US Life Expectancy 42nd! And Getting Worse!

OK, new info merely confirms what I have been screaming about for the last few months in this blog and in other forums for longer: The US is slipping in the health of it's citizens. A new story on MS NBC, http://www.msnbc.msn.com/id/20228552/wid/11915773?GT1=10316 tells of how the US had dropped from 11th to 42nd over the last couple of decades. Countries like Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands are living much longer lives at a MUCH LOWER COST TO THEIR ECONOMIES.

“Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries,” said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington. That is correct Doctor, there is something wrong and we are spending nearly 17% of our Gross Domestic Product on health care and only to see ourselves getting less and less healthy.

One "major" factor, according to "experts" is the fact 45 million people in the US have no health insurance. That may explain a little of the discrepancy, but more likely it is because the ability of US citizens to choose crappy lifestyle choices! Adults in the US have one of the highest obesity rates in the world. Nearly a third of U.S. adults 20 years and older are obese, while about two-thirds are overweight, according to the National Center for Health Statistics.

Heart disease, hypertension, stroke as well as diabetes area all directly related to weight and lifestyle. So, US citizens are self-prescribing a deadly mixture just because we have the luxury to do so.

What did seem surprising is the high level of infant mortality in the US compared to other nations including Cuba and Taiwan. The level of infant mortality is much higher in Black US families on par with countries like Saudi Arabia which is disturbing and has a significant impact on the nation's infant mortality rate as a whole.

But, the U.S. health care problem is not limited to access to health insurance.

The country MUST find ways to reduce cancer, heart disease and lung disease. We must make it a national drive and effort to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar.

“The starting point is the recognition that the U.S. does not have the best health care system. There are still an awful lot of people who think it does,” says Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington. More government and business leaders have to understand the same thing. Until then, we are just pissing away our money as we whistle in the dark...

Claims Assistance Professionals

I just found another resource to help people with their efforts to get around the US Health Care maze. People called Claims Assistance Professionals are a new group who created a service to help patients address the complexities of their health care insurance claims.

CAPs are usually insurance and/or medical specialists who are better suited to help consumers get around their medical billing and health insurance requirements. For more information, please take a look at the following article:

http://www.goarticles.com/cgi-bin/showa.cgi?C=546291

Americans Just Not Getting It!

I read an editorial from the LA Times Tuesday where the editorialist was so complementary of the US Health Care system because she was able to have her breast cancer diagnosed and treated immediately. Her argument was that only in the US could such immediate treatment occur, therefore, the US had to have the best health care in the world.

US Health Care is fair, but it is not the best in the world for many reasons: US Health Care, is an inefficient institution that needs better oversight and accountability by the marketplace; US Health Care has incorrect pressures to make it what it is, rather than the 'free hand' of the market dictating pricing, outside economic decisions determine pricing and availability; The actual users of medical services are totally ignorant to the pricing, options and availabilities of medical services; Finally, the way we have designed medical insurance coverage and the artificially low price the consumer ultimately pays for almost every cost imaginable, the 'real' cost is never seen, nor understood by the average consumer.

As a result, inefficiencies have run rampant throughout the industry. How can one say that? Look at the amount of GNP US Health Care consumes each year. Notice US Health Care consumes nearly 17% of annual GNP and is rising. The trend for the increase places US Health Care to soon cost every man, woman and child in the US 20% of all generated dollar.

Compare our current 17% to every other country in the world. Choose 5, choose 10, or carefully choose 50 countries and combine their expenditures on health care and see that it is still under what we spend each year! Next, review national health statistics like infant mortality, life expectancy, obesity levels, diabetes, heart disease and other frequency of disease and see that the US is in a pretty low spot on the overall health of its citizens.

Are you getting it yet? We are not getting our money's worth! All of what I say is evident of an inefficient system. I also agree with the LA Time's editorial writer's opinion that nationalizing US Health Care would only make things worse, because that is what has already happened here! The overly cheapened and largely subsidized health care we receive creates an unreasonable expectation of greater supply than actually exists at a price that is 'artificially' lower than the market really demands.

Now, the concept of artificially lower pricing is based upon those who pay little or nothing out of their own pocket for US Health Care. The previous statement and premise is seen in the complete opposite by those without health insurance or who do not have any subsidized manner for their health care pricing.

