Tag Archives: healthcare

Problems and Solutions to the Broken Healthcare System

My wife and I recently had a little girl. Until that moment I had never been exposed to the healthcare and insurance ecosystem. I have been fortunate. I’ve never had an extended stay at the hospital, I’ve never been on prescription medication, and as an adult, I have never been to the doctor outside a checkup. Now I realize that the system is completely convoluted and non-transparent.

From what I can tell there are four major problems with the healthcare and insurance mechanisms.

1. Prices for healthcare services are unavailable, non-existent, or not published.
2. There is no crowd-sourced ratings system for hospitals (think yelp for hospitals).
3. Since everyone is insured no one cares about cost. This has resulted in higher prices.
4. The people have no power to control the quality or cost of the healthcare services.

These four problems ultimately result in a system that is too expensive, low quality, and where the people have no power to do anything about it.

Here are my proposed solutions:

1. Pricing for healthcare services are unavailable, non-existent, or not published.

Require all hospitals post itemized prices for their goods and services. Every procedure should have an itemized “menu” outlining what the procedure may cost. Since any given procedure is highly variable the menu should include “average cost”, “best case”, “most likely”, and “worst case” scenarios.

The menu should also include things like bandages, medication, and anything else a hospital could use to inadvertently pad the bill.  Great hospitals should even consider hiring a “budget specialist” who discusses costs and options with each patient.

These menus should be posted online and available before he procedure. This will allow individuals and insurance companies to shop around for a facility that meets the individuals’ need. This will also drive prices down since hospitals will be forced to compete based on price (or provide superior service to justify higher prices).

I would not eat at a restaurant that didn’t post prices so I should not have to receive healthcare services without prices either.

2. There is no crowd-sourced ratings system for hospitals (think yelp.com for hospitals).

There should be a crowd-sourced ratings system for hospitals. In my opinion this would have been a much better investment than healthcare.gov. When hospitals are forced to compete for business based on price and services the consumer benefits. Prices will ultimately fall and service will rise.

For example, in Atlanta there are several major hospitals in the metro area. For most procedures I have no idea what a service cost or who the best service provider may be. I usually just go to the closest major hospital. I imagine most people do the same thing.

A rating system would enable a consumer to quickly and easily search for a service provider based on thousands of consumer ratings. Ultimately a sick person cannot choose if they want to go to the hospital, but they can choose which hospital they visit. The power of consumer choice based on good information will ultimately force hospitals to compete.

3. Since everyone is insured no one cares about prices. This has resulted in higher prices.

The third major problem I see with the healthcare system are insurance companies.

Healthcare prices are so complex and expensive (for reason listed above) that no one can or wants to deal with it. We defer all responsibility to our insurers. Now, with the implementation of the Affordable Care Act (Obamacare) we have no choice anyways. Ultimately this leads to a system where no one cares about prices because they will be paying the same insurance premium regardless. But this is a false premise.

Because no one cares about prices and live under the illusion that their costs are the same there is no incentive to seek more cost effective solutions. People rarely look at their hospital bill and pay whatever the insurer requires. This ultimately leads to higher healthcare costs and higher healthcare insurance premiums.

Healthcare insurers should provide incentives (lower insurance premiums) to individuals who shop around for better prices and value. This would ultimately lower insurance prices and force hospitals to compete again.

4. The people have no power to control the quality or cost of the healthcare services they receive. 

The biggest problem with our healthcare system is that the people receiving the services have no power to control prices or the quality of service they receive. The appropriate infrastructure is not in place. All of the power resides with the insurance companies and healthcare providers.

Insurance companies operate as powerful unions who dictate what they will pay a hospital for a given good or service. Insurance companies have large staff who perform complex pricing studies so they understand what people are paying and how much a product SHOULD cost regardless what a hospital charges.

This results in hospitals charging several times market value for a given good or service because they fully expect the insurance company to pay only a small fraction of that amount. Meanwhile: the consumer is screwed, hospitals charge too much, and insurance companies reek most of the profits.

Obamacare:

Obamacare has only served to strengthen this broken system by further empowering insurance companies and disenfranchising the individual. Since EVERYONE is now forced to have healthcare insurance this eliminates any opportunity for individuals to negotiate or bargain for themselves.

