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One of the unintended, and ironic, benefits of the recently enacted “health care” legislation is the government and medical insurance companies are now firmly in the same boat.  They both benefit from anything that would reduce the shared costs of medical care.  However, it may be a stretch to imagine them coordinating their efforts on programs and policies that will actually reduce medical costs by…hold your breath…improving Americans’ health.

Ever the optimist, I’ve taken the liberty of creating a list of programs and policies I believe will make a difference.  I’ve put a focus on the young because they will have the biggest impact on future costs.  And, truth be known, there will be nothing left to pay for their medical care after we – the Baby Boomers – have exhausted all of the government’s resources.  The least we can do is get them off to a good start.

  1. Mandate (and pay for) a nutritionist in every high school in the country.  And mandate that all high school students must earn a nutrition credit before graduating.  I can already hear the screams.  Our public schools can’t afford it!  (But we can afford rising medical costs??)  It’s taking away from other programs!  (There are already health programs in most high schools.  This is just an expansion.  Again: Do we want to spend money on sickness or spend money on health?)
  2. Provide incentives for individuals to spend money on preventative care.  Ever try to use your pre-tax health savings account on a massage?  How about to get a personal training session at a gym?  To visit to a naturopathic doctor?  You can’t!  If the government and insurance companies would like to reduce medical care costs they need to re-consider what can be paid for out of health savings accounts.  Or stop calling them health savings accounts!
  3. Tax junk food like we tax cigarettes and alcohol.   The negative health consequences of regular consumption of junk  food is well documented.  We know that a high sugar/simple carbohydrate diet increases the odds of diabetes (an epidemic in this country and one that is costing us all dearly in personal and financial terms).  And we know that some of the same foods increase the likelihood of heart disease.  If insurance companies really want to improve their bottom line (without increasing premiums) they should direct more of their lobbying dollars on an effort to tax junk food.

It’s a modest list but it would be a healthy start.  And if just these three reforms were enacted future medical cost savings would be in the billions of dollars.  And the tax on junk food might even pay for the other two.  What do you think?  Shall we work to enact these proposals and any others that help reduce our future medical costs?  Or shall we just sit around and squabble about who’s going to pay for an increasingly large medical bill?

Call it Sick Care or, better yet, simply Medical Care.  But stop calling it Health Care!  We’re talking about money spent to cure sickness.  We’re talking about what we pay the medical establishment to fix us when something doesn’t work.  We’re talking about money spent when we’re NOT healthy. We’re not talking about Health Care.  That’s a completely different discussion and it revolves around the food we eat, the exercise we get, and our overall quality of life.  (A worthy discussion, for sure, but not what the President and Congress are calling Health Care today.)

So what’s in a name?  Plenty!  By calling it Health Care the issue becomes much more emotionally charged and the facts get distorted.  Calling it Medical Care allows us to dispassionately break it down into its different components such as major medical events and routine care.  And requiring Americans to have insurance for major medical events is something we can get some form of national consensus on.  After all, we require every car owner to have car insurance today (but not to cover routine care).

Calling it Health Care paints a picture of the government intruding into all aspects of the decisions we make regarding our health.  Do you want that?  Insurance companies, the government, and, yes, even the medical establishment have not proven themselves to be good at improving the population’s overall health.  If they were good at it our medical costs would not be as exorbitantly high as they are today!  Do you really want any of these groups to be responsible for your overall health care and its costs?  The country’s wariness about the proposed “Health Care” legislation says it all.

So, let’s start by calling it Medical Care and simplify the debate.  Let’s try to get some consensus around insurance for major medical events and, while we’re at it, remove any barriers to insurance companies competing for that business.  We can then focus our efforts on reducing medical costs through better health and wellness education.  If the President and Congress really want to have an immediate and measurable impact on medical costs, they should start with more/better health education and healthier cafeteria food in our public schools.  Now that’s a Health Care Plan.

