Personal Experience with Some of the Problems in Heath Care.

[grapejelly]

Re: Personal Experience with Some of the Problems in Heath Care.

Thanks. I read the article and always enjoy Gladwell's stuff.

1. I believe that demand for healthcare *is* virtually unlimited. And demand is elastic -- it responds to price incentives.

2. It is my impression that poor people have a disproportionate amount of diabetes, obesity, high blood pressure and asthma. I believe it is a matter of lifestyle choices and not an access to health care issue. I think people with these problems are clogging up our healthcare system and if they changed their lifestyle they would become healthier and wouldn't need medical care to the degree they do.

3. I think medical care is mostly destructive. Some of it is good but most of it is bad. Pills and procedures are demanded by US patients and provided by ignorant US doctors. Avoiding doctors and hospitals, while exercising and doing the things that contribute to good health, is the best course for longevity and good health. So I don't think more doctor visits is the answer to better health. Quite the opposite.

4. Where health care is socialized, the limits to consumption are put in place through either financial disincentives, or rationing in the form of long waits, long queues, etc. People who can afford it will look outside the system because their time is more valuable than the waiting and hoops they have to jump through so these countries have a two tier system in any event.

5. As I have gotten older the front office has expanded and I think a large percentage of health care dollars are spent in billing, claims and administration. I am sure this can be cut back in a big way without socializing the whole thing. I am very much against further collectivizing of American life so I am against socialized medicine. The government has never proven to be the solution, so why would they be one here? It makes no sense...

[jk]

Re: Personal Experience with Some of the Problems in Heath Care.

This wasn't that big a deal to me - maybe one can argue that US healthcare is better, for those who can pay.

I used to think this, too. I thought “everyone knows the u.s. has 2 healthcare systems, and the bad stats are the result of averaging things over the whole population. The people in the GOOD healthcare system must be doing much better." But a recent study compared health in britain [not necessarily the healthiest folks re diet, etc] and the u.s., and found that health in britain was better than that for people with good health insurance. Reason: lifestyle, e.g. diet, exercise, etc.

1. I believe that demand for healthcare *is* virtually unlimited. And demand is elastic -- it responds to price incentives.

Most people hate going to the doctor and avoid it as much as possible. There is a small subpopulation of worried well who overuse resources.

2. It is my impression that poor people have a disproportionate amount of diabetes, obesity, high blood pressure and asthma. I believe it is a matter of lifestyle choices and not an access to health care issue. I think people with these problems are clogging up our healthcare system and if they changed their lifestyle they would become healthier and wouldn't need medical care to the degree they do.

yes, if everyone ate better and exercised more the rates of diabetes and heart disease would plummet. It would also be nice if people read more and watched tv less, patronized the arts, renounced violence and stopped littering.

3. I think medical care is mostly destructive. Some of it is good but most of it is bad. Pills and procedures are demanded by US patients and provided by ignorant US doctors. Avoiding doctors and hospitals, while exercising and doing the things that contribute to good health, is the best course for longevity and good health. So I don't think more doctor visits is the answer to better health. Quite the opposite.

Sure, taking care of yourself in basic ways is a good idea and too much of medicine is geared to procedures and pills. That’s what our system is structured to pay for. We need a whole different system, a health system instead of an illness system, to change that. But in the meantime, you’ll be grateful for the illness system if you or someone you love has a terrible illness.

4. Where health care is socialized, the limits to consumption are put in place through either financial disincentives, or rationing in the form of long waits, long queues, etc. People who can afford it will look outside the system because their time is more valuable than the waiting and hoops they have to jump through so these countries have a two tier system in any event.

perhaps some of our canadian members will comment here. Somehow our northern cousins get along. Yes, some come south of the border for medical care if they can afford it. But again, I refer to the study comparing health among u.s. privately insureds and the british – for all the fact that the national health service is in many ways a disaster, they are nonetheless healthier. This goes back to your own point about lifestyles.

5. As I have gotten older the front office has expanded and I think a large percentage of health care dollars are spent in billing, claims and administration. I am sure this can be cut back in a big way without socializing the whole thing. I am very much against further collectivizing of American life so I am against socialized medicine. The government has never proven to be the solution, so why would they be one here? It makes no sense...

the numbers I’ve seen are that administrative costs eat up about 25-30% of health care spending in this country. It is this fact and my dealing with it personally day by day that have led me, reluctantly, to the conclusion that a single payer system is the best answer. The va system actually isn’t bad.

[Jim Nickerson]

Re: Personal Experience with Some of the Problems in Heath Care.

jk, very incisive (good adjective from a dentist no less, eh?) reply, and I think it is commendable that you didn't disrepect grapejelly's opinion in any way. Without differences of opinion and the willingness to put them forth, all of this is for naught.

[DemonD]

Re: Personal Experience with Some of the Problems in Heath Care.

Jim -

Erm, sorry I didn't quite get the gist of what you were saying at first, heh. Glad I could help you out though.

Incidentally the "D" stands for the first initial of my first name. I've chosen DemonD as my handle for financial based websites, messageboards, etc.

Why is normal human "maintenance" paid for with insurance?

