An Epidemic That Costs Us Billions of Health Care Dollars

Tongues are wagging in the wake of the FEMA flood relief handouts in Milwaukee this week; it has been suggested that the overwhelming turn out for free food vouchers has implications for a Single Payer Health System as in the P.J. O'Rourke quip: "If you think health care is expensive now, wait until you see what it costs when it's free!"

So the blocks of long lines of folks who suddenly had flooded basements in Milwaukee shocks you? Liars. Thieves. Thugs. Buffoons. Mostly inner city folks of color so it must be a racial thing, right? I'm not so sure.

Let me call attention to health insurers who routinely miscode claims thus underpaying policyholders; small (and sometimes not so small) annoying 'errors' that could be remedied through a call to customer service if that didn't require three hour waits on hold. Or, how about doctors and health systems that routinely fraudulently over bill or charge for services never rendered. Or how about insureds who overstate or misstate health conditions so that they may then be covered by their policies. Come on, we've all done that, haven't we?

If all these other dishonest folks were also conspicuously lined up on a sidewalk to collect their unjust rewards, the multiracial lines would be miles not blocks long. Fraud and abuse in health care is no less epidemic than the decline of basic morality throughout our society. It costs us by some estimates 40% or more of every health care dollar. I could not suggest a remedy.

Quick Hit #1

This sounds like something that might have come from Rodney Dangerfield. If I knew for sure, I'd be happy to give proper credit.

"At my age, I've given up sex in favor of eating. Now I can't even get into my own pants.!"

I Think This Has A Ring of Truth To It

The sweet, elderly sounding voice greeted the hospital receptionist on the phone: 'Is it possible to speak to someone who can tell me how a patient is doing?', she timidly asked. 'I'll be glad to help dear' the operator replied. What's the name and room number?' In a weak tremulous voice the caller said, 'Norma Findlay, Room 302.'

The operator replied, 'Let me place you on hold while I check with her nurse.' After a few minutes the operator returned to the phone and said, 'Good news. Her nurse has told me that Norma is doing very well. Her blood pressure is fine. Her blood work just came back as normal and her Physician, Dr. Cohen, has scheduled her to be discharged Tuesday.'

The elderly caller said, 'Thank you. That's wonderful! I was so worried! God bless you for the good news.' The operator replied, 'You're more than welcome. Is Norma your daughter?'

The caller said, 'No, I 'm Norma Findlay in Room 302. No one tells me anything!'

Pondering the "Problem" of America's 301 Million Under Insured

Senator Ted Kennedy's cancer diagnosis resonates with me because it is the same malignant 'glioma' that ended my father's life in 1970 at age 49. Yes, just 49! As I 'celebrate' today one of those milestone birthday's that puts even more years between my own age and Dad's early death, I find myself in a particularly pensive mood.

To wit, it is interesting to recall that Dad's major medical policy had a $250 deductible and a lifetime limit of just $50,000. Remarkably, a team of neurosurgeons and a 110 day hospital stay did not exhaust that modest policy limit!

Roll the clock forward 38 years and now you are hearing many lament the "cost shift" burden of high deductibles and even modest co-pays. (See my blog of June 4th.) Some speak of the growing underinsured problem - never mind the fact that a $250 deductible from 1970 inflated using regular CPI should today be around $1500; using medical CPI well over $3000.

In truth, the underinsured problem is not with front end deductibles and co-pays but instead the back end insurance policy limits of between $ 2 million and $ 5 million. In this vein, Regina Herzlinger (again) speaks of cancer drug therapies alone (e.g. Erbitux or Zevalin to name just two) that can cost $24,000 a month! With evolving ever more expensive treatments, the real debate on health care may need to focus on how much is a life worth? And, should an HMO or government bureaucrat make that call? We might also ponder this: with identical cancers, should 'Joe Lunchbucket' get any less care than Senator Kennedy?

These are tough questions that do not allow for sound bite answers. My birthday wish is that more folks who really care would step forward and publicly address the gravity of the matter.

Wanted: New Software Tool

A logical derivative of 'spell check', I eagerly await the arrival of 'fact check'. Why? As the health care reform debate heats up, statistics and figures are repeated so often they become givens . . . . . regardless of their accuracy.

Consider this quip from an unknown source: "Did you know 46% of all statistics are made up on the spot?"

Perdue Leads Georgia In Romp Over Badgers

I wish this was a sports story. As much as I would hate to see Wisconsin lose to the Bulldogs, a football or basketball game would after all be just that; a game. In this case however, my headline above refers to health care legislation. As reported in the July 1 issue of the Heartland Institutes's 'HEALTH CARE NEWS', Governor Sonny Perdue has recently signed into law legislation designed to make health insurance far more affordable in Georgia. The legislation provides new tax breaks for "qualified" high deductible health plans (HSA's) and other market based, consumer directed reforms.

