Archive for the ‘Body’ Category
Why Preventative Care Won’t Save Money
Tuesday, September 1st, 2009My practice consists of people who want to stay healthy and those recovering from some malady–often of the structural kind, but sometimes of the sub-clinical but bothersome kind. That means, people coming to my office hope to get back to doing what they want or make it so they’re always healthy.
These people are highly motivated. Since my practice is 90% cash, the patients seek out my services, value them so highly that they’ll pay money for them, and they will often be compliant. We have tough talks in my office. I have had this conversation many times:
Me: Here is what we need to do, but it will require a change of behavior on your part, a whole new lifestyle.
Patient: Okay…..
Me: If you are not interested in making these changes, you will not get the health benefits you desire. I do not want to waste your money and my time if you’re not ready for these changes.
Patient: Okay….
Me: How do you feel about (significant change in diet, new exercise regimen, changing sleep habits, changing exercise, at home rehab options, etc.)?
Patient: Well, I…..
And then, the patient thinks about it and decides. Even with paying for care and being self-selected to come into my office, only about 50% are willing to do the changes they need. Some don’t come back until they are ready. Some decide on symptomatic care and admit they don’t really want to change. I had one patient tell me, “I’d rather die than stop drinking Coke.” He was an alcoholic and diabetic. That’s good information to have–I can give him nutrition to supplement his horrendous lifestyle choices, but just the preventative care alone is not going to significantly help him if he won’t help himself. He will be in the hospital, eventually, and have a limb amputated or go into a diabetic coma. Those will be huge expenses.
So, while my practice centers on people taking control of their health and it’s profoundly satisfying because people are self-motivated, this is not the majority of American health care consumers. From the Washington Post:
Using data from long-standing clinical trials, researchers projected the cost of caring for people with Type 2 diabetes as they progress from diagnosis to various complications and death. Enrolling federally-insured patients in a simple but aggressive program to control the disease would cost the government $1,024 per person per year — money that largely would be recovered after 25 years through lower spending on dialysis, kidney transplants, amputations and other forms of treatment, the study found.
However, except for the youngest diabetics, the additional services would add to overall health spending, not decrease it, the study shows.
As an aside, I strongly question the $1,000 price tag for diabetes education and prevention. That seems awfully low. Since one doctor’s office visit alone is around $100, I wonder what else is being covered here. Are meds included? Counseling? What?
Most people, if given a choice, will go to the doctor and want to be “fixed”. That is, they’ll want a drug or surgery that enables them to continue on their path without having to change their behavior. Should socialized medicine come to America, that impulse will be reinforced. Health care costs will soar.
Preventative care only works when a patient is motivated, and even then, it’s challenging. Those under Government Run health care will have less incentive, not more, to take control of their health care.
Do I think that preventative care saves money for my patients? Absolutely. A healthy person over his lifetime, will likely need less health care intervention. Since nearly 90% of chronic disease is preventable, steps to prevent them make a huge difference. A person who never develops heart disease or diabetes or employs dietary ways to prevent cancers makes for a very nice health care cost risk long-term.
In my own life, the life insurance guy was shocked: I have low blood pressure, low cholesterol, I’m on no meds, I’ve had no surgeries. And, yes, I’m overweight, but that doesn’t mean, necessarily, unhealthy. My own grandma who is 92, has spent a lifetime of living preventatively. She is the picture of health–mentally and physically. Prevention does matter. But the individual must be motivated and must take the steps himself to be healthy.
No government can force an individual to have motivation. But they can force behavior…and that’s what they’ll try to do, eventually. In that case, the cure is worse than the disease.
President Obama’s Moralizing
Thursday, August 20th, 2009So, Barack Obama has gotten religion. How convenient. And he’s gotten religion just in time to beat the bitter Bible-thumping, gun-clingers with it. Even better.
Ann Althouse has the whole story:
Bearing false witness? Breaking the 9th Commandment? So his opponents are sinners. I’m trying to imagine the separation-of-church-and-state freakout if George Bush had taken this approach to arguing for one of his policies.
