Zane Safrit

MLRs, Profits and Our Healthcare

Yeah. It always comes down to money...

There was a time, in the early 1990s, when health insurance companies devoted more than 95 cents out of every premium dollar to paying doctors and hospitals for taking care of their members.

Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits,... huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most. - Wendell Potter, former Vice President of Corporate Communications for the CIGNA corporation, The Insurance Industry’s Lethal Bottomline...

That sounds kind of harsh.

On the other hand, if you have ever been forced to deal with coding errors, or just a standard claim, with an insurance company, either directly or through your healthcare provider then you’ll know it is not only...kind, it's also rational.

That’s the best term you can use for the practice of creating layers of bureaucracy (yes, it exists in private health insurance companies...sheesh) for the sole purpose of defeating us, the customers of health insurance companies, customers from using your services. These services being the services we pay for each month with our monthly premiums. Those of us fortunate enough to be able to afford health insurance.

Stepping away from the issue of providing for our healthcare, or the issue of providing the services for which we pay each month...what kind of commercial, for-profit industry can intentionally create layers of bureaucracy for the sole purpose of not providing their services to their customers. Sure, some companies do this as a result of the standard disconnect between companies and their customers. But how many industries do this as part of a profit-making strategy?

Health insurance executive: Hey, guys. I have an idea. Let’s create layers of bureaucracy....no wait a minute, hear me out...staffed with titles like plan administrators and claims adjustors or customer service reps. Except their role is not to administer the plans and benefits our customers have paid for, but to prevent this from happening!!!

Board member who’s executive at real for-profit company: Wait a minute. Won’t that frustrate and anger your customers? And won’t they leave you for your competitors?

Health insurance executive: (Nodding to his colleagues and then pointing at the Board member) He doesn’t get it. You see, our customers have nowhere to go. See. You have to compete for your customers. That's so yesterday. We don't have to compete!

In most states we have an "exemption from competition". It’s a complicated and very legal term (wink) that our PR agencies provided each state's insurance commission to use as they announced they had blocked all competition for us.

Here's the kicker, you'll love this: the rational for blocking competition in each was so we could "provide better service unencumbered by competition!

It's beautiful.

And in those states where we have to ‘compete’ (as he uses his hands to make the quotation mark), well, we’re all going to do this, so our customers will all find out there's no point in leaving one for another!

I think cooperation is so much more beneficial than competition.

And, see, we have the actuaries and their skills to create a table that shows how many layers of bureaucracy we need to implement before the customer gives up on their claims! It’s so cool!

Board member who’s executive at real for-profit company: Huh. Yeah. Now I see. I wish our industry was competitive like yours. (And they all laugh together.)

And that’s how they work together: MLRs, profits and our [declining] healthcare system. As a result of lower MLRs and higher profits, our healthcare system is now the most expensive to administer. And what is administered declines in quality each year as compared to our counterparts in other countries.

And the great thing, the thing I really admire (darkly) of the health insurance industry, is how they used their profits from our rising premiums and their declining level of service delivery to turn literally on the hands that pay them and with expensive lobbyists convince us:

* they are not a monopolistic industry,

* that they are not already subsidized with terms and conditions designed to prevent competition from entering,

* that competition from the federal government (the federal government) is unfair,

* that their layers of bureaucracy are not intended to ration care,

* that they haven’t already created their own death panels from these macabre plans with unaffordable premiums and unattainable benefits and they are far better than the 16-17 other countries whose healthcare systems run far more efficiently, deliver better care to more citizens and claim a lower percentage of their GDP.

* Council on Foreign Relations:

Elsewhere in the world, healthcare systems are much less reliant on private sector support--and much less expensive. For example, the U.S. system costs 83 percent more per capita than the Canadian system, where public funds collected through taxes pay for up to 70 percent of healthcare coverage. A number of East Asian systems also enjoy high quality of care for a much lower cost.

* Competitive Enterprise Institute

Health policy expert Gregory Conko warned that removing antitrust exemptions, which date back to the 1940s, will actually drive up prices and harm consumers.

“Federal enforcement isn’t necessary to ensuring fair competition in the health insurance industry, but could actually drive smaller companies to the brink of insolvency,” said Conko.

The McCarran-Ferguson Act of 1945 exempts insurers from federal antitrust laws as long as the states police anticompetitive conduct.

The chart below shows the results of 40 years of anti-trust exemptions.

* US Health Spending Breaks from the Pack, Economix - NY Times

The Gorilla in the Living Room of Healthcare Reform

[M]eaningful health care reform is unlikely unless we deal with the problem of conflicted, unethical, and sometimes corrupt leadership of health care organizations. - Healthcare Renewal, Former McKesson CEO and Board Chairman Convicted of Fraud

Healthcare Reform: Do we receive the best value?

Ok. Today we still measure value in dollars. What will we have to pay in 2010 to receive the same value from our health insurance premiums?

According to this article in BusinessWeek, to receive the same quality of care in 2010..

• Businesses will pay 7% more
• Their employees will pay 10% more.

By businesses I mean those business which offer health insurance to their employees.

Obviously, their employees means those employees whose health insurance is offered as an employee benefit.

For businesses, this 7% increase is on top of the 149% increase in those costs since 2000.

Did they receive 149% more value...?

Perhaps, not. A recent poll published by Forbes ranks our country as the 11th healthiest in the world. Forbes, hardly a bastion of socialist pandering, ranked Iceland, Sweden and Finland, Germany, Switzerland, Australia, Denmark, Canada and Austria as healthier than us. You’ll note that each of these countries has a...wait for it...nationalized healthcare program.

Personally, the ideology of our healthcare system is irrelevant to me. Despite the noise of its proponents and their tactics, ideology is irrelevant. The data is important. Based on the data, which system delivers the greatest value?

Clearly, the data* shows our current system fails to deliver comparable value. This failure to deliver value only increases as you realize that our healthcare system absorbs 16% (and rising) of our GDP compared to 11.3% for Switzerland, 11% for France (France!), and 10% for Germany.

So, who gets the greatest value for our current healthcare system and its strangulation of our economy? Not us, the customers.

* Kaiser Family Foundation report in PDF.

Healthcare Reform: What about the children?

I believe the children are our future
Teach them well
And let them lead the way
Show them all the beauty
They possess inside

Whitney Houston wrote and sang this in The Greatest Love of All.