Ultimately, we live in a system where the insurance companies dictate how much they will pay hospitals and how much they will charge consumers. Meanwhile, there has been no progress toward a system that promotes competition, dives prices down, or leads to better services.

Facism: The Healthcare system is broken.

Thoughts on the healthcare system in America? Has the ACA helped you, hurt you? I’d like to hear your story.

people 4

Euthanasia: Man mercy kills wife of 62 years

I read an article about an 86 year old man who killed his suffering wife with a revolver. She had been suffering for years and begged him to end her life. I couldn’t help but picture facing my wife in the same situation. Seeing her suffer. Tears rolling down her eyes as she begs me to shoot her. “Will it hurt” she asks. I can picture her final moments, while I’m holding her tight. My last conversation with her – we don’t deserve this. God.

This got me thinking: This can’t be happening. Not in 2013. We’ve sent a man to the moon for God’s sake and we can’t figure this out?  I wonder why we can’t have an adult conversation about Euthanasia? A man should not have to make the decision between watching his wife suffer or concede to her pleads for death – he shouldn’t have to be the one to kill her – and surely he shouldn’t be shamed in public for it!

Euthanasia

This isn’t only a question of killing yourself. This is a question of morality. A question of what the Government’s role in your life, your suffering, should be.

Should a man be allowed to kill himself if he so pleases? What about help someone else end their life if that’s what they want? Where is the line drawn when it comes to the rights to your own body, murder, and protecting the mentally ill from themselves?  Maybe it’s easy to see why no clear solution has been developed yet.

It seems simple. The right thing to do might seem like picking a side and demanding legislation to enforce it. You demand the government outlaw such actions in the name of protecting the mentally ill or as not to encourage such suicidal behaviors. We do no want to send the wrong message about the value of human life! I admit, that sounds reasonable.

On the other hand perhaps you have experienced the slow deterioration of a loved one when you were powerless to help. You could do nothing but watch as they died – slowly in agony – losing their dignity and their life I can only imagine what watching the love of your life plead for you to end their life must feel like. Not wishing those circumstances on anyone you demand a person’s right to end their own life, if they see fit, be protected under the law. That seems reasonable too.

So where is the balance? What is the right mix of the prevention of suffering and protection of those who need psychological or clinical treatment for depression? I think the solution starts with having an adult conversation.

An Adult Conversation about Euthanasia

The truth is that there are appropriate times where Euthanasia may be appropriate and other times when it’s not. The problem is, in my opinion, doctors or other care-givers have been excluded from the decision making process. They are prohibited from appropriately diagnosing or aiding in these situations at all. What’s left is a black market where the truly and critically dying are bunched together with the mentally unfit and suicidal.

If doctors were able to appropriately diagnose and aid with ailing patients and utilize Euthanasia when appropriate people would not have to resort to shooting their loved ones in the head with a revolver to ease their pain. If a person could go, in confidence  to a physician, and request an end to their life the doctor could carefully determine if the person is truly suffering or if they are simply ill and need additional treatment.

Instead, what our current system does, is make innocent people murderers. Or refusal to discuss Euthanasia makes it virtually impossible to distinguish the mentally ill from the critically suffering. It forces people to decide between helping their loved ones pass or watching them suffer for days, months, or even years. In the end – sometimes it even prevents treatment completely.

Perhaps what we need is to recognize that Euthanasia is neither good nor evil, but a necessary part of medicine. We should treat it just like any other serious medical procedure.

The Media is Bought and Paid for

This was a recent story played on CNN. If you can’t see this as a “media story” that is a total advertisement for Ambien you are an idiot. Start looking at all media this way – it’s all bought and paid for by someone. Popular media is all an advertisement.

Message from the media: Take Ambien two at a time. It’s good for travelers. If you take it correctly you shouldn’t feel groggy. It’s safe. Even Navy Seals take it!

What a crock of shit! This is our media folks.

Partial Birth Abortions

Before you say you support abortion, especially partial birth abortions, maybe you should read up on the procedure.

