Forgive me as I yell at the Press Register. Deroy Murdock’s syndicated column (you can find it with Google, I’m not going to help) either provides talking points to conservative talk radio or takes marching orders from conservative talk radio and is carried in the Mobile newspaper this morning. In it, he misrepresents  an analysis of the current health care legislation done by the Health and Human Services Chief Actuary. A misrepresentation that is, oddly enough, consistent with Republican Leadership and Talk Radio News. Following is the ACTUAL conclusion:

• 33 million more people would have REAL health care access (not just access to Emergency Departments if dying)
• Medicare and Medicaid would probably COST LESS
• Total health expenditures would increase transiently as more people get coverage
• Long term care would probably cost more than estimated
• The effect of comparative effectiveness research is unknown.

It’s just a lot easier to defend a deeply held belief if you are able to avoid facts, I guess.

“At first blush, the notion of eating our way out of huge public health challenges like obesity, diabetes and heart disease may seem an overly simplistic and idealistic fix for complex, multifaceted problems. But health experts say that, in fact, an apple a day does keep the doctor away, and that many studies prove it.”

Nice affirming news from The New York Times. Companies like Safeway are realizing that health care costs are getting out of control, and are now focusing on preventative care. So many of today’s “expensive” diseases–obesity, type 2 diabetes, heart disease, and cancer–are tied to diet and lifestyle choices and are quite preventable. And so, the reasoning goes, if an employer can encourage its workers to eat things like vegetables and whole grains instead of Doritos and McDonald’s, costs for health insurance will ultimately go down or at least stabilize. And it’s working.

The article acknowledges that it’s easier said than done to make dietary and lifestyle changes. There’s so much conflicting info about nutrition out there–which should you listen to?

That’s why I do what I do. As a holistic nutrition counselor, I help my clients discover what works for them, and I support them every step of the way–holding them accountable, but also serving as their biggest cheerleader. You can make lasting changes. And you don’t have to do it alone.

Investigating Obama

by Snidely Whiplash

The Game is Afoot Watson

Sir Arthur Conan Doyle’s Sherlock Holmes laid it all out for us when in The Sign of the Four, detective Holmes uttered “When you have eliminated the impossible, whatever remains, however improbable, must be the truth.” That’s where we find our nation today.

No matter how many questions are asked of the Obama Administration the answer is always the same – “We have it under control,” or “it’s deficit neutral,” or “we have saved or created “X” number of jobs,” and of course my two favorites, “the critics are mistaken,” or best of all, just ignore the question.

News broke yesterday government is advising women they no longer need mammograms in their 40’s and only one every two years after 50. Surgeons and oncologists have exploded onto the scene criticizing this effort by government to ration health care. Of course the Obama Administration says the critics are just wrong.

Congressional Budget Office (CBO) says the actual costs of health care will add significantly to the deficit. This morning I saw a woman who was the former head of the CBO stating the cuts in medicare and the proposed health plans will harm the medical system, not deliver the promised care and end up rationing health care, drive up costs and budget shortfalls and causing huge number of doctors to retire from the profession.

Our President has had 22 meetings since January 20th with the head of the SEIU, but met twice for about 2 hours total with his hand picked leader in Afghanistan. We have a President who tells us not to jump to conclusions about obvious sectarian terrorism at Ft. Hood, but he has no problem jumping to conclusions by stating “the actions of the Cambridge police were stupid.” (paraphrased)

The Obama Administration loves to tell us what a mess they inherited yet hear this week the Bush initiated Medicare related plans have come in under budget. Gee, somehow the Obama Administration missed that, or at least failed to mention it. They never fail to point the finger of blame.

To continue reading the conclusion of Snidely’s article, click HERE

I’m in correspondence regarding the concept of Advanced Primary Care with soeone from a rather large corporation who feel that the senior executives are having trouble distinguishing or telling the difference between a medical home and a the old HMO concept of primary doc being the gatekeeper in terms of who picks the specialists and asked id I can you help explain the difference.

It strikes me that the difference is both one of attitude and a new emphasis on evidence based care. From the standpoint of the HMO, the insurance company dictated the “panel” based on who would accept their fee schedule and paid PCPs not to refer. The “advanced primary care model”, depending on how it’s set up, allows the patient to go see anyone (no reward for denying service) with several caveats. 1) The specialist must provide outcomes to the primary care office. Meaning, if you are seeing the specialist for a blocked carotid artery, the Primary Care doc should have a list of who does good work, bad work, or “kills people” work and you get to pick. 2) The patient must be willing to work within the “advanced primary care model” to accomplish outcomes. It turns out that it isn’t about one doctor but it’s that the patient is seeing several doctors who’s area of expertise overlap. All of the data needs to go to the “advanced primary care” practice, who will share that info with all of the other doctors. Most people think that happens, anyway. If one doc is unwilling to share then that doc is not referred to but would you really want to see that person anyway? 3) Typically, a lot can be done in the primary care office. Some plans pay a differential to the specialist if they accept someone on referral vs seeing people off of the street. In that way I can catch the person who needs their lipids checked while taking their skin tag off and give them a flu shot. If they want to see the dermatologist, they can, but at a higher out-of-pocket cost

Ask most Americans about the economy and they will say that it is what makes America different from other countries. We have “free enterprise”. This unbounded freedom drives entrepreneurship and from that innovation. We have a steady flow of new goods and services.  We are a rich country because of that.

