Common Sense - An Alternative To Universal Health Care

Safeway has over 1,700 stores across the country. Like most companies its size, Safeway is self insured for its health care. In the 4 years since the program started Safeway costs are flat while most American companies have seen their prices go up close to 40%. How did they perform this remarkable feat? The answer is short: Personal responsibility and financial incentives.

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if the nation had adopted our approach in
2005, the nation's direct health-care bill
would be $550 billion less than it is today. This
is almost four times the $150 billion that most
experts estimate to be the cost of covering
today's 47 million uninsured.

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Safeway has discovered that fully 70% of all health care costs are a direct result of behavior - and 74% of all costs can be attributed to four chronic health conditions:

1. Cardiovascular Disease
2. Cancer
3. Diabetes
4. Obesity

Safeway then went the extra step and took an idea from the automobile insurance play book that rewards safe drivers and charges more for drivers with tickets for not following the rules of the road. The company leverages HIPPA, which allows employers to charge different premiums based on behaviors. Safeway’s program is voluntary and currently covers 74% of their workforce.

Does it work? Yes, the savings in reduced claims which allowed the company to keep their rates level for 4 consecutive years is evidence in itself. Read more about this here.

Wait times in Canada

"Canadians are used to waiting. They wait in line for coffee and for buses on the way to work. But waiting for health care is very different. Five years ago the governments of Canada resolved to improve wait times for health care by committing nearly $6 billion to the cause. Although there are signs of improvement, the lack of uniform and timely information on wait times is just one symptom of the ‘unfinished business’ relating to wait times in Canada. What’s going on?"

That is the opening of the Unfinished business, a Report Card on Wait Times in Canada. As the name implies it looked at the wait times in Canada for;

• procedures/conditions in 7 specialties (Opthalmology, Anesthesia, Obstetrics and Gynecology, Nuclear Medicine, Gastroenterology, Plastic Surgery, and Orthopedics)
• Cancer Care
• Emergency Department Wait times

Here is a quick review of some of the worst performing areas;

(Click on the table for a larger version)

Cancer Care:
According to the study results, the median wait for radical (curative) cancer care was 46 days or nearly 7 weeks (against a benchmark of 4 weeks!). In a classic understatement, the study said, “This is troublesome given the clear link between a delay in radiation therapy and a chance of cure.”

Emergency Department Wait times
The study found that the average wait time from the time the patient presented at the ED to the time the patient was discharged was nearly 9 hours (against a benchmark of 4 hours). Moreover, the average wait time for patients requiring an inpatient bed-that is, from the time the patient presented at the ED to the time they were admitted to an inpatient bed-was 23.5 hours or nearly one full day, substantially higher than the 6 hour guideline for high-level acuity patients (due to the inability to find an available hospital inpatient bed – but that is another story).

The Wait Time Alliance (WTA) is comprised of 13 associations and brings together several national medical specialty societies whose members are directly involved in providing care to patients. Since 2005, the (WTA) has been issuing reports on Canadians’ access to timely specialty care.

Rationing Care

I have always said that if a government run health care system comes to this country, you are going to see two levels of care;

1. The government run system (the 'Base Plan')
2. A private system for those who can afford it (the Buy-Up Plan').

Why? We are used to a level of care in this country that we are not willing to give up easily. Rationing of care is not something we are going to tolerate. I am not really going out on a limb with that prediction. Every country with a government run system has a second health system for those with the means to access it. Whether it is acknowledged (like in Italy) or not (ex: Canadians coming to the U.S. for health care).

Apparently the president and I are in agreement (kind of). During an ABC News town hall in the White House last week, the president suggested "that one way to shave medical costs is to stop expensive and ultimately futile procedures performed on people who are about to die and don't stand to gain from the extra care."

That sounds like rationing care to me.

Later, the president struggled when asked if he "wouldn't seek...extraordinary help for his wife or daughters if they became sick and the public plan he's proposing limited the tests or treatment they can get." He refused to make such a pledge, though he allowed that if "it's my family member, if it's my wife, if it's my children, if it's my grandmother, I always want them to get the very best care."

Sounds like a secondary health system for those who can afford it.

What's In A Name?

