What I Learned From Grandma

My husband David's grandmother, Maurine Brannigan, died last Friday. I felt closer to her than to my own grandparents as an adult, and I'm devastated. Death can be a great teacher, and naturally leads us to reflect on how the deceased lived his or her life. I don't have to think real hard about what Grandma taught me; the lesson is obvious.

For lack of a better term, I came from what I will call a "limited" family. There always seemed to be drama and strife among different branches of our very small clan. I had an extremely insular, stingy view of family. So what an eye-opening experience meeting David's family was! First of all, there are a lot of them. They are loud, but loyal and united. Above all, they are extremely inclusive. The most dramatic example of this the Brannigan's relationship to the adoptive parents of one of David's first cousins. The cousin, Jon, was given up for adoption as an infant and raised by a local family. His biological parents ended up marrying and having two other children. When Jon turned 18, he got back in touch with his biological family. There are many ways this could go, right, most of which is the stuff of talk shows, therapy, and advice columns, right? In the most stunning display of peace and generosity, the Brannigans have bonded tightly with Jon's adoptive parents. They are at every wedding, holiday, and other family celebration. At Jon's wedding, both his biological and adoptive parents were represented in the wedding party.

The Brannigans also easily adopt "strays"; people who don't have any family nearby who are absorbed as naturally as any blood relative. They, too, are invited to every single family gathering. I experienced this open generosity first-hand as an outsider. From the first time I met Grandma and the rest of the family, I felt totally welcome and accepted. This is all the more remarkable to me when I reflect on what a friggin' mess I was back then; angry, self-centered, judgmental, and wearing all of that for the world to see on my 250-pound body.  I feel like they accepted me even when I could not accept myself.

I see this welcoming family culture as Maurine's doing and family legacy. She was the matriarch of the family and set this open-hearted culture. I and many others are the lucky beneficiaries. Very importantly, my exposure to Maurine and the family she led truly changed me and helped me expand my own definition of family for the better. This was not a easy or quick transition; there was no come-to-Jesus moment. In fact, I was initially very overwhelmed and puzzled by the Brannigans' acceptance, openness, and love. I was baffled at how they could have normative relations with Jon's adoptive family. It just seemed, well, wrong. I can only shrug now and see how what I was exposed to in my own family, and what I thought was normal, was comfortable and fit into my little, tiny box labeled "Family: The Way Things Are." I am so grateful that Grandma showed me a more selfless, loving, and inclusive definition of family. It's one that David and I have tried hard to replicate in our own lives, viewing certain friends as "family-by-choice." They are closer than regular friends and no less important to us than blood kin.

I've found myself over the last few days surprised by my grief at Grandma's death, especially in light of the fact that she was not my blood relative. Then I quickly remember that that is exactly the lesson she taught me: blood is thicker than water, but love is thicker than blood.

Health Care Chills

I just got health care chills, and as a veteran consumer of health care, I don't GET health care chills. Nothing was shocking, until today.

I am in Phoenix, AZ to go to my father's first appointment with his oncologist. He was recently diagnosed with multiple myeloma (MM), a cancer of the plasma cells. Plasma cells are blood cells that make antibodies called immunoglobulin. I am a firm believer that you need lots of people paying attention to health care matters. I take advocates with me to important appointments and think everyone else should too. If you disagree, maybe this will change your mind. Too many cooks can spoil the broth, but not enough cooks can also be devastating. The doc we saw today will not be my dad's main doctor, but he was who was available for us to have a consultation before my dad is scheduled to begin chemotherapy next week. Let me say from the outset that this is no slacker practice; it's definitely a top oncology practice in the area.

For this instance, I had read up on MM to brush up for this consultation, and had read from two excellent sources that if a patient uses certain chemotherapy drugs, it rules out the option of the patient getting a bone marrow or stem cell transplant later. One of my questions for the doc today was, "Is my dad a candidate for a marrow or stem cell transplant?" I got a very non-committal, "We'll figure that out later as we see how things go" kind of response. I told the doctor, "I read in the book your office gave us and on the Mayo Clinic Web site that use of certain drugs rules out this option. Are you planning to use one of those drugs?" The doctor looked at the chemo order and said, "You're right. We are planning to use that drug and it would rule out the transplant option. Clearly we need to figure this out before we begin treatment." The doctor said he would consult with my dad's oncologist and their practice head and get back to him. He added, "If that delays therapy a week or two, it's worth it." We said goodbye and my dad and his wife said that they were really grateful that I was there and had brought that up.