Since wealth can only be created by mining, growing, or manufacture, most Americas may not be taking into account the richness of the land that makes up the US, or the strategic advantage the Atlantic and Pacific Oceans have provided. I think it is safe to say that while free enterprise has been important, other factors have played at least an equally important role.

Is there a role for Government? For example, should your City, State, or even Federal Government establish roads or sewers or harbors, or should these be left to “free enterprise”? In most cases, the answer (if not just the common practice) is that Government undertakes these projects on the behalf of the “commonwealth”. Government pools our money and spends it on projects that directly contribute to our well being and interestingly, facilitate other “free enterprise” activities.

So when it comes to health care, is there a role for Government?

Most of us think of health care as a “free enterprise” domain. Private insurance, private doctors, private hospitals, and of course, private drug companies. What’s wrong with this picture?

In one sense nothing is wrong, in another sense, everything.

If you have insurance or can afford to buy it (at any price), you can receive very good health care services in the US. We hear the cry that US medical care is the best in the world. Wrong. And even more dangerous, all the other industrialized countries have systems that deliver as good (and most better care), and all cost far less per capita. This is not some big mystery. Canada, Germany, France, Japan, and some 14 others all have life expectancies greater than the US. All these countries have health care where no resident is denied coverage for any reason.

So why are we being told that health insurance belongs exclusively to the free enterprise arena? Why are we being distracted with arguments that suggest our system will collapse if the Government offers a “public options” (expanded Medicare)? Why are private insurers dropping coverage everyday?

One of the unspoken justifications of free enterprise is that the service or products involved are continually changing to meet new and emerging needs, and do so in order to make profit. Do you think private insurers are offering Americans better coverage, or simply improving their profits? Do you think Americans are likely to overtake other countries in the world in life expectancy any time soon? Do you think that private insurance health care is likely to cost less, or ever match that of other modern industrialized countries?

I ask you, then, how can the public option be a misstep?

I was sent a video on Health Care Reform that did an outstanding job of identifying the issues that our country is struggling with. It starts, interestingly enough with the story of Walkin’ Tall, the prise winning pig at the Indiana State Fair. Turns out the pig is unable to walk due to his weight and the author points out that the choices ar to kill the pig, put the pig on a diet, or continue to feed the pig and carry it from place to place. This is, as it turns out, a metaphor for healthcare. As is pointed out in the video, what we Americans chose do with our “pig” depends on how we view our responsibility to our fellow citizens. In the video, the question of healthcare as a right versus a privilege is addressed. The view of the author is that though we view it as a right (EMTALA) that we choose not to pay for directly, which is why we have such a convoluted system of getting folks paid when compared to our fellow citizens of the world.

 Now that all of the bills are out of committee, it is clear that Congress is a reflection of America. We continue to debate what should be included in a health care package for all Americans. Jon Kyl does not, for example, want to pay for maternity care that he certainly will never need. He is a Senator from the state of Arizona. If you are white (as Senator Kyl is), pregnant, and live in Arizona, your baby has a 6/1000 chance of dying in the first 30 days of life (Kaiser Family Foundation). Although access to prenatal care may not make all of the difference, it likely would reduce this even further as we as a country are 5.7/1000. If you are non white, non hispanic your chances of having your baby alive at the end of 30 days in Arizona is 1.2/100. Senator Kyl may want to rethink his willingness to pay for care for people unlike him if he’d like for the infant mortality of these citizens to be better that the Russians (1.1/100).

Kill the pig, feed the pig, or put the pig on a diet. We as a country will need to decide which strategy to follow. Continuing to feed the pig, some say, will result in further economic decay. Others say the “health care sector” is an important part of the economy. Maybe we need to switch to soy bacon.

The American way is often confused with “life, liberty, and the pursuit of happiness”. Today, however, we are bombarded with news reports of successful people and companies, and the one criteria to qualify for news is to make money. More newsy is more money. Most newsy is making the most money. And what’s wrong with that?

In the abstract, nothing. In the specific, everything. Reading history there is no shortage of American heros and highly news worthy people who gained this notoriety by amassing (and spending) gobs of money. It seems to me, however, that in the past these “made rich” people actually did something (other than Ponzi schemes) to become wealthy. They may not have been perfect in ever respect but they did make things, invent things, or provide a critical service (like railroads). In doing so, they provided Americas with jobs, and products and services that made life fun and a lot easier. Money was simply their reward for creating value.

