Catastrophic Care – How American Health Care Killed My Father – And How We Can Fix It

Catastrophic Care – How American Health Care Killed My Father – And How We Can Fix It

By

David Goldhill

Infections from a hospital stay killed David Goldhill’s father in 2007, one of more than 200,000 deaths annually caused by medical error.  The medical bill was huge and fully paid by Medicare.  David wanted to know why it happened and why a business was paid after such a colossal error.  This would not happen in a market driven business.  This book is the result of Mr. Goldhill’s quest for answers.

The major premise of Mr. Goldhill’s book is that the patient is not the customer.  The actual customers are what he calls “surrogates” and these are private insurers, Medicare and Medicaid.  All of these are institutions begun with the best of intentions that have grown into unwieldy, inefficient behemoths over the last 45 years and have established a culture in our Health Care arena that is going to be difficult to change.

Originally, health insurance was in place to take care of “catastrophes” and not the common cold or the equivalent.  We have turned an insurance into a “payment mechanism” over the years.

The “surrogates” have become the consumers and are driving the market. They are profit driven, not market driven and have created a 3rd party administration that continues to drive up the price of health care and not the efficiencies.  The “Surrogates” along with the pharmaceuticals operate with a unique set of rules and, ironically, the higher premiums are, the higher the profits.  Medical costs go up [not down as in true competition], premiums go up, profits go up, and the true consumer [the patient] suffers from increasing costs.

In a true market scenario, prices drop and things become better and/or more efficient.  The most obvious analogy is computers.  The first laptops were thousands of dollars; you can now buy a better one for about $350.00.  Lasik surgery and most cosmetic surgeries prices drop because of competition.  Why?  They are not covered by insurance, thus no surrogates.

We, as the patients, have come to accept the status quo.  We go crazy when a gallon of gas rises by 10 cents, however, just accept the fact that medical procedures continue to escalate because the surrogates are in control and we are just paying the deductibles.  The surrogates benefit from rising prices.

So, what about the Affordable Care Act [Obamacare or ACA]?  More of the same.  We need to create a new system that is not procedure driven, is a true marketplace and is driven by the true customer, the patient.  This will take a minimum of a generation; however, it can be done.

Mr. Goldhill presents a possible scenario that places the patient in control and promotes transparency in costs in the medical field.  His suggestion is a combination of a very high deductible in true catastrophic insurance, health accounts and health loans.  I am not sure if that is the answer, but he presents a convincing argument and makes it very clear that the present situation in health care is unsustainable.

My suggestion is that you read this well-written and well researched book and get your legislators to do the same.  Thanks to Mr. Goldhill for presenting such a well articulated case in a tremendously complex situation.

Thanks for reading,

Mike

Salt, Sugar, Fat: How the Food Giants Hooked Us

Salt, Sugar, Fat:  How the Food Giants Hooked Us

By

Michael Moss

Obesity, processed foods, marketing to kids, etc. are almost daily news today as we face a health epidemic, not just an obesity epidemic.  The food giants, large corporations have made it a science to lure the public, with a huge emphasis on children, into eating cheap, convenient, unhealthy foods.  Mr. Moss has done an excellent job of describing how these corporations have knowingly spent and made billions of dollars on these efforts and are hugely responsible for today’s health epidemic.

On April 8, 1999 representatives from Pillsbury, Kraft, Nabisco, General Mills, Procter & Gamble, Coca-Cola, Mars and Cargill met in Minneapolis to discuss the burgeoning obesity epidemic and what they should do about it.  Together these companies represented 700,000 employees and $280 billion in annual sales.  The presentation which was conducted by a representative from Kraft explicitly portrayed the obesity epidemic and why they as corporations were largely responsible and how they could now help correct it.  A well intentioned effort, however, it all came to naught because of the voice of one man, Stephen Sanger, the head of General Mills at that time.  Sanger was “the man” in those circles and no one defied him.  Thus, it was back to “business as usual” and they continued to pour billions of dollars towards the health epidemic we have today.

