Big Picture Healthcare Articles

As Dave Lazarus has written in the San Francisco Chronicle, there is a healthcare implosion in the works, with GM's union negotiation being one more visible piece of the implosion. While Dave expresses concern over the pieces of the health care funding being taken apart he does not go far enough. Here are some other concerns:

• Health Savings Accounts (HSAs)/high deductible plans will become the next 401K. Over the next few years, they will be offered and embraced by most Fortune 500 companies. Younger, healthier and wealthier employees will enroll. PPO, HMO and indemnity health insurances will lose their actuarial elements of risk sharing as the lowest risk participants leave the system. PPOs, HMOs and indemnity plan costs per person will skyrocket as a result, just like they did after HMOs were first marketed to the healthiest among us.
  
  Employers will then provide incentives for the older, less wealthy and less healthy employees to switch to the HSA/high deductible plans. This decreases corporate risk placing it squarely on the shoulders of employee/participants. Risk sharing with a group of one is risky indeed. The average low income person, 5 years from now, will now have to manage the risk of up to 25% of their total income needing to be available for medical expenses. Every year. Expect medical bankruptcies to skyrocket too.
  
  
• Meanwhile, US businesses are missing opportunities to decrease healthcare costs by 20-30% per year, by not exploring alternative paradigms for health.
  
  As an example, most health plans designed to save employer health costs stress "disease management" and "educating patients about healthcare costs". These measures can assist, but do not address the major causes of the out of control costs. Other countries around the globe have embraced models of healing, which are more cost efficient including, but not limited to single payer and universal plans. Chronic diseases tend to respond well to holistic approaches.
  
  Asthma, for example costs this country billions of dollars each year. Emergency room visits account for most of these costs. Disease management programs have decreased emergency room usage by perhaps 20%. Homeopathy is well known in Europe to be highly effective in not just managing asthma, but in addressing the cause. The cost for a complete homeopathic assessment, the typical three -four visits required to get the homeopathic treatments right, and the cost of treatments is less than a single emergency room visit and will keep annual costs down for years. A recommendation of asthma patients to homeopathic experts could decrease the cost of asthma in this country by over 60%. 60!
  
  Back pain is one of the leading causes of disability in this country. There are studies that have linked back pain in middle age to prior auto accidents. Accident victims who have chiropractic treatments after the accident, even if they had no pain after the accident, have a significantly lowered chance of back pain later in life. This could save millions of dollars in healthcare, disability, workman's comp and lost workdays each year.
  
  Elderly persons in nursing homes had less pain and increased mobility after just one visit with a student training to be a massage therapist. With regular visits by licensed practitioners, mobility increases were greater than reported with any medication. Yet most health plans in the US, including workman's comp, limit these treatments, or do not cover them at all, favoring and incenting patients to use covered drugs and surgeries.
  
  
• Last but not least, in the US, businesses and government have become like co-dependent family members, who despair at the alcoholic habits of a loved one, but who enable the alcoholic to continue to drink, with every move we make. But it goes farther. As the enablers, we abhor the traffic fatalities from drunken drivers, but we keep renewing their driving licenses. We vent about the wasted potential, then offer offenders only the best spirits when they visit socially. Or we offer them apple cider and pretend there is no problem at all, or that it is someone else's problem, and not ours.
  
  How do we do this with healthcare?
  
  We support the pharmaceutical industry, with our insurances, our investments and our benefits practices. We ignore the fact that side effects from drug interactions may be the primary cause of death in the elderly and one of several causes of the rising cost of healthcare. We fund health practices designed to provide a flow of revenue to health providers, not keep workers healthy. We ignore as "not our business", the data that suggest that many current "health practices" are costing every business thousands of dollars per employee. While we spend 10-30% of our labor costs on health benefits, we remain ignorant of the components of this cost.
  
  While we were cutting middle management from every other industry, bringing customers closer to the business, we happily paid for hundreds of thousands of new middle management "case managers" and managed care bureaucracy whose primary job it was to decline treatment and add layers between the provider and the patient.
  
  We support federally mandated vaccine schedules for children of our employees, that guarantee regular pediatric visits, and thimerisol (mercury) loads in vaccines given to a 2 day old infant greater than would be safe for a 250 pound adult according to EPA standards. Then we look the other way when autism cases increase from one in 450,000 to one in 150 during the same time period that vaccines using thimerisol increased thousand fold. (Autism and mercury poisoning symptoms have pretty much a 1:1 correlation). While other countries ban vaccines we mandate, foreign vaccine makers laugh all the way to the bank, as we approve new vaccines (flu), mandate them, and then outsource production to Europe, when we cannot keep up with demand.