The political chess piece that is Medicare

Imagine your employer paying you the same salary for 8 years in a row. Then, in year 9, the employer informs you that you will have to take a 21% pay cut. Would you stick around?

It's a similar scenario between Medicare and physicians. The aggregate physician fee schedule has been essentially flat for many years. In real terms, it's like taking a pay cut because physicians can't hold their staff salaries flat for that period of time. Supply companies tend to tack on annual increases as well. To even consider a 21% cut is laughable. You will see a mass exodus of physicians from the Medicare program, and you can't blame them.

The Medicare formulas are in desperate need of update. It's been a cat and mouse game for quite some time. Now it's gotten even more political than it's been in the past. Private insurers have made up the difference by giving physicians annual increases. Now they're under fire for their high premiums. What a mess!

I believe the average Medicare beneficiary has 2 chronic conditions, takes 12 meds, and sees 7 different physicians each year. If we want to bend the Medicare cost curve, it seems to me that we should look into why those stats are so poor. The private sector cannot continue to shoulder the entire burden of Medicare's woes. Let's address the problems directly instead of shifting them elsewhere.

Obama vs. AHIP

Try backing a stray cat into a corner and see what you get. It would probably look similar to the situation health insurers are facing right now. It's getting ugly and Obama's not pulling any punches with his rhetoric. There's no doubt that he wants to be "the President that got healthcare reform."

We will probably get some version of reform this year. Unfortunately, a disproportionate share of focus has been placed on health insurers when they are only a small piece of the cost driver pie. Maybe we need to get this first round of "reform" out of the way so we can build momentum. It makes me weary just thinking about the fact that we're going to have to endure another, probably more painful, wave of reform.

Phillies win!

The Fightin' Phils' make it exciting again! One win away from the World Series!

Capitalism

I checked out Michael Moore's flick about capitalism last night. In terms of political and ideological views, I consider myself slightly right of center. Mr. Moore is unmistakably far left. With that said, I still enjoy his documentaries. I found Sicko entertaining even though I thought about 60% of it was BS.

Back to Capitalism: A Love Story. It was funny and entertaining, but was essentially similar to the rest of his films, just based on a different topic. I found nothing in the film to be an outright lie, but he has continued his MO of using context to his advantage. No opposing views were included.

One of the main points he attempted to portray was the huge gap between the rich and the poor, and the fact that there is no longer a middle class. I am not thrilled that there are people out there making $50 - $100+ million a year when many are losing their jobs. To me, that is a red flag that there are problems with the system. However, there is a balance to be struck because we must not stifle innovation and entrepreneurial spirit. If Mr. Moore had his way, we'd probably be all earning the same amount (although I think it's safe to say he's among the rich, but just doesn't want anyone to know that). Also, I am in the middle class and I can probably name 500 other people that are, just among family, friends, co-workers, and neighbors. The only thing that has changed about the middle class is how it's defined to fit neatly into certain ideologies.

I have some questions for you, Mr. Moore:

• Are you advocating for government to take over all sectors currently controlled by private companies?
• Are you ok with the fact that you probably have more money than 97% of the population? Is capitalism only ok when it makes YOU money?
• Of all of those people you interviewed who were in bad financial shape, did you ask any of them what kind of grades and how much effort they put into high school?
• Do you believe that someone should be allowed to stay in a house they can't afford indefinitely?
• Are you ok with the IRS reverting back to 90% tax rates for the top income bracket, knowing that you will lose a lot of your disposal income?

The reality is, capitalism in its purest form is not a bad thing. It only becomes bad when bad people are allowed to do bad things. Even Mr. Moore's beloved "democractic system" can be tarnished by bad people. It's too easy to blame things on systems these days, when really any system can be compromised by bad people.

Greed drives most decisions in our culture these days. Until we figure out how to change that, we will have problems throughout society.

Ideology and healthcare reform

Here's an interesting article about why Americans agree or disagree about elements of healthcare reform. Ideology certainly goes a long way, as does the way in which an issue is framed. An excerpt:

They set up an experiment that showed Republicans and Democrats alike supported measures to reduce the risk of type-2 diabetes.

But the Republicans lost enthusiasm when the researchers presented arguments about how hard it is for people to exercise and eat right when streets have no sidewalks and fast-food restaurants abound, Sarah Gollust of the University of Pennsylvania and colleagues found.

"If you are more liberally minded the 'neighborhood explanation' can be motivating, but for people who are more conservative politically, that message can backfire and make them even less interested," said the University of Michigan's Dr. Peter Ubel, who worked on the study.

"The same information can polarize people."

That last sentence is very important. I can't imagine there's anyone out there that doesn't want to address diabetes. And yet, Americans remain divided by increasingly irrelevant ideology, and it prevents or at least delays progress from happening. What happened to the good old-fashioned skills of listening and compromise? Why can't diabetes have personal and social causes? The answer to the second question is, IT CAN. Diabetes and it's evil stepmother, obesity, are complex problems with multiple causes. Let's put ideology aside on issues like this, and let logic and reason get back in the driver's seat.