I went to the bathroom, shaking. It is the most dramatic example I have of the need for patients to be their own advocates. Gone are the days where you can assume that doctors have your back and all you need to do is listen and trust. Sorry, hon, you need to take a crash course and become a bit of a doctor yourself, or you can be totally screwed. It is harrowing to think that if I hadn't read the info I had and challenged the doctor on it, my father could have had one dose of a drug next week that would completely rule out his options for treatment forever. Doctors are too stretched to give every patient the best care they can; I happen to think it's an effect of our insurance-driven health care system: docs have to see 35-50 patients a day just to earn enough to pay their bills and draw a decent salary. No doctor can keep great tabs on that many people a day; it would be super-human.

Another dramatic example of the need to be your own advocate from my own health care saga, is that I had to ask my doctor for IV antibiotics for my Lyme Disease. I had read that people with my degree of infection rarely, if ever, get well from just oral antibiotics alone. My doctor was about to discharge me from his care with just four weeks of oral doxycycline therapy, when I said, "I've heard from many sources that people with neurological damage from Lyme need the IV antibiotics, too. Is that right?" He said, "Oh, you want to try that? Sure." I saw a dramatic improvement after the IV treatments; until I had them I could not wash my own hair because I couldn't lift my hands to my head. I had and still have a long road to go in my healing, but there's no way I'd be where I am without those four weeks of IV Rocephin.

I am superbly grateful that I have the wherewithal to be this kind of advocate for myself and my loved ones, and that I have people in my life, like my husband, who do the same for me. I shudder to think about the people who don't have the resources, intelligence, or communications skills to do the same. It's scary to think that your entire quality of life -- or your life itself -- can hinge on the extent to which you do so effectively.

My Celebrity Encounter

I recently got back from a whirl-wind trip to New York City, where I pushed myself entirely too hard, but had a great time. I love theater, especially musicals, so was glad to buy deeply discounted tickets for two shows through BroadwayBox. The first was Rock of Ages, a show with a weak plot that basically is an excuse to string together every hair metal and arena rock anthem from the '80s. Nothing could be more my cup of tea, so I was super-excited to see this show. Luck was on my side that night; I bought really cheap seats in the back, but the box office informed me that they were upgrading me to 8th row center. Whoo-hoo! My next lucky break was when I noticed the guys next to me were holding LED "lighters" to wave during the ballads. They were handing them out of the door, but I was oblivious to that. I got out of my seat to track one down, but the theater employee told me that they had run out. Oh well! I walked away, but the employee ran after me -- she had found a "lighter" on the floor.

I sat down to read my program, and saw Dee Snider listed in the cast. For the uninformed, Dee Snider is the awesome, awesome singer for 80s hair legends Twisted Sister. He is also the host of the hair metal radio show "House of Hair," and was one of the artist leading the fight against Tipper Gore's Parents Music Resource Center (PMRC). My mom still teases me for having a hand-made "I hate the PMRC" sign on my bedroom door for much of my adolescence. Interestingly, Dee and Alice Cooper are heavy metal's family values guys, having been married and staying faithful to one woman for many years. That led to Dee Snider recently taking a great snap at Al and Tipper Gore when they announced their separation. So, back to me: when I see that Dee Snider is in this show's cast, I lose it; seriously, I get so excited that tears are leaking out of my eyes. This led me to text my sister and my husband the following message: "I am 8 rows away from Dee Snider. Give me one good reason I shouldn't shout, 'I love you, Dee!'" My sister replied, "Because I'd have to disown you as my sister ;)."

