrelevant things (about himself and other clients) and seemed to have little inclination to listen to what I was saying (and I ended up saying very little).

And he was extremely irritated when I ended the session early (I stayed for an hour but really, I was ready to bolt after the first five minutes).

I left feeling more than a little shaken and relieved that I had not gone to see this fraud when I was actually feeling vulnerable (like say, right after I had learned of the metastasis and not right after getting good news, when I feel healthy and strong).

The next day, I came upon this poem by Jacqueline over at Rebel 1 in 8 (I am reproducing it here because I really need you all to read it but please do go to her blog and also, here to buy here beautiful jewelry and check out her clothing designs):

what it's not. and the gratitude of my flesh.

it's not
a victim
of your shame
or mine

it's not
a symbol
of your fear
or mine

it's not
a reflection
of your arrogance
or mine

it's not
an armor
for your struggles
or mine

it's not
a billboard
for your truths
or mine.

it's not fabric to be stitched
clay to be formed
marble to be carved
a book to be read
a song to be sung
a cheer to be shouted
a code to be broken
a mystery to be solved
a key for a lock
or a
puzzle
piece
without
a
space!

it is simply flesh.

MY flesh.

and it is grateful.

for the things
it
is
not.

One of the beautiful things about poetry is that interpretation can always be left up to the reader.

But what Jacqueline wrote spoke directly to me.

I realized that everything that therapist said was really about him, not me. His own fears, his own insecurities. And his own ego.

And I have taken Jacqueline's words to heart. I will continue to strive to be as comfortable as I can in this skin of mine. I will think of myself as healthy, strong and beautiful.

And I will forgive myself when I don't.

California Policy Cancellation Scandal Heats Up As Republican Candidates Propose Health Reform Based On An Individual Health Insurance System

All of the leading Republican candidates for president favor health reform based on the individual health insurance model instead of the more common employer-based system.Apparently, a number of health insurance companies would like to derail those Republican health reform plans by scaring the heck out of consumers and voters picking the year before the election to hold a policy cancellation

sunnier days then or now?

Another NaBloPoMo cop out today, since I am so tired from my week end that I can barely see straight.

My nine year old brought this article in the New York Times Magazine to my attention. Seems that my children need to be protected from the Sesame Street I watched as a child.

I always thought that Bob guy was a little suspicious.

what a mother does for love

I saw The Bee Movie this afternoon.

D. loved it.

I loved that he loved it.

And I looked at my watch a lot.

the ones that turn the day around

Today has been one of those days. I am re-covering from chemo and I have caught a cold (likely from one of the little parasites otherwise known as my children). My throat hurts and I am sore all over.

The following two bits of conversation very likely saved my day:

"Do you like hot toddys?"

and

"Mama, I love you as much as all the days."

Both of those offerings warmed me from the inside out.

SCHIP, Medicare Physician Fee Cuts, and Medicare Advantage--We're Getting Down to Crunch Time

Since September of 2006, I have been pointing to this year-end as the time that would require some big budget decisions impacting SCHIP, the scheduled 10% Medicare physician fee cut, and corresponding Medicare Advantage cuts to health plans to pay for the doc fix.Guess what? New Year's is just over six weeks away.For now, each of these issues is bogged down in the overall budget stalemate between

i thought i had seen it all

Too tired and brain dead to really write today, so I give you this:

This is what is written in the first couple of paras of the smaller text:

Too late, when love has gone for a wife to plead that no one has warned her of danger. Because a wise, considerate wife makes it her her business to find out how to safeguard her daintiness in order to protect precious married love and happiness.

One of the soundest ways for a wife to keep married love in bloom is to achieve dainty allure by practicing effective feminine hygiene such as regular vaginal douches with reliable "Lysol."

Wow.

I cannot imagine. Really, I can't.

VEBA's--The New Growth Opportunity

With word that Ford workers have followed those at GM and Chrysler in ratifying their new labor contracts we may be at the cusp of the next big growth opportunity in the health plan business.GM alone will transfer as much as $50 billion in long-term retiree health care liabilities to the Voluntary Employees Beneficiary's Association (VEBA) and Chrysler and Ford will also set up the structure over

Health Wonk Review Is Up

Maggie Mahar does a particularly good job this time of accumulating some very good posts from the best of the health care blog world.This is also an opportunity for you to check out her new and excellent health care blog, "Health Beat" which is "a project of the Century Foundation."

passage of time

I had to help J-Dog up onto the bed tonight.