Ah, something I can definitely add to the conversation in terms of parting my own macro knowledge. I'll have to look up some figures, but health care costs are similar to wealth curves when you look at cost. Something like the 20% most sickest people account for 80%+ of medical care in this country. Now, if we kept the "sickest" 10% of cars alive, car insurance may be this high too... but what happens when a car costs too much to fix? It gets totaled and put into a junk lot (or sold to a foreign country, or recycled into a gray market of used cars). The ethics of medical care are far more complex. You can blame the US constitution for this if you like, or you can take the glass-is-half-full view that a society can be judged by how it treats it's most vulnerable (the elderly, the sick, the disabled, small children).

Here is a link; there is a graph there for all you chart lovers, but I will type out the percentages

source: http://kff.org/insurance/snapshot/chcm111006oth2.cfm
(kff = Kaiser Family Foundation)

Concentration of Health Expenditures % of Total Health expenditure
Top 1% - 23.7%
Top 5% - 49.2%
Top 10% - 64.0%
Top 15% - 73.3%
Top 20% - 80.0%
Top 50% - 96.6%
Bottom 50% - 3.4%

So basically the 50% of us that are healthy are subsidizing the 50% of us that aren't, or more appropriately the sickest 20% in the country.

Now you say that isn't fair. But what is fair? While income distributions may be attributed to societal stability, medical expenditure is wholly different because of medical ethics. Sure, we could just let that top 1% die... but then what about the top 10%? And what if you were to fall into that situation where you had to be in an ICU for 6 months with chest tubes and the works? What if you had a child with cerebral palsy or muscular dystrophy? Who are you to decide who gets what services at what costs?

I'm not saying that we should always treat all the sickest people all the time with full expenditure. What I'm saying is that when you talk about paying for medical services, there is a lot of gray area, there is a lot of debate, there is a lot of things that involve medical ethics. Business ethics, for the most part, are cut and dry. If you apply for a loan as an investor and claim that it will be your primary residence, you are being unethical and committing a fraudulent felony. Now, what if you are a hospital administrator where a homeless person with AIDS walks into you ER... how do you deal with that situation? The human element makes any debate about medical costs much more difficult than debates about bubbles and currencies.

the numbers I’ve seen are that administrative costs eat up about 25-30% of health care spending in this country. It is this fact and my dealing with it personally day by day that have led me, reluctantly, to the conclusion that a single payer system is the best answer. The va system actually isn’t bad.

Medicare's costs are around 2% for administration. Very efficient. This doesn't take into account what is being paid for administration on the provider side, but the for-profit insurers are never paying out more than 85% (because they need their profit margins along with the cost of administration).

http://www.medicarerights.org/mainco...fastfacts.html
"17. Private plans typically have administrative costs eight to ten times that of Original Medicare. Whereas Medicare uses less than 2 percent of funds for administrative costs, Medicare private plans, on average, use 15 percent of funds for administrative costs."

Also, in terms of frivolous use of medicine, the regular payor family doctor system is probably not being used frivolously. The worker's compensation side of it however... let's just say when lawyers get involved in the medical care, everyone loses except the lawyer. I once read that the presence of a lawyer in any medical case decreases the chance of a positive outcome by 80%. o_O

Okay my head is going to explode... we can talk about medical insurance issues forever and it's not going to change anything, not on an internet message board like this anyway. I hope someone out there has a little better idea of what is going on though and how this is probably the most difficult thing our country will be dealing with in the very near future.

[Jim Nickerson]

Re: Personal Experience with Some of the Problems in Heath Care.

Contiued from post # 1.


That line read: 99214, X-mark, E&M Level 4, 181. At the bottom of the slip “181” was translated into $181.00 or bonars.

Now does anyone reading this, if anyone is, who is not jk or DemonD and is not a health care doctor, or allied health care worker know what “99214” and "E&M Level 4" mean?

If anyone knows exactly what they mean, or even approximately what they mean, please answer, and please add how you happen to know.

What are the purposes of those notations?

Picture yourself as the patient and ask yourself: was I just treated honestly?

Please comment if you like, otherwise just think about all this.

Stay tuned.

This is a continuation of my experience with the neurologist, post #2.

Actually after wife brought out charge slip showing $181 for a 10 minute visit, I either thought or said a lot of very uncivil sentiments as we drove home.

Between the visit and about 4:00PM that day, I went online and found a rather poor listing of CPT codes, which as I have written were truncated definitions, but they sufficed to convince me that the neurologist had over-coded or up-coded his services for my wife's visit and what his office would file with her insurance company.

I wrote him a letter, and hand carried it to his office that afternoon, recounting what he actually had done and said in the 10 minute visit, and I stated that I thought there had been some error in his ticking off the correct charge box for the visit. Further, if there were no error, then someone from his office should call me, preferably him, and tell me there was no error.

He called me about 30 minutes after I left the letter with the office receptionist. In my letter I had not specifically questioned in any way anything about the amount of the charges for the muscles and nerves stimulations studies he (in part) had performed; however, the first thing he offered in explanation was that the insurance company would not allow all of those charges (~$1500) and that we should not worry because some siginificant portion of them would be disallowed by wife's insurance, a company with which he had a contractual agreement to accept certain levels of reimbursement.

