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There is a humorous article, “Insurance Company Frustrated By Another Cancer Patient” on “The Onion,” a satirical fake news site. (Warning: The article contains profane language at .) An excerpt: Frustrated executives from the Blue Cross Blue Shield Association announced Friday that they are getting “frustrated” by Allentown, PA resident Matthew Greison, a 57-year-old man suffering from an advanced form of Hodgkin’s lymphoma. Stressing that this is not the first issue they have had with such patients, company sources expressed their outrage to reporters over Greison’s “totally unfair” comprehensive health care benefits and claimed the skyrocketing costs of his cancer treatment have gotten out of hand. “We got the first bill and just couldn’t believe how expensive it was,” said Blue Cross Blue Shield CEO Scott Serota, adding that at first, he thought the invoice was a mistake. “Every visit to the oncologist ran about $140, not to mention the thousands of dollars for every MRI and CT scan, and then the chemotherapy and cancer drugs were more than $10,000 per month. And he paid for maybe —maybe— 5 percent of it. The rest was dumped on us.” Is it funny because it is true? We talk a lot about how “unsustainable” healthcare costs are. According to The World Bank, 18 percent of America’s Gross Domestic Product is spent on healthcare. (What is it in your country?) And Forbes reports an average wage-earning male will receive $180,000 from Medicare over his lifetime, having paid in only $61,000. Because she will live longer, a female will receive $207,000. If “it can’t go on this way,” practically speaking, what do you think will be done? (Be constructive, please.) What is our responsibility as medical device manufacturers to curb healthcare spending? What is the impact on our industry? ++++++++++ Next week I’m hosting a webinar on contemporary online medical device marketing strategies. If you’re not satisfied with the quality or quantity of your leads, listen in. It’s free for Medical Devices Group members at http://medgroup.biz/meddev-mktg-strategies and I’ll send you a link to the replay if you can’t make the live presentation. ++++++++++ Visit http://medgroup.biz/subgroups to discover our 60+ subgroups. There you can network with professionals in your specialty and geography. Here are the Top 12: If you have something to share with group or subgroup members, contact our Group Ambassador Gary Welch at GWelch@MedicalDevicesGroup.net with details. ++++++++++ Make it a great week. Joe Hage P.S. Do you need medical device distribution? http://medgroup.biz/hida Bogdan Baudis Jerrold Shapiro Steve Birch But, going back to Joe’s original question, what role can medical device manufacturers play in this. We can help educate people through our websites and other vehicles of consumer education. We can also shift some of our R&D into home monitoring and treament modalities. The challenge will be finding out how to maintain or preferably grow our revenues and profitability as we change the nature of our business’. Burrell (Bo) Clawson There will be no “feasible answer” to a “great healthcare system.” Economics make it impossible as you can’t tax the entire country to do this without causing a collapse. With good education, which is certainly lacking in the US, early choice of habits, choice of home testing, personal choices in end of life care and better, less invasive and corrective medical procedures, I think we can start to lower the health problems in society. My view is education comes first. The U.S. established the first universal public education system in the world because industries and the US congress agreed you couldn’t run factories unless people could read, write, calculate and converse in one language. It was a MONUMENTAL decision, that is not generally recognized as to how significant it was and how within a generation it supercharged manufacturing. Honest, accurate and even personalized medical education is just as important as other forms of education. Boring “Health Education classes are NOT the way to go. Turn the classes into health data analysis, home testing and monitoring experiments, measurements, and statistics of testing such that students can actually start testing themselves and their family and passing on what they learn. Steve Birch I do believe that this is a part of the puzzle, but it will not fix all of our healthcare woes. Jonas Moses, PhD PA As a former clinician, sometime medical missionary and lifelong Humanist, I can find no merit in prolonging the pulse, instead of promoting the quality. Tom, your point is close to home, having watched members of my own family – once brilliant, vibrant and incredibly engaged human beings – become living shells, albeit surrounded by loving family and friends. However, other than having the distinction of being a living reminder (placeholder) for the people we knew, there ceased to be any self-substance, self-awareness or passion for life. How is this “human existence,” Dr. Ena? Tom never said he was not also interested in seeking cures…for the “living.” Respectfully, Dr. Jonas Moses Tom Holman Dr. Ena Onikoyi What is the value you place on human existence???? Tom Holman John Abbott Steve Birch Burrell (Bo) Clawson But as always, the net effect has to be better product for less overall cost. Steve Birch Burrell (Bo) Clawson That is the way we get improvements and advances. Lillian Tatka Burrell (Bo) Clawson Not one single person could ever understand it all. Paul Wismer Sacha Marcroft Burrell (Bo) Clawson Because Medicare sets prices below market rates (as evidenced by doctors unable to pay their bills on Medicare reimbursements and thus go out of business if that is there only source of funds) then Medicare has a HUGE OVERHEAD. Knowing what everyone knows, Obama still will not go along with the elimination of medical malpractice claims. By the way is withholding of medical treatment “malpractice”. Someone will litigate it. I don’t have a belief that a system with 30,000 pages of documents can ever succeed. Anything with 30,000 pages of “plans” for how to make it work is literally non-understandable by any mortal. Any 30,000 page operating plan is designed to employ vast numbers of people in the bureaucracy and, in my belief, eventually force all insurance companies out of business. Pres. Barak Obama said he wanted to do this before being elected President; on video tape. That is why there is this ACA monster and why there is no effort by the Democrat party to make the ACA efficient. 