Healthcare and Society

The most important thing I've learned

2010-04-21T06:18:00.002-04:00

As strange as it might sound, the most important piece of information I've ever learned is the fact that humans can cause their brain to rewire every day. I'll let you decide how to use that information, but I've used it to greatly enhance my life!

Comparison of bailouts

2010-03-15T06:45:00.003-04:00

Did you ever stop to think that the government bailout of a corporation has similarities to the welfare system? Each is designed to provide money to those in trouble: one for companies and the other for individuals. The question is: Are the paths by which individuals get in financial trouble different from the paths a corporation takes? I think you could find good and bad reasons to bailout an individual, just the same as you could with a company.

Bailing out the banks after they took on excessive risk and made horrible mistakes probably didn't allow them to learn the painful lessons they needed to learn. The same could be said of the welfare system. Many individuals make poor choices (or no choices at all) and cannot provide for themselves. There appears to be a growing portion of the population that has no problem using the government as a safety net, when making better choices would have made that unnecessary. It goes as far back as grade school. When a child does not put in effort in school, which then leads to him or her being a chronic user of the welfare system, is that an effective use of limited public funds?

Reality check

2010-03-09T06:15:00.003-05:00

There is a large portion of the people that voted for Barack Obama who are now finding that he cannot provide a better life for them. He skated into office by giving people the impression that he could rescue them from dispair. Hopefully, they are now realizing that only they can take charge of their own life and make a better future for themselves.

There is no substitute for personal responsibility!

Something to watch out for

2010-02-23T19:04:00.003-05:00

I've felt for a very long time, that our society is in too much of a hurry. However, I'm starting to see it show up in more disturbing ways. In the past, it was just the annoyingly aggressive drivers weaving in and out of traffic. Now I'm seeing something much worse, although less dangerous: typos in printed media as well as respected electronic media sites. It seems that speed has completely overtaken quality to the point of doing away with the proofreading step. Wow!

Why are we not talking about the dangers of being in such a hurry? Quality of life is taking a nosedive as we continue to obsess about the destination at the expense of the journey. The market for hypertension meds should continue to grow in the coming years. Chill out people! I can promise you that you are subjecting yourself to significant regret in your later years.

What society really needs?

2010-02-07T08:18:00.003-05:00

One of the best things we could do for our society right now is to declare a one year moratorium on new technology. This rapid-fire rat race of ours is robbing us of our lives. Is faster really better? Just how fast do we want to get through life? We have become so hurried as a society that we run the risk of reaching the end of our lives only to look back and wonder where they went.

The crazy snowstorm here in the Northeast has slowed the rat race to a crawl, and it's amazing! It allows more time for reflection and time to regain perspective. This relaxed state is when the body undergoes healing and the immune system is at peak performance. If more people understood that, I wonder if they would be in the same hurry to go nowhere.

The good and bad in society

2010-01-31T09:03:00.003-05:00

A great example of the good and bad in our society. A coward or cowards that are not worthy of sharing our oxygen beat a defenseless terrier to near death and threw it in a city garbage can. A young girl hears the dogs cries and rescues it. The dog is now on the road to recovery.

It brought a tear to my eye to see the local animal shelter director bring the dog out to meet the little girl at her school's awards ceremony. Very cool!

Teen pregnancy should be a top target of reform

2010-01-26T19:11:00.004-05:00

No healthcare reform can be considered complete without getting this under control. The cost of teen pregnancy to our society is astronomical, not only because of the direct healthcare costs, but also because most teens are ill-equipped to be parents. Unless you know a teen that got pregnant, I can assure you that you have no idea how dreadful the average teen is at parenting a child. Working for an OB/GYN group has enlightened me to that unfortunate reality.

If the teen got pregnant, the chances are very good that she does not have good boundaries in her life and is not emotionally solid. Those are traits that are passed on to children in nearly all cases. Because nearly all physical illness begins as an emotional issue, I think you can see a major reason why healthcare costs are rising so fast.

The similarities between healthcare and gov't

2010-01-22T21:21:00.002-05:00

The U.S. government and the U.S. healthcare system have a lot in common. Both have gotten too big to manage and each is fraught with greed and waste. However, the most disturbing trait they share is the fact that neither is particularly good at addressing real problems.

Instead of looking for the underlying causes of things like bank failures and poverty, our government breaks out the pen and drafts legislation or regulation. Those are very blunt instruments and show a lack of willingness to confront things like greed and social irresponsibility directly.

Our healthcare system is fueled by people with health problems, but those problems rarely get dealt with directly. Instead, the focus is on managing symptoms. This is precisely why Big Pharma is so, well, BIG. Pills do not address problems like neglectful parents or loveless marriages. They attack the physical symptoms that arise from those underlying emotional toxins.

Why are we so afraid to confront our shortcomings? I guess it's probably political suicide for a senator to tell a constituent he is a bad parent or a selfish schmuck. It's too uncomfortable for many physicians to tell a patient she is obese and needs to deal with it ASAP.

I'm still waiting for the "change we need." Unfortunately, it's not going to come from Washington. It can only come from the people.

The future never comes

2010-01-21T19:12:00.002-05:00

I have resolved to live not in the past or future, but in the present. I suspect that I am in the minority in this crazy world. Stop and smell the roses, folks! For God's sake, stop hurrying and worrying through life. When we all reach our death beds, I think we will find that faster is not all it was cracked up to be.

Jessie and Al: Silent?

2010-01-18T06:23:00.003-05:00

Has anyone heard from Rev. Jessie Jackson or Al Sharpton regarding the Harry Reid bumble? I expected them to be all over the place calling for him to resign. Oh, wait, Reid is a Democrat. I forgot that politics trumps life.

JFK, where are you?

2010-01-18T06:13:00.002-05:00

Then: "Ask not what your country can do for you, ask what you can do for your country."

Now: "Why isn't the government finding me a job?" "I think healthcare should be free." "Me, me, me at the expense of all of you, you, you!"

The change we need!!

2010-01-10T12:18:00.001-05:00

Having read his book Free to Love, Free to Heal, I consider Dr. David Simon to be one of the most important people on Earth today. Do yourself a favor and check out this interview, then buy the book.

The inadequcy of Western medicine

2009-12-19T10:28:00.004-05:00

Not only does Western medicine focus more on treating problems than preventing them, but I would argue that it doesn't even focus on problems at all. It focuses on symptoms instead of employing patience and persistence to uncover the real problems.

Examples of things that should be considered symptoms, not problems:

Obesity
Depression
Dissociative disorders

And possibly even:

Cancer
Heart disease

Let's look at one of them as an example. Obesity, when treated as a problem, leads to such "cures" as fad diets and a overall focus simply on nutrition and physical activity. To truly address obesity, we should look at and address the underlying cause of it, which might be unmet needs for love or career satisfaction.

We need to dig deeper if we want to fix what ails us. Western medicine falls well short of that, but there is a general lack of acceptance of alternative therapies like meditation. I don't see Congress picking up on that any time soon, but hopefully others will.

Who are you?

2009-12-15T21:52:00.000-05:00

Are you one who:

is content with just getting by in life, while taking from and giving back to society in equal amounts?
is so selfish and focused on your own pursuits, that in the final analysis you be viewed more as a liablility than an asset to the world?
has decided that there is more to life than money and stuff, and who is in search of deeper meaning, with a desire to make a contribution to something bigger?

There's a lot of #2 in today's society, if you know what I mean. I don't know about you, but I certainly don't plan on lying on my death bed questioning whether I made a difference in the world.

Are you ready to rewire?

2009-12-12T19:17:00.004-05:00

The next thing you think, the next action you take, will either create a new possibility for you, or it will repeat the past.

- Deepak Chopra from Reinventing the Body, Resurrecting the Soul

Obesity is not a problem

2009-12-11T21:32:00.003-05:00

There are a lot of community-based obesity initiatives underway around the country. My guess is that most, if not all, of them are focusing on environmental and public policy angles. I think that's great, and those are the only two areas in which a large number of people can be reached at one time. Unfortunately, that approach will fall short of reversing the obesity trends in the U.S.

You see, the problem is much deeper than that. It actually deeper than nutrition and exercise. Most of it originates in that funny looking organ in your head. No one wants to be obese. Add to that, the fact that most people already understand that you have to take in less calories than you expend if you want to lose weight. Based on those facts, how can people possibly be obese? For many, food is a source of reward and satisfaction. For someone not getting sufficient rewards from other sources such as career and relationships, food is probably playing a disproportionate role in his/her reward profile. The only good news about that is, at least it's not drugs playing that part.

Obesity is not a problem. It is a symptom of other problems lying beneath the surface. Until we recognize that as a society, we will not make sustainable progress. My goal is to take what groups like the CDC have already done in terms of environmental and policy focus, and add to that a focus on the underlying causes of obesity. This could be an interesting journey. First stop is a conference call next week with a senior scientist from the CDC.

The political chess piece that is Medicare

2009-10-22T06:13:00.000-04:00

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

2009-10-20T06:48:00.005-04:00

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!

2009-10-20T06:26:00.003-04:00

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

Capitalism

2009-10-17T07:45:00.006-04:00

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

2009-10-16T06:28:00.003-04:00

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

2009-10-15T06:24:00.002-04:00

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

2009-10-12T06:04:00.003-04:00

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

2009-10-10T05:56:00.006-04:00

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

2009-10-07T06:22:00.002-04:00

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?

2009-10-05T07:35:00.000-04:00

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.

The Washington answer to over-testing (I talked about it a long time ago)

2009-10-02T06:09:00.005-04:00

The Senate Finance health reform bill includes a provision that allows for Medicare reimbursement cuts for those physicians who order large numbers of diagnostic tests in relation to their peers. Supposedly, there are mechanisms that allow for the calculation to be risk adjusted based on the profile of the physician's patient panel.

As expected, physicians are up in arms about it. They are calling it rationing and an intrusion into the doctor-patient relationship. I happen to like the idea and I was talking about it long before Senator Baucus added it to his bill. I just don't know of another way to curb over-testing. It's such a difficult problem to address, mainly because it has so many different causes. Those include: defensive medicine, profit motives, patient pressures, physicians not spending enough time with patients and lack of adherence to evidence-based guidelines, to name a few.

It's hard to assess the validity of physician concern that a measure like this will discourage physicians from seeing the sicker patients. For me, it's a tough sell for a physician to say that s/he is consistently seeing sicker patients than his/her peers. Even if that is the case though, it can be taken into account to some extent through proper risk adjusting. AND, physicians can bill for higher level office visit codes when they treat sicker patients. That can more than make up for any reimbursement decline if it truly is significantly skewed.

Docs - You need to give a little. Healthcare reform doesn't mean reforming every stakeholder group except physicians. That's how many of you are acting. This measure will not cause you undue harm and, if it benefits the system as a whole, it will have benefits for you as well.

Another NL East Crown!

2009-09-30T22:13:00.002-04:00

How 'bout them Fightin' Phils!! National League East Champs for the third straight year!!!

