Monthly Archives: July 2011

Second Opinion, Second Thoughts on My Spine

As I explained in a previous post, I have a serious back injury that keeps me from sitting without pain. Sitting is something that I had certainly taken for granted, never having had any problem or pain from sitting. In fact, when I’ve sprained my ankle or been sore from exercising or running, sitting had been a way to have some relief from my pain. I’ve never hurt while sitting. Since my injury, I have spent most of the time either lying down, standing or kneeling. Eventually, even standing will cause discomfort. I was told by a orthopedic spinal surgeon that I needed to have fusion surgery, where my injured disc would be removed and my vertebrae surgically fused together.

After I shared this diagnosis with family members and friends, I received lots of advice about how to proceed. An uncle who had back surgery recommended that I go to a neurosurgeon who specialized in spinal surgery; this was echoed by others who had a history of back ailments. I began to look for a suitable surgeon. The most qualified one I could find had a glowing biography; service in the Air Force, numerous published articles, professional associations, and the chairman of the spinal surgery department at the closest teaching hospital to us. I called his office, discovered that he did take my brand of insurance, and got an appointment. The only problem was my appointment wasn’t for 8 weeks, a seeming eternity for someone with a back problem. I called his office and asked to be on the list of people willing to move my appointment if one became available. I was exited about finding such a qualified doctor willing to have a look at my case, but frustrated by the delay in getting the second opinion, since I was almost certain the answer would be the same as my first diagnosis.

In the mean time, I explained to many of my friends and coworkers about my situation. While I don’t always feel it is necessary to divulge my medical information to others, some of the methods I used to cope with the pain and discomfort begged for an explanation. When you bring a large pillow to work and kneel in front of it to work on your computer, most people are understandably curious. When you lie on ice packs, most people notice and ask what is going on.
One of my coworkers had been visiting a chiropractor and mentioned my case to her. She purported to have a relative who had been in a similar situation who followed a treatment plan devised by this chiropractor and who had avoided having surgery for several decades. He gave me her card, and I decided that I would give her a call to see what she had to offer. Now keep in mind that I have been seeing a chiropractor for months. I had seen some improvement, but my chiropractor said he wouldn’t be able to fix the extent of the damage to my spine. I knew that he was probably right, but the thought of not having to have surgery, especially as drastic a surgery as a spinal fusion, was appealing to me. I called up her office, and got some slick talking receptionist who was sure that Dr. So-and-so would be able to fix me up. It would only take the new patient amount of $170 including x-rays to get her opinion and treatment plan. I asked what she would do differently than the current chiropractor that I was receiving treatment from, and she basically said “I’m not saying Dr. Whatsisname isn’t good, but I think we can get better results.” I asked what types of treatments the doctor offered, and if she could do anything else besides align my spine. As the conversation continued, I kept getting the impression that I was going to be sold something that I didn’t need. While attempting not to overtly slam the chiropractor that I was seeing, I was basically told that he didn’t know what he was doing and it would be better to see this new one. But, I was assured, she would tell me if she couldn’t treat my case. In my experience, it would take about a $1000 worth of treatment before she decided that she couldn’t fix it.

The whole scenario was troubling; I realized that I was vulnerable because I badly wanted to avoid surgery, but logically, I decided that the second chiropractor couldn’t offer anything other than spine alignment services, and therefore wasn’t likely to be any more successful than the chiropractor that I was already seeing. I was really torn, though. The idea of one last crack at my back by a chiropractor before surgery was appealing, but I decided I’d have the second opinion before making up my mind.

After weeks and weeks of trying to be patient, and generally failing, my second opinion appointment finally came. I was expecting a cursory look at my films, a brief interview, and a confirmation of the first opinion and well wishes. Instead, I got a whole new diagnosis, a proposed surgery that is much less invasive and should allow for a much quicker recovery. And the most amazing thing of all is that I have a surgery date in only a couple of weeks, a surprising development after the long wait for the second opinion. At my appointment, the first thing that happened was the student doctor (there is probably a more correct term here, but I don’t remember it offhand) came in and performed a neurological exam. She asked me quite a few questions, and said she would be back in a few minutes. After some more waiting (it was at a hospital, after all), the surgeon arrived. My first impression was that he reminded me of someone with his mannerisms, but it took me a while to remember who it was: Anton the food critic in the movie Ratatoullie. In fact, he seemed to be the caricature of a surgeon, with a booming voice and commanding, confident air.  Having previously worked with pilots, he took an immediate interest in my case and promised to get me back if it was possible(puns are almost impossible to avoid with this subject, I know I’m stretching here, but sometime I crack myself up–back to the post).  In fact, he had experience in returning pilots to flying even after more invasive surgeries than he prescribed for me.  He explained that the area in my lumbar spine that was causing the problem was not quite right.  There is supposed to be a certain amount of space where the nerves come out of the vertebrae, but in my case there was very little space.  This hadn’t cased me a problem before as there was just enough space.  However, when I had my flying over-g incident, my disc shifted into the already-too-small area containing nerves that went to my lower body, resulting in pain and lower body neurological pain.  His operating plan was to make a little more space for the nerves, and possibly trim the disc if he thought it was needed after opening me up.  All of this is definitely less invasive than removing a disc and fusing vertebrae.  After he explained what I needed to have done, I asked him when he could do it, expecting to hear something like “in a couple of months”, but instead he checked his calendar, and came up with a date a scant couple of weeks away.  Wow.  I can’t wait to get this fixed and get back to normal.  While there are risks for any surgery, there is a certainty that not having something done will result in pain and discomfort.  Given the track record of the surgeon, I like my chances.