( Please see http://www.goarticles.com/cgi-bin/showa.cgi?C=545010 for a look at those who are part of the subsidy for the rest of us because they pay 300% to 450% more for the same medical services!).

Check out the facts in comparison to the rest of the world and ask yourself, can we keep paying a fifth of our GNP to be behind almost every other developed nation in the world in our nation's health? Why is it acceptable to pay so much to be so far below average? Open the eyes! It isn't!

Nationalized Health Care - How Consumers Act

The abrupt and direct response to US Nationalized Health Care is that it will become a floundering mess of inefficiency and waste. One can argue, will nationalized health care in the US become more inefficient than what we have today and will it consume 20% or more of our nation's resources like what we experience today? My opinion is that if it doesn't consume 20% or more of our nation's resources, it soon will be designed to do so!

Two main problems exist with nationalized health care in the US: The supply side and the demand side. More clearly, in an environment where everyone is allowed and encouraged to seek medical attention as often as they want, the demand goes skyward. And since everyone is supposed to have equal access to health care considerations and resources, there certainly will never be enough to go around.

We get back to the major premise of socialism and why it distorts the reality of the free hand of an open market. With everyone wanting a service and theoretically enabled to have that resource, demand will always outstrip supply. (Insert image here of an old Soviet-ere Babuska slugging it out with another, similar woman over a package of toilet paper in a bare-shelved Moscow store).

One can argue all day about how successful Britain's or Canada's semi-socialist medical system is and they would be absolutely correct! Let's see if we could transfer that model to the US. Hmmm! I don't think so!

Why? Because US citizens are used to having the access of total availability of health care resources but at the already subsidized rate. If one thinks the present market has placed any restrictions upon consumer demand for health care resources, then please let's look at the reality of the marketplace.

There is no real "open-market" considerations where the actual payer makes decisions based upon price, availability and local resources. Most consumers are insulated from knowing the "true" cost of a procedure because insurance programs almost always pay the bill. The consumer only has to find a medical provider and the cost be damned! He or she really doesn't pay the bill anyway, so there is no understanding of the overall economic cost of specific services, resources or facilities.

So, what exists now is a "seemingly subsidized" consumer health care system in the US. Consumers buy the insurance program options when their employer's benefits renewal program presents repriced options, but nowhere does the consumer take direct responsibility of their own health care dollars as if no insurance existed.

As a nation, we are seeing more and more people without insurance for health care. The US Census Bureau has calculated that amount to be near 45 million up to 50 million people per year. The realities of a true consumer market for US health care actually only exists for a little less than one sixth the present population. These 45 to 50 million people have to make decisions as to how to spend their limited monetary resources on health care without the benefit of an insurance policy to smooth the way. WOULD A CONSUMER WITHOUT INSURANCE MAKE DIFFERENT DECISIONS ABOUT HEALTH CARE THAN ONE WITH?

The answer would have to be a resounding YES! Certain tests would have to be weighed with extreme scrutiny for cost-effectiveness. "Iffy" procedures and operations with low response and success rates would be immediately removed from the decision-tree. Greater importance would be placed upon how an individual makes choices for him or herself.

Specifically, individuals would have to take greater responsibility for diet, physical exercise, alcohol and tobacco consumption in order to preemptively remove the excessive and extremely high cost of obesity, diabetes, heart failure, arterial sclerosis, emphysema, various and sundry cancers and other life-style diseases.

Why is it then, when spending time with most Western Europeans or Canadians, they continue to exhibit such consumerism in health care even when there is socialized medicine in some form or another in their native countries? While US citizens are bellying up to the buffet table/trough on cruise ships, our German, Icelandic, Italian, French and Danish counterparts have modest portions. Why is smoking so unpopular in Europe, but still nearly 40% of Southern US adults still smoke? What is different where in countries health care is readily available the citizens show individual responsibility for its use? My premise is that such responsibility would not be exhibited by US citizens who would fight and claw for each very last piece of good or service to claim as their own, regardless if they needed it or not. Possibly, after years and years of being told they have to take on their own health care concerns, especially regarding life-style issues, Europeans have been conditioned to do so. And since post-WWII was the beginning time for such education, the remaining population really had to believe the government's statements of limited resources!

