By Caleb Hellerman
CNN Medical Senior Producer

The fight over changes to the health care system has been so fierce for so long, the turning points aren’t always clear. But for me, the past two weeks answered a big question: Are Americans willing to sacrifice their health care to try to hold down costs? To me, it’s clear the answer is no.

This question has been hanging over the debate all along. President Obama and Democrats in Congress are selling the bill as cost-control. Health care costs have risen much faster than wages or inflation over the past two decades, and these Democrats (along with some Republicans) say that if we don’t get that under control – soon – it will crush the economy, and force drastic cutbacks for all kinds of health care. Supporters of the bills say we don’t have to sacrifice, as long as we emphasize preventive care – catch problems while they’re minor– and if we’re more “efficient,” avoiding unnecessary tests and treatments. Just like that, they say, we can save almost $500 billion from Medicare alone. The Congressional Budget Office, the definitive bean counter, agrees.

But one person’s “efficiency” is another person’s “rationing.” That led to accusations about “death panels” and unelected boards withholding vital care. In fact, the bills do set out a big role for government experts to shape what procedures are covered by insurance. Many people don’t like this, on ideological grounds. Others, right or wrong, fear the government will be stingier than private companies that currently administer insurance for two-thirds of the population.

We were reminded recently that we live in a democracy - and that Congress doesn’t like controversy. This tension started coming to a head with something that wasn’t even part of the health care bill: a recommendation from a federal health advisory panel that said most women can wait until age 50 to have regular mammograms – instead of starting at 40, as most doctors now recommend.

Opponents of the health care bill, mostly Republicans, called this evidence that the federal government is hankering to ration care. No matter that the mammogram panel has no power over insurance – for weeks, members of Congress have been jumping over one another to denounce its recommendations and to say – in effect – that only over their dead bodies will there be limits on mammograms.

A few jumped the shark into outright falsehood, like Florida Rep. John Shadegg, R-Arizona, who asserted that the health care bill would prohibit millions of women from purchasing mammogram coverage. But the result was a Senate vote, 61-39, to expand preventive health screenings for women, and a unanimous vote to prevent the panel’s recommendation from restricting mammogram coverage – a non-existent power in the first place.

The details of the mammogram debate are beside the point. The bottom line is that the recommendations were deeply unpopular, and so Congress stepped up to avoid even the hint of limiting coverage. That’s a good sign for democracy, but it doesn’t suggest we’ll be cutting the cost of care, any time soon.

To see how your senator voted on amendments to the health care bill, you can click right here.

Do you trust the government or private insurance companies more, to decide what treatments should be covered?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Miriam Falco
CNN Medical Managing Editor

This week, Dr. Regina Benjamin, the new U.S. surgeon general, joined 550 health professionals, educators, executives, community health activists, patients and politicians at Morehouse School of Medicine's third annual "National Health Disparities Conference. The goal: to "focus on how to build a better health care system for all Americans" says Morehouse spokeswoman Cherie Richardson. Most of those in attendance are aware of the problems; they've been around for a long time. One of those problems is the lack of minority physicians and nurses. In her keynote address, Benjamin noted that the percentage of minority doctors has not risen in nearly 100 years. A 2004 report on health disparities, Benjamin said, found that although 25 percent of the nation's population is minority, only 6 percent of its physicians are minority. That's the same percentage found in the Flexner report, which was published in 1910. "There's something wrong with that," the surgeon general said.

I had no idea what the Flexner report was – so I looked it up. Abraham Flexner was a research scholar at the Carnegie Foundation for the Advancement of Teaching. He undertook an assessment of medical education in North America, visiting all 155 medical schools that existed in the United States and Canada.

It's hard to disagree with the surgeon general when she says there's something wrong with that. It is hard to believe that we have the same percentage of minority doctors and nurses in this country today, in a population of 300 million people, as we had a century ago, when the population was only about 92 million.

One theory of why the disparity exists was offered by Dr. John Ruffin, who heads the National Center on Minority Health and Health Disparities. He told the gathering: “African American, Hispanics and Native Americans make up 31 percent of college population, but only account for 14 percent of life sciences graduates.”

Benjamin challenged the attendees to do their part to encourage more minorities go back to school and become nurses and doctors. "Our nation faces a growing ethnic and racial disconnect between those who seek care and those who provide that excellent care." Having more medical professionals tending to the needs of all Americans will help the country as a whole, she argued.

