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Should Personal Responsibility Be Rewarded With Lower Insurance Premiums?

September 7th, 2009 by Happy Hospitalist in Better Health Network, Health Policy

Tags: Health Insurance, Healthcare reform, Insurance Pool, Lifestyle, Lower Premiums, Obesity, Personal Choices, premiums, smoking

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.

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*

Study Shows That Thin Thighs Are Associated With Heart Disease

September 7th, 2009 by Toni Brayer, M.D. in Better Health Network, News

Tags: BMI, Cardiology, Diet and Nutrition, Heart Disease, Obesity, Weight Loss

Finally, a study that many women can like. The British Medical Journal published a study out of Denmark that looked at the association between thigh circumference and the incident of cardiovascular disease and mortality. Why anyone would even think of thigh circumference being of importance is beyond me, but the Danes seem to think it was important. They found people with thin thighs had more risk of developing heart disease or premature death.

The study looked at 1436 men and 1380 women and examined them for height, weight, hip, thigh and waist circumference. The results showed that small thigh circumference (below 60cm or 23 inches) was associated with more cardiovascular disease and mortality. They did not find the same association with waist size and the findings were independent of percentage body fat mass or obesity. Small thighs were a disadvantage to health and survival for both sexes.

Twenty three inches is not a very small thigh, and in fact, more than half of the men and women aged 35-65 have thigh circumferences below that size. Maybe it has to do with muscle mass (less exercise, less mass). I can’t imagine any other reason this strange finding should occur.

I think this study will probably not hold up to analysis and further investigation. There are just too many variables and I don’t think people with large thighs should feel they are immune to heart disease.

But the idea that, for once…the skinny models and actresses don’t have the advantage is kind of heart warming.

*This blog post was originally published at EverythingHealth*

Healthcare And Illegal Immigrants: Why The Confusion?

September 7th, 2009 by DrWes in Better Health Network, Health Policy, Health Tips

Tags: Congress, Federal Payments, Healthcare reform, House Bill 3200, Illegal Aliens, Illegal Immigrants, Undocumented Aliens

“I don’t know what could be more clear,” said Representative Bruce Braley, Democrat of Iowa, who has read aloud from a section of the House bill with the title “No Federal Payments for Undocumented Aliens.”

“Heath Care Debate Revives Immigration Battle,”
New York Times, 6 Sep 2009

From House Bill 3200, page 143:

SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTED
4 ALIENS.
5 Nothing in this subtitle shall allow Federal payments
6 for affordability credits on behalf of individuals who are
7 not lawfully present in the United States.

* * *

Taxpayers are concerned whether they will have to foot the bill for illegal aliens in the upcoming health care bill. Many ask good questions, like how will health care workers know who’s an illegal alien? If they are included, how will it be paid for? These are important questions that we would hope could be dealt with squarely, openly and with full transparency.

But this is a sensitive topic for Congressmen interested in securing reelection.

During the summer recess, many Congressmen were barraged by questions to this effect. So it was interesting reading this New York Times piece this morning on whether illegal aliens will be covered under the new health care plan before Congress. On one hand we have Congressmen placating his constituents by assuring voters that “I don’t know how it could be more clear” as they suggest taxpayers will not fund illegal aliens, but careful inspection discloses that illegal aliens will just not be eligible for federal subsidies to reduce their payments for federally-supplied health insurance.

But from here, it gets even more byzantine:

… the report finds that the House bill would not prohibit illegal immigrants from enrolling in a health insurance exchange. The exchange would allow participants to buy coverage from one of several plans, including a public option offered by the federal government.

At the same time, illegal immigrants would not be exempt from the obligations in the House bill. According to the research service, most illegal immigrants in the country would be required to buy health insurance or face tax penalties.

And since they would be barred from subsidies, they would have to pay for coverage at full rates, regardless of their income level.

So here we have illegal aliens, already strapped for cash, paying their “full payment” and if they don’t, the tax man will come after them (which is confusing to me, because I didn’t know that illegal aliens pay taxes).

So what is wrong with the public? How could they possibly be confused?

Here’s a thought: the only real way out of these shameful machinations is to deal with the immigration and health care issue separately, incrementally, and without this shell game. Doesn’t the American public deserve a more thorough discussion of this issue, rather than shoving it in to our upcoming health care legislation?

My personal sense of it is that such an issue will never be decided at the Emergency Room door. Rather, it is part of a systemic immigration control and reform question that involves our borders, employee verification, and a decision about existing illegal immigrants.

