Comments

Back from a wonderful week in Malta - beautiful sun; warm people and a pleasure to visit!

Thanks for your thoughts Val. Same problem here in UK - whoever cracks the balance of supply/demand/cost/technological progress/ will make a fortune writing the book. Actually I don’t have a problem with ‘free screening’ if it allows doctors to got on treating ill people rather having too much of their valuable not to mention expensive time drained away by having to see people who are not ill. Let doctors use their skills fixing sick people and let the worried well be better educated in managing their own health. We all know it makes sense. The Pareto effect over here is that the great majority of health care is provided in primary care and yet significantly less funding is provided for primary care. Conversely a small proportion of healthcare is actually provided in hospitals and yet the biggest lump of expenditure goes into hospitals! Where is the sense in that? But ask politicians if they are prepared to see hospitals close and more money spent in primary care and the answer is always no.

Posted by Trevor Gay at August 22, 2006 2:21 PM

Having spent a career in Automotive, and having family in healthcare, it would be an informative study to see exactly where the money goes (Pareto). Physician wages are lower than relative historical, nurses are frequently on strike, and HMO's are an added cost layer.

One hospital nearby has successfully implemented Lean Manufacturing concepts in their Emergency Room and now advertises their ER will see you in 29 minutes or less. Their per-patient costs will have come down as the time and patient stress is reduced. Using a data centric approach will uncover the cost factors in the rest of the healthcare system where they can be addressed.

Unfortunately, there are strong lobbiests for the HMO's, drug companies, and government payment systems like Medicare that will reduce opportunities.

Posted by john at August 22, 2006 4:14 PM

Make each healthcare consumer responsible for paying their own premiums, just like they do for car and house insurance.

It amazes me how a large number of women in LA can afford medical services such as breast augmentation, a procedure not covered by most insurance plans. Oh, that's right, market forces have made the procedure "economical" and safe.

The American Dream is achievable once you take government controls out of the equation.

We keep punishing small businesses with increasing healthcare demands so they will finally throw up their hands, give up and their employees be "saved" by government run universal healthcare.

I'm surprised Tom missed that...

Posted by Jerry Martinez at August 22, 2006 4:38 PM

I'm one of those consumers who have been responsible for paying my own (high)premiums, including the high deductible. Year after year I continue to get the large annual increases, notices to encourage me to go to free screenings and clinics and letters informing me that the preventative measures that I have been taking to insure my stellar health are interesting, but not covered. My company holds me up as a fine example of responsibility. Ka-Ka.

Everyone is being punished.

Posted by Kate at August 22, 2006 5:24 PM

I think more market-based selling and buying are in order. I work for a Fortune 100 company with over 100,000 employees. Our group insurance administrator sends statements showing the amount billed and the amount the doctors in the plan hve agreed to. The billed cost is often 100% to 400% higher than the agreed-to amount. I suppose I am glad my company has negotiated a discount, but I wonder about the prices the uninsured must pay. I already know that doctors will take half what they charge, so why can't everyone benefit?

There is a huge amount of paperwork involved. I also wonder where the money goes.

Posted by Richard at August 22, 2006 9:43 PM

It reminds me of a comment I read a few years ago. Why are doctors paid for ill patients, why are they not paid for keeping people healthy? In the old days this is what happenened...maybe this would reduce the burden on the system....interesting principle.

Posted by Anna Farmery at August 23, 2006 2:24 AM

"Free enterprise" and "Healthcare" may never meet. Obesity epidemic challenge too driving costs! Radical lean & serene & get in PLAN with like radicals to save Zillions.

Posted by sean at August 23, 2006 8:09 AM

Why not have a P2P self-funded network of similar individuals to insure themselves? Why should those who lead a healthy lifestyle pay for those with an unhealthy lifestyle? Remove the insurance company from the equation. We could do this today.

Posted by Brett Rogers at August 23, 2006 8:42 AM

I continue to be disappointed with our country's unwillingness to step up to the health care crisis. It is perhaps a symptom of a democracy that has been hijacked by business interests at the expense of our health. I do think there is personal responsibility here as well. Smokers, obese, and other unhealthy conditions by choice should pay far higher premiums. I am not hopeful that we will soon find a remedy.

Posted by Mike Neiss at August 23, 2006 10:26 AM

Sean & Brett--Here's why not, because a "healthy lifestyle" is only one factor in a person's overall health. Genetics play a big role. What about the living environment? Can I join your P2P network if I live 20 miles downstream from a chemical plant? LIFE has as much an effect on health as lifeSTYLE--divorce stress, financial worries, kids becoming delinquents, boss abuse, job loss, and not to mention plane crashes, car wrecks, sports injuries, and so on. Despite what some would have us believe, USE of health services does not drive up costs--it is the ABUSE--presriptions for everything, constant E-room visits instead of waiting for a doctor appointment, etc. Second major factor is the fact that those of us who are insured are paying for the uninsured. Third factor is the gov't fountain of "no questions asked" Medicare/Medicaid payments to unscrupulous types. Fourth factor is over-inflated clerical "businesses" who only send bills and collect receipts, but who get their "cut." Fifth factor is the litigous society we live in and the CYA attitude that brings about in medical professionals.

Posted by Mike at August 23, 2006 10:36 AM

ACCOUNTABILITY!!

