By this time next week I should be all done with the chemo infusions for the IVAC round four and beginning the steady path upwards to recuperation. Judging by how long it’s taken to begin to feel better after then end of round three this could take awhile. Today was the first time since doing the methotrexate over a week ago that I felt my energy level lift a little. The methotrexate mouth problems are clearing up, but the vincristine neuropathy in my feet shows no sign of abating. On the positive side, I’ve spent lots of time getting lost in Patrick O’Brian and am now rereading “The Letter of Marque.”

I tried helping Miranda with her math homework today, but it’s difficult translating how you understand the subject into the particular way that the school is approaching it. She understands division, of course, but did not realize that the horizontal bar in a fraction also denotes division. The methods she is taught are so cumbersome, and will be tossed aside once she has a grasp of algebra. Seems to me that schools waste too much time teaching pre-algebra and would be better served just teaching algebra! End result, I ended up frustrating her by introducing concepts that she hasn’t learned yet. My mother is probably right – math is better taught by people who had trouble learning it themselves. I had better success helping her with her trumpet practice. She’s doing well, I think, and her tone is getting much better. Her school band concert is this Tuesday. I will be in hospital that day and the current plan is for Maureen to let me listen in by cell-phone. Not sure if that’ll work, but we’ll see.

There’s a decent, but somewhat confused article about U.S. Healthcare in this week’s Economist. Confused because the article seems uncertain about what side of the debate it’s taking until the last few paragraphs. Apparently the Shrub is going to be pushing a greater role for Healthcare Savings Accounts (HSAs) in next week’s State of the Union – fine if you’re rich and can afford them – useless for anyone else. According to the Economist, the U.S. already spends about the same as other western countries on public funding of healthcare (Medicare and Medicaid) when measured as a percentage of GDP, about 6.5%. Private insurance accounts for another 8.5%. The problem is that we’re not getting value for money for that 6.5% because the government is prevented from doing so by the inflation that’s rampant in the 8.5%. Attempting to control healthcare costs in privately insured sector by messing with HSAs and tax breaks for insurance companies is ineffective because the government ultimately has no control over that sector. One of the biggest problems in healthcare is quality of care, but the public, in general, does not directly care about quality of healthcare; increasing the amount of information about the quality of care is not going to affect the market. When I say that the public does not care about the quality of healthcare, I mean that it expects all healthcare to be 100% excellent, just as it expects all commercial aviation to be 100% safe. And so it should be.

To improve the quality of healthcare and get better value for money for the 6.5% of GDP of public funding that the U.S. already spends, the government needs to be able to regulate healthcare better. A more regulated industry can set controls on quality of care and performance of hospitals. If Medicare and Medicaid were expanded to provide universal coverage in the U.S. the government could gain that leverage. Public coverage would continue coexist with private insurance – those that can afford it will always want something more – but the fact that the public coverage was also universal would put some teeth into healthcare regulation.

Of course, the Shrub will not see it this way. May he shrivel up and be cast on the compost heap of history!