Are you a minority healthcare professional? How do you think this disparity can be changed?

By John Bonifield
CNN Medical Producer

Elijah Wiertel has been sick with H1N1 flu for several days now. The 8-year-old thinks he's getting well, but would he know what to tell his mom and dad if he suddenly started getting worse? Elijah's pediatrician, Dr. Author Lavin, says parents can empower children who are sick with swine flu to help look for specific warning signs.

"A lot of times kids are actually the ones that come to their parents and say, 'I'm not feeling right. Something's not right. I hurt here. I'm having trouble breathing.' Or, 'Should my fingernails be looking like this?' Or, 'I can't move my neck anymore,'" Lavin says. "It's often the children who blow the whistle and let everyone know something's wrong."

So how can worried moms and dads talk to their sick kids about the flu? Here's how Elijah's doctor talked with him about what he should do as he continues to remain ill:

Dr. Lavin: If you start having trouble breathing, you'd tell your mom and dad, right?
Elijah: (Nods).
Dr. Lavin: If your neck got stiff and you couldn't move anymore, you'd tell your mom and dad about that?
Elijah: It never got stiff but –
Dr. Lavin: But what if it did?
Elijah: I'd tell my mom and dad.
Dr. Lavin: And then if your fingers got blue, you would notice that? You might not notice that...
Elijah: Yeah.
Dr. Lavin: You would notice that?
Elijah: I write a lot, so I have to put my hands on paper.
Dr. Lavin: They're usually pink, but what if they turned blue? What would you do?
Elijah: I'd tell my mom and dad.
Dr. Lavin: And what if something really hurts? Hurts so badly you had to cry? Who would you tell?
Elijah: My mom and dad.

Trouble breathing, a stiff neck, blue fingernails, and continuous pain in one spot are all warning signs that could signal a child's H1N1 flu has crossed the line to become a potentially deadly virus. Lavin says parents shouldn't rely solely on their child's observations to determine whether they're getting worse, but he says kids can be "a very important part of the equation."

For more advice to parents on H1N1 warning signs, be sure to check out Senior Medical Correspondent Elizabeth Cohen's "Empowered Patient" column.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

CNN blogger, Beata, asks:

"Of those who have lived long lives, what is the common thread? What's the one thing I can do today that can make me live longer?"

Answer:

For well over a decade I've been investigating the answer to this question. The good news is there are actually a lot of small lifestyle changes you can make today that will add years to your life. For instance, flossing can add a year to your life – a whole year – just by adding to your daily routine. Turns out there's a pretty clear link between gum disease and heart disease. Flossing is your best bet at stopping that.

Here are a few more: A low-dose aspirin a day could add two years, and limiting your coffee intake to two cups a day could add another year. Simply checking blood pressure regularly could add one and a half years, and exercising three times a week could add three years. Cut work hours down to a manageable 40-50 hours a week and you add another one and a half years. Add it all up – and you have added a decade of functional life.

I will be the first to admit, it isn't always easy to practice what I preach, especially when it comes to the work-hour issue. But, we do know stress affects just about every part of our bodies. Our bodies simply start to shut down and become unable to tolerate the assault being placed on them every day.

Earlier this week I sat down with anti-aging expert Dan Buettner. He explores the world searching for longevity hotspots, known as blue zones, and looks for the lessons we can learn from them. One thing Buettner points out is that the people who live long lives in blue zones around the world are stressed out too. Yet they are still living disease free and often to 100 years old. The difference is they don't internalize their stress as most of us do. They all practice simple techniques to de-stress including praying, napping, even happy hour. Also meditating, which I have started, for 20 minutes every day and taking time for yourself every day can help.

In case you missed it, click here to hear more of my conversation with the world's leading anti-aging experts and get more tips to live a longer, healthier life.

By Dr. Sanjay Gupta
Chief Medical Correspondent

This week we will be talking a lot about Afghanistan and the impact of the President’s speech. Having spent a fair amount of time there, including a trip just a couple of months ago, I am always reminded of the human impact of any conflict. I am reminded there are consequences to all those booms and explosions we see on television. I am reminded of the horrific injuries I saw due to IED explosions where young men and women are robbed of their legs, and their lives. I am also reminded of the remarkable sacrifice the doctors, nurses, medics and all the medical personnel make every single day out there. They truly risk their lives to save the lives of others.