The increasingly insignificant red light

Is it just me, or are traffic lights becoming less relevant in today's society? There are intersections in my local area that cause me to question it. Here are my estimates of what someone would find if they were to sit at one of those intersections for a period of time and count the number of people that run each red light:

1 car: 90% of the time
2 cars: 75% of the time
3 cars: 50% of the time
4+ cars: 25% of the time

I'm less concerned with the increased risk for accidents than I am with the fact that this might be a symptom of deeper issues plaguing our society. Why are so many people in such a hurry, that they are prepared to blatantly disregard traffic laws? Are they really running late, or is it something else? Do they see how ridiculous they look when everyone catches back up to them at the next light?

Increasing impatience and a focus more on the destination than the journey are real issues. It's happening gradually over time, so it's not on too many radar screens. The underlying problems at play will not cause enough disruption to require corrective action of any kind in the next year or two. Probably not the next five years either. However, like obesity, the longer these things are allowed to spread, the more difficult it will be to reverse them.

At some point in time, the focus must shift from legislation and regulation as a means to keep things on track, to a focus on individual and broader societal behaviors and views.

Random thought: Political strategizing

A Wall Street Journal Online headline: "Pelosi Key to GOP FY2010 Playbook"

That's just another example of what's wrong with our government/political system in this country. Our elected officials spend more "quality" time strategizing to gain control than they do trying to solve real problems. Actually, many politicians are very good at political strategy. It's just a shame that it has absolutely no value to those of us that pay their salary.

America: The Land of the Fat

I just got back from a vacation in Disney World. As much as I enjoyed the trip, I can't help but feel discouraged about some of what I saw. Please forgive my bluntness, but we are a FAT country. Normally I wouldn't speak like that about such a sensitive subject. However, things have gotten so serious that protecting feelings can only make it worse.

The most recent statistics I've seen put the number of overweight and obese Americans at around 65%. From what I saw in DW, it's higher now. I can only imagine what the travelers from other countries were thinking. I was embarrassed to visit the various countries at Epcot, where most employees are originally from that country. If I had to guess the % overweight and obese among them, I would peg it at around 25%.

So why are Americans so heavy? Well, I think we all know it's lifestyle, as well as a constant barrage of food marketing. The scary part is, it is now the norm to be fat. If some of those people I saw would have been walking through the parks 30 years ago, they would have felt very uncomfortable. Today they fit in, which takes a lot of the societal pressure off them and makes a reversal of these awful trends all the more difficult.

This gives me more motivation to work on addressing the obesity epidemic at the local level. If we think healthcare costs a lot now, wait until this generation of people hits 60-65 years old. I can promise you that none of us is prepared for the cost problems down the road.

For God's sake people, please make some effort to take care of yourself. If you are 40 and have a BMI of 30-35, chances are it hasn't completely caught up with you yet. Don't take too much comfort in the fact that you don't need to visit the doctor often. I can promise you that you will have to endure many doctor visits down the road when the chronic conditions, knee/hip problems, etc. start setting in.

Average Joe Contributions to Healthcare Reform

Here are some more contributions the Average Joe can make to healthcare reform:

• If you have children, please set a good example for them in terms of leading a healthy lifestyle.
• Think when you eat. Research shows that mindless eating is one of the main drivers behind the obesity epidemic. Making a conscious effort to think about what you eat and how much you eat can only benefit you.
• Take a health risk assessment (HRA). It's designed to assess your overall health and highlight areas that you need to work on before big problems arise.
• Laugh whenever you can. It really does reduce stress.
• Write a letter to your local Senator or Representative and ask him/her to actively seek out input from a variety of sources in the healthcare debate.
• Get out and enjoy the fresh air.
• Read as much as possible, with as much variety as possible. If you keep your mind active throughout life, it is unlikely that you will reach a point where you don't recognize your own family members. It will also take your mind off that sugary snack that continues to be your weakness.

Are we inherently selfish?

Have you personally performed or witnessed a truly selfless act lately? I think those things are becoming a rarity in today's society. There is almost always a hidden motive behind every action taken by every member of society. One of the better examples can be found in Corporate America. When a company makes a contribution to a particular cause, it is usually doing so to boost it's image in the eyes of the public. When a politician kisses a baby, s/he is doing the same thing.

We should not lose sight of the fact that humans are inherently selfish, and we should remain skeptical to avoid undesirable consequences. It sounds like a negative view of society and life in general, but it doesn't have to be. How can we take this selfishness into account and improve our ability to compromise and establish mutually beneficial goals?

There's a lot of selfishness in U.S. healthcare right now, and it's being exacerbated by the selfishness in U.S. politics. Can we get back on track by more actively listening to opposing views and looking for common solutions? I think we can, but we need to start soon or we're going to end up with solutions that do more harm than good.

Don't be afraid to question the motives of others, or even your own motives. A certain level of selfishness is ok, but there is a point where it can inhibit real progress. You will never be a "good" person if you only look out for yourself. Keep an open mind and consider how your words and actions impact others. If you do that, then you can truly be a productive member of society.