July 16th, 2009 by DrRob in Better Health Network, Health Policy, Opinion
Tags: Behavior, Denial Of Coverage, For-Profit, Health Insurance, Healthcare reform
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It seemed like a reasonable plan.
I was having trouble keeping track of my chickens – they kept somehow escaping from their coop. So I figured that I would set guards to make sure none of them got out any more. I got some rabid wolves and put them outside of the coop, figuring that they would scare the chickens enough to stay in their place.
But here’s the problem: these rabid wolves are eating my chickens! Can you believe it?? You would think they’d have the moral decency to respect the fact that I hired them to guard my chickens, but now they try to bite me whenever I go out there! It’s amazing to me that these wolves would act in such a way. What’s the world coming to when you can’t trust rabid wolves to guard your chickens??
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What? You think I’m crazy? Take a look at our healthcare system! This is exactly what we are doing with our healthcare dollars.
In a recent article, Ezra Klein (coincidentally mentioned in two consecutive posts) discussed Wendell Potter, a disillusioned insurance executive who shared why he left the industry. Potter explained that the for-profit insurance industry (Cigna in this case) uses the following tactics to maximize profits:
The industry, Potter says, is driven by “two key figures: earnings per share and the medical-loss ratio, or medical-benefit ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what it has left over to cover sales, marketing, underwriting and other administrative expenses and, of course, profits.”
So it seems that a for-profit company is in it for the profit. Disgusting. Klein goes on:
The best way to drive down “medical-loss,” explains Potter, is to stop insuring unhealthy people. You won’t, after all, have to spend very much of a healthy person’s dollar on medical care because he or she won’t need much medical care. And the insurance industry accomplishes this through two main policies. “One is policy rescission,” says Potter. “They look carefully to see if a sick policyholder may have omitted a minor illness, a pre-existing condition, when applying for coverage, and then they use that as justification to cancel the policy, even if the enrollee has never missed a premium payment.”
So the insurance industry is “cherry-picking” healthy people to insure – people they won’t have to pay much on – and dumping unhealthy people. How can this happen? How can the insurance industry be taking money from the system and using it for their own profits?
But who is actually the problem here? Are the Wolves evil for eating my chickens? No, they are just acting like wolves. I am the fool for trusting them to watch my chickens without getting taking advantage of their position. Putting for-profit insurance companies in charge of huge sums of money is just as foolish. As Klein states:
The issue isn’t that insurance companies are evil. It’s that they need to be profitable. They have a fiduciary responsibility to maximize profit for shareholders. And as Potter explains, he’s watched an insurer’s stock price fall by more than 20 percent in a single day because the first-quarter medical-loss ratio had increased from 77.9 percent to 79.4 percent.
Actually, I think Mr. Klein understates it a touch. It isn’t that the insurance companies need to be profitable; they are under huge pressures from shareholders to maximize their profits. They are being pressured to milk as much money from the system as possible. Maggie Mahar underlines this fact:
Potter is right. Disappointed shareholders can be brutal. And it doesn’t take much to disappoint them. In this case investors sent the share price plummeting because the insurer had the poor judgment to increase the amount that it paid out to doctors, hospitals and patients by 1.5 percent.
Even if an intelligent CEO wanted to do the right thing, take the long-term view, and provide labor intensive chronic disease management so that, over the long term, customers would be healthier—the CEO of a large publicly-traded insurance company probably wouldn’t keep his job long enough to find out whether or not his ideas worked. This helps explain why for-profit insurers have not followed the example of non-profit insurers and created “accountable care organizations” like Geisinger or InterMountain.
Those who have followed this blog have heard me say it before: the system won’t change until we stop trusting for-profit insurance companies to guard the money. Those who are morally indignant over the fact that these companies would milk the system as they do are blustering in the wrong direction. You don’t blame wolves for acting like wolves, and you don’t blame for-profit publicly-held companies for trying to maximize profit. They are just being themselves. We are the idiots – assuming they could be trusted in this position.
Obviously, the best solution is to put the politicians and lobbyists in charge. Surely they are trustworthy.
Image Credit
*This blog post was originally published at Musings of a Distractible Mind*
July 16th, 2009 by Joseph Banken, Ph.D. in Better Health Network, Opinion
Tags: Pop Psychology, Positive Thinking, Psychiatry, Psychology, Self-Help
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Since the publication of Norman Vincent Peale’s 1952 book called The Power of Positive Thinking, the world has been bombarded with a plethora of self-help books guaranteed to show us the way to happiness. But is there a down-side to these suggestions?