30,000 pages to control an entire population and take over their lives by requiring the government to know everything, meaning they can control everyone, because they can then use the IRS & healthcare to virtually enslave the average individual. Unfortunately as time goes on the regulations and the cost will escalate, particularly when the elderly population mushrooms as we know it will and we will have a fiscal crisis the world has never seen. The number tossed around now is $160-170 trillion in unfunded “promises” to pay mainly seniors. I have seen and unfortunately worked with, occasionally, government workers and they are not the type of people I could ever hire for my business and for the very few that were good, they were mostly highly motivated ex-military who knew how to drive to execute relentlessly. The young people in this country do not yet understand that the ACA is going to decimate their take home pay in order to feed it to the older retiree population. Democrat plans did this exactly so that Democrats would get retiree votes because of the average poverty most retirees live in. When the young people wake up, I think they are going to revolt and turn on the Democrat party with a vengence that Obama never expected, though he will likely be out of office by then. But Barak’s name is forever going to be linked to what he did with the term Obamination, and it is not going to be a good reflection on the man. Ted Lazakis “Total Medicare outlays were $431 billion in 2007, or 19 percent of total national health care expenditures. If one assumes that fraud is equally prevalent in Medicare and other types of health care, that would make the Medicare share of the NHCAA’s $68 billion fraud estimate $13 billion. And $13 billion in fraud divided by $431 billion in total Medicare outlays would be 3 percent of total Medicare expenditures — a far cry from Coburn’s 20 percent. (A rate of 20 percent is “possible, but I don’t think it’s very plausible,” Saccoccio said.) Skeptical that Medicare is only being defrauded at rates equal to the private sector? Let’s triple that number to $39 billion in fraud. If you do that, it still comes out to 9 percent — less than half of what Coburn asserted it was. In the meantime, Coburn’s dollar figure — $80 billion in fraud — would be no more accurate if the NHCAA is right. The group says there’s $68 billion in fraud in all health care expenditures — but Coburn’s figure for Medicare alone is bigger than that.” Burrell (Bo) Clawson This is my objection to government trying to run complex business efficiently. Ted Lazakis As long as we rely on profit motivated insurance corporations to allocate the money and make decisions about care we will need to pay them for it and dearly. All of the rest of the industrialized world have figured this out and have better outcomes with lower costs. Follow the money… “Insurance companies have balked at the ACA’s requiring them to spend at least 80-85 percent of their revenue on delivery of health care. (In contrast, more than 98 percent of Medicare’s expenditures are clinical [16].) Estimates vary, but one-quarter to one-third of our current costs are driven by insurance company overhead, profits, and the administrative costs embedded in clinical settings. Roughly half of these costs would be recovered under single-payer and could be reallocated to the delivery of meaningful health care services [17, 18].” Steve Birch Burrell (Bo) Clawson Medicare has always priced things below market value as far as I remember and we have since then seen continual rises in the relative cost of healthcare. Burrell (Bo) Clawson Ted Lazakis Many services provided by our government have no competition because that is the most fair way to deliver them. We did once try private fire departments for example and the businesses’ profit motives made them behave in ways that were not beneficial to society. Where life and death are in the balance I would prefer to have a government bureocrat directly and indirectly accountable through the ballot box in charge rather than a financially driven corporate minion accountable to his managers and investors. This includes protecting our clean air and water, publicly held lands and resources, public education, courts, military defense, border control and police, and most certainly our healthcare. Burrell (Bo) Clawson I doubt the US Congress or POTUS would listen. POLs #1 goal in WDC is to get reelected, and what better way to get reelected by limited education voters than to promise to give the populace goodies. Much of healthcare costs, estimated at various numbers between 40-50% of healthcare expenditures are due to personal choices or what might be called “human nature.” The US Govt. spends all the time & money exhorting their value to voters for “giving them free healthcare”. They send the wrong psychological signal to the uninformed and