N. Gregory Mankiw’s article “Why Health Care Will Never be Equal” http://bit.ly/2m0wzU describes only two legs of the three legs of health in America. He excludes from his equation the fact that compliance by individuals and their physicians with known guidelines for care can reduce medical risk and increase longevity at dramatically lower cost. These efforts can reduce as much as a third of the money spent today for health in America. This amount of money is more than enough to pay for everyone and even leave a little over for other items to reduce our national debt.
We are overweight, comply with recommendations for diabetes management less than 50% of the time, and do not get screened for cancer when we should. These low cost non compliant behaviors insure the continuing supply of patients who wastefully consume our health dollars. We have become dependent on the bail out of expensive medicines and treatments instead of taking actions to avoid their use in the first place.
In addition, significant proportions of Americans who take multiple drugs have adverse drug reactions (not drug interactions) and are not aware of them. These idiosyncratic (Specific to each individual person response to medicines) reactions often lead to unnecessary tests and hospitalizations. In fact, the Institute of Medicine has reported on average five thousand dollars of every hospital admission is spent on the clinical presentation of adverse drug reactions.
Dr. Mankiw does not address the contributions to society that result from the investment in life years gained from treatment.
We could avoid the ethical dilemma raised by Dr. Mankiw, if our culture changed to simply follow a more logical approach to health using available information technology correctly.
The Health Gadfly
Thursday, September 24, 2009
Monday, September 14, 2009
Pathway to Health Care Reform
HealthNewsDigest published “Pathway to Health Care Reform” written by The Healthgadfly and his colleague this past Sunday September 13, 2009.
http://bit.ly/U835y
Health News Digest is a member of the New York Press Club, The Association of Health Care Journalists and The Online News Association. This prestigious 10 year old Online Magazine publishes news stories on the Health Industry on a daily basis.
They are syndicated to thousands of major health industry Websites and wireless phone systems. Also, over 2,000 news editors, and health columnists subscribe and have free access to use any and all content.
The Health Gadfly
http://bit.ly/U835y
Health News Digest is a member of the New York Press Club, The Association of Health Care Journalists and The Online News Association. This prestigious 10 year old Online Magazine publishes news stories on the Health Industry on a daily basis.
They are syndicated to thousands of major health industry Websites and wireless phone systems. Also, over 2,000 news editors, and health columnists subscribe and have free access to use any and all content.
The Health Gadfly
Thursday, September 3, 2009
Our President is on the Ropes
The Health Gadfly was again welcomed as a lead Op-Ed by The Health Care Blog on September 3, 2009. http://bit.ly/3nqGxu9
Thursday, August 27, 2009
Change Your Strategy, Mr. President
Emerging consensus is against another health plan sponsored by the federal government.
There is already much oversight at federal and state levels of all insurance programs, yet these programs experience unsustainable cost trends. Medicare, Medicaid and the Federal Employee Health Benefit Plans are modeled after private insurance plans and they do not work economically. In the instances where profit incentives have been removed from government-run programs such as the federal employee health plans, the trends in these plans are not significantly different from private insurance plan trends.
One sustaining aspect of our health system is the belief in the patient/doctor relationship. This bond between patients and their physicians continues to survive insurer, government, and other third party interference. This patient physician bond must be strengthened in any successful strategy for change.
Instead of continuing to list all that is wrong with American Health and coming up with new unproven expensive plans for change, the president should focus on practical ways to improve quality in health care by leveraging our patient physician bonds.
First he has to communicate the message to everyone that on average clear evidence indicates that Americans receive substandard basic health care. This circumstance is driving up our health costs because without basic care we often develop catastrophic expensive illness. Less than 50% of all Americans participate in early cancer detection programs whether or not they have insurance coverage. Similarly for diabetes, many people develop complications of stroke and kidney failure because they do not follow basic treatment recommendations of the American Diabetes Association.
Physicians and their patients, contrary to their perception, do not have useful up to date information when making health care decisions that involve everyday health care.
One powerful source of information to improve health, and strengthen physician and patient bonds has been available for years yet not shared. Medical claims, laboratory results, and pharmacy data stored in health plan administrators’ computers (Medicare, Medicaid, Private Insurers, and Third Party Administrators) are available and able to support individual and doctors efforts to narrow quality of care gaps. Proper organization of this data can link every diagnosis, test, and prescription for each patient in a way that each doctor and patient are unable to do for themselves. The government can make this happen by regulation.