If we do as instructed, by a multitude of sources, to push away the negative, or bad thoughts and focus only on the positive, or good thoughts, how do we prepare for the bad times of reality?
Come with me, if you will, on a journey through the cluttered half-baked theories of my mind, but watch your step, there’s no liability insurance in here. If you trip into the corpus callosum, you’re on your own.
Part one of the half-baked journey begins with the extreme outcome of pure positive thinking. If I am truly thinking positively, then nothing at all could possibly go wrong, I have nothing to worry about, I am perfect just the way I am, and the world exists just so that I might gain pleasure from it.
If nothing could go wrong, why should I plan for a rainy day? My job will last forever, the roof will never leak, and my kids will remain perfectly healthy. There is only sunshine in my world.
If there is nothing to worry about, then I can count my life savings while walking down a dark alley without fear, my car will last forever- that banging under the hood means nothing and adds an interesting beat to the music playing on the radio, and I will never grow old. Throw away the botox; there are no wrinkles here.
If I am perfect just the way I am, why should I exercise to take off that extra ten pounds, why should I try to improve my mind with literature, the theater, or a higher degree. Why should I get off the couch?
If I buy into this extreme sport of pure positive thinking, why would I work like a dog to get ahead? Wouldn’t I be perfect enough for everything to be given to me?
Now for part two of the half-baked journey; are you still with me? We are getting really deep in the frontal lobes now.
If I remain in a positive thinking mode until I gain a serene, carefree state, does that mean my brain is unstimulated? And in turn, does that mean that the firing of neurons has diminished so much that if danger were to occur, I would not be able to act quickly enough for self-preservation? Would I react at all if I were a true positive thinker? What could happen if I stayed on the couch?
Let’s go back to the unstimulated idea. If I continue to not stimulate my brain, will my brain begin to deteriorate? After all, the old adage “Use it or Lose it” has been around longer than “Think Positively”. Let’s throw in another adage: Necessity is the Mother of Invention. That being said, if we have no necessity because we are positively thinking about everything and therefore need nothing new, why would we trouble ourselves to invent new things?
If I remain unstimulated for an extended period of time, what will happen to my mood? If there are no highs or lows, no release of adrenaline to handle excitement or danger, no need for the release of serotonin or dopamine to stimulate my brain, will these receptors be decommissioned as no longer needed? Will my mood sink into depression?
Now for the flip side of this saga.
What if I experienced continual negative thoughts? Would my life mirror the same lack of moving forward I found while hanging out on the couch with positive thinking? I may have more supplies stored in the basement with negative thinking and the door would be locked, but would my life be any more interesting? Would it be just as flat, but in a negative way?
If danger startled me off of the couch, would I be too paralyzed by negativity to react in time? If I think nothing good will ever happen, have I made this come true simply by closing the door to the possibility?
This leaves us with the good old fence straddlers.
Ordinarily, sitting on the fence is thought of as a bad thing. We are urged to choose a side, be decisive and stick with our convictions. What if I had a mixture of positive and negative thinking tempered with a good dose of reality thinking? Would my life attain a better balance necessary to survival? Would I have happy little neurons firing quickly and efficiently because they were getting a healthy dose of exercise and rest? If I use reality thinking with a mixture of both positive and negative thinking, will I be better prepared to weather hard times?
If I have a huge project due at work, would I be more effective if I used a dose of negative thinking that I don’t have enough time to complete this project, mixed in a little anxiety that if I don’t finish then my job may be finished, added some positive thinking that all I can do is my best, and stirred it around with reality thinking that I’ve proven myself by meeting hard deadlines in the past and have the ability to do so again. My project will most likely be completed on time because I have made this mixture of positive, negative, anxiety and reality work for me instead of against me. Too much positive thinking and I won’t push myself hard enough to make the deadline. Too much negative and I will give up before really trying.
The fence straddlers can enjoy a healthy mixture of both positive and negative thoughts, knowing each has its own value if kept in balance. And the view from the fence is not bad either.
Thank you for coming along on this trip through the half-baked theory region of my mind.
Now that I’ve shared some of my thoughts, feel free to share some of your own.
