Better Health: Smart Health Commentary

Featured

America Boycotts Personal Responsibility

September 13th, 2009 by Happy Hospitalist in Better Health Network, Opinion
No Comments »

How expected. The CEO of whole foods says that government is not the solution to out of control health care expenditures. He says we are. The American people are responsible for out of control health care expenditures. He preaches a life of personal responsibility, of personal choice and actions that lead to health. And what does he get for it?

*This blog post was originally published at A Happy Hospitalist*

Why Do People Cling To Misinformation About Healthcare Reform?

September 9th, 2009 by KevinMD in Better Health Network, Health Policy, Opinion
No Comments »

Blame motivated reasoning.

Newsweek’s Sharon Begley writes about the phenomenon, which goes a long way why the myth about “death panels” continues to persist in the health reform conversation. She cites the work of sociologist Steve Hoffman, who explains: “Rather than search rationally for information that either confirms or disconfirms a particular belief, people actually seek out information that confirms what they already believe.”

And with a growing majority obtaining their news through pundit-tinged lens, such as from FOX News on the right and MSNBC on the left, there’s always fodder to confirm pre-existing beliefs.

Ms. Begley goes on to suggest that cognitive dissonance is also in play:

This theory holds that when people are presented with information that contradicts preexisting beliefs, they try to relieve the cognitive tension one way or another. They process and respond to information defensively, for instance: their belief challenged by fact, they ignore the latter. They also accept and seek out confirming information but ignore, discredit the source of, or argue against contrary information.

This is seen often in those who believe there is a link between vaccine and autism, despite convincing evidence to the contrary.

And with information freely available on the internet and on the 24-hour cable news cycle, there are endless opportunities to confirm, rather than challenge, one’s beliefs.

*This blog post was originally published at KevinMD.com*

The Five Biggest Misconceptions In Healthcare

September 9th, 2009 by EvanFalchukJD in Better Health Network, Health Policy
No Comments »

Newsweek tries to refute the “Five Biggest Lies In the Health Care Debate.”

But I’ve heard much bigger lies than the ones in this article.

I mean, are people really showing up angry at town hall meetings over fears that “the government will set doctor’s wages”?

Misinformation – or just plain old confusion – about our health care system is common.  To try to help fix this, I offer five of the biggest, most commonly repeated misconceptions I hear regularly about the U.S. health care system.

1. Government plays a relatively small role in American health care. Government actually plays a big role.  In 2007, federal, state and local governments paid for more than 46 cents of every health care dollar – more than $1 trillion.  In fact, since 1980, the government has paid at least 40 cents of every dollar, and as early as 1960 – 5 years before Medicare – government paid a quarter of health care expenses.  Government is a massive health care customer and has the impact one might expect such a big customer to have.

2. Health insurance companies drive the increasing cost of care in America. Not true, and here’s why:  perhaps 200 million Americans don’t get their coverage from a health insurance company.

Most of these people, or a family member, work at one of the thousands of companies that self-insure (the rest are covered by government programs).  What this means is those companies take the health care risk themselves, and use an insurance company mostly to handle the bills.  For these companies, the cost of health care directly affects their bottom line.  It’s one of the reasons employers have implemented so many programs to try to help their employees live healthier lifestyles, make sure they’re getting good care, and many others.  Some data suggest it is working to control health care costs.

The exception is small groups and individuals.  They have to buy health insurance, and face few, expensive options.  There are many reasons for this, which I’ve blogged about extensively here.  One of the most important is that there is not a truly competitive market for this kind of coverage.  Still, many of these insurance companies are not-for-profit  (some say as many as half of Americans with health insurance are covered by non-profit plans), and so it cannot be that profit drives the premium increases they, too, experience.

3. America has a free market in health care. Health care may be the most heavily regulated industry in America, with layers of state and federal regulation of care and insurance.  For example, your doctor can only practice in the state in which he is licensed.  If he wants to move to another state and be a doctor there he can’t do it unless he’s gone through a licensing process in that other state.

One of the most important reasons why the market for health insurance is so uncompetitive is that it, too, is regulated by 50 different state bodies.  If an insurer wants to sell in another state, it has to go through an extensive process in order to do it, and be subject to all kinds of mandates and other requirements that make it very impractical to do so.  It makes for a market that is much less dynamic than it could be.

