While healthcare reform is gaining momentum (and rightly so), plenty of experts believe that improving the healthcare system will save money.
Don't believe it.
A recent USA Today piece titled, "Do smokers cost society money" suggests that smoking and dying earlier saves the healthcare system and other benefit programs. It may be that healthier individuals living longer, and consequently having the opportunity to have more chronic illnesses like diabetes and cancer, cost more.
From the article -
Smoking takes years off your life and adds dollars to the cost of health care. Yet nonsmokers cost society money, too — by living longer.
smokers die some 10 years earlier than nonsmokers, according to the CDC, and those premature deaths provide a savings to Medicare, Social Security, private pensions and other programs.
A Dutch study published last year in the Public Library of Science Medicine journal said that health care costs for smokers were about $326,000 from age 20 on, compared to about $417,000 for thin and healthy people. The reason: The thin, healthy people lived much longer.
This is something I've always thought was a possibility. It makes some intuitive sense. Back in the 1950s, if a man died of a heart attack that would be the only cost to the healthcare system. Now as people live longer as we know better on what we must do to stay healthy and well, then they have more opportunities to not only become ill, but also injured, as well as need surgery for joint replacements, etc.
The additional wrinkle is that even the smoker now is likely to survive what was a fatal heart attack a generation ago, presumably quit smoking and also develop illnesses that can't be current, but controlled with a dizzying array of medications.
Why is this important? Healthcare reformers keep talking about cost savings to the system which isn't likely. Instead of claiming huge savings, we should be talking on how better to shift costs from expensive medical expenses like emergency room care and hospitalization for an uninsured patient with a heart attack to providing affordable health insurnace to the person to completely avoid the heart attack.
The healthcare system will still cost employers and the government a lot of money. We as a nation shouldn't expect savings from requiring doctors and hospitals to have electronic medical records (which is the right thing to do) or other touted improvements despite what the experts tell us. The irony and curse of our healthcare system is if we are as good at preventing premature death, by definition we are extending life and the likelihood of more healthcare costs for individuals saved. Can't argue with more time with family and friends.
So be cynical about stories that fixing the healthcare system will save money. It won't. What is far more important is given the amount of money we spend can we ensure it is wisely spent so all of us have the potential to live productive healthy lives?
A recent article from the Associated Press, "Insurers offer to stop charging sick people more" is welcome news for everyone. To accomplish the goal, however, it is important to understand why the insurance industry is asking that everyone be required to purchase health insurance also known as an individual mandate.
Without an individual mandate, people who don't need medical care and view themselves as healthy won't participate. As a result, the costs for those buying health insurance is higher for two reasons. First, those who want health insurance are often those who need medical care. Since their costs are often higher than the insurance premiums they pay, these additional costs must be borne by someone else (that would be those paying for health insurance but not requiring medical services). Second, if those healthy non-participants do require medical care, like emergency room services, because they don't have insurance and usually cannot afford the costs, hospitals and doctors don't just absorb this free care, they also pass it on to those with insurance.
Understandably there will be complaints from many who don't wish to be mandated to purchase health insurance, however, for the insurance mechanism to work properly, like Medicare and Social Security, it requires participation by all to work. As a result, those individuals with pre-existing conditions who are currently offered unaffordable coverage may in the future get their own insurance plan.
Although the theory of insurance makes sense, time will tell whether insurers do what they are supposed to do, make insurance affordable when everyone pays into the system.
The complete article follows:
Insurers offer to stop charging sick people more By RICARDO ALONSO-ZALDIVAR, Associated Press Writer Ricardo Alonso-zaldivar, Associated Press Writer Tue Mar 24, 7:08 pm ET
WASHINGTON – The health insurance industry offered Tuesday for the first time to curb its controversial practice of charging higher premiums to people with a history of medical problems. The offer from America's Health Insurance Plans and the Blue Cross and Blue Shield Association is a potentially significant shift in the debate over reforming the nation's health care system to rein in costs and cover an estimated 48 million uninsured people. It was contained in a letter to key senators.
In the letter, the two insurance industry groups said their members are willing to "phase out the practice of varying premiums based on health status in the individual market" if all Americans are required to get coverage. Although the letter left open some loopholes, it was still seen as a major development.
"The offer here is to transition away from risk rating, which is one of the things that makes life hell for real people," said health economist Len Nichols of the New America Foundation public policy center. "They have never in their history offered to give up risk rating."
"This letter demonstrates that insurance companies are open to major insurance reform, and are even willing to accept broad consumer protections," said Sen. Jeff Bingaman, D-N.M., a moderate who could help bridge differences on a health care overhaul. "It represents a major shift from where the industry was in the 1990s during the last major health care debate."
