Zane Safrit

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.

How to fix our healthcare: Give Congress our healthcare options

"If every member of Congress put their heads on their pillow every night like I do ... knowing this could be the night I lose my house, we'd fix healthcare in a week," said Rep. Steve Kagen. Kagen is a Wisconsin Democrat who worked as a Green Bay-area physician for decades. - Washington Monthly.

He is the only member of Congress who refuses federal healthcare benefits, on the principle it is unfair to have better have healthcare options as an elected official than those who elect him. So, he goes without.

Take Congress' generous healthcare options away. Give them the same healthcare options as we, their electors, enjoy. Then let them wonder, as many of us do, is this the night our healthcare costs take our houses away.

Many Americans, myself included, say we should have the same healthcare as Congress. No, they should have the same healthcare options as we are allowed.

We'd fix healthcare in a week. Maybe, even today. Definitely before the Congressional recess this month.

Health Insurance Costs: Revisionist Disconnects

Good news! A solution to rising healthcare costs has been found. And it can be applied for immediate savings.

First, let's review the trends for healthcare costs. They've been rising. From around ...10% of GDP in the early '70's to over 20% of GDP now in the first quarter of this year.(What a coincidence! Our economy was heading south at the same time healthcare costs were peaking in their movement north.)

But, that trend, at least for healthcare costs, will now reverse itself. And, let's all snap our fingers...like that.

Here's how they'll do this to for us:

[H]ealth insurance, which is now viewed as a health care expense, will be partly redirected toward financial services. Say you spend $1,000 on health insurance. Under the old system, that was a $1,000 health care expense. Now the government will try to figure out how much of that $1,000 will really be spend on health care — say $900 — and how much on the insurance company’s own expenses or left over for profits. Say that is $100. The result will be that health care spending will be viewed as $100 lower than it had been. Revisionist History...Floyd Norris, NY Times.

We pay the same amount to the health insurance company. We pay it for the same goal: our healthcare. The same gaping hole exists in our household budget. The same gaping gap in our household GDP...exists

But the percentage of our national GDP will drop.

Now, in all fairness, this revised definition, is possibly more accurate. The expenses and profits of health insurance companies aren't directly related to our healthcare expenses. The health insurance company executives though claim otherwise. They tell us without profits they cannot exist.

If we don't pay for the health insurance company's profits, we don't have affordable healthcare.

If we do pay for the health insurance company's profits, we don't have affordable healthcare.

See the common theme. The health insurance company's profits are irrelevant to our affordable healthcare.

How do bring this back to being about our healthcare?

Prediction 1: I see, oh, sometime, later this year, the health insurance industry and maybe the entire oligopoly of our corporate, for-profit, healthcare industry (for-profit hospitals, big pharma, health insurance industry, AMA) will claim they have worked together to lower their costs and their percentage of our GDP. And like the access to affordable healthcare, it too will be a phantom claim.

Prediction 2: This 'savings' done to us will justify price increases to us.

Can Healthcare Reform Reverse the Trends in Obesity?

Daphne Leigh blogs at Just So You Know...Getting Feisty about Healthcare Communications. And she tweeted* a question the other day. It was How's health reform gonna address this? The this in her question was the obesity epidemic.

Now, unlike the swineflu whatever, obesity is an epidemic. Check out this interactive map she linked to. It's provided by the CDC. Scroll down quickly or just hit refresh. You'll see the changes over the past 20+ years for the rates of obesity here in the US.

Here's the comparison of the first and last years of this survey.

* FIRST: 1986. ALL states reported LESS than 15% of their population were obese.

* LAST: 2008. ALL states reported MORE than 15% of their population obese.

According to the CDC's site: Obesity is a major risk factor for cardiovascular disease, certain types of cancer, and type 2 diabetes.

And USAToday shared this article Cost of Treating Obese Patients Soars to $147 Billion. WASHINGTON — Obese Americans — those who are 30 or more pounds over a healthy weight — cost the country an estimated $147 billion in weight-related medical bills in 2008, double what it was a decade ago, a new study shows.

Overall, an obese patient has $4,871 in medical bills a year compared with $3,442 for a patient at a healthy weight.

