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 13th, 2009 by DrWes in Better Health Network, Health Policy, Opinion
Tags: Burn Out, Cardiology, Healthcare reform, Medical School, Physician, Training
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It was supposed to be delayed gratification.
After all, that’s the American way: work hard, put your nose to the grindstone, get good grades, be obsessively perfectionistic, then you’ll be rewarded if you just stay with it long enough. It’s the myth that perpetuated through medical school, residency and fellowship, and our poor residents, purposefully shielded from the workload they’re about to inherit, march on.
But then they graduate and find that just as the population is aging, chronic and infectious diseases are becoming more challenging, health advances and potential are exploding. Just then, we decide to launch a full scale attack on physicians and their patients with increased documentation requirements, call hours, larger geographic coverage of their specialties, reduced ancillary workforce, and shorter patient vists.
Physicians get it – burn out and dissatisfaction are higher now than ever before. This is probably the greatest real threat to the doctor-patient relationship and health care reform discussions don’t even put it this on the table.
At the same time that we expect our doctors to be devoted, available, enthusiastic, meticulous and at the top of their game with perfect “quality” and “perfect performance,” while simultaneously cutting their pay, increasing documentation reqirements and oversight, limiting independence, questioning their professional judgment, and extending their working hours. We must become more efficient!
Deal?
*This blog post was originally published at Dr. Wes*
July 9th, 2009 by Dr. Val Jones in Book Reviews, Medblogger Shout Outs, Opinion
Tags: Christianity, Creationism, Director, Faith, Francis Collins, Intelligent Design, NIH, Science Based Medicine
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Francis Collins, M.D., Ph.D., is probably best known for his leadership of the Human Genome Project, though his discoveries of the Cystic Fibrosis, Huntington’s, and Neurofibromatosis genes are also extraordinary accomplishments. Dr. Collins is a world-renowned scientist and geneticist, and also a committed Christian. In his recent best-selling book, The Language Of God, Dr. Collins attempts to harmonize his commitment to both science and religion.
Some critics (such as Richard Dawkins) have expressed reservations about Dr. Collins’ faith, wondering if it might cloud his scientific judgment. Since Collins was rumored to be the most likely candidate for directorship of the NIH (and he was nominated for the position yesterday, but must be confirmed), and because I wanted to know if Dawkins et al. had any reason for concern, I decided to read The Language Of God.
First of all, Christians are a rather heterogeneous group – with a range of viewpoints on evolution, science, and the interpretation of Biblical texts. On one extreme there are Christians (often referred to as “young earth creationists” or simply “creationists”) who believe in an absolutely literal interpretation of the Genesis story, and see evolution as antithetical to true faith. Dr. Collins suggests that as many as 45% of Christians may actually be in this camp.
On the other end of the spectrum are Christians who embrace evolution, accept and promote scientific thinking, and understand the Bible to be a blend of poetry, allegory, and historical literature. While they see the Genesis account of creation as poetic, the Gospel accounts of Jesus’ life and teachings are considered to be more literal.
Collins’ views are very representative of the scientific end of the Christian spectrum. In fact, he spends several chapters attempting to help creationists embrace evolution. He takes great pains to explain how irrational it is to deny the evidence we have (both from a genetic, and an archeological/basic science perspective) for evolution. He argues that evolution is not an enemy of faith, but rather an enlightening look at how God’s creative process works.
Collins also takes on “Intelligent Design (ID),” exposing it as a PR play, not a true scientific theory. He suggests that ID is an “argument from personal incredulity” expressed in the language of mathematics, biochemistry, and genetics. Furthermore, Collins explains that ID proponents have confused the unknown with the unknowable – there is no current “irreducible complexity” that cannot be explained by evolutionary theory. We don’t need a “God of the gaps” to explain what we’ve yet to learn.
One of the more interesting parts of the book is Dr. Collins’ mathematical review of the incredibly low odds of the right blend of atoms/elements and the correct rate of expansion of the universe to occur by chance. He argues that certain atomic particles needed to be present in unequal and varying amounts at the earliest moment of the Big Bang to produce – eventually – the right conditions for life as we know it. He uses this analogy: it’s possible that a poker player could randomly obtain a straight flush in 50 consecutive hands. However, a more plausible explanation is that he’s cheating. In the same way, the universe could have come into being by coincidence, but it’s more likely that it was a coordinated event.