Quote of the Day

2009-09-30T06:55:00.003-04:00

There is no connection between food and health. People are fed by a food industry which pays no attention to health and they're healed by a health industry which pays no attention to food.

- Wendell Berry

Being healthy: It's just common sense

2009-09-29T06:15:00.003-04:00

Here are some good common sense tips to reduce stress. I call them common sense because they are hardly revolutionary. However, many people these days have gotten so tied up by the rat race and generally hectic lifestyles, that many of these things are lost on them. If only people (including myself) realized just how easy it is to be healthy. It's a lot more about common sense and a lot less about rocket science.

My favorite one of these tips is learning to live in the present. It's my favorite and yet the one I struggle most with. I often find myself worrying about what I have to do by the end of the week, next month, etc. It adds stress to my life that I don't need. I'm making a conscious effort to live with what experts call "mindfulness", or paying more attention to the here and now.

We all have room for improvement in terms of leading healthy lifestyles. We tend to be a nation of procrastinators, but health is not something we should be putting off. Unhealthy lifestyles are the main reason healthcare costs so much in this country!

Healthcare reform: A summary of discussions UPDATED

2009-09-29T06:13:00.002-04:00

Ok, there are no updates because nothing has changed.

A summary of healthcare reform discussions to date:

The citizens want the freedom to get sick whenever they want with no worries about how the resulting care will be paid for.
Republicans want to keep the system as is. In fact, they would prefer that the system would become more costly because we all know that the GOP exists solely to make the wealthy wealthier. They could care less if people die in the streets as long as the above happens. They would, however, prefer that those dying not come from the ranks of the wealthy.
Democrats want job security for themselves. The more responsibility given to government, the better they feel about themselves and their chances for getting re-elected. They believe getting sick and running up costs is a right we should ALL be able to enjoy. Their ultimate goal is for every American (except for Nancy Pelosi and a few other non-poor Dems) to have the same take home pay.
Physicians just want to be left alone. How can a non-physician tell them what to do? They have $200,000 in med school debt that proves they are smarter than the average bear. They want tort reform because the more tests they have to order, the later they get home at night.
Insurance companies have done no wrong. They have good ideas on how every other stakeholder group can be reformed. If they have to concede on anything, they will allow the government to give them more business by mandating coverage for all. That's a lot to ask of them, but they are being patriotic.
The major media outlets are excited about reform, particularly its more controversial aspects. After all, divisiveness is a profit center for them. They fully intend to do everything they can to be sure that reform chugs along. Reporting on angry old men and very sick people dying because of lack or insurance coverage = RATINGS. Reporting on people working together in healthy and happy ways = BOR-ING.

We all lead busy lives, so I hope this summary helps you keep up with this very important topic. It will allow you to fulfil your civic duty of complaining about the performance of government and yelling at your neighbor if he has a different view.

Time to restructure the United States government?

2009-09-28T07:09:00.000-04:00

How do we change our government/political system to minimize the mindset of members Congress that their entire term is nothing but a re-election campaign? That is one of the most important questions that should be on the minds of all Americans. I'm sure you can agree, whether you are Republican or Democrat, that our Congress is rather ineffective and certainly very inefficient. The tough decisions rarely get made, and when they do the solution is watered down.

I couldn't imagine having thousands of people who know very little about me hold the fate of my job in their hands. If I were a U.S. Representative, I might spend more time telling people what they want to hear and closely following polls than I would spend on digging in and developing real solutions. I'll bet you would do the same.

This makes me question whether it's the people or the system. Is our two-party system and our political infrastructure holding us back? The system was probably effective back when there were only 5 million people in the entire country, and when the general public was much more aware of their civic duty. Today, there are more than 300 million, and most are "too busy" to pay attention. Instead, they react to soundbites and superficiality to form their opinions.

It's time we modernize the system to meet the needs of the 21st century. Everything else changes almost daily, and yet our government is essentially the same as it was in the very beginning. I'm not sure where to begin with a resturcturing, but I wonder if it should start with an assessment of the value of a two-party system. Do the benefits outweigh the divisiveness it creates?

I don't have all the answers. I also don't have anything resembling a political science degree. What I do have is common sense and a general concern for the direction our country is heading. I hope people smarter than me will take up this cause and develop a system that works for us in today's crazy times.

Think about it!

2009-09-26T10:52:00.001-04:00

If a nation expects to be ignorant and free, in a state of civilization, it expects what never was and never will be.

- Thomas Jefferson

Things you shouldn't discuss at work:

2009-09-24T06:25:00.001-04:00

politics, religion and healthcare reform.

Random thought

2009-09-24T06:12:00.002-04:00

I was reading about how Republicans are pushing Senator Baucus pretty hard on the individual mandate issue. They are concerned that it is a loss of liberty. In a way, I guess it is. However, those same Congressmen should then be against the issue of removing pre-existing clauses from insurance contracts, because that can't happen without an individual mandate. If we did one without the other, I think we all know that there would be widespread abuse in the form of people not picking up insurance until they get sick.

Healthcare and society

2009-09-23T06:20:00.000-04:00

In this blog, I discuss two things I follow fairly closely: healthcare reform and societal issues in general. I work in the healthcare system as a medical group administrator, then I go home and continue thinking about healthcare. It has always been an interest of mine because, 1) it is essential to the functioning of society, and 2) it is very complex with a lot of moving parts.

The healthcare system will be "reformed" in President Obama's first term. However, the chances are remote that it will be as comprehensive as we need it to be. I'll be happy if we get 30% of what we need, but I won't be completely satisfied unless every cost driver is identified and addressed. Our government and political system is not set up to allow this to happen because politicians have a difficult time pissing off their constituents. Unfortunately, real reform would be less like a Cumbaya campfire scene and more like a long, heated, but constructive debate.

Real reform will also acknowledge that healthcare is merely a subset of society and its problems are no different than the problems faced by society as a whole. Greed, selfishness, indifference and myopic thinking are all over the place and they must be addressed, or all aspects of society will suffer. Some day, a prominent and intelligent person will show us how problems with education, poverty, racism and healthcare are all related in some way.

While Washington struggles with reform, I strongly urge you to take whatever steps you can to lead a healthy life and to encourage those around you to live healthy. In the end, that is the best way you can ensure that poor health does not ruin your life.

The Great Divide II

2009-09-22T06:15:00.002-04:00

I can't imagine anyone, other than the media, likes the level of divisiveness in our country at the moment. This guy has some answers to help minimize it.

I can't help but think that it is driven by two main forces at play: competitiveness and fear.

Competitiveness - Americans are winners and cowboys. We like to be on the winning team. Better yet, we like to be the MVP on the winning team. Many of us don't get the chance to win in our daily lives, so we try to obtain our victories through others. The two most popular are sports teams and, you guessed it, political parties. I can't tell you how many people I've encountered that have picked a party, but can't really speak intelligently about the underlying principles that have guided that party through time. That's kind of sad.

Fear - This one isn't as powerful or pervasive, but there's no doubt that nothing creates more fear than uncertainty. We are afraid of the future because we have no idea what's coming. The only way we can reduce uncertainty is to pick a side and hope that we at least come out victorious, regardless of whether the victory is good for the country.

Regardless of what's driving it, divisiveness is not good for the country. Progress is limited when two sides do not listen to each other. Under these circumstances, compromise is superficial at best. It's one thing for politicians to act in divisive ways, but it really becomes a problem when the citizens join in on a large scale.

Stop the presses and shut down the political spin machine for a moment. Let's talk about how we can move forward as a country, not as Republicans and Democrats. We are in danger of losing our "Greatest nation on Earth" status, but it's not too late.

That price of that can of Pepsi will soon be 12 cents higher

2009-09-21T19:37:00.003-04:00

Now this is news we can use. A tax on sugary beverages is just what the doctor ordered, and the soft drink companies are pretty worried right now. Even if a tax on Coke and Pepsi doesn't curb consumption, it will raise billions to fund health initiatives. However, studies show that consumption most definitely goes down when price goes up.

When I read the reaction of the beverage industry, I want to vomit. These people just won't admit that their products are contributing to the obesity epidemic. Their defense is that we shouldn't tax "groceries". Well friends, I don't think anyone is proposing that we tax apples or broccoli, so stop with the transparent tactics. The FDA got Big Tobacco to come clean about their products, now we need to take on Big Food.

I don't disagree that a large part of the responsibility for battling obesity falls on the individual, but food and beverage marketing is not making it any easier and it is certainly not creating an environment that is conducive to weight loss. The "we're just giving consumers what they want" defense is complete bull shit. Sorry for the language, but I get highly annoyed when some profit off the problems of others. If this legislation doesn't pass, then we have no one but shady politicians to blame.

Where do you fall on the societal continuum?

2009-09-20T10:22:00.004-04:00

Whose responsibility is it to ensure that our society stays on the right path? I would argue that, with each passing year, more and more eyes look to government, whether it be federal, state or local when problems arise. We look to this small group of elected citizens to bail us out no matter the cause or size of the problem. It seems that we feel the best way to solve problems is through legislation or regulation. Would it not make more sense to have every citizen make small contributions (not $$) to the greater good? It seems to me that millions of people working together with a common vision can have far greater success than a couple hundred Congressmen tasked with "solving" hundreds of problems at once.

I question whether the time will ever come in which we all step back and realize what we are doing to our society and to our country. Greed is so pervasive that it's becoming hard to recognize. It's almost expected these days. Selfishness is no longer discouraged or looked down upon. We are simply becoming numb to our transgressions in a world where we are bombarded by stimuli of all kinds, leaving us constantly thirsting for more.

The local newspaper website includes forums for the community to engage in all kinds of conversations. Many of the conversations become quickly dominated by whining and complaining. On a couple of occasions, I have attempted to get discussions started about how we can improve our local community to allow it to become a vibrant place we can all be proud of. I am no longer surprised when these posts generate no interest. The reason is because the problems of the community and the world are someone else's problems. If they continue long enough, they become the government's problems.

I hope everyone reading this will look in the proverbial mirror and ask themselves what role they are currently playing in society and whether more can be done. There is a continuum that we all fall on. At one side are those that cause problems and harm society. The other end includes those that devote large amounts of time to solving societal problems they themselves did not create. I imagine if we graphed it, it would resemble a bell-shaped curve with most of us falling in the indifferent middle.

So my question is this: What are you doing to make society better for all? Are you going to sit back and watch greed and selfishness rule the day, or are you going to dedicate at least a small amount of your time to making a real difference. While I have never died before, I am confortable stating that you will die happier and with more dignity if you know that you added to society as opposed to taking away from it.

The need for speed

2009-09-18T06:17:00.002-04:00

What's the rush? Do you ever find yourself in a hurry for no good reason? Do you notice those around you speeding about with an apparent sense of urgency, particularly on the roads?

I fear that patience, deliberation and depth of thought are being replaced by an increasingly perceived need that we need to have things RIGHT NOW. Fast food opened the door to this mentality. Now, even fast food isn't always fast enough.