Medicine and the military are embraced in an awkward dance and no where is that more true than in Afghanistan. Because of the terrain, most of the med evac missions are carried out by chopper. They typically have 20 minutes to fly to the patients, 20 minutes to stabilize and treat, and 20 minutes to get the patients to more medical care. It is one golden hour. Right now, even as I write this, these medics are sleeping in forward operating bases just behind the front line troops - with their boots on, and eyes half open in dusty desert tents waiting to get the call. Waiting for a chance to save their fellow soldiers who got the call before them.

Truth of the matter, nearly three-fourths of the time, the call they get is to take care of an Afghan local or soldier. In fact, if you look at the breakdown of operations performed at the coalition force run Kandahar Role III, the largest trauma hospital in the country, most are performed on Afghan patients. The local medical system in Afghanistan lacks the infrastructure to take care of most of these sorts of injuries. There is only one vascular surgeon in the country, two neurosurgeons and really no ability to perform cardiac surgery. It made me wonder what will happen to patients with trauma a year from now or in five or ten years.

If you look at pure numbers, for every 10,000 troops, 127 will be wounded in action. A tenth of those wounded will have traumatic brain injuries and several others will need amputations. Still others will have serious burns. It costs close to $20,000 per soldier to provide field care, and if you add in an air evacuation, the cost is closer to $50,000. At the Kandahar hospital, doctors are performing close to 300 operations a month, and that number is expected to increase over the next few months.

Of course, these numbers are meaningless to the tens of thousands of troops in Afghanistan right now and the tens of thousands about to head there. As you watch the speech tonight and the analysis over the next few days, try and remember the medical staff there as well. They are the ones embraced in that awkward medicine and military dance – they are the ones trying to repair the ravages of war.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Ashley J. WennersHerron
CNN Medical News Intern

My preschool-age cousin was hospitalized last year for a bad infection. A happy and good-natured kid, she kept her spirits up with visits from family and friends, as well as multiple viewings of “The Little Mermaid.” After nearly a month, she was well enough to go home, as soon as she had her chest port surgically removed.

The surgery was brief, but required her to have general anesthesia. After waking up, she felt sick from the medicine, she felt pain from where her port had been, she felt frustrated by not being allowed to run around and play like normal — it’s a lot for anyone, and it’s even more overwhelming when you lack the ability to articulate all of those emotions. The feelings build up and, often, crying is the result.

Tears show emotion, but we didn’t always have such a clear indicator. According to a study released this spring by the University of Maryland, humans developed to shed tears to efficiently communicate distress, whether it’s grief, fear or frustration. It’s suspected that before we developed the vocabulary to express our emotions, our tear ducts advanced our ability to effectively communicate.

In the study, participants were shown sets of photographs. They were asked to identify the emotions in each pair. The pictures were identical, except tears were digitally removed in one photo per set. The individuals viewing the photographs ranked those with tears as sad and those without tears as less sad, puzzled or confused, even though the facial expressions were the same in every other way. The tears portrayed sadness for those viewing them, but in the photos without the tears, the same message wasn’t as clear.

Children, without the vocabulary to explain a simple emotion or even a need such as hunger, cry. The tears demonstrate that they need attention for something. When we grow up, we can describe what we want or need, but emotion builds up for even the most-level headed person. No, we don’t necessarily cry because we are hungry or tired, but something sad or upsetting can cause the tears to spill.

We use tears to show others a need for understanding and compassion. It’s a cry for help, literally. It’s instinctual, even as infants, we know crying will bring what we need, even if it’s simply attention.

Why do you cry? How do you react when you see others crying?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Rebecca Leibowitz
CNN Medical Intern

It all started one afternoon. “Grandma,” I asked, “how did Karen like my hand-me-downs?” “What?” she responded, “I didn’t know what those clothes were doing in my trunk. I gave them to charity.” We all knew immediately that something was wrong. And there was more to come. Once a skilled, careful driver, my grandmother terrified her passengers when she blew through a stop sign as if it didn’t exist. I would catch her staring at me in confusion, often calling me by the name of my cousin or aunt. My grandmother, like her own grandmother, two brothers and a first cousin, has become one of the estimated 5.3 million people in the United States living with Alzheimer’s disease – the most common cause of dementia.