I suspect one reason people call the U.S. system a “free market” is that rich or well-connected people can get better care than those who are less fortunate.  This may be true, but this is just a reality of the human condition, not the health care system.

4. There is an Obama reform plan, and you’re either for it or against it. Much of the media – and even Chuck Norris – describe the various health care reform ideas as part of an “Obama plan” or “ObamaCare.”  But other than broad outlines of what the President thinks are important principles, the President has not proposed any plan.  Most of what people are talking about – including the entirety of the Newsweek article I started this post with – is the 1,017-page bill from the House Ways and Means Committee.  While there are indications that the President is going to propose something concrete in the coming days, calling what is on the table Obama’s plan is more politics than reality.

5. Rising health care costs are a uniquely American problem. America’s not the only country suffering with rising health care costs.  In Canada, for example, the government of British Columbia has seen its health care costs increase by 45% over the last 6 years.  It’s created a budget crisis, and efforts to steadily increase the premiums it charges consumers and employers.  The U.K. has actually experienced a higher rate of growth in health care costs than the U.S. over the last several years.  So while it is true that the cost problem is worse in America than in in other countries, this is a matter of degree, not of kind.

I’ve heard lots of others, but these are the ones I most commonly run into.

What kinds of misconceptions have you heard?

*This blog post was originally published at See First Blog*

Journey of the Piñata Master Part 2: The Great American Health Care Bash

September 9th, 2009 by AlanDappenMD in Primary Care Wednesdays
No Comments »

As I mentioned in my post last week, Journey of a Pinata Master, The lessons of a piñata party are many and subtle, where children must acquire sufficient skill and insight to reach the highest status. Let me show you how the custom of the Mexican piñata, stuffed with candy and used to placate children, has been adopted unwittingly by the U.S. healthcare system to create the Annual American Healthcare Bash. At this gala, candy replaces money and adults represented by special interest groups fill in for children.

The American Healthcare Bash is hosted yearly by insurance companies and the government. These two organizers start asking for donations. In 2009, the piñata will be stuffed with $2.4 trillion (give or take a few billion). In 1999, the piñata held a measly $1.2 trillion. By 2019, piñata is expected to hold $4 trillion. Party planners already are worried about finding a rope strong enough to hold this massive elephant piñata (or donkey, depending on which animal you prefer to hit).

Donations arrive through taxpayers, employers and anyone willing to gain admission to the festivities. Before the party starts, insurance companies remove 20% of the money as their “set-up fee” for hosting and establish the basic game rules. During the event, they take turns controlling the rope holding the piñata.

Any American who contributed to the party, including everyone over 65, is invited to watch the spectacle as the myriad special interest groups (SIGs) take turns batting the piñata. These SIGs include ad almost infinitum: primary care doctors, nurse practitioners, radiologists, imaging specialists, laboratory services, pharmaceutical companies, durable medical suppliers, lawyers, software engineers for electronic medical records, coders, billers, patient navigators, receptionists, schedulers, nurses, billing specialists, hospital administrators, HIPPA compliance “police,” pay-for-performance analysts, the American Medical Association delegates, and hundreds of other professional organizations and credentialing specialists.

Every year, more SIGs have been invited to the gala for their turn to bash the piñata. Most thank the public for such an extravagant event, repeating the chorus, “Don’t worry what this is costing, we’re not hurting you, we’re going after the piñata.” This piñata promises more loot than any other in America.

One by one, players are blindfolded and spun in dizzying circles by the insurance companies or government. Patients start the play and then hand we doctors the bat saying, “Good luck! Give your best shot at whacking what you can from that piñata! I could care less because I’m “protected” by my insurance plan.”

Each player swings wildly, sometimes accidentally bashing the others crowding around the bobbing target. The crowd roars its approval while some SIGs scream instructions of where to aim as the batter swings away. The rope jerking increases as more skilled batters take their turn. When money pours from the breaking hull of the piñata, hordes of SIGs dive in a feeding frenzy. After decades of careful construction, the piñata has been compartmentalized so that no single player can knock out too much money at once.

