September 7th, 2009 by Happy Hospitalist in Better Health Network, Health Policy
No Comments »
The time has come to change the rules. As you know the current insurance market is unsustainable. Whether you’re talking about The Medicare National Bank or your Blue Cross, they are all doomed for failure. Why? Because they treat everyone (group plans) the same . And as a result, the incentive towards health has been lost.
What if it wasn’t like that? What if your cost of insurance was 1/10 as much? What if you only paid $1000 a year in insurance, and carried an income based high deductible health policy? What if you were required to take care of the oil changes while your insurance, an affordable insurance, was there to protect you from disaster. An insurance you bought in the open market.
Is all this possible in the current insurance market? Not even close. If you are lucky enough to be employed by a big corporation, you are lucky enough to have deep premium discounts and a large population to spread the risk. If you work for a small business or are a small businessman, you are just one major illness away from catastrophic premium increases. Should you or one of your employees get sick, you’re all screwed.
If three of Happy’s hospitalists suddenly became gravely ill with H1N1 and were left on the ventilator for weeks and accrued hundreds of thousands, perhaps millions of dollars of health care bills, the cost of my premiums would rise dramatically, as a consequence of the large risk in a small pool of people, Happy’s private hospitalist group. While big business is able to spread that risk over hundreds, sometimes thousands of employees, they too are finding that they can’t keep up with the cost of health care inflation.
Why? Why does it have to be so difficult? When people are put in control of their health care dollars, they have a skin in the game that can’t be appreciated by the third party insurance model. Few people realize that the $12,000 in premiums their employer is paying, on their behalf, is $12,000 that is coming out of their pocket.
Many liberals want to claim that middle class wages were stagnant during the Bush years. Hardly, when you account for the health care premiums their employers paid on their behalf, the numbers don’t look so bad. These are stealth wages, wages which might as well be cash in your pocket.
Unfortunately, the current rules of the land have created a completely irrational playing field. Why should my choices be limited to what my employer offers or what my state says is right for me? Why should I be straddled with massive rises in insurance premiums because three of Happy’s partners had an unlucky run in with a virus? It shouldn’t have to be that way.
That’s why I see market choice and responsibility as the way out of this fiscal disaster. If premiums have doubled in the last 10 years to $12,000, how many businesses big and small can afford $25,000 in ten more years? The answer is almost none. Obama’s proposals do nothing to address this factor. The solution is not more insurance. The solution is not Universal insurance. The solution is to change the rules of the game. Rules your government created. Rules which brought us where we are today. The current insurance model does not work because our insurance has become an inflated currency of trade. A currency which is not allowed to follow the rules of supply and demand. Look only to the expansion of health care jobs in the worst recession in over 50 years and ask yourself how that is possible. And ask yourself if that is sustainable.
I do not want to be paying $25,000 a year a decade from now. $25,000 a year for taking care of myself and doing what’s right for my body.
- Don’t smoke,
- Engage in 3 1/2 hours a week of exercise.
- Eat a diet high in fruits and vegetables and low in read meat
- Don’t become obese (BMI >30)
If you do these four lifestyle actions, your odds of falling ill with one of these top four life changing or life ending diseases is slashed by 80%. That is an amazing fact. To a major degree you have the ability to decide your destiny of health by the actions you choose.
That’s the insurance pool I want to be a part of. Read more »
*This blog post was originally published at A Happy Hospitalist*
September 1st, 2009 by Happy Hospitalist in Uncategorized
No Comments »
There appears to be some controversy brewing. The New York Times is reporting that the CDC may recommend just that in an effort to protect the boys against HIV as they become sexually active:
The topic is a delicate one that has already generated controversy, even though a formal draft of the proposed recommendations, due out from the Centers for Disease Control and Prevention by the end of the year, has yet to be released.
The American Academy of Pediatrics is currently neutral. As a result, many state Medicaid programs do not pay for the procedure. But it sounds like that may be changing, with a policy indicating circumcision has health benefits beyond HIV prevention.
Hundreds of commenters wrote into the New York Times today to complain about “child abuse” and “genital mutilation” and one “religious sect’s agenda of control” (i.e. Jews).
I don’t see what the big deal is. Everyone seems to be piercing and tattooing their bodies these days. What’s wrong with a little circumcision?
Perhaps you could mandate the same kind of prevention that schools do with their vaccination requirements. What do you think? Should all boys be circumcised?
*This blog post was originally published at A Happy Hospitalist*
August 22nd, 2009 by Happy Hospitalist in Better Health Network, Opinion
No Comments »
Boy if that statement doesn’t hit the nail on the head.
Talking to Cortese this week, I heard two themes that cut to the heart of the debate. First, he thinks Obama has made a mistake in moving toward the narrower goal of “health insurance reform” when what the country truly needs is health system reform. Imposing a mandate for universal insurance will only make things worse if we don’t change the process so that it becomes more efficient and less costly. The system we have is gradually bankrupting the country; expanding that system without changing the internal dynamics is folly.