The plot for Rock of Ages is feeble, but I enjoyed it anyway. How can you not like a show that turns REO Speedwagon's "Can't Fight This Feeling Anymore" into a gay love anthem? I have to say that the audience sucked; they were not into it, and the show is meant to be a big old sing-along. On the plus side, Dee Snider looks amazing.

I have always wanted to hang out after concerts to meet stars, and the various people I attended with, usually rationalists like parents or husbands, always nixed my plans. Finding myself alone in NY with no one to nix my plans, I decided to try to make a go of meeting Dee. I sniffed around outside until I found the stage door exit, and watched various actors leave, including the lead, Joey Taranto (what a cutie!). I asked some of them to sign my program. A group of people were hanging around, prompting the security guard to ask who they were waiting for. I appointed myself the spokesperson of the group and said, "Dee." The guard replied, "You know, he's really new to the cast, and he has family in town and he's showing them around. He'll be at least an hour." This was met by a massive groan, and all but about six people left. "That's ok, I have nothing better to do," I lied. After the crowd dispersed, the guard looked at me and said, "You are a true fan. I was screwing with those people. Dee won't be an hour. If they were real fans, they would've stayed." Yeah!

Ten minutes later I was rewarded with Dee Snider. I said, "Dee, I have been a fan of yours for decades. I read your book when I was a kid, and it helped me." Yes, he wrote "Dee Snider's Teenage Survival Guide," and I am probably one of 50 people in the country who has read it. In fact, note that the first review of it on Amazon says that it was "published in one of the Russian teen magazines." At the news that I read his book, Dee gave a warm, huge laugh and said, "YOU DID?! That's awesome!" before taking me in his arms. He was really sweet, genuine, and kind, and it was a huge rush for me to meet him. Yes, he signed my program, but no, I don't have a photo, but that's ok. When I was hanging around the stage door, I was slightly nervous that I'd meet Dee and that he'd be an asshole; I specifically thought of the line from "Limelight," a Rush song : "I can't pretend this stranger is a long-awaited friend." So, I was relieved by Dee's friendliness.

In a tangentially related closing, I just became full of gratitude for my parents and their senses of humor. Between me buying books like Dee's survival guide and "The Satanic Bible", the anti-PMRC sticker on my door, and the six-foot posters of Motley Crue, Poison, and other guys who looked like chicks literally covering my wallpaper, I give my parents a lot of credit for tolerating that stuff and not laughing when I could hear them. I can't imagine what they were thinking, but I'm grateful because I really think I might have attempted suicide if not for the outlet I found in music. Junior high through high school was the worst time in my life, and rock music made it bearable.

A Happy Weight

I heard a podcast today that featured an interview with Kathianne Sellers Williams, a registered dietitian, life coach, and artist. She made a comment about helping clients find their "happy weight." She defines this as a weight at which you feel comfortable and at which you don't have to do anything extreme to maintain it. The distinction is more holistic than the traditional mode of thinking about weight-loss goals: the ever-ambiguous, just-out-of-reach "healthy weight," which varies based on whatever chart you're using.

I've lost about 103 pounds but am still about 25 pounds overweight. For about a year, I have been trying to lose more weight, but in reality, I have gained and lost the same four or five pounds over and over again. I perked up when I heard Sellers Williams talk about the "happy weight," because I've felt very dejected by failing to get my body to release more weight by cutting down on my calories and increasing my exercise. I've tried, and it's not budging. I've worked with my registered dietitian to change my food plan, and I already weigh all my food, so I have exact portion control. I can't exercise any more than I am due to my physical limitations from Lyme Disease, so I'm really doing all I can. The truth is that my dietitian could cut more food from my food plan, but that leaves me hungry and unsatisfied, which then makes the temptation to binge quite unmanageable. I'm just not willing to walk around hungry and cranky all the time just to lose some more weight.