Today there is still some of that. Unfortunately, not enough, and there is more money to be made other ways. You can run a bank or investment firm and look for ways to make a sure bet when someone else (trying to do the same thing, make money without working) does not bet as well. No new products or services result from this and for sure no jobs results. You also could run an insurance company and deal in the field of health care coverage. This is an extremely important service but interestingly it is also a gold mine of opportunity to make money. With limited competition and a service that people can not do without, it is perfect for skimming profit. And with no regard for improving the quality or productivity of the service there is lots more time to think of ways to make more profit.

While some degree of regulations would help shield Americans from some extremes in money making, it would help us more to put greater emphasis on returning to basics, math, science, and engineering. We need people who get rich by making, mining, and growing “things”, and in the process providing jobs for many other Americans. This type of honestly earned money will make the Country strong and dilute the cancerous infection of the pure money making leaches.

As I watch the post speech debate on what “health insurance reform” really means, I am reminded of the “Sultans of Swing” lyric by the group Dire Straits.  On the one hand, “the most interesting health care consultant in the world”, a Canadian PhD named Steven Lewis, has posted a very watchable video which points out flaws in the comparison of the Canadian system to the US system and makes a strong care for the advantages of “single payor”. I guess as a fan of Dan Aykroyd and Michael J Fox it shouldn’t surprise me that Canadians could be funny and serious.

In this country, however, the competition in the marketplace of ideas is not coming from the Canadians. It is coming from the Republicans as illustrated by the March on Washington yesterday organized by a group called FreedomWorks. Led by Dick Armey,  near as I can tell they are against lawyers (who isn’t  unless you need ‘em) and for allowing “competition across state lines”. Not being a particular fan of the company responsible for 90% of the commercial policies in the state of Alabama, I thought this last idea might have some merit, until I looked into it further.

John McCain brought up the idea of competition across state lines in the 2008 presidential election.  I have to admit, it kind-of appealed to me. Since he didn’t win, I hadn’t thought too much more about it until now. It seems simple (why not let Mississippi Blue Cross into Alabama), American (companies should compete), and would seem on the face of it to produce lower costs.

The New America Foundation did not think any of those things would come to pass if “reform” took this guise. A non-partisan group, they looked into this policy change in October 2008. What they speculate would happen given the current state of regulation would be a race to the bottom. States that do not mandate such “luxuries” as emergency care, maternity care and pediatric immunization and prevention would quickly become the home state for many insurance companies so employer based policies would become less comprehensive. There would be even less types of policy choice under such a system. Integrated systems that we are striving to emulate such as Intermountain Health Care, Group Health Cooperative, and the Mayo would have their survival threatened as employers raced to the bottom. If employer coverage were not encouraged through tax policy, the number of uninsured would rise as insurers developed means to exclude high risk individuals and risk pools would become prohibitively expensive.

On the other hand, the foundation feels it could function with guaranteed issue (you get a policy no matter what your risk history is) and federal regulation of health insurance (back with the Stalin pictures), reforms such as are proposed for the “health care cooperatives”. Dick Armey has made his position clear on these addendum to his conservative policy position

““The only thing ‘guaranteed issue’ guarantees is more expensive health insurance and more government involvement. Imagine if they did this to restaurants—if restaurants had to serve dinner to everyone who wanted it (guaranteed issue) from a longer menu (to qualify for the national exchange) at the same price (community rating). The feast would be great—except that all the restaurants would close shop before I got dessert.”

What it comes down to is this: do we as a country see ourselves as having an obligation to provide for basic health care for our citizens? Do we see health care as a privilege along the lines of a restaurant meal? If it is a privilege, are we willing to allow the consequences of denial of care that we know would improve the well being of a fellow citizen because they have not had the good fortune of working for a company that supplies health insurance? Are we willing to do that while we gorge on excessive medical tests, medications for erectile dysfunction, and allow our physicians to make over $1,000,000 annually as they reassure us that America has the best health care in the world?

Health care is an area of demanding and controversial health care programs, insurance and spending.  

Medicaid and Medicare are government run programs that account for a large portion of health care cost.

Insurance overall is a funny business – there is insurance for almost anything including pets, fire, medical, vehicle, and others. Insurance has become so essential that many either overspend for insurance or work in terrible jobs, just to get insurance.

But then there is the large portion of individuals, for whatever reason, are unable to get insurance at all.

Private insurance is even more difficult to understand. These programs are allowed by employers or private individuals and vary from company to company and policy to policy. It is believed that over the last 7-10 years, employee-sponsored health insurance premiums have increase over 100%. This is almost 5 times the amount of inflation over the same period of time.

This is markedly more difficult for individuals and employers. Less and less companies are able to afford these important programs. And this will continue to get worse and worse.

It is believed that by 2020 or so – it will cost a family of 4 more than $25,000 per year to cover health insurance. Currently it is almost $13,000 per year for health care.

Cost for employers will continue to rise as well. Currently the cost to employers for insurance is just over $300 billion dollars. Within 10 years that number may jump to the mid $800 billion dollar range.