The question we should all be asking ourselves is: How is this rushing around affecting our quality of life? It's allowing us to experience more things, but are we really experiencing anything? If you find yourself asking, "Where did the day go?", there might be a problem. It's good to be busy, but was it a productive busy or were you just bombarded with useless transactions that added no value to your life or the lives of anyone around you?

I predict that the most successful people in the 21st century will be those that can tune out the thousands of daily distractions and concentrate on adding real value to society. My guess is that you won't find them spending much time on Twitter!

Everyone's covered and we know who's stroking the checks. Now what?

2009-09-17T06:20:00.004-04:00

Ok, so I'm underwhelmed by the Baucus proposal. As with everyone else, he's worried about covering everyone and how to finance care. It is very light on cost cutting or even cost containment. Washington needs a wake up call. Insurance company profits are a very small cost driver in the grand scheme. Covering everyone is a worthwhile goal, and contrary to reports from the left, everyone would like to see that become a reality. Unfortunately, no one is talking about the fact that it will be easier to cover everyone if we first start tackling the cost issues. After all, it is those cost issues that are the reason the uninsured total has risen to the level it's at now.

Everyone wants to be a hero in Washington. Obama wants to be seen as the president that finally tackled healthcare reform. He knows full well that he won't "tackle" it unless he proposes watered down legislation that doesn't piss off too many constituents. That's the Washington Way.

I can't voice too much opposition to what's out there for fear that Jimmy Carter might call me a racist. After all, if you aren't siding with Obama on this, it must be because he's part African-American. Also, if I voice opposition it will be because I don't want ANY reform. It's the Liberal Way or the highway, or so it seems.

Ask me what reform looks like and I'll show you something that directly addresses the major cost drivers. Many system stakeholders won't like it, but the good ones will benefit in the end because it will make the whole stronger than the sum of the parts. I'm still waiting on the call from President Obama...

Big people, little brains

2009-09-13T11:38:00.006-04:00

One of the biggest challenges our society faces in reversing our disturbing obesity trends is the need to make a case compelling enough to promote action on the part of an increasingly indifferent population. In other words, we need to create a powerful message in order to reach a society that requires a more and more salient message to capture our already bombarded attention. It's not sufficient to simply say obesity makes you unhealthy.

Maybe messages like this will help. When you tell someone that obesity leads to diabetes and heart disease, they might not completely make the connection to the point that they change their deeply ingrained ways. That's because those conditions have traditionally affected a small percentage of the population and many do not understand the poor quality of life (or death) that they cause. However, mentioning that obesity shrinks the brain should raise some eyebrows. An excerpt from the short article:

For the study, the researchers examined brain images of 94 people in their 70s who had taken part in an earlier research that investigated cardiovascular health and cognition. Among the participants, no one had dementia or other forms of cognitive impairments. The participants were monitored for five years, and any of them who developed symptoms of cognitive impairment were not included in the study.

Compared with the brain tissue of people in the normal weight group, the brain tissue of those who were considered clinically obese was 8 percent less, while those considered overweight was 4 percent less.

Those are not insignificant numbers by any stretch of the imagination!

Essentially, if you are obese, you can count on the quality of the latter part of your life being rather poor. This isn't like procrastinating on that book report in school. Every day that goes by in which you do not take care of yourself makes getting back on track that much more difficult. I tend to believe that most of this is cumulative, meaning the later you start improving your lifestyle, the more damage that is already building.

The speech that will change everything

2009-09-10T06:08:00.003-04:00

Ok, it probably won't change everything. Check that, it won't change too much. Wait, I think it was just more of the same.

I really want to believe that Obama means what he says. I truly hope that he wants to work together on healthcare reform with all that want to work with him. In the end, all of the people in that chamber last night were politicians. His speech did not make this issue any less political, and for that reason it was at least a mild disappointment. Obviously Bonehead Wilson's remark was absurd, as was Pelosi's arrogance that is quite evident in her smirks each time the President speaks to Congress.

I am amazed that more people aren't getting tired of this. I suppose that speaks to the seriousness of the issue AND to our love of a good fight here in America. Watching the speech constituted my weekly dose of politics. Now I must go back to actually moving real healthcare reform along by working on improving the health of my local community. I think this country is lucky to have the thousands of people out there working on local initiatives despite the embarrassing behavior coming out of Washington.

"Back off", said the cardiologist

2009-09-09T08:14:00.000-04:00

A cardiologist discusses the 10 things he hates about reform in this WaPo article. I'll let you guess what/who he doesn't think needs reformed in the system (hint: his occupation). Seriously though, these articles by stakeholders such as insurance company execs and specialist physicians are getting old. Call it turf protecting, diversionary tactics, selfishness, or anything else but helpful or socially responsible.

Is obesity contagious?

2009-09-08T06:04:00.004-04:00

Is obesity contagious? This article reinforces the idea that obesity has a social side. In the featured study, children tend to eat more when they are dining with their overweight friends than with their normal weight friends. When you think about it, that makes sense. Some disturbing stats:

Really, an "obesity bug"? In 2007, Harvard researcher Nicholas Christakis and his colleagues analyzed 32 years' worth of data from an interconnected social network of 12,000 adults and found that a person's chances of becoming obese increased 37% if a spouse had become obese, 40% if a sibling had and 57% if a friend had.

But by far the most disturbing point in the article:

Socializing with overweight people can change what we perceive as the norm; it raises our tolerance for obesity both in others and in ourselves.

I've made that point before as well. The longer we allow the obesity epidemic to spread, the more difficult it will be to stop. With two-thirds of the population being overweight or obese, it is already becoming the norm in some areas. That gives people less reason to maintain a healthy weight because the social pressure is lessening. Go to Manhattan and nearly everyone you see appears to be a healthy weight. Go to West Virginia, and well, not so much.

This is why I bring this topic up so much. There are a few forces at play that will bring down our society if we continue to let them. Obesity and greed are the two most powerful that come to mind. My suggestion would be that we dedicate a lot of resources to stopping their spread ASAP.

Change education to change society

2009-09-06T13:21:00.003-04:00

I have a lot of respect for educators. Their role in society cannot be overstated. With that said, I think we need to take a fresh look at the approach we're taking to educate our children. There is too much focus on cognitive intelligence, and not enough on emotional intelligence and practical life skills.

History class has a role in education, but I think too much time is spent looking back and not enough time looking forward. It would make perfect sense to replace one required History class each year with a Future class. Instead of looking back, the focus would be on teaching kids planning skills and the value of developing a vision for the future. Too many people in society do not take the time to consider the potential consequences of their actions or inactions.

We must also revamp health class. Not enough focus is being placed on health and it is starting to take its toll on society. Children must be taught, at a very early age, the importance of healthy lifestyles. Much of that should come from parents, but it must be supplemented with courses in school that go beyond the knowledge a parent can provide.

Revamping our educational system can be the solution to a lot of the very difficult societal issues we face today. Things such as health, income disparity and poverty, racial intolerance, and many other difficult problems would no doubt be positively impacted by any thoughtful education reform.

Thought of the day

2009-09-06T09:39:00.002-04:00

True heroism is remarkably sober, very undramatic. It is not the urge to surpass others at whatever cost, but the urge to serve others at whatever cost.

- Arthur Ashe

What is Keith Olbermann's role in our society?

2009-09-03T08:26:00.000-04:00

Every so often, I like to watch Countdown with Keith Olbermann. I do so because they say that you should always consider views that are different from your own. Each time I watch, I can't help but question what his role is in this world. He is one of the poster boys of divisive, partisan thinking. He would have been sent back to ESPN a long time ago if we as a society did not eat up his nonsense like a tasty plate of hot wings.

Sure, his show is just entertainment and not meant in any way to inform the public. However, what is job security to Mr. Keith Olbermann just so happens to be very destructive in today's society. As much as any time in history, we need to be coming together as a nation to tackle some very difficult problems and keep this big ship on course. Unfortunately, endless partisan rants are more conducive to everyone picking a corner and then coming out swinging.

I ask that all of you reading this consider the source on everything you watch and read. Never lose sight of the fact that there are two sides to every story and neither is ever 100% correct. We are Americans before we are Republicans and Democrats. We will never reach our potential as a nation or as individuals if we continue this one-dimensional thinking.

Mr. Keith Olbermann and all other divisive TV personalities on the Left and Right - In the final analysis, it will be clear to all just how useless you are in your roles as a TV personalities. Enjoy the millions you are making from it while we struggle as a nation to tackle very difficult problems. I can only hope that some day you see the light and use your massive exposure to do something constructive.

Not so proper nutrition counseling

2009-09-03T06:14:00.001-04:00

Proper nutrition is key to good health. This, on the other hand, is not so proper.

Happy Birthday to Me

2009-09-01T07:34:00.000-04:00

Holy Schnikeys! This blog is officially one year old today. I am no longer a puppy. I am just another mutt. That was a very fast twelve months! A lot has happened in that time, but essentially nothing has happened in terms of healthcare reform, except political wrangling.

When I first started posting, I was a starry-eyed rookie who thought he could make a difference in the healthcare reform arena. I had great intentions and a lot of energy and ideas. Unfortunately my title is not Senator or Representative, so my potential impact has been severely limited. I now see just how ridiculous my first post was, and how our massive government and political system tends to have numbing effects. I guess that's why the best minds do not make their way into government.

One fundamental belief that I will always have is the fact that real reform requires contributions from all of us. We cannot change the system unless we change ourselves. Our healthcare problems are nothing more than a manifestation of deeper societal issues. Greed, selfishness and myopic thinking are not unique to healthcare. Sooner or later we need to see the big picture and the trendlines of our existence. The problems in the financial services and healthcare sectors should be gigantic red flags for all of us. These are not someone else's problems and it's not someone else's responsibility to fix them. These are OUR problems and as they say, "If you are not part of the solution, you are part of the problem."

With that said, I am actively working with an insurance company to improve the physician/insurer relationship. I am also part of a very large effort to address the obesity epidemic in my community. Most importantly, I am taking much better care of myself. What are you doing to contribute to reform?

The Weight of the Nation

2009-09-01T06:35:00.001-04:00

I've watched nearly every minute of CDC's Weight of the Nation (July 27-29), via the on demand webcast. It's great to see a lot of good things going on in the health realm, while politicians continue to spin their wheels and get nowhere with healthcare reform.

Several presenters at the conference mentioned the fact that obesity initiatives need to happen at the local level. A couple presenters also stated that effective politics happens at the local level. With those two things in mind, I have to believe that healthcare reform must happen at the local level. Anything happening at the federal level is, by default, gigantic and difficult to manage. Health and healthcare are too vital and too complex to be addressed with blunt instruments. We need programs that are targeted to specific communities and specific medical conditions.

With that said, I couldn't help but notice that many of the presenters at the Weight of the Nation conference were overweight or obese themselves. That illustrates just how pervasive the condition has become, and how it can affect people of all backgrounds. As former U.S. Surgeon General Dr. Richard Carmona said in one of the videos from a previous post here, obesity is the terror within. It is a societal evolution that will limit progress and reduce aggregate life expectancy.