Issues like single-payer, socialist healthcare, rationing by bureaucrats in a health insurance company (now) or the federal government (possible) or by income (now), medicare reimbursements, mandated health insurance, uninsured...are what's being discussed in the media and DC.

Issues like the real epidemic of obesity and its impact on our companies, our communities, our nation, our families, our lives...now and in the future, seem to be overlooked in what's called the  healthcare reform debate.

Maybe, that's the problem. 

The healthcare reform debate we see going on around us in the media and in DC, is too little about our healthcare and too much about our money: who gets it and how much. And we're not even invited to participate.

Daphne Leigh is on twitter at DaphneLeigh. You should follow her there and read her blog, too.

Who's not invited to the healthcare reform debate? Us

You and I. We're not invited. As consumers or voters.

Oh sure, we, healthcare consumers and voters, are invited to sit back and watch. But we're neither invited nor allowed to participate in the conversations with the decision-makers.

The recent White House Summit on Healthcare Reform held in March invited all the experts who have built the current system or allowed it to persist. Each of these have vested interests, careers and incomes, attached to the current system.

Asking these same people to correct the system which they've allowed to be perpetuated on us is like asking your IT guys to change their processes that generate  their bonuses and salaries, perks and favors.

And to his credit, President Obama has held townhall type meetings with voters with some open Q & A.  For stagecraft, this was excellent. But those meetings were few in number, limited in duration and allowed questions to be asked, answers to be given and concerns forgotten in the face of the daily influence of those who've created our healthcare system.

Oh, sure. We can call our representatives. Some will even listen genuinely. The highest percentage would be the recent arrivals, the first-termers.

But when the healthcare industry can spend $1.3 million...per DAY...or roughly $20,000 per day per member of Congress, to lobby just our representatives in Washington...it won't be long before we're not invited and their listening becomes nothing more than a nod to us and a wink to their donors.

And in all fairness, would you vote against the hand that feeds you $20,000 a day in dinners, receptions, donations, pre-packaged stances, talking points, and more?

Oh. Those numbers are from 2008. Healthcare industry lobbying budgets are up over 40% this year.

Do you have an extra 40% in your budget to lobby congress? No? Oh, wait, we're paying for that increase in lobbying efforts with our higher premiums and higher pharmacy costs and higher co-pays or no-co-pays.




One of the fundamentals of growing a brand, building customer loyalty, generating word-of-mouth, lowering costs, delivering what's needed, innovating and marketing is...ask your customers.

The healthcare industry has asked their customers. It's Congress, they've asked. And it's each other they've asked. Their products, solutions, service are directed there, not here for us. That's the conversation they all are having. And we're not invited to that one.

But that doesn't make us victims. We have to find other forums to have our conversation and to force change that meets our needs. Fortunately, with social media we can have them.

My Healthcare is Killing Me: I recommend it

I recommend the ebook (and site), My Healthcare is Killing Me.

Why?

Let’s look to its reasonable aspiration* or hoped-for goal. In the words of their authors at Change Healthcare, the book seeks to educate, encourage, and reward savvy healthcare consumers...

If you already are a savvy healthcare consumer, then they arm you with more tools and resources in your negotiations with healthcare providers, primarily health insurance companies as they set the prices for the providers.

But, more importantly perhaps, I think they go one step farther. They create....savvy healthcare consumers. The state of our healthcare system, and its poor delivery of quality to its consumers, indicate the majority of healthcare consumers are not savvy.

This book will move  us all quickly up the path to becoming one.

The book is:

• smartly written
• concise( 60 pages )
• well-designed
• well-illustrated
• free

And these help it fulfill it's vital purpose as the healthcare reform debate heats up. And as we, the consumers, realize we must participate in this debate.

Arm yourself with knowledge from  My Healthcare is Killing Me. Then join the debate.

* reasonable aspiration is a term coined by author, consultant and coach, Erika Andersen, in her excellent book, Being Strategic. She defines it as our hoped-for goal.

Wal-mart and the SEIU Now Support Employer Health Insurance Mandate

A crisis can create strange bedfellows. Among the strangest bedfellows to-date in the healthcare reform discussion are Wal-Mart and SEIU, Service Employees International Union and their interest in solving our healthcare crisis.