Don’t be fooled either – the coverage will not improve as time continues. Increasing costs, number of sick, and rising average age will continue to worsen the actual coverage by each individual.

Increasing Health Concerns

1.) Health Care Spending

- United States is leading all countries in the percent of GDP that is spent on Health Care.

- United States currently spends 16.2% as of 2007 and was around 15% in 2006

- Switzerland and France follow at around 11%

- Other countries above 10% are: Canada, Belgium, Germany, Portugal and Austria

- most of these values are from 2006

2.) Cost

- as the cost per person rises – the burden increases for employers and individuals to get enough coverage and the correct coverage

- $2.2 trillion dollars were spent in the United States in 2007 on health care costs

- $700 billion in 1990

- $250 billion in 1980

3.) Bankruptcy and Foreclosures

- Over 50% of bankruptcy are linked to lingering health or medical expenses

- 1.3 plus million people loose their homes because they also have medical expenses that can’t be meet

- Many families with the above mentioned health care costs do have insurance – over 75% on average

4.) Aging

- It is believed in the United States that by 2030 the number of individuals over the age 65 will double

- Over 70 million Americans will be over 65 at that point

- This will comprise around 20% of the population

- The cost of an older individual is 5 times greater for someone over 65 than under 65 [on average]

- The overall projected spending is believed to increase by 25%

“The aging of the U.S. population is one of the major public health challenges we face in the 21st century. One of CDC’s highest priorities as the nation’s protection agency is to increase the number of older adults who liver longer, high-quality, productive, and independent lives.” Julie Louise Gerberding, Md, Director, Centers for Disease Control and Prevention – 2007

5.) Smoking, Poor diet, and physical inactivity

- It is believed that these 3 items result in 35-35% of deaths each year

- These are preventable conditions

- Are quite costly to individuals, companies, governments, and tax payers

- Are risk factors for serious medical conditions of: Diabetes, Stroke, Cancers, and Heart Disease among others

6.) The Uninsured

- Some do not qualify for government-provided health insurance

- Some do not qualify for private health insurance

- Not provided insurance by employer

- Some are unable to afford health insurance

- Some choose not to have health insurance

- As of 2007 – 15% of population or 45 million individuals were without health insurance

- 2008 numbers are expected to be statistically similar to 2007 despite the recession, but a rise to 46 million is anticipated

According to the US Census Bureau, in 2007:

Of the 45 million uninsured:

. 37 million between ages 18 and 65
. 27 million worked at least part time
. 38% had household income of greater than $50,000
. 36 million are legal U.S. Citizens
. 10 million are non-citizens (This may or may not include illegal immigrants)
. 20% could afford insurance
. 25% are eligible for public coverage
. 55% need financial assistance to cover health insurance

7.) Fraud

- It occurs daily and helps “almost” no one

- Occurs on many levels and by many individuals

- Health Care is often about profit

- The most visible areas are Medicaid and Medicaid

- However, fraud occurs in all health care areas

- It is believed to occur on 5-10% of all health care expenditures

- Your increased health cost is, at least in part, to health care fraud

8.) Disparities

Defined by the Health Resources and Services Administration as …”population-specific differences in the presence of disease, health outcomes, or access to health care.“

Goldberg, J., Hayes, W., and Huntly, J. “Understanding Health Disparities.” Health Policy Institute of Ohio (Nov 2004) page 3

- Medicare and Medicaid spending is often quite different from state to state

- Sometimes the spending amount is double in one state when compared to another
. Example [Medicare in Miami in 2006 - $16,351 and in San Francisco $8,331]

- Access to health care and insurance is often a cause point, but not always

- The cost for such disparities may directly impact social and economic status

- Race, ethnicity, socioeconomic, sex, age, medical conditions, sexual orientation, and more are all linked to disparity

All is not loss

We are doing several things well – probably not perfectly but well

1.) Improved overall medical quality and treatment allow for a larger number of patients to live longer

2.) Improved Mammogram screening

3.) Improved Cholesterol screening

4.) Overall awareness for preventative care increasing, it still must increase in importance to not only improve care, quality of life, and overall balance health care costs.

5.) Disparities have begun to be looked at more closely and continue monitoring and goal setting to manage specifically targeted areas have been put in place.

Post originally seen at InterActive Health: Health Care Spending

For further information take a look at the following

- http://www.nchc.org/facts/cost.shtml

- http://www.cdc.gov/aging/pdf/saha_exec_summary_2007.pdf

- http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5813a5.htm

- Goldberg, J., Hayes, W., and Huntly, J. “Understanding Health Disparities.” Health Policy Institute of Ohio (Nov 2004) page 3

- Centers for Disease Control and Prevention and The Merck Company Foundation. The State of Aging and Health in America 2007. Whitehouse Station, NJ: The Merck Company Foundation; 2007.