Further, he did not seem to think his having coded the 10 minute follow up visit of earlier that day as excessive in checking it off to be a level 4, CPT 99214 service that he had rendered. He offered the same type explanation as above. The company would disallow a lot of it, and that would lessen what we would be responsible for paying for his "service."

I replied that I thought the coding he chose was definitely an overcharge and should be appropriately revised to something less whereupon he relented and said he would make it a "level 3" charge. I asked how much would that be. He had to put me on "hold" and go to his front desk to find out (perhaps I was then and am now wrong to think there is something significantly awry when a provider cannot tell you what he is charging for a commonly rendered service) He returned and said a level 3 charge would be $116 for the 10 minutes he expended with us. I asked him if he really thought his time was worth so much when 10 minutes at that rate is extended to a per hour charge? His reply was the charge would be $116.

My contention was and is that by any standard the level of service he rendered was at best a level 2 service, and thus a CPT code of 99212. I know as a fact that in the collective billing organization in which the neurolgist's office participated that a level 2 service is billed at $83. I don't think I am being unfair to anyone to say if Jane Sixpack, a retired dental assistant, had encountered these same events, her insurance company would have been billed $181, and the company would have disallowed about 40% of the charge leaving Jane with a legal liability of $108.60 to pay because she carried a $2500 deductible.

In the actual claim submission using a level 3 CPT code to wife's insurance company 41.18% of $116.00 was disallowed, and we had the legal liability to pay $68.23. I also know as fact that if a level 2 visit were billed at $83.00, the disallowance would have been 40.99% leaving the patient with a legal liability of $48.98. So what this comes down to is that a provider by up-coding a 10-minute visit by two CPT levels could generate right at $60 more in charges due or perhaps collected, or 60/48.98 = ~ 120% more in revenue. Just to remove any doubt, up-coding in submission of a claim to an insurance company is FRAUD.

Now if a provider has the greed/dishonesty/lack of self-respect to engage in such activity as this and succeeds in getting away with it just once a day, 5 days a week, 49 weeks a year, then it amounts to $14,700 a year. If one is more brazen in his/her greed/dishonesty/lack of self-respect and up-codes more frequently then the "jackpot" can just grow and grow.

DemonD suggested that insurance companies have algorithms to catch such as this to which I replied I think that notion is BS, though I will later recount an experience which could support his contention, so I will go ahead and apologize for my incivility to DemonD's comment.

One thing worth noting is that a health care provider in this free society of ours is not legally limited, to my knowledge, in what he/she/it can charge for services. The neuroligist, as an example, could have charged twice what he did in coding wife's visit as a level 4 service, i.e. $362 and coded it as a level 2 service--that would be an exhorbitant charge as I see it, but it would not be fraudulent. If such were to occur in a patient with same insurance as wife's, the allowance by the company would be for a level 2 service and payment by the company or patient could not exceed $48.98. So there is not limit on what a provider chooses to charge. Consider the patient who has no insurance, and encounters one of the neurologist's ilk. Without having insurance that unfortunate person would be legally liable for whatever the neurologist charged.

One lesson from this is that even with a high deductibe insurance policy, having insurance protects the policy-holder from onerous charges for which he/she would otherwise be legally liable--this all assumes the provider is contracted with the patient's insurance company.

There are certainly much graver afflictions than the progressive loss of function wife continued to experience in her dominant left hand from the time of onset to when she last saw the neurologist whom I have been brow-beating, which had her hand not come to being operated upon with what fortunately was a very successful outcome, she would have faced a life-expectancy of 35 more years with a very disabled left hand. In three visits to this neurologist she generated $2023 in charges, of which the insurance disallowed ~$1157 leaving the remaining $866 as our liability.

I have thought a great deal about all this single series of encouters with one medical provider. I expect the neruologist were he invited here to defend himself could rationalize that what he charged was fair, usual, and customary, and though it was of no remedial value whatsoever to my wife there was nothing at all out of line with his care, and I think most everyone in the medical community likely would be on his side because this is the way medical care works in America. A provider gets paid, assuming he isn't stiffed, whether or not there is actually any value of the attempts at diagnosis or treatment. Perhaps I am not being charitable enough in my thinking on this, but there is something wrong when you pay a lot of money for the pure hope of receiving something of worth. We as American consumers generally are not so frivolous when it comes to spending what for many people amounts to a lot of money with the possibility of getting nothing of value. That, however, is the system in health care as it has evolved until today.

If one, for realistic reasons, cannot guarantee the correctness of his/her diagnosis or interventional treatment, or that there will be beneficial effects to a course of some drug, why do these things cost so much?

Stay tuned, so far this is just one experience.

[grapejelly]

Re: Personal Experience with Some of the Problems in Heath Care.

Most people hate going to the doctor and avoid it as much as possible. There is a small subpopulation of worried well who overuse resources.

That isn't my experience. As an employer, I have gotten used to people going to the doctor for colds that can't be treated, demanding pills and injections for things that can't be medically addressed, etc. I have seen over-utilization again and again where co-pays are very inexpensive.

yes, if everyone ate better and exercised more the rates of diabetes and heart disease would plummet. It would also be nice if people read more and watched tv less, patronized the arts, renounced violence and stopped littering.

