President: "Sign up; it will save you money"

During a speech in the Rose Garden today, President Obama expressed his frustration regarding the problems with the healthcare.gov website developed to allow people to sign up for health insurance under the Affordable Care Act.

While President Obama acknowledged that the website was experiencing problems at the moment, he encouraged us to be patient and consider other means to enroll; e.g. by phone or in person.  The main thing, he said, was to sign up, IT WILL SAVE YOU MONEY.

The President obviously doesn't understand how insurance works.  EVERYONE can't save money. Everyone pays premiums and claims get paid to those who are sick.  For the sick, it saves money IF and only IF their illness results in expenses that are greater than the premiums they paid.  The un-sick never save money.

Obamacare

One of the big advantages of the Affordable Care Act is that previously uninsured people will now be able to afford coverage.  One big benefit is that conditions can be treated in the early stages instead of after they get out of hand.  Let's think about this a little.

I don't have any health insurance and I'm not feeling very well.  Something's just not right.  A doctor visit costs $100  and I just can't afford to go.  I put it off for a month.... maybe 2.... maybe a year.  The next thing I know, I've had a heart attack when I could have started taking a statin a year ago and avoided the whole thing.

Along comes the Affordable Care Act to save the day.  Because I don't have much income, I qualify for a subsidy, which means I can get coverage for $60/month.  It won't be easy, but I"ll find a way to pay for it.  Now, here we go again... I'm not feeling well, I really should go to the doctor.  But guess what.  My $60/month Bronze plan has a $3000 deductible.  It still costs me $100 to go to the doctor and not only couldn't I afford it before, now certainly can't afford it with a $60/month insurance payment.  I still don't go to the doctor and I still have a heart attack.  The difference now is that I have insurance to cover part (maybe only 50%) of the hospital bill.  Seems like I'm just as sick and just as bankrupt either way.

I don't see how the "early stage detection" outcome is going to be achieved.  Perhaps some will be discovered during a covered yearly physical exam, but from my experience: a) other than the routine blood work, there really isn't much depth to an annual physical exam, and b) if something is discovered, any likely required follow up is NOT covered until the deductible is reached. I couldn't afford $100 for a doctor visit, how am I going to afford $200 to see a specialist?

Humanizing Mitt

So, we  found out a lot about Mitt Romney, the "person", through incredibly well scripted and staged testimonials.  But when Mitt took the stage, it was the same old MITT.  What a let-down.  Rubio was great! Eastwood was entertaining.  Mitt was Mitt.  Exactly what are you going to replace "Obamacare" with Mr. Romney??????

Healthier Lifestyle Drives Healthcare Costs UP

Popular wisdom has it that if we live a healthier lifestyle, we'll keep the cost of healthcare down. I suggest that perhaps the opposite is true.

Not too many years ago, we got old, we got sick and we died. Sometimes we didn't even get old, we just got sick and died. We really didn't think much about a healthy lifestyle. We smoked, we watched a lot of TV, there were very few joggers. We rode a bicycle of we liked it, not to get any cardio benefit out of it. We ate trans fats and loaded up on cholesterol laden foods. We got cancer, heart failure or complications from diabetes. There wasn't much to be done except go home to die.

We now live longer than in the past for two main reasons: we live a healthier lifestyle and medical science has advanced to the point that they can now cure or slow down previously terminal diseases. While that is all well and good, it doesn't come free, and we have not yet figured out how to pay for our new-found health.

Our obsession with health leads to several costly things. The most glaring one is that, since we live longer, we are more likely to need nursing home care due to Alzheimer's, dementia or some other debilitating illness. Like it or not, no matter how healthy we are, our bodies eventually wear out. While there have been significant strides made in the area of prolonging life by lifestyle, medication,surgery and machines, there has been very little progress in dealing effectively with end of life issues. Collectively, we have not come to a realization that there is some point beyond which it is not worth keeping someone alive. As such, we spend enormous amounts of money on people who would choose death if it were an option.