The lyrics came to mind as I read this statistic:

Uninsured children are 60% more likely to die in the hospital than insured children regardless of medical condition, according to a large-scale study by researchers at Johns Hopkins University. Modern Healthcare (registration and annoying Dell popups req'd.)

Regardless of medical condition. That phrase caught my attention. All things being equal (same gender, age, condition, stage of diagnosis), the child with no health insurance coverage has a 60% greater risk of dying IN the hospital than their counterpart whose parents can afford health insurance.

Maybe that statistic rings...abstract. Maybe it does not connect. Here's where that statistic starts to apply: Lack of health insurance may have contributed to nearly 17,000 deaths among hospitalized children nationwide in the past 20 years...

17,000...in 20 years...That's 850 children per year, nationwide. 17 children per year, per state. 17 children per year, per state, for over 20 years died because their parents could not afford health insurance.

17,000 sets of dreams and skills, talents and strengths, lost.

17,000 families...devastated with the loss of a child.

17,000 parents being forced to bury their child.

And all because...what? Profit? Stock prices? Shareholder concerns? Quarterly results? CEO bonus plans? Companies too small to afford health insurance for their employees, too small to pay the wages necessary to provide health insurance for their employees and their families?

Sadly, the conversation on healthcare reform centers around costs. The costs are measured in...dollars.

What if we changed that term to lives?

What if we measured the costs of our current system, and any reforms, by the lives it saved? Or did not.

What if we discussed healthcare reform in terms of the lives saved, and the families, the dreams, the contributions with those saved lives...to our communities?

Would that make a difference? 

* Photo credit: istockphoto, pixdeluxe

Upcoming Radio Guest: Tori Tuncan, founder of Lend4Health

Tori Tuncan, founder of Lend4Health may be one of the most inspiring guests on this show. That says a lot; a regular stream of great guests generously share their time and tips and resources on their shows. Her organization, Lend4Health, is a non-profit organization that facilitates community-funded, interest-free micro-loans as a creative funding option for individuals and groups seeking optimal health. Currently, Lend4Health is facilitating loans for the "biomedical" treatment of children and adults with autism spectrum and related disorders.

Her sentence says so much.

It's not about her. There's nothing on this site about her, her passion, her journey...

It's all about those in need. The only content is those in need who Lend4Health can help and how they can help and how you can help.

Lend4health is a community, an open and transparent community.

Tori's a very smart, organized, efficient, entrepreneur. She saw the potential with micro-finance lending used with Kiva and Grameen Bank to solve an unmet need: affordable healthcare for those and their families who suffer from a vexing, debilitating disorder.

I'm delighted she has found the time to share her story of her purpose and her startup: Lend4Health.

Join us, Monday, October 19 at 9:30 AM, Central. You have two listening options:

LIVE

1. Listen in streaming on-demand at this link.

2. Live call-in. Join the conversation. Call 646-915-9212 during the show, 9:30 AM - 10:30 AM, Central.

ARCHIVED

1. Listen in streaming on-demand at this link.

Highlights from My Conversation with Dr. Jacob Teitelbaum

Dr. Teitelbaum is a board certified internist and Medical Director of the national Fibromyalgia and Fatigue Centers, Inc. He is the author of the perennial best-seller From Fatigued to Fantastic! which has sold over 500,000 copies. The 3rd revised edition from Avery/Penguin Group USA publishes on October 4, 2007. In Pain Free 1-2-3 (McGraw-Hill, April 2006), Dr. Teitelbaum outlines a step-by-step program that can help anyone identify the source of pain and understand how to alleviate it. Three Steps to Happiness: Healing Through Joy (Deva Press 2003), provides a blueprint for creating and maintaining a natural state of happiness and vitality at any time.

He is the lead author of groundbreaking “gold standard” research on effective treatment for Chronic Fatigue Syndrome and Fibromyalgia, which was published in the Journal of Chronic Fatigue Syndrome, volume 8, number 2 in 2001. Up to 24 million Americans are chronically fatigued. And as many as 12 - 13 million are diagnosed with either Chronic Fatigue Syndrome and/or Fibromyalgia. Dr. Teitelbaum shared his tips and resources to address our nation's personal energy crisis and allow us to leave the vibrant lives we deserve.

You can listen in streaming on-demand at this link. Warning: a heckler joins for about 10 seconds, screaming obscenities for the last 2-3. Dr. Teitelbaum handled this very well. And BlogTalk Radio’s host controls allowed me to remove the caller immediately.

What projects are you working on right now?

Our general goal is to make effective treatment available to everyone using natural and prescription therapies, which is not part of the big pharmaceutical money game. We have an iPhone application called Natural Cures which is currently available to the public free of charge, but will increase to $1.00, so download it now. Once downloaded to the phone, you are able to search any illness and find any natural or Rx remedy. Health Fact has a nutritional primer and soon an herbal primer. My book, “I am Beating Sugar Addiction Now” is coming to press shortly and my next book will teach people how to recover from the difficult economy and how to get their life back, physically, emotionally and spiritually.

Congratulations on being recommend in Oprah magazine and that issue has been out for a few weeks now. What has been the impact on your business?

After the mention, I received a call from Dr. Oz to be on his show in 3-4 weeks. The impact has been interesting. I think the general economy has been picking up and I can see that our product sales have increased. Things are healing and this is a good thing. Most businesses have taken such a hit, but I think things are turning around for the better. It is like spring time for the economy. It is time for small businesses to heal on all levels. This takes the lead for healing our whole country.

Why does your program work so well for so many, when seemingly all others especially Western drug treatment has failed?

It is important for our listeners to understand what drives Western medicine. I appreciate it, but there are many weaknesses. Basically in medicine today, for anything to be promoted for use, it has to be very expensive and patentable. The way the system is set up, it must go through the FDA process, which costs $800 mil. If it something is not patentable, that money is lost, no matter how well proven that treatment is. On the flip side, no matter how deadly or dangerous or infective to other treatments that are out there, if it can show statistical benefit, not clinical over a placebo, without being too dangerous, that is all it takes for FDA approval, even if it kills just a few people. Medicine is no longer based on what is safe and effective; it is based on patent and dollars. This is so dangerous. We are moving towards change, but it takes a great deal of time and energy.