Our President can no longer avoid sharing available and accurate health information that may be in conflict with some special interest groups that supported his campaign. Those involved in health plan administration must no longer withhold vital information about our health even though it may not be in their financial interest to disclose it.
Only with clearly understood reasons for change will change occur, patient physician bonds strengthened and special interests pushed aside. Changing the discussion to a “Moral Imperative” as mentioned today http://xrl.us/bfat4w does not give a practical incentive for change that is ultimately determined by the people of America. He has already won consensus on the need for change.
If our President does not get off the ropes quickly and change his strategy to improving health by strengthening the patient/doctor relationship he will get knocked out of the health care arena very much like his predecessors and the opportunity for “Change” regarding health care in America will be lost. The President and the nation risk losing much more than the battle for our nation’s health.
The Health Gadfly
There is already much oversight at federal and state levels of all insurance programs, yet these programs experience unsustainable cost trends. Medicare, Medicaid and the Federal Employee Health Benefit Plans are modeled after private insurance plans and they do not work economically. In the instances where profit incentives have been removed from government-run programs such as the federal employee health plans, the trends in these plans are not significantly different from private insurance plan trends.
One sustaining aspect of our health system is the belief in the patient/doctor relationship. This bond between patients and their physicians continues to survive insurer, government, and other third party interference. This patient physician bond must be strengthened in any successful strategy for change.
Instead of continuing to list all that is wrong with American Health and coming up with new unproven expensive plans for change, the president should focus on practical ways to improve quality in health care by leveraging our patient physician bonds.
First he has to communicate the message to everyone that on average clear evidence indicates that Americans receive substandard basic health care. This circumstance is driving up our health costs because without basic care we often develop catastrophic expensive illness. Less than 50% of all Americans participate in early cancer detection programs whether or not they have insurance coverage. Similarly for diabetes, many people develop complications of stroke and kidney failure because they do not follow basic treatment recommendations of the American Diabetes Association.
Physicians and their patients, contrary to their perception, do not have useful up to date information when making health care decisions that involve everyday health care.
One powerful source of information to improve health, and strengthen physician and patient bonds has been available for years yet not shared. Medical claims, laboratory results, and pharmacy data stored in health plan administrators’ computers (Medicare, Medicaid, Private Insurers, and Third Party Administrators) are available and able to support individual and doctors efforts to narrow quality of care gaps. Proper organization of this data can link every diagnosis, test, and prescription for each patient in a way that each doctor and patient are unable to do for themselves. The government can make this happen by regulation.
Our President can no longer avoid sharing available and accurate health information that may be in conflict with some special interest groups that supported his campaign. Those involved in health plan administration must no longer withhold vital information about our health even though it may not be in their financial interest to disclose it.
Only with clearly understood reasons for change will change occur, patient physician bonds strengthened and special interests pushed aside. Changing the discussion to a “Moral Imperative” as mentioned today http://xrl.us/bfat4w does not give a practical incentive for change that is ultimately determined by the people of America. He has already won consensus on the need for change.
If our President does not get off the ropes quickly and change his strategy to improving health by strengthening the patient/doctor relationship he will get knocked out of the health care arena very much like his predecessors and the opportunity for “Change” regarding health care in America will be lost. The President and the nation risk losing much more than the battle for our nation’s health.
The Health Gadfly
Thursday, August 20, 2009
Government Intervention VS. Personal Responsibility in Health
The health Gadfly was welcomed by The Health Care Blog and they discussed health care reform!
http://tiny.cc/HMCYm
http://tiny.cc/HMCYm
Starting Points for Change
President Obama has challenged America to a fresh dialogue about how to improve our healthcare system. Yet, proposed steps for health care reform recapitulate old failed strategies. We can not reduce payments to hospitals and doctors, decrease payments for pharmaceuticals, replace physicians with nurses, and deny care based on age and anticipated life years, as our first steps to reform.
We all acknowledge that Healthcare is one of our Nation’s top priorities. Health (cost and quality as measured by health status) determines our productivity, our competitiveness in the world economy, and ultimately the strength of our national defense.
So what is it that has to change in order for our President and our country to succeed in making us a healthier nation at an affordable cost?
First, we must recognize that health, like democracy, requires active participation of our citizens. Our government does not work when we fail to vote; our health system can not work when most of us fail to actively participate in taking care of ourselves and our families according to known guidelines for prevention and disease management.