It seems like yesterday that he was the puppy and Emma was the senior dog who needed a bit of help sometimes.

Now Emma is gone and tonight, for the first time, my puppy is old enough to need help getting on the bed.

Part D Medicare Drug Plans See Major Price Increases--Why?

The Part D Medicare drug program's weighted average monthly premiums will increase 17% in 2008 and 23% since the program's January 2006 inception. The 2008 increase is well above basic pharmacy cost trend meaning the insurers are doing some rate catch-up. The average is weighted by actual enrollment.Premiums for the top two Part D Plans (PDPs) by enrollment are up dramatically. According to a

contemplating a return to the two-dog (and a crotchety cat) life

Tonight, I am stoned from the Demerol that I am given to mitigate the side-effects of the Herceptin.

Boy, typing is hard when I'm stoned.

I am reading, A Three Dog Life, a memoir by Abigail Thomas.

She starts her book with the following quote from Wikipedia;

Australian Aborigines slept with their dogs for warmth on cold nights, the coldest being a 'three-dog night.'

I am loving this book. I am seriously too stoned to be coherent as to why, so here is the blurb from Abigail's web site:

When Abigail Thomas’s husband, Rich, was hit by a car, his brain shattered. Subject to rages, terrors, and hallucinations, he must live the rest of his life in an institution. He has no memory of what he did the hour, the day, the year before. This tragedy is the ground on which Abigail had to build a new life. How she built that life is a story of great courage and great change, of moving to a small country town, of a new family composed of three dogs, knitting, and friendship, of facing down guilt and discovering gratitude. It is also about her relationship with Rich, a man who lives in the eternal present, and the eerie poetry of his often uncanny perceptions. This wise, plainspoken, beautiful book enacts the truth Abigail discovered in the five years since the accident: You might not find meaning in disaster, but you might, with effort, make something useful of it.

This memoir is really resonating with me (and not just because she has three dogs and knits).

I especially love the last line of that quote.

Amen to that.

stay in the moment, damn it

To myself, in yoga class:

"Should I force S. to do yoga?"

"I wonder what time it is."

"How long will it take to get good at this?"

"I think I'll add a little turmeric to the tomato sauce."

"Should I walk J-dog when I get in or clean up and make dinner, first?"

"Where does the day go?"

"I'm thirsty."

"She's much better at this than I am."

"I have to remember to send a cheque to school with D.s' picture order form."

"I really need to wash this yoga mat."

"I should blog about this."

Giuliani Puts His Foot In It With the Claim He Would Have Only Gotten Quality Treatment For His Cancer in the U.S.

There is this myth that all of the extra money we spend on health care at least gets us the best care in the world. Study after study debunked that long ago and the fact that someone running for president doesn't understand that claim is a myth is inexcusable.But Rudy Giuliani actually has a radio ad in New Hampshire that repeats the myth.All Giuliani's remark did was give opponents of a market

Report: "Health Insurer Tied Bonuses to Dropping Sick Policyholders"

It's hard to imagine a worse headline for the health insurance industry just as we are heading into what will be a fundamental debate over who should run our health care system.It is even harder to imagine a dumber thing for the insurance industry to do than continue to argue and litigate the notion that an insurer can cancel--or rescind--an insurance policy for a misstatement of fact on an

not your grandmother's shawl

I wore a shawl that my friend D. knit for me tonight.

I looked pretty spiffy.

I got a whole bunch of compliments on it.

It covered up the bulges that should be flat and the flat bits that should be bulges.

And I felt like I was being hugged all night.

I love it when people knit, weave or sew for me.

cancer crusader

Meet Nancy Baye (please forgive the quality of this pic. I borrowed a friend's camera and I obviously didn't know how to use it properly). I found her among the vendors at the National Conference for Young Women Living with Breast Cancer. In a sea of pink (dotted with squishy prostheses for sale), the vibrant colours of her booth were a sight for sore eyes.

Nancy is a three time breast cancer survivor (as she says, "I'm an overachiever.") who, finding that there weren't a lot of materials out there that "empowered" women living with breast cancer, decided to make her own. The Cancer Crusader was born.

Since I love thinking of myself as a badass superhero, I was thrilled to meet Nancy. Loved her work. Really liked her personally. Admired everything she does (she's also an artist and an actor).

She was selling these terrific t-shirts (you can buy them with the 'survivor' or 'supporter' caption):

She was also selling journals for women who are newly diagnosed. They have blank pages for, well, journalling but also places to make notes during each step of treatment, pages for listing folks who have offered to help with various things and even a page on which you can paste a lock of your hair.