Recently, Microsoft unveiled their new search engine, Bing. A recent New York Times article, attempted to explain how Microsoft happened upon the name "Bing" for its revamped online search engine. Although Microsoft CEO Steve Ballmer is enthusiastic about the possibility for Bing to become a commonly used verb, along the lines of Google, the article concludes with a sobering observation:

"Meanwhile, some tech people were already noting that Bing is also an unfortunate acronym: 'But It's Not Google.'"

Life Brings Change

Has Your Life Insurance Coverage Kept Up?

The one constant in life is change. Chances are your situations in life have changed over the year—and your life insurance policies need to keep up.

The harsh reality is that—while more than 80% of Americans think they have enough life insurance coverage, in truth, just 49% actually have the financial protection to meet their financial goals*

Have you recently:

• Bought a home?
• Had a Baby?
• Received a Promotion?

Or are you:

• Nearing Retirement?
• Changing Jobs?
• Preparing for your children’s or grandchildren’s college expenses?

Or any number of other changes in your life that need the protection of life insurance. If you would like us to review your existing life insurance for free, or you need new coverage, we are a phone call away or email away.

Canadian-Style Health Care? Be Careful What You Wish For

"The beginning of May marks the end of income tax season in Canada. ...over one-half of the personal income taxes Canadians just paid in aggregate are required to cover the cost of our taxpayerfunded health care program. Given this level of expenditure, you might expect that Canadians receive world-class access to health care. But the evidence demonstrates that this is not so.

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waiting lists for access to health care in Canada
reached a new all-time high of 18.3 weeks from
referral to treatment... this wait time is 54%
longer than the median wait time of 11.9 weeks
back in 1997.

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Consider Canada’s waiting lists. In 2007, waiting lists for access to health care in Canada reached a new all-time high of 18.3 weeks from general practitioner referral to treatment by a specialist. Despite substantial increases in both health spending and federal cash transfers to the provinces for health care over the last decade or so, this wait time is 54% longer than the overall median wait time of 11.9 weeks back in 1997.

■ Canadians were more likely to experience waiting times of more than six months for elective surgery than Australians, Germans, the Dutch, and New Zealanders, but slightly less likely than patients in the United Kingdom;
■ Canadians were least likely among the six nations to wait less than one month for elective surgery;
■ Canadians were most likely to wait six days or longer to see a doctor when ill, and were least likely among the six universal access nations surveyed to receive an appointment the same day or the next day.

Access to medical technologies is also relatively poor in Canada. In a recent comparison of age-adjusted inventories of medical technologies, Canada ranked 13th of 24 nations for which data was available in terms of MRI machines per million population. It ranked 18th of 24 nations for CT scanners per million population, seventh of 17 for mammographs per million population, and tied for second last among 20 nations for lithotripters per million population. Clearly, Canada’s relatively high expenditures are buying neither quick access to care nor high tech health care services for the population.

Among 28 developed nations that maintain universal approaches to health insurance, a recent comparison found Canada ranked 24th in the age-adjusted number of physicians per thousand population.

Statistics Canada determined in 2005 that more than 1.3 million Canadians could not find a regular physician, while a recent estimate suggested that the number of Canadians without a regular physician was around five million.
That is hardly the sort of access you might expect from the developed world’s third most expensive universal access health insurance system."

Nadeem Esmail

Idea - Mandate Coverage Then Get Out Of The Way

Several weeks ago, my wife put the paper in my lap and pointed to an op-ed article. It was by Ross Mackenzie in the Richmond Times-Dispatch. The article, titled, The Car Insurance Alternative To Obamacare, Mr. Mackenzie made the point;

"We have a real-world example of how the private sector can handle mandated coverage. It's called automobile insurance -- and it works exceedingly well.

Most states require motorists to have insurance. State regulators license insurance companies to sell policies, and the companies compete for customers -- who shop for the coverages they want at the lowest premiums."

In other words, if the federal government wants to insure that everyone has health care, why not do what they did in the automobile insurance industry - Mandate minimum coverages they think you need and then get out of the way and let the private sector take over.