  1. “Good public servants” don’t necessarily make good candidates.  Martha Coakley has been referred to by supporters as a “good public servant” and smart person.  She may very well be (I’ve never had the pleasure of meeting her) but that doesn’t make her a good candidate.  She came across as a lackluster campaigner, a follower of the party line, and someone unable, or unwilling, to articulate any original ideas.  In a word she was uninspiring.
  2. Primaries are a lousy way to pick candidates.  The Democratic primary campaign was yawner despite four quite distinct personalities running to represent the party.  And the least dynamic candidate won.  Why?  Because the primary is dominated by local party operatives and they almost invariably vote for the anointed candidate (in this case Coakley).  In addition, the political uniformity that usually pervades local party ranks forces challengers to spout remarkably similar positions (although this election might have set a new record for candidates agreeing on almost every position).
  3. Voters are real people who make real decisions.  This election might also have set a new record for political complacency (arrogance?).  I suppose it’s easy to become complacent when you have a 30+ point lead in the polls.  But, really, you don’t think voters notice when the candidate assumes the position of senator-in-waiting?  Last I checked we still live in a democracy and voters have the final say.  To make matters worse, Coakley’s demeanor/style conveyed the perception that she could take it or leave it.  Maybe not a true reflection of her desire but it’s the way she came across (see point #1 above).
  4. Negative ads don’t work all that well (at least as a desperation measure).  The last minute barrage of special interest-sponsored ads for Coakley also set a new record…for desperation!  As I’m watching the ads on TV my jaw just kept dropping lower and lower.  And one negative ad would follow right after the other.  I can’t help wondering whether Coakley herself didn’t wince every time she saw one.  They certainly didn’t match her image up until that point.
  5. Betting against last minute Barack Obama interventions (Olympics, Carbon Treaty, and, now, MA Senate election) has become a sure thing.  Wow!  I have only one piece of advice for Obama.  Next time someone calls – or sends you a note on your Blackberry – to ask for help to bail them out don’t pick up the phone!  Or explain to them that, as much as you’d like to help, you have a crisis to deal with in (fill in the blank…Haiti, Afghanistan, Wall Street…) and can’t leave your post.
  6. A relative unknown with a winning personality, a can-do attitude, and a clever campaign is a good formula for a come from behind victory.  What a campaign!  This one will be studied for some time to come.  What else can I say?  Regardless of political persuasion you have to tip your hat to Scott Brown and his team.
  7. “All politics is local.” (OK, Tip O’Neil said it first.  How ironic!)  You have to get out there Martha!  You may be a well known attorney general but that doesn’t mean people really know you.  People vote emotionally for logical reasons.  In other words, they need to justify their vote based on where they stand on the issues but they are voting for a person and how they feel about that person.
  8. Massachusetts has become more diverse.  This is another way of saying that the old Irish-Democratic machine is losing its grip on the state.  I know it’s been going on for awhile – the old machine certainly didn’t make Mitt Romney governor – but this election is another nail in the coffin.  One could argue it was only somewhat sustained until now through the force of Ted Kennedy’s personality and the aura of the Kennedy name.  If you come from that world you can blame your loss of power on immigration and the homogenizing force of the suburbs. 
  9. It’s the economy, stupid!  I went to one of the Democratic primary debates and I was surprised how little the economy was discussed.  Coakley, in particular, was more interested in touting her record as a defender of human rights and civil liberties than providing any original ideas on getting people back to work.  I got the feeling she was just where she was most comfortable – serving as Attorney General of Massachusetts.  The only Democratic primary candidate that made the economy the centerpiece of his campaign was Steve Pagliuca and he had little chance of winning over the party faithful (see point #2 above).
  10. And, yes, we are worried about what Congress has cooked up on healthcare.  Do you really know what’s in the bill?  If so, drop me a note and let me know why I should want it.  I’m not a reactionary on the subject but, quite frankly, I don’t have any faith that Congress and the army of Capital Hill lobbyists is capable of cooking up a healthcare bill that is rational and cost-effective.  (If you’re interested in my position go here.)  Brown cleverly exploited our unease about the bill while Coakley was stuck touting the party line.

So, there you have it.  Democracy works.

There’s been so much written on this subject that I hesitate to add to the noise.  But a recent article brought me back.  The article – Healthcare’s a Difficult Case – by Thomas Donlan of Barron’s is really a review of the book The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care (Penguin Press) by T.R. Reid.  Reid took his injured shoulder to doctors around the world to determine how each of the different systems works.  His shoulder is still not healed but he knows a lot more about the world’s healthcare systems.  Donlan believes Americans should read the book to better understand the tradeoffs that other societies make to get some form of universal healthcare.

I haven’t read the book but, in some ways, I’ve lived it.  I’m a Canadian living as a permanent resident in the U.S. who was raised in Aruba and lived in various corners of the globe.   I have a wide range of experiences with healthcare around the world and, fortunately, none of them have been bad.  For example, in 1982 I shattered my wrist (yes, shattered) in Saudi Arabia where it was expertly put back together by an Australian orthopaedic surgeon.  Back in Canada my rehabilitation was also expertly managed – and fully covered – by the “socialized” healthcare system.  That was almost 30 years ago and I haven’t had any problems with my wrist despite a 10+ year period as an active squash player.  Now my shoulder on the other hand…

My perspective on healthcare options and outcomes has also been influenced by other factors including my parents experience living in Spain for the past 25 years.  They’ve used both the public and private healthcare options in Spain and have been happy with both.  Last, but not least, six months ago I was laid off and I’m experiencing – for the second time this decade – what it’s like not to have employer-subsidized insurance premiums.  It’s costly and unsettling.  I would prefer some form of publicly funded safety net.
 