You suffered from Chronic Fatigue in medical school. Was it identified with that term then and what was your experience in dealing with it?

Back in 1975 I had a nasty viral infection that I called the drop dead flu. We could not tell what it was. I was bedridden and had to drop out of school. I became homeless at this point as I was paying my own way. My medical professors knew there was a virus but could not identify it after six weeks. They figured I was depressed. In medical mentality there was a rule of thumb, that if the docs didn’t know what was wrong, they think the patient is crazy. I had the disease and they had no idea what it was. I learned how to treat the virus much better while I was homeless. I met naturopaths and herbalists who taught me how to get well and I soon recovered. I did go back to medical school and got my honors. Through my studies, I learned that 91% of patients improve when treated on an energetic level.

Tell us about your journey with alternative medicine.

I read a great deal of medical literature, beyond funded medical studies. I did an extensive amount of research based on some of the questions that patients had regarding natural treatments. Most physicians do not read any of this information nor are they interested. They only read the materials put out by the pharmaceutical companies.

When did Western Medicine begin to accept Chronic Fatigue Syndrome and Fibromyalgia as valid distinct disorders?

About 15 years ago. An important thing happened about one year ago. For the first time ever, three new medications were approved by the FDA for Fibromyalgia pain and because of that, companies are spending millions of advertising dollars to inform the public. They realized there is money to be made; however, it has also brought to light that it is a real disease.

I want to be able to help people effective treat their disease as well as to recognize if they have it. Basically the symptoms are: exhaustion and lack of sleep. It is a paradox and doesn’t go away with vacation. If you ache all over and have brain fog you have CFS until proven otherwise. Most doctors will not acknowledge some of the symptoms exist. They represent the energy crisis in your body. The fuse that is blown in the body is sleep.

You have a SHINE protocol based on these symptoms. What is that?

It is an acronym: how to restore energy production which turns on the circuit breaker.

The "SHINE Treatment Protocol" is an itemized list of all the common treatments for Chronic Fatigue Syndrome and Fibromyalgia, both natural and prescription, that can be used by a patient or practitioner. A personalized treatment plan can be created from this list by identifying the underlying causes of these two, based on an analysis of the patient's particular symptoms. SHINE stands for:

S: SLEEP - You need 8 hours per night and there are many natural remedies to help.

H: HORMONAL SUPPORT- in the medical field, we confuse the normal rage with healthy, which has nothing to do with health. It is based upon computing the standard deviation. You need to treat the hormones and compare to the symptoms using bio-identical hormones. These are cheap and most docs will not even look at them.

I: INFECTIONS– because our immune systems are not working properly when people have these illnesses. People tend to get yeast infections or an overgrowth of Candida. Basically it is really odd in medicine because there are no tests for normal as compared to overgrowth of yeast. Doctors say there is no such thing as an overgrowth.

N: NUTRITIONAL SUPPLEMENTS- Optimal nutritional supplementation is essential. Many nutrients can be depleted as a result of Chronic Fatigue Syndrome or Fybro Myalgia. B-12, magnesium,... as well as your basic A, B, C and D vitamins need to be supplemented at a level that your average over the counter multivitamin cannot provide.

E: EXERCISE- Exercise as able. After 10 weeks on the 4 steps above, you will be able to slowly increase your exercise-without being wiped out the next day!

35:50

I do recommend that people go to the Fibromyalgia and fatigue clinics as these physicians are experts in these diseases. The doctors know what they are doing.

What is your reasonable aspiration or hoped for goal* with all that you are doing?

Short term: heal our healthcare system. Basically right now I am looking to be involved that people have access to natural remedies and teaching people they can be empowered in their own health. A big part of this is bypassing the pharmaceutical companies. I had the great opportunity to speak with President Obama and Michelle on these issues and there are some processes/laws in creation to work on this task.

You mentioned that some of these changes and reforms are already happening in our healthcare system. Why are you so optimistic?

The system will reform or collapse. There is a certain evolution and growth that occurs with what is common sense and necessary. The public is able to go online and get the information they need and get their own tool kits. People have a certain common sense about them.

On a recent appearance on Good Morning America, you said we suffer from a personal energy crisis that is far greater than an oil crisis. Why and is this worse now with the economy?

This is absolutely what is going on. How many listeners don’t need more energy? People go into the doctor’s office saying “I have fatigue and I have pain.” Pain is an energy crisis. Doctors are not trained in this area. A lot of this is occurring due to our nutrition. One third of our nutrition comes from white sugar and white flour, which are devoid of vitamins and minerals. The government forced companies to enrich the flour with a few nutrients. This is like one third of a loss of your paycheck. This detriment leaves us nutrient deficient and adds on lack of sleep and things are speeding up exponentially. The good news is that all this is treatable. We can help the body handle what is in the environment. Our vitamin powder and energy powder or some from the health food store can help combat this health crisis. Also, go out in the sun – your body needs sunshine!! Vitamin D is a critical hormone/nutrient. Just avoid sunburn, not sunshine. The lack of sun causes overwhelming amounts of cancer.

50:26

You offer wonderful advice with a simple phrase: Follow Your Bliss. What do you mean?

I have always said, if you get people healthy and they go back to a life they hate, I guarantee that they will get sick again. You can’t just treat only the physical component – the disease will pop up somewhere else. You need to treat the whole person. Check in with your feelings - Your gut reaction. Cut out the things that feel bad. Follow your bliss!! You will be filling your life with wonderful positive things and as you continue this thought, more positive will surround you.

Looking at the rise in chronic diseases, it looks like we are working at jobs we hate. Would you connect the two?

I am not sure we are doing more of jobs we hate, but I do presume our entire nutrition and environmental atmosphere is more damaging. I think more people are starting to wise up and do what they love and people are shifting their focus and their lives.

Where can people find your FREE weekly newsletter?

The website is Vitality 101. There is a lot of fun and useful information and even a joke of the day.

If we speak next year, and I hope we do, what will you celebrate with us?

Celebrating my new book, “I am Beating Sugar Addiction Now” as well as my next book. Maybe I will even be on Oprah.

Caller: Do you see a shift in the healthcare field to where we will start to see more people come in looking at naturopathy and alternative medicine?

I believe so. I think health insurance should be catastrophic coverage only and natural treatments are out of pocket. We already know there are more visits to naturopathic doctors than traditional medicine. Natural remedies are a growing area and this scares the pharmaceutical industry.