From Wikipedia the procedure is as follows:

[T]he largest part of the fetus (the head) is reduced in diameter to allow vaginal passage. According to the American Medical Association, this procedure has four main elements. Usually, preliminary procedures are performed over a period of two to three days, to gradually dilate the cervix using laminaria tents (sticks of seaweed which absorb fluid and swell). Sometimes drugs such aspitocin, a synthetic form of oxytocin, are used to induce labor. Once the cervix is sufficiently dilated, the doctor uses an ultrasound and forceps to grasp the fetus’s leg. The fetus is turned to a breech position, if necessary, and the doctor pulls one or both legs out of the cervix, which some refer to as ‘partial birth’ of the fetus. The doctor subsequently extracts the rest of the fetus, leaving only the head still inside the uterus. An incision is made at the base of the skull, a blunt dissector (such as a Kelly clamp) is inserted into the incision and opened to widen the opening, and then a suction catheter is inserted into the opening. The brain is suctioned out, which causes the skull to collapse and allows the fetus to pass more easily through the cervix.

If I was a doctor I would refuse to perform such a procedure.

Thanks to the super conservative blogger from Canada for pointing out the Wiki link.

The Irony of Death

My Mom called me about six times last night before I finally answered.  I wasn’t screening her calls I just left my cell phone on vibrate.  I didn’t notice she had been calling until she finally called my wife and left a voice message.

“Your Mom sounds really upset, you should call her.”

Normally I would wait until morning to call my Mom back, but if she is sounding really upset I call back immediately.  I’m just never sure if its an emergency or not.  I call my Mom back and she doesn’t sound that upset so I’m a little relieved.  I was dreading the thought of possibly having to drive an hour at midnight to handle a situation.

“Mom has breast cancer.” Mom in this case is Grandma.  She’s in her early 60’s and found out yesterday that she has early stages of malignant breast cancer.  Her sister, my great aunt, just passed away within the year from the same disease so I gather everyone is concerned.

What struck me wasn’t a feeling of dread about my Grandmother’s potential death, but a lack of empathy and a strong concern and realization about my own death.  That is horribly selfish I know, but I have always had a difficult time feeling well, what you are supposed to feel.  I was more concerned about my lack of raw emotion than concern for my Grandmother having breast cancer – that seems potentially narcissistic.

The other thing that bothered me was my own death.  I don’t dwell it, but occasionally I think how strange it is that one day I will have to face my own death.  I’m not sure how it will come and that is just as weird.

There will be a time where things happen on this earth and I will not be here to witness them.  I will be no more.  I will one day lay in a  hospital bed and count down my own passing.  Or I’ll die instantly in an accident – who knows.  It might be painful or it might be quick – but I will face death.  Strangely, there is some comfort in knowing that every single person on earth and every person who has ever been has and will experience the same thing.  That is one thing we all have in common in the human experience.

Thinking about my own death I thought about the things I would want.  I think I would want to know that people cared for me, that people were rooting for me, and to be prepared.  So I think its only right that I give my Grandmother that same respect.  To let her know I’m rooting for her, that I care for her, and to help her in any way possible to be prepared if it comes to the point where she does have to face death.

I will lie to her if needed.  I will pretend I care more than I do if I have to when the time comes.  I’ll even give in to her religious comforts when inevitably I find myself in a room full of people praying over her sick body.  I’ll even nod my head and put up no fight when people tell her she’s going to a better place, a magical place.  Why?  Because if religion makes her passing easier, provides her comfort, who am I to take that away in her last moments?

I’m being morbid.  They caught this early.  She’ll probably come out fine, but the rules about death still apply – or at least they will someday.  Death, I think it’s just a part of life.  You recognize it’s there, ignore it, prepare for it, hate it, but it’s a gift.  Death is the one thing holding you accountable for life – it’s your term limit – in a way it’s what makes you enjoy life the most. Maybe that’s the irony of death.

The Problem with the Buffet Rule

I follow Barrack Obama on twitter. Recently every tweet has been about the “#BuffetRule”. Reason after reason why the rich should pay as much or more as a percent of their income in taxes as the middle class and poor. On the surface I get it – but are we asking the wrong questions?