As the party winds down, most SIGs have received a “fair “ amount of money, but they are angry, never satisfied with their share. Of course, there are a few masters in the crowd, who are grinning ear-to-ear.  When the party closes, the insurance companies take the piñata to another room and remove, behind closed doors, the remaining money (profit) of the day.

After counting its loot, the insurance companies emerge, announcing that it’s been another successful party, drinks all around! Then they say, “The party next year will cost only 8% more. Before you leave tonight, pay up.” Feeling threatened, taxpayers and employers reach deep into their pockets to pay for next year’s gala. Why ruin a great American tradition? If you get sick or don’t pay “your fair dues,” then hasta la vista.

As we grow up, most of us move past the need to gorge candy. Contrarily, when it comes to healthcare, few can limit how much they want to consume, nor recognize its often empty promises. Americans watch with fascinated horror at what’s happening in healthcare while remaining paralyzed to move cohesively towards change.

No matter how well intended and dedicated the doctors and nurses or how amazing the technology and medical breakthroughs to which the  “insured” have access, the unrelenting piñata party lure inevitably results in a mass psychology of “How much money can I make?”

If you, dear reader, are scared of change and continue to support the current  American healthcare piñata party, then be prepared to be beaten to a pulp. Now that you’ve paid your $20 co-pay entrance fee to the party and have emptied your wallet to the insurance company for what you believe is unlimited access to care, you have unwittingly turned yourself into the piñata.

Personally, after lots of experience and practice, I developed a healthy cynicism regarding the greed of this kind of parties.  Ten years ago, I no longer could support the American Healthcare Bash. We built a new practice where the only focus is the patient; the patient pays transparently for the time they need. This idea delivers better care, 24/7 immediate access whenever and wherever you need help at a price that is almost 50% less than the current model.  We need a lot more healthcare professionals and patients to invest in a new future of responsibility. A growing mantra is needed among patients and doctors alike, ”Do the right thing, for the right reason at the right price.” Unlimited wealth, and unlimited health are nothing but mirages, the deepest secret of all stuffed inside the piñata.

Until next week, I remain yours in primary care,

Alan Dappen, MD

We Need To Decide What Kind Of Society We Want To Be Before We Can Reform Healthcare

September 8th, 2009 by DrRich in Better Health Network, Health Policy, Opinion
No Comments »

Because some of his recent posts seem to have confused many of his readers (why is he so strongly against proposed healthcare reforms when he supports so many of its goals?), DrRich will state once again, for the record, his political philosophy.

DrRich is a classical liberal. This means he deeply values the concepts that guided America’s Founders; individual autonomy, property rights, freedom from restraint, free markets and limited government. He is deeply committed to the Great American Experiment, which is, to determine whether a nation conceived in personal liberty and dedicated to the proposition that all people are created equal can long endure.

He believes that healthcare is very, very important, and indeed, has dedicated his career and most of his life to healthcare. But it is not the most important thing. For our generation to abandon the Great American Experiment for the sake of healthcare, or anything else for that matter, would be a perfidious act against our posterity, and indeed a crime against humanity.

DrRich is in favor of healthcare reform, and is glad that serious efforts to reform healthcare are at last taking place. He even finds much to like in the proposed reforms now percolating through Congress, such as, provisions for health insurance to be made available to most, if not all, of the people who cannot afford it today; the provision for health insurance to be made available to all the people who are blocked from insurance today because of their underlying illnesses; and the provision to prevent insurance companies (if any continue to exist in their present form) from canceling policies of their subscribers who get sick. These are all very good things.

But, as regular readers will know, DrRich has recently strongly criticized these proposed reforms, and hopes they will fail. This has angered and confused some of his readers, who know that he has favored universal healthcare, comparative effectiveness research, and other aspects of the reform plan now before Congress.

DrRich has turned against this reform plan not so much because of what’s in the reform bill itself. As DrRich has pointed out, the actual words of the reform bill are entirely open-ended. This is why proponents of one view or another can find in the bill what they wish to see (death panels vs. no death panels, continued availability of private insurance vs. a poison pill for private insurance, etc.), and it’s why their arguments take on the cast of debates among Biblical scholars over the true meaning of some cryptic Old Testament passage.