During this weight plateau, it also has occurred to me that I would mostly be satisfied at this weight if I didn't lose another pound. I can buy clothes off the rack, not in the plus size section. I no longer take up 1.5 seats on the bus, and people sharing an aisle with me in an airplane can have their full (albeit, tiny), seat to themselves. My weight doesn't limit any of the physical activities that I want to participate in. There was a time when I wouldn't ride a horse, or be able to walk to the movie theater close to my home, or feel comfortable swimming because someone would see me in a bathing suit. Thank God, that's not the case anymore. Do I love my body? Hell no! I wish. My body shows the scars of my eating disorder: stretch marks, cellulite, and hanging skin. It's not gorgeous, and as much as it pains me to say this, it probably never would be -- even if I lost these last 25 pounds. But by dressing semi-well and occasional judicious use of Spanx Higher Power Panties (they're the bomb!), I manage to look ok clothed.

When Sellers Williams works with clients to help them find their "happy weight," one way they arrive at that number is by looking at the client's weight history. I have had two nutritionists I've worked with tell me that given my weight history -- how obese I was and how young I was when I became obese -- that it would be extremely unlikely that I'd ever get to be an ideal weight on a chart. One of the nutritionists said, "If you ever made it below 150 pounds, that would be incredible. Much more than that is not realistic given your background." Happily, I am below 150! I've exceeded their expectations.

Although I find the concept of a "happy weight" quite freeing, there is still a piece of me that resists it. My rational brain says, "You need to be as healthy as possible, and it's not healthy to carry extra fat." True, but we can't say I haven't tried to lose it, and again, we have to acknowledge that my health history makes it unlikely that I'll ever be thin. More critically, we need to take a more holistic view of what health means; it certainly is more than a number on the scale. It includes data like blood chemistry, lung capacity, and endurance, but also sanity, balance, serenity, and other non-quantifiable markers of a quality, healthy life. For the record, with the notable exception of my Lyme Disease, I do seem to be quite healthy. I used to have elevated insulin levels and triglycerides, but those and other health markers normalized after I lost 40 pounds.

Another thing that conspires to keep me from embracing the concept of a "happy weight" is some peer-pressure from inside OA rooms to be a good role model for the program and demonstrate three-fold recovery: emotional, spiritual, and physical. When people see me, they see an average-looking American woman, meaning someone who could stand to lose a few pounds. They don't know how much weight I've lost and how hard I've worked to facilitate that. I think I just have to let this one go: if some people in OA rooms judge me for still being somewhat overweight, oh well. I can't control what they think, and they have the right to their self-righteous judgment. Whatever. It also occurred to me that fighting this weight my body seems to have settled at (which, by the way, it is evolved to do -- if you lose enough body weight it triggers the "starvation" switch in your brain, at which point the body fights like hell to hold on to every last pound) is very antithetical to Step 3: became willing to turn our will and our lives over to the care of God as we understood him. Step 3 is about surrender, not fighting. Isn't what I'm doing by trying to nudge the scale down -- and failing -- fighting? It sure feels that way, and I'm tired. And I think I'm done. If God, my body, or whatever sees fit to release more fat in the future, great, but I think I've given it a good go and now I need to let go, and enjoy my new, mostly healthy body.

Yoga

About eight weeks ago I was longingly looking into the "Mind-Body" studio at my gym, wishing that one day my body would be up to taking a yoga class. Damara, the group fitness instructor, came up to me and said, "You should take that class." I replied, "I will, one day." "No, you should do it now," she said. I launched into my explanation that my Lyme Disease has left me so disabled that I couldn't possibly do yoga. Damara told me that the instructor is amazing, and that I should just pull her aside and tell her about my disability and that I'm a newbie. I went into it with a good attitude: that I would do only what I could, when I could, and that was fine. No hurting myself, no pushing myself into pain, no worries about not keeping up. I stuck to that, and found the class surprisingly enjoyable. It challenged me in a good way.

I went back to that class and another led by another instructor that Damara recommended, and now, I'm hooked. My body is getting stronger more rapidly than it has in years, and I'm seeing some surprising (and welcome) strength gains. Lifting free weights triggers the pain in my arms, but evidently my body can handle supporting its own weight most of the time. If this was all I got from yoga, it would be enough. In fact, watching my husband's face as I used my arms to lift myself to sit on the kitchen counter would've been enough. But I'm finding that the yoga practice I'm beginning is changing my life in profound, unexpected ways. It's thrilling. I am certainly becoming more mindful, and calmer -- yoga reboots my nervous system. I had a good example of this one recent weekend, when I was feeling very irritable and discontent for many reasons. Since it was my Sabbath, my usual options for blowing off steam for prohibited for me: I couldn't call a friend, write a journal entry, escape via TV. My husband was at synagogue, so I couldn't talk things out with him. I didn't have an immediate outlet for my restlessness, so I unrolled my yoga mat and started doing the little bit of yoga that I know. 35 minutes later, I felt significantly less tense.

