Unhealthy Irony
"Cost-shifting" used to mean that wealthier patients helped pay for the care of the poor. But these days, with insurance companies insisting on deep discounts, the opposite is true. Charges for services can vary by 45 percent, reports the New York Times. One doctor said he gets $25 for a routine exam from a member of one health plan and $175 for the same exam if the patient does not have insurance.

Healthcare administrators say the problem began about a decade ago, when insurance companies offered to make hospitals "preferred providers." This arrangement was supposed to yield higher patient volume in exchange for deep discounts. But insurers soon learned that their patients wanted a wider choice of providers, and the companies obliged. Hospitals were then left with low prices, less patient volume than expected, and the problem of how to make up the difference. To do so they are forced to rely on patients outside the managed care system, like those with fee-for-service plans and people without any insurance at all. As a result, many uninsured people put off seeing a doctor until minor problems become major ones.

"It is the people who are most provided for, not the people who are least provided for, who get the benefit of cost-shifting," said Paul Menzel, professor of philosophy at Pacific Lutheran University in Tacoma, Washington. "It's horribly ironic."

The Ends, the Means, and the Taliban
One of Islam's least popular figures is Mullah Mohammad Omar, supreme leader of Afghanistan's fundamentalist ruling party, the Taliban. His word is law in this troubled central Asian nation. Recent decrees have been met with both international outrage and high levels of support within the U.S. government.

First, there was the destruction of two 1,500-year-old carved stone Buddha statues in Bamiyan, Afghanistan. Soldiers described using rocket launchers, tanks, explosives, and heavy machine guns to bring the Buddhas down, reports the New York Times. "It took us four days to finish the big statue," one Taliban soldier said. "He was very strong." Omar ordered the destruction in an edict, claiming such images were contrary to Islam: "These idols have been gods of the infidels, who worshiped them, and these are respected even now and perhaps may be turned into gods again."

Then came the instruction, issued through Afghanistan's religious police, the Ministry for the Promotion of Virtue and Prevention of Vice, that non-Muslims must wear a distinctive marker on their clothing so that they might be "differentiated from others," as reported by the Chicago Tribune. In the west, the decree was all too reminiscent of the use of yellow stars by Germany's National Socialist party to differentiate Jews from Germans under the Third Reich. But an American scholar on Afghanistan, Barnett Rubin, disputes these parallels. "They don't even know about yellow stars or Nazis . . . They're not thinking in those terms," he said. "Hindu men are not obliged to wear a big beard like Muslim men are. So this way, if they see a guy without a proper beard, if he has [the identity symbol] it shows that he is a Hindu, then it's OK."

A U.S. State Department spokesman described this as "the latest in a long list of outrageous oppressions."

It's all part of a recent Taliban crackdown on women, foreigners, and now non-Muslim Afghans. Some believe it is a response to sanctions by the United Nations that were imposed because of the Taliban's refusal to turn over accused terrorist Osama bin Laden.

The Taliban also came under fire for closing an Italian-funded hospital because it permitted men and women to eat together in the same cafeteria.

But despite all of this, the United States recently authorized $43 million—in addition to the $81 million provided so far this year—worth of aid to the rogue nation, reports the Los Angeles Times. Announcing the aid package in May, Secretary of State Colin Powell revealed why. The United States will continue to look for ways to aid Afghanistan because of Omar's ban on the cultivation of opium poppies, "a decision by the Taliban that we welcome," he said.

Last year, 75 percent of the world's opium was grown in Afghanistan. This year, reports the New York Times, it will grow none. Last July, Omar issued an edict banning the cultivation of poppies as a sin against the teachings of Islam, and by all accounts poppy cultivation in Afghanistan has ceased.

While Taliban officials insist that the poppy cultivation ban is rooted in religious principles, they are nevertheless aware of the compensation that wealthier nations provide for help with the war on drugs—such as American aid to Columbia, Peru, and Bolivia. Taliban leader and Governor of Kandahar Province, Mullah Mohammad Hassan, said: "Our people are very needy. They have given up the poppy crop, and timely financial assistance is very important." And so the United States will help prop up one of the most oppressive governments of our age—in the name of a drug-free America.

Organs and Altruism
Recently installed Health and Human Services Secretary Tommy Thompson said that one of his first initiatives would be a national effort to encourage more organ donation, reported the Reuters Health wire. "We need a national donation effort that measures up to the medical miracle of organ transplantation," he said during a speech at the Chicago Auto Show, where the initiative "National Donor Day" was launched.

Organ donation is always pitched with the language of altruism. "Give the gift of life," we are urged when renewing our driver's license. "Become an organ donor." Who could ignore the urgent face staring out of the poster? Thompson has even proposed a national "Gift of Life" medal for the families of organ donors.

But what is never mentioned in these "public education campaigns" is the fact that a body provides tissue of all types, not just organs, supplying a booming industry in human parts that are used not only to help people live longer, but also to help them feel and look better. To take only one example: donated skin can be used to treat severe burns, but more often it is used to smooth facial wrinkles, enhance a lip's contour, or enlarge a penis. The companies that harvest and process those body parts can reap up to $200,000 per cadaver.

A recent article in the Virginian-Pilot took a look at a Virginia Beach-based tissue bank, LifeNet. Organizations such as LifeNet sell 300 or more products: dental bone at $25, a 3x8-inch patch of skin at $144, corneas at $1,500, a lung at $19,500. Federal and state governments monitor donations and transplants of the heart, liver, lungs, kidneys, and pancreas; but there is practically no oversight of the rest of the human tissue trade. Only two states have laws governing the industry, and the U.S. Food and Drug Administration does not even know for certain how many tissue banks are in operation.

Last year the Department of Health and Human Services conducted a lengthy investigation of human tissue banks. The agency published its report earlier this year, and recommends strict new measures to regulate the industry, reported the Chicago Tribune. George Grob, deputy inspector general in charge of the study, said: "I think it's not unreasonable to expect a much greater disclosure of how [human tissue] is obtained, what the costs of it are, and what the transactions are that created it and what happens to it." The report comments upon growing "tensions" between a family's "altruistic act"—donating a loved one's organs—and the interests of an increasingly profit-driven industry.