Reengineering Healthcare

There’s been a lot of criticism of Congress over their inability to deal with healthcare, specifically the repeal of Obama-care [Affordable Care Act], despite the seven and a half year timeframe. No alternatives. No new thinking. Zilch. Nothing. Perhaps we should have learned that government is NOT the solution to our problems. If you doubt this, go visit an Indian reservation.

Could Congress be that dense that they are just incapable of the healthcare assignment? Do they not care or understand that the electorate will hold them accountable for their promise and failure to act? Or, more likely, lobbyists [insurance companies, Big Pharm and healthcare providers] are so deeply and intractably in the pants of Congress as to make change impossible?

But, just in case the favorability ratings of Congress [13.2% “Real Clear Politics,” Spring 2018] are a true reflection of their ability, outlined below is “Reengineering Healthcare” based on three criteria: Logic, Intelligence and Efficiency. The acronym [LIE] is something Washington can relate to – the thinking is honest and pure [but admittedly, not perfect – feel free to adjust and add your own tweaks]. Everybody needs a “Plan B” for EVERYTHING. What would you [or WILL YOU] do when left standing at the altar, all by yourself?

This analysis assumes a couple of things.

1). You are your own best advocate – don’t look to Washington [or ANYONE for that matter] to take care of your business. Washington is expensive, inefficient and can’t be relied on.

2). Rely on yourself – what is the lowest cost option, with the best results if YOU were paying out of your own pocket? As if insurance DID NOT EXIST. The truth is [as stated by a South Florida Personal Injury attorney], insurance companies “are NOT on your side,” you are NOT “in good hands” and they are NOT “good neighbors.”

Insurance companies make money by maximizing premiums [income] and minimizing claims [expense]. They have buildings full of lawyers who specialize in insurance law to make sure their two objectives are met. And you cannot begin to afford [nor should you even consider] the cost of a riskless life. It’s impractical and dreadfully expensive. In short: “Stuff” is going to happen.

Further confounding is the payment of premiums [let’s assume $1000 a month or $12,000 a year] and a deductible [$5000] – a total of $17,000…for a card you get to put in your wallet and the false sense of security that you are INSURED. And for simplicity purposes, co-pays that you shell out along with the $17,000, have been excluded from this analysis.

So that leaves us with two questions:

Q1: How can you arrange your affairs to best deal with and manage known healthcare risks?

Q2: Is there a better way to spend your money?

NUTRITION

Without a doubt, the #1 consideration in health is what you put into your body. For purposes of this analysis, we’ll assume nutrition explains 50% of your healthcare situation, although some estimates are higher. Half of your health can be explained by what you eat.

Why then, do we pay it so little attention?

First, we’re a society [for the most part] dealing with pleasure and immediate gratification. There are food manufacturers who research preferred tastes with maximum profits. Fat, sweet, salty and carbohydrates built the industry. Healthy options are considered tasteless and boring. And we like speed — fast food [“quick service” in the retail industry]. We’re BUSY [not necessarily productive] people.

Not so fast. In my experience with Weight Watchers [WW], I found that over time, with guidance, tastes can change — for the better. Once a big consumer of candy and sugary cereals, I found, after six months or so, to start craving better things – fruits, vegetables and beans. NEVER would have imagined, NEVER by design – it just happened. Same with red meat, a lot of carbohydrates and junk food – it just doesn’t interest me. Not noble, not a saint – just courtesy of natural tendencies and the good people at WW.

So, consider WW or something equivalent which changes you organically, using regular foods and not being dependent on packaged [some say tasteless, expensive, limiting] diet program foods.

One of the things we learned in WW – never do anything that has the word “die” in it – like “diet.” You want to change your eating style, or habits. There always seems to be some theatrics around the announcement “I’m going on a DIET.”

Really? Who cares? Some might feign interest just to get the name of the program – ever notice there are always TONS of new diet programs? Figure it might be because the old ones don’t work well? Or just typical New Product Development found in any marketing department.

Given the large 50% role of nutrition in our health, it might make sense to have a professional watching over you, monitoring, recommending things. Easy fixes first. Technology probably plays a role in the process. Then add in the home delivery option – we’ve gotten good at that [thank you Amazon], from packaged meals [Blue Apron] to groceries from major stores.