Disclaimer: I was introduced to Dr. Teitelbaum by our mutual friend Dean Draznin. Dr. Teitelbaum, Dean and I spoke earlier this summer about what Twitter could do for him. Dean is founder of Dean Draznin Communications which serves as Dr. Teitelbaum's PR firm. I scheduled this show working with Dean. Recently, my wife joined Dean Draznin Communications. I received no remuneration for this interview, nor asked for any. But I did convince my wife to bring home a sample box of Dr. Teitelbaum's Energy Revitalization from her office. And it's great! I feel clear, focused, with energy but not jittery. I slept well. I worked out at the gym yesterday and still felt like working in the yard for a couple of hours the next day. That's a first.

Small Business Already Taxed for Healthcare (or its lack)

And their employees get nothing.

Opponents of healthcare reform, coincidentally those with health insurance, often cite its impact on small business. In particular, healthcare reform opponents cite the provision that small businesses, all businesses, be mandated to provide health insurance for their employees. They costs will be draconian, it's claimed.

Putting aside the inconsistent logic that investing in the health, care and maintenance, of your number one asset is unproductive...let’s look at the current draconian taxes already forced on small business by our current healthcare system.

Bankruptcy costs. 50% of personal bankruptcies are caused by catastrophic healthcare costs. Catastrophic means...their recipient cannot afford them. Their catastrophe arrives from many sources:

1. No health insurance
2. Inadequate health insurance
3. Rejected health insurance claims
4. Delayed healthcare. Like delayed justice, delayed healthcare is no healthcare. A chronic health issue ignored over time becomes a catastrophic healthcare cost. No one chooses to ignore their healthcare. We ignore our healthcare because we cannot afford to pay attention to our healthcare or that of our children.

This number, 50%, only continues to rise as the costs of healthcare grows faster than wages and inflation.

Why does this matter? Debt waived in a personal bankruptcy only disappears from the balance sheet of the bankrupt. It’s passed on to their creditors, who then pass it on to their consumers in the form of higher costs. So, first the bankruptcy debt is absorbed by the business. Then business, in turn, passes on those costs to we, the consumer, in the form of higher prices.

How much is all of this? Let’s look at the math:

* Average amount of debt by those filing for personal bankruptcy was 1.5 times their annual income in 1997. Bankrupcty Action
* Average personal income in 2006 was $36,000. Link
* Number of filings in 2009. 1.251 million non-business bankruptcies were recorded in 2009 (june 2008 to june 2009) US Administrative Court Filings
* Total Cost of Bankruptcies Caused from Catastrophic Healthcare Costs? $33,777,000,000.

(1.5 x 36,000 x 1.251 million = (drum roll, please) $67,554,000,000 and then 50% of this = $33,777,000,000.)

For $33,777,000,000, small business and its employees receive:

* No health insurance, no or inadequate healthcare for its employees.

Job-lock Job-lock is the term used to describe employees locked in their current job. They are locked in their current job for the healthcare benefits the bigger company offers and the small business cannot afford to offer.

What’s this cost to a small business? Quantifying this cost to small business and our economy is difficult. But, did you notice the news that this economic recovery is a job-less recovery. And did you notice that small business remains the top source for layoffs?

Without the talent needed to provide leadership, ideas, skills and strengths, to find solutions, to attract more talent of the same caliber increases the likelihood that both scenarios remain. Why? Small business is unable to provide the healthcare benefit needed to lure the talent necessary to drive their business and create jobs.

Lost productivity. This will come in several forms:

• More sick days
• More employees sick
• More time off to take care of families
• More distractions in the workforce. As more of your employees must spend their resources to deal with the lack of affordable healthcare...you lose their productivity from their lack of focus, from their time spent on the phone with family members and doctors, etc.

Lost employees. See job-lock. This is the flip-side. Your talented employees will leave to find the healthcare benefits you cannot afford.

Like most of our healthcare system, the true costs are hidden or disconnected from their impact, their provider and the recipient.

Small business is already taxed with the costs of providing for our current healthcare system. The difference is there are no benefits received by small business and its employees for these taxes, these costs.

Lucky for her! She can afford her healthcare

Rep. Sue Myrick of North Carolina issued the latest warning against a Democratic-backed health care overhaul as she recalled her fight with breast cancer. She said in the GOP's weekly radio and Internet address that her diagnosis "took six doctors, three mammograms and one ultrasound before they finally they found my cancer. GOP Lawmaker Warns Against Healthcare Changes, USAToday.

Lucky for her! Her employer offered her the time from her work to meet with those six doctors, [ and undergo] three mammograms and one ultrasound before they finally they found [her] cancer.

Lucky for her! She could find six doctors, who would conduct three mammograms and one ultrasound before they finally they found [her] cancer.

Lucky for her! She was employed by a company, US Congress, who offered an affordable healthcare coverage and insurance.

Lucky for her! She didn't have to then choose to either forgo her treatments or choose bankruptcy.

Lucky for her! She didn't have to file for personal bankruptcy from these medical expenses needed to save her life. 50+% of all personal bankruptcies are filed as a result of catastrophic healthcare expenses that...Rep. Myrick, R-NC, did not have to pay. Her health insurance company paid.

Lucky for her! As a member a member of Congress for 14 years, now serving her 8th term her health insurance and healthcare were provided at our expense: taxpayer money.

Lucky for her. She enjoyed a government healthcare plan, the healthcare plan enjoyed by members of Congress.

The FDA Wants to Regulate...Social Media?

Huh. Pharma Marketing Blog says Let's Respond to FDA's Questions Regarding Its Regulation of Social Media

According to his post, the FDA posted its request for hearings on the Promotion of Food and Drug Administration-Regulated Medical Products Using the Internet and Social Media Tools. Given the buzz on social media, especially Twitter under the hashtag of #fdasm, they could...if they looked, see the power of social media.

But, they can’t, at least on Twitter. Someone else has the Twitter username FDA.

That may be the biggest problem for the FDA. They’re proposing regulations for a resource they do not use. How do you regulate what you do not use? That’s like Twitter changing Terms of Service when they use Twitter much, much, less than their members use Twitter.

Ok. It’s worse. At least those who provide us Twitter, use Twitter, somewhat.