They first announced their partnership in 2007 in a coalition they titled Better Healthcare Together. According to this Medical News Today article dated Feb. 12, 2007... The purpose of the coalition -- called Better Health Care Together -- is to end the nation's reliance on employer-backed health insurance and develop a system for providing universal low-cost coverage within five years.

So, when they say Better Healthcare Together...what they mean is...we're all in this together as long as someone other than we, the employer, and we, the union, pays for it.

This IS the same Wal-mart known for paying its employees so poorly that many were forced to seek healthcare for their families from free and public resources. Right? Well. Yes.

And three years ago, Wal-mart fought the efforts of states like Maryland who sought to require large global brands to offer health insurance to their employees. (  Ah...but they were young, then.  )

And this is the same Wal-mart who has more employees than any other business in the world, right? So an employer-sponsored mandate would be, could be, expensive for them, right?

Right.

And this is the SEIU, Service Employees International Union, with more than 1 million members whose interests are protected with the help of their member dues paid to the SEIU. Right?

Right.

Jump forward to last week. Now,  these two young, healthcare-for-all-as-long-as-everyone-else-pays-for-it lovers...decided that, um, you know, about that employer-backed health insurance thing....um, we've rethought that and we now support an employer health insurance mandate. ( Oh, crazy love....)

 CAP, Wal-Mart and SEIU Join Forces in Support of Employer-Mandate.

The Center for American Progress, the Service Employees International Union, and Wal-Mart joined forces today to release a letter (PDF) endorsing the dual ideas of an employer mandate to provide health insurance and “triggers” to automatically reduce costs if health care spending gets too high...

( Question: Is today's healthcare spending not high enough? )

I couldn't understand why Wal-Mart would endorse this potentially huge expense until I read some of the comments:
Maybe Wal-Mart thinks it will be in a better position than their smaller competitors to comply with an employer mandate, thus providing it with a competitive advantage.

With 2 million employees...Wal-Mart would be able to create its own health insurance company and save the current exorbitant adminstative costs of current health insurance providers passed on through premiums to their customers.

Coincidentally, this initiative in support of mandated employer-sponsored health insurance comes a week before President Obama said this:

Here's the problem, is that the way our health care system evolved in the United States, it evolved based on employers providing health insurance to their employees through private insurers.  And so that's still the way that the vast majority of you get your insurance.  And for us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive.  And my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free market system.

Notes:

Disruptive. Yes, it would be disruptive. But, the dysfunction of not only our healthcare industry, in particular our health insurance industry, is far more disruptive.

Innovations in a free-market system. Clearly, if our health insurance industry operated in a free-market system, we would have innovations arising that:

• would help drive down current health insurance costs, 
• improve levels of service
• make obvious the mockery of the 'threat' of competition from the federal government,
• result in indictments for the health insurance industry when they offer to collude together to lower their costs.  That means they're colluding together now to keep their costs high and competition from innovators low.

SUMMARY:

Ultimately, we'll pay. We, the voters. Or we, the consumers. Or, we the employees. We'll pay.

Right now, we already are.

We pay in higher health insurance costs passed on to those who can afford it, in higher healthcare costs to compensate providers for the costs of those unable to pay, in lower productivity, in lower competitive resources to compete globally.
We pay in constant worry and fear of a healthcare crisis.
We pay for the bankruptcies spawned by healthcare crisis of those with inadequate health insurance or no health insurance.
We pay in lost innovations when talented employees remain in unproductive jobs with companies who can afford to pay their health insurance costs.

Can the rest of us listen to each other, to find our own common ground. If not, we're left to take solutions dictated to us from either Wal-Mart, Unions, or Congress...and not the other way around.  This other way around, voters and/or consumer dictating their desires, is how both a democracy and a free-market would work.

Links:

Kaiser Health News. Wal-Mart backs employer-sponsored health insurance mandate.

Kaiser Health News. Transcript of President Obama's recent town hall meeting.

Oxdown Gazette (Firedog Lake blog) President Obama takes a question about single-payer universal healthcare.

Medical News Today.