Rather, DrRich’s objection to this healthcare reform is based on the context in which it is being advanced. And in recent months he has come to see the context as this: a broad dismantling (whether inadvertent or not) of the Great American Experiment.

This dismantling probably began earlier than the fall of 2008 when DrRich first noticed it. But last fall was when our Congress (the peoples’ representatives) first began the wholesale abandonment of their duties and of the Constitution, with their passage of TARP. TARP took $700 billion and presented it to the Secretary of the Treasury to spend as he saw fit, thus creating, arguably, the second most powerful government official in U.S., and certainly the most powerful unelected one, in a manner never conceived under our Constitution. This was followed by the government’s moves to begin consuming Fannie Mae, Freddy Mac, AIG, numerous banks and investment houses, and the auto manufacturers. And all of this was begun under a Republican administration.

While the Obama administration did not start any of this, they took the ball and ran with it, and to a degree that would have seemed impossible (to DrRich, at least) a year ago. They completed the acquisition of the car companies and other private and quasi-private institutions into the federal portfolio. They added yet another $800 or $900 billion onto the federal debt with the Stimulus Bill, and in the process our flaccid Congresspersons once again acceded to the idea that when the executive branch cries “crisis,” it is perfectly acceptable to pass a 1000+ page law into existence without even making a pretense of discovering what is in it.

Then there is the disturbing gathering of power by the executive branch. This includes commandeering control of the upcoming census by the White House, and just this past weekend, bringing the interrogation of foreign (and presumably domestic) terror suspects under White House control. (Under what circumstances do you suppose a Congressional Intelligence Committee would ever launch an investigation of the White House’s interrogation practices?) Perhaps more disturbingly are the 30+ unelected “czars” the President has named so far, individuals with potentially very big (but undefined) powers that at least threaten to impinge on the functions of Constitutionally legitimate government agencies and branches. These czars are not approved, or even vetted, by Congress (our representatives) – and at least some of them look to DrRich like very scary people, whose avowed political philosophies are collectivist, anti-capitalist, and dismissive of the Constitution.

So when the healthcare reform process began, yet again, with the presentation of a 1000+ page bill and the exhortation to pass it immediately – don’t bother reading it – on account of the dire crisis confronting our healthcare system, DrRich had seen enough. When that “pass-it-quick-it’s-an-emergency” strategy failed for once, and people began reading the monstrosity and reacting to it (as the Constitution provides that they may), and when in response our leaders accused them of being fascists, terrorists, mobsters, and other disturbing things, DrRich had seen enough. When DrRich read big parts of the reform bill himself, and realized that it is an intentionally ambiguous document whose effect will be to turn over the re-shaping of our entire healthcare system to appointed functionaries, czars, and other unelected bureaucrats,  DrRich had seen enough.

DrRich has never been a conspiracy buff. He has always believed that sustaining for any length of time a conspiracy any more extensive than, say, cheating at bridge, would be impossible. He has always considered the right-wing nut-jobs who think the opposition secretly wants to convert the United States to a Marxist utopia to be, well, nut-jobs. But if the governmental activities we’ve seen over the past six months are not a concerted effort to end, once and for all, the Great American Experiment, then they are at least an inadvertent effort to do so. DrRich wants this to stop.

Reforming healthcare is important, very important.  But reforming healthcare is not worth abandoning the foundational precepts of the most exceptional country the world has ever seen.

We can reform our healthcare system effectively and equitably, in a way that specifically preserves and strengthens those foundational American precepts. (DrRich has described how elsewhere.) At one time DrRich thought current reforms could possibly be turned into a first step in that direction. Now, thanks to the context in which these reform proposals are being advanced, he sees present efforts at healthcare reform as an irreversible step in the opposite direction, and possibly a final step from which we are unlikely to ever recover.

First we must decide what kind of society we are to be – and that’s the real “discussion” we’re having now – and then, and only then, can we decide how we are to reform our healthcare system.

And this is why DrRich will make his paltry efforts to try to stop it.

*This blog post was originally published at The Covert Rationing Blog*