Health: A luxury–say what?

A health care blogger (Patient Centered Healthcare) made the following observation about health and poverty:

Let’s take a pessimistic view of the situation for someone living in poverty:

• Fast food is probably cheaper than many health foods.
• The working poor likely have less time to exercise and no money to belong to a gym.
• The working poor may have more than one job to make ends meet and/or may work in an environment which is hazardous to their health.
• Financial stress could impact sleep which impacts obesity.
• Access to quality health providers may be limited based on location and/or access to transportation.

This fellow is probably a nice enough guy but the “mind set” he reveals shows how much he is being influenced by health care system propaganda.

 

You don’t need health foods to be healthy. Eat the basics; temper the red meat, fruits instead of processed sweets. It’s cheaper than fast foods. You don’t need a gym membership to stay fit. Invest in a set of free weights ($50), and a jump rope ($5). If you’ve got another $100, invest in a combination pull-up/dip bar. These things plus discipline are all you need. My grandfather was relatively poor, lived off of basic Mexican food, his wife made her own flour tortillas (to die for!); he had very limited access to doctors and no health insurance. He lived to be 83, His last three years were mediocre, but doctor’s could do little about that.

 

You know, wealthy people have the highest medical bills. So, luxury is not keeping them healthy (remember—health means you don’t need medical care!).

 

Health care will become more affordable when we stop paying billions of dollars to keep the extreme elderly alive. If I get passed 70, I’ll count myself as in that club. Take Ted Kennedy. He’s in his mid-70s, and he has a brain tumor. Ok. He’s got his death card. He should have a big party, invite all his friends, and reminisce about the contributions he’s made to the world. He had a good run! But that’s not what’s going to happen. He’s under “the doctor’s” care now, and he can look forward to many days in the hospital, radiation, debilitating chemo-therapy, and 24 hour attention. All the money they’re going to spend on him could have paid the health insurance premiums for 500 children through aged 25. Multiply this scenario times 10,000 or 100,000 elderly people, and you’ve got the U.S. health care crisis! U.S. thinking on death needs to be refocused. It is inevitable for all of us. So we need to call it like it is. The value of delaying death is in the eyes of medical providers! And they see big $$$$! That’s why the medical profession will fight changes in how we think about death. Face it–latter year care is their bread and butter.

DTC drug advertising is having an adverse influence on the growing health care crisis.

Here’s how I figure. Pretty much every drug ad tells prospective users to “talk with their doctor” before taking the medication. That’s going to require an office visit, and that’s $75 bucks on the low side. All the ads say you should take a “simple blood test” to check for liver problems. Well, that’s another $100 bucks or so. Then all the drug ads report long lists of side effects that may require another trip to the doctor and another $75 bucks. Say that only happens about 10% of the time. Here’s the costs: $75+$100+(0.10x$75) = $925. This cost does not include the actual cost of the drug. Ok. So if the DTC ads persuade just 0.5% of U.S. adults to do all this, health care spending would go up an estimated $971 million per year. If the drug ads persuade 0.6% of U.S. adults to do this, spending goes up to about $1.2 billion. And the thing is no one has even paid for the drug yet!

Some employee’s not seeking care due to cost

In a study conducted by Hewitt & Associates it’s reported that 30 percent of employees do not go to the doctor due to the cost of care. You know, I don’t think this is necessarily a bad thing.  If you consider that an employee’s chances of dying due to a medical error are higher than their chances of dying in a car accident on the way to or from the doctor’s office, I’d say not going to the doctor in some cases may actually be the healthier choice. Consider too how often people invest a couple of hours to see a doctor, only to have the doctor say it’s probably a virus, tell them to go home and rest, then charge the insurance $120 bucks. Also, consider that if that 30% of employees actually sought care instead of foregoing it, health care costs would rise billions and billions of dollars!

 

The idea that doctor care is required for a healthier life is blown way out of portion. Doctor’s have their place, but they are certainly not at the center of a healthier life.

 

 

Are these kids really $5.8 billion dollars sicker?

Remember “7^th Heaven”, and “Married With Children”?

 

I mention these two shows because of the difference between the parents and how they dealt with the kids. The 7^th Heaven parents were clearly devoted to the health and welfare of the kids. Kelly and Bud Bundy were—well—pretty much on their own!

 

So, here’s the point. In an examination of 2,201 health plan enrollees from 2005 with dependent claims, levels of agreement with the statement: “Members of my family take care of their own health” identified a spread of nearly $2.4 million dollars between those who strongly agree (like Al and Peggy Bundy) and those who strongly disagree with the statement (like Mr. and Mrs. Camden). This level of variance did not come from the dollar amount of actual claims, but from differences in the frequency of how often claims occurred. For example, those members who strongly agree with the statement (n=1,624) accounted for only 8.6% of total dependent claims, while those who disagreed with the statement (n=1,742) accounted for 34.7%. The total dollar amounts associated with each group were $741,380 and $3,091,144, respectively. The rate of dependent claims generation within the populations was also dramatically different: for the agreement group it was 11.6% per year; for the disagreement group it was 43.8% per year. For the statistical bozos out there like me, the “p” values (not to be confused with the value normally associated with urine) were all significant at the p<0.0000001 level. Yeah, this is for real!