Back to the FDA. A survey has been created by the FDA to gather responses from the public. You can participate in the survey offered by Pharma Marketing Network. (Sure, a wiki forum would have been more useful for gathering responses and creating a live-lab, social-media petri dish, to study the responses and the community of those interested in those responses. But, again, the FDA doesn’t use social media.)

My only response to the survey would be a letter:

Dear FDA,

Regulate drug and food research and production. Provide for its safety and proper use. Concentrate on that. That is your strength. (Ok, it could be with adequate mandates, funding and personnel. )

An open, transparent, conversation by the public with social media quickly exposes any untruths propagated by...anyone, a drug manufacturer, their PR agencies, the minions of either, doctors paid in some form by drug manufacturers, big pharma lobbyists, even members of Congress. But, they expose them only after damages are done to unsuspecting patients.

Your limited resources are best used to prevent that damage from happening.

Then we, the public, using social media tools like blogs and YouTube and Twitter and Facebook can talk about your successes, instead of your failures. We speak too often, too frequently, with too much damning data about the latter now.

Thank you,

Zane Safrit

"No “Free” Healthcare to Illegal Immigrants!"

When people say (shout ) No “Free” Healthcare to Illegal Immigrants! here’s what I think they’re saying:

Go home.

You’ve entered our country without proper documentation. Back when our ancestors did it, that was ok. And lucky for us, too.

But, you’re not part of our family, so...it’s not ok...anytime.

We don't know, nor care, that our nation is a nation of immigrants. Who cares that we serve, once served maybe, as a beacon of hope for those with the motivation and courage to come here as strangers and forge their own opportunities.

We're scared. And besides, we’re scared. We’ve been told to be scared of ‘others’. You’re ‘others’. We’re scared of you.

And things are changing. That scares us. You're change. You scare us.

We don’t want you.

But...hang on a minute.

We do want you to do all the jobs we refuse to do. Like, clean our hotels and our restaurants, and work the lines in meat-packing plants and be janitors in our office buildings when we’re at home with our families because we believe in family-values.

We like the cost-savings from your low wages. Can you imagine how expensive our bacon and ham would be, or our hotel rooms, if we had to pay wages and benefits high enough to convince us to work there? Can you imagine the impact of those higher costs on corporate stocks?

We do want you to live in cramped quarters, separated from your families, though. That’s less expensive. For us. And it leaves the nicer areas of town for us, not you. Because you can’t afford them. Because we won’t pay you enough to live there.

We like your work ethic. We don’t like to acknowledge the hours you must work in order to send money home to your family where they live in towns where there are no jobs. But, we like how much money it saves the companies we buy from. That keeps our prices low, so we can live better.

But...

We're threatened. The poor jobs, the low wages, the cramped living quarters, the distance from your family don't slow your motivation to come here. You see the opportunity to make a life for yourself, if given the chance to work. We, on the other hand, complain about commutes in our air-conditioned cars , an office chair that squeaks and co-workers with funny smells.

So...

Our hospitals are for us. You can keep those jobs. We don't want 'em. We need 'em to be done. We just don't want to do them. But don’t you dare come bringing yourself to our hospitals for ‘free’ healthcare. That’s for us and our families...because we're entitled; we've earned it. Have you?

That's what I hear. What do you hear?

Our Healthcare Reform Debate is The Tragedy of the Commons; Now What?

Have you been...experiencing...our healthcare reform debate? Like democracy, it’s a messy experience. The alternative is what we’ve had until now: silence, acquiesence. And the system, we have in place now. That’s a system our silence allowed. It’s best described as the Blob that’s about to eat a nation.

The debate we’ve experienced so far has almost consumed us. And, it seems the debate is less about healthcare reform than it is a debate about our values. I wrote about this early in my post: Healthcare Reform Debate: It’s really about our values.

But what’s bothersome about the debate, regardless if you have health insurance and/or can afford healthcare or whether President Obama is a socialist or a failed progressive or not. It's the tone. Would you agree? Or maybe, it's the imbalance between tone and substance.

I’m reading Clay Shirky’s book Here Comes Everybody. If you haven’t read it, you should. Around page 45, he discusses the different forms of sharing and collaboration everybody can use now. At the end he discusses [t]he commonest collective action problem is The Tragedy of the Commons*.

This is where individuals are incented to damage the collective good.
As long as everyone refuses to behave greedily, everyone benefits...

And this is the Tragedy of the Commons: while each person can agree that all would benefit from common restraint, the incentives of the individuals are arrayed against that outcome.

People who benefit from a resource while doing nothing in recompense are free riders.

The resource here is...the commons. That’s our treasured right to have a debate, in public. The free riders are those who offer nothing to, or worse, benefit from this commons while effectively destroying it with vitriol and names, half-truths, and outright lies and money and resources to propagate those lies in order to defend their positions.

Mr. Shirky says we have, generally, two ways to deal with the problem of free riders.

1). Eliminate the commons. In this case, eliminate the debate or the opportunity and means to have a debate. But, we’ve already tried that. In fact some of the pent-up anger from either side in this conversation is the result of having this conversation denied for 10-20-30 years. Here’s a timeline for the changes in our healthcare system over the past century.

Looking at it, I remember little debate over these incremental changes that have occurred. Oh sure, there’s the debate in the ’90’s. It was effectively squashed by many of the same industry players and their representatives in Congress who remain in their positions in this debate. We allowed it, mind you.

2) Governance. The other option, from Mr. Shirky, for mitigating the Tragedy of the Commons is through governance, or mutual coercion, mutually agreed upon. We’re disallowed in some way from acting in our own interests at the expense of the group’s interests. Taxes are a common way. So are civil and criminal penalties.

We have those in place now, even for this debate:

* Peer approval. There’s peer approval that regulates our behavior with each other. That’s been long gone judging by the recent town hall behaviors and members of Congress.

* Taxes. Taxes already exist in our current healthcare system, though they are hidden and disconnected from their source. The taxes are paid in the costs of a healthcare system that’s the most expensive while at the same time failing to deliver the highest level of care for the highest number of people. Everyone shares in this, even those with health insurance and who can afford the costs of their healthcare. The costs of those unable to afford the costs of our healthcare are borne by those who can afford them. Multiple points of data show this. They include:

• costs of personal bankruptcy borne by customers of the companies whose services remain unpaid by those filing for bankruptcy
• higher hospital costs as hospitals seek to recoup their losses
• lower productivity from higher numbers of sick days by employees and their families
• higher health insurance premiums
• etc, etc.