ill-educated people in society. Whenever something is viewed as “free”, people overuse it. It is pure human nature. It is also human nature to put off “doing the right thing” if there are no immediate consequences. We see this avoidance with people who develop lung or liver cancer and then suddenly decide to quit smoking and drinking (an educated friend right now is in her last days with liver cancer.) When the government controlled nationwide school system is controlled by a union devoted to supporting one party and wants only that party in power so the union also gets bennies from that party, they modify their school instruction to promote the idea that government “programs to help the poor” are good for the country, you wind up with kids who grow up believing government has all the solutions for them. In other words, government programs are just another disincentive for people to do what they should to support themselves. Another 500 posts here on “fixing healthcare” can not accomplish anything if the US government doesn’t remove itself from control of the healthcare system, except to keep a level playing field that promotes competition. Competition is at the heart of every advancing product or industry. Medicare as a give-away has no competition. Medicare bastardizes the payment system in the U.S. Just my beliefs. Steve Birch Jonas Moses, PhD PA Respectfully, Dr. Jonas Moses Jerrold Shapiro For example, the restaurant that serves large portions of high calorie food laden with fat and salt does not bear the cost of the morbid obesity which results from consumption of their product. The “Smoke Shop” that sells not only toxic inhalants but also many means for converting carcinogens into smoke does not bear the cost of treating the resulting cancers in many sites in their customers, nor for providing revenue to the family who survives the death of that customer if that customer is the primary revenue provider of that family. States that impose a very high tax on tobacco products have seen some reduction in teenage smoking because teens can’t afford to buy the cigarettes. Perhaps if the purchase price of an unhealthy product included the full cost of remedying the damage it causes, the free market system would encourage consumers to make healthy choices. Steve Birch Francis Roosevelt Gilliam I am in favor to reduce unnecessary interventions, but aside from words that proclaim dropping fee for service will immediately lead to savings, where is the data any of this is true? The magnitude of savings would need to be huge and the magnitude of abuse also huge. probably not the scale needed. I agree with Steve above, we can do it better but much of our baggage is the crushing weight of the system we are forced to work. We should plan to treat our patients better and eliminate the non essential trappings which only add to costs and no benefit. How much overhead can we eliminate?? Are we willing to really CHANGE the system? Steve Birch Russ Alberts For medical device manufacturers this should be very good, more people who need medical devices will be able to afford them. I also have a story about a man who had cancer. I am an American working at the University of Southampton in England. There is a man I met at the Farmer’s Market here that told me his main home is in Utah where he has a large family. He is a dual US/UK citizen. He developed pancreatic cancer some years ago and could not afford treatment in the US. So he returned to England to be treated by the NHS (National Health Insurance) system. He was cured of the disease at no charge (very lucky guy!). Had he stayed in the US he probably would have died. Other countries do do it better. The US is far and away the largest per person spender on health care, but our vital outcome statistics put us in the bottom of the heap compared with other industrialized countries. I don not believe that the UK has the best system. The Western European countries that have a much different mix of private and public involvement generally do better on the outcome measures. In terms of medical devices, the manufacturers still do a thriving busines in the UK, in Europe and in Japan. Responsible health care reform should not be the end of the world for manufacturers. Todd Staples, MBA Ted Lazakis http://www.medicaldevices.org/sites/default/files/GPO_pricing_litan_singer_distribution_oct%202010.pdf%7Cleo://plh/http%3A*3*3www.medicaldevices.org*3sites*3default*3files*3GPO_pricing_litan_singer_distribution_oct%25202010.pdf/V2eu?_t=tracking_disc] Steve Birch Regarding Todd’s comments, I agree that we’re off track on the discussion and that further there is a lot of finger pointing as to who’s to blame and who can do what to fix this broken system. I agree that a system involving ACOs will help. I’m not sure about them sharing in the surplus as I don’t know how we’d define that. How would you calculate the surplus. Certainly not based on current levels of revenue, but if not what level. I think that ACOs will help close the health-sickness loop and incentivize healthcare providers to keep people healthy. I was recently told by a colleague of mine from Korea that is Korea and China that a person under the care of an acupuncturist becomes sick the acupuncturist stops billing them. The driving belief being that if acupuncturist had been doing everything correctly the person would not have become sick. So I think that closing this loop will go a long way to reducing costs. The medical device industry needs to look for way to reduce costs, although this has been a common theme since DRGs care in being. However, most of this deals with reducing the costs of caring for someone already in the hospital or at least under care for a sickness. This