Who has heard of the “bliss point”?  This is a measurement largely credited to a man named Howard Moskowitz.  Howard is the guy employed by the U.S. Army who added sugar to Meals Ready to Eat (MRE’s) to make them more palatable to our service men and women.  From there Howard became a key player at General Foods and Phillip Morris and discovered the “bliss point” which is the precise amount of sugar or fat or salt that will snare the consumer.  By adding these cheaper, addictive ingredients instead of costlier, healthier ingredients Phillip Morris and company were able to pump up the value of their stock.

Consider Betty Crocker who is a fictional character invented by General Mills for the sole purpose of marketing their unhealthy, processed and refined foods.  Legions of women were hired to go out and give cooking classes in the name of Ms. Crocker which included recipes all containing the products of General Mills.  Ms. Crocker’s cookbooks have become a part of Americana lore.

It was determined by laboratories funded by these corporations that babies do not like salt for their first 6 months of life.  Strategies were invented and implemented to train these babies to “like” salt.  Many of those babies today are either dead from or suffer from hypertension.

I could go on and on; however, I’ll save that for Mr. Moss who has written an excellent eye-opening book.  I must close with Mr. Moss’s message, though…

We are in control!  Yes, we have been the victims of unfair marketing; however, we are the ones operating the knives and forks.  In the transparency of today, we must arm ourselves with the knowledge of healthy vs. unhealthy foods and use a little will power.  After all, when it all trickles down, we are the ones buying the foods and contributing to today’s and tomorrow’s health epidemic.

Thanks for reading,

Mike

The Creative Destruction of Medicine

The Creative Destruction of Medicine

By

Eric Topol, M.D.

Dr. Topol has written a book describing the effects of today’s “digital revolution” on our medical culture.  This revolution is driving “collaboration and crowd sourcing”, “customized consumption”, “cloud computing”, and “constant connectivity”, what he refers to as “the C’s”.  The C’s drive us to one of the “D’s”, “data driven culture”.

Traditionally, pharmaceutical companies have tested drugs by “population based” trials, which, in their most accurate form are terribly inaccurate.  In its most simple form, in a population based trial, a drug is tested on a certain number of people; works on a certain percentage, then is approved and used on a 100% of the population.   In other words, one dose fits all.  It does not take into account individual characteristics that can cause harmful side effects, or segregate parts of the population that the drug will not help.  Thus we have a drug prescribed to a large part of the population that it either hurts, or has no affect.  A prescription for sickness and loss of huge dollars.

In today’s digital landscape, the technology is emerging for “evidence based” medicine.  Evidence based medicine will be individual based vs. population based.

With new technology we are able to “capture the data”.  Sensor laden devices are shrinking and can be embedded on the person to monitor vitals of all sorts.  These sensors include embedded nanosensor chips, “chip tattoos”, and more.  “There is an app for that” has and will have new meaning.  Doctors will have apps on their smartphones that will measure your vitals while you are at home in comfort.  So will you.  Remote monitoring will achieve new levels and eliminate many office visits and the doctors that accept the new technology will be able to take care of more patients and the doctors that don’t will see their practices diminish.  Personal visits will be a HIPAA compliant “Skype” call.  All of this without the onerous “office visit”. 

Remote monitoring, accurate data collection, data transparency and sharing will all contribute to a healthier population and result in hospital populations shrinking.  In other cases, the patient will remain at home.  Hospitals will be reserved for the severely ill.

You will have access to the central database enabled by all of this “data capture” and will become more educated as to your own health.  Between your self-education and the doctor’s access to all of the available information, diagnoses will be more accurate, mistakes will be greatly reduced and a new era of “transparency” will have arrived.

DNA sequence documentation is also emerging and will result in proper treatments for illnesses.  As Topol says “ routine molecular biologic digitization of humankind is just around the corner”.

3D printing of human organs has the possibility of eliminating the need of spending time on a waiting list for a kidney or other organ.  Currently 3D printing has expedited the process of manufacturing artificial body parts (knees, etc.) and lowered the cost.  Electronic Health Records and Health Information Technology will connect virtually every citizen, physician, clinic, and hospital enabling a transparent diagnosis tailored to every individual.

Yes, there are many potential downsides, but they are outpaced by the benefits.  I could go on and on, however, Topol has covered these and many other subjects I have not mentioned.  This is a book that gives you a good look into medicines past, present and future.  The future looks good for the consumer and the progressive doctor.

Thanks for reading,

Mike