So, now what. We have a Tragedy in our Commons. We have tried the two generally agreed upon measures: elimination of the commons, a fragmented or non-existent discussion and mutual coercion, mutually agreed upon.

Now what?

* The Tragedy of the Commons was brought into our national discourse in 1968 with Garrett Hardin, a professor of biology at UCSB in this article published in 1968.

Healthcare Reform Debate: It's Really About Our Values

Our healthcare reform debate is moving nowhere fast. Well, nowhere good anyways.

Regardless of your view of our healthcare system, can you say the debate in its current form is...productive? Whether you think our healthcare system is in shambles or the greatest in the world has, has this debate been...useful, productive, helpful?

Yes. And no. No. It is not proved helpful as a means to find a solution to some of the inconsistencies, and their fallout, from how healthcare is provided and to whom it's provided in this country.

Yes. If I look at this healthcare reform scrum being held daily, nightly, 24 x 7 now with social media as a debate over our nation's values, then...yes. It is very valuable.

But that's the confusion. We think we're debating our current healthcare system with its drug reimbursement costs, criteria for health insurance coverage, EMRs, doctor visits, prescribed treatments, plans and means to deliver any and all.

Instead, we're debating do we love our grandparents, how much, competitive business models, who pays for our healthcare and why, when do we pay, should we help others, why should we, is health a right or a treat, why a private bureaucrat is oh so preferred to a public bureaucrat when denying healthcare treatment, should children have healthcare, who's a socialist, why a single-provider makes a competitive marketplace, why do I have to change...why government intrusion in our healthcare is bad but government intrusion in our marriages is good...we're debating our values as a nation.

We were built on the foundation of that statue in the NY harbor entrance. You know her. The Statue of Liberty. The one that greeted our ancestors, who entered this country uninvited and without a visa, and greeted them with the sign: give me your poor, etc, yearning to be free.

And fortunately, everyone was embraced more or less, as the common bond of yearning to be free was shared, equally and openly. And on that basis we became, until recently perhaps, the most generous nation in the world. Got a disaster? Well, there we were helping the strangers effected by it. Got a vexing national problem? There we were with volunteers and agencies helping. We weren't the only ones. Other nations were there, too. But for 30-40-50 years, it seemed we were there more often, with more people, with more resources.

(Yes, it's understood that government and corporate interests sometimes clouded the intent.)

And somewhere along the line, on a bi-partisan basis, we became confused or lost sight of that ideal. The nation who served as a shining city on a hill for so many became but an election speech metaphor. And with bi-partisan support that's where it rests now it seems.

The healthcare reform debate as with so many other debates (stimulus funding anyone) will never be resolved until we decide who we are as a nation, a community, individually. Are we the nation whose open arms accepted immigrants yearning to be free, created a nation with them and their dreams to be free to pursue their lives not the lives of institutional interests, who created the greatest public educational system in the world, whose GI bill created a generation of college-educated leaders, and that together drove innovation and leadership and affluence and generosity and a few makeovers along the way and created a shining city on the hill for others, a beacon of hope, a dream they could reach?

Or are we the nation that turns that city on the hill into an empty storefront, mocking all who continue to believe in it, denying access to it for those unable to afford it? In essence, we choose to say: We've got our shiny city, now you get yours?

Once we figure out our values now as a nation, this healthcare reform will be a snap.

(And tip of the hat to the lobbyists for the healthcare industry for distracting us away from looking at what they have wrought. Their victory today will prove their defeat tomorrow. )

How the Healthcare Reform Debate Reveals Our Wrong Priorities

Exhibit #4 I recently testifiedbefore the Senate Finance Committee on the question of whether there needed to be $8 billion worth of tax cuts to businesses to offset the impact of the federal minimum wage increase.I argued that the cuts were unnecessary, but in this context, consider this point: Because tax cuts must now be paid for, the committee was able to come up with $8 billion of offsets to pay for these cuts.

In other words, when they want to, Congress can allocate or raise money. The problem, as put by my colleague Lawrence Mishel, is “... the direct consequence of maintaining other priorities. Some [policy makers] are wedded to maintaining the recent tax cuts. Many more believe we have to spend whatever it takes for the wars in Iraq and Afghanistan ... [o]thers believe that moving toward a balanced budget is essential. Whatever one thinks of these positions it is clear that the result is that human capital investments get the leftover fiscal scraps.”

For those of us unhappy with this state of affairs, who believe that these are the wrong priorities, the big—giant, really—question is what has to change? - Jared Bernstein*, There's always money for war at TomPaine.com.

What has to change?

Maybe, our priorities and our willingness to communicate them.

* Jared Bernstein is senior economist with the Economic Policy Institute and author ofAll Together Now: Common Sense for a Fair Economy.

Mandated Investment in Your Most Important Asset?

When did our business community reach the point where we need to be told to invest in the assets of our business?

When did we need a legal mandate, essentially a parent, to force the good business practice of investing in the upkeep, the enhancements, of a corporate asset?

Have we reached the extreme end of this pendulum swing where assets are churned, as customer accounts are?

There’s no mandate required to change the oil in the cars of their fleets. Businesses are thought smart when they buy extended warranties or online support to maintain the upkeep and care of their equipment. Companies regularly consider it a smart decision to purchase insurance on their office assets (computers, desks, furniture). There’s no mandate required to invest in the current technology to remain competitive. There’s no need for any regulatory body to issue laws requiring businesses to protect their intellectual property.

But when it comes to investing in their number one asset, well, all those rules of the obvious kind are just thrown out the window.

That number one asset for a company is the human asset. That’s the asset that differentiates a brand. That’s the asset that delivers the brand. That’s the asset that makes all other assets valuable. Take the same non-human asset of a company and bring in a different group of human assets and you’ll see a completely different level of efficiency, of customer loyalty, of market share gain (or loss) or word-of-mouth and customer evangelism.

And yet, the idea of investing in this asset in the same way you invest in the upkeep of a front-end loader is considered...what...socialist...or handled with the response of ‘no one’s going to tell me how to run my company’. Well, no one would have to tell you how to run your company if you treated your human assets with the same care as you treated your inanimate assets.

Yes. I’m talking about investing in the healthcare of your employees.