Matt Yglesias at Think Progress

More voices in the healthcare debate

It's a good news, we've-still-got-miles-to-go-before-we-sleep news, article: In Maine, Two Sides on Healthcare.

First the good news. More people are participating in the debate, the discussion, the search for solutions, to our healthcare system, our need to insure all of us, all the time, to provide quality healthcare regardless of income, geography, political ideology.

That's the power of our democracy.  We're loud, we're obnoxious, we're pushy, we're ideological, we're pragmatic, and over time...lurching forward...we get many things right.

Now, the we've-still-got-miles-to-go-before-we-sleep. Are we listening? Are we listening to each other? Are we seeking common ground? Do our stories connect with the needs of our prospects?

Do those who care about the possible collapse of our health insurance industry understand the needs of those who can't afford health insurance for their family, and what that means to the health of their family?

And vice versa.

Do those without health insurance have the time to understand why people are afraid our health insurance industry may not be able to compete against the ineptitude of the federal government?

Do those who want a single payer option understand why eliminating competitive options likely means poorer quality of service. Think DMV; then think about going to the DMV for your healthcare. Not pretty. (Here in Jefferson County, our DMV is as fast if not faster than a doctor's visit so...but I know we're unique in that respect.)

Do those who worry about the collapse of our health insurance industry understand that many don't see that as a problem? And this group includes current customers of the health insurance industry.

Why can the health insurance industry never explain why they are afraid of the competition of inept federal government? or why their adminstrative costs are so much higher than their counterparts in systems they then call 'socialistic'? And why can the health insurance and healthcare industry now claim to be able to lower their costs by 1-2% per year....and claim to work in a free-market, competitive,  industry? Working together with your competitors...is commonly known as ...collusion...It's an anti-competitive, monopolistic, tactic.

Why is Congress worried about the health of the health insurance industry and not the health of Americans? Could it be the $1.2 million in donations they receive collectively from the healthcare industry...PER DAY?

The good news is we're talking.

The we've-still-got-miles-to-go-before-we-sleep news is that we've got miles to go before we hear each other, I think.

Giddy'up.

Are your business rules based on your principles?

I came across two articles this week on Canada's banking system. One was on its success, its ability to survive and avoid the current banking crisis. Why Canada's Banks Don't Need Help.

Consider that the Geneva-based World Economic Forum... earlier this month ranked Canada's banking system as the soundest in the world. The U.S. came in at No. 40.

The other article was on how those same rules wouldn't work here in the US, according to a banking expert: Canadian Bank Rules Don't Fit US Model.

Banking rules that spared Canada's big banks from the woes that hit global rivals would not work in the United States because of cultural differences..."You need principles-based rules and we're* (the U.S.) not going to do it."

The message could not have been any clearer, don't you think?  These two articles conveniently juxtaposed at one business site that show the failings of our system vs the success of another make it clear.

But we've already understood this by now. Business models, and cultures,  lacking principles are doomed to failure. Their failure arises as their business model implodes from their own unbridled excesses.  They have no foundation to stand on with the changes in personnel, markets, economies, technology...They have no compass to guide them through the storms of change.

So. Are your business rules based on your principles?

Note: There's another time to digress into the discussion of free and open markets, transparent and full access to knowledge and information by all parties involved so that the consumer can make an informed decision, business models with proper incentives that reward achievements that build a sustainable brand, empowered regulatory bodies, etc.

* I for one wish the speaker whose quote I bolded would ask before he spoke for me.  I know my culture is not one based on the lack of principles. Sure, there are those who have abused the trust we gave them and maybe we empowered them with our priorities that made us too busy to acknowledge the obvious blunders and excesses they gladly incentivized themselves to carry out. But if our culture was not based on these principles we would not be correcting the excesses incurred from allowing one powerful industry to violate our principles.

One last thought: Can Canada help us with our healthcare system? They seem to run their banking industry quite well. Maybe they know how to run a healthcare system?

If you can't compete...don't blame the competitor

If private insurers say that the marketplace provides the best quality health care; if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business? That's not logical.They should be able to compete. - President Obama.

Our health insurance companies complain that the entrance of the federal government, which they say can't run anything, will put them in an unfair competitive stance. And besides....they tell us, the free-market will provide the solution.