According to the lede paragraph in the linked NYT article:
President Obama sought Wednesday to reframe the health care debate as “a core ethical and moral obligation,” imploring a coalition of religious leaders to help promote the plan to lower costs and expand insurance coverage for all Americans.
Strangely, the context of that quote — “a core ethical and moral obligation” — is missing from the body of the article. Was something cut? Was it too embarrassing? Too Bush-y? I have to go elsewhere:
First, bearing false witness is not the same as lying. Bearing false witness means witnessing against someone, knowing he is innocent, in order to harm him. In the Old Testament days, a false witness could get a person stoned. Is President Obama actually implying that those who disagree with his ideas are against him personally? Of course he is. Because to disagree ideologically is to besmirch his very existence.
Second, health care is a core moral obligation? Of the government? Now there’s the crux of the matter. See, a Christian has a duty to care for the weak, oppressed, widowed, orphaned, imprisoned, etc. But what President Obama is talking about is NOT Christian charity, he’s talking about forced taxation to redistribute to all who don’t have health care. That might mean the able-bodied and lazy, those who don’t care for their health, etc.
President Obama should steer clear of his religious talk. First, he doesn’t walk the talk as Ann points out. Second, he is talking about the state taking on the obligation of an individual’s religion which is a personal choice–whereas taxation is most definitely NOT a choice. Well, not much of one.
Health Care Summary
Wednesday, August 19th, 2009While politicians and policy wonks get lost in minutiae, it’s important to remember the essential truths about the health care debate:
1. The Democrats control the House, the Senate & the Executive Branch. They can do whatever they want. Republicans are window dressing designed to give political cover for bad policy.
2. America cannot afford a new entitlement program and that’s what any Democratic plan will be.
3. To pay for this new program, taxes will rise.
4. To cut costs, rationing will be the solution.
5. The fight is between Progressives who want Government Run Health Care and Moderate Democrats who know they will never be re-elected if they vote for this mess. Thus the talk of “intraparty reconciliation“.
6. This is a Democrat problem. The Republicans should not give wrong-headed Democrats political cover by coming up with some half-assed, moronic legislation that solves nothing.
I am sick of the health care debate. I wonder if under Obama’s plan, there will be a drug that helps people deal with stupid politicians. I bet they give out free Xanax.
New York Times Takes A Leftist Activist Stance: Surprise!
Friday, August 14th, 2009The New York Times once again talks bout Death Panels. A.J. Strata writes an excellent rebuttal.
It’s simple, really. Right now, families and doctors make the decisions. Under Government Run Health care, a panel of “experts” will decide what ailments will receive coverage….or not. People will not get coverage because the coverage will not be cost-effective.
Special interests groups will lobby this panel. It will become a political decision, not a personal decision. Health care will be politicized.
The only reason the Left loves this notion right now, is because “their” people are in charge in the government. Their tune will change when the opposition is in charge.
Rationing Health Care: Orgeon’s Example [Awesome Video]
Tuesday, August 11th, 2009Best video demonstrating who will make your health care decisions should the dreaded “public option” aka single payer aka Government Run Health Care become a reality:
I’ve also written about the taxpayer funded propaganda here.
On Weight Loss…
Thursday, July 30th, 2009Hi guys, I see that you’re having a discussion about weight loss [at MelissaClouthier.com]. It’s not a burden to the website. Thought I’d share a couple thoughts and you guys can continue the discussion:
1. Often, there is an underlying issue around why a person gained weight. A physical trauma like a busted knee that forces immobility, say, or an emotional trauma that causes the cortisol-insulin feedback loop to go haywire.
2. Often, a person has to resolve the underlying issue in order to get to the desired weight.
3. Weight loss is a simple equation: burn more calories than you consume. Simple does not mean easy.
4. Nearly everyone (I see this in practice all the time) knows the answers for weight loss for himself on some level. That is, they know that ___________ thing is bad for them and that they should avoid it, but they often feel a compulsion toward the unhelpful thing. There can be a mind or body component here. For example, many people crave sugar because it is a natural serotonin booster which is the feel-good hormone. