A Physician Takes Note By Linda Halderman, M.D.

I learned a lot about the cost of health care when I had a hybrid general surgery practice in California's rural San Joaquin Valley. When serving in the rural health center in my community, my colleagues and I offered free or discounted care for a large number of patients. Many were covered by Medi-Cal or one of dozens of state programs paid for by the taxpayers of California.

The following items were commonly seen on patients or carried by their dependent children, who were also covered by subsidized programs:
- Cell phones and Blackberry PDAs, including just-released models with a price tag of $400, plus an ongoing monthly service fee of $65-$150
- Ipods and portable DVD players
- Game Boys and handheld electronic games
- Artificial fingernails requiring maintenance every two weeks at a cost of $40-$60 per salon visit
- Elaborate braided hair weaves, $300 per session plus frequent maintenance
- Custom-designed body art, including tattoos covering entire torso, neck and arms, as well as body jewelry piercing every skin surface imaginable-and a few unimaginable ones

Custom tattoo work, particularly the "portrait-type" and "half-sleeve" art popular in this area, runs from $100-$300 per hour and can require up to 20 hours of work, depending on the complexity of the design.

From the office I shared with another doctor at the clinic, I had a clear view of the patient parking lot. It was not unusual for me to see clinic patients drive away in late-model SUVs or cars customized in the style popular in my area. I was given an education about the after-market accessories I saw daily, including "mag" wheels, chrome trim, spinning hubcaps and fancy custom paint jobs. Gasoline prices were particularly high in central california at that time.

From James Cook Market Update-Investment Rarities Inc. Late October 2009