Well, news flash. Our health insurance and healthcare industries aren't free markets. That lie was exposed when they announced they would work together to lower prices. That's known as...collusion. Anti-competitive collusion. That makes their industries, at best, oligopolies organized to prevent the influence of competitive alternatives.

They've done a fine job of that too. That's why administrative costs per capita for our healthcare industry is more than triple that of Canada. That's right. That old inefficient system they have up there, so we're told, costs 66.66% less per person to administer. Oh, and they administer healthcare to everyone.

One of the principles of free-market economies is economics of scale. The US has a population roughly 8 times greater than that of Canada. Where's the economies of scale reflected in our healthcare industry?

Surely, with a population 8 times greater than Canada administrative costs for our healthcare system should not be...3 times greater per person served, should it?

Actually, yes, it should. If you're an oligopoly, you're always worried about the bigger, stronger, competitor who can force change on your business model, the change that would have come naturally by smaller competitors arising in a free-market economy.

Investing in the #1 outcome: healthier employees

Workforce Management offers wealth of useful tips and articles to help you with...workforce management. Here's their most recent useful offering Paying for Healthier Employees, not Just Health Care.

The article goes on to list some changing business models in the employer-sponsored healthcare market that are favorable to employers, employees, their families and even healthcare providers. The new dynamic is paying for outcomes.

Digression: Don't you laugh when you read that the healthcare industry consider paying for outcomes a new business model? It's a dark laughter. But, only our healthcare industry could judge paying for outcomes as an innovative idea. I can't think of another industry that doesn't understand and embrace the idea that their customers pay them for...a positive outcome from the use of their products or services.

Still, better late than never.

And as expected this change did not arise from within the healthcare industry. It arose from...their customers. Businesses who see investing in their employees' health as a top priority.

Pioneered by employers, these contracts are helping to refocus the culture of health care so that instead of paying for a service, employers pay to improve a person’s health.While overall costs may not go down, these kinds of guarantees mean employers will be spending their health care dollars more effectively. Rather than paying for health care services, employers will be paying vendors only if they can show they’ve improved the health of employees.

That last sentence says it all: 

Rather than paying for health care services, employers will be paying vendors only if they can show they’ve improved the health of employees.

The article profiles two examples of outcome dependent programs that deal with heart attacks and asthma attacks. There are penalties to the healthcare provider if what they provided did not delivered the desired outcome. In these cases, the desired outcome was the avoidance of either, a heart attack or an asthma attack that resulted in an emergency room visit.

There is hope. 

Hat tip to Susan Poirier, CEO of Ace Concierge, for the link.

There's no recession for health insurance lobbyists

It may be a recession for the rest of us, but lobbyists for the health insurance and big pharma industries are having a great year. According to an article in the USAToday The largest medical insurers and drug companies spent 41% more on lobbying this year.

There's a lot at stake:

• 17% of our GDP with a growth rate twice that of inflation.*
• $2.5 trillion in spending every year expected to grow to $4.3 Trillion by 2017.*

And they, the health insurance and big pharma, see their cake and their ability to eat it, too, being threatened by concepts like..c-c-c-c-ompetition (And by the federal government, no less. I mean you have to be so inept to be afraid of a competitor whose cold call starts with I'm from the federal government and I'm here to help) and greater FDA oversight.

Congrats to the lobbyists for the health insurance and big pharma industries. You're doing a heckuva job for the country.

* National Coalition on Healthcare

If the military can't get EMRs, EHRs, right...

Healthcare Renewal blog asks:

If The Military Can't Get Electronic Health Records Right, Why Would We Think Conflicted EHR Companies And Incompetent Hospitals Can?

She writes about...Making yet another case for how the concept of national electronic health records is probably a bad idea at this point in time with respect to our understanding of health IT and its social-technical interactions and challenges, it appears the military's EHR system AHLTA is simply a disaster.

Despite this experience shared in testimony before Congress that she includes in her blog post, perhaps the reason EMRs are such a buzzy topic right now comes from the results of a massive lobby that has grossly over-represented the benefits of healthcare IT, committed a cross-disciplinary invasion of medicine, and created a myth about HIT's supposed transformative powers in curing healthcare's ills.