The right foods, on our doorstep – making us feel and perform better at the optimum weight [for health reasons – appearance is a bonus]. And drop vitamins and supplements in the trash – if you’re eating right, everything you need is right there.

Cost: You already buy groceries. You’d effectively be buying different things, healthier things – probably some new things, discarding some old things – so, a “wash.” Maybe $500 for a nutrition “coach” and technology to keep you on plan.

EXERCISE

Next to nutrition, exercise is the most important and equally overlooked area of health. We’ll use 25% or roughly half the impact of nutrition, but still a sizeable contributor. Why then, is it ignored?

People seem to spend more time rationalizing or evaluating which form of exercise to pursue.

The simple answer is this: do something that you enjoy. That way you’ll be sure to follow through. Walking is easy and acceptable. Or choose something that reminds you of a happy time, maybe your childhood. For me it was ice skating or swimming. Fun and great aerobic activity. Or join a gym where you have a place to go and might get motivated by seeing others in the same pursuit.

Probably the simplest and most motivating activity is a piece of equipment in your home. Warning – if you don’t use it, it become a very expensive laundry rack that will mock you every time you walk by.

Use it every day and many manufacturers finance, deliver and set-up equipment for you. As a stroke patient, I use NuStep [Ann Arbor, MI] which is a recumbent bicycle design for folks physically affected by their infirmity. In other words, don’t waste your time or energy rationalizing why you can’t exercise. It’s a requirement!

One excuse [myself included] is “I don’t have the energy to exercise.” Truth is, exercise GIVES you energy, along with a mental health boost and sense of accomplishment. Especially if you exercise first thing in the morning – done and deposited in your exercise bank, allowing you to get on with your day.

Cost: Some things, like walking and swimming, are free. A good piece of exercise equipment – like NuStep, costs $5000 and lasts 10 years [often more], so let’s use $500 a year as the cost of exercise.

NATURAL REMEDIES

Since the dawn of time, mankind has discovered and used a variety of natural remedies to ease pain, sooth irritation and even heal maladies. Many of these solutions are found in the plant world – such as aloe, commonly used to treat burns, especially sunburn. Even today, doctors point to plants as the source of most pharmaceuticals, with some additional compounding and chemistry thrown in.

The animal [specifically here, insect] world also contributes great resources. Bees work diligently to create not only honey [the food that never spoils] but a variety of hive products to sooth skin and contribute to our well-being. Additionally, even the sting of the bee, producing venom, has been successfully used in treating arthritis [see Health and the Honeybee, by Charles Mraz]. China [experience treating millions of people over thousands of years] has rolled out a significant number of bee centers to treat its population.

Two other ancient treatments: massage and acupuncture. Common between them is the “laying on of hands” [and needles] philosophy, but useful in a variety of conditions – managing pain, smoking cessation, weight reduction and others. An interesting outing might be found in a Chinese apothecary, often co-residing in acupuncture centers.

Cannabis and hemp have recently taken center stage through medical and recreational legalization in many states. Some think it’s a matter of time before we’ll see national legalization. But many conditions have seen improvement through consumption or application of derived oils.

Clearly, a lot of the value in this category is through research, then trial and error by the individual [same is true of pharmaceuticals too, by the way – where often one compound is ineffective, but newer formulas do the trick]. In fact, this entire premise of “Reengineering Healthcare” requires a certain amount of “skin in the game,” effort and “sweat equity” where you will uncover and hopefully be rewarded for your efforts.

Cost: Some of this should be absorbed under Nutrition expenditures, others might be ancillary and additional – like Cannabis and some hive products. $1000 a year.

 

PREVENTIVE MEDICINE

“Reengineering Healthcare” doesn’t advocate “pulling the ripcord” and totally disconnecting from traditional healthcare. That would be reckless indeed.

BUT, the legions of specialists [undoubtedly ideal, but also driven by a liability reduction strategy] has become cost prohibitive – and even good specialists can shake their head, shrug and say “I don’t know.”

In the cadre of specialists, it often makes sense to have an Internist/Family Medicine doctor to serve as “quarterback.” Looking for duplication, interactions, possible alternatives. And, as a byproduct, familiarity with your case. Another benefit: “one stop shopping.” Nowadays, even in the form of telemedicine where you schedule an appointment over the phone or computer.

Perfect? No, but still a good value for the money and an important aspect to include in your program.