People in the US have conditioned themselves to be couch potatoes and then expect to pop pills to help them keep from dying.

The most common and expensive medical problems are the result of lifestyle. Diabetes, obesity, high blood pressure, acid reflux, asthma. In my experience, these are all quite easily treated by simple things someone can do without medical intervention.

Sure, taking care of yourself in basic ways is a good idea and too much of medicine is geared to procedures and pills. That’s what our system is structured to pay for. We need a whole different system, a health system instead of an illness system

There is terribly high confidence in today's medical system. I can't fathom the reason for that. People expect medical solutions to all health issues, and they are problem oriented instead of health oriented. I don't think that would be any better with a single-payer system. Why would it?

Except in a Big Brother sense...if "everyone" pays because I sit on my butt eating junk food, then "everyone" can tell me what to do, order me off to health boot camp, or whatever. I don't like where this leads.

the numbers I’ve seen are that administrative costs eat up about 25-30% of health care spending in this country. It is this fact and my dealing with it personally day by day that have led me, reluctantly, to the conclusion that a single payer system is the best answer. The va system actually isn’t bad.

Monopoly is the answer, ehh? But just for healthcare, not for anything else? A bit puzzling how health care is best handled by a medical monopoly. The lesson of all monopolies is that they manipulate government power to their own advantage. I can't say I am inspired by the other examples of government monopoly. I wouldn't want the British system or Canadian system. There is no answer except rationing of healthcare there through long waits and delays. Health care decisions are politicized. No thanks.

[Spartacus]

Re: Personal Experience with Some of the Problems in Heath Care.

IMHO, everything you write about began in a major way with the prescription system that put doctors in charge of medicine.

No prescription? No drug. Then this got much worse with sweeping powers granted to the FDA in the wake of the Thalidomine tragedy.

It's well advanced now - you are trained from the earliest age that these priests trained in special schools, wearing the special collar and robes are THE place for medical information.

It's surprising to me why US doctors demand that drugs can only be dispensed with a prescription to a highly educated population like the US, but in places where literacy is extremely low, they manage to get along without the prescription-only system.

Maybe something about being educated makes people less able to decide what they need?

PS - there already is one powerful monopoly in the field - the doctors' guild.

That isn't my experience. As an employer, I have gotten used to people going to the doctor for colds that can't be treated, demanding pills and injections for things that can't be medically addressed, etc. I have seen over-utilization again and again where co-pays are very inexpensive.

[grapejelly]

Re: Personal Experience with Some of the Problems in Heath Care.

IMHO, everything you write about began in a major way with the prescription system that put doctors in charge of medicine.

No prescription? No drug. Then this got much worse with sweeping powers granted to the FDA in the wake of the Thalidomine tragedy.

It's well advanced now - you are trained from the earliest age that these priests trained in special schools, wearing the special collar and robes are THE place for medical information.

It's surprising to me why US doctors demand that drugs can only be dispensed with a prescription to a highly educated population like the US, but in places where literacy is extremely low, they manage to get along without the prescription-only system.

Maybe something about being educated makes people less able to decide what they need?

PS - there already is one powerful monopoly in the field - the doctors' guild.

You are so right. Thank you! An eye-opening post.

[Jim Nickerson]

Re: Personal Experience with Some of the Problems in Heath Care.

That isn't my experience. As an employer, I have gotten used to people going to the doctor for colds that can't be treated, demanding pills and injections for things that can't be medically addressed, etc. I have seen over-utilization again and again where co-pays are very inexpensive.

I believe jk's comment that patients don't like to be sick and don't like going to the doctor are correct, but that perspective from any given doctor might change depending upon what he practices. Except for patients who were physically or mentally additicted to taking narcotics or mind-altering drugs (valium), it was seldom I encountered patients that would state they liked buying and taking drugs particularly if the drugs could cause or did cause undesired side effects, and they did not like the time involved with seeking care even if they had 100% insurance or lots of money.

grapejelly, what would happen if the population went to the doctor with colds and were told to go home and get over it? For about 7 of the 17 years I practiced fee for service oral surgery, a part of that practice involved seeing patients for removal of impacted wisdom teeth. If a patient did not have an identifiable infection, I would take the teeth out and not put the patient on antibiotics, assuming an otherwise systemically healthy patient. At times I encountered patients or parents of these wisdom teeth removal patients who would demand antibiotics if the patient was going to be treated by me. Depending upon the time frame of my practice, taking out impacted wisdom teeth--not all, but a lot of cases--generated anywhere from $300 to $400 of revenue. It was never difficult for me to tell these individuals that I did not think it was medically appropriate, and they would have to see someone else. This dilemma certainly did not occur with every second or third patient. Had it, I don't know but that I would have rationalized someway that everybody needed antibiotics when they had their third molars excised. I encountered a person the other day by chance who had just had 4 third molars excised under sedation in the oral surgeon's office--fee $1400. I assume with that much money at stake, it is a no-brainer for a lot of surgeons to say to patient or parent, if you want antibiotics, no problem.

