This could change everything…

In a well designed study done in Oregon, researchers have demonstrated that having health insurance improves health, economics, and peace of mind. It’s hardly a surprise, but the study had never been done before. Read this summary in the New York Times: Study Finds Benefits in Providing Health Insurance to the Poor.

Closer to home than the last post…

“Insurer’s enormous cash surpluses prompt calls for rebates or community spending”

“The non-profit insurers have large reserves and the for-profit insurers report larger than necessary reserves as well: Colorado’s for-profit health insurers also are doing well, and the state is required to take their profits into account when approving rate increases. UnitedHealthcare reported a capital reserve of 413 percent at the end of 2009, Anthem had 449 percent of the minimum, and HMO Colorado had 578 percent. Health Care for America Now, a pro-reform group in Washington, said the five biggest commercial insurers saw profits climb 17 percent in 2010 to $11.7 billion.”

So how do we interpret these facts?

“something is seriously wrong”

How can this be? Blue Shield’s cumulative rate hikes could reach 86.5%

“People are justifiably concerned when they get a significant rate increase. We wish that we didn’t have to do that,” [Tom] Epstein [company spokesperson] said. “When people are getting increases like that and we’re still losing money, something is seriously wrong.”

A book review

The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine by Thomas Goetz (2010) is a compelling call to action on behalf of one’s health. Goetz describes how we are generally passive regarding decision-making for our own health. We are inclined to allow our health care providers to make choices for us rather than consider our alternatives–even the ones not offered by our doctors–and decide ourselves. As he describes, we are often more likely to investigate the purchase of a car or technicalogical gizmo more than a suggested medical treatment. And yet, the information age makes it much easier to manage our health, so why are we generally willing to hand over our lives, and our health, to others?

Focusing on “health” care rather than “illness” care, the stories and experiences related in the book encourage each of us to have a plan to manage our health and to take an active role in making choices that affect our lives. While the model of “decision trees” isn’t explained as a process, it is descriptive in showing where we make choices. And each choice gives us options to become more (or less) involved.

Goetz shows how medicine today gives us glimpses of the future by not only diagnosing illnesses but by measuring risk factors that might lead to diseases. In a particularly revealing and somewhat sobering chapter, he describes how the risk factors have come to be recognized–and treated–by the health care field (including insurers) as illnesses themselves even though they are only increase the probability of a diagnosis. Similarly, the field of genetics is coming ever closer to predicting one’s medical future.

The options for technology to support us in leading healthier lives are discussed. If apps are good for directions, social media, and games, why not use them to help us to eat better, exercise more and reduce stress?

It’s an interesting book. My biggest question after completing it is about the vulnerable populations; how can decision trees and technology help those who have few resources and no homes to lead healthier lives? Not every book needs to address this question, but it seems like the issues presented are relevant to all of us…not just those with computers and cell phones.

Now this is more like it…

On Friday, the HHS of the federal government announced that it will cut premiums for health insurance for the high risk pool. The lower rates will start in 2011 in a program that will last until 2014 when it be phased out because at that time (because of the reforms) insurance companies will no longer be able to deny coverage based on preexisting conditions.

There are some requirements for this coverage; you can read more about it.

But, this sounds like it’s going in the right direction, don’t you agree?

Shocking news

An article in the LA Times this morning has a striking headline: WellPoint and Aetna post higher profit in 3rd quarter: The insurers say reduced healthcare costs helped boost their earnings. The story explains that Aetna’s net profits are up 53% over the same period last year.

53%!!!

So this is why so many are working diligently to reduce the costs of health care? I thought it was to pass the savings on to those who use the health care system, people who are ill or trying to prevent illness. But no, cost saving measures are used to increase profits.

Does that seem right?

A quotation that triggers questions

“Over the last two years in an emergency situation we worked with the process instead of to transform the process,” President Barack Obama talking with Jon Stewart about change in policies on The Daily Show on 27 October 2010.

And I respectfully ask: When do emergencies allow us a more radical approach to change? When will we consider our health care system in an “emergency situation”? Can we transform health care so that…
…everyone has all and only the health care they need?
…we work on health and not just illness?
…health is not a “big money” business?