I mean I saw this push a mile away. When Buffet first published “his” article (or at least an article he endorsed that his secretary probably wrote for him) I knew a push for higher taxes was coming. All in the name of “the rich paying their fair share”. But why are we asking ANYONE to pay more taxes. The rich paying more taxes doesn’t mean the rest of us win, just that we all lose.

Instead of asking the rich to pay more taxes to catch up with the rest of us, why not lower taxes for everyone else? I know an increased tax on the rich will not benefit me. They’ll probably use it to buy more body scanners that I’ll have to opt out of in the airport. Or maybe they’ll find another country to invade in Africa.

If Obama wants this so bad why doesn’t he promise 100% of it to education or food for the poor? No one knows for sure where the extra cash is going. I mean, why are we trusting the Government with MORE or OUR money? Oh, all for Universal Healthcare and to “level the playing field.” Right? I doubt it.

Currently the US pays as much or more in taxes as any country on the planet. Notice how many of those countries have Universal Healthcare. In fact I just returned from Japan who pays about the same tax rate as us, but has Universal Healthcare. How can they do it, but we can’t? Maybe it’s because WE are the Japanese military!

So why are we agreeing to MORE taxes again?

Any good business man (even bad ones) will tell you that the easiest way to add to your bottom line is to cut expenses NOT add revenue (via taxation for the government). So why aren’t we focused on balancing the budget and maybe, just maybe, cutting back on the military. Why are we concerned about getting involved in Africa and staying involved in the Middle-east. I thought this was the “peaceful” democratic party!

If it doesn’t bother you that our Government can find excuse after excuse to increase taxes instead of lowering them for the rest of us – then we have lost. We will continue war-mongering. We will continue deficit spending. We will continue giving more and more power to those who already have it.

If you really think that raising taxes on the “rich” will in any way benefit you, you’re crazy. If you think this isn’t benefiting the most powerful “1%” – then you’re wrong.

One Opportunity Lost and Another Gained, I guess

Something I never talk about is that I almost went pro as a MMA fighter when I was in college.  Honestly, I don’t really like to bring it up because there are a lot of ideas attached to someone being a fighter. Most of them ideas that I’d rather not have associated with me.

In any case, I trained with a coach and gym that is known around the Southeast for being authentic and tough.  I was 6 – 0 as an amateur, had a background in wrestling, Muay Thai, and Brazilian Jiu Jitsu.  I was even offered an opportunity to fight in the Governor’s Cup in Russia – which was considered a big opportunity at the time.

Long story short – I hurt my knee. I down-played the severity of the injurt, of course.  I told myself that it was just a strain and I would bounce back.  Eventually I had to cancel the upcoming fight.  I limped around for about a month without seeing the doctor because I was also uninsured.  Looking back on the whole thing I was taking a big risk doing a sport like that with no insurance (duh!), but at the time I had never in my life had insurance so I had no choice but to never let it hold me back. (I guess that’s another story.)

About a year and a half later after I started my career, gave up fighting, and had health insurance for the first time in my life – I went to the doctor after I re-strained my knee (again) playing flag football.  The doctor informed me that I had tore my ACL and meniscus.  Without surgery and a lengthy rehabilitation process I would never be 100% again.  The whole situation was a lot more serious than I thought.

I haven’t forced myself to have the surgery yet either. I hate the idea of spending a year in recovery before I’m back to normal. It would be at least three months before I could even exercise.  The doctor also explained the process is very painful – great. Right now I’m “rehabilitated” and can run and lift weights normally.  I’ve even ran a marathon recently.  So it’s tough to talk myself into getting the surgery – it feels like moving backwards.

The real tragedy isn’t the knee injury though. I can handle that.  Rather my biggest problem is hearing about a few of the guys I used to train with who are now going pro and doing pretty well.  I used to beat up (in the friendliest way possible) those same guys at practice every day.  I could be on TV right now, who knows.  

From a young age I thought I was going to be a pro athlete.  When the “usual” sports didn’t work out and I excelled in high school wrestling MMA seemed like a natural fit. It was.

Now I can’t even watch the sport on TV because I kind of feel like “that should be me.”  Almost like I missed an opportunity.  It’s just kind of hard – like seeing an old girlfriend with another guy or something.  I know its for the best.  I would probably end up brain dead with Parkinson’s Disease or worse.