Perhaps in a family doctor or internist's office for established patients who have colds the easy way out, if you wish to maintain your clientele is to give them a prescription for antibiotics, collect the fee for the office visit, and expect to keep the patient happily coming back. If all doctor's earnings were fixed, with incentivization, not for saving money, but for exceptional hours spent and practicing whatever is determined to be "good medicine" a lot of the problems as you see them, no doubt with some correctness, would disappear I believe. If society learns or is forced to accept that antibiotics do not alter the course of viral infections, then at some point infividuals will not seek such care.

People in the US have conditioned themselves to be couch potatoes and then expect to pop pills to help them keep from dying.

The most common and expensive medical problems are the result of lifestyle. Diabetes, obesity, high blood pressure, acid reflux, asthma. In my experience, these are all quite easily treated by simple things someone can do without medical intervention.

What you say here with regard to "most expensive medical problems" may or may not be true, and I am not going to attempt to prove you wrong. I did not look up what you described for your treatment of your asthma, but if it is in fact the most correct, best treatment, then a system in which such treatment is all that is initially offered to the patient, or even all that is ever offered to the patient would I presume significantly reduce the cost of health care. In the present system doctors do not make as much money if people do things that prevent their needing doctors' interventions.

I smoke cigarettes right now. My own attitude is that if I develop lung cancer, I am not going to subject myself to whatever treatments exist--whether I have the cojones to stick to that remains to be seen. The reason being is that I deserve cancer if I get it, and I am not fearful of facing death as it is inevitable, and I am an aetheist so I don't think death leads to something better in the "next life." I also have been on an antihypertensive for 29 days for elevated blood pressure. I know the effects of nicotine are not good for hypertension, incidentally my mother and her 11 siblings all had hypertension and not one of them smoked, and when I smoke up my cache of cigarettes that I bought at the end of 2006 to escape a tax increase of $1/pack I am going to stop smoking cigarettes. So perhaps in another few weeks any posts I make will become particularly cranky. Because I have a problem with hypertension, and I fear the incapacity that can follow a stroke, I think it is to my benefit to stop smoking. If I didn't have hypertension and if cigarettes had not increased in cost above what I said ten or so years ago would be the most I would ever pay for a pack, I would not even consider giving up smoking right now.

Had I gone to the doctor a month ago, and had he determined by urine testing that I smoked (I told the doctor my correct history as a smoker) and said, Jim, you really need treatment for your HBP, but you can't get it until you clear your body of nicotine, I think I would have begun stopping smoking 29 days ago. One of the proper things medically if one has essential hypertension and smokes is to stop smoking and take anti-hypertensive medication. I am not over-weight, and generally throughout my life not sedentary except for the past 10 months, and in the past 29 days I have become less sedentary. One could just go to another doctor, but if universally accessible medical records existed, and there was no incentive to the doctor to treat me despite my being recalitrant and not giving up smoking, then the choice forced upon me and from which I would stand to be the only beneficiary would be to stop smoking--immediately. I could either take the sane road or continue perhaps on my present path of insanity.

There is terribly high confidence in today's medical system. I can't fathom the reason for that.

I agree totally.

People expect medical solutions to all health issues, and they are problem oriented instead of health oriented. I don't think that would be any better with a single-payer system. Why would it?

The last 10 years I practiced, the most time consuming aspect was attempting to manage patients with facial pain, headache, and jaw joint problems. I often told patients what they and most of the American public seemed to want was to "drop" their afflicted parts off in my office with the admoniton to me to "fix it" and they would pick them up in a few days--do anything I wanted, but just not involve them in the treatment. It was a fact and the patients were told that they must be involved with management of their problems. They could either alter their life-style by sparing their overworked chewing system from more work than it could tolerate--thus the pain--or not alter it and continue their pain experience, or seek other care. Some I know for a fact walked out my door and saw other surgeons, got an operation that was insinuated (or perhaps honestly believed by the doctor) to be the "fix" the patient needed, then showed back up later in my office with their same pain problem, but with some entity's wallet a bit lighter and some doctor's, hospital's, and drug company's a little heavier. As medicine is today, if one does not like the answers from one doctor, it is easy enough to find another that will often offer the answer a patient thinks he/she needs. This sort of crap needs to be controlled, and the only way I see it being controlled is for the government to dictate treatment algorithms for various maladies and the patients can either accept them or reject them or go to Thailand, India or wherever and get what they deem they need.

Except in a Big Brother sense...if "everyone" pays because I sit on my butt eating junk food, then "everyone" can tell me what to do, order me off to health boot camp, or whatever. I don't like where this leads.

What will come to past, someday, is a system in which choices determined medically to be good for patients will be offered, and patients can either accept them or reject them, if they reject them then they do so with understanding of the consequences. Through tracking of my purchases of cigarettes for 40+ years based on analysis of my biometric money card, the doctor will tell me, Jim, you are mostly responsible for your lung cancer and as such it is going to kill you. I'll prescribe for you pain medicine and when that is of no benefit I will assist you in dying, or you can go out to the garage and asphyxiate yourself, or out in the woods and blow your brains out. It has always been your choice and it shall remain that way.