Dubbed Healthy Wisconsin by its Senate sponsors, 'our' approach to health care reform has largely been centered around a sweeping takeover by the state. While Georgia embraces market based reform, Wisconsin seems hell bent on destroying markets. Perhaps however rational minds will prevail. Just yesterday, the Wisconsin Policy Research Institute released a detailed report entitled "Will Healthy Wisconsin Bust the State Budget?".

The contrast between the breaking news out of Georgia and the WPRI report on Healthy Wisconsin is striking. I never thought I'd be a Georgia fan but their 'team' seems to have a far better 'game plan' for health care reform. Now sit back and watch as they run up the score!

Scans or Sneakers

How sad, the sudden death of Tim Russert. (My blog of June 2nd on AED's now seems somewhat prescient!) Like this article from USA Today, there has been so much written about Tim Russert's heart. I think he would be pleased to be teaching such an important lesson even in death.

So as I contemplate the extra pounds I see in the mirror each morning, I wonder if I am also a candidate for a cardiac event. How many others are thinking the same? There would seem to be two courses of action; spend a ton of money on scans and tests and statins and more or, a little less money on a pair of sneakers. Our health insurers will no doubt see a big spike in claims over the next few months. That's OK but I also wish the health clubs would see a spike in new memberships.

I went for a jog this morning. and had a salad for lunch. Thanks Mr. Russert!

Where Is The Outrage?

Imagine if in the United States a 747 crashed every other day; that would amount to a death toll of about 100,000. Wouldn't there be an outcry for improved safety? Wouldn't the FAA demand that the industry correct whatever problem was causing such a loss of life!

So where is the outrage that right now in America, more than 100,000 people die each year unnecessarily because of preventable medical errors? As reported by the Health IT NOW Coalition, about a fifth of these errors are simply attributable to the lack of immediate access to patient records!

There is growing support for the establishment of an health IT system. The reduction of errors and saved lives will save billions and billions of dollars, by some estimates enough money to insure more than three quarters of all uninsured Americans. It is just one of many bright spots in how the delivery of health care can be improved. Read more at the link provided above.

Just What 'The Doctor' Ordered

Harvard Professor Regina Herzlinger - not an MD but a PHD - has often spoken/written about how consumers will figure out the best buys in health care; just give them information! I don't think Dr. Herzlinger could have ordered up a better course of information treatment than what is in the July Issue of Consumer Reports.

In an important article entitled "Too much treatment", we get a look at the 2008 Dartmouth Atlas of Health Care decades long study of millions of Medicare beneficiaries. Not surprisingly, "the local supply of doctors and hospitals has more influence on the amount and type of care that patients receive than their actual medical conditions." The kicker is, the more costly aggressive care does not yield better results!

This news on top of the United States Department of Health and Human Services Hospital Compare tool that has just recently received headlines, suggests that Dr. Herzlinger's 'prescription' for transparency of health care cost and quality is well on its way toward being filled.

And to further connect the dots; reporting of this kind will foster competition which lowers costs thus making health care more affordable for the under or uninsured.

Revisiting My Mantra: "Co-Pays Suck - Get Rid of Them"

Yes, I did utter those words at an MMAC Forum several months ago. Pretty eloquent, huh?! In the context of discussing how "qualified" High Deductible Health Plans (HDHP's) combined with HSA's drive behavior change - thus reducing health utilization - the idea is (just) one key component of the Consumer Driven movement.

At a May 15th Healthcare Conference in Chicago sponsored by the Illinois Chamber of Commerce, I heard an intriguing presentation describing the importance of "Value Based Insurance Design" (drum roll please for just what the insurance business needs, another acronym: VBID). The issue is, do High Deductible Health Plans (or even modest Co-Pays) create financial barriers that cause people with chronic conditions to be non-compliant with drug and other therapies thereby increasing, instead of lowering, cost?

There will be much debate about this and having implemented many HDHP's, I know well the issues. Will the considerable premium savings of the HDHP be banked in an HSA or spent on the rent or higher gas prices? If banked, there are no "barriers" for health compliance. In fact, there are rewards; ie., we can spend enormous additional premium sums (or taxes) so that insurers (or Big Brother) can manage our care; or we can manage our own care and keep the savings!

I still think "Co-Pays Suck".

Legislating Common Sense

Dental hygenists in Wisconsin have a new requirement as a condition of renewing their licenses. Under 'Act 104' they must now show evidence of proficiency in the use of an Automated External Defibrillator (AED) and Cardiopulmonary Resuscitation. http://drl.wi.gov/prof/denh/whatsnew.htm

At first blush, this news didn't seem all that relevent to the employee benefits arena but then I got to thinking, how many dental offices already have AED's on site and one or more staff members proficient in CPR? Do any of them advertise this competitive advantage? Wouldn't it be nice if market forces prodded common sense change instead of legislators. (Of course, I am sure there is at least one AED in both the Assembly and Senate chambers in Madison!)

More to the point, is it just a matter of time before employers are required to have AEDs at the work site? The very best Work site Wellness Plan is arguably fatally flawed (pun intended), if there are no contingencies for a sudden cardiac event. http://www.redcross.org/services/hss/courses/aed.html