Through yoga, my senses are deepening: I am acutely aware of how the breeze feels in my hair, or how the sun warms my skin. On the best days, everything feels more vivid, like when "The Wizard of Oz" movie changes from black and white to technicolor. My existence is becoming more colorful. I'm also definitely noticing differences in how I relate to other people. My compassion is growing. I get annoyed less often (but we don't talk about yesterday!) The other day a car cut me off when I was trying to cross the street in a pedestrian crosswalk. The driver accidentally sped through the intersection, realized it, and made some kind of "sorry" gesture. Instead of getting pissed and giving her stink-eye, I found myself waving and nodding "it's ok" to her. Whoa! What have you done with Sarah?

For all these reasons, I'm enthusiastically trying to practice yoga regularly and learn as much as I can about it, with all the zeal of the recently converted. It certainly is not just about the asanas (postures); yoga is geared to strengthen people in the areas where I'm personally weak: mindfulness, judgmentalism/criticism of self and others, contentment, being reactive, etc. This point about the holistic nature of yoga became very clear to me recently, when I hung out with a friend who is currently training to be a yoga teacher, but was acting distinctly non-yogic. Where I saw the improvement in myself is that I reacted to her harshness with compassion and sadness for her, instead of any feelings of judgment or superiority. We are all on a journey, and hers has been especially difficult lately. I was in one of the really shitty situations she's reacting to harshly, and I was able to explain how I've been able to approach the issue with more compassion to the offending person as I've grown older.

No authentic spiritual discipline is all pretty, in my opinion, and that includes yoga. My practice is bringing up all kinds of psychic sludge that I carry, and my little brain is looking for e-s-c-a-p-e. Illegal substances? I want them with an intensity I haven't had in years. Inappropriate actions? I want to indulge in them. I have spent more time thinking about foods I abstain from than I care to admit. Honestly, I feel like a petulant toddler, if toddlers had PMS. The cool part about all this craving is that I understand why it's coming up; uncomfortable things (the aforementioned psychic sludge) are coming up, and greeting them is unpleasant. My mind is trying to distract me, "Nothing to see here! Move along!" Very importantly, I'm acknowledging these things and working through them instead of numbing out. Pretty nifty!

Elvis Week

When I was 16, I started working at Graceland, the famed Memphis home of Elvis Aaron Presley. What began as kind of a joke ended up being by far the most rewarding and interesting job of my life. Back before the pre-recorded, stock tours visitors to the mansion listen to now, I was a tour guide at Graceland mansion and the accompanying attractions like Elvis's two airplanes, and the really awesome movie that plays in the plaza every 20 minutes. I've watched that movie around a thousand times, and I never got sick of it.

The biggest event of the year for Elvis Presley Enterprises (EPE) is Elvis Week, the extravaganza that brings in thousands of Elvis fans around the world to celebrate and mourn The King of Rock n' Roll. Elvis Week culminates with the Candlelight Vigil on the night of August 15, the night before Elvis died at his home. Tens of thousands of Elvis fans walk up the long driveway to Graceland and around to the grave sites of Elvis and his family on the side of the estate. To say that I was snarky about Elvis's hard-core fans when I started at Graceland is understating it; I wondered what kind of losers flew from Asia and Australia to stand in line for hours to file past a grave at a very specific hour. My attitude would soon change.