*This blog post was originally published at eDocAmerica*
July 15th, 2009 by Gwenn Schurgin O'Keeffe, M.D. in Better Health Network, Health Policy
Tags: Administrative Burdens, Health 2.0, Health Insurance, Pediatrics, Star Trek
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One of my favorite summer activities is watching reruns of Star Trek Next Generation. It’s become somewhat of a summer tradition in my family the last few summers. Having become trekkies themselves, my kids were able to very much enjoy the recent movie, and get the history and lore behind it.
The longevity of the Star Trek enterprise is fascinating. Decades after it’s first launch, it still captures the imagination of inquiring minds and still provides endless hours of entertainment to viewers of all ages.
Even more amazing than the longevity of it’s run is the technology it represents. When the show first debuted, the sci fi components seemed truly out of reach. Today, much of the technology in the new movie and even some of the older shows doesn’t seem that implausible, especially when it comes to health.
Early Trek was a preview of our current Health 2.0 world. When first portrayed, that was not a concept any of us could grasp. Think about it. In the original series, and continuing through to the latest movie, they used communicators in high tech ways with online computers to search data bases and emails and video calls to talk between doctors at different inter-stellar locations. The doctors even had high tech gizmos to look inside and offer a 3-d look within. All medical records were online and available anywhere. New advances in medicine came from experience, science as well as other cultures and the experience of the treating physician. Patients and doctors could review information online and use that to improve their own care.
What wasn’t so out of reach was the portrayal of the practice of medicine and the limitations of what the human physician could achieve. The bedside manner was always first and foremost the key element to a patient’s survival. The physician treated all patients, regardless of species, and had tolerance for different cultural beliefs in treatment. And, not all patients made it through their ordeal. After all, the doctor was “just a man, not a miracle worker”.
So, Trek’s docs were all health 2.0 with a healthy dose of health 1.0 in that they had these important features:
1. high tech gizmos and computers to diagnose and treat
2. traditional docs to take a history and offer counsel but computerized medical records
3. limits on what could be done
4. online communication with “Googling” ability
5. New advances and lessons from other species to tackle new issues and problems
Sounds a great deal like our health system, minus the insurance headaches, huh?
The practice of medicine is begging to be more health 2.0 but with doctors who very much want and need to be involved and keep their health 1.0 skills. Today we have gizmos that keep becoming more high tech…think robotic surgeons. Today we have doctors still driving clinical care with bedside manner still crucial to the success of an outcome. Today we still have limits of what can and can not be done, with a limit of human life, regardless of our efforts to prolong it. Today we have very robust online communication between doctors, between patients, between doctors and patients, and between everyone and the computer, but with an importance still placed on the face-to-face visit.
There’s one big difference between the docs on Trek and us…insurance. Because of that, what we see on Trek is still just a dream. Those docs can do their jobs so admirably and with great patient satisfaction because they are not burdened with an insurance system gone awry and not forced into cycles of defensive medical practices.
Until health reform sorts out how to allow us to have a patient-focused, physician driven system again, what we see on Trek will remain a dream. What’s sad and discouraging is that is this is one sci fi dream that is actually within reach. Don’t you think it’s time we stopped the insurance companies from preventing us from grabbing on?
*This blog post was originally published at Dr. Gwenn Is In*
July 15th, 2009 by KerriSparling in Better Health Network
Tags: Diabetes, Diabetic Dog Game, Endocrinology, Glucose, Internal Medicine, Type 1 Diabetes, Video Games
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The idea of creating a game about diabetes both intrigues me and creeps me out a little bit. Diabetes is a game? I guess after an evening of “WHY 200? WHY?!!” I’m not feeling so light and fluffy about diabetes. But I see the potential for kids to learn about diabetes and its management through the use of games, so I’m all so for whatever gets good information out there. And over the last few days, I’ve come across two particularly interesting games, thanks to reader alerts, aimed at kids who either have diabetes or have friends with diabetes.
The first game is on the Nobel Prize educational games site and it’s cleverly called The Diabetic Dog game. (Wee bit short on imagination once they got to the naming part, I suppose.) I will admit – I played this game for at least 15 minutes and I appreciated the cuteness of the doggy.
As a “caretaker,” I was instructed to keep my diabetic doggy (named, in my profile, “DoggyPants”) happy (by petting him), well-fed (by purchasing food for him), getting him to exercise (by walking him), and keeping his blood sugar in check by giving him insulin injections. Keeping an eye on the bar at the bottom left of my screen let me know what DoggyPants’s blood sugar was, and I could feed and dose him accordingly.