Insurers are trying to head off the creation of a government insurance plan that would compete with them, something that liberals and many Democrats are pressing for. To try to win political support, the industry has already made a number of concessions. Last year, for example, insurers offered to end the practice of denying coverage to sick people. They also said they would support a national goal of restraining cost increases.
The latest offer goes beyond that.
Insurance companies now charge very high premiums to people who are trying to purchase coverage as individuals and have a history of medical problems, such as diabetes or skin cancer. Even if such a person is offered coverage, that individual is often unable to afford the high premiums. About 7 percent of Americans buy their coverage as individuals, while more than 60 percent have job-based insurance.
"When you have everyone in the system, and you can bring (financial) assistance to working families, then you can move away from health status rating," said Karen Ignagni, president of America's Health Insurance Plans, the leading trade group.
The companies left themselves several outs, however. The letter said they would still charge different premiums based on such factors as age, place of residence, family size and benefits package.
"If the goal is to make health care affordable, this concession does not go far enough," said Richard Kirsch, campaign manager for Health Care for America Now. "It still allows insurers to charge much more if you are old." His group, backed by unions and liberals, is trying to build support for sweeping health care changes.
Importantly, insurers did not extend to small businesses their offer to stop charging the sick higher premiums. Small employers who offer coverage can see their premiums zoom up from one year to the next, even if just one worker or family member gets seriously ill.
Ignagni said the industry is working on separate proposals for that problem.
"We are in the process of talking with small-business folks across the country," she said. "We are well on the way to proposing a series of strategies that could be implemented for them."
___
On the Net:
America's Health Insurance Plans: http://www.ahip.org
Blue Cross and Blue Shield Association: http://www.bcbs.com/
Technology certainly has allowed convenience of communications, commerce, and collaboration. It also has spawned new ways of viewing entertainment as well as new forms of play.
Yet this recent Associated Press article "Deaths of gamers leave online lives in limbo" demonstrates we haven't realized its effect on society particularly when it comes to "alternative lives" or "second lives" on the internet in forms of online gaming. When someone passes away, who is responsible for communicating to those unseen others which a person may spend quality time together in the virtual world, but may be unbeknowst to those in the real world?
It's not in the role of an advanced directive, which is a document that directs doctors what type of care you wish to receive (supportive care, CPR, ventilation, IV fluids, antibiotics, etc.) if you cannot speak for yourself. But who does one inform?
The article in its entirety follows:
Deaths of gamers leave their online lives in limbo (AP)
* Posted on Sat Mar 14, 20091:39PMEDT
NEW YORK - When Jerald Spangenberg collapsed and died in the middle of a quest in an online game, his daughter embarked on a quest of her own: to let her father's gaming friends know that he hadn't just decided to desert them.
It wasn't easy, because she didn't have her father's "World of Warcraft" password and the game's publisher couldn't help her. Eventually, Melissa Allen Spangenberg reached her father's friends by asking around online for the "guild" he belonged to.
One of them, Chuck Pagoria in Morgantown, Ky., heard about Spangenberg's death three weeks later. Pagoria had put his absence down to an argument among the gamers that night.
"I figured he probably just needed some time to cool off," Pagoria said. "I was kind of extremely shocked and blown away when I heard the reason that he hadn't been back. Nobody had any way of finding this out."
With online social networks becoming ever more important in our lives, they're also becoming an important element in our deaths. Spangenberg, who died suddenly from an abdominal aneurysm at 57, was unprepared, but others are leaving detailed instructions. There's even a tiny industry that has sprung up to help people wrap up their online contacts after their deaths.
When Robert Bryant's father died last year, he left his son a little black USB flash drive in a drawer in his home office in Lawton, Okla. It was underneath a cup his son had once given him for his birthday. The drive contained a list of contacts for his son to notify, including the administrator of an online group he had been in.
"It was kind of creepy because I was telling all these people that my dad was dead," Bryant said. "It did help me out quite a bit, though, because it allowed me to clear up a lot of that stuff and I had time to help my mom with whatever she needed."
David Eagleman, a neuroscientist at the Baylor College of Medicine in Houston, has had plenty of time to think about the issue.
"I work in the world's largest medical center, and what you see here every day is people showing up in ambulances who didn't expect that just five minutes earlier," he said. "If you suddenly die or go into a coma, there can be a lot of things that are only in your head in terms of where things are stored, where your passwords are."
He set up a site called Deathswitch, where people can set up e-mails that will be sent out automatically if they don't check in at intervals they specify, like once a week. For $20 per year, members can create up to 30 e-mails with attachments like video files.
It's not really a profit-making venture, and Eagleman isn't sure about how many members it has — "probably close to a thousand." Nor does he know what's in the e-mails that have been created. Until they're sent out, they're encrypted so that only their creators can read them.