Our family has learned what many other families know well: Alzheimer’s disease is devastating. We’ve seen our loved ones change into someone entirely different. According to the Alzheimer’s Association, a person develops the disease every 70 seconds in the U.S., and the amount of people living with Alzheimer’s is expected to double every 20 years. The illness’ economic costs are nearly as distressing as its emotional toll. Each year, an estimated $148 billion is spent on Alzheimer’s, including direct costs of Medicare and Medicaid and indirect costs to businesses. This figure, like the burden of Alzheimer’s disease in the U.S., is expected to only get worse.

Alzheimer’s has no cure and its damage can begin decades before symptoms are apparent. The exact cause is still unknown, but tangles and plaques in the brain are thought to lead to symptoms like memory loss, poor judgment, changes in mood or behavior. Without a cure in sight for this disease, what can people like my mom, who is approaching the age when the disease could already be developing, do to prevent or slow the onset of this debilitating illness?

Researchers are convinced that mental activity and socialization can help. Reading, playing board games, playing musical instruments and dancing have all been shown to decrease the risk of contracting any form of dementia. Engage your brain, build up your social networks and you’ll put off getting the disease or possibly avoid getting it altogether.

Other studies have found a link between unhealthy living and increased Alzheimer’s risk. A study earlier this month in the Archives of General Psychiatry concluded that for people with a family history of the disease, high blood pressure in middle age is a significant risk factor for Alzheimer’s in old age. So, what can you do if Alzheimer’s is prevalent in your family? Don’t smoke, eat a well-balanced, heart-healthy diet, stay stress-free and exercise regularly. Not only will these measures decrease your risk for Alzheimer’s, they will improve your overall quality and length of life.

Unfortunately, this information wasn’t around when my grandmother was growing up. But for my mom, her siblings and myself, (as well as the millions of other Americans with a strong family history of the illness), there is hope. Not only can we decrease our Alzheimer’s risk by maintaining a healthy and active brain and body, but researchers are constantly discovering new things about prevention and treatment of the disease. Perhaps one day we will even find a cure.

Do you have a history of Alzheimer’s disease in your family? Are you taking any measures to try to keep from contracting the disease?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Connie in California:

"My family will be flying for the holidays. Should we be concerned about being in an enclosed space for five hours?"

Answer:

Connie, more than 2 million people are expected to be flying over this holiday weekend and many have the same concern as you. The Centers for Disease Control and Prevention points out there are not many studies about the spread of flu on airplanes, but anytime people are in close quarters the chance for germs spreading is much higher.

If you are sitting next to someone who is coughing excessively or seems ill, that’s when you are most at risk. According to researchers at Purdue University, you’re most likely to get sick from the people sitting in your row or the row behind you. They actually developed an animation showing how germs move around an airplane. If you’re in this situation, there are things you can do to lessen your risk of getting sick. Point the air vent away from yourself and towards the sick person – that may help push the germs back at that person. Also, turn your body away from the person who seems ill and as we’ve been saying – don’t touch your face. Dr. Julie Gerberding, the former director of the Centers for Disease Control and Prevention, adds that you could ask a flight attendant whether a mask could be given to that person or if that person or you could be moved to another part of the plane. Gerberding also points out that the air on planes is circulated through a HEPA filter, so if you are several rows away from a sick person you’re unlikely to catch his or her germs.

Keep in mind, you can go a long way in protecting yourself by taking some simple steps. I know we talk about this all the time, but wash your hands frequently with soap and water. If soap and water aren't available, you can carry those alcohol-based hand sanitizers. Cover your nose and mouth with a tissue while sneezing and encourage people around you to do the same thing and avoid touching your eyes, nose and mouth. We touch our hands to our faces a lot. In addition, some people might consider carrying a disposable mask, especially if you're feeling sick yourself. Finally, the CDC recommends that you get vaccinated, if you can. That’s sometimes harder than it sounds. For more information, check out flu.gov and CNN’s special report on H1N1.  Have a safe trip, Connie

By David S. Martin
CNN Medical Senior Producer

Talking about health care costs in July, President Obama asked this question: “If there's a blue pill and a red pill, and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that's going to make you well?”

Many ophthalmologists believe there is just such a blue pill out there. Only the red pill’s not twice as expensive. It costs almost 50 times much: $2,000 compared with about $45 for the alternative. And Medicare covers both.

