Posts Tagged ‘healthcare’

A Healthcare Rant from Me…

November 14, 2013

Aren’t you all tired of this healthcare wrangling  in Congress? Tired of the website disaster? Tired of the monthly insurance bills? Tired of the letters from your insurance companies that are saying “you don’t have to do anything.” and then describing all the things you should do or consider doing? It just goes on and on…

I have opinions. Anyone who knows me thinks I have an opinion on just about anything (and I do)! Disagree with me if you like, but here is what I think:

Change is difficult for the average person. You get used to a process, you budget for the expenses, you have relationships, and then, “Wham!” Things change, and you have to figure it all out. Bummer. Most people don’t like changes to important things in their lives, and most changes come with a wrinkle or two. People don’t like change. Maybe we all just need to “get over it, and get with the program”.

Healthcare is important, and healthcare is expensive. It should be less expensive. Healthcare is complicated. As one gets older, the decisions seem to become even more important and more complicated. This needs to get easier as you get older and not harder. Are you helping a parent make healthcare decisions? It is daunting, even for me!

Obama-care establishes a minimum insurance “quality” and coverage benchmark. I say”Good!” I know that some people are so encumbered by health insurance expenses that they buy poor quality insurance because that is all they can afford. This is a problem, but I think that the healthcare credits fix much of this affordability problem. We need to get rid of the garbage policies in this industry.

The website didn’t work very well out of the gate. I say “Bad…” It should have worked. It should have. When I am disappointed by the quality of a service I am paying for, I refuse to pay the bill. I am a taxpayer, for crying out loud, and I would like Congress to stop payment on that check to the website contractor. The good news here is that it will eventually work like it should.

The law is the law. All this wrangling by the Republicans in Congress should have taken place years ago. Now that Obamacare is law, Congress can fix what is broken in the law, change what proves not to work, streamline what doesn’t work well enough, and improve this horrible law over time. I read this law as it went through its many iterations. It started out as a sensible, noble effort to make the poor and middle class healthier and make healthcare more affordable, and the draft law got worse and worse as the politics unfolded and edits and amendments piled up. In the end, it was a really messy law. There is a lot of room for improvement. Congress – get to work on this!

I am struck by the fact that we in the US spend about twice as much per capita for healthcare than any other industrialized country in the world. But we do not live longer – we are kind of in the middle of the pack for that statistic. Infant mortality is shockingly high in the US. Our doctors are skilled, and our hospitals are modern and well equipped. There are obviously big and bad problems with the “system” – with the processes that healthcare providers are following. AMA – let’s fix that!

When I am not satisfied with my healthcare, I don’t have any real recourse except to seek a new provider, and if I am ticked off enough, I guess I can sue. If I am dissatisfied, I don’t have the latitude to refuse payment (or they will sue Me). I, as the consumer, don’t have any significant power in this market. That issue is still unaddressed. I want a consumer “Bill of Rights” for healthcare.

When things are broken, and they are, my friend, a good manager sets objectives and delegates tasks. Here is what I would do:

  • Describe the scope of the problem and justify the incentive to repair what is broken. US healthcare costs twice as much as it should, and care outcomes are just average compared to the rest of the world. A healthy population is simply more productive and happier.
  • Heed the 80-20 rule. Don’t “upset the applecart” for the 80%… If that is what needs to be done, then move a little more incrementally with a Phase1 and a Phase 2 and so on to limit impact to the 20%.
  • Set a burden level for the healthcare  industry in the economy – 10% of GDP would be in line with the rest of the industrialized world. “Right-size” this sector of the economy.
  • Set coverage targets: a 1-sigma, 2-sigma, 3-sigma approach. 68% should be covered by insurance from the private marketplace without any government assistance; 95% should be covered with the benefit of credits if necessary for the additional 27% of the population; provide indigent care (medicaid) for 4.3% of the population so that 99.7% of the population receive healthcare.
  • Set performance goals: Infant Mortality down to less than 2% after five years of improvement programs – down from more than 6% today, for example.
  • Set a participation transition timeframe that is realistic. Six months is really a short period of time for people to change something so fundamental. Make it a year. I see that President Obama has essentially just done this. Give every business and every individual the entire year of 2014 to make the necessary changes.
  • Pay for performance improvement. Audit the hell out of poor performers – poor hospitals, bad nursing homes, incompetent doctors, etc. Challenge poor performers with incentives to improve – or go out of business.
  • Address the “tall pole” expenses. The last two-months of life problem is a “tall pole”. This is the most costly category of healthcare to provide. It has ethical considerations, quality of life considerations, and total scope of care considerations. This is complicated, but it is a crucial component of care to address.
  • Focus more on prevention. Focus more on lifestyle. Make chronic illness management more effective and efficient.