Nothing like lobbyists to perpetuate a myth on us, especially if there are billions of tax dollars awaiting their clients from their success.

I'm not saying the benefits of EMRs are a myth. But are we ready for them? We, being hospitals, doctors, nurses...patients, insurance companies? And by ready I include...can we maturely, rationally, balance the convenience EMRs promise vs the potential for abuse and exploitation by oh, say, advertisers and Big Pharma, hospitals and...insurance companies?

My one hope is that we can learn from the mistakes of the pioneers in the military's EMR program. And coupled with existing and soon-to-be developed technologies at least create a system that works. Then we can begin to address the other issues of greed, incompetence, inefficiencies...and oh, our healthcare.

Then, again, If the military, with its internal discipline and ability to take over entire modern countries with just a few thousand soldiers lost, and its constrained patient population (active military personnel and families generally free of complex and chronic illnesses) can't get electronic health records right, why would anyone think inept and corrupt EHR companies, incompetent hospital IT departments, and reckless and cavalier hospital executives can?

I want to have hope. But I want it to built on a solid foundation.

The Oligopoly of Our Healthcare System

There’s news today that members of the healthcare industry trade groups have crafted plans that will turn projected annual increases into annual decreases. Annual healthcare costs were projected to exceed 7% for the next decade.  Their plan claims to instead create annual decreases totalling $2 trillion in savings over the next 10 years.

That’s good news. $2 trillion in savings in healthcare costs over the next 10 years. $200 billion per year.The group claims the savings from their plan will save $2500 per year in healthcare costs for a family of four. And, by itself, virtually eliminate the federal deficit.

Many of these members, drugmakers, insurers, hospitals and the American Medical Association were among the harshest critics of a similar reform plan by President Bill Clinton in 1993. The insurance lobby, for instance, sponsored the "Harry and Louise" ads that ultimately turned popular sentiment against reform efforts, according to the article in today's Washington Post.

This possible change of heart by the healthcare industry was forced, not chosen. And it was forced by the outcome of their decisions that have brought us to the point where healthcare costs absorb upwards of 16% of our GDP today, projected to exceed 25% of our GDP within a decade.

It’s an industry that proclaims itself the most efficient, yet whose combined costs to administer its services are greater than its counterparts in any other industrialized nation. And our system fails to cover 15% of our population compared to 100% coverage offered through their system.

These results are the results of an industry where the principles of free-market competition have long been submerged except in the claims of PR agencies, lobbyists, and partisan-politicians whose donor lists are filled with members of this same trade group.

These results are the results of an industry most accurately described as an oligopoly. What’s an oligopoly? Let’s look at a few definitions:

Wikipedia
An oligopoly is a market form in which a market or industry is dominated by a small number of sellers

This causes oligopolistic markets and industries to be at the highest risk for collusion.

Dictionary.com

–noun
the market condition that exists when there are few sellers, as a result of which they can greatly influence price and other market factors.

Investopedia

What Does Oligopoly Mean?
A situation in which a particular market is controlled by a small group of firms.

A few sellers within each trade group of the healthcare industry have met and decided to greatly influence prices and market factors. This industry was able to collude in the 90’s to prevent reform. It’s able now to collude to prevent the entrance of the only effective source of competition: the federal government. 

Those market factors in effect are our economy.  By effectively colluding to prevent reform in the 90s and by colluding to create effective barriers to entry of innovative, competitive, alternatives the industry has been able to claim a disproportionate share of our economy.  That share is a share that does not add to our ability to innovate new technologies, nor compete on a global scale. For that matter, they have colluded to prevent the increase in the quality of our health seeing cost-effective solutions as a threat to their profit goals.

The irony that our most inefficient federal government can out-compete our healthcare industry, particularly the health insurance trade group, seems lost on those who decry the threat of the federal government offering an affordable, competitive, option for US consumers. Some members of Congress have said the reason why the federal government should not offer a health insurance/healthcare option is that it would win against the current offerings available. That means that the federal government would be more competitive, more efficient, than the free-market offerings available now.

