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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.

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…