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.
That’s why I see market choice and responsibility as the way out of this fiscal disaster. If premiums have doubled in the last 10 years to $12,000, how many businesses big and small can afford $25,000 in ten more years? The answer is almost none. Obama’s proposals do nothing to address this factor. The solution is not more insurance. The solution is not Universal insurance. The solution is to change the rules of the game. Rules your government created. Rules which brought us where we are today. The current insurance model does not work because our insurance has become an inflated currency of trade. A currency which is not allowed to follow the rules of supply and demand. Look only to the expansion of health care jobs in the worst recession in over 50 years and ask yourself how that is possible. And ask yourself if that is sustainable.
I do not want to be paying $25,000 a year a decade from now. $25,000 a year for taking care of myself and doing what’s right for my body.
Eat a diet high in fruits and vegetables and low in read meat
Don’t become obese (BMI >30)
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 »
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.
At a time when two thirds of Americans are either overweight or obese, health officials are correctly warning that most of us need to lose weight. But we may be setting ourselves up for a surge in eating disorders.
The two main types of eating disorders are food restricting (commonly referred to as “anorexia”) and binge eating and purging (commonly referred to as “bulimia”). The disorders typically begin in adolescence and affect women much more commonly than men.
Statistics are tough to come by – partly because of under-diagnosis and incomplete reporting – but a recent review estimated that 500,000 women in the U.S. have anorexia and 1-2 million women have bulimia.
A key feature of an eating disorder is the disparity between perception and reality. Over the past thirty years, obesity (BMI >= 95th percentile) in teenagers increased from 5.0 percent to 17.6 percent. While that rate has skyrocketed, it’s still much lower than the perceived rate of obesity among students.
Among children in grades nine through 12, 10 percent of females were obese and 15.5 percent were “at risk” for becoming obese (BMI >=85 percentile but <95th percentile). Yet 38.1 percent of students described themselves as overweight and 61.7 percent were trying to lose weight.
Put another way, more than half the women trying to lose weight were not overweight.
Why do people who are not overweight think they need to lose weight? There’s no simple explanation. Experts believe that genetic, environmental, psychological, and social factors can all play a role in eating disorders. Studies suggest that movies, magazines, and television contribute to eating disorders by idealizing overly thin women and exacerbating body dissatisfaction, especially in people with low self-esteem. Fashion magazines often feature models with obvious signs of anorexia. The theme is clear: less is more.
My intuition tells me we’re at a tricky point in the national discussion of weight. Since research suggests that the wrong public message can be especially dangerous for patients at risk of an eating disorder, we need to be very careful as we develop strategies against obesity. As they create their plans, agencies such as the Centers for Disease Control (CDC) should include experts in eating disorders.
For this week’s CBS Doc Dot Com, I talk to Leslie Lipton and her father, Roger, about how Leslie has successfully battled anorexia. Click below to watch the video:
I also interviewed Dr. B. Timothy Walsh, a renowned expert on eating disorders and Professor of Psychiatry at Columbia University Medical Center and author of the book, “If Your Adolescent Has an Eating Disorder.” Click below to watch the video:
Day in, day out, it’s like a broken record. Patient comes in with uncontrolled diabetes. Patient gets sick. Patient gets patched up. Patient could care less about their health. Patient goes home to live another day, before coming back in a month. Everyday you just accept the reality of reckless self destruction, do your best to help them while they pretend to care and then send them on their way.
Except when a patient actually shows some interest in their health. Let me give you an example. I was asked to consult on a woman with shortness of breath, unbearable heartburn, aches and pains, low energy and sleep apnea. This woman weighed close to 400 pounds. Her husband was close to that as well. Together I sat them down and talked to them for darn near an hour. We talked about all the complications that come with folks in their age group. I asked them if they had a plan for success. What their motivations were. What their goals and expectations were.
They talked about how their exercise regimen. When I tried to pin down exactly what they were doing and how much and how often, it turns out that the twice a week walk around the lake was their idea of trying. They swore up and down about the their appropriate food choices, until they admitted that their biggest problem was not what they eat, but how much they eat. For an hour I heard about how hard it was. About how frustrating it was not to see any success. About how life wasn’t fair.
And then I met their polar opposites. A man and his wife both pushing 300 pounds. He was admitted with cellulitis of the leg. But both had lost a combined 220 pounds in just seven months. I was floored. 220 pounds? That put the biggest smile in the world on my face that day. I congratulated them probably 20 times.
I asked them, “I have so many patients who just can’t find a way to lose weight. How and why did you do it?” The answer was exactly what I expected.
“We had to. We were always tired. I was always hurting. I could barely walk. My wife could barely move. We considered gastric bypass but they wouldn’t do it without first doing six months of diet and exercise. Now I’m not even considering surgery. We went through our cupboards and we got rid of all processed foods. We eat healthy. We control our portions.”
Their motivation was their own. They realized they didn’t want to live their current reality. They took the initiative to make positive change in their lives and were basking in the glory of their success. What was the difference between these two couples? It was their attitude. One couple chose to make excuses for their plight. The other was doing something about it.
For this week’s episode of CBS Doc Dot Com, I went back to camp. OK, it wasn’t my camp – Camp Algonquin in Argyle, New York – now defunct, where I spent many an idyllic summer growing up. It was Camp Shane in Ferndale, New York, listed on their website as “The original, longest running weight loss camp in the world” at 41 years and counting.
This is a tough time to be overweight or obese. Last week the Centers for Disease Control announced that obesity-related diseases account for 147 billion dollars in medical costs every year in the United States.
About a quarter of Americans are obese and two thirds are either obese or overweight. Over the past twenty years, obesity in teenagers has increased from 5 percent to almost 18 percent. Obese children and adolescents are more likely to become obese adults. Which brings us back to Camp Shane.
I spent an hour talking to about a dozen kids ranging from ages 11 to 17 who had been gathered into a group by Camp owner David Ettenberg and his wife, Zipora. They came in all shapes and sizes but shared a common sentiment – they felt safe at camp, surrounded by people who accepted them for who they were. It brought tears to my eyes to hear how supportive they were of each other, how open they were about their emotions and fears.
In school other kids often mocked them. There’s no way that would be tolerated at camp – not just by the staff but, more importantly, by the campers. “We’re all in this together,” one boy offered. A girl added, “It’s a safe zone for us.” A teenage girl said “You can wear a bikini without being made fun of.” I asked, “What would happen if you wore a bikini at home?” She answered, “You’d most likely get made fun of and like pushed in a pool. Ah ha, you’re fat.”
A boy told me that kids at his school would ask him, “‘Why are you so massive?’ And like usually I’d just laugh it off but sometimes it does get a little annoying. I’m like, how long until I get back to camp?”
The kids all said they had lost varying amounts of weight at camp through portion control and exercise, a program supervised by pediatrician Dr. Joanna Dolgoff. The challenge has been trying to stay on track once they leave camp and return home.
If they can do it at camp, they can do it at home. But not without the support of parents and schools who have been educated about how to help their children make healthy choices. My good friend, Dr. Mehmet Oz, has launched a wonderful organization called HealthCorps “to help stem the crisis of child obesity through school-based health education and mentoring, as well as community events and outreach to underserved populations.” Click here to see the HealthCorps website.
Click here to see this week’s CBS Doc Dot Com about my trip to Camp Shane.
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