Monopoly is the answer, ehh? But just for healthcare, not for anything else? A bit puzzling how health care is best handled by a medical monopoly. The lesson of all monopolies is that they manipulate government power to their own advantage. I can't say I am inspired by the other examples of government monopoly. I wouldn't want the British system or Canadian system. There is no answer except rationing of healthcare there through long waits and delays. Health care decisions are politicized. No thanks.

I've read that ~87% of personal health spending is based on decisions by physicians. I don't know if that is correct or not, I would guess it is very close to 95% as there are damned few things one can do medically except on direction of some sort of a doctor and for which with rare exceptions a doctor generates income/profit either for himself or for another doctor, drug manufacturer, device maker, or hospital etc. I believe everyone on the provider side is incentivized to generate as much profit as possible in most situations. The only way that system will ever be changed will be for it to be monopolized and overseen by govenment. If the government is the "bad apple" in the bunch, then it would be the govenment that needs to be changed and not the national health care system. The present health care system in the US is the quintessential case of the "fox guarding the henhouse."

jk, offered documentation of the heath of those in the UK vs. that of us, and they have a national health scheme. You individually, based on whatever wealth you may have, might not find favor in a national health care scheme, but for 45-47 million without health care, just how long do the think the queue is in which they are standing. I accept it as a fact that health care right now and for a long time has been rationed here, those who have more wealth get more health care when they want it, and those with less wealth get less health care when they need it. Right now, I can buy a drug in Canada for a third or more less than I can buy the same drug here, so is not something already politicized? I believe that those most against a national health scheme are those who least feel the pain of the expense of health care, and at the tippy-top of that list are those elected to run this country.

[jk]

Some Employers Are Offering Free Drugs

Some Employers Are Offering Free Drugs



http://www.nytimes.com/2007/02/21/bu...034f92&ei=5070

For years, employers have been pushing their workers to pay more for health care, raising premiums and out-of-pocket medical expenses in an effort to save money for the company and force workers to seek only the most necessary care.
Now some employers are reversing course, convinced that their pennywise approach does not always reduce long-term costs. [emphasis added-jk] In the most radical of various moves, a number of employers are now giving away drugs to help workers manage chronic conditions like diabetes, high blood pressure, asthma and depression.

Major employers like Marriott International, Pitney Bowes, the carpet maker Mohawk Industries and Maine’s state government have introduced free drug programs to avoid paying for more expensive treatments down the road.
Companies now recognize that “if you get people’s obesity down, cholesterol down, asthma down, you save a lot of money,” said Uwe E. Reinhardt, a health economist at Princeton University.

Despite the Bush administration’s efforts to promote “consumer directed” health care, many companies are recognizing the limits to shifting too much of the cost of medical care to employees. Experience, Professor Reinhardt said, is contradicting the theory that “patients will be more prudent shoppers for health care if they ache financially when they ache physically.” [emphasis added-jk] Another motive for the business world could be to stave off a greater government involvement in health insurance, now that most presidential candidates and other politicians are promoting health care reform.

Big drug makers like Pfizer and Merck, which could benefit politically and financially from the employer drug programs, are also supporting the effort.

Richard T. Clark, the chief executive of Merck, made the political connection in a recent trade journal article. “If we all don’t do a better job, the private employer-based market will continue to weaken and the country will move forward toward rationing of care and greater government control, with greater pressure for a single-payer model with price controls,” Mr. Clark wrote in the American Journal of Managed Care.

One clear motive is to help workers stay well, averting expensive emergency room care and hospital stays. As health coverage has grown more costly, many people have been skimping on care, and millions of Americans are going without health insurance altogether.

Employers are reacting to a disturbing trend. As most employer-sponsored health plans have raised co-payments sharply for drugs in recent years, employer drug spending has slowed. But total health care spending by employers has nonetheless continued to rise: 7.7 percent last year, or more than double the general inflation rate, according to the Kaiser Family Foundation. The free drug programs are being adopted in hopes of countering the rising costs, taking their place alongside other steps by some employers that have included opening or expanding health clinics in their factories and offices, and offering checkups and medicines at no cost or for a modest co-payment.

Given the millions of Americans who suffer from heart disease, depression, asthma or diabetes — about one in four working-age adults — the movement toward free drugs and preventive care has the potential to help many people, said Craig Dolezal, a health care specialist at Hewitt Associates, a consulting firm.

Co-payments of $10 to $20 a prescription have become typical, while the co-pay for some expensive drugs can be $50 or more for a month’s supply. The new employer programs are waiving those fees.

For people with serious health problems, free medicine is an incentive not only to stay with their prescribed regimens, but also to keep in touch with nurses and pharmacists who monitor changes in their weight, blood pressure and other vital signs.

At the Mohawk Industries carpet factory in Dublin, Ga., about 200 of the 750 employees signed up for free blood pressure and heart drugs last summer after the company held meetings to describe the benefits of lowering blood pressure and cholesterol.

Alan Christianson, Mohawk’s benefits administrator, said that the company recognized a few years ago that it could eventually face health costs so high that employees could not afford insurance. “We felt we had to do something about it,” he said.