While Congress continues to make a mockery of our American political system, I hope all of you will consider joining the fight against the obesity epidemic.

Another meaningless healthcare bloviation

2009-08-31T06:28:00.006-04:00

When you read this WSJ article, you really see how healthcare reform is in the hands of the people who are least qualified to tackle it: politicians and uninformed individual citizens. It becomes clear at the very beginning of the article with the quote of a concerned citizen: "Don't do anything. Nothing is better than something."

This is politics at its finest. Propose some inadequate legislation, let the constituents complain, water it down, and water it down some more. Does anyone else see huge flaws in the process?

I think a lot of this, at least on the part of the citizenry, is just fear of the unknown. Even those that read the 1,000 page proposals out there cannot have the foggiest idea of what the end result is going to look like. When ideology governs the process, it becomes more difficult to see a defined path. That's why I choose the pragmatic route every time.

Change is not usually well received, particularly by the older generations. Many Medicare beneficiaries follow the principle of, "If it ain't broke, don't fix it." Unfortunately, many of them don't know that it IS broken. We've got major cost problems and when people become insulated from them they are less compelled to demand action, particularly the right action. Add to this cloudy soup the fact that when the media gets their hands on a juicy story, it only makes an issue more polarizing thanks to distortion, bias and just plain sloppiness.

Sooner or later, we need the smoke to clear and we need to initiate meaningful non-partisan reform. I didn't say bi-partisan, because that just leads to concessions, backroom deals and inadequate legislation. We need to diagnose and treat just like physicians do (at least the ones that aren't driven by profit or outdated clinical protocols). We know there are problems and we know problems need solutions. We know some are more qualified than others to develop solutions to certain problems. Let's be pragmatic and get the right people on the bus, and in the right seats. From there, we will most definitely see the results we need.

Definition of the day

2009-08-29T13:59:00.005-04:00

Government, noun - Pronunciation: gə-vər(n)-mənt

1. Collection of men and women, elected by men and women, whose sole purpose is to protect man and woman from themselves and their fellow man and woman
2. Elected body that cleans up the messes of the electorate

Fatostatins: Cause for celebration?

2009-08-27T20:18:00.006-04:00

This sounds like good news, but there are a lot of things wrong with it. We are just starting to see increased awareness of the need for wellness initiatives and their ability to make a dent in the obesity epidemic and the prevalence of chronic conditions. The last thing we need is to plant it in people's heads that they do not need to worry about obesity because drugs can "fix" it. We already have bariatric surgery as a perceived "backstop" for those that do not want to be bothered with leading healthy lifestyles. Now we could have fatostatins.

It's the dreaded "easy way out" and it is a pervasive attitude in our society. It does nothing but drive up healthcare costs. What could be done naturally through lifestyle efforts now will require prescription drugs. I don't know what the ultimate cost of this drug will be if it makes it to market, but I do know that higher demand leads to higher costs. I think we can all figure out where it goes from there.

This is just another sad reminder of the role that patients play in driving up healthcare costs. Insurance companies, Big Pharma, physicians and hospitals get most of the bad press, but patients are equal partners in this crisis we're facing. For healthcare reform to be complete, it must include a wake up call for the U.S. population. I can't find the exact stats, but the average Medicare beneficiary sees 6 or more physicians per year, has two chronic conditions and is on 10+ meds. That does not sound like a textbook definition of "golden years" to me. A connection must be drawn between unhealthy lifestyles at 35 and the resulting health problems at 65. I suppose I won't be happy until I see a prominent person successfully drive that point home.

Is it all worth it?

2009-08-26T20:01:00.005-04:00

Have we gotten too analytical in our society? Is it possible that a lot of problems in our society stem from the fact that we have gotten too complex, all in the name of "progress"? Do we need 24/7 news? How about cell phones and iPods? Is our quality of life better because of those things?

Do we need to live past 85? Is 20+ years of being a senior citizen worth it? Is it better to go out with a bang as opposed to going out while barely being able to walk, jumping from physician to physician, on 15 medications?

These are just some questions that each of us should be asking ourselves. In healthcare, it used to be the family doc and the patient. Now there are 12 other people involved. Did you ever try comparing TV today with TV from 25+ years ago? The editing today is absurd. Has our attention span gotten so short that we lose interest if we're not seeing a new frame every half second?

At 37, I'm probably too young to be questioning things like this. I should just be trying to live my life, make as much money as I can, and have the biggest house and UV possible. (For those that don't know, a UV is an SUV without the sportiness. If you own an Expedition, Suburban, or any other hulkin machine like that, I hate to break the news to you, but they ain't very sporty.) For some reason I've decided that I need to see the forest, instead of just the trees. I feel that way despite the fact that 37 is the new 17.

My point is, consider how your actions or inactions affect others and the world around you. Try to savor the simpler pleasures every once in a while. You can't take your Lincoln Navigator or your 4 1/2 baths to your grave with you. Your parents' generation was not a bunch of underachievers just because they moved at a slightly slower pace. They probably "got it" more than we ever will.

Signs of deep societal problems - the sequel

2009-08-21T21:37:00.002-04:00

The press is still talking about Michael Jackson's death
Old men make fools of themselves in healthcare town hall meetings when a) they know very little about the subject and b) they should be enjoying their golden years
Google has increased the speed of its searches with its Caffeine update; now it only takes 0.32 seconds to get the results from that "Michael Jackson's estate" search; it used to take a whopping 0.41 seconds (that's like watching grass grow these days)
The entire country has become mesmerized by the health insurance reform follies coming out of Washington. In the meantime, the uninsured aren't becoming any more insured and the country is not getting any thinner.
Michael Vick is allowed to see the light of day....and make millions again
McDonald's felt the need to develop a Third Pounder

The original Signs.

How about a do over?

2009-08-21T06:45:00.003-04:00

The other day, I was talking with a VP from one of the health insurers that our medical group has a contract with. While our organizations cannot be seen as completely free from blame in this high cost system, I think neither of our organizations fall into the "bad apples" category that gives rise to all the soundbites.

He and I continue to be amazed at the direction healthcare reform is taking. Politics has a funny way of making complex issues, well, more complex. Both of us are clear thinkers and we know that our stakeholder groups have contributed to the problem and need to be part of the solution. Insurance companies and providers played a big part in driving up costs, but that doesn't change the fact that they are more qualified to develop solutions.

If this was done right from the start, President Obama would have created a task force made up of "good apples" from each stakeholder group. He would have given them the task of identifying the cost drivers and quality issues, and developing solutions that directly address them. To keep things productive and on track, he could have added a moderator to the group such as Secretary Sebellius or some other high end official.

Had he done this, he would have kept Congress out of it and would have eliminated most of the opportunity for political nothingness. Because Washington would not have been developing the solutions, elected officials would not have to take as much heat during the development phase from lobbyists or angry old men. It would also have allowed the patient stakeholder group, and its role in our high cost system, to be better addressed.

There's still time. I would be willing to sit at that table if lunch is provided. We could still scrap this current train wreck and start over. I doubt we will, but I'm just sayin'...

The rat race in your brain

2009-08-20T06:47:00.000-04:00

If you had to pick one way to live, would you choose:

a. Dwelling on the past
b. Worrying about the future
c. Living in the moment

I would expect your answer to be c, but I'll bet you spend more time on a and b. Stopping and smelling the roses is a lost art in a world where everyone is in a hurry to go nowhere.

Folks, it's not an urban legend. Some people actually use blow up dolls so they can access the HOV lane on the highway. I personally witnessed it for the first time yesterday when I was driving through Staten Island. How sad do things have to get for someone to resort to such desperation? That guy needs to rediscover his soul, very soon!

In any event, take time away from your personal rat race and relax every once in awhile. Enjoy the journey for a change, because the destination is really nothing special. Reading this short article might give you some much needed tips.

Comparing Medicare and private insurers

2009-08-18T07:07:00.000-04:00

I would love to find an unbiased, non-partisan source that compares administrative costs between Medicare and private insurers. The odds of that existing are slim to none, but I can dream.

Seriously though, it would be nice to have something like that. Back when single-payer and a public option were on the table, proponents often quoted statistics showing that private insurance admin costs were multiples of what Medicare experiences. As a concerned citizen, I think that is an important topic worth pursuing further.

Is there a such thing as an unbiased source these days? I'm starting to think the answer to that is no. In today's society, even the news is a show.

Healthcare: The "engine" of our economy

2009-08-17T06:21:00.003-04:00

There is so much wrong with this WSJ opinion piece, I'm almost afraid to comment on it for fear that I might be punked. An excerpt:

"Viewed from every angle, our results support the proposition that both historical and future increases in the health spending share are desirable. . . . [W]e believe it likely that maximizing social welfare in the United States will require the development of institutions that are consistent with spending 30 percent or more of GDP on health by the middle of the century."

I agree that money spent on healthcare doesn't just evaporate because it is paid to other Americans and, therefore stays in the economy. However money spent on healthcare is money that cannot be spent on other, more productive uses. It is an inefficient use of limited resources, which means it must be addressed.

The healthcare sector has been one of the few bright spots in the employment picture over the last couple years. That is something that cannot be ignored. With that said, waste should not create jobs. Nor should preventable disease. Productive and informed consumption should create demand and jobs.

I work in the healthcare sector and I will admit that the job security has been nice over the years. However, I am also an American citizen paying high insurance premiums and high taxes to subsidize others' healthcare. I have not yet heard a valid argument for the status quo in healthcare. All the "noise" out there is making reform more difficult than it needs to be.

I have some questions for you

2009-08-15T09:27:00.002-04:00

I don't mean to burst your bubble, but chances are you are not seeing the big picture if you are allowing the major media outlets to capture your attention in the healthcare reform debate. I'll bet you like drama. After all, you are a red-blooded American. The town hall meetings feature angry people acting like idiots, and you can't help but feel better about yourself when you see them. Grown men and women have been reduced to acting like children over something they know very little about.

Enjoy the show folks. Enjoy the arguments and enjoy the divisiveness. You are witnessing a death of time like nothing you have seen in your lifetime. Make sure you win your arguments and make sure you come out on top. You need to go to sleep each night with a sense of accomplishment.

You would never dip to the level of watching Jerry Springer, yet you watch this healthcare battle royale with all of its twists and turns. You find pleasure in career politicians telling you how their opponents have it all wrong. You stand by them because you voted for them, and you made the right decision. Right?

I strongly suggest that you assess just how important that Republican or Democrat label is to you. Where has it taken you in life? Have you made more of yourself as a result of picking a side? Can you identify with Nancy Pelosi or John Boehner? Do you see them as real people representing the things most important to you?

Let me break this down in the most fundamental way I can. You need to lead a lifestyle that does not put you at risk for illness or disease, because those things will take away from your ability to make the most of the time you have on this big round rock. When you do become ill - and you will no matter how diligent you are in your pursuit of health - you need to seek the care of someone who truly has your best interests at heart. When I was younger, my family doc was a true caregiver, the pediatrician, the OB/GYN, the endocrinologist, etc. for my family. I have four brothers and two sisters, each of whom is rather healthy by today's standards. We were raised on a single income of a hard working machine shop worker, with a mother who stayed at home and made sure that we developed into productive citizens that have never lost sight of the most important things in life. Were we just lucky? Did we have a secret that others weren't privy to? I highly doubt it. We simply kept our focus on what was right and stayed away from what was wrong in life.