And the best part is they're not pink! They are red and blue, with motivational captions throughout (superhero themed, of course) and lovely comic book type graphics (I live in a house with some hardcore comics fans; some of this has definitely rubbed off on me).

Nancy writes:

This journal is dedicated to all women, who, like me, have been called into action by cancer. May your writing be cathartic, liberating and a constant companion on your journey...And may you find your inner super-hero along the way."

I thought these journals were so cool that I bought two (and I really wanted to support Nancy). It was only later that afternoon that I realized I didn't know what to do with them.

I don't really have anyone in my life right now who has been newly diagnosed.

So I've decided to share the love. Do you know someone who is in a place right now that they would appreciate this journal? Drop me a line at laurie dot kingston at gmail dot com and let me know how you would put one (or both) of these journals to good use. I'll mail it to you.

if a picture is worth a thousand words, then four blurry pics are worth a NaBloPoMo entry

In lieu of writing anything of substance this evening, I am letting D. entertain you.

Every Saturday he goes to gymnastics. A couple of weeks ago, I attended, camera in hand and played paparazzi (while attempting to not be too obnoxious about it)...






Regularly scheduled programming will return shortly.

He is pretty cute, though, isn't he?

Sometimes It's the Little Things--The NCQA Announces an Agreement Between Providers and Payers to Better Pay for the Quality of Care

Particularly in this election season we tend to focus on the big health care reform plans. It is natural to want to see a big fix to a big problem. But everyday things are going on in the market that can make a difference. Make no mistake, these good works will not replace the need for systemic health care reform but it would be wrong to think just big policy changes are the only answer.A case in

not waiting for the other shoe

The night after my CT, I dreamed that my dog had been in a terrible accident. In the dream, I rushed to the hospital and waited, feeling anxious, terrified and grief-stricken, while he was in surgery. In the end, my dear dog survived the accident and was expected to recover. He was, however, really traumatized.

It wasn't until I was re-counting this dream at the breakfast table that I realized that it hadn't been about the dog at all.

Back in July, when I got the first good CT result, I was overjoyed at first but then angst-ridden. And the reality is that while I have now twice received the best news possible, my day-to-day life will not change very much.

I will continue with chemo - two weeks on, two weeks off.

I am still a cancer patient.

But as I continue to defy the odds (the stats on survival rates for women with metastatic breast cancer are abysmal and the stats when the metastasis is in the liver, even worse), I need to give myself permission to let down my guard a little. To be hopeful.

It's starting to feel OK to make plans for a few months in the future. And in a few months, perhaps I will feel I can plan even further ahead than that.

My friend T. said to me as we left my appointment on Tuesday, "You are going to get to see your kids grow up." I am not sure I'm ready to let myself believe that but I replay her words to myself and I feel warmed by them.

I'm starting with teaching myself not to panic whenever I feel the familiar stitch in my side. I know now that the pain is due to scarring but I am still working on quieting the panic it instills.

So, not much has changed but everything has changed.

I can't have my old life back but I have a great deal of hope.

I think I can live with that.

on life as a pincushion

I am covered in some spectacular bruises today. To do the CT, they not only have to find a vein, they have to thread the needle through it in order to create an iv for radioactive dye.

If this sounds painful, it's because it is. And, veins on someone who's had a lot of chemo are hard to come by.

First, they tried on the inside of my elbow.

Then they tried on the side of my forearm.

Finally, they had to go for the inside of my wrist.

The nurse informed me that she usually avoids this at all costs, because it is "torture" (she actually said this more than once).

It hurt like hell.

I think the nurse was astonished that I didn't yell or lose my temper. I did gasp, and rather loudly, as the murmers from those waiting on the other side of the curtain indicated. But I was good (as we first-born children tend to be).

The nurse kept commenting on how good-natured I was.

And I'm certainly more stoic than I used to be.

But really, though, I was too stressed about getting the test done to think much about about being stuck with needles.

It's all relative, really.