Yet, if we were to try that very same thing today to instantly limit the access medical resources, with the current level of over-abundance of medical resources just waiting to be called upon at our slightest whim, consumers would revolt.

And that is what we are going to see. As resources tighten-up further and further and people who had previously had access to too much in terms of medical resources suddenly have little or no options, there will be problems. What needs to happen is more "medical consumerism" where the vast population understands and realizes the true value of each and every medical procedure. From there, individuals can decide on how and on what to spend their 20% per annum charge. Additionally, everyone will have to acknowledge the fact that those with more income and wealth have more options.

At least, that is, until US citizens understand how to responsibly use nationalized health care.

California Health Care & Big Business

Yesterday's LA Times published and article about how big business is jumping into the discussion about US Health Care and how Gov. Arnie is trying to get more people in the state of California covered under health insurance plans. This is another example that politics make strange bed-fellows. The article, in its entirety is at http://www.latimes.com/news/local/la-me-health7may07,0,4141456.story?coll=la-home-headlines
I applaud the 30 or so companies trying to make improvements to their employees lives by getting better insurance coverage, however, it also appears to be a little disingenuous considering how management typically and "normally" acts regarding overhead expenses, the largest being personnel and affiliated personnel expenses like benefits (insurance being the largest of that component).

The biggest way to improve health care in the US, is for each and every individual to take responsibility for their health. From being a wise and informed consumer of health care options to wise and aware consumer of food and lifestyles which keep one healthy and not endangered due to "fast living" or poor life decision-making. As a country, we have to teach our citizens such practices. (One can always tell the US citizens on international cruise ships -- they are the ones who habitually pig-out at the open buffet lines of food. Europeans show much greater restraint and moderate eating behavior).

The other part, is to make sure the medical/health care market place really is open. If we are allowed to make informed decisions based upon our wallets, I think we will do fine. Unfortunately, we as a nation don't see health care that way and think it is someone else's responsibility to pay. Wrong answer. I am healthy and don't want to pay for the hypochondriac. Let that person use most of their disposable income to chase phantom boo-boos. I don't want to pay for someone who enjoys their vacation time in medical waiting rooms. Not me!

But there is plenty of blame to go around for making the US a bunch of pill-popping wimps. Medical light-weights who are abdicating our ability to make our own decisions. Force it back to my wallet and I will be as cheap as I can be. Wait. I already do that with insurance! Then, I challenge the rest of my citizen cohort to do the same. Be brave. You can do it!

Patient Experiences - Mini Monopolies

I write this a day after I had a minor outpatient procedure. The procedure was conducted at the local hospital, which is the only facility within a 3o mile radius for such procedures. The intake process was demeaning and impersonal. The intake clerk expected me to provide all information without question or hesitation.

When I was to sign the contract between me and the hospital, she refused to comply to my request for my copy of the contract. I would be able to ask for a copy from medical records some other time. I was not allowed to get a copy of what I had just signed.

Wait! This is the sort of contempt back-office and billing areas of hospitals seem to normally exemplify to patients. I only requested a copy of a legal contract I was entering into with the hospital. I do believe that is part and parcel for US business; all parties are provided with the agreements to which they enter.

A secret agreement or one in which is hidden certainly is one that is not made in good faith. And that is what I postulate here - that the contempt and one-sidedness of US hospitalization (the back-office, admissions side) makes the validity of the contract questionable.

Please understand, I had absolutely wonderful care from the floor nurses. They were attentive and concerned about my feelings, concerns and desires. My biggest problem with the floor nurses was that they were a little hurried trying to do as many procedures as scheduled, so much so that they were not always aware of my little jokes or comments. They were being extremely professional, moving fast, but efficiently and always aware of how I, the patient, was feeling.

Wow! the situation was exactly the opposite of the intake/admissions person. She would have rather me drop dead than actually dig out the "Patient Rights" booklet when I asked where it was after I was to sign I had already received it. The booklet was in a bottom of a cabinet on the opposite side of her office area and she had to move her chair and rearrange locations of a few items just to be able to get to a copy. But, I was required to sign a formal document saying I had already received it, but there was no intention of having me get it. I forced her into complying with her own laws which I doubt had been done for a long. All this in regard to documentation stating she had provided mythical information.