is important and we should do even more of this, but the real savings and improvement in satisfaction come in avoiding the sickness in the first place. The medical device industry should start looking for R&D opportunities in parallel modalities that would help to manage health instead of sickness. There won’t always be direct parallels and it’s likely that the new technologies will cost less. Some disease like heart and lung disease can be impacted by smoking cessation, exercise and proper diet which won’t require much in the way of new technology, but some specific heart and lung diseases will still arise do to genetic or environmental factors that we haven’t identified or can’t yet manage and for these we can develop technologies to avoid the onset of severe illness. A lot of this new technology will be monitoring technology as early detection can mean easier management and better outcomes. Already some of this is happening with mobile health devices. I think that this is the future of our industry. Now we just need to figure out how to get there without going broke. Todd Staples, MBA It’s my belief that as manufacturers and developers of devices our mission has always been to drive increasing levels of consumption of our products because increasing revenues is obviously how businesses thrive. I think what we are seeing now is like a wildfire though burning through the dry brush. As long as physician, surgeons and hospitals are reimbursed per procedure they perform, they will continue to also be volume driven. Why diagnose a patient using telemedicine? I don’t get reimbursed for that – make them come into the clinic. How many treatment options are offered these days that DON’T involve either referring a patient to another provider, prescribing a drug, or performing more procedures that are all reimbursed. The practice of medicine is more a business than ever before, and as an industry, we generally support that “consumption” mindset. I firmly believe that when and if our reimbursement system is converted to a patient management system of some sort where ACOs share in the surplus revenues when a patient is maintained in good health, only this type of system will ensure people actually GET treatments they need, rather than the procedures providers need to deliver in order to keep their revenue streams elevated. So if wellness is a goal for our systems, and they profit by our wellness, not the procedures they perform and the patients they treat, then we have a model that will cut costs and reduce waste. As for our industry, the impact would be immediate – reducing pain and suffering, enabling patients to live fuller more productive lives, and getting the sick back to their lives quickly will things that are mandatory to create value. Commodities sold cheap with the hope of making profit on volume would have to compete on levels of quality and competence that they aren’t accustomed to, and the vetting process to new technology would ensure only the best products came to market, reducing the burden on providers to swim through crowded catalogs of similar products. I think we are a long way from this reality however, but it is still a good question to ask yourself – if my customers were suddenly paid by maintaining health, would that be good or bad for my business? Jeff Archer Joe Hage In 35 years, we’ll need money from those paying into the system at that time. And when there are more users than payers, things devolve quickly. I hate to say it, but maybe this problem is just too big to solve. By anyone. Jim Bemman, PMP And why we are at it, lets assume this contribution makes 5% yearly compounded interest for 35 years. The fund would have a total of $189,672.65 total after the 35 years. If we are being taxed, why can’t we assume the government can use our money and give us interest for letting them use our money? Burrell (Bo) Clawson Demographics will doom the economics of healthcare in the US as set up by US Congress. I’ve been reading articles about this since about 1980 by demographers who started the discussion of government Ponzi schemes. Some people, including me, think that the Democrat Party recognized back then that if they didn’t do “giveaway programs” (not actuarially sustainable) to citizens, that the aging & increasingly conservative baby boomers would make for a permanent Republican control of WDC government for many generations. There is one matter of fact, however, which I believe was incorrectly presented. It “common knowledge” that smokers, as a group, are a major drain on the healthcare system. This was the premise of the lawsuit a number of years back, in which states sued tobacco producers and won a rather hefty settlement. The truth is just the opposite: smokers–again, as a group–are not a major drain on the healthcare system, precisely because they tend to die younger, and after shorter illnesses, than do non-smokers. They’re a special boon to Medicare, because their deaths still tend to occur in retirement. The very premise of the lawsuit was bogus, but the defendants did not want to have the truth become public knowledge, any more than did those who brought the suit. Guy Hibbins Joseph Walsh However, care should be taken as alienating in a form of exclusion or other wont make the problem go away it will only make it worst … for everybody. And then again, this “insurance deal””, it’s an abstraction layer which pretty much blinds both sides and gives the illusion of a comfort zone. In any case, I doubt that either smoking or obesity is responsible for the high price tab of a CT/MRI scan or chemotherapy and cancer drugs. If anything a high demand should bring the prices down right? Presumably a lot of drug cost is in the research