Free markets, operating freely, should not allow an industry to flourish whose only competitor is the federal government. Even more so, a free market should not allow the federal government to outcompete it. Proponents of free-markets and competition should not support industries who cannot compete against the federal government.

Walgreens Clinics Giving Free Care to Uninsured and Jobless

NEW YORK – Drugstore operator Walgreens will offer free clinic visits to the unemployed and uninsured for the rest of the year, providing tests and routine treatment for minor ailments through its walk-in clinics — though patients will still pay for prescriptions. - Yahoo News.

I don't even know what to say about this act of corporate philanthropy, corporate step-up, stand-up, help-a-neighbor-out...

Very inspiring.

Link is from Bob Garrett on Twitter.

Healthcare Costs: 9 Reasons They're High and Getting Higher

From The System MD blog post, Why are Health Care Costs So High?

In 1960, the USA spent 5.1% of GDP on healthcare and last year it was over 15%. Why are health care costs skyrocketing? Where is all that money going?

There are nine reasons for escalating health care costs.

1. New value (new medical capabilities) resulting in
2. More people who live longer.
3. Inefficiency
4. Regulatory compliance and unfunded mandates
5. Perverse incentives
6. Defensive medicine
7. Adverse outcomes and errors
8. Profits taken out of healthcare (insurance and medical malpractice)
9. Fraud and embezzlement

No percentages are given because the only information available are WAGs (wild-assed guesses). To state that more clearly, the true costs of anything in healthcare – hernia repair; HIPAA compliance; medical errors – are unknown. All of the nine cost categories are real, significant, but not precisely quantified.

To the proponents of our free-market healthcare system....one of the core principles of a free-market, capitalistic, system is understanding costs. Costs determine prices; prices determine supply and demand ratios. Here, our free-market system and the companies who both benefit from and hide behind that label, can't even identify true costs.

Can deductive reasoning bring us a solution:

healthcare costs are rising
healthcare costs are not precisely quantified
(Therefore,) healthcare costs are rising because they are not precisely quantified.

The solution then is to do the opposite of that which is causing the problem: quantify these nine categories of healthcare costs, as they're listed above.

Seems pretty clear.

All those detective shows on TV always tell you to follow the money. It's no different here. There's a reason healthcare costs aren't quantified. Somebody benefits from that status. And it seems it's neither doctors, nor nurses, nor patients.

And those that make money have a vested interest. They have a vested interest in keeping these costs...obfuscated.

Therein lies the rub. Our free-market system of healthcare is more like a nationalized industry where inefficiencies are hidden to protect the vested interests of those who've created them and whose prestige and access to perks and power rests on hiding their inefficiencies.

Young Invincibles: No Health Insurance, Huh? Nah...

Ahhh. To be young and invincible. And uninsured.

A new demographic has emerged in the national discussion about healthcare: young invincibles. Classified as anyone 18 - 29 years old without health insurance.

"Health insurance is not one of the things that younger adults are focused on," said Dr. Ken Thorpe, a professor of health policy at Emory University. "They come off their parents policies, and they're now facing a very high cost. They basically have to pay that high price themselves."

Instead of paying exorbitant prices, many young people choose to remain uninsured, risking injury while harboring the belief that youth alone can buffer them from illness.

A recent study conducted by the Commonwealth Fund, a center for health care policy, found that 13.7 million people ages 19 to 29 did not have health insurance in 2006. The total number of uninsured that year was 47 million, which means "young invincibles" composed almost one-third of all the uninsured in the U.S. - Young Invincibles Ok with Risk of No Insurance, USA Today

Yeah. Cool. I understand.

 It wasn't too long ago...faintly, I can remember...being a member of that demographic. And I'd ruin my day pondering the risk of my life without health insurance.

But, I thought it was riskier not to eat or to live in my car, when I had a car, or make decisions from that frame of mind. So, I went without. It worked out. Now, I'm married and my wife makes sure we're insured.

The tipping point here has been surpassed, though. The numbers* for this group now aren't so great.

• 1/3 are cigarette smokers. (hello?).
• 1/4 are obese with this number tripling in the past decade (double hello. You smoke and you're obese. What's up with that?)
• 2/3's of you don't exercise regularly...(Now, come on. Get it together, 'k?)
• Of the 48 million Americans uninsured, 1/3 are young invincibles.

That's just a bad trendline: rising numbers of unhealthy behaviors among the uninsured. Chickens come home to roost. That's an old saying. Think about it. It kinda applies here...to you and to us.

We all end up paying for the care of the uninsured. Higher costs for care. Higher costs for health insurance.

And in one sense, I'm ok with that.  Maybe, I'm paying now for my sin of omission as a young invincible. Perhaps. But, I never had reason to call on it...

But, I'm not really ok having these higher costs be passed on to me, when people are making unhealthy choices, engaging in risky behavior, not taking care of themselves. Take care of yourselves AND you need help. I'm there for you. Don't take care...and need my help as a result...we're going to have a conversation as the interest rate on that help I offer.

Bottomline: "If we're ever going to get toward universal coverage," said Dr. Ken Thorpe, a professor of health policy at Emory University.  "We've got to find ways to get younger adults to purchase health insurance."

*  Young Invincibles have significant health concerns.

More Expensive = More and Better?

Do we get what we pay for with our healthcare system?  Probably not. If you consider average costs compared to average level of care then, the adage of you get what you pay for, we get what we pay for, has met its match with our healthcare system.

Our healthcare system is considered the most expensive. According to the Council on Foreign Relations:

The United States spends over $1.9 trillion annually on healthcare expenses, more than any other industrialized country. Researchers at Johns Hopkins Medical School estimate the United States spends 44 percent more per capita than Switzerland, the country with the second highest expenditures, and 134 percent more than the median for member states of the Organization for Economic Cooperation and Development (OECD).

• $1.9 trillion.
• 44% more than the 2nd ranked country (Switzerland for goodness sakes...not known for low cost-of-living)
• 134% more than the median for our colleagues in the OECD.

And there are nations who deliver better results for their citizens, aka, customers of their nation's healthcare system.

ProjectHope reported our system ranks in the bottom quartile when compared to other nations.
National Coalition on Healthcare:

• Infant mortality rate in the US is more than double that of the top 3 countries.
• Among six nations studied by the Commonwealth Fund in a recent report on quality of care performance measures–the U.S. ranked last.
• Among adults in seven countries surveyed by the Commonwealth Fund, adults in the United States reported the highest overall error rates.

So, how does the world's best healthcare system become the world's most expensive while not delivering the best quality of care?

It's not from the commitment and passion of the tens of thousands who provide the care to patients. 

If we look at the care providers as the supplier and the patients as the customer...then anything in between, any element in between would be an inefficient element. Like grocery shoppers and farmers, the middle-man adds the costs to the product. Marketing, packaging, branding, delivery, ingredients to extend shelf-life...Sure, they add variety and convenience. And that's why we're not complaining.

But in healthcare, the middleman adds costs while raising the levels of inconvenience.

Here's but one example provided by Managed Care Matters. A fundamental change to Florida's Worker's Comp law would potentially raise  employer's work comp claim costs by several hundred million dollars.  This change doesn't bring an accompanying increase in care. In fact, it looks like it will result in reduced levels of care.

And as he writes, Ok, that's bad. What's going to happen with hospital costs may even be worse.

The net result would be a dramatic increase in the reimbursement for outpatient services billed by hospitals. There are four issues here.

First, methodology will increase costs - today - by 181% for surgeries and 330% for other hospital outpatient services.

Second, the annual inflation rate for charges in FL is 14%. (That's double the national  average...)

Third, ... procedures which were being done in offices will now be billed - at the much higher rates - by hospitals.

Fourth, outpatient surgeries ... will likely shift to inpatient for ...the much higher reimbursement.

Granted, I'm not a keen supporter of caps on medical malpractice. Yes, there are abusers of the system. Yes, attorneys get rich. Yes, these add costs. But what those costs do provide is a painful, meaningful, means to deliver accountability for negligent care providers.

But this change in a populous state is a change in the system that...rewards the middlemen and neither doctors (suppliers) nor patients (customers).

And that's why we have the most expensive healthcare system with something much less than the best quality of care.

Maybe we do get what we pay for!  Definitely, we get what we settle for.