My bottom line here is that a healthy population is a more productive population and a happier population – you aren’t working when you are ill in the doctor’s office, and you aren’t happy to be there, and you don’t want to be still paying that bill when you return to the doctors office the next time you need healthcare…

I believe that the Government has a vested interest to enable a productive economy to the greatest extent possible in part by putting a comprehensive healthcare system in place – healthy people are more productive. I believe that every person in the country has a natural desire to be as happy in their lives as they possibly can be day to day, and everyone should have a desire for the most effective healthcare possible when they are ill or injured. A comprehensive National system gives everyone the same vested interest and an organization that is accountable to you and me for system performance if “done right”… And it hasn’t been done right.

There is a lot to fix.

How You and I will Rescue the Economy

October 20, 2010

I have been fiddling with this post for awhile – I half write it – don’t like it – add and delete. You know where I am coming from. Well, I had a dream in the springtime of 2009. I dreamt that I died with no money in my pocket. The last words I heard were from my insurance advocate who said directly to the doctor standing next to me, “He’s out of money – we have it all. Now, we can pull the plug.” And I awoke to an electrical storm and my cat looking up asking me for breakfast. This dream revealed to me how we are going to save the American economy. I won’t like it one bit. Neither will you.

Premise #1: the most vibrant capitalist economy depends heavily on three elements:

  1. a vast marketplace selling desirable and affordable goods and services;
  2. everybody spending their income primarily on domestically manufactured goods and on a variety of locally provided services;
  3. enterprises exporting every good and service possible to other economies.

Every time you buy an imported good or service, you contribute directly to another economy, and to your own only to the degree that your economy adds value by bringing that good or service to you so that you can buy it the way you want it. That added value can be high if an imported good is designed, developed, managed, sold and serviced by a local company such as Apple, but Apple is the exception, and not the rule…

Premise #2: you can’t very easily import healthcare – that service is provided to you directly by a local service provider – a doctor or nurse who examines you, runs tests and supervises your care, or a surgeon, an office or hospital, a testing laboratory minutes or hours away, and by pharmaceuticals that are sold locally. Healthcare is a good contributor to a local economy.

Premise #3: healthcare administration, medicines and equipment are all easily exported. A bill for services can just as easily come from Timbuktu as from New York City. You should expect a heavy emphasis in these areas in our future national economy.

Premise #4: the healthcare industry accounts for about one-sixth of our national economy today, and that portion is forecast to double over the next 10 years – and continue to grow and become more globally focused.

Premise #5: entitlement systems are only sustainable into the long term if individuals on the whole contribute more over their lifetimes that they withdraw from those systems. The Medicare and Social Security systems are likely to change in some significant ways to demand greater rates of contribution over longer periods of time with shorter periods of benefit payout.

The longer you live, the longer you can work – and consume healthcare. The longer you work, the more you pay into entitlement systems and the less you withdraw from these systems.  Many of us are likely to work into our 70’s – like it or not.

Healthcare’s mission may well evolve to this objective:

Prolong our Working Lifetimes.

Entitlement systems may also evolve to incorporate this directive:

Eliminate prolonged, lingering deaths by requiring Living Wills for all system participants.

So, if we all spend every dime we have on our healthcare before we die, you and I may very well help rescue our faltering economy – we’ll be doing “our part”, yes sir! And when one runs out of money, well, then I guess you can die – and die quickly when that time comes. It may require an entire country of exuberant healthcare consumers who spend more on their healthcare than on food and shelter to buoy our future national economy. I can’t for the life of me think of a sustainable alternative cure for our current economic woes as we flounder, offshore manufacturing and jobs, and underinvest in many other industries.

Lest I forget – what I want from my healthcare providers:

  • a focus on long term good health and high quality of life
  • a focus on cures and not chronic illness management
  • a promptly delivered, cost-effective and efficient service
  • a statement of services and costs before service is provided
  • a “warranty” – my satisfaction guaranteed, or my money back
  • an ombudsman to resolve consumer complaints, not a lawyer

Likely? Probably not in my lifetime.