Every person in America needs to have a clear understanding of the rules of the road for health and follow them. We have plenty of precedents that require individual behavioral change to reduce high cost damage to society. “Click it or Ticket” is one example. We have to begin to drive on the right side of the road to health or some of us must pay more for their health care. Paying for health care with increased taxes will not change the behavior of rich and poor who do not participate in their own individual health reform. The knowledge gap that needs to be closed is to let uninsured and insured of all socioeconomic groups know the truth about the quality of their health care. Quality is defined as compliance to known standards for preventive health and medical condition management.
Americans put off proactive management of health, choosing to exchange low cost opportunities for high cost treatment of advanced disease that is often preventable. We have been seduced by our technological success and then blame pharmaceutical companies and health providers for the high cost of health care.
There are other mechanisms to achieve health care reform without adding new insurance programs. The technology already exists to provide every member of society a simple straight forward outline of their individual responsibilities for health care.
We have come to believe that if some kinds of care are not covered by insurance, we do not need it. We have also become sidetracked into believing that limited access to physicians who accept low fees is good enough. It is not. The economics of health cost in America is a demand side problem, not a supply side problem. The economics of health is market driven, and much like the failed war on drugs, can not be won by eliminating the suppliers. (Alcohol Prohibition 1930’s !)
Runaway health costs can only be reigned in by reducing demand for services; not by limiting access to care that will certainly result from reducing payments to hospitals and doctors. This insurance company strategy of lowering payments for services has not worked for the past 40 years; why would one think it will work today? Contrary to traditional thinking, the rising cost of health care is not as much related to how much is paid for a unit of service, a procedure, or a specific drug as it is to diagnostic and treatment plans outlined by doctors. The real driver of medical inflation is lack of use of existing resources in a rational manner and according to known guidelines for preventive care and chronic disease management.
One recent development gaining momentum in America which successfully aligns physicians, their patients, and their claims administrators is Value Based Health Care. This new benefit design links compliance to health care standards required by each individual plan member to the cost of his contribution for premium. The components of such plans use existing web based personal health records as the vehicle to communicate an individual’s preventive and condition management responsibilities. Aggregate reporting highlights improved population health status as costs decrease. Hospitals and physicians adjust to less demand, and irrational regional expense differences for care are reduced. Physicians and hospitals, who achieve better health status among their patients, can receive better payments.
Change is required and simple is better. Health Care is a behavioral and social problem; it is not amenable to change by administrative economic fiat as currently proposed.
The Health Gadfly
We all acknowledge that Healthcare is one of our Nation’s top priorities. Health (cost and quality as measured by health status) determines our productivity, our competitiveness in the world economy, and ultimately the strength of our national defense.
So what is it that has to change in order for our President and our country to succeed in making us a healthier nation at an affordable cost?
First, we must recognize that health, like democracy, requires active participation of our citizens. Our government does not work when we fail to vote; our health system can not work when most of us fail to actively participate in taking care of ourselves and our families according to known guidelines for prevention and disease management.
Every person in America needs to have a clear understanding of the rules of the road for health and follow them. We have plenty of precedents that require individual behavioral change to reduce high cost damage to society. “Click it or Ticket” is one example. We have to begin to drive on the right side of the road to health or some of us must pay more for their health care. Paying for health care with increased taxes will not change the behavior of rich and poor who do not participate in their own individual health reform. The knowledge gap that needs to be closed is to let uninsured and insured of all socioeconomic groups know the truth about the quality of their health care. Quality is defined as compliance to known standards for preventive health and medical condition management.
Americans put off proactive management of health, choosing to exchange low cost opportunities for high cost treatment of advanced disease that is often preventable. We have been seduced by our technological success and then blame pharmaceutical companies and health providers for the high cost of health care.
There are other mechanisms to achieve health care reform without adding new insurance programs. The technology already exists to provide every member of society a simple straight forward outline of their individual responsibilities for health care.
We have come to believe that if some kinds of care are not covered by insurance, we do not need it. We have also become sidetracked into believing that limited access to physicians who accept low fees is good enough. It is not. The economics of health cost in America is a demand side problem, not a supply side problem. The economics of health is market driven, and much like the failed war on drugs, can not be won by eliminating the suppliers. (Alcohol Prohibition 1930’s !)
Runaway health costs can only be reigned in by reducing demand for services; not by limiting access to care that will certainly result from reducing payments to hospitals and doctors. This insurance company strategy of lowering payments for services has not worked for the past 40 years; why would one think it will work today? Contrary to traditional thinking, the rising cost of health care is not as much related to how much is paid for a unit of service, a procedure, or a specific drug as it is to diagnostic and treatment plans outlined by doctors. The real driver of medical inflation is lack of use of existing resources in a rational manner and according to known guidelines for preventive care and chronic disease management.