What Will It Take to Get a SCHIP Bill This Year? The Budget Outlook Deteriorates Even More

Democratic and Republican negotiators are hard at work to get an agreement on the State Children's Health Insurance Program (SCHIP) extension.The current SCHIP bill failed to get a veto-proof majority in the House.President Bush has said there is no way he will sign a SCHIP bill with a tax increase in it--the current bill would increase the per pack cigarette tax by 61 cents.The only way the

The Best Places To Get the Inside On the Workers' Compensation Market

Workers' Comp has always been a unique niche in the health care business.If WC is on your mind, I was reminded again today how important it is for you to be a regular visitor on Joe Paduda's "Managed Care Matters." While Joe is also a great source on all things health care, his perspective on WC is a must for those in that business. It's the real insider view that I always enjoy. His recent post

i am spectacular

The results are in:

My liver functions are normal. The condition of my liver has improved. There is no evidence at all of metastasis (no sign that I have cancer at all, in fact).

Why am I so surprised by this? I have had a dull ache (sometimes a sharper pain) in the area of my liver for the last couple of weeks. It's exactly where the stitch started last year, the stitch that led to the discovery that my cancer had spread. I have had moments of pure unadulterated terror, when I have thought of what it could mean.

It turns out that the pain, which I had been hoping was in my head (but knew in my heart to be real) is due to scarring. You know how scar tissue is so tight and inflexible? The scars on my liver are causing it to retract, making it sensitive.

My oncologist seemed even happier than he did back in July when I first discovered my tumours had disappeared. "It's all gone!" he crowed.

I was relieved and over-joyed but felt the need to reassure him that I was also being 'realistic' about my prognosis (the longer we can maintain the status quo the better but I do know that one day, this treatment will stop working).

But he surprised me.

He said, "Well, realistic....For some women the results of combining Herceptin and vinorelbine have been spectacular."

Spectacular.

And then he added, "I think you might continue this way for a long, long time."

He concluded by telling my friend T. to take me out for a drink (which she did).

"Go celebrate."

I did have a glass of wine. Now I am going to put my four year old to bed and then collapse out of sheer exhaustion and relief.

And tomorrow? I am going to go back to being spectacular.

I think the November curse may have been broken.

Romney Says There Are Already "Pots of Money" in the States to Pay For Health Care Reform---Where?

Mitt Romney says states could implement comprehensive health care reform without having to raise taxes.However, states trying to replicate the Massachusetts health plan would likely have to raise taxes in order to pay for it. That is the conclusion of a November 3rd Boston Globe article. Here are some points:Massachusetts had something other states don't have--a $610 million uncompensated care

lap cat distracts from CAT scan worries (dog snoring does a pretty good job too)

I am home. And exhausted.

I have to get up early tomorrow, to go to for abdominal and thoracic CT scans (also known as CAT scans) .

Once someone has had cancer, every headache, stitch, lump, bump or bout of dizziness becomes suspect. And every test, no matter how routine is fraught with anxiety.

I have been the best kind of busy these last few days. The conference and the time I spent with friends and family (as well as the chance to change my environment for a while) provided both a distraction and more reassurance than a fist full of tranquilizers.

But I do feel a little queasy and a little a lot scared when I think about what the results of this test could mean. The worst doesn't bear thinking about, actually; so I'm trying not to do so.

And right now, with my youngest asleep, my oldest in the bath, my sweetie in the room with me, the dog snoring with his head in my lap and the cat doing his best imitation of a nice kitty, it's not so hard to feel optimistic. I just wish the test was over, the results were in and I could share the good news with all of you.

Medicare Buy-In For Retirees--Private Options Make It an Even Better Idea

"We should act now to let companies and unions buy their early retirees into Medicare." That's the point of a Washington Post op-ed today by Democratic Congressman Rahm Emanuel and the president of the Democratic Leadership Council, Bruce Reed.These two former Clinton aides are arguing that:"The troubles at GM and Chrysler--and Ford, which reached a tentative labor agreement this weekend --

writing when i don't feel like it: thank you NaBloPoMo

Today's post is brought to you by NaBloPoMo, or "National Blog Posting Month."

I participated last year and met my commitment to blog every day, despite being diagnosed with metastatic cancer.

I benefitted from participating in NaBloPoMo 2006. I discovered new blogs and found many new readers. And blogging through that most difficult time helped to make it more bearable. Naming my fear and talking about it made it so much easier to cope with it.

I look forward to blogging every day throughout this month.

I hope I can find something interesting to say every day. But if life during NaBloPoMo 2007 is relatively uneventful, that will be OK by me.

i wish i didn't qualify to be here but since i do, i'm glad i am

My head is very full.

I have been attending a conference for the last few days, aimed at young women living with breast cancer. I have learned a lot. My resolve has been renewed, I have been energized and I have made some new discoveries about myself.