The George W Bush Administration inherited a budget surplus from former President Bill Clinton. President Barack Obama inherited a projected $1.2 trillion deficit from the Bush Administration, and the projection was prepared well before the economic melt down that subsequently occurred. In the best of the Bush years, deficits were encountered primarily because tax revenues (following Bush’s tax cuts) were not large enough to cover the cost of government. Think about that. Why was anything not done during the Bush years to end the deficit spending?

Today the Government announced they project about a $1.5 trillion deficit for this year, and about $9 trillion more over the next 10 years. And you might ask, “what is President Obama’s solution”? His Administration remains silent and leaves us to believe this is just a small problem for another day.

The budget can be viewed as composed of four parts. They are Medicare/Medicaid, Social Security, Defense, and everything else. The health care parts and social security are alledgedly funded by payroll taxes. The problem is that the Government is not collecting enough to ensure these funds will last and the Government is paying money into them each year to keep them afloat. Defense spending is about $ 600 billion each year and should be a target bigger than a barn to shoot at. The $600 billion is more than all other countries’ defense budgets combined.

We have heard often that health care costs can be trimmed and that changes in social security rules can help, but in the end, they are simply underfunded. The Defense Budget is clearly too large but it is unrealistic to imagine it going away. It is reasonable to think about a reduction of $200 billion a year but that is only a small down payment on a budget deficit of $1.5 trillion.

Most homeowners are incensed that others are walking away from their mortgages, or seeking to renegotiate their terms. Some are even seeking to have principle forgiven. Why then should the US Government allow deficits of this magnitude to exist without any plan to pay them off? How can we ask everyday citizens to pay their credit cards bills when the US borrows steadily to pay its bills with no idea how to pay its debts? Do Government officials think that they can ask forgiveness from the Country’s debt holders?

In politics, unfortunately it is not about right or wrong, it is about surviving and helping those who have supported the elected official’s election. It will be tempting to use inflation (which they will all decry) as a means to pay back this enormous debt with much cheaper dollars. We will all lose out on this ploy as our cost of living skyrockets and our savings shrink in value.

So what about bracing our backs and raising taxes on everyone.  This is a far more cost effective tool than inflation.  We already know that the tax schedule in force during the Clinton years was quite compatible with prosperity. With higher taxes, then we can all decide, in a clearer light, how much Government Services we can afford and really want.

I think it is time to “think twice” about taxes.

All major industrialized countries , except the US – all of Europe, Canada, Japan, South Korea, Hong Kong, Taiwan, Singapore, Australia, New Zealand – (and quite a few so called “emerging countries” such as Brazil, Argentina, Chile, Malaysia or Thailand) offer universal health care. Germany has had universal health care since 1883! The vast majority of universal health care systems in the world are single payer systems, with either public coverage or dual public/private coverage. There are no examples of a purely private universal health care system in the world and it is very unlikely that the US will be able to change that.

At close to $7,000 per person, the per capita cost of health care in the US dwarfs the cost in any other country (Germany comes distant second at $3,300). US health costs approach 17% of GDP, substantially above those of any other industrialized countries, with the closest second coming at a little over 10% of GDP. Meanwhile, the number of uninsured in the US is close to 50 million people, and growing steadily. A growing number are under-insured, meaning that their co-payment exceeds their financial means, or necessary care is excluded from coverage; estimates on under-insured go from 25 million to as high as 50% of all insured people. How can you get more dysfunctional? Still, most Americans have been brainwashed through savvy public relation campaigns into believing that their health care system is the best in the world and that America will fall into socialism if universal health care is implemented and long lines will form at health care centers while dying people will routinely be denied treatment, which is complete insanity. As if the industrialized world was socialist, as if dying people were not presently denied treatment right here in the US, not in “socialist” Europe, Canada or Japan!

Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Over half the family bankruptcies filed every year in the United States are directly related to medical expenses, and a recent study shows that 75 percent of those are filed by people with health insurance. At 6.3 death per 1000, twice the rate of top ranking Iceland, Singapore, Japan and Sweden, the US ranks 33 in infant mortality rate in the world, laggard of all major industrialized countries and even behind arch-enemy Cuba. The US ranks 45 in life expectancy, again laggard of industrialized nations. Is it a coincidence that the US ranks behind the vast majority of countries offering universal health insurance in these two key health indicators?

What is the problem with Americans that they don’t seem to be able to learn from others? What would be wrong to look at what every other major industrialized nation is doing and trying to learn from them? Isn’t there in the American attitude some fatal arrogance, which by the way is not too different from the fatal arrogance that led the US into the insanity of the Iraq war? Not incidentally, the money spent on the Iraq war would more than pay for the health care reform and universal coverage and it would be hard to argue that the Iraq war is more beneficial than universal health care to the American people.