Tell me, please,:

•  how you expect to grow a business with unhealthy employees?
• which adds greater sustainable value to your company, a health employee or an ad agency?
• what better way to recruit top talent than by word of mouth initiated by your employees?
• what better way to generate high levels of engagement and loyalty and commitment, inspiring your employees to become volunteers with that same level of passion and commitment that volunteers bring to a purpose...than to invest in the care for their health and that of their family.

Do you know how many hours an average employee spends on personal healthcare issues while at work?

Buddy, that’s downtime for your business. Pretending it doesn’t exist by not investing in a solution with them is the same as pounding your head on the wall and pretending it doesn’t hurt.

There’s a name for that kind of behavior. It’s called denial. Usually, angry denial. And it’s seen in adults who constantly seek to blame others (the employees, the federal government, the competition...somebody) and use ideological terms to mask the truly absurd proposition that you can ignore an asset’s upkeep and still expect it’s top performance.

It’s a company’s responsibility to its shareholders as well as stakeholders to maximize the value of their assets. And that requires constant investments in those assets that generate the highest return. ROA.

Why do so many companies then choose to ignore their most important, most valuable asset?

Talk, instead, turns to why should they be forced to do make the right business decision. The terms fall into the realm of ideology and dogma. Those are always so useful.

And you’re right. No one should be forced to invest in their most important asset. No one should need to force you to do that. ( You know. The logic is like that with smokers and laws prohibiting smoking. It's my right...they claim. Uh-huh. No one should need to tell you to not or to stop smoking. It's kinda obvious. )

Sure, it’s expensive to invest in your employees' training and health. But like all good leaders and managers you make choices. Which investment in which asset generates the highest? Which doesn’t? Stop the latter. Expand the former.

Do you really think your investment in...any other asset generates the rate of return as an investment in the health of your employees? Show me.

If you’re thinking of the healthcare expenses for the union employees with the former Big Three automakers, think again. Back in the day, when they made models people wanted, their corporate leader bragged that their workers were the most productive in the world.

Then they continued to make big engine trucks and Suvs while the market repeatedly told them they wanted. Employees were still the most productive. But they were productive making the cars no one wanted. It wasn't their healthcare costs. It was the products they were told to make.

Yes, it’s the responsibility for each of us to maintain our health. We are not a valuable asset to anyone, company or community or family, as we fail to invest in our health. Denial in us is as ugly and absurd as it is in corporate leaders. And as unproductive.

It’s kinda like children and vegetables. Children don’t like to eat vegetables.

Sure, it’s expensive. Vegetables and fruit are more expensive than soda and fast food. That is until you tally up the lost wages from chronic health problems caused by obesity or the inability to learn with children unable to focus after a rush of sugar and starch.

On the other hand, what are the options? Don’t eat vegetables and eventually become unhealthy, unproductive, unhappy, unnecessary?

Don’t invest in your employees and eventually see your brand become unhealthy, uncompetitive, unhappy and irrelevant?

Children complain about eating their vegetables because we haven’t educated them to the value of a healthy diet. We're the adults for our children and in our companies. We shouldn't need a parent at our work to tell us to do the right thing when there's so much logic and data to support doing it.

This issue of mandated health insurance for all companies is a false flag. The issue is why we need someone, a parent in the form of the federal government, to mandate we do what’s best for our business. We, the most competitive nation in the world, have forgot how to compete in the global marketplace. It starts with a healthy well-trained workforce. It stops there, too.

Be creative. God gave all of us a brain. That's a faith-based assumption. But I'm sure of it. Though data in our business leaders leads me to doubt my faith on this point.

Find a way to take care of your employees’ health. Health insurance is but one element. That's an expense that gets higher as you ignore the health of yourself and your employees.

Don’t first refuse to invest in your most important asset, your employees, and then complain at not having a healthy company. Or pout that someone makes you do that. Did your mom ever let you pout? No, otherwise, you'd never have grown up. So buck up and do the right thing. Invest in the care and training and motivation of your most important asset: your human asset, those who make the other assets and your brand, their brand, a great brand.

Healthcare Reform Debate: Value vs Values

I'm enjoying The Leader's Guide to Storytelling: Mastering the Art and Discipline of Business Narrative. A wonderful book written by a wonderful person. It's one of those rare business books that continue to improve as you read.

And recently I came across this passage. It's lengthy. But, it's important to consider in light of our healthcare reform debate.

Douglas Smith, in On Value and Values, suggests that...society has lost sight of the importance of 'values' and instead pursued 'value': "Value arises in conversations about economics, finance, shopping, investment, business, and markets. People worry about getting value for money or shareholder value or market value. The use value to describe business or economic prospects. Value connotes a pointed estimation of current or anticipated worth never too distant from monetary equivalence. There is no value that is not a dollar value.

Smith notes that the meaning of the plural values is something very different from the singular value. "Values are estimations not of worth but of worthwhileness. Unlike value, talk of values ignores money; it opines on timeless appraisals instead of transient ones. There is a deep backward- and forward-looking quality to values. If value is what makes us wealthy, values we assume and regularly assert, are what make us human.

Now, our culture has become obsessed with the single overriding value of winning.

As the screaming and shouting gets louder in the name of a healthcare reform debate, the ability to look backward or forward even superficially to stands taken but a few months ago become impossible. What's lost in these dreadful escalations of rhetoric (I'm being generous) is our ability to converse from a common appraisal of our shared values as a nation, as a people, as families and neighbors, co-workers and fellow citizens. Our culture's obsession over winning at any cost manifests itself as a collective and growing memory-loss of what we share in common with each other, those values that make us...human.

Data Worsens with Personal Bankruptcies, Healthcare and Health Insurance

* 50% Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs.

* 2,000,000  2 million of our friends, family members, colleagues, neighbors...are affected by these personal bankruptcies caused by healthcare expenses.

* 56% of those filing bankruptcy for healthcare costs owned a home.

* 30% of those filing bankruptcy for healthcare costs had their utilities cut off.

* 61% went without needed medical care.

* $13,000 The amount of uncovered medical bills at the start of an illness by those with health insurance.

* $35,000+ The average medical debts for those with cancer.

The statistics above were reported in 2005 from a study conducted by jointly by Harvard's Medical School and Law School and published in Health Affairs. The article Medical Bills Leading Cause of Bankruptcy, Study Finds was published in Consumer Affairs in February, 2005. 