(Sidenote: Having that bar gauge with his blood sugar in it sure helped me figure out what I was doing, and I wondered if the developers of this Diabetic Dog Game realized how they’re helping further the case for continuous glucose monitors.)
Overall, I liked how this game showed the importance of insulin, food choices, and exercise as the cornerstones for good diabetes management, and it didn’t tout insulin as “a cure.” Basically, all you do is chase this little puppy around and feed him or dose him or walk him. Constant cycle of redundancy, only the results aren’t predictable. Kind of like real life. 🙂
The other game I have been receiving reader alerts on is the Didget from Bayer. I haven’t seen this game in person, but according to the word on the street (read: their website), “The Didget blood glucose meter from Bayer is the only meter that plugs into a Nintendo DS or Nintendo DS Lite gaming system to reward children for consistent testing.”
So it’s an actual meter that snaps into the Nintendo system. (It appears to be, or be completely identical to, the former “GlucoBoy” from a bit ago.) Honestly, that is pretty darn cool, and I wish that kind of “fun” was available when I was testing my blood sugar as a kid. Hell, I’d like to have that kind of positive reinforcement NOW, thank you very much.
“This unique meter helps encourage consistent testing with reward points that children can use to buy items within the game and unlock new game levels. And, since the DIDGET meter is based on Bayer’s trusted CONTOUR™ system, you know you’re getting a meter that’s reliable.” They are also building a community for kids to “hang out in” virtually, comparing notes. Of course, since it’s Bayer, they need to slide in their personal product endorsement, but they have the right idea. Test often, get rewarded for keeping tabs on your numbers, and maybe Nick Jonas will show up at your house and give you a hug.
That last part? A lie. But Bayer is working its way into the hearts of kids with diabetes, and as a former kid with diabetes myself, I would have appreciated that kind of innovation as part of my childhood with this disease. From what I can tell so far, this meter is being marketed towards diabetics in the UK, but hopefully there will be a United States counterpart. With mg/dl readings. Because doing conversions when low? Not so easy.
So there you have it. We’ve come a long way from that game with the elephants or the other one about the Escape from Diab, and hopefully more efforts will be made to engage kids – and adults! – with diabetes. Positive reinforcement is hard to come by in this whole diabetes mess, so every little bit helps.
*This blog post was originally published at Six Until Me.*
July 15th, 2009 by Medgadget in Better Health Network, Expert Interviews, Health Policy, News
Tags: 16 Patients, Johns Hopkins, Kidney, Renal Disease, Surgery, Swap, Transplant
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A team at Johns Hopkins has coordinated the world’s largest kidney swap, involving sixteen patients in multiple medical centers across the US. One of the donors was the vice president of human resources at Johns Hopkins Health System, a woman who has promoted organ donation and finally got a chance to do the ultimate charity work herself.
Johns Hopkins reports:
An altruistic donor started the domino effect. Altruistic donors are those willing to donate a kidney to any needy recipient. Just like falling dominoes, the altruistic donor kidney went to a recipient from one of the incompatible pairs, that recipient’s donor’s kidney went to a recipient from a second pair and so on. The last remaining kidney from the final incompatible pair went to a recipient who had been on the United Network for Organ Sharing (UNOS) waiting list.
As part of this complex procedure, Johns Hopkins flew one kidney to Henry Ford, one kidney to INTEGRIS Baptist and one kidney to Barnes-Jewish, In exchange, Henry Ford, INTEGRIS Baptists and Barnes Jewish each flew a kidney to Johns Hopkins.
The 16 surgeries were performed on four different dates, June 15, June 16, June 22 and July 6. The 10 surgeons in charge included four at Johns Hopkins, two at INTEGRIS Baptist, two at Barnes-Jewish and two at Henry Ford.
Johns Hopkins surgeons performed one of the first KPD transplants in the United States in 2001, the first triple-swap in 2003, the first double and triple domino transplant in 2005, the first five-way domino transplant in 2006 and the first six-way domino transplant in 2007. Johns Hopkins also performed the first multihospital, transcontinental three-way swap transplant in 2007 and the first multihospital, transcontinental six-way swap transplant in 2009.
Nearly 100 medical professionals took part in the transplants, including immunogeneticists, anesthesiologists, operating room nurses, nephrologists, transfusion medicine physicians, critical care doctors, nurse coordinators, technicians, social workers, psychologists, pharmacists, financial coordinators and administrative support people.
*This blog post was originally published at Medgadget*
