Personal

Except as they shed light on my positions, I try to keep my personal affairs out of this blog. Its purpose is to account for my work in the City. Today, however, I make exception to this policy so that I may account for my whereabouts during the two months since my last entry.

On January 16, for reasons more selfish than altruistic, I donated a kidney. I donated it to my daughter. It was a win-win situation for both of us. She needed my kidney, and I needed my daughter.

Because said daughter has no wish to become a public figure, I will not describe here the details leading up to this event. Instead, I wish to share a few insights from the experience which, though they have little bearing on city politics, have informed my views on the national health care debate.

Insight No. 1: The free market is at the foundation of nearly every medical advance.

I do not believe my daughter would be alive today without the free market. It has made (at least) four vital contributions to our medical economy which government planning could never replicate. They are:

1. Specialization and exchange. I marvel to consider the breadth of specialties we drew upon and the depth of each specialization. To list just a few: nephrologists, nurse practitioners, surgeons, nurses, dieticians, social workers, technicians, teachers, writers, researchers, lab personnel, office managers, administrators, financial counselors, pharmacists, transplant pharmacists. There are also pediatric variants of many of these. At Primary Children's Hospital, there's a team who does nothing but install IVs all day.


2. Risk management (insurance). Insurance is one of the most ingenious and indispensable innovations of the modern age. It enables us to pool our money to take care of society's most urgent and unpredictable needs. My daughter's condition came as a complete shock to us. There was no family history of it and no apparent cause for it. It set in almost overnight; we were less than a year from diagnosis to total kidney failure and transplant. In that year, we amassed bills in excess of $400,000 which our insurance company cheerfully paid. I am keeping these bills to show my children when they come of age. The lesson: Never, never go without medical insurance.


3. Appropriate compensation. Consider the case of the surgeon. He has completed and paid for at least twelve years of higher education to be able to do what he does. During these twelve years, he received no compensation, and must now with his income not only repay his educational debts, but also provide for an expensive lifestyle. Now he must deal with blood and gore on a daily basis. Worse than this, he faces the daily risk that a patient will die in his hands, and when this happens, the surgeon must pick up and go on tomorrow. Facing constant emotional trauma, he and his family need to be able to retreat to a comfortable home and recreate on a frequent basis. I need to know that my surgeon is handsomely compensated so that he can sustain his difficult lifestyle. Without generous compensation, few others would choose his career path, with the result that succeeding generations would languish on long waiting lists for surgery.


4. Competition. Competition means that each provider must give peak performance or lose patients to his competitor. I like what this means for me, the consumer. A case in point is the case of Medicare vs. the private insurance company. Kidney failure, thanks to the 1972 Congress, results in automatic Medicare coverage, which works in coordination with my family's private medical insurance. When I called Medicare to ask about my daughter's benefits, I was told that Medicare does not explain benefits and does not answer questions. My private insurance company, by contrast, has dedicated a caseworker to my family. She calls me frequently for updates; she answers my every question; we are on a first-name basis. Excellent, individualized service is what competition means in the medical arena.

Insight No. 2: Free market notwithstanding, government still has a role to play in the arena of public health.

I believe there is a place for Medicare and Medicaid, but these should play supporting roles to the market's starring role. Apart from this, government can and should exercise its stewardship under the heading of public health. Three f'rinstances:

1. Regulations and standards. I appreciate the FDA's role in screening legitimate from spurious medical claims. I also believe our nation needs to move to electronic medical records, but this cannot happen unless the government creates uniform standards.


2. Advocacy and awareness. When I think how many of our costliest medical conditions are caused by obesity -- in many cases, a preventable condition -- I applaud the impulse for advocacy and awareness campaigns. Problems like this impose costs not only on individual patients, but on society at large. Clearly a compelling public interest is at stake. Air pollution in Utah is another prime example. Much of it can be reduced by changing behavior. Those of us who idle our cars in the drive-up lane at the school or the bank can learn to turn off the ignition -- but we will probaby not do so unless the state undertakes an an aggressive public education campaign.


3. Infrastructure. Electronic medical records, cited above, are an example of infrastructure. Another is walking routes. I firmly believe American Fork needs to create more safe and convenient walking routes. These have a direct bearing on public health.

Insight No. 3: There is widespread need for organ donation.

A few simple facts:

1. In the United States, almost 100,000 men, women and children currently need organ transplants.


2. In the year 2005, a typical year, there were 7,593 deceased organ donors and 6,895 living organ donors resulting in 28,108 organ transplants.


3. This means that approximately 72,000 souls each year are left waiting for organ donation. Of these, 6,000 die every year -- 18 every day and one every 90 minutes.


4. A deceased donor can save as many as 15 lives, potentially providing one heart or two heart valves, two lungs, two kidneys, one liver, one pancreas, two hip joints, two corneas, bones, connective tissues, skin, and blood vessels.


5. Ninety percent of Americans and every major religion support organ donation, yet fewer than thirty percent of us actually become donors at death. The largest reason for this is that grieving families are reluctant to give their consent. If you wish to become an organ donor on your death, don't just mark your driver's license; inform your family. Donor families incur no expense for donation, and most donor families say donation helps their grieving.

Living kidney donation is considered major surgery, but thanks to modern medical miracles (i.e. laparascopy) recovery time is brief, two to six weeks. Now at four weeks post-op, I am still banned from physical exertion, but insofar as the doctors have not restricted mental exertion, I am back to meetings.

My colleagues in the City have been more than generous in their support, accommodating my absence by scheduling meetings and agendas around the surgery. Thanks to this, I only missed one Council meeting and one work session, so I feel I am still pulling my weight.

(Just don't tell my doctors. I'm not supposed to lift anything over ten pounds.)