And this data inspired the leaders of  the best healthcare system in the world to improve since then, right?

Wrong.

Medical problems caused 62% of all personal bankruptcies filed in the U.S. in 2007, according to a study by Harvard researchers. And in a finding that surprised even the researchers, 78% of those filers had medical insurance at the start of their illness, including 60.3% who had private coverage, not Medicare or Medicaid.- BusinessWeek, June 2009

Wrong, again.

A new study published in the American Journal of Medicine has found that bankruptcies due to medical debt rose 50 percent from 2001 to 2007.- Health Related Bankruptcies Up 50%

I want to see the costs of these personal bankruptcies to business.  The costs to business would be in lost productivity and lost revenues. And compare them then to the costs of health insurance for their currently uninsured employees.

I would love to see the costs of these personal bankruptcies compared to the costs of social programs with medicare, medicaid, Schip, healthcare clinics, that compensate for the lack of affordable and complete health insurance.

 I'll bet my senator Chuck Grassley and Nancy Pelosi, both, a year's supply of one daily latte at Starbucks that universal, single-payer, healthcare that covers all healthcare expenses will prove ultimately more affordable.

Note: I choose Starbucks for he convenience of their gift-card So, Senator Grassley or Speaker Pelosi, if you can present data that shows the costs to our economy and our federal budget is less from the current system where 62+% of all personal bankruptcies arise from the uncovered costs of medical care (even when 78% of those filing for personal bankruptcy as a result of uncovered medical expenses had health insurance) I'll buy each of you one latte each day for 365 days. ( That's a small latte.)

And you can drink that latte and continue with our current healthcare system.

But if you can't (and you won't), then you have two options:

1. Buy me and every American the same.
2. Do the right thing. Honor your oath to us. Work together to devise a healthcare system that delivers the same level of care you receive as a member of Congress...without risk of personal bankruptcy.

I love this part about our health insurance companies, don't you?

Yes, the insurance company status quo rocks. I learned recently about something called the "loading fees" of insurance companies. That's how much of every health-care dollar gets spent by insurance companies on things other than the medical care—paperwork, marketing, profits, etc. According to a University of Minnesota study, up to 47 percent of all the money going into the health-insurance system is consumed in "loading fees." Even good insurance companies spend close to 30 percent on nonmedical stuff. Sweet. What's Not to Like. Reform? Why do we need healthcare reform? by Jonathan Alter at Newsweek.

Yeah. Sweet.

And this article shares more what there's more to love about about our current healthcare system.

And the healthcare industry loves their industry more than we do. That's why they're working hard to keep change at bay. And when they lack data, they instill fear. When they lack talking points, they make up talking points with meaningless debates about economic philosophies and ideologies, applying terms and labels that do not apply but invoke baseless fear and outrage.

Now's probably a good time to participate in this debate. Here's 5 ways you can.

5 Ways You Can Join the Healthcare Reform Debate

Educate yourself

Read. Read a lot. Read lots of sources. Ask questions. Read more. Educate yourself. It is our healthcare system. And that includes you. And your family.

Here's a link to Read the Bill 101 from US Health Crisis blog. It explains how a bill from Congress is organized and presented in text, and tips on how to read through the bill all the while taking notes. And there's a link in the post to a PDF version of the bill itself. Judge for yourself if the fear and hysteria is justified or manipulated.

Comment on healthcare reform

Write a letter to your editor. Leave a comment on a blog. Call your elected officials. Talk about it at dinner parties and backyard barbecues. Help people look at the terms, what they mean, what they don't, why fear isn't helpful.

Ask others

• Do you know...?
• Did you read...?
• Do you understand...?

Tell elected officials

Call them, write them. They do listen. They do respond. They respond to what and who they hear.

Make your voice one of them. Make your company one of them. Make your community one of them.

Don’t Rant.

This is difficult. Our healthcare system offers a lot of rant material.

Ranting helps you and others overlook all that works in our healthcare system. Inspirational leaders, problem-solvers, models that work, are hidden underneath all this rantable material. Trust me. I know. I’ve ranted. I’ve missed solutions, resources and leaders.

Here is a free ebook that I and others created to share our ideas on how to reform our healthcare system. It's called: Healthcare Reform: it's our debate, too.

Some ideas in it are outrageous. Some outrage.

What are yours? Comment here and share them. Or share them elsewhere. Feel free to pass this to others. I don’t care who. I don’t care if they come back here to comment. But join the healthcare reform debate. It’s our healthcare system, too. And that includes you.

How Much Does Big Pharma Spend on Advertising?

How much does Big Pharma, aka the drug manufacturing industry spend on advertising?

• 24.4% of sales in 2004, or $57 Billion.

A report published in Science Daily in January 2008 showed Big Pharma spends as much as 24.4% of total revenues on advertising in 2004. That’s nearly twice the amount, 13.4% they spent on R&D during the same time period. With total domestic sales of $235 billion in 2004, they spent over $57 billion in advertising.

However, the advertising is productive:

In 2006, Americans bought 42% of the world’s prescribed medicines. We have 5% of the world’s population. - Healthcare Reform: it's our debate, too.

Do you want to participate in the debate about your healthcare system?

Here's one way: The link is to a free ebook, Healthcare Reform: it's our debate, too , that encourages you to participate in the debate on reforming our healthcare system.

Download it. Read it. Share it. Pass it on. Leave your ideas here. We'll issue new editions that may include your suggestions.

Or, download it. Read it. Disagree. Share your ideas. Pass it on. We may add your ideas, too.

If we don't include your ideas, we'll explain why.

The point here is to encourage more of us to connect, communicate and collaborate to find solutions for our healthcare system.

Free PDF: Healthcare Reform: It's our debate, too

Download Healthcare_ebook_FA5

Have you noticed, we the consumers, are not invited to the healthcare reform debate? Those debating changes to our healthcare system and the same ones who created it. They also are the same ones with vested interests in the current system.

We can reform our healthcare system. We have to participate in its debate. We have to offer our ideas. Our ideas to reform our healthcare system. Otherwise, it remains...their healthcare system.

This is a first-step. It's only a first-step.  It's not the only one. Take this step here. Or find a place to take a step, your step. And make this healthcare reform debate, our debate, too.