The major problem of the US health care system is that it is primarily intended to protect the often competing interests of two powerful industries: the health care industry and the insurance industry, both of them intent on maximizing profits and minimizing risks for the highest benefit of their executives and shareholders, and these two industries live in close symbiosis with a third parasitic industry which is the litigation and malpractice industry. At no point is the public interest taken into account. The insurance industry tries its best to enroll low risk enrollees while routinely denying or limiting coverage to those deemed high risk. The medical industry sherry-picks patients with the best insurance plans while pushing often unnecessary expensive tests or high profit (and often high risk) procedures and medicines – according to government statistics, close to 60% of open-heart surgery are unnecessary, often resulting in patient’s death. The refusal of senate and congress to have a public insurance system competing with the private insurance on the ground that it would be unfair competition to the private insurance industry is laughable, shameful and ultimately criminal as the inefficiencies of the current system results in tens of thousands of unnecessary deaths. If they really had public interest in mind, the benefits of a dual public/private single payer system would be obvious to lawmakers as has been amply demonstrated throughout the world; if the health care costs per capita in the US are more than double those of any other country for sub-standard coverage, isn’t because the health care industry serves first and foremost the interests of its executives and shareholders?

The free-market works best argument is moot and even criminal – a fraud perpetrated by the health care industry powerful propaganda machine; it sure does work well for cars or TV sets, but health care is a whole different story. I buy a new car when and where I chose so, and can do beforehand as much shopping around as I wish trying to get a deal I can live with and if at the end of the day I decide I can’t afford as new car, I just don’t buy it. No so for health care. The insurance side is convoluted, unintelligible to the common person and subject to almost arbitrary deductions and exclusions, and that in any case are mostly out of the user’s control. On the provider side, most people don’t chose to get sick and when they do, don’t have the opportunity to go shop around for the best possible deal. Just try anyway to get a quote from an hospital! And in any case, in most cases they must get the care even if they can’t afford it. So, this is not free market whatsoever and the insurance and health care providers have a huge unfair advantage that must be corrected in the public interest.

As for the fear of bureaucracy argument raised by fear-mongering opponents of health care reform, it is laughable; the existing system of literally thousands of often undecipherable plans with hundreds of different carriers each using their own forms and procedures results in wasted administrative costs estimated at $160 billion per year in paperwork alone, that could be saved in a single payer system; and this doesn’t even take into account all duplications and unnecessary procedures caused by the inefficiency of the existing system.

Obama’s intentions are probably genuine and there is all reasons to believe that he really wants to fix the broken US health care system, but his hands are tied as he needs to deal with the systematic obstruction of the republican camp openly intent on torpedoing his efforts with a total disregard for the American public interests while too many democrats have far too incestuous relationship with the medico-insurance interests to enact meaningful reforms that squarely places public interest front and center.

At the end of the day, the US is first and foremost a moneycracy where money buys votes and lawmakers’ primary allegiance is to their donors, as the recent bail-outs of the financial industry and their obscene bonuses aptly demonstrated; Goldman Sachs’ recent stellar earnings further drive the point. The financial industry now produces over 50% of total earnings of all public companies, to the sole benefit of a handful of powerful individuals with an inordinate sense of entitlement who run the show behind the scene, controlling both public opinion and lawmakers. Will American people ever wakeup from their propaganda induced torpor?

The following senators have huge power in the health care reform. Put pressure on them:

http://reid.senate.gov/contact/index.cfm

http://conrad.senate.gov/contact/webform.cfm

senator_bingaman@bingaman.senate.gov

http://grassley.senate.gov/contact.cfm

http://baucus.senate.gov/contact/emailForm.cfm?subj=issue – max@baucus.senate.gov

http://snowe.senate.gov/public/index.cfm?FuseAction=ContactSenatorSnowe.Email

http://enzi.senate.gov/public/index.cfm?FuseAction=ContactInformation.EmailSenatorEnzi

Chris Garlasco, Owner & Managing Partner - Founders Insurance Group

Insurance is a product like any other product that we purchase. Somehow, we have reached a point of confusion in America that insurance is something other than a product. My favorite laundry detergent is designed to make my colors look brighter than the other brand, so that’s why I purchase it. My favorite bread is designed to add fiber to my diet so again, that’s why I purchase it. My favorite detergent or loaf of bread is not a right, it’s a product.

The detergent protects my colors, the bread protects my body, and the insurance helps me to pay for things that I cannot normally afford. That is what the insurance product is all about. Unfortunately, the cost to rebuild our house after a fire is more than most of us can shell out when that fire occurs. My wife’s most recent visit to the hospital was tens of thousands of dollars, more than most of us can afford out of pocket. If I have an employee injured at my place of business, it may be more than I can afford. I think that you get the point!

The insurance product simply protects us from events in our life that we otherwise cannot afford. If insurance didn’t exist, the cost to rebuild your house after a fire would still be the same. The cost for all of the exposures that I mentioned would not change either. This product that we call insurance helps to protect us from financial destruction yet many people these days are viewing insurance as something that it isn’t. Insurance is not the cost of the health care. Insurance is not the cost of the house fire. Insurance is not the cost of the car accident.

Instead of asking why our insurance costs so much, maybe we should be focusing on why all of the things that we need insurance for continue to rise. Focusing our attention on that will bring about true reform.