Let me give you the truth of our current reality. We as a nation are headed for a devastating bankruptcy at the hands of our current health insurance model. A model that pays for everything (of substance) and passes on those costs to current and future generations.
Obama’s push for health insurance reform will do nothing to save America’s model that pays for everything (of substance) and passes on those costs to current and future generations.
The argument, as I see it, is not that a lack of insurance is bankrupting our country, but rather the model of insurance itself. Getting more of the same won’t make health care less expensive, it will make it more expensive. And ultimately, if we keep paying for things the way we pay for things now, there won’t be any money left for anyone.
Some people argue that spending money now with universal access will create a healthier and cheaper to insure America. To that, all I have to say is look to the history of the last 50 years. Medicare did not make health care cheaper. It has, for the last 50 years lead to a devastating economic death spiral. FREE=MORE is bankrupting our country. The model of insurance is bankrupting our country. The storm on the horizon will be the death of America, unless something changes, and soon.
I think the whole current nonsense debate is a travesty both from the Republicans and the Democrats. Opponents and proponents are both focusing on the wrong issues at hand. The issue is cost. If you can’t control costs, nothing else matters.
Doctors every where should embrace a system of delivery that encourages value and quality. The ones that will fight you tooth and nail are the ones that are ripping off America with their pretend care. The bad ones will suffer as will.
The physicians most expensive procedure is the pen. If doctors can’t lead the way toward cost effective care, then they should get out of the way while others do. Because if we as physicians don’t do something, we will have spent all the Treasury’s money for all future generations. And we will have no one to blame but ourselves.
Thanks again to Are You A Doctor for pointing me to this article.
*This blog post was originally published at A Happy Hospitalist*
August 16th, 2009 by Happy Hospitalist in Better Health Network, Humor
No Comments »
A humorous slam at private insurance companies. I read the whole article and wonder how much better life would be, not only for doctors but for patients as well if their third party paid a reasonable bundled fee, with profit potential, and let the patients and the doctors and the hospitals figure out how to divvy up the money. This humor is a take on private insurance companies, but it might as well be the government behind the Medicare National Bank. Neither has been able to control the cost of delivering health care to the masses. The only way to do that is to stop paying for it.
So, Mr. President, I write to you with this demand: we are not a socialist country, one which believes the health of its citizens should come without the proper profit-loss determinations. I believe that my healthcare decisions should be between me, my insurance company plan, my insurance company’s list of approved doctors I am allowed to see and treatments I am allowed to get, my insurance company’s claims department, the insurance company doctors who have never met me, spoken to me or even personally looked at my files, my own preexisting conditions, my insurance company’s crack cost-review and retroactive cancellation and denial squads, my insurance company’s executives and board of directors, my insurance company’s profit requirements, the shareholders, my employer, and my doctor.
via Surgeonsblog
*This blog post was originally published at A Happy Hospitalist*
August 12th, 2009 by Happy Hospitalist in Better Health Network, True Stories
No Comments »
Day in, day out, it’s like a broken record. Patient comes in with uncontrolled diabetes. Patient gets sick. Patient gets patched up. Patient could care less about their health. Patient goes home to live another day, before coming back in a month. Everyday you just accept the reality of reckless self destruction, do your best to help them while they pretend to care and then send them on their way.
Except when a patient actually shows some interest in their health. Let me give you an example. I was asked to consult on a woman with shortness of breath, unbearable heartburn, aches and pains, low energy and sleep apnea. This woman weighed close to 400 pounds. Her husband was close to that as well. Together I sat them down and talked to them for darn near an hour. We talked about all the complications that come with folks in their age group. I asked them if they had a plan for success. What their motivations were. What their goals and expectations were.
They talked about how their exercise regimen. When I tried to pin down exactly what they were doing and how much and how often, it turns out that the twice a week walk around the lake was their idea of trying. They swore up and down about the their appropriate food choices, until they admitted that their biggest problem was not what they eat, but how much they eat. For an hour I heard about how hard it was. About how frustrating it was not to see any success. About how life wasn’t fair.
And then I met their polar opposites. A man and his wife both pushing 300 pounds. He was admitted with cellulitis of the leg. But both had lost a combined 220 pounds in just seven months. I was floored. 220 pounds? That put the biggest smile in the world on my face that day. I congratulated them probably 20 times.
I asked them, “I have so many patients who just can’t find a way to lose weight. How and why did you do it?” The answer was exactly what I expected.
“We had to. We were always tired. I was always hurting. I could barely walk. My wife could barely move. We considered gastric bypass but they wouldn’t do it without first doing six months of diet and exercise. Now I’m not even considering surgery. We went through our cupboards and we got rid of all processed foods. We eat healthy. We control our portions.”
Their motivation was their own. They realized they didn’t want to live their current reality. They took the initiative to make positive change in their lives and were basking in the glory of their success. What was the difference between these two couples? It was their attitude. One couple chose to make excuses for their plight. The other was doing something about it.
*This blog post was originally published at A Happy Hospitalist*