Another costly effect of our healthy lifestyle is that we are no longer content to sit in front of the TV with our knee elevated when it is stiff and sore. We want to run, cycle, play golf and kayak. Not a problem, get a knee replacement, hip replacement, shoulder replacement.... or even two of each. These are not inexpensive procedures. I'll be the first one in line to get one as soon as I can no longer swing a golf club, but it should be recognized that these expensive procedures are part of the COST of a healthier lifestyle.

While it's somewhat related to the first issue, another costly result of living "healthier" and longer is that, in the long run, we need more medical care and medication. Again, like it or now, no matter how healthy we are, our bodies will wear out. We'll go to the doctor, we'll have surgery, we'll get medicine. First one pill, then two, then three. Some are necessary, like insulin for a diabetic. Others solve problems we didn't even know we had until we saw it on TV (didn't you always wonder why you were carrying around that beaker of green liquid?). The more different medicines we take, the more unpredictable are the interactions. Some mixed side effects lead to the prescription of yet another medicine.

So, if I don't smoke and get lots of exercise, I'm much less likely to get lung cancer and die when I'm 50. But, since I live past 50, I'll have a hip replacement, a knee replacement, a coronary bypass, treatment for prostate cancer, and extended physical therapy for a torn rotator cuff. I'll eventually be taking medicine for gout, overactive bladder, blood pressure, type 2 diabetes and arthritis. I start to forget things and wander off in the grocery store. Finally, my wife can no longer take care of me, so it's off to assisted care, then a full blown nursing home where, in my lucid moments over a period of 8 years, I wish my life could end.

Again, I do NOT mean to imply that smoking from age 16 and getting cancer and dying at age 50 is a preferred life scenario. What I am saying is that the healthy lifestyle and longer life leads to expenses that neither we as individuals nor the country as a whole were able to anticipate or plan for. So as we continue to invent new cures, prolong life and fill up our nursing homes, we will continue to cripple ourselves with unsustainable cost increases.

What to do? The first order of business should be to figure out a way by which a healthy person can define, unambiguously, the point beyond which he/she no longer wants to live. When that point is reached, a humane, legal and socially acceptable means to end life should be available. We've got to quit avoiding this issue and figure out a way to deal with it. I want that option for myself and I know many people who think the same way.

Second, maybe it's time to slow down the pace of medical advancement. Or, if we're going to continue, we've got to consider the results of that advancement in the context of what is affordable. OOPS, is that starting to sound like rationing? As much as I hate to use that emotion-laden word, we already do it and to manage our health care costs in the future, we've got to get it out in the open and have an honest dialog about how to do it. We can either ration the development of new technology (by constraining the available research dollars), or ration the use of the technology (say, by constraining the number of a given procedure to be performed each year). Alternatively, we can come up with some kind of single payer system where we, as a nation, decide how much we want to spend on health care, we tax the citizens and businesses to collect that much money and we budget the expenditures to achieve that cost. Of course there won't be enough for EVERYONE to get ANY procedure at ANY time they want it. Of course, there will be abuse. Of course, the rich will be able to buy services outside the system. Those are issues to be addressed, not issues that invalidate a single payer system.

It's easy to bash "big pharma" or "greedy insurance companies", but they are only part of the problem. Our culture is another big part of the problem. We've got to think seriously about how our current expectations for health care are not affordable and part of solving that problem should be managing those expectations.

Death by Budget Cut

In Arizona, a second person has died after he was denied Medicaid coverage for a transplant. Coverage was denied primarily due to budget cuts needed to close a shortfall. It seems to me that this is being reported as a tragic scenario. While it certainly is tragic on a personal level, it indicates one of the primary reasons our medical costs are out of control. Each and every one of us believes we are entitled to any and all procedures regardless of how much we make or how much they cost.

Unfortunately, when reality sets in, there ARE constraints on funding and someone, somewhere has to fall outside those constraints. If there is less money this year than last year, more people will fall outside. Unfortunate, but true. We have to accept it and move on.