 

This huge difference in dependent claims may be the result of many different factors, including the number of children per group, the age of the children in each group, the age of the parents in each group, or the priority of dependent’s health per group. Whatever the associated factors might be, the fact is that the assessment of one cognitive dimension identified millions of dollars of difference in demand for health care services among a relatively small sample of health plan members. These demand levels need to be verified by more similar studies of course. But assuming this kind of claims variation holds within the US population of parents, the projected spread in dependent claims levels associated with the varying priority of family health is about $5.8 billion dollars a year.

 

I’ll bet a handful of guitar picks that the dollar difference between these two groups is not because the parents who disagree with the statement just happen to have kids who are $5.8 billion dollars sicker!

How about taking Plavix for the next 20 years?

I went to a family gathering this past weekend and talked awhile with a cousin I don’t often see. She told me about a male friend of hers, 47, who just was put on Plavix by his doctor. The doctor said he was healthy with no signs of problems, but wanted to put him on Plavix to prevent heart issues that might come up 20 years from now. My jaw dropped!

 

For those of you unaware, here is the description of Plavix:

How To Use PlavixPlavix PrecautionsPlavix MisdPlavix Interactions

Plavix Side Effects

Plavix Storage

Before taking Plavix (clopidogrel), tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies.

Plavix (clopidogrel) should not be used if you have certain medical conditions.  Before using this medicine, consult your doctor or pharmacist if you have: blood disorders (e.g., hemophilia), bleeding conditions (e.g., active peptic ulcers).

Before using Plavix (clopidogrel), tell your doctor or pharmacist your medical history, especially of: recent surgery, serious injury (physical trauma), severe liver disease, severe kidney disease, history of abnormal bleeding, other conditions that may put you at high risk for bleeding (e.g., certain stomach/abdominal problems, certain eye diseases).

Before having surgery, tell your doctor or dentist that you are taking Plavix (clopidogrel).  Your doctor may instruct you to stop Plavix (clopidogrel) prior to surgery.

Plavix (clopidogrel) may make you dizzy; use caution engaging in activities requiring alertness such as driving or using machinery.

Limit alcoholic beverages.  Daily use of alcohol, especially when combined with this medicine, may increase your risk for stomach bleeding.

Plavix (clopidogrel) should be used only when clearly needed during pregnancy.  Discuss the risks and benefits with your doctor.

It is not known whether Plavix (clopidogrel) passes into breast milk.  Breast-feeding is not recommended while using Plavix (clopidogrel).  Consult your doctor before breast-feeding.

IMPORTANT NOTE:  The preceding information is intended to heighten awareness of health information and does not suggest diagnosis or treatment.  This information is not a substitute for individual medical attention and should not be construed to indicate that use of the drug is safe, appropriate, or effective for you.  See your health care professional for medical advice and treatment.

Store the US product at room temperature (77 degrees F or 25 degrees C) away from light and moisture.  Brief storage between 59-86 degrees F (15-30 degrees C) is permitted.

Store the Canadian product at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture.

Do not store in the bathroom.  Keep all medicines away from children and pets.

Properly discard this product when it is expired or no longer needed.  Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

IMPORTANT NOTE:  The preceding information is intended to heighten awareness of health information and does not suggest diagnosis or treatment.  This information is not a substitute for individual medical attention and should not be construed to indicate that use of the drug is safe, appropriate, or effective for you.  See your health care professional for medical advice and treatment.

Plavix (clopidogrel) is used to prevent heart attacks and strokes in persons with heart disease (recent heart attack, unstable angina), recent stroke, or blood circulation disease (peripheral vascular disease).  

 

Based on review of the initial clinical trials, Plavix lowers the risk of heart attacks or stroke a little better than aspirin alone (about a three percentage point improvement on average). Keep in mind that Plavix is recommended for people with a heart problem—not for people that might have one in 20 years.

 

In my opinion what this doctor did and what his patient accepted is what’s wrong with medicine and the source of the nation’s health care spending crisis. Consider this: Plavix can be bought on-line for $90 for a month’s supply (28 tablets). Compare this with 100 aspirins for about $4. Maybe in a race between Plavix and aspirin Plavix wins, but it is only by a hair (or maybe two hairs). The $90 Plavix fee works out to $1,080 dollars per year per person. A similar regimen of aspirin would be under $20 per person per year. If doctors did what this doctor did to just 0.5% of U.S adults (1.1 million adults), the annual costs are just shy of $1.1 billion per year, and $22.7 billion over the 20 years.