Cost: Assuming four visits a year, some generic prescriptions and minimal lab work, $1000 a year. Tell the office you’ll be paying cash with no insurance, to qualify for all the discounts they might offer.

 

UNDERSTANDING THE END: WHEN AND WHAT

When we are born, and arrive here, the clock starts ticking and each day we are closer to the end and our exit from this world. That’s the one [and only] commonality that we share – life is finite and will end.

What we DON’T know is when and from what cause. If we did, we’d be so neurotically pre-occupied with the end, we wouldn’t enjoy the present. But, suffice it to say, the end, for many, will come too soon. The death of children is always troublesome, as adults have a history while children only had a future.

Sometimes the end is totally unexpected, such as an accident. Often it is after a long, productive life – at the ripe, old age of 95 or more. In your sleep. A “quality” situation indeed, often referred to as “a good death.”

The “what” is always troublesome. Was a painful disease involved – such as bone cancer, which typically lasts five years or more accompanied by excruciating pain? Or was it sudden and painless, as in many accidents? Did the person take their own life? Was it taken by another?

Regardless of the philosophies, the certainty is life will end from a terminate cause. Your death certificate will list it, along with contributing factors – like “heart failure” [the most common cause of death – your heart quits beating] typically caused by “cardiac disease” or “cardiac arrest.”

If you are diagnosed with a terminal disease, your “what” will be revealed. The “when” can be estimated, based on knowledge and experience with the disease.

The key question or decision is: What do you do about it? Healthcare philosophy and human reaction is usually – do everything possible to buy additional time. I understand that, but at what cost? Even if insurance shoulders the majority of the panicky decision, is there a limit? What cost and what additional, marginal time is “twizzled” out of the combination?

During our normal years, if the cost of maintaining our health is $25 a day, does it make sense to suddenly shift into $25,000 a day to eke out an additional 90 days?
Is there a better use of the [$25,000 * 90] $2,250,000? Leave it to your children, or fund a scholarship perhaps? You’re going to face the same end-game regardless [if not from this terminal disease, then from something else]. Panic-mode seems a bit desperate, even selfish.

Understand that death is a door, connecting rooms between lives. And when one life ends, so does illness and pain as we are ushered into the new life. How liberating. But that’s another topic for another day. [see thenewfloridian.com/problems-with-death]

 

SUMMARY

Most decisions are made on “how much” and “what do I get?”

As discussed, traditional healthcare costs $17,000 a year and you draw benefits against that expenditure. Part of that burden is due to all the resources available to you – some predictable [a checkup or flu diagnosis], some less so [an MRI or chemotherapy]. You might forever be “upside down,” paying out way more than you’ll ever draw in benefits. But God forbid you’re not covered – that you don’t have that card in your wallet and something happens.

Reengineered healthcare is $3,000 for the year – a much more manageable position.

With traditional healthcare you are covered for almost ANY situation – surgery, terminal disease, failing organs, skin disease….and on and on. As mentioned, that’s one of the reasons for the $17.000 payment – to defray all the options available to you. Note: Insurance programs still may often exclude treatments they view as questionable – hyperbaric chambers, stem cell treatment, acupuncture, etc. In their [superior] judgment, the expense vs. benefit is questionable.

With reengineered healthcare, the options are more limited which also explains the lower cost of $3,000. You are betting on a couple of things – one, you might sidestep many of those dire treatments offered by traditional healthcare because you followed a strong nutrition/exercise/preventive medicine regimen. More importantly, you’ve adopted a “what” and “when” philosophy about your end, adult realism without desperation and panic. And a reengineered approach should cover most things – but not ALL things.

Reengineering gives you 75% coverage right off the bat [nutrition and exercise]. The remaining 25% is a combination of natural remedies, preventive medicine and no coverage. We hope the last point is the smallest of the three, but realize it is “the elephant in the room.”

So, what if something totally traumatic happens? Think EXTREME – major illness or accident for you [or your family]. Further assume the family just can’t bring themselves to wheel you out to the garage and await the arrival of The Grim Reaper.

A county hospital MUST accept you. Further a hospital must accept your repayment pledge – even if it’s $10 a week. Finally, healthcare debt is dischargeable through bankruptcy proceedings – in fact, is the leading cause of those actions.

It’s your money. Your health. Your life. Make them count.

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