Have a great day!

Chris Garlasco

"Bending the curve" from the Commonwealth Fund

In late 2007, the Commonwealth Fund published a paper entitled “Bending the Curve“. The point of the paper was that given the current trajectory, health care expenses will exceed our country’s ability to pay, leading to insolvency. Although this has been the worry of policy makers forever (what’s a good amount of money to spend onhealth care? 5% of GDP like England? 12% of GDP like Canada? 16% of GDP like the US?) and previous policy was that health care jobs were to take the place of manufacturing jobs, increasing our GDP. It turns out that there is an optimum amount to spend if the objective is to achieve optimum health with the least cost possible. That amount seems to be less than what we spend.

The report does not mention rationing at all. Many of the concepts in the report were included in HR 3200, which does not mention rationing either. What is mentioned is “medical effectiveness”, improved health information technology, and shared patient decision making. Using these three concepts, physicians can help to bend the curve down, eliminating the need for hard rationing.

Improving information regarding medical effectiveness should lead to a reduction in use of expensive, unproven technology. We Americans have a fascination with technology. In fact, part of the utilization of the emergency room by patients is because of a belief that technology is necessary for effective diagnosis and treatment. Hospitals in rural Alabama hired physicians away from their practice and had them move into the Emergency Department, subsidizing thier salaries, because they knew that would help attract patients into the hospitals who would then be referred into the technology areas (CT scans, MRIs, etc). Unfortunately, the use of this technology has not translated into people doing better (they may feel better having seen their insides but it is an awfully expensive placebo). Most insurances will pay for technology because there is limited evidence to indicate when technology is good (avoiding an unnecessary surgery) or when it is bad (finding something that is likely normal but “might be something bad” causing excessive worry and unnecessary procedures). In fact, some procedures (placement of stents in certain patients) are found to be harmful after years of having been done. Evaluation of all procedures ought to be more rigorous and establishing money with which to do this will ultimately reduce costs.

Improved information technology (already funding through the stimulus package) should help to reduce costs as well. Transferring information by snail mail and fax is the rule in health care rather than the exception now. Electronic transfer of information, with appropriate safeguards, has revolutionized the banking industry (so much so that the regulators unfortunately got lost in the shuffle). Making information easier to transfer will reduce waste and duplication.

Lastly, encouraging shared decision making is probably the most important of the three. As a physician, I get paid for time in a piecework fashion. If I need to have an hour conversation with a patient about prognosis, different treatment options, or longterm care decisions, I have to schedule it outside of my normal patient care hours and do not get paid at the same rate I would for seeing “regular” patients. Yet, this is probably the most important conversation I will ever have with a given patient. It has been my experience that when faced with a disease that is terminal or that there are several different treatment options, what people want most is someone who knows a little about them to help guide them to a decision they will be comfortable with. All too often, we in medicine assume that the patient always want more and wish to cling to every last second of life but often it is the physicians who impart their worldview instead of listening to the patients and their families. Additionally, the primary care physician, the doctor who knows the patient the best, is often not involved in these conversations at all for a number of reasons. Changing the payment structure will go a long way towards inclusion of the primary care doctor in these discussions.

It is the belief of the Commonwealth Fund as well as myself that these measures will “bend the curve” down without hard rationing. We may have a chance to find out.

The most recent proposals coming out of the House for alleged health care reform will make your headaches worse when dealing with health issues regarding treatment and  insurance coverage.  We all have our own horror stories about ourselves or some relative or close friend who has endured a nightmare of paperwork and confusing letters and “billings” from insurance companies, hospitals and doctors for medical care.  You often can’t even tell if the paperwork you receive is a bill or what.  So often the paperwork will indicate that you “might” be billed so much for such and such a procedure.   Who in the world can understand the final billing you get from the hospital?   Those line item entries might as well be written in Greek.  Some of that is our own fault for not asking questions up front about services and costs when we go to the hospital.  Rather than being charged a set fee to have a gall bladder removed and a three day stay in the hospital we are billed for each and everything thing they do, everything they hook us up to and all that paraphernalia attendant.  Why does every single patient need the finger monitor for oxygen content?   Millions went to the hospital for gall bladder removal and survived just fine without that, thank you very much.   There is no question that improvement can be made.  However, let’s not make the classic mistake of trying to fix what ain’t broke.  We do get excellent care.  The costs and paperwork or insurance coverage rules are out of control and that is where we need to make the improvements.   The last thing the system needs is more bureaucracy.  The hospitals and insurance companies already give us enough of that.