Collins’ argument for the existence of God is compelling to me. His explanation of why he chose to become a Christian is a little less so. Collins often resorts to lengthy quotes of C.S. Lewis in lieu of his own theological rationale – but I suppose we can forgive him for this. He is first and foremost a scientist, not a theologian, and his book simply reflects that fact. [Those interested in a more compelling theological rationale for Christianity might try Timothy Keller’s, The Reason For God: Belief In An Age Of Skepticism.]
In summary, Collins claims to believe in “theistic evolution.” He says that few people have heard of it because it harmonizes science and religion – and “harmony is boring” and doesn’t have a PR agenda. Nonetheless, he finds it internally consistent and intellectually satisfying. The material world is best understood through scientific inquiry, the spiritual world cannot be tested or understood by science. Matters of conscience, morality, and a yearning for answers to questions that may not be resolved empirically (What happens to us after death? What existed before the Big Bang? Is there a soul?) are matters best left for religion.
After reading The Language Of God, I feel confident that Collins is a reasonable person. He embraces science more successfully than many people of faith, and I didn’t notice anything about his beliefs that would make me question his ability to lead the NIH in true, scientific inquiry. In fact, The Language Of God may embolden other Christians to join the Science-Based Medicine movement by offering them a rational way to allow faith and science to co-exist. I hope that scientists who hold atheist or agnostic religious views will embrace this small group of evolutionary theists as religious moderates who fully support scientific orthodoxy.
July 3rd, 2009 by admin in Better Health Network, Health Policy, Opinion
Tags: Administrative Costs, Charlie Baker, CMS, Costs, Finance, Harvard Pilgrim, Health Insurance, Healthcare reform, Medicare, Savings
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[This post was written by Charlie Baker, President and CEO of Harvard Pilgrim Health Care, Inc., one of New England’s leading non-profit health plans.]
I heard this idea promoted at a luncheon I was at last week — that the best way to fix health care in the U.S. would be to move to a “Medicare-For-All” system. Needless to say, I find this odd — since I think many of the things people hate most about our existing system — too procedure driven, doesn’t support primary care and prevention, favors technology over face-to-face interaction, doesn’t support multi-disciplinary approaches to care delivery, etc. — derive from the rules of the game set up and enforced by…Medicare!!! Yikes!
But aside from that, the two things I always hear about why it’s a good idea are — Medicare has lower Administrative costs than private health plans and they’re a ”better” payer than the private plans. Hmmm…Let’s take the first one. What I’ve heard before is that Medicare only spends 4% of its money on a per beneficiary basis on administration, while the plans spend 14% per member on administration — a big difference. This is interesting, but misleading.
Medicare beneficiaries are over the age of 65. They spend almost three times as much money on health care as a typical private plan member — most of whom are under the age of 65. If the Medicare member typically spends $800 per month on health care, and 4% of that is spent on administration, that’s $32 a month on administration. If the private health plan member typically spends $300 per month on health care, and 14% of that is spent on administration, that’s $42 a month — a much smaller difference. But we’re not done yet. Medicare is part of the federal government, so its capital costs (buildings, IT, etc.) and benefit costs (health insurance for its employees and retirees (!), pension benefits, etc.) are funded somewhere else in the federal budget, not in the Medicare administrative budget.
Private plans have to pay for these items themselves. That’s worth about $5-6 per member per month, and needs to come out of the health plan number for a fair comparison. Now we’re almost even. And finally, Medicare doesn’t actually process and pay claims for all of its beneficiaries. It contracts with health plans around the country to do much of this for them. That’s not in their administrative number, either — and it is, needless to say, in the private health plan number.
People push and pull these numbers all the time, and there may be “some” difference between Medicare and the private health plans on administrative spending as a percent of total spending. But it’s not huge, if you try to compare apples to apples.
On the payment issue, the numbers I’ve seen suggest that nationwide, private plans — on average — pay somewhere between 120 and 125 percent of what Medicare pays for hospital and physician services. In other words, private plans pay MORE than Medicare pays, not less! If people want Medicare For All, they need to be prepared to either dramatically raise Medicare rates and payment — and therefore, Medicare costs — by a lot of money — 20 to 25% by this estimate — or kick the bejeebers out of the physician and hospital communities and make them eat the difference.
Medicare-For-All is not as simple as it seems.
*This blog post was originally featured at the Let’s Talk Healthcare blog.*