One recent development gaining momentum in America which successfully aligns physicians, their patients, and their claims administrators is Value Based Health Care. This new benefit design links compliance to health care standards required by each individual plan member to the cost of his contribution for premium. The components of such plans use existing web based personal health records as the vehicle to communicate an individual’s preventive and condition management responsibilities. Aggregate reporting highlights improved population health status as costs decrease. Hospitals and physicians adjust to less demand, and irrational regional expense differences for care are reduced. Physicians and hospitals, who achieve better health status among their patients, can receive better payments.
Change is required and simple is better. Health Care is a behavioral and social problem; it is not amenable to change by administrative economic fiat as currently proposed.
The Health Gadfly
Wednesday, August 19, 2009
Health Cooperatives
Ontogeny Recapitulates Phylogeny
Blue Cross and Blue Shield regional health plans were begun in the 1920’s in Texas as not for profit efforts to provide health insurance that protected individuals and families from unacceptable cost of hospital and doctor care. These regional cooperative efforts between doctors, patients, and labor were very successful because their rates were the same for everyone. Not until employers set up their own plans and spirited away the lowest risk groups from the cooperatives did the cost of the Blue Cross plans begin their long ascent to not being affordable for anyone.
Medicare then guaranteed that the government would have the highest premium based on age adjusted risk. Medicare also relieved private insurers of high risk liability. And finally, HMOs appealing to young families with little risk continued to fragment the American health risk pool. As HMOs gained in popularity and their membership aged they could not deliver the same benefits at lower cost as promised.
In the evolution of health care as in the development of embryos of all kinds, ontogeny recapitulates phylogeny. We learn form this axiom of science that nature will not allow us to evolve to the past. This is especially true when it comes to health care reform. Any new system of health will now require reduction of high cost outlier care by improving the health status of everyone. Any new system will have to be all inclusive to succeed. The goal of health care today today is to reduce the number of people in our whole population that require care for catastrophic illness. Any one left out of the process costs us all more.
No alternative administrative change to health cooperatives or budget reductions for insurers and third party administrators can succeed to stabilize health expense unless we use existing high quality readily information for each of us to guide change to better health. By focusing the debate on improving health and avoiding risk for unnecessary, avoidable and expensive medical care, lower medical expense will be achieved, wastfull spending eliminated and unwanted unpopular government fiat avoided.
New methods of budgeting disguised as health cooperatives is the ostrich head-in-the-sand approach to dealing with our personal and national health need. Preventive proactive health is the responsibility of each person and his physician. Until this behavior change to practive health care occurs there will be no opportunity to reduce medical expense trend in America.
The Health Gadfly
Blue Cross and Blue Shield regional health plans were begun in the 1920’s in Texas as not for profit efforts to provide health insurance that protected individuals and families from unacceptable cost of hospital and doctor care. These regional cooperative efforts between doctors, patients, and labor were very successful because their rates were the same for everyone. Not until employers set up their own plans and spirited away the lowest risk groups from the cooperatives did the cost of the Blue Cross plans begin their long ascent to not being affordable for anyone.
Medicare then guaranteed that the government would have the highest premium based on age adjusted risk. Medicare also relieved private insurers of high risk liability. And finally, HMOs appealing to young families with little risk continued to fragment the American health risk pool. As HMOs gained in popularity and their membership aged they could not deliver the same benefits at lower cost as promised.
In the evolution of health care as in the development of embryos of all kinds, ontogeny recapitulates phylogeny. We learn form this axiom of science that nature will not allow us to evolve to the past. This is especially true when it comes to health care reform. Any new system of health will now require reduction of high cost outlier care by improving the health status of everyone. Any new system will have to be all inclusive to succeed. The goal of health care today today is to reduce the number of people in our whole population that require care for catastrophic illness. Any one left out of the process costs us all more.
No alternative administrative change to health cooperatives or budget reductions for insurers and third party administrators can succeed to stabilize health expense unless we use existing high quality readily information for each of us to guide change to better health. By focusing the debate on improving health and avoiding risk for unnecessary, avoidable and expensive medical care, lower medical expense will be achieved, wastfull spending eliminated and unwanted unpopular government fiat avoided.
New methods of budgeting disguised as health cooperatives is the ostrich head-in-the-sand approach to dealing with our personal and national health need. Preventive proactive health is the responsibility of each person and his physician. Until this behavior change to practive health care occurs there will be no opportunity to reduce medical expense trend in America.
The Health Gadfly
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