Our healthcare system is not what it was when I was 8, nor is any aspect of society. Are any of you truly happy with the path our society is on? If you are, I envy you because you have a tolerance I cannot currently understand. If you are not, then what are you doing about it?

Should we focus on politics or should we focus on this?

2009-08-14T20:14:00.003-04:00

While most of America is caught up in politicizing healthcare, an important group of citizens in my communiity, of which I am proud to be a part, is embarking on a journey to reverse the obesity trends that have reached epidemic levels. This video helps paint the picture of the formidable foe we are up against.

Are you due for a rebalance?

2009-08-13T06:19:00.005-04:00

WARNING: This post does not mention any Congressional health insurance bills, the heated town hall meetings, or anything juicy about reform that could raise blood pressures or add to the troubling divisiveness in this country. If that's what you're looking for today, go visit Matt Holt's blog (or stop back here tomorrow)

I spent the first half of my life trying to become as intelligent as I could. Now I'm seeing the importance of wisdom, and it's ability to complement cognitive intelligence to make a complete person. I am now constantly on the lookout for sources of wisdom. After all, with wisdom comes perspective. When one has perspective and can define the context of a situation, he or she is less likely to go off on an unproductive or irrelevant tangent. All the intelligence in the world will not help you if you're "barking up the wrong tree."

Ladies and gentlemen, I cannot stress to you enough the importance of leading a balanced life. There is no better way to get or remain healthy than to obtain the rewards our brain needs from a variety of sources. As I've said before, problems arise when an individual's reward portfolio gets out of balance. Over-reliance on career as a reward source can lead to a poor family life, which could strengthen career as a reward source leading to a very unhealthy life. It could also lead to obesity if the individual turns to food to make up for the loss of happiness from the family dynamic.

That is just one possible scenario, but I think it illustrates the problem and the solution. As Dr. David Kessler mentions in The End of Overeating, one of the most effective ways to tackle obesity is to find substitute rewards to lessen the value of food as a reward source. I think that can be carried over to any situation in which a reward source starts to dominate.

Bottom line: Take a step back from your crazy life from time to time and assess where you are getting your rewards. Like a 401k retirement account, you have to rebalance your portfolio from time to time. The earlier you catch problems, the easier they are to remedy.

The CBO take on prevention/wellness

2009-08-12T06:51:00.003-04:00

This article that features CBO Director Doug Elmendorf's views on prevention and wellness made me think of an important thing we need to consider. Essentially what he's saying is that there is no data to support the fact that prevention and/or wellness save money in the long run. However, we need to think about where Mr. Elmendorf is getting his data: from the past.

Isn't the goal here to reform the system so that the future works better than the past? I'll even give him the benefit of the doubt that prevention does not deliver an ROI in financial terms. However to suggest that wellness programs, if designed properly to promote individual engagement, won't save money is counter intuitive to me. It's basically a backward-looking, pessimistic view of things. We always need to look to the past for guidance, but we can't use it as an argument to do nothing.

I respect the CBO's position and its role in the grand scheme, but we need to look at what they say in the proper context. It is not their role to make things better. They, as accountants, can only look at the past and tell us what hasn't worked previously.

Winning is everything, healthcare is secondary

2009-08-12T05:56:00.000-04:00

So what's all the fuss about? Is it about healthcare anymore? As each day passes, it seems to be more about "My side's better than yours. Na na na na na na." Let's face it, as Americans we want to win. We want to be associated with the winning team. I guess it makes us feel better about ourselves. It has rekindled the flame of divisiveness in this country that will haunt us for quite some time unless someone or something (God forbid) happens to bring us together.

If the goal is to drive down costs, then...

2009-08-11T06:32:00.000-04:00

Now THIS is healthcare reform that will drive down costs. It's not health insurance reform. It doesn't change who or how healthcare is financed. It goes right to the heart of the matter: our high costs.

If much of the illness and disease in this country is preventable, why not focus on preventing it? When you do so, you eliminate a lot of the healthcare transactions that everyone is focusing on these days. It would reduce the demand for specialists, and it would reduce the number of claims sent to those greedy, inefficient insurance companies.

Some very important excerpts:

If we just cover bypass surgery, angioplasty, stents, and other interventions that are dangerous, invasive, expensive, and largely ineffective on 48 million more people, then costs are likely to increase significantly at a time when resources are limited. As a result, painful choices are being discussed -- rationing, raising taxes, and/or increasing the deficit -- and these are threatening the public acceptance and thus the viability of health reform.

Meaningful health reform needs to provide incentives for physicians and other health professionals to teach their patients healthy ways of living rather than reimbursing primarily drugs and surgical interventions. If lifestyle interventions proven to reverse as well as prevent many chronic diseases are reimbursed along with other strategies for improving cost-effectiveness across the U.S. health care system, then it may be possible to provide universal coverage at significantly lower cost without making painful choices, and the only side-effects are good ones.

And:

These choices are especially clear in cardiology as an example of this larger issue. Large-scale studies have shown that changing lifestyle could prevent at least 90-95% of all heart disease. Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.

In contrast, many people are surprised to learn that bypass surgery and angioplasty don't work very well. In 2006, for example, according to the American Heart Association, 1.3 million angioplasties and stents were performed at an average cost of $48,399 each, or more than $60 billion. In addition, 448,000 coronary bypass operations were performed at a cost of $99,743 each, or more than $44 billion -- i.e., more than $100 billion for these two operations.

Actually, the whole article is great. I'm not against looking for ways to cover everyone. I am just confused as to why the points mentioned in this article aren't getting at least equal press as healthcare.

Public healthcare coverage (with strings attached)

2009-08-10T06:23:00.001-04:00

The world will always need trash collectors and other lower paying occupations, just as it will always need physicians, CEOs, etc. For this reason, we will always need some system of ensuring that the lower paid individuals have access to healthcare. We have a long way to go to make healthcare affordable, but I doubt we will ever make it affordable for everyone without stifling innovation, sacrificing quality, and/or giving up on our quest to extend lifespans to 150 years +.

I support any effort that serves to enroll those currently eligible for Medicaid that are not taking advantage of it. I also support the expansion of Medicaid through the increasing of income limits by 20% or so, and through subsidies for those above the income limits that need to buy in to Medicaid because they cannot afford private coverage. Finally, I believe Medicaid should be available to anyone losing coverage through employment, because it's hard to argue that tying health coverage to employment has a downside.

However, in order to get me and people like me to support these things, I think it's only fair that some very reasonable strings be attached. Handouts are not why our system of government was created and it's not how we've achieved so much as a nation in such a short period of history. Those receiving public health coverage must demonstrate that they are taking all possible steps to lead healthy lifestyles so they do not needlessly increase demand for services they aren't paying for. Participation in prevention and wellness programs should not be optional. Failure to follow through on treatment plans of their healthcare providers should lead to penalties of some sort. Etc. etc.

I guess what I'm getting at is, both sides of the ideological divide need to give a little. We need to help those that need help, but in return they must take care of themselves and not place unnecessary strain on the wallets of those that do not require public assistance. I hardly think that's too much to ask. If there's a free lunch out there, we all know that many more will do what they can to get it.

(By the way, those on the rolls of private health plans should also be taking steps to avoid unnecessarily running up costs for others in the same risk pool. Now more than ever, I think it is clear that leading a healthy life is almost as much a social responsibility as it is a personal one.)

Let the imagining continue

2009-08-07T22:31:00.004-04:00

Imagine a world where:

strangers go out of their way to help each other
no animals are mistreated
you can leave the doors to your house unlocked when you aren't home
people ask "How are you doing?" because they actually care about your answer
music brings people together
hedge funds and stock options don't exist
healthcare is a good value because it's about the patient
families eat dinner together and have engaging conversation
no one runs a red light
everyone has access to good education, and takes advantage of it
AIDS and cancer have met their match
people whistle while they work
a two-party political system is no longer necessary, because we realize that we can all "party" together
the journey is more important than the destination
those in the depths of poverty are given the hope they need to prosper
speed takes a back seat to things like quality and depth
the news is dominated by stories of triumph and accomplishment
people like Ann Coulter and Keith Olbermann are irrelevant
everyone employs a buy and hold investment strategy
other points of view are welcomed

Never stop imagining, and take every opportunity to promote a better world.

France battles high healthcare costs

2009-08-07T06:20:00.003-04:00

Phrases like "The grass in not always greener" and "Be careful what you wish for" came to mind when I read this WSJ article about cost problems with universal healthcare in France. Those that know me can easily see that I get annoyed when our healthcare system is compared to that of France. We are simply not France in many cultural aspects. If France had our independent, diverse, "cowboy", gluttonous culture, they would be spending a lot more on healthcare than they currently are.

Well, now we're hearing that costs are on the rise over there and they are looking for ways to cut. The concept of copays has even been introduced. If we are going to redesign the U.S. healthcare system, we need to design it to fit our culture. Modeling it after the French or Dutch systems ignores a lot of cultural differences, and is quite naive.

Here's an interesting excerpt:

France claims it long ago achieved much of what today's U.S. health-care overhaul is seeking: It covers everyone, and provides what supporters say is high-quality care. But soaring costs are pushing the system into crisis. The result: As Congress fights over whether America should be more like France, the French government is trying to borrow U.S. tactics.

In recent months, France imposed American-style "co-pays" on patients to try to throttle back prescription-drug costs and forced state hospitals to crack down on expenses. "A hospital doesn't need to be money-losing to provide good-quality treatment," President Nicolas Sarkozy thundered in a recent speech to doctors.

Imagine

2009-08-07T05:58:00.002-04:00

Imagine endless energy throughout the day
Imagine complete concentration and unwavering focus
Imagine looking forward to waking up in the morning
Imagine getting enjoyment from smelling the roses and taking big deep breaths of fresh air
Imagine playing in the yard for hours with your kids, or the dog, or the neighbors
Imagine ending each day, tired from the days work and play, leading to a restful nights sleep
Imagine not being a slave to cigarettes, or food, or work, or gambling

There is a better life out there for you if you change your focus to what's really important. Short-term happiness that comes from food or money will continue to leave you wanting. Strive for long-term happiness that comes from good health and a productive life. Put more focus on the journey than the destination.

If you don't believe me, ask John.

Visit msnbc.com for Breaking News, World News, and News about the Economy

Reform Town Hall Meeting

2009-08-06T06:32:00.000-04:00

I attended a health insurance reform town hall meeting in my local area last night. It was hosted by two Pennsylvania congressmen (both Democrats if you're keeping score). Things got very heated in the audience with a lot of standing up and finger-pointing and just plain rudeness. Yes, things like manners and class were not in attendance.