I had my first unusual siting during Elvis Week as I was walking from the employee parking lot up to the ornate gates of the mansion with my coworker. In Memphis, there are not many homeless people on the streets, and they definitely don't hang out in Whitehaven, the neighborhood where Graceland is. "Oh, Mike," I said. "That's so sad! Look at those homeless people sleeping outside the gates." Mike, a seasoned veteran, chuckled. "They're not homeless -- they're fans!" When I looked again, I saw that the family had an extension cord plugged into an outlet they found somewhere, and they were watching TV on the sidewalk like it was the most normal thing to do. That family, and many others, were camping out to be among the first people to ascend the hill during the Candlelight Vigil. In case you're planning a trip to Elvis Week, please note that no matter how early you camp out, if you are not affiliated with a registered Elvis fan club, you will be behind the thousands of official fan club members, so wear really comfortable shoes. Additionally, book your hotel room really early, or you'll end up commuting in from far out in Mississippi and Arkansas since every hotel room in Memphis and its close environs will have been sold out for 11 months.

As Elvis Week progressed, the elaborate floral arrangements you see above start to roll in from the fan clubs. There are so many of them that few get displayed, and the ones that are displayed on the driveway and at the grave site are rotated frequently to showcase others. I was new to this whole Elvis Week culture, and was a little intimidated at first by the Fans. I mean Fans with a capital "F": the hard-core, Elvis fans. They are easy to spot, as they are usually clothed head to toe in Elvis paraphernalia. Some, but not all, are middle aged and they literally come from all over the world and will eagerly tell you that they saved their money for years to make the journey to Memphis. Some come every year, like the haj. I was afraid the Fans would be really hard on me as a tour guide, or try to usurp my role. Nothing could be further from the truth. The Fans are frikkin' awesome. They are the nicest, most genuine people. They love EPE employees whom they believe are carrying on the King's life's work, and they are eager to show their appreciation. Accepting tips was strictly forbidden, so the fans would bring us roses or get us tickets to exclusive Elvis Week events that their fan club was hosting. Cool stuff like that.

As Elvis Week went on, God softened my heart to the Fans. How could it not be softened? I had hundreds of conversations with the Fans, and a theme became very clear: Elvis made their lives better. They loved Elvis as much for his philanthropy as for his music, and they were totally committed to charitable works and service in the name of the King. I don't know of any other entertainer who has had a similar effect on his or her fans. People are fanatical about many musicians, but how many times have you heard people say, "I work at a soup kitchen because Michael Jackson influenced me to help people in my community" or "I raised $10,000 for a charity because Lady Gaga made me realize the importance of doing my part to make the world a better place"? The Fans truly look up to Elvis and try hard to impart his generosity and charity in the ways they can. How can you not respect that? People often ascribe a religious fervor to Elvis Fandom, but they don't get it: they think that the religious undertones are veneration for Elvis's music. It's not. It's that call to service, to making the world a better place, that illuminates the fans and bonds them together. The Fans love of all things Elvis is critical, of course, but secondary.

My first year at Graceland I was eager to experience the Vigil for myself, so I volunteered to work the night of Aug. 15. I am so glad I did. It was truly overwhelming to see tens of thousands of people holding candles, making their way up the driveway all night to pay their respects at Elvis' graves. They cry. Elvis music plays all night on speakers. I cried. I drove home the next morning after being awake and on my feet for about 14 hours.

Today marks 33 years since Elvis died, and the fans are no less passionate now than they were in 1977 or in 1992-1994 when I worked at Graceland. In fact, 15,000 fans withstood Memphis's 118-degree heat index last night to walk up the driveway and pay their respects. Elvis, I was a doubter when I went to work at your house, but my admiration and respect for you grew during the two years I worked there. I came to revel in your entertainment and respect your commitment to your friends, to Memphis, and to the world at large. I once was lost, but now am found. Was blind, but now I see. Rest in peace, Elvis.

Walking Away From Health Insurance

Given what I wrote in my last post about how many out-of-network health care practitioners I see, why do I bother having health insurance? I use it more than I let on: for every prescription drug that would be $270 without insurance coverage, I pay $40. My $1,200 lab bill ends up being $23. And God knows I couldn't afford hospitalization without health insurance.

