Consumer Directed Healthcare

This is a great article from www.americandreamproject.org. Health is a major topic for everyone, young, old, rich or poor.

“Seven Democratic candidates for president promised Saturday to guarantee health insurance for all, but they disagreed over how to pay for it and how fast it could be achieved.” (NY Times Article) Well, awesome! Polls everywhere confirm that’s what America wants. But it’s not as easy as a political promise.

There are lots of people that are making lots of money on the current system. They profit for inefficiency, regulation, and limiting access to care. Some want the government to take over everything. Turn our health system into a kind of Medicare - Post Office. Hmmm. One thing’s for sure, we need something vastly better than what we have.

Why Healthcare Is Killing Us

Recently I was in a small café and saw a plastic canister with a photocopied picture of a child in need of a $300,000 surgery to remove a brain tumor. The canister was for donations. The child’s parents worked at the café and everyone, their co-workers and regular customers, were pitching in to raise money. These hard working parents made too much money to qualify for Medicaid, but too little to have adequate health insurance. Two thoughts went through my mind. First, their only real option was to have the surgery and declare bankruptcy.

About half of American bankruptcies are caused by stratospheric medical bills not covered by insurance. That’s right; lots of us have health insurance and still go bankrupt.

Second, this is absolutely nuts. We live in the only first world country in the world where full time, hard working people have to beg for money to take care of their children’s medical needs. We all see it. Homemade donation canisters for uncovered medical expenses are on store counters in every town in America. Think about it. The only countries where people have to beg for money to be cared for is us and countries run by thieving dictators who don’t care about their citizens. Too strong? You might not think so if you were trying to raise money for your child. Or you had your medical insurance claims denied based on a trivial technicality, which also happens to millions of us each year.

So now, every politician is talking about universal health care. Talk is cheap. What’s outrageous is the cost. Empty promises mean nothing. The solution isn’t schemes to make it illegal not to own health insurance or new programs to cover prescription drugs which will cost presently uncalculated hundreds of billions of ours and our children’s tax dollars a year. Of course access to quality healthcare is essential to 21st century civilization. That’s a given. But it’s the wildly escalating costs of healthcare that must be stopped. The healthcare system is a crazy hodgepodge of old processes, individualistic doctors, inefficient hospitals, financially driven insurance and drug companies, non-sensical regulations, and bewildered, frightened and frustrated patients all competing in a jungle of self-interests. The result is not efficiency and quality predicted by a free market of voluntary exchange but the opposite. We lead the developed world in cost and in death by medical errors. The American Medical Association estimates over 800 people a day die in American hospitals due to avoidable mistakes. That is more than an “oops.”

We just aren’t getting much for all the money we spend. So it’s silly to work on access to a ridiculously expensive health system when the system is broken and cost of subsidizing it will bankrupt us.

We have to re-invent the whole system of health prevention, education, and care. It starts with us. Most of us need a healthier diet, more exercise and less work and debt-induced stress. We all know that. Next, there are many islands of excellence where costs are lower and quality is higher in US health care. These include doctors, hospitals, and insurers that work collaboratively, employ technology, and specialize in specific illnesses and treatment. It’s just applied common sense without the barriers of bureaucracy and greed. We can fix healthcare and create universal access with the right leadership. But if government subsidizing the current system with our tax dollars is the only solution, heaven help us. Because we’ll all be broke and dying sooner than we need to.

Where do you stand? What are your ideas to solve this problem?

In my travels over the last week, I encountered a lady who had just opened a HSA. As we began to talk, she explained that she was a diabetic. I asked her how she did her research to see if HSAs made sense for here with a chronic condition. She explained that she was able to get a High-deductible health insurance policy which was a savings of $200 dollars in reduced premium and even thought her out of pocket expense for insulin and other supplies was over 80 dollars a month she would still save over a 100 dollars a month. This calculated into a $1200 dollars a year savings that she keeps in her Health Savings Account. She decided that she would prefer to kee the dollars than pay it in premium.

Many of the detractors of Health Savings Accounts warn that only young, healthy, financially stable people with good jobs benefit for HSAs because they are the only ones who can afford it. But in reality, the amount you invest in Health Savings Account can be deducted from your annual income tax calculations. In addition, once you deposit that money into a Health Savings Account it is left to grow tax fee. This is not a tax haven for the rich, but can benefit anyone for whom lower taxes mean more money in the bank. As well until you do the calculation, you really do not know if a Health Savings Account works for you and your family or not.

On top of this, you can use the money in your HSA for a wide range of medical expenses such as preventive care, dental checkup, and other medical appoints. Check the IRS web site for the entire qualified medical expenses allowable (http://www.treas.gov/offices/public-affairs/hsa/pdf/HSA-Tri-fold-english-07.pdf).

As the individual becomes more responsible for their healthcare, my expectations are that they will shop for healthcare better. From a more optimistic view point, individuals paying medical bills and seeing the real price of medical care will fuel healthy competition among healthcare providers, reduce cost and increase the quality of healthcare.

First, let me start by saying that it is hard to characterize the system. It is too large and too fragmented to make really good general comments that apply to the entire system. Having said that, let me offer some general observations.

First, it is an old system of hospitals based mostly in large cities with the general attitude that veterans need to come to the hospital for treatment. This works best in the large cities that have good public transportation.

Second, it is way too political a system. The budget is always driven by what else is going on in the country, not by the true need. In today’s world it should be easy to know what it costs to treat veterans to good health card. If we are going to fight a war, we can figure out how many will suffer what type of wounds, who will need long term care, things like that, and then project what it will cost for the next however many years. A process like this would allow for a budgeting process that would reasonable cover future costs.

From what I have seen in 30+ years of dealing with the system on behalf of veterans is that care and treatment all depends on several factors. If a veteran has a service connected disability and can get to a hospital, generally the care is alright. If a veteran doesn’t have a service connected disability but needs care, the results are much more uncertain.

If you are a WWII vet, you get different care than if you are a Gulf War vet. Because of cost the VA system doesn’t provide the same criteria to qualify for care, not the same care if you get qualified.

The outpatient services tend to be the weaker part of the VA, partly because the VA never wanted to be an outpatient facility.

For years following Viet Nam, the VA refused to provide any treatment for PTSD outside of the facility. When congress finally made them provide outpatient facilities, they did what they could to make it difficult for these facilities to exist. The system is in bad need of a major overhaul, but to do that would cost money and so it just isn’t going to happen. Look at the new commission the president is appointing. Headed by two really great political people, but lets wait and see who the other members appointed will be, in order to have any credibility with me there has to be one or two common veterans on there who have a history of working to get veterans the health care they deserve.

cw

The USA Weekend www.usaweekend.com ran an article on life expectancy. The interesting part about the article is that it really is about taking charge of your health. It is nothing more than our bodies saying, pay me know or pay me later. It is about being accountable for the usual suspects, i.e. eating, exercise, life style, and stress management.

Thomas Perls, M.D. introduced a longevity calculator in 1999. He came up with 23 questions that looked at personal lifestyle, family history and preventive care measures.

As medical discoveries have been made and old ones clarified, Dr Perls added to and modified his calculators. With the help of special on line calculator. Dr Perls and USA Weekend partnered to invite 25,000 readers to take his new longevity test. The results are very interesting. As Dr. Perls says,” The older you get, the healthier you’ve been.”

To date 1 million people have tried Perls’ calculator (to try out calculators and find out your score, go to www.LivingTo100.com if you are under 50, or to www.eons.com if you are 50 or older.)

Whether your score is 60 or 106, the stark number can be a wake up call. That’s because many of the factors that affect how long we live are things that we can control.