Despite all that experience I can’t honestly say I know what the right solution is for the U.S.  Unlike almost every other developed country that has some form of public health care, the U.S. is not a very homogeneous society.  And Americans, in general, have a lower health IQ than people in other developed countries. As a result we have an unhealthy (literally!) over reliance on doctors and the medical system to manage our health.  This no doubt adds to our costs.  
 
Regardless of the unique challenges we face there’s a consensus in this country that everyone should have some form of coverage.  My thought, and I don’t have any data to back it up, is that we should be thinking of some form of free, or relatively low-cost, public health clinics that the government helps subsidize.  These public health clinics should also be supported by the healthcare community including doctors and pharmaceutical companies in the form of charging less for products and services. (It‘s somewhat analogous to our approach to legal aid.)  This approach has the benefit of being true to the American spirit of giving back while at the same time keeping costs in check.  Would do you think?

[In my previous blog on the subject I suggested that healthcare savings accounts would be a good option.  I still believe it would be a good way to bring down the costs of the private part of our healthcare system.  But you still need a public part to cover those that never have the resources to build a health savings account in the first place.]

I’m concerned that we only add cost to an already costly system if we try to create a publicly funded system that mimics the current private system.  But I’m not sure our politicians share that concern.  Congress typically only knows one way to solve a problem – create complicated legislation that serves the needs of as many vested interests as possible, at a tremendous cost to the taxpayer.  Hopefully, our politicians will wake up and realize that building another wing on a burning house will not prevent it from burning to the ground.  It only delays the inevitable.

Yesterday was a strange day.  I woke up with a running nose and some feelings of a mild allergy.  Not that I know much about allergies because I haven’t had much experience with them.  But I knew it wasn’t a cold (which I’ve had plenty of experience with).  And it wasn’t just one of those morning things because it persisted all day.  I kept thinking it must be something in the air – but what could it be this time of year?  Today I woke up and it hit me.  Saturday night (the night before I experienced the allergies) I had a large bowl of Pad Thai (a Thai noodle dish with peanuts in it) and I’m slightly allergic to peanuts.  I didn’t recognize it because I’ve never had that kind of a reaction the following day.  I usually just notice some immediate sneezing as well as mild skin reactions. Maybe my diagnosis is off but given that I don’t have any of the symptoms today it’s the best I can come up with.

Which leads me back to the subject of healthcare.  I read an article in the latest Barron’s about a guy named David Goldhill who penned a provocative article on healthcare in September’s Atlantic magazine.  It’s provocative because David is a businessman and card carrying, check writing Democrat and his proposal is one previously championed by Republicans.  You’ll have to read the article – or at least a review – to get more information but I will tell you his prescription.  He advocates health savings accounts because they put control back in the hands of consumers and take it away from the insurance companies.  It doesn’t eliminate health insurance; it simply relegates it to its original function, namely providing insurance against major medical events.  I like it but I doubt it will take root because just about every vested interest will fight it.  Insurance companies will fight it because it diminishes their role and will force them to shrink.  Medical device and pharmaceutical companies will fight it because it’s harder to sell expensive procedures and treatments when the consumer is paying the bill.  And liberal Democrats will fight it because it doesn’t bring them closer to their cherished goal of government run healthcare.

So what do allergies and the current healthcare debate have in common?  Simply that I don’t want someone to tell me how to treat my allergies – or any other health issue I might have.  I want to be able to choose between natural remedies, drugs, or simply modifiying my diet.  I don’t trust governments or insurance companies to make the right decision for me.  As I’ve said before I’m not ideologically opposed to government run healthcare – my experience is that they do just as well as the insurance companies.  I just don’t see how adding a government option on top of the current mess gets us any further ahead.  And I don’t understand how we can get costs down without consumers being responsible for the bill (major accidents and illnesses being covered by insurance).  Maybe someone can enlighten me.

One argument made for government run healthcare is that the average consumer is not capable of making the right decision when it comes to his/her own health.  But that’s an education problem that can be addressed by the government without controlling healthcare resources.  Maybe the government should get involved by funding community health centers and other organizations that promote health and wellness.  That will do more to reduce overall healthcare costs than any other initiative I can think of.  And, for those of us who feel we understand what we need to do to stay healthy but are sometimes reluctant to spend after tax dollars on the our own health, legislate before tax health care savings accounts.  But don’t tell me how to use the funds!  Anything that has anything remotely to do with health – doctors’ visits, homeopathic remedies, health club memberships, smoking cessation programs, massages, etc. – should be allowed.  Talk about driving innovation in healthcare and improving outcomes!  I know, I’m dreaming.  But, hey, we have a black president in the White House so anything is possible.  Maybe he’ll have a healthcare dream himself…