I will share what I have learned and thought and concluded very soon (as well as respond to the wonderful comments and emails I have received).

But tonight I am drained and exhausted. And there is more conference tomorrow.

Going to knit and watch a movie where lots of things go boom now.

where do you draw the line?

Yesterday I was asked by someone not to write about something on my blog.

Even though I don't share this person's concerns, I decided to respect their wishes. It actually wasn't a hard decision to make, as it was only the second time this has been asked of me and I really don't want my writing to hurt or embarrass the people I love.

Writing this blog has changed the way that I view the world, in that I am constantly experiencing events as potential blog fodder. There are very few topics (if any) that I would consider to be off limits in and of themselves but, as I do not blog anonymously, I don't feel I can write at the expense of those to whom I am closest.

What about you? If you are blogger, where do you draw the line?

"Medicare Advantage: Wrong Way to Spend $54 Billion"--The AMA Goes After the Medicare HMO's Money

The American Medical Association (AMA) in an editorial in its journal, American Medical News, has pulled no punches in its argument that Medicare HMO plans (Medicare Advantage) need to be cut in order to find the money to fix the upcoming Medicare physician fee cuts--10% in 2008 and another 5% in 2009.Without a doubt their attack on "excess payments" to insurers is self serving--as about all

Why Consumers’ Checkbook v CMS is a Sideshow--Bush Administration Refuses to Release Provider Data

Brian Klepper joins us again today with another one of his welcome posts. This time he points out the hypocrisy in CMS, which has been calling for market transparency, refusing to provide provider data to a consumer group.Why Consumers’ Checkbook v CMS is a Sideshowby Brian KlepperThere are people who call for market solutions as the answer to every societal problem, but who then work to restrict

candy hangover

Every year, my spouse and I have the same argument.

(Four year old D. was Batman by day)

He buys the Halloween candy. I tell him he didn't buy enough. One of us goes out to buy more. We have candy left over.

Every year it's the same.

So, this year, when I checked out the stash of candy that T. bought, and it looked like there wasn't enough, I did the only thing that made sense.

I went out and bought more.

And gave it away by the fistful. I restrained kids who were eager to move onto the next house, "No wait! I need to give you more! I have too much! Don't you want chocolate?"

(and a Doggie by night)

When it looked like I was still going to have too much candy I did the only other thing that made sense. I started eating.

By the time I went to bed I felt a little woozy.

(S. was a bloody good zombie)

And I had candy left over.

I'd say, "live and learn" but I really don't thing that I have. Next year, when I don't think my spouse has bought enough candy, I'll go out and buy more.

(The end.)

More Halloween photos here.

enough for today

I have been struggling a little these last few weeks.

It's around this time last year and the year before that cancer changed my life and I've been finding it hard to shake the grief and anxiety.

But today, I experienced a moment that quite literally took my breath away. I was out walking my dog in the arboretum, pretty much lost in thought when I was taken off guard by a tree, a pond, the sunset and scattered leaves in all my favourite colours. And the thought suddenly came to me, "I am grateful."

Grateful for my kids for bringing me joy, making me laugh and for needing me.

Grateful for my spouse, who is kind and gentle and who loves me even when I am crazy.

Grateful for my dog who gets me out walking.

Grateful for a lovely walk in a beautiful place.

And grateful that I am healthy and fit enough to enjoy it all.

Tomorrow remains uncertain but for today, it is enough to be grateful.

A Good Idea and Bad Leadership--A Way Out of the Entitlement Crisis Meets Partisan Politics

I call your attention to a column this morning by the Washington Post's David Broder.He tells us that there will be an important Senate hearing tomorrow on the issue of Social Security and Medicare entitlement costs.It seems that two Senators, one a Republican and one a Democrat, are trying to create a bipartisan task force that would have the power to fast track a solution to this huge emerging

Bush Ups the Budget Pressure--Shows No Sign of Compromising on SCHIP

President Bush just made a statement on the SCHIP bill and the upcoming 2008 budget votes. Standing in front of the White House with the Republican leaders behind him, he blasted the Democratic Congress, the recent SCHIP bill passed by the House, and rumored efforts on the part of Democratic leaders to couple defense and Iraq spending bills with domestic budget bills.The bottom line is that the

getting out in the world

Well, folks, I am now a "contributing author" (I accidentally typed "contributing other", which could make sense, too) over at Mommybloggers.com (how clever were they to register that domain name?).

I was very flattered to be asked to write for them (the women who founded Mommybloggers are very interesting women and terrific bloggers).