so then with more patients for return of investment should price it lower. I am still struggling to understand why these costs ? Larry Mark McCarty I don’t pretend to have an answer, but medical care just does not feed back into a GDP loop in a way that makes up for what it takes out. The whole retirement ethic is only about 50 years old and it’s already obsolete. We simply have to stay on the job longer. I see no other option. Nobody in Washington is saying it, but the age of eligibility for Medicare and Social Security will simply have to go up. That won’t save our bacon all by itself, but I can’t see how we can avoid capsizing the economy without it. And Washington might not have the nerve to do that until Generation X has numerically overtaken the Baby Boom generation in Congress. I’m not sure we can afford to wait that long. Jonas Moses, PhD PA Where medical practitioners could and must certainly be involved, were we to adopt a similar legal code for self-abusers, is in the identification and reporting (conducting) of such individuals to the proper orgs, for the processing and punishment (fines, restrictions, mandatory public service) of said persons. I would encourage you to rethink your sentiments concerning the impact that individual medical professionals can make. The members of MoveOn (an incredibly successful, grassroots civic organization) would beg to differ. Here is a highly visible organization whose very existence was based upon the principal that a single voice DOES make a powerful difference! And, as a US Army Veteran, I will posit that if you ask any military leader (including the Commander-in-Chief of our Armed Forces), she/he will tell you that “every single soldier is critical to the success of the mission.” Pointless to say more…you will either get it, or you won’t. At least we can agree to disagree, I suppose. Peacefully, Dr. Jonas Moses Francis Roosevelt Gilliam Speaking of recent changes in medicine. What of the primary physician? You know the one who is aware of the patients’ medical history that will insure appropriate interventions based on potentially years of patient knowledge. But at the patients time of most need a hospitalist who have never seen the patient will be making those decisions. “Primary” doctors do not go to hospital. We do not hold patients accountable for their actions in regards to healthcare. If an insurer were to charge more for risky lifestyles then yes that is “accountability” But in the end, no matter how reckless for example the drug addict may be, when brought to a facility in need we will ALWAYS treat to the limit of our ability again and again. I do counsel each and every patient I see as to what would be healthy lifestyles as well as what may address their special problem. I only see a small fraction of my overall community. Statistically, I make no impact. The individuals that I see are improved but statistically insignificant when compared with the overall community.. We should be strong advocates for individual as well as public policies which will impact medicine. But we should be honest and aware of our position in the greater community. Much of what we need to address is best addressed from the legislature as well as from programs that can reach people before they become patients. When were you last able to in regard to any patient (your words) ” punish them (by limiting freedoms, assessing fines and levying mandatory civil service, for example) – it is as logical and rational as punishing citizens for engaging in criminal activity. ” I do agree that we should advocate better behaviors, but let us not delude ourselves that we have been successful. Jonas Moses, PhD PA “We are the firemen of the health world,” is really only accurately the role of the ER physician. “Care of the masses is public health, something most physicians are NOT trained or equipped to perform,” can only have been stated by someone who was trained more than 25 years ago. At the very least, you were trained before the development of the Standardized Patient/Clinical Simulations programming in the US, and are remarkably uninformed about these Medical Education developments. As an intermittent member of the SP/ClinSim community (and advocate for same) over the course of the past twenty years, I can state with certainty that the vast majority of student doctors are, in fact, being trained to address global public health issues, are being trained in wellness protocols and are being trained to actively engage patients about healthy behaviors, as preventive medicine and not merely once their patients are diagnosed with a disease. You would do well to investigate the SP/ClinSim program affiliated with your nearest medical school campus. These programs are exceptionally robust, well-respected and rapidly expanding/improving. The approval ratings among medical students, regarding the inclusion of SP/ClinSim during the first two years of medical school, are quite high. “We could mandate forced exercise, and even force obese people into programs that will lead to weight loss.” An excellent idea! (see below) “BUT we live in a free society and people are free to make their own choices.” No…this is not an accurate statement. This is perception, a fantasy (wishful thinking?) but not fact, at least if you are referring to those actions that impact the lives of others. “We as a society do not allow individuals to suffer the consequences of poor choices.” Yes…yes we do. Indeed, if citizens make poor choices that result in the commitment of a criminal act (or a criminally negligent act), they are subject to be punished with incarceration, monetary penalty, mandatory (and unpaid) civil service and even death. “If I choose not to pay for