What we’re observing instead, is a Congress is too scared to deal with this issue honestly.

*This blog post was originally published at Dr. Wes*

Does Nicotine Replacement Therapy (NRT) Cause Cancer?

September 5th, 2009 by Jonathan Foulds, Ph.D. in Better Health Network, News

Tags: Cancer, Lung Cancer, Nicotine Replacement Therapy, NRT, Research

A recent research report by Professor Robert Murray (University of Manitoba) and colleagues examined whether nicotine replacement therapy (NRT) may cause cancer. The report was published in the September edition of the journal, “Nicotine and Tobacco Research”, and was based on analysis of the Lung Health Study.

The Lung Health Study recruited 5887 smokers starting November 1986, and 3923 of them were randomly selected to receive an intensive, state-of-the-art stop smoking treatment (group therapy plus nicotine gum). The participants in the original study were followed for 5 years, and 3320 were included in a longer study focusing on lung cancer for another 7.5 years.

The study presents one of the best opportunities of measuring the known exposure to either smoking, or NRT, or both over a 5 year period, as this information was accurately recorded throughout the study.

The study found that 75 participants were diagnosed with lung cancer and 203 with cancer of any type during the follow-up period. Those with the largest cigarette smoke exposure during the study were significantly more likely to suffer lung cancer, but those who used a large amount of nicotine gum were not at any greater risk of suffering from lung cancer or any other cancer examined in the study.

Even though most of the participants were relatively young at enrollment (just under 50) and so had relatively low risk over the immediately following years, around 3.2% of the heaviest smokers developed lung cancer, as opposed to half that proportion in those smoking less. But the amount of use of NRT during the study was not associated with getting cancer.

The results of this study are consistent with the vast majority of human studies, in that they do not find any convincing evidence to suggest that NRT causes cancer.

Murray RP, Connett JE, Zapawa LM. Does nicotine replacement therapy causecancer? Evidence from the Lung Health Study. Nicotine Tob Res. 2009 Sep;11(9):1076-82. Epub 2009 Jul 1.

This post, Does Nicotine Replacement Therapy (NRT) Cause Cancer?, was originally published on Healthine.com by Jonathan Foulds, Ph.D..

Med School Memories

September 5th, 2009 by Bongi in Better Health Network, True Stories

Tags: Medical School, Memories, South Africa, Tree

When I got accepted into medicine as a last minute add-on due to one of their other applicants turning down the post, I knew how lucky and privileged I was. It was the first step in a very long journey and I wasn’t going to mess it up.

The first year in those days was spent at the main campus and we would only be at the medical campus from second year onwards. Second and third years would be spent on the pre-clinical campus and only from fourth year onwards would we be in close proximity to the big boys. All this I didn’t know when, during first year orientation they bussed us to the medical campus so we could see the preclinical buildings and watch with a fair amount of jealousy when the higher year students walked past. The whole medical training thing was very hierarchical. It didn’t bother me. I had been in a similar system before and had moved up the ladder. I could do it again.

The preclinical campus was a very relaxed place. There were essentially only two buildings (ok, ok there was also the dentistry building but we didn’t go there) with a large grassy lawn between them. There were a few trees providing shade for groups of students lying on the grass and reading or chatting. Our group of first years on orientation clearly didn’t seem to fit in. None-the-less we found a tree to sit under during a short break in the orientation program.

And there I sat in a state close to euphoria with my hopes and my dreams all layed before me. I knew I stood at the beginning of a journey that would lead me to what I one day would be. What I was at that stage was of little significance other than the fact that it was a pointer to what I would become.

I lay under the tree and, as best I could, told my friend who was with me about these thoughts. I then added that I would use the tree as a sort of temporal marker that I could come back to when I was finally what I would be. Then I would stand under the tree and remember that exact moment when I looked into the unknown future with innocent hopes and dreams.

Recently I had the opportunity to go back to the preclinical campus. I remembered that moment so many years ago and was quite eager to stand under that same tree and reflect about the years that had passed and what I had become. On that day, so long ago, I would never have guessed that I would have gone on after medicine to specialise in surgery, so I actually achieved more than I dared dream. I was really looking forward to a moment that would link one specific moment in the past with the present.

The campus was just as I remembered it. The lawn was still there and there were still students sitting in small groups. they just looked so much younger than I remember being. Then  Iwent towards the far side of the lawn to have my moment under the tree.

They had cut the tree down! It was gone. Everything else was exactly the same except my tree. Is there nothing sacred?

*This blog post was originally published at other things amanzi*