 

The thing about Plavix is that heart patients who were taking it still had heart attacks, just not quite as many—about 3% fewer; so that means 20 years from now most of the patients who were on Plavix for twenty years generating $22.7 billion dollars of costs will still be getting heart attacks, and more medical spending will have to take place to deal with it.

 

I don’t know if the doctor who chose to prescribe Plavix to a healthy guy for “possible” problems 20 years in the future is misinformed about the actual impact of Plavix or just getting drug company kick backs.

Health care consumers are not homogenous

Does that mean we’re not non-fat? But seriously, the above headline comes from Deloitte who claims to have “discovered” that health consumers do not think and behave the same, and now claims knowledge of “the six segments” that define health care thinking for the whole country based on a sample of 3,000. That’s great. But, you know Yankelovich recently did their own really large survey of over 20,000 respondents across 14 countries including the U.S. and found twenty-five segments? And what about the nine health consumer types promoted by the PATH Institute (my company) that were discovered back in 1989 and that have been verified across the U.S. with over 250,000 people?

 

Sorry, Deloitte, but to say you’ve discovered that U.S. health consumers are not homogenous is to claim discovery of something that’s been scientifically known for almost twenty years, and intuitively known for a lot longer than that. It’s one thing to truly discover hidden segments of people who share common thinking and behavior patterns, and it’s another thing to create them with a fancy statistical routine. I’m pretty sure I could prove you’ve done the latter, and that’s a shame. Because lots of people will look at your name and trust your “discovery” and only later find out it has no legs. That will just make my job tougher!

Patients, providers, health and who has the power?

This post is in response to World Health Care Blog, for 11/24/07 by Scott MacStravic:

 

Hospitals have another obstacle, which is learning to persuade and motivate people who have not relinquished power to them. When a “patient” comes into to a hospital for treatment of some disease the power in the relationship is clearly understood–the hospital has it. The success of the treatment is in the hands of the doctors and nurses. The health priorities of the patient, their behavior patterns, levels of trust or self-efficacy are generally irrelevant. This is easy to prove because no hospitals include this kind of information in the patient chart for nurses and physicians to consider during patient interactions (if there are any hospitals are out there who do, feel free to write in an prove me wrong). Patients do what they are told and they are expected to behave themselves. In terms of treatment delivery, the patient is little more than a cog. The whole mentality of hospital medicine is based on this paradigm. People with the health risks you mentioned (e.g., obesity, smoking, inadequate sleep) generally do not admit they have them or recognize them as severe. These folks are the way they are and see it as their right to be so. Out beyond hospital walls the paradigm of the power relationship is different. In the wellness world, the success of the treatment is in the hands of the person who has not assumed the patient role. These folks will not just do what they are told. The health priorities of the person and how these shape behavior are front and center, and must be dealt with. Unfortunately, this is the area where hospitals have the least experience or know how.

 

 

 

 

Health risk conditions, disease and productivity loss

I think it is silly to judge the impact of risk conditions or disease states on productivity 1) without understanding the interactive impacts of different combinations of them, and 2) without considering the NATURE OF THE PERSON who has them. An employee with hypertension and depression might say, “I’m not feeling good today so I’m going to take it easy” and use that excuse three days out of five, while another employee with the same conditions might say, “I refuse to let my issues slow me down,” and be more productive than an employee with no conditions. The only way that productivity impairment from risk conditions or disease states can really be judged is by first controlling for employee attitudes and response to health issues. There’s a huge psychological component here that is not being considered. That’s a mistake.

The cost of maybe illness and fake medical care

About 16% of the adult population strongly disagree that they “only see physicians for serious illness or injuries.” This means these people go for minor ailments or concerns. This 16% generate $500 to $1,500 more in paid claims per person per year than those who agree with the statement. That’s somewhere in the neighborhood of $1.7 billion dollars year in health care spending caused by folks because they have a lower trigger point of when they decide it’s time to see the doctor.

 

I don’t mind my insurance premiums paying for the treatment of illness or injury, but it angers me that my health insurance premiums are higher than they need to be because they are paying for the care of people who just feel like going to the doctor just because something might be wrong. But the thing that really raises my blood pressure is that lots of doctors are happy to see these people, charge them for an office visit, and then give them a prescription for fake medicine to make the feel better.

What’s Your Life Worth?

An article in last Monday’s Wall Street Journal (Apr 28th) talked about a women with leukemia who went to M.D. Anderson Cancer Center in Houston, TX for treatment. The center didn’t like the women’s limited insurance and wouldn’t treat her unless she came up with $105,000 cash. Recently, lots of uninsured patients have been getting care and stiffing the center.

In a related story, a guy hiking on a mountain trail had the ground give way under him and ended up holding on to a tree root while dangling over a 3,000 foot gorge. Some other hikers came by, the guy yelled for help, and the hikers said, “We’ll help you but we need $105,000 up front, in cash. The last three people we helped promised to pay us $105,000 and we’re still trying to collect.”