What are the drugs? The expensive one is Lucentis. The other, Avastin. They’re not pills, really, but a medicine injected into the eye every four to six weeks to treat age-related, wet macular degeneration, a leading cause of blindness in seniors. With monthly injections, the annual cost difference is $24,000 versus $540.

It’s a difference that we, the taxpayers, underwrite. Lucentis cost Medicare $557.3 million last year, according to U.S. Centers for Medicare and Medicaid Services. That’s a figure that could rise as the population ages.

Many retina specialists think Avastin works as well as its more expensive rival, Lucentis, and roughly half of the wet macular degeneration patients are opting for Avastin, according to Dr. David F. Williams, president of the American Society of Retina Specialists.

Not surprisingly, Williams says, Medicare patients with supplemental insurance that covers the 20 percent co-pay are the most likely to choose Lucentis. (Medicare recipients ponied up $142.7 million in co-pays for Lucentis last year, according to government figures.)

Lucentis received FDA approval in 2006. The chemically similar Avastin was originally developed to treat cancer but its off-label use for wet macular degeneration predates Lucentis’ arrival on the market. To make this tale even stranger, both Lucentis and Avastin are made by the same company, Genentech, a division of the Swiss drug giant Roche. Can you guess which treatment the company advocates?

The National Eye Institute, part of the National Institutes of Health, is now conducting a head-to-head comparison of the two drugs. Initial results are expected at the end of next year.

Should the government require patients to choose the less-expensive drug? How about if the clinical trial shows no difference between the two?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

By Jillian Michaels
Guest blogger

The holiday season is upon us and this time EVERY year I write diet, fitness, and motivation tips about how to not gain weight and let your health spiral out of control. It’s nothing you haven’t heard before so honestly why the heck am I writing about this again?! Did no one listen the last 10 years?

You are not stupid. You know how to be healthy. Eat less and move more. It doesn’t take much to know that a second helping of stuffing and pumpkin pie and yams and biscuits is a bad idea.

You know all the obvious stuff… Eat white meat turkey, not dark. Do whole grain rolls instead of biscuits. Bring fitness DVDs with you if you are traveling so you can workout on the road. Create fun family fitness activities to do together such as touch football instead of sitting around eating or watching TV. And the list goes on…

Let’s get down to the bottom of it. The holidays are a time to be grateful. Grateful for the blessings you have and the ability to create new blessings symbolized by the coming of a new year. However, at a time when we should be celebrating our lives most, we are prone to depression and dysfunction. Eating becomes gluttonous. Family issues become magnified. The gym becomes a distant memory. Stress levels go through the roof and so on.

So how do we create that shift in our thinking, behavior, and overall holiday experience? Desire. The first step is to stay focused in the present tense on the things you want for yourself and in your life. Transformation doesn’t happen in the past or in the future. It happens right now. By focusing on the positive things you crave and deserve, you shift your focus from one of resignation to one of inspiration.

Start by picking a goal. Maybe the one you have been saving for January 1 and begin pursuing it immediately. Every day this season, I want you to wake up and think about that goal and how the actions you take throughout your day will bring you closer to that goal. If holiday parties create temptation for you, avoid them. Find a healthier way to celebrate with your friends like a night on the town dancing. If stressful family reunions throw you off track, set boundaries or stay away. Take a healthy vacation with close friends instead. If the memories of holiday seasons past cause you to feel lonely, channel those feelings constructively instead of destructively. Take them as a sign that it’s time to form new connections. Join a club, support group, or online community where you meet new people and make new friends. And with every decision you make ask yourself this question – “is my choice or behavior in this moment getting me closer to my goals?” If the answer is no, make a different choice.

Some of you are thinking “it’s not that simple. I have to go to my office party. I have to go to my grandmother’s house for dinner where she guilts me into eating thousands of calories. I have to let my in-laws stay with us even though they insult me.” Do you? Do you physically have to? Are you being held at gunpoint to engage in behaviors that upset or hurt you in some way? I bet 99 percent of the time the answer to that question will be no. So stop wasting time and start putting your health first, physically and emotionally. Let’s redefine the holidays as a time of inspiration and possibility one empowered person at a time. And remember, taking care of oneself is a gift to everyone else because everyone ends up having a happier and healthier holiday.

How will you maintain your health goals during the holidays?

Jillian Michaels is a fitness expert and trainer on the TV reality show "The Biggest Loser".