And who will refuse to purchase a product or service that will immediately extend their life by even a few quality moments? No one with money in their pockets… Until it is all gone, of course…

16 Questions – Answers, anyone?

February 18, 2010

The Economy – is there a paradigm shift happening that we don’t see, yet? One that will impact us in the future? One that gives us new opportunities?

1. Economic modeling – why did the economists miss the recent global economic crisis? What should the average person look for and change in their own mental models of the economy? What is changing at the macro level and the micro level that may not be apparent to the casual observer – or maybe it is apparent, but we don’t see it very well as individual participants in the economy? Can a major economy shed almost all manufacturing, retain managerial and oversight functions, add to the service sector, maintain the current standard of living and still be a sustainable economy? Does a vibrant economy have to manufacture?? Hyper-Inflation could cure this country’s debt load (but ruin the value of my savings) – is that likely? What will potentially high future inflation do to retirement planning, and how does one insure their future financial security today?

2. Workforce – is the US workforce transitioning from an army split between sole proprietors and “W2” corporate employees to an army of “1099 mercenaries”? How do you evolve from a “W2’er” to a “1099’er”? What will the workforce look like in 2025? How do you recast your career at mid-career? What is the risk to a company that sheds experienced staff and chooses to retain larger numbers of cheaper and less experienced skilled workers? Will mentoring return to professions as a new way to utilize experienced workers?

3. Geopolitics – is China a threat to the US? Will the US economy play very well/very happily as second fiddle to China? Will the US economy even play second fiddle? To China? To Europe? Will there be a new rise of Russia in the world economy? Does a capitalist system tend to decompose into a communist system just like a communist system tends to decompose into a capitalist system? Is China really communist? Russia really capitalist? What is the economic “steady state” – a socialist system of some kind? Are the Scandinavian countries at a real macroeconomic “stable point” compared to the rest of the world?

4. Global Warming – what is the real economic impact of global warming? The real social impact? To me? To my city or State and country? To the world? Where/when is the” tipping point”, and just what is the tipping point?? What is the real cost to curb global warming? How does curbing global warming impact my lifestyle today? Five years from now? Twenty years from now? Is there a net financial gain or loss due to the paradigm shift required to curb global warming? On a micro-scale and a macro-scale? Will it matter in our lifetime? Does it matter at all – in the big scheme of things (over eons)? Is Global Warming a real problem? Is attacking global warming like adding a stoplight to a busy intersection – you have to have a significant accident before you can justify acting to fix things?

5. Healthcare – roughly 1/6 of the US economy is in the health care sector forecast to grow to 1/3 of the US economy in the future – is this a realistic forecast? Is this an unhealthy concentration of industry in the economy? The healthcare industry wants every dollar in my pocket – and when it is all gone, then I can die, I guess… I want to spend zero dollars on healthcare, not 1/3 of my personal wealth (or more) – is a 1/3 concentration on healthcare in the future economy essential for a sustainable future economy? Do we have to adopt this spending habit at this level to be fiscally healthy in the future? I want this industry to treat me like a consumer – what will it cost (tell me beforehand) – if I am not satisfied, is there a guarantee or warranty? Why should I pay for ineffective treatments or medications? Should the compensation model for healthcare change – should we pay to stay healthy, and not to get better, for example? Should we tax consumption of unhealthy food ingredients such as saturated fats, sugar and salt and health-impacting products such as cigarettes and alcohol to pay for the medical cost to society that results from the consumption?

6. Taxes – what is the real impact of the average person being unable to do their own taxes? How many people do their own taxes by following the IRS publications that the IRS mails out? Should the taxpayer be able to allocate a portion of their taxes to specific programs? What are the real consequences of a consumption-based tax system or flat tax system compared to the current progressive tax system? What would be the “ripple effect” in the economy, in other words, with different tax systems – would spending habits change significantly with a different basis for taxation?