I spend the rest of the day getting pre-admitted to the hospital since my surgery was so soon.  While I had an aching back from all the time in the hospital, and a long, painful ride home with a screaming two-month old, I was glad to have a possible end to all of this in sight.

The moral of the story:  get a second opinion.  I recommend you get one from a different medical discipline, if there is more than one approach to your problem.

Does Taxing the Rich Work?

As our nation is in deep discussions about raising the debt ceiling versus raising taxes, and there is much debate in Washington DC about how to fix some of our deficit problems, I often hear that the rich should be taxed more so we can balance the budget.  The well-meaning centrists will note that we should cut spending and raise taxes so that we can bridge the budget gap and get our fiscal house in order.  I would submit that the way that we are taxing people isn’t going to really raise much revenue, and certainly taxing the “rich” isn’t going to get the job done.

One caveat before I begin:  I don’t believe that we need to raise taxes on anyone.  The problem is we have overspent, not that we have under taxed.  So if I had my way, we’d do what the states are required to do, and we’d cut spending if we have shortfalls in revenue so our budget would always be balanced.  I’ll admit that the 40% cuts that would be required would probably cause mass unrest as the entitlement majority finds themselves sucking on a dry teat and now having to do something radical, like work or be responsible in order to put food on their tables, cigarette smoke in their lungs, beer in their bellies, and lottery tickets in their wallets.

However, I think it is useful to look at our structure of taxation.  We have a progressive income tax in this country (in addition to many other forms of taxation).  As you report more income, you will move from lower brackets to higher brackets as you pass certain monetary thresholds, after you take your exemptions and any deductions that you may be entitled to.  Sounds simple, right?  It isn’t, but that isn’t my point.  Who has income?  What qualifies as income? Who are all of these rich people that the nanny state can plunder from?

One common stereotype of wealthy people is rich offspring of hard working parents, living off of an enormous trust fund and doing nothing but playing golf, polo, and other such activities of the idle rich.  There may be people like this;  I’ve never met any, but I live in Mississippi at the moment, and I can’t imagine why people with wealth would want to live here.  I’m off on a tangent; the real question is do these trust fund babies have income?  In short, no.  They might have some interest or capital gains from the funds being in the bank, but they are not working and generating income.  Their income is portfolio income, and is taxed differently than earned income.  So do these rich people have income that can be tapped using our progressive income tax?  No, they don’t.  If you have accumulated a giant pile of money, and just live off of it, assuming taxes have already been paid when the money was earned, you don’t have to pay income tax as you spend it.  The “idle rich” don’t have income and so can’t fix our income problem without our actually going after their wealth, which would amount to a bill of attainder, and be constitutionally prohibited (for those of you who still care what the constitution says).

What about the wealthy investor class like Warren Buffett?  He has famously claimed that the rich don’t pay enough in taxes.  Mr. Buffett has much of his capital at risk, and is paid in return by dividends, capital gains disbursements, and the like.  These generally are classified by the IRS as capital gains, and are taxed at substantially lower rates than income.  However, this income is different because it is generated by having some capital at risk:  gains are not guaranteed and you might lose your initial capital.  (Even Warren Buffett, although he has an enviable track record.)  Wage income doesn’t have a generally negative income possibility (unless you get sued or incur some penalty or fee):  the worst thing that could happen is that you lose your job.  Investments that might generate capital gains could lose value, and you could even lose all of the money that you invested.

So how can we raise more in taxes?  I believe the simplest way would be to not tax income at all, but tax consumption instead.  When the trust fund babies spend, they would be taxed.  When the wealthy investor spends his capital gains, he would be taxed.  Such a taxation scheme would have several beneficial consequences.  First, it would eliminate the complicated and expensive record keeping required to comply with the current laws that tax income.  While notionally we are assumed to be innocent until proven guilty, when we are taxed we have to prove our innocence to the IRS by a complicated record keeping process.  We are required to submit records that we shouldn’t have to in a free society.

In addition to reducing the record keeping and improving privacy, a consumption tax would capture tax revenue from numerous people who don’t have reportable income either because they are spending already-taxed income (the “idle rich”), or because they don’t report their activities because they are illegal for some reason.  For example, I doubt many drug dealers report their incomes to the IRS, and illegal aliens also don’t typically request to pay taxes either.  It would eliminate the ever popular “just pay me in cash” scheme that many people use to avoid income taxes.

It would also tax the poor and middle class.  There are some good ideas such as the Fair Tax that would provide a rebate up to a certain level to avoid taxing the poor and making the tax system slightly progressive.

I don’t believe taxing the rich is the way to go, but if you are going to be fair about taxation, a consumption tax makes much more sense and would be more effective than the current income tax system.