As bad as it might be now it can be worse and will be if the current House proposal were to become law.  You will have exactly the same problems as before but now you will have a whole new layer(s) of bureaucracy on top of that existing now.   Under the proposed new regime there will be: Health Choices Administration, Health Insurance Exchange, Health Insurance Exchange Trust Fund, Government Health Plan, Bureau of Health Information and the Health Benefits Advisory Committee and that is not all of them.   My first thought is just how many more Federal employees will Government, Inc. need to man these outfits.  The average wage these days is reported to be $74,000 per federal employee.   You can be assured those agencies and bureaus won’t be hiring only a few dozens employees.  D. C. will grow even more and so will those unions and the power of politicians who support all these agencies.   What exactly are these people going to be doing that will improve the quality of medical care for me?  How are they going to make my medical care cost less?  Just as with every government agency you can be positive that they will never diminish in size; they will only grow over time.  You will not only have to deal with the insurance company and the doctor but one or the other of these agencies.  They will have the power to enforce federally mandated standards of care.  Which of course means you take what they offer or nothing;  there will be no other option except to go to completely private health care as the ones who can afford it do in Great Britain, France and Canada now.  

The system in the proposal does make it mandatory to go to the public plan.  Don’t let the rhetoric fool you.  Yes, you can keep the coverage you have now.   But, and it is a huge but, if you ever change then you must join the government program in one of their three tier programs.  If you have coverage by an employer and leave that employment and lose coverage the same thing applies and you must join the government program.  Likewise if you have never had coverage then you are forced to go with one of the three levels offered by Government, Inc.   You can’t get private coverage even if that is what you prefer.  If you have never had insurance then again you are mandated to one of the government plans, no option.

I notice that Connecticut is coming up with its own health plan.  We all know that Massachussetts has implemented a plan a few years ago.  I don’t know the details of the Conn. plan but I think that is fine.  Our federalist system is wonderfully flexible and allows for tremendous freedom to experiment with ideas.  I think it would be great if several of the states tried different methods for dealing with health care issues.  Let them give it a go for ten years and let’s all take a look at how they worked out.  The better ideas will emerge and the ones that were fraught with unintended consequences will also be revealed.  The health care system is much too important to rush through half cocked ideas that are driven much more by ideology than sound business and medical methods.  Those pushing so hard for passage want it because it is a government program and gives Government, Inc. tremendous control over an important and large segment of our economy. 

We haven’t even touched on the cost problems.  Those costs will be much much worse under Government control.  Some in government in fact won’t really mind that because it will keep so many new government employees and others dependent on the very politicians who hand out these goodies.  The more they spend the more folks that will depend on them.  Of course at some time  they will reach the point of diminishing returns because the private sector will be smaller and smaller and more anemic and there won’t be anyplace to grab the money to pay for all these benefits.  Government can’t create wealth or value, it can print money but that is not the same thing.  The private sector has to exist to have someone to tax, unless their plan is to go completely Commie and have everything belong to Government, Inc.

It all makes one wonder if Government, Inc. will do away with the Hippocratic oath and require a loyalty oath to the government system.  After all a strict application of that Hippocratic oath would often run counter to Government, Inc.’s health policies.   www.olcranky.wordpress.com

In a move that highlights the politics of stupidity, leaders of the house announced a health care plan that will force the smallest employers to provide health care or pay a tax. According to an article in the WSJ, “Under the House measure, employers with payrolls exceeding $400,000 a year would have to provide health insurance or pay the 8% penalty. Employers with payrolls between $250,000 and $400,000 a year would pay a smaller penalty, and those less than $250,000 would be exempt. Certain small firms would get tax credits to help buy coverage.”

Read the article by Janet Adamy and Laura Meckler (reg required). BTW, the WSJ just ran an article on the  rising costs of health care and how it is already causing major problems for small business and entrepreneurs. In that piece from a July 13th special report, Simona Covel writes

At some businesses, in fact, health care is the highest expense after salaries—with devastating consequences. Owners must skimp on vital investments like marketing and research. Some can’t hire the people they want because top candidates demand premium coverage. Or they end up understaffed because of the high cost of insurance—and lose potential clients as a result.

At the same time, to keep costs in check, countless companies are slashing coverage or dropping it entirely. Some are turning to freelancers or offshore workers instead of hiring full-timers and locals. And some would-be entrepreneurs find insurance so onerous that they’re not even starting a business in the first place.

What’s more, it isn’t just individual companies at risk. It’s the entire economy. Historically, small businesses have boosted recoveries significantly. Since they can’t simply make mass layoffs and hunker down, as so many big companies do, they must take risks to survive—like investing in innovative ideas and hiring more workers to implement them. But stratospheric health-care costs threaten to damp that enthusiasm and choke off investment.

“We have got to figure out how to get an affordable [insurance] package to people who would be entrepreneurs,” says Carl Schramm, president and chief executive of the Ewing Marion Kauffman Foundation, a pro-entrepreneurship organization in Kansas City, Mo. If such a package existed, he adds, “the chances of a more robust recovery at the hands of entrepreneurs would decidedly be higher.”

As an entrepreneur with a new venture (roughly 18 months old), my partner and I have not taken on any employees and with policies like this coming down the pike, we are likely to continue to outsource and pay contractors. Image if they cap and trade our computers, etc?