John Mackey: The Whole Foods Alternative to ObamaCare – WSJ.com
While we clearly need health-care reform, the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system. Instead, we should be trying to achieve reforms by moving in the opposite direction—toward less government control and more individual empowerment. Here are eight reforms that would greatly lower the cost of health care for everyone:
Make sure you read toward the end to see what the Whole Foods Canada employees ask for…
Just as “all politics is local”, so is all medical care personal. One patient; one physician; one moment; one decision. And in this era of balanced physician and patient autonomy, that decision often is an informed joint decision. Many patients now make serious efforts to learn about their conditions both before and after visits to their physicians. Many physicians welcome such informed patients and willingly discuss comparative effectiveness of the available diagnostic and therapeutic options. However, a frank discussion about the comparative costs and charges for the options, whether they be to the insurance company, Medicare, Medicaid or out-of-pocket for the patient, is usually missing.
Many health economists insist that the medical marketplace does not behave like other markets and believe it is fruitless to expect market principles to usefully inform the medical arena. That bias is true in emergencies,
operating rooms or intensive care units, and with patients who are mentally disabled.
Such behavior does not have to persist in an outpatient setting. In my book Severed Trust: Why American Medicine Hasn’t Been Fixed (Basic Books, 2000, paperback 2002), I presented the concept of “the economic informed consent.”
I believe that every patient who is mentally competent and in a non-emergency situation should be informed of the cost of a proposed diagnostic or therapeutic procedure or product, before it is “ordered.” This includes referral to another (often more specialized and costly) physician, no matter who pays the bill. The costs should all be discussed IN ADVANCE decision. This discussion should include whether it is worth it and
whether there a less expensive good alternative.
A recent NPR/KFF/HSPH survey reported that 55% of Americans believe that their insurance company should have to pay for an expensive treatment, even if has not been proven to be more effective than a less expensive
treatment. This attitude underlies the ruling convention, “if insurance will cover it, do it,” that lies at the root of our problem of health care cost inflation. No one is held accountable.
If we as a country could widely apply the “economic informed consent,” physicians and patients would become educated together. They could both become wiser shoppers for the most cost-effective diagnostic tests,
prescribed drugs, and specialists.
With an “economic informed consent,” physicians and patients can reset attitudes toward a healthy concern for the total costs or charges, stifling the usual knee-jerk response, “if the insurance covers it, do it.” No one
knows whether this approach, diligently applied, would actually cut down on wasteful spending, such as choices that drive huge geographic variations, but we do know that pricing an automobile, an airplane ticket, a dinner or a bottle of wine does affect consumer decisions. Why not try it for medical charges as well? Current sweeping proposals for health system reform all state that there must be “cost control” but offer little likelihood of delivering real cost savings.
Now is the time for the US Health Information Technology Initiative to create inter-operative systems that would provide the data to support widespread use of the “economic informed consent” in a timely fashion and
let the medical marketplace speak. Knowing the cost of a medical decision in advance should become a part of a new “Patient’s Bill of Rights”. In a medical care decision, it is the right of a patient to know “who pays whom
how much for what.” All of us in health care laud “transparency”–let that include economic transparency.
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.
The sense of smell is a very powerful sensation. A distinctive fragrance can stir up a long-forgotten memory, or put you in a place you haven’t been in years. There’s a certain clean, dusty smell that always reminds me of the cottage on Wisconsin’s Lake Koshkonong, which we used to rent every year when I was a kid. There’s a perfume that always reminds me of a girl who I briefly dated in high school. The girl was forgettable but the aroma was not. We all have these triggers and associations.
All this occurred to me last night as I hunched over the face of an intoxicated gentleman who had lost a fight with the pavement. He was unresponsive, and I was painstakingly stitching back together the tattered pieces of his lips and forehead. Every time he exhaled, I was subjected to an intense and pungent smell of dried blood, saliva and alcohol. It’s an acrid scent, sour, with an overlying cloying sweetness. Very distinct and unpleasant.
And that, my friends, is the smell of the ER.
At least for me. I will never be able to smell that in my life without being immediately transported back to this place and activity (repeated so many times over the years). Fortunately, I am unlikely to ever experience this particular smell outside of the ER. Later, after the ER emptied out for the night, I discussed this with a few nurses & others. Not surprisingly, there was quite a diversity of opinion. One nurse insisted that the smell that, for her, screamed “ER” was that of melena (bloody stool from a brisk GI bleed — also very pungent) It can fill the entire department when you have one GI bleeder. You come into work, smell the melena the moment you walk in, and you just know what sort of shift it’s going to be. A tech said that the scent he thinks of as “ER” is the sweet plastic smell of freshly opened oxygen tubing. Another nurse came up with an inventive and hysterical bit of slang that I just can’t bear to repeat for, um, how shall I say it, the ammonia and fishy smell of unclean or diseased lady parts.
Ultimately (of course) we came up with a list of “Smells of the ER”:
Alcohol, Saliva & Dried Blood
Fresh Plastic Tubing
Melena
Feminine Issues
A Freshly Incised Abscess
80-proof Vomit
Clostridium Difficile (a GI illness producing a distinctive smelly diarrhea)
“Hobo Feet”
Coffee Grounds in a tray (used by nurses to freshen the air and cover some smells)
Surely there are more — perhaps you can contribute some in the comments. It’s gotta be distinctive to the ER, though, or at least a medical setting. Just poop or vomit doesn’t cut it. And, like the plastic tubing, it doesn’t have to smell bad, necessarily.
So what do you think?
*This blog post was originally published at Movin' Meat*
Many of the surgeries I do are elective. They can and should be scheduled to be convenient. It happens – God laughs at our plans or life interrupts or …..
Last week was such a time for one patient. She called, very apologetic, “Dr Bates, I need to reschedule my surgery. My father is having tests done. He hasn’t been feeling well.”
I quickly assure her that no apology is necessary. Her family comes first. I suggest we simply cancel the surgery for now until the “dust settles.” She can call me back when she is sure things are okay with her family. We’ll reschedule then.
She is still worried. “The surgery center called me today. Do I need to call them? Will I need to pay them or anesthesia or you for the canceled time?”
Again I reassure her, “No, I’ll call them and take care of canceling the surgery. No, we don’t charge you for surgery we don’t do. It happens. It’s okay to cancel surgery for whatever reason – another family member gets sick, an accident happens, you just get scared.”
It happens on both sides. Sometimes (as for me earlier this year when my mother had surgery) it’s the doctor who has to cancel or reschedule. Sometimes it’s the patient. I once had a patient not show up for surgery, only to find out later she had been in a motor vehicle accident the evening before her scheduled surgery. She turned out to be okay, but it really cemented how I fell about patients who call to cancel or reschedule. It’s okay. No need to apologize. Thank you for letting me know.
It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…
I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…
I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…
When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…
I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…
The sense of smell is a very powerful sensation. A distinctive fragrance can stir up a long-forgotten memory, or put you in a place you haven’t been in years. There’s a certain clean, dusty smell that always reminds me of the cottage on Wisconsin’s Lake Koshkonong, which we used to rent every year when I was a kid. There’s a perfume that always reminds me of a girl who I briefly dated in high school. The girl was forgettable but the aroma was not. We all have these triggers and associations.