Peggy Cauley, 36, who supervises a customer service unit at Mohawk’s factory, said she was 30 pounds overweight and had spent $40 a month on blood pressure and heart drugs before she started the program.
Now the drugs are free, and Charles Posey, an independent pharmacist stationed at the plant, monitors her blood pressure and gives advice on “how to maintain my weight,” Ms. Cauley said. She has lost 20 pounds, she said, but is “still 10 pounds over my goal.”

Eastman Chemical, which is based in Kingsport, Tenn., and has offered free mammograms for its workers and free vaccines for employees’ children, now also provides free drugs and supplies for diabetics under its health plan.

The company is trying “to drive value and to target where care is most needed,” said David H. Sensibaugh, the director of integrated health.

The state of Maine found that it was spending more than $20 million a year on treatment for about 2,000 diabetes patients in the state’s health plan, which covers 40,000 employees, retirees and dependents.

About half the diabetics had at least one additional serious problem like heart disease, said Frank Johnson, the Maine plan’s administrator.

Working with Anthem Blue Cross and Blue Shield, a unit of Wellpoint, the state has started offering free drugs and supplies to employees with diabetes who take part in a face-to-face interview with nurse educators and agree to a year of follow-up telephone sessions, Mr. Johnson said.

Benefits executives at dozens of large companies are weighing the initial costs and potential savings of free co-pay programs and other health-plan incentives at seminars, including one last week at the Midwest Business Group on Health in Chicago and another scheduled for next month <>There can be perceived drawbacks for employers, according to a recent academic article that was generally favorable toward the programs.

Companies with high rates of worker turnover may believe that they will not get their share of the eventual savings from a free drug program, while smaller employers may fear attracting too many workers with chronic illnesses, according to the article by Michael E. Chernew, a health care policy professor at Harvard, and Dr. Allison B. Rosen and Dr. A. Mark Fendrick, both of the University of Michigan.

Their report was published last month in the online edition of the journal Health Affairs.

Later this year, a Marriott executive is to make a presentation at the University of Michigan, where researchers are analyzing Marriott’s move to waive co-payments for generic drugs related to heart disease, diabetes and asthma.

“We can see in the preliminary numbers that employees taking part have improved their compliance,” said Jill Berger, the vice president for health and welfare at Marriott, which covers 160,000 hotel and resort workers and dependents.
Active Health Management, a health data technology unit of the Aetna insurance company, has been helping to identify Marriott workers who are eligible to volunteer for the heart, diabetes or asthma programs.

Protecting the privacy of employees is an “enormously important and sensitive issue” in these programs, said Dr. Lonnie Reisman, Active Health’s chief executive.

“We don’t share the health plan members’ data with physicians or anyone else, unless a member explicitly gives permission,” Dr. Reisman said. Only “if we see something that is a real health issue, we will call the doctor without getting permission,” he said.

Dr. Reisman said his company scans records of millions of drug purchases and refills and other medical claims in search of high-risk patients who are candidates for free drugs and other incentives to get their health priorities in order.
Perhaps the oldest free drug program was started 10 years ago with diabetes drugs for city workers in Ashville, N.C. Since then the city has added free drugs for asthma, blood pressure, cholesterol problems and depression.

Patients in the Asheville program agree to meet regularly with pharmacists who advise and encourage them to take their medicine and adopt healthy habits. The program has been emulated by more than 30 employers nationwide.
Frank Street, 63, a retired employee of the tax collectors office of Polk County in Florida, said he had been getting six free drugs from the county for diabetes and blood pressure for about two years.

“At one point, my blood pressure was so out of whack that they started monitoring it on a daily basis,” Mr. Street said. The program’s records are managed by Thomson Medstat, a health care information firm.

Now his blood pressure is “down to target level,” and he reports once a month to his doctor and Liz Berndt, the program’s pharmacist.

Without the county program, his drug co-payments would total $110 a month, Mr. Street said.

As employers grapple with rising health costs “and we become more aggressive about cost-shifting to patients,” said Dr. Reisman, the Active Health executive, “it will be important to have this kind of safety net.”

[Spartacus]

Re: Personal Experience with Some of the Problems in Heath Care.

Thanks. I read the article and always enjoy Gladwell's stuff.

2. It is my impression that poor people have a disproportionate amount of diabetes, obesity, high blood pressure and asthma. I believe it is a matter of lifestyle choices and not an access to health care issue. I think people with these problems are clogging up our healthcare system and if they changed their lifestyle they would become healthier and wouldn't need medical care to the degree they do.

There needs to be a complete review of the incentives that are in place.

I think if one looks closely, one will find dis-incentives (greater taxes and regulation) for the food industry to produce healthier foods and incentives (subsidies and tax breaks) to produce unhealthy foods.

These were put in place for political, not health, reasons. And once in place, the industry will fight to maintain the status quo. The pressure seems to have to get very, very high before they change - until it drastically affects their bottom lines, they fight like crazed, cornered wolverines.

This maintenance of status quo includes things like pressuring the university that Dr Mary Enig (principal trans-fats critic) works at, to get her to stop her research , or pressuring publishers to block publication).

Or hiring your own experts, so the reporters, when they write a story as they normally do, will just be "presenting both sides", regardless of whether one side is bought and paid for.