"Does My Insurance Cover It?" Mentality

"Imagine if your car insurance covered oil changes and gasoline. You wouldn't care how much gas you used, and you wouldn't care what it cost. Mechanics would sell you $100 oil changes. Prices would skyrocket. That's how it works in health care. Patients don't ask how much a test or treatment will cost. They ask if their insurance covers it. They don't compare prices from different doctors and hospitals. Prices do vary. Why should they? They're not paying. Although they do in hidden, indirect ways.

In the end, we all pay more because no one seem to pay anything. It's why health insurance is not a good idea for anything but serious illnesses and accidents that could bankrupt you. For the rest, we should pay out of our savings."

John Stossel, New York Sun

It goes back to what we have been saying - Insurance is for low probability, high cost events. Health insurance has evolved into ALSO insuring high probability, low cost events.

Why Scrap A Health Care System That 250 Million Americans Like?

"...Lacking health care insurance is not the same as lacking health care. By law, most emergency rooms must provide health care — to both legals and illegals. Yes, they stand in line, but no health insurance does not equal no health care."

"...Take a look at a Reason Foundation video of interviews with a bunch of non-health-insured 20-somethings."

"...So here's the question: Do we allow a complete government takeover of the section of health care it doesn't already run, for 10 million to 15 million or so without health insurance on a permanent basis?"

"Again, 255 million Americans already have it. Many millions more could get it if they wanted to. And 89% of Americans are satisfied with the care they now receive.

What to do? Unleash the free market. Allow greater competition among health care providers. Decrease costly regulations that increase the price tag. "

See the complete editorial by Larry Elder here.

Bribery Or Blackmail?

"Majority Democrats running the Finance Committee have told lobbyists that their views will be taken into account as long as their groups don't mount public campaigns against the legislation, numerous lobbyists say. So far, health industry groups have not launched aggressive attacks against Democrats' emerging plans."

Is this how the process is supposed to work?

Source: My Way

Fix The Current Plans Before You Start A New Plan

As I read the headlines about the health care debate in this country, it occurs to me that shouldn't we fix they current problems - Social Security and Medicare - before we create more problems?

Until they (politicians) develop a track record of;

1. putting programs in place that work
2. putting programs in place that we can actually pay for

Do we really want the government - who gives "few specifics ... But emphasized the need for swift action" - to start a new program as important as health care?

I'm just saying...

If You Can't Get The Medical Help You Need When You Need It...

From Dennis Gartman and John Mauldin...

"Canada is a wonderful place to have a nasty gash on one's forehead stitched, or to break one's nose in a game of pick-up baseball; but have cancer, or need eye surgery, or want an MRI, and the business of medicine in Canada and/or the UK breaks down badly in favour of medical care here in the US. For example... and we wish to thank The Investor's Business Daily for the data noted here this morning...

"... here in the US men and women survived cancer at an average of just a bit better than 65%. In England only 46% survive.

In the US, 93% of those diagnosed with diabetes receive treatment within six months; in Canada only 43% do, and in the UK only 15% do!

For those seniors needing a hip replacement and getting one within six months, 15% get it done in the UK; 43% get it done in Canada ... and in the US 90% do!

For those waiting to see a medical specialist, 23% of those in the US get in within four weeks, while 57% in Canada have not yet done so, and in the UK 60% are still waiting after four weeks.

"When it comes to proper medical equipment, in the US there are 71 MRI or CT scanners available per million people. In Canada there are but 18, and in the UK there are only 14!

...Do we pay too much for health care here in the US? Everyone says yes. And there is a lot of waste (and waist) in the system. But if you are the person who needs treatment, maybe the answer is "not really." If you can't get the medical help you need when you need it, maybe the fact that it is theoretically free doesn't mean anything.

And if I don't want some nameless bureaucrat dictating who gets to live or die in the name of his scientific system, why in God's name would I want a bureaucrat deciding to ration my access to health care? But that is what the majority in Congress are planning for our future. And bluntly, I find that far harder to swallow than my taxes going up.

Open Letter To President Obama

It is no secret to those who know me that I am against the government getting into most things, but health care in particular - for a variety of reasons. As the debate over health care heats up in the next months, we are going to focus more on some of the things we read and hear about this issue. Everything you hear me say or write comes from those much smarter than me. They will come from a varied background of experience and perspective.