My interests have changed, but that disire in the pit of my stomach to do something “great” is still there.  It feels like nothing can replace that feeling I’ve felt 100 times after training so hard and then getting a win.  I mean its hard to describe training for 6 weeks, running miles, taking hits, losing weight, not drinking when your friends are out having fun, hitting pads for 2 hours then going home to study – literally blood sweat and tears – then winning.  Fighting is pure. Not many things are. I like that.

Today I heard a guy from my former gym is fighting in Madison Square Garden in a month or so.  I started fighting before him and at the time when I was still training I was the one teaching him – so I might of  had the same opportunity if circumstances been different.   I’m happy, very happy, but I can’t help but feel those old stirring feeling every time I realize I can’t do that stuff anymore.  Kind of sad, but with the realization its all for the best.

Now I have to find something that can put out those flames in my stomach – I wonder sometimes if that’s something only a fighter former fighter can relate to.

Will you Die Gracefully?

A blog friend so graciously provided me with this story – “Why Doctors Die Differently” – in response to a post about euthanasia I wrote a few weeks back.  In the post author Ken Murray, a physician himself, gives a very touching and thoughtful account of realities of death.  So I figured I would revisit the idea myself.

Why are doctors planning for death when the rest of us are ignoring it?

In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public.

Maybe those figures aren’t surprising, but what is – is that doctors aren’t asking to be given every opportunity to be kept alive, but rather often choose to die gracefully.  Recently an acquaintance’s mother died in the hospital.  She spent a week in the hospital and several painful surgeries (one of which finally killed her) trying to get well – which was almost surely futile.

Would it have been better to had spent her last days at home, with loved ones, comfortable, and to die with grace?  I think so, but others disagree.  A lot of people I’ve talked to say that not fighting for life when there is even a .0001% chance of success is “sinful”.  That every resource should be exhausted to defend life.  I believe that sounds good in theory, but isn’t practical or maybe even moral.

For one, we can’t ignore the facts (which apparently doctors know) – keeping someone alive is expensive and painful – for everyone involved.  The unnecessary burden one puts on their family fighting a losing battle is something I could never bare to put my family through.  What’s more, is 99.9% of the time it’s all for nothing.  Ignoring the cold hard truth about death is ignoring a part of life – how we swallow that pill will make all the difference.

Fear of Death

Death is scary.  I mean it petrifies me sometimes.  I know that one day I will no longer exist.  I will be gone.  What’s worse it that I do not know how it will happen.  I might die of cancer, sickness, old age, painfully, peaceful, suddenly – who knows?  It’s a reality though – that’s no doubt.  Everyone we ever knew, ever will know, ever has existed, and will exist – will die.

On the other hand I think there is some peace in that.  We will be in good company.  Whether we fade into the abyss of darkness or there are others to greet us on the other side is sort of irrelevant.   We’ll all find out soon enough.  So soon in the grand scheme of things.  I think of Carl Sagan when he talks about the pale blue dot – our planet – a tiny speck in the Universe.  So insignificant when you think about it.

Death isn’t that scary when you put it in perspective.

Die Gracefully

What’s unusual about doctors is not how much treatment they get compared with most Americans, but how little.

For me, I’m not going fight the inevitable. I’m not going to prolong the pain of my final days – forcing my loved ones to change my diapers while I’m unconscious. Rather – I hope I have the courage to face it. To smile at death as it comes right at me. Not in anger, but in acceptance of the inevitable part of life that will meet us all.

I’ll enjoy my family like never before. I’ll say my good-byes and love unconditionally. I’ll make my peace and settle my business, but not on death’s terms – rather on my own – with dignity. That’s how its supposed to be, I think.

The Truth about Healthcare, Culture, and Taxation in the US

I discuss the myth that higher taxes will result in a better healthcare system and compare the United States to Japan and Switzerland (both countries with Universal Healthcare Options) .

I also touch on the myth that higher healthcare costs and lower life expectancy in the United States versus other developed nations is a result of not having a Universal Healthcare Option. *You can see the charts and statistics better if you expand the video to full screen.

You can check out the all the stats used in this video here.  Also thanks to Phil Ebersole’s Blog for the inspiration on this topic.