And I am not above asking you all to go check me out (and maybe even comment over there).

120

I've laid them out randomly, in order to try and figure out how to lay them out. Wishing my artist friends were handy to tell me what to do. I feel like I'm too close to it.

Thoughts?

There are a couple of squares I think I need to unravel and reknit, though:
See that one with the dark border? It's got to go.

I'm also wondering about the low contrast (light blue and turquoise) one just beneath it. There are two of those and I think they might have to go, too.

Thoughts?

I think I'm going to keep it like this for the week end and play with moving the squares around a little.

Update: I came home to find that one of the pets (not sure if it was the cat or the dog) did a little creative re-arranging while I was gone.


Sigh.

Maybe I'll just sew the squares together randomly.

House SCHIP Vote Fails to Attract Veto-Proof Majority

Yesterday evening, the House passed a slightly modified version of the SCHIP bill President Bush vetoed last week, this time by a vote of 267-142. That is still likely at least 7 votes short of the two-thirds needed to overturn the expected Bush veto.The bill now goes to the Senate.It is possible that both sides will try to work out a compromise--but not likely.Expect the Senate to pass it, Bush

Poll Shows Democratic Presidential Candidates Attracting Independents and Moderates With Their Health Reform Plans

I was struck by this conclusion in today's Los Angeles Times regarding their recent voter survey:"In one of the most politically significant results, the poll finds that independents and moderates were generally lining up with Democrats in the healthcare debate."The survey also suggested an explanation for the emerging alignment: Independents were most likely to complain about "job lock" -- the

Discussions Regarding Scheduled Physician Fee Cuts and Possible Reductions in Medicare Advantage Payments Getting Serious

As the year winds down, the Congress must deal with the scheduled January 2008 9.9% Medicare physicians fee cut. Both Democrats and Republicans want to fix it.To fix the physician fee cut, proposed cuts to Medicare Advantage have been on the table.Senate Finance Chair Max Baucus (D-MT) has been working on a package that would cost $25 to $30 billion and fix the physician fee problem not only for

New Study Shows Lower Costs in Consumer-Driven Plans--But the Findings Won't Settle the Debate Over Just How Effective C-D Plans Are

HealthPartners, a highly regarded not-for-profit Minnesota health plan, has issued an important report on its consumer-driven care book of business. It includes Health Savings Accounts (HSAs) and Health Reimbursement Accounts (HRAs).Their findings include:After adjusting for "illness burden," HealthPartners found that heath care costs were 4.4% lower for members in a consumer-driven plan compared

conference for young women living with breast cancer

Has anyone heard about this?

It's a national conference for young women with breast cancer (young in breast cancer terms being under forty-five). The program looks amazing (and more than a little ambitious). And it's relatively cheap: three days and evening events for $150 (although I wonder if they have extended the "early bird rates" because registration is low).

It's in Toronto, November 2-4, so it's easy for me to get to (and I have any number of people with whom I could stay) so I am seriously considering it.

Anyone else out there planning to go?

Democrats Pushing to Vote on New SCHIP Bill This Week--Bush Starting to Give

Democratic attempts to modify the SCHIP bill just enough to pick off the seven more Republicans they need are intensifying.The House failed to override Bush's veto by 13 votes last week.Yesterday, Bush's lead person on the SCHIP issue, HHS Secretary Leavitt, said the administration is now willing to consider covering kids up to 300% of poverty--they had said they would not go above 200%. Leavitt

The Fight Over SCHIP Tells Us This Budget Season is Going To Be One Big Food Fight--Medicare Payments to HMOs and Physicians Are in the Middle of It

Now that the House has failed to overturn President Bush's veto of the SCHIP bill by just 13 votes, Democrats are looking to tweak the $35 billion expansion of SCHIP just enough to get the extra Republican votes they need to get their bill passed.The House Democratic leadership is now in discussions with Republican House members who voted with their President last week and who might be persuaded

looks like fall, feels like summer

I'm back on my feet.

I was knocked flat by the one-two punch of cold and chemo but I am doing much better now, thank you very much.

Today, it was ridiculously warm out. I went for a long, lovely walk along the river. I dressed too warmly since I refused to accept that it should feel like summer outside at this late date.

Tomorrow will be cold and drizzly. And another chemo day.

So you'll forgive me for neglecting the blog in favour of the sun.