My goal is not to convert anyone to my way of thinking (except maybe Jay), but rather, to get ideas and thoughts out in the open to make you think. If you feel we are not giving a particular viewpoint, and you have something you would like us to share, let me know.

The first in this series is an open letter to President Obama. It was written in February by George Dawson, president and CEO of Centra, a not-for-profit healthcare system in Lynchburg, VA.

I encourage you to read his letter.

February 27, 2009

President Barack Obama
The White House
1600 Pennsylvania Avenue
Washington, D.C., 20500

Dear Mr. President:

Thank you for your leadership. All of us are invested in the success of your new administration as we work to get the United States back on track. As I listened to your address to the nation last week, I took particular note of remarks about healthcare -- especially the comments about inefficiency, costs that are out of control, lack of quality, Medicare insolvency and fraud, and the hope of electronic medical records. For the past 22 years, I have served as the Chief Executive Officer of Centra, a not-for-profit healthcare system in Lynchburg, Virginia. You may remember Lynchburg – you spoke at our E.C. Glass High School during your successful campaign swing through Virginia.

At Centra I’m privileged to work with approximately 5,500 employees, 550 doctors, and more than 500 volunteers in a high-performing, fully integrated healthcare system that includes three hospitals, three long term care facilities and also offers comprehensive rehab and mental health services. Some of the recent national distinctions these dedicated people have earned include:

• Forbes Magazine ranking as one of the safest hospitals in America
• Premier/CareScience ranking as top 1% nationally in clinical quality
• One of the 100 Most Wired Hospitals in America by the American Hospital Association publication
• Our region was rated by the Dartmouth Health Atlas among the lower cost-per-capita regions in America.

The Virginia General Assembly just declined to name the eastern box turtle as the Virginia state reptile. Nevertheless, at the risk of sticking my head out, I am writing to offer advice and comment about healthcare reform:

• The healthcare reimbursement system in this country is broken. It shifts massive costs from public programs like Medicare and Medicaid to the private sector. This cost shifting is a hidden tax on all who purchase private healthcare insurance. Last year, reimbursement to Centra for hospital care provided to Medicare and Medicaid recipients was $26.8 million less than the actual cost of treating these patients and we provided another $39.8 million in charity care. The private sector made up these funding shortfalls. It is no wonder employers and individuals are increasingly unable to afford health insurance. Expansion of the Medicare and Medicaid programs will only make matters worse unless funding is adequate to cover the full cost of the care provided.

President Barack Obama Page 2

February 27, 2009

• Moreover, the system rewards volume rather than efficiency, quality, and improving the health of populations served. How about a system that really rewards providers for extraordinary quality and efficiency? How about a program that will give doctors and hospital systems an incentive to actively participate in improving the health of our population, rather than an incentive to drive volume of services?
• As a nationally recognized user of information technology, we know that implementing electronic medical records offers great promise – but it is not a magic bullet. Healthcare IT should not be characterized as a quick fix because it takes time and careful planning and comes at an early cost of lost productivity. Full benefits will come only when analytical data is pulled from automated systems to drive quality and efficiency improvement.
• Broad statements about fraud and dishonesty inaccurately portray the entire healthcare system in a negative light. Those of us on the front lines and who are deeply dedicated to patient care know that there are many opportunities to eliminate waste and improve efficiency while improving the health of our country. We look forward to working with your administration in accomplishing this.
• Despite the fact that they have foregone pay increases, despite the fact that their retirement plans have been threatened and delayed, despite the fact that their lost wages are financing unprecedented increases in charity care and volumes of Medicaid patients, the 5,500 employees at Centra show up every day to give extraordinary care to the many patients we serve throughout our region. As you talk about what’s wrong in healthcare, it would be good to recognize hardworking healthcare employees like these because they are what’s right with the system and they deserve recognition for the work they do.

Finally, we invite you to come visit us. We would like to show you and members of your team the many things we are doing at Centra to be part of the solution. Our 5,500 high-performing staff members would love to have the chance to talk with you about our mission of Excellent Care… Every Time.

Thank you and God bless you, your family, and our country.

George W. Dawson
President and CEO



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