In a recent edition of your web column you said: “The original idea of insurance was based on a cost-effective plan, where you get back essentially what you put in.”

Here’s the American Heritage Dictionary definition of insurance: “The action, process, or means of insuring or the state of being insured usually against loss or damage by a contingent event.”

Protecting oneself against the risk of an adverse event is the “original idea of insurance.” It wasn’t meant to be some sort of account where you get back essentially what you put in.

Instead of coddling the guy who wrote the letter, you should have told him that if you have SARS-like symptoms, don’t wait two weeks to go to the local clinic. Get your mother (or a friend) who lives nearby to drive you to the VA. If he had gone when the symptoms first manifested themselves, he might have had to pay only $88.

STEPHEN NORTHRUP
Denver, CO

Dear Stephen,

I think you have a point. But consider too that we don’t have a system that encourages prevention or early intervention. A patient such as the one who wrote flinches at the anticipated costs and lives in denial until it is almost too late–more evidence that the system needs reform all the way to the roots. And not because these were “SARS-like symptoms” but because when you aren’t feeling well, you should have access to regular, ongoing medical care.

I’m disturbed by a recent new advertising campaign in Columbus that is being conducted by a bariatric surgery corporation. Well-placed Internet and television ads target obese patients for relief through surgery. I once read an article about the dangers of this type of procedure and wonder if you have an opinion on the matter. It disturbs me to see doctors trying to make money by selling a risky surgical procedure that may not be necessary or beneficial. I understand the dangers of obesity, but isn’t this procedure a marginal solution, to be used only in extreme cases? Is this “industry” crossing the line of acceptable medical ethics? Or am I off-base here?

JACK BYROM
Columbus, OH

Dear Jack,

You are not off-base. Aggressive advertising can create need and expand a service beyond its prudent use. For many, fad diets and procedures are driven more by narcissistic needs than common-sense health practices. The procedure has a use for extreme cases, as you say, but for more common, moderate obesity, better nutrition and exercise are first-line treatments. Of course, no one is advertising exercise–except health clubs and gyms–and as far as diet, I suppose the dairy manufacturers could get together with the cholesterol-lowering drug manufacturers and advertise simultaneously. A boon for one would ultimately mean a boon for the other.

A friend of mine is using a device called Brava, recommended to her by her boyfriend, to enlarge her breasts. Although I think it’s foolish and her boyfriend is a jerk for suggesting it, I am more concerned about the value and safety of this thing. It looks like some science-fiction apparel that she is forced to wear at least twelve hours a day, or else she forfeits any refund if it fails to work. It purports to be some kind of suction that gradually pulls out the breasts, and she has already suffered some rashes and peeling skin. This device was by no means cheap, costing at least $1,000, maybe more. What do you know about this thing?

MARILYN MOCKUS
Sanford, ME

Dear Marilyn,

The breast is supported by Cooper’s ligament, which is strong, but weakens over the years, causing sagging. The breast is also not a muscle but a collection of glands and fat. I think exercising it, or trying to pull it out to a larger size, is, frankly, absurd, and on an aesthetic level alone, I believe it would lead to an unhappy customer. And on a more fundamental level, I believe it’s possible to obtain a satisfying self-image without distortion or self-mutilation. Though I am certainly for the right of a person to alter his or her appearance as he or she sees fit, I am at the same time disturbed by many people’s preoccupation with image-conscious, cosmetic concerns. Needless to say, the beauty industry, Hollywood, “laddie” magazines and jerky boyfriends don’t help.

Rep. John Conyers’s bill, The National Health Insurance Act, is a comprehensive, universal, single-payer plan that everyone should support. A rally is being held at CUNY Graduate Center in New York City on August 31 and September 1, at which a wonderful array of speakers, including, of course, Conyers, will speak about the urgent need for healthcare reform and the steps we need to take to support H.R. 676 to make certain that healthcare for all becomes a reality. The myth that such a plan would be too costly is dispelled by studies of the Congressional Budget Office and the General Accounting Office [now renamed the Government Accountability Office], which show that the money now being spent on healthcare in the United States is more than enough to cover everyone.

EMILY MALONEY
Santa Cruz, CA

Dear Emily,

Thanks for bringing this to our attention. I agree that a well-organized single-payer system is a way to save millions, if not billions, of dollars while providing better and fairer coverage for all Americans. The most important challenge will be insuring that quality of care is preserved, and that the current lavish profits don’t find their way into bureaucrats’ pockets. But quite frankly, I don’t see how the waste and misuse and undercoverage of sick people can get any worse than what we have now, so even this concern is minimal in the face of the problem.

Regarding your comment that, “The solution to one of America’s most critical problems–affordable healthcare–is simple…”

I say nationalize both the healthcare industry and the pharmaceutical industry. There’d be so much money left over, America could not only continue to provide free healthcare to Congress, we could even cover everyone in America and lead the world in research while we’re at it.

JAY DASA
Attica, MI

Dear Jay,

Close to perfect, in my view. Though I’m not sure I would want to see pharmaceuticals nationalized. Of course it’s obscene that we pay three times as much for a drug as other countries do when the drug is created here. National health insurance, yes. In terms of the drug companies, I would like to see them regulated and allow Medicare to engage in bulk buying for the purpose of negotiating lower drug prices. This works for Western Europe, and could work for us.