A Detailed Analysis of Rudy Giuliani's Health Care Plan

A Detailed Analysis of Rudy Giuliani's Health Care PlanRudy Giuliani's health care reform plan generally follows the Republican health care reform template that places the emphasis on making the health care market more effective in controlling health care costs and thereby enabling more people to be covered.Giuliani would remodel the income tax system to help people buy coverage and encourage

Health Wonk Review is Up

Jason Shafrin is hosting this edition of "Health Wonk Review" over at the "Healthcare Economist."

SCHIP Veto Override Fails in the House--Now What?

As expected, the SCHIP veto override effort in the House failed by a vote of 273-156--thirteen short of the two-thirds necessary.Now what?First, SCHIP will not expire. A continuing resolution funds the program at current levels until mid-November and that can likely be extended indefinitely. However, at current levels hundreds of thousands of kids will eventually fall off the program.The

Why Bush is So Ready to Use the Veto Now When He Never Did When Republicans Were "Spending Like Drunken Sailors"

This from an article in today's Washington Post stood out for me:"President Bush declared yesterday that he remains 'relevant' despite his political troubles, and he derided Democrats for running a do-nothing Congress that has failed to address critical domestic, economic and security issues in the nine months since they took control of Capitol Hill."Back on August 2nd, I did a post, Why Is

Kaiser Family Foundation Creates a Great Tool to Compare Presidential Candidate's Health Care Plans

The Kaiser Family Foundation interactive comparison tool for the presidential candidates' health care plans can be found here.You can find my evaluation of each candidate's plan in the index on the right side of this blog.

The CED Health Reform Plan Gets It Right Until They Have to Make the Tough Decision

The Committee for Economic Development (CED) has released its report, "Quality, Affordable Care for All."A few days ago I asked a number of questions about just how far the CED would go toward creating a better health care system.While I think the group has made a number of very valuable suggestions, when it comes to cost containment they don't offer more than the long list of incremental and

Upcoming "Common Good" Forum: Health Courts, Administrative Compensation & Patient Safety: Research, Policy & Practice

For years we have debated reforming the medical malpractice system. But, most of that debate has focused on capping a system most people believe just doesn't work when it comes to improving the quality of our medical care. To me, that has always begged the question, Why cap a system that is fundamentally flawed?Common Good has been doing good work on that more fundamental question and will have

on colds, clicks and chemo

I have great kids and we have been having a lovely time together during my stint as a single parent.

We all have colds. Young D. is back at school but older S. has been off for the last two days.

My spouse is in Paris (with a head cold and coming home tomorrow, I hope his sinuses are OK on the trip), thanks to his dad.

I have chemo today, if they don't veto it because of my cold.

My mom-in-law is here in the land of snot to help with the kids when I go down for the count. What are the odds of her staying healthy?

Finally, if you have a minute, please click on the link in my side bar to take a survey. It's for BlogHer Ads so they can find out more about demographics, to help with ad placement (and so they can sell ads to a broader range of advertisers).

And, if you feel like it, you can click on whatever other ad is there too (the more clicks the better!).

I made a whopping $25.41 in September. But the way I see it, it's found money (five lattes, one pizza dinner, a trip to the movies or four packs of cold medicine). I have been happy with the kinds of ads that have run on my blog. And readership is up, so that's cool too.

I did mention the fact that Canadians have not been eligible for any of the giveaways so far. I am told that, as markets expand, BlogHer Ads hopes to recruit more Canadian advertisers.

Going to go blow my nose now.

Committee for Economic Development (CED) to Release Its Health Plan This Week--The Questions to Ask Them

David Broder gave us a preview of the Committee for Economic Development's (CED) upcoming health care reform plan. With the likes of Alain Enthoven and "a high powered business group" involved, we all need to pay attention.Key points the report will make according to David's column:Business can no longer afford afford to pay for health care.Five years ago the group laid out a strategy for

Health 2.0 and the Promise of Market-Based Health Care Reform

"The ONLY policy-based reform approach that makes real sense is for the leaders of non-health care business to come together around a change agenda. They could use their collective strength to overwhelm the health industry’s objections, and drive disciplines and tools – standards, information technologyinfrastructure, evidence-based best practices, transparency and decision-support, and

SCHIP Veto Override Vote on Thursday--The Ragged Line Between Those Who Need Assistance and Those Who Don't

The House is scheduled to vote on overriding President Bush's veto of the State Children's Health Insurance Program (SCHIP) expansion.As I said last week, I believe the Democrats will come up about ten votes short in their attempt to override. I would be surprised, but not shocked, if they can find the two-thirds necessary to override the President.One of the arguments opponents of the SCHIP

When It Comes To Drug Prices the Europeans Are Better Health Care Capitalists Than We Are!