A matrix or a maze? Neither is a good option

The Boulder community of resources are many and varied. Food, shelter, clothing, health care, child support, spiritual support—are just some of the essentials that our community makes available. And health care is included. The community health centers offer primary care on a sliding fee scale. The hospitals offer services to many in our community who have financial challenges. And there are other safety net providers, like St. Benedict Health and Healing Ministry, that go out into the community to improve access and offer free screening .

The list of services is long and varied.

But when a person who is medically and financially challenged moves among these services, the complexity of piecing together resources becomes readily apparent. The rules and regulations are complicated and often have restrictions that prohibit someone from having access. Maybe he is disqualified because he makes a tad too much money or because she still owns a car—it could be one of many things—so the person falls through the cracks.

And even if a person does qualify, it takes a great deal of planning and coordination to learn what is available, what is required to apply for it, when it is possible to go to the site for service, and to arrange to get there.

To start understanding, imagine a matrix with multiple dimensions.

The first is basic needs: air, water, food, shelter, clothing and love.

The second is different kinds of health: physical, mental, spiritual, social, emotional.

Then think about the different stages of life that affect the needs and kinds of health: prenatal, birth, infant, child, youth, adolescent, young adult, middle adult, older adult, elder, end of life.

There is another axis that crosses all of these that reflects the impact of culture: money. Not a necessity in and of itself as it can’t be eaten or breathed or worn. But there is no doubt that in our culture, money makes other things possible. With it, we have access to many resources; without it we have access to much less.

Finally (for this matrix) consider our health system and the myriad services and resources available: primary care, specialists, ancillary care (e.g., physical therapy, occupational therapy, rehabilitation, speech therapy), hospitals, laboratories, radiology services, medications, respite care (i.e. home care for those without a home), hospice, long-term care, nursing homes, medical devices, complementary care (e.g. acupuncture, massage, herbalists). Conditions can be acute or chronic. There can be other players in the mix like employers, insurance companies, state governments, the federal government.

Imagine the matrix of these for an individual person. Every dimension is connected to every other; the stage of life affects one’s spiritual and mental health; whether or not there is shelter and food affects ones physical health. Each of these—as well as the presence or absence of money—also affects which health services and resources are available. It is almost overwhelming. And yet this is what we ask the most vulnerable in our community to do—to work their way from health provider to federal agency to local support group to another health provider—usually without phone or transportation or a home base. It’s a daunting task when you are well; it’s almost impossible if you are ill.

How can we simplify this convoluted maze? How can we close the gaps among resources? And how can we fill in the wide-open spaces where no support or service exists at all?

Please offer your ideas and suggestions in the comment section below.

Urgent care–an alternative

This article describes the move of more people to urgent care rather than emergency rooms when they can’t get in to see their regular primary care doctor. And there are more urgent care centers now than ever before.

Urgent care is quicker and cheaper than a visit to the ER, and from personal experience, cheaper than primary care too (based on the costs quoted). It doesn’t work for life threatening emergencies like heart attacks, strokes or severe trauma and the article cautions that people can be turned away (unlike in the ER).

Still it sounds like this option works for people who are not satisfied with the lack of timeliness and the high cost of care in the existing settings. It’s worth monitoring.

More statistics

From today’s news…

The top-earning 20 percent of Americans — those making more than $100,000 each year — received 49.4 percent of all income generated in the U.S., compared with the 3.4 percent earned by those below the poverty line, according to newly released census figures. That ratio of 14.5-to-1 was an increase from 13.6 in 2008 and nearly double a low of 7.69 in 1968.

A different measure, the international Gini index, found U.S. income inequality at its highest level since the Census Bureau began tracking household income in 1967. The U.S. also has the greatest disparity among Western industrialized nations.

The poorest poor are at record highs. The share of Americans below half the poverty line — $10,977 for a family of four — rose from 5.7 percent in 2008 to 6.3 percent. It was the highest level since the government began tracking that group in 1975.

This can’t be good for health.