coverage (and I have means) then if I were to require care I cannot afford… TOO BAD! we do not have that policy. I am not advocating that policy, but it is equally unreasonable to think people will not engage in unhealthy behavior.” Again, I have to disagree, Dr. Gilliam. It is not only reasonable to expect and mandate that people engage in healthy behaviors – and to punish them (by limiting freedoms, assessing fines and levying mandatory civil service, for example) – it is as logical and rational as punishing citizens for engaging in criminal activity. Respectfully, Dr. Jonas Moses Steve Birch Francis Roosevelt Gilliam Steve Birch It’s been an interesting observation that cardiologists tend to be more succesful in getting compliance after someone has had an MI than a pulmonologist in getting a COPD patient to stop smoking after a pneumonia. Perhaps if people are better able to appreciate the consequences of their choices they would be compelled to make changes. While everyone understands that in many cases a heart attack means death they don’t know what years of suffering with reduced lung capacity, diminsihed exercise capacity and a chronic cough mean in terms of quality of life. If they really knew what lay in store for them I can’t imagine make choices that would lead to this kind of life and that is without regard to the financial impact. Maybe I’m just naive, but I prefer to make what I think are better choices. Burrell (Bo) Clawson Interestingly, we are already on that road and accelerating with the implementation of Accountable Care Organizations that recognize the mandatory need for home testing and monitoring for both healthy and ill people. In catching “disease” early, we must wind up considering a lot of tests or indicators that don’t diagnose anything. Surprised? Thermometers and Blood Pressure meters are examples of tests which merely indicate whether an ‘indicator’ is within normal range. Early on, many diseases have few recognized symptoms by a person, but may have changes of a nature that can give a warning of a potential disease. That is what I am doing with my latest medical IVD test, a hospital grade FDA OTC cleared fecal occult blood test (FOBT) to detect hidden small extra blood released into the digestive tract. In fact there are about 200 conditions which cause internal bleeding, plus after about age 45, people have 100-200 times the number of gastrointestinal problems as younger people. Existing FOBTs are not OTC cleared, nor are they properly packed in foil pouches to meet modern quality standards. By making a FOBT kit available for home use, people can take a test now and then for less than the price of a fancy cappuchino @ Starbucks. There are about 90-100 million people on blood thinners or regular aspirin with chronic disease who are at extra risk of GI bleeds, so it is not an uncommon event. Finding early indicators can potentially allow a doctor and patient to be able to eliminate a problem BEFORE it becomes a chronic problem. That is the sort of home testing & consumer awareness we need to be able to minimize health costs. Will it happen quickly? From what I’ve heard, ACOs and the likes of Blue Shield are already pushing physicians to “require” home testing-monitoring to catch conditions early to limit health care costs. From the patient side, such things may lead to a better quality of life. Francis Roosevelt Gilliam We could mandate forced exercise, and even force obese people into programs that will lead to weight loss. BUT we live in a free society and people are free to make their own choices. We as a society do not allow individuals to suffer the consequences of poor choices. Look at the loss of the individual mandate. If I choose not to pay for coverage (and I have means) then if I were to require care I cannot afford… TOO BAD! we do not have that policy. I am not advocating that policy, but it is equally unreasonable to think people will not engage in unhealthy behavior. Jonas Moses, PhD PA Obesity may or may not constitute a disease…however, stuffing one’s face with crap is not. The Catholic Church called it “gluttony.” Gluttony may be a “sin” (according to them), but it is not a disease. So, how do we address those who are already ailing from self-abuse? Well…first, restrict payment of care to those who continue to self-abuse, once they are in treatment. Second, oblige all who seek to receive disease treatment to completely abstain from the self-abuses that resulted in illness (no more smoking, drinking, drugs, fast food,…). And, for the rest? For those who are not already disease-laden, secondary to self-abusive behaviors, set some new precedents. Make it clear to Americans that “from now on, those who willfully engage in self-abusive activities will be responsible for paying their own way, when it comes to future illness, secondary to elective self-abuses.” While it may not be appropriate to refuse payment of care to all who have already entered the ranks of the patient population via self-abusive behaviors, admonishing those who may choose – in future – to engage in such behaviors that there will be consequences beyond illness – both monetary and legal – may prove a real and viable inducement to behave. Consider this: since the US began major advertising campaigns admonishing that the penalties for drinking and driving (legal/monetary consequences) are severe, both DUIs and alcohol-related traffic fatalities have decreased. Just my two cents…still, when the consequences are made clear, are appropriately strict and are uniformly enforced, there are positive (measurable) results. Developing such a strategy for addressing self-abusers can and will result in lower costs to all. I just read another comment, regarding “healthcare” versus “sickcare.” (paraphrase) Respectfully, Dr. Jonas Moses Steve Birch I think that it likely will take a generation to change the way that people look at health and take responsibility for their own health. At that point there will be much lower rates of the preventable diseases and this will bring the costs back into line. Additionally, we’ll be able to commit resources to develop low cost diagnostics for other diseases so that we can catch them at an earlier stage and manage them more effectively. Had that Hodgkins patient have been caught earlier he could have been managed more cost effectively and had a better outcome. I’m sure we can get there, but not if everyone, patients and providers alike want to keep doing the same thing. Sandro Pires Gomes Thanks Joe for a great theme! Sincerely, Sandro Selmo Gomes. Joe Hage So let’s fast-forward 10(?) 20(?) years. When it breaks, what will rise from the ashes? Steve Birch John Abbott Francis Roosevelt Gilliam This is not intended to be exhaustive listing but when we start mandating EHRs, bar coded pills, reduced resident hours, and other interventions with the promise of cost reduction. I have NO BELIEF that most of these interventions will be anything but MORE expensive. Jonas Moses, PhD PA Notably, though, inferring (from prior comments) that the US, and by corollary our healthcare insurers, it may prove a very wise decision to place a premium on well-documented and intentional self-abuse by citizens engaging in toxic lifestyle activities: drinking, smoking, other drug abuse, over-eating (induced obesity and diabetes), et al. These are choices, not accidents or genetic misadventures. These choices cost everyone – not just those who abuse their own bodies – a massive burden in taxes, skyrocketing insurance costs, medical care, … All too well do we (collectively) know and appreciate the collateral fallout from such indiscriminate and self-destructive behaviors. Yes…I do think it makes sense; and I do support a cost premium levied against those who willfully abuse themselves and then expect the rest of us to pay for their self-abuse. I will go further, and state that the taxes levied against tobacco products – for example – are grossly insufficient, and must be radically increased to address the calculus of supporting the monumentally higher healthcare costs of those who choose to smoke. Of course, we must face the ultimate question: Do we have the right to regulate (control) the choice to self-abuse? The answer is bifurcated and sticky… If those who are determined to self-abuse then become ill, do they have the right to burden our healthcare system, or must they pay for themselves (or, ultimately, suffer the unchecked/untreated consequences of their self-abuse)? The tobacco companies, breweries/distilleries/vineyards and junk food purveyors are satisfied to opine that the choice to self-abuse is simply not their problem, “we do not force people to use or abuse our products!” A few companies make a feeble effort to be good corporate citizens, by spending some meager share of their billions in marketing dollars to advertise that people should “drink, responsibly.” Not one of these companies says, “okay…if you cannot control your sugar intake, don’t consume our junk food!” The Bottom Line… is not the real question: “by continuing to pay for those who choose self-abuse – are we not only enabling them, are we (and not they) ultimately responsible for destroying our economy, by enabling them?” Respectfully, Dr. Jonas Moses Larry Lart For example, I am having a bad back pain lately mostly because of my position at my desk so I thought maybe I should implement a small app for my phone and keep my phone in my shirt pocket just to alert me every time I am tilting down for a prolonged period of time … to implement that will probably take me couple of days which will be less then what will cost me to go to see a physiotherapist and that just for me. David, I think that should be a starting point … with relevance here at least for medical devices. Someone here maybe should do some simple math let say for a CT scan or MRI – factory or retail device price add standard maintenance costs, consumables and divide by how many scans will run just to get an idea how much a CT or MRI scan costs as per device no hospital labour involved. Interesting will be to break down the device factory price as well as in production cost, research cost, government licensing or whatever is required and that will give an even more accurate image as what goes where and how much. Burrell (Bo) Clawson, sure you can control habits with pricing to an extent and not always successful as despite high taxes on smoking addiction still prevails and all these premiums go to hat and you get rabbits out … I will say it’s not fair for a tax payer of any kind of tax to pay and get almost nothing in return … as in a smoker who runs cancer well there isn’t much to do at that point and for the premiums he paid wont even get a shiny coffin. In the case of the smoker all these taxes might be better invested in habit control therapy something to prevent I don’t know you can make a scheme you pay tax or you do your therapy and try to fix things earlier .. incentives. Larry Mark McCarty But if you ask a cardiac electrophysiologist about apnea, he or she would say it’s a huge burden, and if NTSB could measure the number of accidents in which sleeplessness played a role, the percentage might be a lot higher than any of us knows. Not all sleeplessness is due to apnea, that’s true, but a lot of it is. Burrell (Bo) Clawson It ought to be a trivial application to make for the iPhone. Mark McCarty Want to put a dent in the cost of healthcare in decades to