Sometimes I think the government-run European health care systems do a better job of using market tools to control their drug prices than we do in the U.S. market.For example, some government-run systems in Europe, France for example, are not afraid to take a drug off their official formulary if they don't get a competitive price.In January, the Democratic House passed a bill requiring Medicare

making like a duck

It wasn't supposed to be like this.

My spouse is away on a well deserved vacation and I am playing at being a single parent.

I had been imagining all the fun things my kids and I would do together. Go for bike rides, to the park, the library. I would get my writing and errands out of the way today and even have time for lunch with a friend I haven't seen for a couple of years.

But the weather sucks, my oldest has been testing his limits and my four year old has come down with a miserable cold. I cancelled my lunch date, am behind on my writing and feeling like the world's worst mother (how many consecutive hours should any child be allowed to watch TV, even when he's sick?).

My spouse left yesterday.

So D. (the sick four year old) and I put on a cd this morning and danced around. I promised S. a movie this evening. Things may not be going the way that I'd planned but we'll roll with it.

The minute that the sun comes out, I am throwing on some clothes (did I mention that I am still in my pajamas?), bundling D. in the stroller and going for a walk. I'm washing my hands a lot so that I don't get sick. I'll see if I can set up a play date for S. this week end.

In the days before cancer, this turn of events would have left me feeling pretty bitter.

Now I'm only a little bitter.

etching myself in their memories

"I'm starting to forget Emma."

My nine year old son said this to me a couple of days ago.

Our old dog died last summer. She was very nearly fourteen and had had a great life but her passing was a sad event for my little family.

"I can't really remember what she looked like or the things she liked to do," he went on.

"That's perfectly normal," I replied.

"Is it?"

"Yes, and that's why we tell stories about our loved ones who've died, to help each other remember them."

"Like the time Emma almost drowned Grandpa?"

"That's right. And you have lots of pictures, too."

That was pretty much the end of our conversation but it did put a lump in my throat.

I'm in remission but I do know what the statistics are when it comes to Stage IV breast cancer. I try not to torture myself with these but I know that I will die long before I am ready.

The thought that I might become a hazy memory to my children is something else on which I try not to dwell.

But it hurts.

This morning, I was cuddling with my youngest, covering his little head with kisses. I felt both intensely happy and very, very sad.

"Remember this moment," I wanted to whisper.

"Remember me."

Cavalcade of Risk--Recent Posts From the World of Risk Management

Today, it's my turn to host the "Cavalcade of Risk." Every two weeks the Cavalcade offers insights into efforts to manage risk.Having spent substantial time at a main line property and casualty company, when I hear the term "risk management" my thoughts go to the things that corporate insurance managers do to limit their "loss costs."The popular notion of individual responsibility, and the

pleasant surprise and a potentially great resource

Last Monday, I was asked to participate in a conference call.

I loathe conference calls. There is something about not being able to see people's faces that seems to bring out the worst in all participants. I usually avoid them like I would like to have avoided cancer.

So when I received an email request from Revolution Health to participate in a conference call prior to the launch of their online breast cancer support group, I cringed.

I get a lot of these kinds of requests.

But there was something in this email that stood out for me. It was very clear that Tim, the staffer who'd written to me had actually taken the time to read my blog and think about what I'd written there. I was impressed.

So, I agreed to be on the call.

It was amazing.

The Revolution Health team members all appeared to be genuinely interested in what we had to say. Hester (an oncology social worker and herself a survivor) and Carolyn seemed genuinely committed to the building of an online community for those whose lives have been affected by breast cancer.

But the best part for me was the interaction with the three other breast cancer bloggers on the call. Amazingly, we were all under 40 when we were first diagnosed. We were all very well-informed and highly opinionated. I have never, ever had a conference call fly by that quickly.

I was so happy to meet Minerva (a Woman of Many Parts), Jeanette (Two Hands...) and Jenny (At Least it's a "Good" Cancer). We pretty much took over the call, from the first question. The energy and the passion that we all feel was palpable.

Revolution Health claims to be trying to build "the best breast cancer resource on the web." I haven't had time to really explore the site yet, but I have been impressed with what I have found there. Their online support group just launched yesterday (I just joined). It remains to be seen how well this will work (support groups, are after all, what the participants make of them) but Revolution Health appears to have laid down a good foundation.

Let me know what you think.