3. I think medical care is mostly destructive. Some of it is good but most of it is bad. Pills and procedures are demanded by US patients and provided by ignorant US doctors. Avoiding doctors and hospitals, while exercising and doing the things that contribute to good health, is the best course for longevity and good health. So I don't think more doctor visits is the answer to better health. Quite the opposite.

Hopefully the cholesterol story will soon bring a lot of this out into the open. I'm not holding my breath, though, because of the extreme lack of fallout from the cox-2 inhibitors story. Maybe the US public has really been drugged into submission already.

[Spartacus]

Re: Personal Experience with Some of the Problems in Heath Care.

Do you have a breakdown for those statistics that takes age into account?

Also, I've been reading a lot about "administration", what I'd like is if anyone has data on how much is actual administration, and how much is sales/advertising/marketing and sales commissions.

Jim -
Concentration of Health Expenditures % of Total Health expenditure
Top 1% - 23.7%
Top 5% - 49.2%
Top 10% - 64.0%
Top 15% - 73.3%
Top 20% - 80.0%
Top 50% - 96.6%
Bottom 50% - 3.4%

So basically the 50% of us that are healthy are subsidizing the 50% of us that aren't, or more appropriately the sickest 20% in the country.

[Jim Nickerson]

Re: Personal Experience with Some of the Problems in Heath Care.

Do you have a breakdown for those statistics that takes age into account?

Also, I've been reading a lot about "administration", what I'd like is if anyone has data on how much is actual administration, and how much is sales/advertising/marketing and sales commissions.

Perhaps DemonD will answer your first question. Regarding costs of adminstration of health insurance plans is what I presume you to be asking?

jk put that up on this thread, the basic answer is too much in private insurance, and very little in Medicare, I think jk wrote 2%. Anything over 2%, which might be the absolute lower limit, is wasted in that it is not going to pay for health care.

To me the most sickening ads on TV have long been those touting OTC pain remedies because if you as a consumer react to them and purchase them e.g. Tylenol with nothing or with this, that, and the other, they are truly rip-offs, same for name brand aspirin containing products. If that shit is free-speech and/or capitalism, it is against the common good.

If one stays alive long enough, one is going to develop some osteoarthritis in some of one's joints, and unless one is unusually lucky one is going to have some pains in the joints from time to time and to a degree the amount of pain will depend upon to what one subjects the joints.

In my late 40's I used to have a lot of lower back pain and a bit less neck pain, both were worse when I had to bend and carry loads, or operate a long time with regard to my neck. Probably then if x-rayed the spine would not have looked bad, if x-rayed today, it might well look relatively terrible compared to someone in the twenties. But today I think I can write honestly, I almost never have any pain. That is the way the disease behaves. Stay alive you get it; keep on staying alive and it generally gets better.

Pain as I grew to understand it usually is a protective phenomenon. Most musculoskeletal pains are your body telling your brain that they have been overused or have become no longer capable of tolerating what used to be tolerable use. You read or see some athlete getting such and such numbed up so he can play the big game--total nonsense. The height of such nonsense as I recall was Bo Jackson, Heisman winner and also good baseball player. Unfortunately had the head of femur "die" after injury playing ball--had a total hip replacement, and I believe went back and tried to play baseball. There is no doubt that Jackson had far greater athletic skills that he ever came close to having brains. It's part of the erroneous American psyche of "fix me back to normal so that I can do what I have always done."

The ads said get your doctor to prescribe so you can take vioxx and do what you want with your aching joints--it's crap, as it turned out I guess that vioxx was too, except for the lawyers. If one has an abnormal joint, and one could only do one thing to hopefully make it though life with that joint, the one thing from the time of awareness that the joint was abnormal onwards would be to choose carefully what loads to which you wish to subject the joint. If one has abnormal knees e.g. had to have meniscus removed, one would likely better choose thereafter to be a swimmer rather than a jogger.

Heaven help today's doctors in dealing with patients who determine that they need from the doctor what they saw on TV last night, the night before, and the night before. All the ads serve to confuse ignorant consumers and add to the end-costs of drugs and thus health care.

[Spartacus]

Re: Personal Experience with Some of the Problems in Heath Care.

I'm just wondering if the actual administrative overhead work in private insurance is 2%, but the statistics lump advertising and sales commissions in with "administrative", making up the rest of the inefficiencies.

Perhaps DemonD will answer your first question. Regarding costs of adminstration of health insurance plans is what I presume you to be asking?

jk put that up on this thread, the basic answer is too much in private insurance, and very little in Medicare, I think jk wrote 2%. Anything over 2%, which might be the absolute lower limit, is wasted in that it is not going to pay for health care.

[jk]

Re: Personal Experience with Some of the Problems in Heath Care.

I'm just wondering if the actual administrative overhead work in private insurance is 2%, but the statistics lump advertising and sales commissions in with "administrative", making up the rest of the inefficiencies.

a lot of administrative cost goes into "underwriting" [figuring out which people to avoid insuring] and "managing care" [figuring out ways to avoid paying for things]. medicare doesn't have either of those costs.

i hope people don't ignore that ny times article i posted, perhaps it was too long to post. message: give people free care for basic common chronic illnesses and you reduce overall cost.