I am supremely grateful that I have health insurance and that our premiums are very low in exchange for ridiculously high deductibles. However, I would really like to see the United States move away from this model of health insurance. Normal insurance is not for everyday things: it is meant to cover large costs when catastrophe hits. We don't get car insurance to cover oil changes, but car accidents. Health insurance as we know it is an anachronistic concept; it was born during World War II when companies had to freeze wages, but wanted to attract employees. Thus, health insurance was invented. It didn't cost the companies much since health care was so much simpler, and people were just more likely to die if they became seriously ill. Another reason to abandon our current ways is that insurance companies are for-profit entities that care above all about earning money. That's not necessarily evil, but when it comes to a contest between making shareholders happy or patients getting the care they need, insurance companies can't be expected to advocate for their customers. It's against their interests. The system is completely adversarial: I want my claims paid, my insurer has a strong incentive to dick around and deny it, or cover a paltry sum.

I would like to see health insurance function more like car, long-term care, and homeowners insurance: used to cover extraordinary, high-cost events. I would like to see all other health care priced for and offered on an open market. I'd like to be able to go to a web site for Radiology Clinic A and see how much they would charge me for an MRI of my cervical spine and compare it to the price of Clinic B. Cost is only one factor that I consider when choosing my health care, so that's not all the information I'd need. In this example, it would be helpful to know whether Clinic A or B has the most powerful magnets, and yes, they differ widely in the Washington area. One clinic in particular, owned by radiologists, has invested in higher-end MRI machines that yield clearer images. In this change that I'm proposing, clinics A and B -- and pharmacies and laboratories and every other player in the health delivery system -- would be competing for my business the same way every other part of the commercial sector does. I could use all of the resources at my disposal to compare the variables meaningful to me and make a choice about where I get my care. After all, we are not just patients: we are health care consumers, which is why drug marketing directed at the public is called direct-to-consumer advertising, not direct-to-patient advertising. Let us be educated consumers and consume!

I used to take a prescription vitamin for acne that was amazingly effective, but not covered by my health insurance. My jaw dropped when I inquired about the price at my local CVS pharmacy, and I thought, "I have to be able to do better than this." I found a pharmacy in upstate New York that sold me the same drug at a fraction of CVS's price. It was a much smaller business than the behemoth CVS, so theoretically CVS should be able to use its bargaining power to get the vitamin more cheaply; instead it imposed a higher markup, and I took my business to New York. Wal-Mart took this type of price discrepancy to heart and started manufacturing and selling its own brand of insulin several years ago to sell it at a much lower cost than even generic insulin already was retailing for.

I think the model that I'm advocating will allow the advantages of a free-market economy to prevail: health care providers who give the best service and who keep their prices competitive will be rewarded with business. It would also lift the ridiculous veil of secrecy around medical pricing. Once, I called the office of a neurologist who has opted out of insurance to ask how much a consultation with him cost. I was told between $400 and $900. That is a big, big difference. Doctors can't reasonably know everything that a new patient visit might entail, but they should be able to narrow the gap by more than $500.

Perhaps best of all, doctors would be freed up from the bureaucratic red tape of insurance companies that tie up their valuable time and resources. They would no longer be beholden to insurance companies' rules that they will not compensate doctors for visits longer than a set period of time, or bully doctors into changing their patients' medication for the convenience of the insurance companies. I'd like to think that removing the insurance barrier would make health care more accessible to all. Without our current system, don't you think it would allow clinics like CVS' Minute Clinic -- an in-store, walk-in clinic staffed by nurse practitioners (NP) or physicians' assistants (PA) who treat common illnesses -- to proliferate? Not everyone can afford health insurance premiums, but many more people can afford the $30 the Minute Clinic charges to test you for strep. I envision many stand-alone clinics staffed by PA's and NP's who have substantive medical education, are authorized to prescribe pharmaceuticals, and who are thoroughly trained to refer patients who need to see a doctor to an appropriate caregiver. Savvy operators of this type of practice would be open late into the night to accommodate people who find it tough to make it to appointments during business hours, and it's that kind of service that would make such outfits stand out from their 9-to-5 competition.

Obviously, in my proposal, insurance companies would shrink dramatically if they only covered catastrophic care, and I think that's a good thing.