Contempt doesn't appeal to me as a way to continue doing business with a company or entity. And yet, what choice do we have? My physician is in a town 11 miles away and the hospital is the only facility in a 30 mile radius. Do I or the people who live in my community really have an option? NO. We are in a localize monopoly. And the hospital knows it too. Every week they spend local advertising dollars to tell the community how wonderful they are. The hospital has several half-page newspaper ads touting their contribution to the good of the community. Why would or is that necessary if it were really the case? Truthfully, because it isn't. The emperor is all to aware he (or she, as is the CEO) has no clothes. The hospital is not all that great. It overcharges by a factor of 400% on procedures and more on pharmacy and oncology. The hospital is stated to be a "Christian-based and not-for-profit", but has employed about every technique available to make it a huge "reserve" generator. Recently, the hospital added more new construction, new heli-pad and business relations with other, larger hospitals to feed patients. And above all, nastier, meaner and more contempt-filled back-office workers.

If other hospitals were available, I would certainly like to check them out. And basic consumerism is denied. At great expense to the consumer.

Skewing the Medical Supply/Demand Curve

As of yet, I have not addressed the issue of US Universal Health Care. I can only assume readers will be asking themselves as to my position of such a national offering.

Universal, or more accurately, nationalized health care will not work in the US. If you are a fairly cognizant person, emergency rooms now are overrun with people who have no need being there. For the most part, visitors of ER's are there because they have no regular physician for themselves or more likely their children. ER visits happen when the parent is not at work, which often is after 6 pm and before 7 am. As a result, ER's become overwhelmed with sore throats, minor viral infections and little boo-boos.

Now, consider the scenario of health care where the individual feels it their right to take as much of the resources as possible in order to get their 'fair share'. Consumers will see health care with the same concern as cheap gasoline which spawned the overly huge SUV's that get terrible gas mileage. At today's gas prices of $3.++ a gallon, SUV's are dying horrible dinosaur deaths.

The 'cheapening' of valuation of US Health Care would only drive the hypochondriacs out of the woodwork and choke the limited resources we have now. In a way, cheap health care insurance up until now, has cheapened US Health Care too. The process of cheapening a resource also drives up demand (refer to Econ. 101 for supply/demand curves). Artificially cheapening a good or service really screws up the demand curve!

The reality is that US Health Care is to be more expensive in order to allow the market to keep it scarce. But, why is the thought to raise the cost to the middle class and the working poor? And is making such an important service like health care scarce what this country really wants or needs? What makes it very hard to accept as an institution, is to see the very poor who are taking a disproportionate amount of the total resources because THERE IS VERY LITTLE OR NO COST TO THEM!

Really! Oh, some states have a small co-payment for their programs for children's health care, like $15 - $25 per child for total care coverage. California, I believe has a very generous plan which has people opt for a state run program that is totally inclusive rather than use a commercially available plan with co-payments of 10 - 15%. What happens? People will find ways to cheat the system by excluding specific information in order to qualify for cheaper, but more inclusive state programs and by-pass the higher costing, but more legally accurate market available health care insurance program.

US Census data can tell us that there is a huge number of uninsured individuals and it even may tell us of how many citizens qualify for extremely low cost or no cost health care coverage. And with that data, one will begin to see the amount of waste directly attributed to undeserving individuals. Indirect waste is the viewpoint that the service is worth less than it really is in the market, and the demand for service for boo-boos and runny noses is totally unnecessary, artificially taxing our US Health Care resources. (Thanks to intelligent triage nurses, most of the people who don't need to be in an ER have to have a very long wait).

No, we need to bring the concept of higher value (best administered by cost) to the ones paying the least illegally and artificially. We must attack the hit to US GDP at 16 - 18% for US Health Care by attacking waste in all areas. The waste Southwest Medical Bill Review & Recovery challenges is the $51 Billion in fraud conducted at the medical provider level and the over $220 Billion at the error and clerical aspect of hospitalizations. Hitting the problem from several ways will increase the efficiency of US Health Care to make it more market realistic.