7. Disruptive technologies – where does future opportunity lie, and what current opportunities are in decline that will be replaced by these disruptive technologies? Will “Local” and community power generation (windmills and solar panels) actually replace centralized power generation on a large scale in the future? What about miniature nuclear reactors? What about backyard fuel cells? Will nanotechnology change “everything” – paper and pens, paint, medical instrumentation and medicine delivery, food production and processing, new pollutants and new approaches to pollution management?  When will homes become “super-efficient” and LEED-certified – how will “going green” affect established housing and new housing? Ubiquitous computing and “ad-hoc” computer networks – how will computers invade our clothing, appliances, cars, homes, businesses, bathrooms, grocery stores and workplaces? How do you “jump on the bandwagon” and pitch a business plan when banks are risk-averse and VC’s are reluctant to invest, too?  Who has been successful and how did they succeed – what was the nuance that they exploited and the critical difference they brought to the market? Social networking on-line – how do you build and manage an on-line presence? Are Internet-based social networks going to change the “face” of local, State and Federal governments? Of education? Does a Tweet deliver enough context and information, or is tweeting harmful because it stifles deeper thinking and communicating en-masse?

8. Intellectual Property – is there really value in patenting inventions? For the individual inventor? For the corporation? What are the flaws in the system that must be repaired? How does the individual best protect their intellectual property today and tomorrow? How does “open source” impact the future of intellectual property ownership and its exploitation by the creator? By others?

Odds and ends – a hodgepodge of curious mishmash – with tangible impact to our prosperity and well-being…

9. Education – is there a beter way to learn? The US spends more per student on public education than any other country in the world, but ranks in the middle ground on measures of success in the K-12 programs – why is that? How can schools better engage students? Parents? Teachers? What is the impact to the future economy of the US if our children are poorly educated compared to the rest of the world?

10. Privacy – do we actually have a Constitutional guarantee of privacy – a “real” right to privacy? Is privacy now a “thing of the past”? How do you protect your privacy? Should you even worry about it? Do you want to be bombarded my “meaningful” advertising and promotion in the future instead of the mass-mailings received today because a marketer knows more about you that you know about yourself? Do we need to sacrifice our privacy for the sake of our security? Is there a shifting balance in privacy vs. security that needs to be recognized and arrested or even reversed?

11. The law – I can’t read the law and understand it (and I am pretty smart) – is that ultimately damaging to a democratic society? There are so many laws – how do you remove from the body of law when the compulsion of legislators is to add to the body of law? Is it harmful to have laws that are inconsistently enforced, or laws that are unpopular or onerous and simply disregarded by the public? Why isn’t computer or network hacking treated like criminal trespassing, and identity theft treated like burglary? The law tends to focus on the tail-end (the consumer end) of an illicit “food chain” and not the head-end (the producer) or the middle (the distributor) – why this enforcement focus when it isn’t effective to stop the flow of illicit goods and the resulting profiteering?

12. Prisons – roughly 10% of the US lives has lived in prison at some time – what is the cost? What is the lost economic contribution of the prison population? What is the ability to constructively reintegrate convicts into society? The ability for a convict to be reformed? What is the opportunity cost of the “war on drugs”? What is the cost to incarcerate individual consumers for “victimless” crimes and “possession” crimes?

13. Terrorism – can technology ever really protect us effectively from terrorists? Full body scanners, ariel drones with cameras, particle detectors for bio/rad/chem threats? What’s next? How do you evacuate a city?  What is the real threat of “cyberterrorism” – what will it look like, and how would it impact us? What is being done about cyberterrorism, and how are we protected today? How will be better protected tomorrow? Is ID theft really a dimension of cyberterrorism – should it be considered as such?

14. Religion – has the notion of “separation of Church and State” disappeared from our culture? Is the US really a “Christian State” just like Iran is a “Muslim State”? What does the Declaration of Independence, the Constitution and the Bill of Rights really say about the separation between Church and State?

15. Media and creative self-expression – how do you self-publish a book or magazine or blog and make it a business? Amazon and Lulu publish individually generated physical media (paper, CD’s and DVD”s) on demand for anyone. WordPress and Blogspot publish on-line media on demand for anyone. How do you market and prosper with these relatively new capabilities? What is the business model? How do you get started?

16. The power of volunteering – is volunteering a new future wave of economic contribution for the individual? Has it ever been measured? What is the total economic value of volunteerism today locally? Nationally?Globally? Are some cultures reluctant to embrace volunteerism? Which, and why? How to “infect” uninterested individuals and cultures?

If you know the answers, please let me know…