If Deathswitch sounds morbid, there's an alternative site: Slightly Morbid. It also sends e-mail when a member dies, but doesn't rely on them logging in periodically while they're alive. Instead, members have to give trusted friends or family the information needed to log in to the site and start the notification process if something should happen.
The site was created by Mike and Pamela Potter in Colorado Springs, Colo. They also run a business that makes software for online games. Pamela said they realized the need for a service like this when one of their online friends, who had volunteered a lot of time helping their customers on a Web message board, suddenly disappeared.
He wasn't dead: Three months later, he came back from his summer vacation, which he'd spent without Internet access. By then, the Potters had already had Slightlymorbid.com up and running for two weeks.
A third site with a similar concept plans to launch in April. Legacy Locker will charge $30 per year. It will require a copy of a death certificate before releasing information.
Peter Vogel, in Tampa, Fla., was never able to reach all of his stepson Nathan's online friends after the boy died last year at age 13 during an epileptic seizure.
A few years earlier, someone had hacked into one of the boy's accounts, so Vogel, a computer administrator, taught Nathan to choose passwords that couldn't be easily guessed. He also taught the boy not to write passwords down, so Nathan left no trail to follow.
Vogel himself has a trusted friend who knows all his important login information. As he points out, having access to a person's e-mail account is the most important thing, because many Web site passwords can be retrieved through e-mail.
Vogel joked that he hoped the only reason his friend would be called on to use his access within "the next hundred years or so" would be if Vogel forgets his own passwords.
But, he said, "as Nathan has proven, anything can happen any time, even if you're only 13."
Fascinating article from the Associated Press titled, "What's the best medicine really?" in which a government panel will try to determine which therapies and medications are better than others in a study of "comparative effectiveness". Funded by the stimulus package passed by Congress, about $1.1 billion will be spent understanding this.
Naturally, all parties involved have a stake in this because there will be losers. Although the article states that it is a secret that newer medications don't need to be better than older proven therapies, that isn't true. It's that the public is unaware that for FDA approval, medications only need to be better than placebo.
Pharmaceutical companies rarely do comparative effectiveness studies because they can backfire. Note how Bristol-Myers Squibb compared its cholesterol lowering medication PRAVASTATIN (PRAVACHOL) against Pfizer's ATORVASTATIN (LIPITOR) in the PROVE-IT study. Bristol-Myers sought to prove that its medication was better than the newer one, LIPITOR. They were wrong and it cost them.
The real challenge isn't just understanding what works better than others. The real challenge is how to get this information to doctors consistently and in a timely manner. Research shows that on average it takes 17 years for medical research and findings to be practiced routinely in the community doctor offices. Whether the internet and information technology shortens this time frame remains to be seen. As a result, all the studies in the world are meaningless unless those at the front lines - doctors and patients get this information.
I am skeptical that any study will ultimately help manage healthcare costs.
A recent NY Times piece titled Bargaining Down the Medical Bills which has practical advice on how one might negotiate medical and hospital bills particularly in the time where everyone is looking for areas to save money on.
Highlights:
DON’T BE SHY
OFFER TO PAY CASH UPFRONT
BE RESPECTFUL
STRIKE A DEAL, THEN CHECK IN
MAKE A COUNTEROFFER
Of course I appreciated the opportunity to be quoted as well.
Recently NBC Nightly News suggested that doctors on salary might be the answer to the healthcare crisis. Specifically, without a financial incentive to do more, that is reimbursement which is fee for service, that doctors can focus more on medical care rather than making a business and living.
Fascinating article from the Associated Press titled, "What's the best medicine really?" in which a government panel will try to determine which therapies and medications are better than others in a study of "comparative effectiveness". Funded by the stimulus package passed by Congress, about $1.1 billion will be spent understanding this.
Naturally, all parties involved have a stake in this because there will be losers. Although the article states that it is a secret that newer medications don't need to be better than older proven therapies, that isn't true. It's that the public is unaware that for FDA approval, medications only need to be better than placebo.
Pharmaceutical companies rarely do comparative effectiveness studies because they can backfire. Note how Bristol-Myers Squibb compared its cholesterol lowering medication PRAVASTATIN against Pfizer's ATORVASTATIN (LIPITOR) in the PROVE-IT study. Bristol-Myers sought to prove that its medication was better than the newer one, LIPITOR. They were wrong and it cost them.
The real challenge isn't just understanding what works better than others. The real challenge is how to get this information to doctors consistently and in a timely manner. Research shows that on average it takes 17 years for medical research and findings to be practiced routinely in the community doctor offices. Whether the internet and information technology shortens this time frame remains to be seen. As a result, all the studies in the world are meaningless unless those at the front lines - doctors and patients get this information.
I am skeptical that any study will ultimately help manage healthcare costs.