I literally walked out at the end with a tear in my eye, in utter shock of what I had just witnessed. Nearly the entire focus of both the congressmen and the audience was on how we can reform health insurance in this country. Yes, those evil insurance companies don't know what they're in for!

If our means for addressing the healthcare crisis in the United States is solely to change how healthcare is financed, we are all in for the biggest disappointment in decades. I am well aware that other provisions in the 1,000+ page bill address non-insurance related issues. However, there is no question that a disproportionate amount of resources and energy is going to be devoted to changing the financing scheme.

If Washington said it wanted to reform insurance companies because pre-existing conditions and medical underwriting are bad, I'm ok with that. However, don't make a case that reforming healthcare financing will make healthcare more affordable. As someone who lives this crisis on a daily basis, I can tell you that will barely make a dent in it.

Nuthin' up his sleeve

2009-08-05T21:17:00.005-04:00

I posted this link as a comment in my last post, but I thought it was important enough to display more prominently. If you have been paying attention to healthcare (read: health insurance) reform discussions coming out of Washington over the few months or so, I think you will understand why I find this chilling!

John Conyers' take:

Thanks to Bob Vineyard.

Who would win a fight between Karen Ignagni and Nancy Pelosi?

2009-08-05T06:36:00.001-04:00

I don't have a lot of tolerance for turf-protecting industry insiders and their lobbyists, but Karen Ignagni of AHIP has said some things that I agree with in this Washington Post piece.

"For a country that's trying to accomplish what it has failed to do for a century, namely pass health-care reform, the same old Washington politics of 'find an enemy and go to war' is a major step back," Karen Ignagni, president of America's Health Insurance Plans, said in a conference call with reporters.

She's right about this. Too many people have ganged up on health insurers, many painting them as the only suspects in our healthcare crimes. This provides too much of a distraction from responsible reform, which states that ALL stakeholders have played a role and need to give up something.

And:

Without mentioning President Obama by name, she tapped into allegations that Obama supports the public option as a way to put the nation on a path to a government-run single-payer system. If that is the intent, it should be discussed openly, she said.

Sure, her motives are to keep her member organizations relevant. However, it's hard to argue with the point that a public option is merely a stepping stone to single-payer. If that's the case, put single-payer on the table and see if can stand on its own. Don't play sleazy politics to win over the American public.

Finally:

"The current health-care system gives insurance companies all the power," Kathleen Sebelius, secretary of health and human services, said in an op-ed piece in Tuesday's Washington Post. "They get to pick and choose who gets a policy. They can deny coverage because of a preexisting condition. They can offer coverage only at exorbitant rates -- or offer coverage so thin that it's no coverage at all," Sebelius wrote.

Let me be very clear. "Picking and choosing", denying for pre-existing conditions, and offering coverage at "exorbitant rates" are not against the law. If anyone reading this woke up tomorrow as the CEO of Aetna or Cigna, you would do EXACTLY THOSE THINGS. Why? Not because you want to "screw the little guy". Your job is to make your company profitable. If any of you don't like some of those tactics, you need to direct your anger at 1) lawmakers for not addressing these things sooner with legislation, and 2) capitalism for causing profits to be the sole motivator in American business. Why go to the huge expense of creating a government option when you can simply create legislation/regulation to prevent the tactics you don't like? The answer, again, is because the gov't option is a stepping stone to Medicaid for All.

I don't know why I'm defending insurance companies because I have more reason to be angry with them than most. They give healthcare providers fits on a daily basis with their absurd policies and administrative hoops. However, they are not the only "villains" as that shallow, sound-bite speaking Nancy Pelosi calls them in the WaPo article. In fact, I have as much anger for my fellow Americans that disregard their health as I do for insurance companies.

Stop with the sound-bites and the smoke and mirrors politics. Let's have an honest discussion about what is driving up our costs, and then let's come up with solutions to address it.

Fee for service vs. bundled payments based on outcomes

2009-08-04T06:29:00.001-04:00

There has been much talk lately about how the fee for service payment model must die. The argument is that it encourages healthcare providers and hospitals to increase volume, without concern for the effectiveness of the additional services. The alternative at the other end of the spectrum is a system of bundled payments, in which all entities involved in the treatment of a patient share a lump sum payment based on the outcome of the treatment.

In theory both models are probably equally effective at achieving the desired result, because each has its positive and negative aspects:

Fee for service: Advantages = properly adjusts for the unique circumstances of each individual condition, rewards providers for taking on higher risk patients; Disadvantages = encourages overtreatment for providers who let greed creep into their practice, doesn't take the outcome into account

Bundled based on outcome: Advantages = Encourages healthcare entities to work together, encourages a focus on the outcome more so than the income; Disadvantages = does not adjust well for risk and individual patient circumstances, punishes providers when patients are non-compliant, outcomes are not always easily definable, how do you divide the payment?

I propose that we adopt something that maximizes the good points of each model, while minimizing the bad points. How about Outcome-Based Fee for Service (OBFFS)? Under that model, providers and hospitals would continue to be reimbursed on a fee for service basis. However, the rates for each unit of service would be determined based on cost and quality data from the previous measurement period.

Under OBFFS, outcomes matter and efficiency is rewarded. Ordering that test to make a couple extra bucks sounds less appealing when your entire fee schedule is at risk. The downside is that it relies on historical data to determine current and future payments, although I don't find that too problematic.

Pure fee for service would work in a perfect world, but not all providers are, well, pure. Bundled payments create administrative issues that are unnecessary. Let's meet in the middle for a change. Pay providers and hospitals for the work they do, but hold them accountable for the quality and cost efficiency of that work. Sounds like a no-brainer to me.

Let the poor and the sick die in the streets

2009-08-03T18:04:00.004-04:00

Chuck Schumer: "Our bill may not be effective, but we will have healthcare reform no matter whether it gets bipartisan support or not." Ok he didn't actually say that, but that is essentially the word from the House at this point. Because you know, if Republicans do not accept what has been presented, it must mean that they want to see the poor and the sick die or at least be shipped off to Gitmo. It couldn't possibly mean that they are pushing for better legislation. Don't you just love politics?

Here's Schumer's real quote:
"If we cannot produce a bipartisan solution by then, you have to wonder if the Republicans would ever being willing to agree to anything," Mr. Schumer said.

It may sound like just semantics to some, but we are a republic, we are not a democracy. The Founding Fathers did not intend for the majority to take over. Having one party in control of the legislative and executive branches at the same time is dangerous. It was dangerous when the GOP had it and it is dangerous now. As a citizen, I'm looking for real (not pretend) healthcare reform. I want it to be effective, but I don't want it delayed for another 3-5 years. Is that not a reasonable request? Is that not why I'm paying $20,000+ per year in taxes?

What would Ben Franklin think?

2009-08-02T09:42:00.005-04:00

Typically, I try to keep my distance from guys like O'Reilly, Hannity, and Limbaugh because they take Conservatism too far to the extremes. The Conservative message is a solid one when it is not distorted by divisive prominent figures. However, I have to agree with Mr. O'Reilly on this one. An excerpt:

That puts Obama squarely against Benjamin Franklin who said, "When the people find they can vote themselves money, that will herald the end of the republic." Dr. Franklin realized that politicians who attempted to buy votes by promising rich entitlements could not look out for the good of the entire country. Thus, an inevitable decline would occur.

No one wants people to die in the streets, but using the government as a backstop to enable underachievement is not good for the future of this nation. Government programs are for those that cannot make it on their own due to circumstances beyond their control. These programs also provide a temporary means for helping those that have fallen on hard times and are trying to get back on their feet. That is where the moral obligation must end. Period!

Unfortunately, the obligation does not end there. Over time, our entitlement programs have become so much more than that. Could we say with a straight face that all people currently living on tax dollars have done all they can to provide for themselves? If we hit the rewind button on their lives, would we see them working hard throughout their school days to prepare themselves for the real world? Would we see their parents spending time with them and supporting them in those all important early years?

I worked very hard throughout school, sometimes at the expense of my own popularity. I now work very hard in my career because I know nothing different. That needs to mean something in our society. Achievement needs to be rewarded and underachievement needs to be more vigorously discouraged. Swelling entitlement programs inhibit our ability to achieve that. I have yet to see anyone successfully challenge that notion, mainly because it is essentially indisputable.

Helping people gets politicians elected, even if those people were not worthy candidates of help. That's Politics 101. Unfortunately, it's difficult to draw the line between the worthy and the not so worthy. As a result, our entitlement programs grow. Anyone that opposes that is labeled a cold-hearted defender of the rich.

As long as our current political system is allowed to function as is, this will be our reality. I don't see it bringing our nation completely to its knees in our lifetimes, but it would be difficult to argue that it's not holding us back.

Because healthcare isn't all I think about

2009-07-30T06:42:00.000-04:00

The "Books" column by Adrienne Carter in the August 3rd issue of BusinessWeek looks at A Colossal Failure of Common Sense: The Inside Story of the Collapse of Lehman Brothers by Lawrence McDonald, a former Lehman VP. It sounds like the book has interesting insight into the failure of such a storied institution, especially since it comes from an insider. An excerpt from the BW review:

As part of their (McDonald and others) research, they flew to California to spy on sub-prime brokers, the hyper-tanned "body builders" pushing dubious home loans. First stop on their mission was the headquarters of New Century, with its parking lot crammed with Ferraris and Lotuses. The "meatheads" told the undercover Lehman traders: "Our job is to sell the mortgage policies," and after that "it's someone else's problem."

That doesn't scream of social responsibility, and okay, I'm going to tie this back to healthcare. The decline in the level of social responsibility in this country is concerning, and it happens to have spilled over into the healthcare system. The group of docs that bought an MRI machine and then started scanning patients left and right probably would have been greedy regardless of the profession they chose. The patient and attorney that sued the gynecologist for $10,000,000 in punitive damages (in addition to actual damages) for the accidental perforation of the uterus during surgery, probably could have cared less about the "lesson" they taught to the doc just trying to do his job. That wad of cash buys a nice lifestyle.

We can't legislate or regulate our way to greater social responsibility (sorry Democrats) just like we can't legislate or regulate our way to greater personal responsibility (sorry GOP). So what do we do? I remember parts of a story about a legendary professional baseball manager (I think it was Connie Mack) who was faced with a team that was struggling, mainly because they simply couldn't get along. He decided to create a common enemy for them, in an effort to bring them together. That common enemy was him, although I can't remember what he did to achieve that. The point is, they had something that they could agree on, and that was the fact that they didn't like their manager. They pulled things together and the wins started flowing.

What or who is our common enemy? What is going to bring together a society with our unprecedented diversity and selfishness? I'm not sure, but I hope it's not something too drastic (ex. an invasion by the Chinese in 2020). I guess it's too much to ask of everyday Americans to take a step back from their daily lives and seek out opportunities to give toward the greater good, but then again maybe it's not.