All the way around. Tax the fatfood? Charge the abusers? Sue the unaccountable?
Did the increased tax on tobacco help lung cancer?
Either way, there needs to be measures taken to improve health generally. Then put in place a scoreboard to measure the progress. How long do we wait?

Posted by Frank J. Foti at August 23, 2006 1:44 PM

Mike - lifestyle CHANGE is the big factor though - almost 90% of illness is choosing obesity, smoking, drugs, chemical laden "nutrition", lack-of-stress reduction technique. P2P is here: 30 of us in my group health have a [2] Family MD that serves us at home - on call - emergency, etc. - based on our FICO scores, medical history, etc. - AND yes it is very cost effective.

Posted by sean at August 24, 2006 8:24 AM

I question your 90%, Sean. Please link me to a credible source.

That P2P is nice for you--until one of the elite 30 gets hit with a huge pay-out for some catastrophic illness (which, of course, the healthier-than-thou elites get as much as anyone else--remember Jim Fixx?) and the other 29 go bankrupt paying for the treatment.

The whole idea of insurance is based on maximizing the numbers to the point that the hit is minimized when something big occurs. Good health is really probably the #1 cause of high medical bills because we are all living so long now that we get all sorts of nasty problems past generations never had to worry about!

Posted by Mike at August 24, 2006 10:49 AM

90%? Seems pretty high to me. That almost entirely discounts the effects of heredity. It also leaves out entirely things for which we simply can't identify a cause. Plus, let's not forget that "health care" is also about caring for people injured in accidents.

Posted by Wally Bock at August 24, 2006 5:30 PM

Sean et al - take a look here about the current and future problems we have in the UK regarding obesity - scary or what?

http://news.bbc.co.uk/1/hi/health/5282446.stm

I too suspect 90% may be a bit high but Sean's fundamental point is right on. We all know that lifestyle change is the most important single thing we can all do as individuals. It is simply hopeless to expect people to 'just change' unless they have a personal commitment to change. Governments, Publicity and Doctors 'telling people' to change will NEVER have the same impact. I say that after 35 years in government healthcare in the UK and in the knowledge that most of my best friends are Doctors! I'm 100% with Sean on this.

Posted by Trevor Gay at August 25, 2006 2:44 AM

I'm not from Missouri, but please SHOW ME. It's easy to say that "we all know that lifestyle change is the most important single thing," but let's see some proof. Actuarial tables would be a good start, IF they break down other environmental factors.

Also, don't forget there is a big difference between what the gov't calls "obese" and what really is obese. There are sound biological reasons people in northern climes put on winter fat.

My point is that the original point--use of healthcare services somehow drives the cost out of control--is completely incorrect. The secondary, but equally important point, is that people (in the west anyhow) are much HEALTHIER than they used to be and therefore LIVE A LOT LONGER, which causes a lot of lat-in-life problems previous generations never had to worry about because they died much younger.

Posted by Mike at August 25, 2006 6:28 AM

Hi Mike - I like your style - good questions. I am a ‘hearts and minds’ man and proud of it rather than always looking for hard evidence before doing something. I follow my gut a lot of the time. ‘Evidence base’ is essential of course and I am not decrying it completely. It is very good that people ask for evidence before investing lots of money into healthcare - it's just that I personally value anecdote, story telling and the subjective FAR MORE than the ‘hard’ measurable stuff. I only have to look around with my own eyes here in England to see the evidence of increasing obesity – particularly worryingly in young people. It is clearly a higher proportion now than when I was a kid all those centuries ago. I only have to ask patients in healthcare about the service they receive to understand how crap it is a lot of the time. Doctors are always being asked for an ‘evidence base’ for their recommendations to improve services and a good friend who is a Surgeon said to me he would love the see the ‘evidence base’ for some dreadful management decisions that happen in his hospital. My point is there does not have to be an ‘evidence base’ for everything – sometimes we have to follow our gut. I do that a lot and needless to say I suffer as a result sometimes by misreading things. That is great learning though. The view I take is that I would rather do SOMETHING than wait until everything is proven beyond doubt before taking any action. Applying the latter in my experience invariably means you miss the boat while you are busy planning, researching and seeking evidence while your more nimble competitors have moved ahead of you.

Great discussion Mike - enjoying it – that makes it ‘15 all’ I hope! :-)

Just a couple of questions – what is the reference to Missouri about and what the heck is a P2P?

Posted by Trevor Gay at August 25, 2006 8:36 AM

Sorry for the Americanism, Trevor. Missouri is known as the "Show Me State." Folklore says that people from Missouri never take anyone's word for anything, they always demand proof.

A P2P is short for Peer-to-Peer (sometimes Patient-to-Patient), same as B2B is short for Business to Business.

Posted by Mike at August 25, 2006 8:48 AM

Thanks Mike - I am learning your language slowly :-)

Posted by Trevor Gay at August 25, 2006 9:30 AM

Trust but verify as Ronald Reagan always said.
"In addition, medical research estimates as much as 90 percent of illness and disease is stress-related."

http://www.cdc.gov/nasd/docs/d001201-d001300/d001245/d001245.html

Mike - you seem simple in your approach and resigned to less than maximizing the divine gift [body & mind].

Posted by sean at August 28, 2006 8:11 AM