come? Spend a bit less on cancer and a bit more on Alzheimer’s. There’s just no way around it. Cancer is over-researched. Mark McCarty Burrell (Bo) Clawson About 50% of all hospitalizations are due to self-inflicted problems. My understanding of hospital costs is that labor costs are the supermajority of expenses, so these 2 points tell us what has to happen to make significant changes. David Pennington, PE This is not an attempt to lay “blame” on the hospitals, but merely to point out that this is one of the places the headache of healthcare is hurting. Mark McCarty If we could delay baby boomer retirement by three years, it would nearly wipe out the Social Security problem. That still leaves Medicare, which is a larger problem and is not particularly affected by keeping people on the job for an additional three years because the really expensive diseases hit in the 70s, but it would eliminate one third of the overall problem, which is nothing to sneeze at. But I don’t think it does any good to argue that the problem is insurance or to argue for penalties for some habits. That would just drive spending on ways to fool the tests. Penalties rarely have any effect if I’m not mistaken. So let’s try focusing on something really outlandish, like helping everyone stay vigorous enough to keep their jobs. After all, the job market is going turn upside down over the next 30 years as boomers vanish from the ranks of the employed. We need boomers to stay on the job to keep from bankrupting the economy and to keep the pool of available talent stocked. Burrell (Bo) Clawson Now insurance with Obamacare is not really about pricing a policy based on risk, but on a lot of arbitrary rules of Obamacare which go against risk analysis as a basis for insurance. Overhead of state and federal government offices & all healthcare related companies compliance on all aspects of medical insurance probably consumes a good chunk of the 18% of gDP healthcare costs. My wild guess is probably one third of that 18% is government regulated overhead. If a patient was 26 years old and buying Obamacare insurance, and he had a choice, $300 a month for a non-smoker and $800 per month for a smoker, what do you think the effect would be on the young person’s habits? Burrell (Bo) Clawson The only way this will ever stop is either a revolution (ballot box or otherwise) or a voluntary Congressional passed amendment to the Constitution to require a limit to the % of GDP it can spend and total elimination of Ponzi scheme type projects in the Federal & State governments. Doubt the Constitutional amendment would ever pass. Larry Lart Same here, imagine that there were no insurance companies, and people will have to pay that out of their pocket – my bet will then all these medical costs will be far better aligned with the reality and competition will do even better. Maybe if insurance companies will do more in-depth analysis on the real cost of lets say a CT scan and have a cap on – in other words make less funds available, then maybe this will drive prices down. However, this will probably has to happen across board so one can say that’s a political issue to solve. On the other hand, medical devices/technology can slice that price and in a long run it will make a huge difference. One, for example, can replace a GP with database/application which can cross-correlate symptoms and lab analysis far better then our mind can remember – all the technology and knowledge to implement this. Then you can have lets say a qualified nurse for human interaction part, symptoms input in the system etc. and that should drive the cost down. Translating these high speed technological advancements in the medical field will be/is way slower given the regulators and politicians – maybe getting them to use more technology to faster evaluate outcomes could speed up the adaption process. What else medical device manufacturers can do? they could do a better details pricing analysis of the cost from top(insurer) down to factory price. Larry John Abbott For all the complaints about “Big Pharma” and “the Government”, it all comes back to my long standing complaint. We as a society want more than we are willing to pay for. We want education, we want to wage wars, we want big ships & expensive airplanes, we want big fences on the borders, we want to help the needy, we want roads & bridges, we want farm subsidies, we want safe products, we want to lock up millions of people, we want, we want, we want… But no one wants to pay for it. Until we solve this underlying problem, all the big boogeymen we always blame are small players. Our congressmen and senators get in office because WE elect them, not because Big Pharma donates lots of money to them. Yes, yes… I realize that it is not that simple but in the end it DOES all boil down down to a society that wants more than it is willing to pay for. Marshall L. Perez Joe Hage Dominic Mastroianni [http://burzynskimovie.com/|leo://plh/http%3A*3*3burzynskimovie%2Ecom*3/bQ0E?_t=tracking_disc] Part 1 and Part 2. Not just about cancer but about the entire system of corruption of Big Pharma and the Government. Heather Thompson Patrick Crawford Burrell (Bo) Clawson Competition between makers of devices tends to reduce costs. Demand is what drives health costs up. Demand for consumers who don’t necessarily care whether their alcohol, diet, drugs, random sex, tobacco or other personal choices affect their health because “Medicare … Blue Shield … Obamacare” (take your pick) will cover it. All device manufacturers can do is make ever better devices and let the market choose which one is best. Marked as spam
 Posted by Asked on February 6, 2012 6:38 pm
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