No one said this would be easy

2009-07-29T06:30:00.000-04:00

The higher the obesity rate climbs, the more it becomes perceived as the norm to have a BMI above 30. While I don't want the obese to be ostracized, we cannot allow it to become the norm to be obese. I see a lot of signs out there that make me realize just how difficult it will be to beat this epidemic. Here are a couple I saw in the span of 5 minutes when watching TV recently:

IHOP commercial - Their slogan is "Come hungry, leave happy". It is a common tactic in food industry marketing to capitalize on the fact that many see food as a significant source of happiness. It is an important subject covered in The End of Overeating by Dr. David Kessler. We need to increase awareness in our society that food (or any one source, for that matter) should not dominate an individual's reward profile. Too much of anything (including sex) is a bad thing.
There is a new reality show coming out in which a large number of plus size women vie for the love of one man, who happens to like plus size women. In the advertisement for the show, one of the contestants makes a comment about how she's happy he likes "normal" women. I have family members, friends, neighbors and co-workers who are obese, and I do not look down on them for that. However, it is dangerous to label obesity as the "norm".

In the case of obesity, the trend is not our friend. There is no more formidable foe than cultural inertia. Cultures and societies do not turn on a dime. However, this is a challenge that we cannot back down from.

Healthcare "reform" makes me laugh (read: cry)

2009-07-28T18:37:00.001-04:00

At what point does this stuff get old? At what point do citizens wake up and say we're tired of this? Politicians put a bill out there. Those the stand to lose raise hell. Politicians water down the bill. Others raise concerns that the bill it too watered down. No one agrees. We get either nothing or ineffective legislation.

Seriously, this is embarrassing. The level of social responsibility in this country is at all time lows. Everyone is looking out for themselves and politicians, the only ones that can make laws, are powerless because of their own personal agendas. Is this really how the greatest country on Earth should go down? Our financial and healthcare sector woes should be a wake up call, but unfortunately no one is phased. Is money really that important? Has the destination (ex. money) completely surpassed the journey (ex. life) as the focus of us as humans? Have we finally reached a point where being "driven" or "independent" is no longer an asset to society?

I apologize. It's been a long day in the healthcare realm!

Winners and losers in healthcare reform

2009-07-28T06:01:00.002-04:00

A listing of the potential winners and losers in healthcare reform. It seems pretty accurate to me.

Did you know?

2009-07-27T12:18:00.001-04:00

The United States is home to roughly 4.5% of the world's total population and 23% of the world's obese population.

Taking on "Big Food"

2009-07-26T18:15:00.001-04:00

The FDA took on Big Tobacco and changed the way the public views its products. Had the industry been allowed to continue unchecked, there's no telling where we'd be right now. Now it's time we take on Big Food. Obesity is the health problem of our time, and the food industry has shown little sympathy. After all, they are only giving us what we want. Right?

Wrong! They are giving us what we've become conditioned to believe we cannot live without. I highly doubt anyone wants to be obese. I can't imagine that an otherwise rational human being desires to have no control over his or her food urges. Unfortunately, an increasingly large percentage of the population in the U.S. has become conditioned to overeat. Even those that are trying to beat it find it next to impossible because food marketing is everywhere.

It's time that we shed a negative light on huge food portions. We must show just how disgusting food consisting of mutiple layers of fat and sugar and salt can be. If we are going to make a meaningful dent in our obesity epidemic, we have to force Big Food to play along. Ultimately, each individual must change the way s/he thinks about food. However, the chances for success on a large scale can increase substantially if we eliminate many of the cues out there that trigger urges.

I know it's hard for most of use to resist that huge mushroom and swiss burger with cheesy nachos, but we must understand that the rewards we get from eating it are fleeting, and often followed by regret. Let's beat this together. Let's take back our lives and learn what it truly means to live free. There is strength in numbers, and right now we need each other's support.

If anyone from the C-Suite at McDonalds, Burger King, Applebee's or Chili's ultimately reads this, I hope they understand that their business model will be under pressure in the near future. Choosing to play along could be a strong competitive advantage for them and will keep them from facing irrelevance.

The start of an obesity initiative

2009-07-25T08:17:00.004-04:00

As I prepare for a stakeholder meeting next week to discuss the structure for a community obesity initiative, I can't help but feel a little pressure. I feel the pressure because I have concerns that most of the nation underestimates the obesity problem, and I have made it my personal goal to change that.

The cost numbers should be an eye-opener for the medical community, elected officials, policy wonks, and the public. The cost of obesity has increased 80% in 5 years to over $300 billion. That alone should be enough to spur action, but it has been completely overshadowed by the concerns of covering the uninsured. And, I think the $300 billion is understated because we don't yet know all of the illness, disease and injury that can be tied to poor diet and inadequate physical activity.

With that said, what should a community obesity effort look like? I know what it shouldn't look like, and that's finger pointing and calling people lazy, irresponsible or lacking in willpower. We need to get to the bottom of why people become obese because I have yet to meet someone who has made a conscious decision to become obese.

The answer for many might be similar to other afflictions such as compulsive gambling, excessive career pursuits, addiction to pornography, etc. That's when it starts to become a deeper issue involving brain chemicals and the need to derive "rewards" to maintain a mental state by satisfying urges. The End of Overeating by Dr. David Kessler addresses that very well.

Another answer might involve improving environmental factors such as more sidewalks to support walking over driving or better access to supermarkets over fast food restaurants. For the younger crowd, it could mean more physical education and health classes in school curricula or more nutritious school lunches.

If anyone has comments on this topic I would love to hear from you. If you are obese or fear that you are headed in that direction, tell me what barriers you see to reversing the trend. If you feel that your community or environment in general is not conducive to promoting a healthier population, tell me about it. If your insurance plan does not provide coverage for nutrition counseling, drop me a line. If you're healthy but concerned for family members, friends, or the community at large, I'd love to hear your thoughts and ideas.

You can respond to this post or e-mail me at healthcare.solutions2008 at gmail dot com.

Ranking the healthcare cost drivers

2009-07-24T07:26:00.000-04:00

My last post alluded to a ranking of the top three healthcare system cost drivers. I have never really thought to rank them before, but I will put it out there. My top three winners, in order of magnitude, are:

1. Unhealthy lifestyles of the population
2. Over-utilization of services for reasons other than those caused by #1. These include profit motives, defensive medicine, lack of adherence or lack of evidence-based medicine, and patient pressures to order tests.
3. Administrative waste

Are those the correct three and are they in the right order? I challenge anyone to shoot me down on this one.

Administrative waste in healthcare

2009-07-24T06:13:00.000-04:00

I'm not kidding when I say that this article nearly brought a tear to my eye. Those of you not working in a healthcare administrator role might not be able to relate at the level I can, but as citizens of this country you will still have an appreciation for the issue.

The administrative side of healthcare includes absurd amounts of waste. No one can tell you that better than a healthcare administrator. By the way, that waste provides a certain level of job security for me, but my social responsibility tells me that waste must be eliminated for the greater good.

Every health insurer that we have a contract with has different policies and processes. It is mind-boggling, and every medical group and hospital needs to hire people just to navigate through the mess. Managed care took a turn for the worse over the years, which lead to waste that few can appreciate.

You'll hear a lot of people try to quantify the waste. Many of the estimates are probably overstated to make the case for single-payer. However if I had to rank the cost drivers, admistrative waste would definitely be in the top 3 along with service overutilization and unhealthy lifestyles of the population.

An 11th hour plea

2009-07-23T06:13:00.003-04:00

President Obama spoke about healthcare reform last night and I think most will agree that nothing new was put forth. So let's cut to the chase. Healthcare in America is expensive. It is expensive, not because insurance companies are driving up costs, but because everyone is driving up costs. Let me define everyone: Everyone = You + Me + Our doctors + Our hospitals + Our health insurers + Our government + Our drug companies + Our fellow Americans. (Further details of how each is playing a role are available upon request.)

Reform that does not identify what each of the above contributors has done to add to our high costs, and that does not identify what each can do to contribute to the solution, is not real reform. You don't rush reform through by the end of August, and probably not by the end of the year, and expect an adequate solution. Is something better than nothing? Of course, but is that where we're setting our bar? Did we achieve everything we achieved as a nation in the last 230+ years by setting a low bar. No, my fellow Americans, we did not.

As someone who believes that our civic duty goes beyond pulling a lever on a voting machine, I think it's time we re-establish the high bar that got us to where we are today. Let's get healthcare reform done, but let's get it done right. If we get it right, it will have profoundly positive effects on the future of our nation. I'm not an industry insider trying to prolong inevitable pain. I am an American that wants a real solution for a change.

Let's stop the presses and change course quickly and efficiently. We must ask our elected officials to 1) get the right people at the table, 2) set a few ground rules, and 3) use the power of the U.S. Government to implement whatever solutions are developed.

I want real healthcare reform. If you're ok with mediocre reform, that is your right. Just remember that your rights and freedoms were made possible because others before you did not settle for incremental solutions. They pushed for significant change with a passion that many cannot relate to today. How about we pull together like never before in our lifetime, and do something that we can be proud of? I can't imagine doing anything less.

Shiny Happy People

2009-07-22T18:01:00.000-04:00

"We are as happy as we decide to be." Abraham Lincoln

Is happiness a moral obligation?

HT: Execupundit

Do you ever wonder why healthcare costs so much?

2009-07-22T06:27:00.001-04:00

Call it bragging if you want, but I just found you the best example of turf protecting in healthcare that you will ever find. CNN very adeptly caught Apria Healthcare in an embarrassing, better yet disgusting, situation. In this example, they were charging Medicare $1,200 for a similar wheelchair to one they charged $350 for to a cash paying customer (CNN). Of course, their spokeswoman called it a "mistake". Wow, didn't see that coming!

Now for the turf protecting. Many think the answer to this problem is competitive bidding in the Medicare program. The American Association for Homecare, which represents the durable medical equipment industry, said that competitive bidding would "sacrifice care for seniors" and "reduce patient access to and choice for medical equipment." If I did not read the article and was asked to guess what that group would have said in response to this issue, I think I could have guessed it almost to the letter.

My question is, which slimeball politicians are preventing competitive bidding from becoming a reality by accepting $$ from AAH? I'm still confused as to why lobbying is even legal. Probably because legislating it out of existence would shut off a cash flow valve to politicians.

"Doing nothing is not an option"

2009-07-21T06:21:00.004-04:00

I'm finding myself getting sucked in to the politics of healthcare reform. When I first started blogging, I was a starry-eyed industry insider who thought we could fix our own problems. After all, we see the cost-drivers first hand on a daily basis. The problem is, I am part of the minority in the industry that wants to find and eliminate the waste, including the waste coming from my stakeholder group.

While I am normally pretty modest, I am very comfortable stating that I am more qualified to participate in the development of reform than Barack Obama or Max Baucus or Ted Kennedy. Unfortunately, the voice of my minority was not heard. The loudest voices from the industry were those trying to protect their turf and the status quo. If Congress and the Administration were smart, they would have done a better job of seeking me out instead of assuming that groups like AMA and AHIP represented the industry.

Now, it's full steam ahead because the only choices presented to us are 1) those coming from Washington, or 2) do nothing. The President's approach of "Doing nothing is no longer an option" is going to resonate well with the public. It's politics at its finest. Never mind the fact that the Washington solutions are scud missiles in a war where we need radar-guided precision missiles.

How would you handle a 21% cut to your paycheck?

2009-07-20T18:25:00.003-04:00

Imagine for a moment yourself in your career in your present position at your present organization. Next, imagine that you have just endured 8 years of little or no pay increases. Now imagine in the year ahead, your boss tells you that you might be faced with a pay decrease of 21%. All of this time, the cost of your groceries, utilities, gas, etc. is going up. You're probably not feeling too good about your career at the moment.

Why is that even an issue with the Medicare fee schedule? Why was the 21% cut for 2010 even introduced? Some physicians have already stopped taking Medicare based on the last 8 years of crap. What will happen if a cut like that goes through? Medicare rates are not what is driving our high cost healthcare system. Unfortunately, out of touch politicians seem to think they are. The 21% cut is now being used as a means to pay for healthcare "reform" coming out of Congress. Nevermind the fact that Medicare cuts only lead to cost shifting to private plans, who are left making up the difference.

We could be facing some ugly times if Congressional "reform" becomes the new Law of the Land. Unfortunately, it might be too late and we might be stuck with a government "solution."

Thought of the day

2009-07-17T06:47:00.003-04:00

I want to see everyone have health insurance coverage. There's no doubt that it's a worthy goal, and despite the media spin, I highly doubt that anyone out there would not want to see the day where everyone is covered.

With that said, we have to do it right. We can't just give access to tens of millions more people to a system that is not ready to handle the extra capacity. If the argument was presented as: "We have a shortage of primary care physicians and an inefficient system as a whole, so we think it is best to increase demand as quickly as possible", would you buy into it? I would think not, but that's exactly what has been presented to us, only it has been nicely wrapped in an ideological cover.

Each day, it becomes more clear that "reform" is going to be driven by politicians. That makes honest, hard-working citizens like myself less willing to chip in to the effort. These are sad times we live in, and there were a lot of people out there with outstanding ideas to attack our high costs. Unfortunately, in the political world, those who speak loudest win. And, those that spoke the loudest were the ideologically driven, and not the pragmatics.

When we still have problems 10 years from now because the main cost drivers were not addressed by government imposed reform, I won't say I told you so because that doesn't achieve anything. I'll just continue working hard and paying my taxes, and try my best to ignore the fact that those taxes are paying for shoddy work by our elected officials.

The numbers are in...

2009-07-16T06:03:00.000-04:00

Obesity is more of a cost driver than most realize. From 2001 to 2006, the number of obese people in the U.S. increased from 23.6% to 27.2%. The total number spent to treat obesity jumped 82% to $303 billion.

We can't gloss over this any longer for fear of offending anyone. This must be addressed now because it is only going to get worse. At the rate we're going, I predict we'll have obese supermodels by 2019.

As I've said before, we cannot just assume that every obese person is lazy or lacking willpower. It is far more complex than that. When it involves brain chemicals, you know it's going to be difficult to address. Our society and the medical community as a whole aren't exactly doing anything to prevent it either. That is going to change very soon and I am going to make every effort I can to enhance the effort.

Thought of the day

2009-07-15T06:22:00.004-04:00

I don't know if you've noticed, by I haven't been saying much about the healthcare reform proposals coming out of the Administration, Senate or House. It's mainly because I think mixing politics and healthcare is not a wise idea. None of the proposals fall under the category of real reform in my mind, because they don't directly address the cost drivers that are responsible for our high per capita costs. I also feel that it is counter intuitive to inject $1+ trillion into an already expensive system.

I'll leave it at that!

Thought of the day: PCPs as detectives

2009-07-15T05:45:00.000-04:00

I'd like to see the day when primary care physicians can be detectives again. I want them to diligently seek the culprit of an illness by spending whatever time with the patient is necessary to make that happen. They need time to ask the right questions, and allow the patient to do so as well. They need time to look at the whole picture, including looking at the patient's fingernails for clues if necessary.

To get to that point, I don't mind paying a PCP $100 for a service that used to pay $60. If it means avoiding $600 in costs from unnecessary tests, I think it's a good deal for the healthcare system.

Healthcare reform's new spokeswoman

2009-07-14T06:45:00.000-04:00

It's almost like she was doing an impression of me, only she's far more attractive and eloquent than I am!

After 300 posts, a summary of the healthcare reform conversation

2009-07-12T09:06:00.007-04:00

As I've now hit the 300 post milestone, let me summarize a few things:

We must identify and attack the real cost drivers head on if we're going to get anywhere with healthcare reform. Simply changing the financing scheme is not real reform.
Despite the greed that exists, the healthcare industry is more qualified to fix the system than Congress. The question is: How to we harness the intelligence while minimizing the greed?
All stakeholders in the system have played a role in driving up costs, and all must be prepared to give something up.
We must move toward a system in which healthcare consumers shop based on value (quality/cost). To make that possible, we need to better communicate information needed by consumers to do their "shopping". The forces of competition, when allowed to work the way they do in every other industry, are very powerful motivators.
Healthcare dollars must be reallocated from procedures to primary care in a substantial way. Why would that not be the first step in any reform effort?
Do not look to France or Germany for ideas on a new model because we are not French or German. There are more differences than there are similarities between the cultures.
There is not enough personal or social responsibility among the players in healthcare. Both issues must be given equal time. If one gets a disproportionate share of our attention, reform will fail.
The core drivers of our healthcare crisis are actually not unique to healthcare. Greed, selfishness, irresponsible behavior, laziness and myopic thinking can be found throughout society.
There is no better way to reduce healthcare costs than to avoid the need for healthcare in the first place. We would not be talking about this issue if everyone lead a healthy lifestyle. That is a pipe dream, so the conversation must continue.
Obesity is far more dangerous and a much more significant cost driver than the medical community or policy makers have lead us to believe up to this point. I think we will come to realize that it plays a role in far more health problems than we currently know. (I just read an article about the role it plays in H1N1. Scary stuff!)
Last, but certainly not least: Our healthcare system is already expensive enough. We absolutely positively should not inject another trillion or two into it. Throwing that much money at any problem is a sign that those trying to "fix" the system either: a) Do not know what the real cost drivers are, or b) are two lazy, cowardly, or unqualified to fix it.

The New Addictions

2009-07-08T19:50:00.003-04:00

Whether you read this article or not is obviously up to you, but let me tell you this: This is a subject that is very important, could potentially impact each and every one of us at some point, and does not receive near enough attention from the medical community or the media.

We all naturally seek rewards. Behaviors that trigger reward responses in the brain can turn to addictions if you're not careful. Whether it's sex, or drugs, or food, it can be dangerous. When one area of life is lacking (career, family, friends, etc.), we are most likely going to compensate by seeking a disproportionate amount of rewards from another area. I think everyone can see how there is a fine line and how that can quickly turn into a problem.

Please be mindful of this. Please strive for a balance in life and try to maintain a high level of self-awareness. A job loss or divorce could easily lead to a drug addiction or obesity if you do not regain a more healthy balance after a setback.

The fundamental problem with healthcare

2009-07-07T18:43:00.000-04:00

After much time spent reading about and experiencing the healthcare system as part of my career in medical group administration, I think I can now confidently boil down our healthcare problems to one fundamental problem. In the healthcare industry, the consumer does not have enough power. The bulk of the power lies with the producers, such as physicians, hospitals, and insurance companies. As a result, the competitive forces that drive every other market are simply not there. That's a pretty significant problem.

Why is this the case? There are probably a lot of reasons, but a couple come to mind right away. Treating illness has always been made out to be this complex science that can only be understood by doctors. Therefore, consumers never bothered to take the time to become educated about their health. The doctor-patient relationship has always been one in which the doctor assumed the responsibility for the patient's health and never empowered the consumer to share some of the load. To be fair, patients need to share some of the blame for this because the physician has no control over what the patient does when s/he leaves the office.

The second reason for the healthcare consumer's lack of power is the fact that we have put entities in the middle of the doctor-patient relationship which have significantly "muddied the water." Insurance companies have made it such that we are purchasing insurance, not healthcare. We have become more concerned about how good our health plan is than how good our doctor is. I think it's obvious why that is a problem. THEN, we have made it even more complex by having the employer shoulder the responsibility of choosing the health plan. It's gotten to the point where the patient is no longer the consumer, even though the patient is the reason that there is a healthcare system in the first place.

I know one thing for certain. Reform will not be effective unless it addresses the healthcare consumer's lack of power. Steps must be taken to empower the consumer to take care of his/her own health. We must make it possible to shop based on value, by making quality and cost more transparent. The consumer-driven concept is a great one, but it actually did more harm than good because it was rolled out before transparency was made possible. As a result, it made a significant dent in the move to empower the consumer because it caused people to lose faith in it. We should not abandon the concept of HSAs, etc. We should put it on the back burner and take care of some of the preliminary steps like increasing patient education and improving value communication.

When the consumer has more power, the healthcare industry will be able to properly function like every other industry. Ask GM how powerful the consumer is.

Thought of the day

2009-07-06T07:03:00.001-04:00

Businesses frequently make decisions about which projects to take on by conducting a significant amount of financial analysis. Many times, the analysis leads to the decision to obtain financing to fund future growth. My finance professors always told me that responsible leverage can be a very good thing. Banks, if they are acting prudently and responsibly, undergo their own financial analysis to determine whether lending money for a project is a good business decision. Often times, the ultimate agreement includes financial covenants that the borrower must abide by in order to avoid default.

Will this level of rigorous analysis be employed when deciding whether or not we pay $1+ trillion for healthcare reform? If so, would any of the plans offered by our lawmakers or the Obama Administration pass the test? Could borrowers (investors in Treasury instruments) impose covenants that the Government must abide by or risk calling of the loan?

Obviously, the processes employed in the business world will not be employed by Uncle Sam. The government has the power of taxation, which provides a good backing for any of its loans. Why else would the Chinese own so much of the outstanding Treasuries?

If our government is going to undertake a project of this magnitude, it should have to undergo an analysis by an independent, non-partisan group to determine if it can move forward. Our democracy must go beyond voting officials into office and then letting them have at it. A small group of individuals should not have the authority to spend trillions. Is that not common sense?

Real healthcare reform on the horizon?

2009-07-04T07:17:00.000-04:00

Now this is an example of real healthcare reform. Reallocating reimbursement from specialists to primary care physicians is long overdue. Radiologists and other owners of MRI and CT machines could take a beating if this goes through. I suppose it will be watered down until we get to the final product, but it is a step in the right direction.

I call it "real" reform because it is pragmatically addressing real cost drivers, as opposed to imposing ideology on reform. Paying primary care physicians more is a no-brainer, as is reducing rates for overused procedures. Of course, the American College of Radiologists is aggressively opposing the move. I suppose if a 30% hit to my income was looming, I'd be worried too. However, that doesn't change the fact that it is necessary for the system as a whole.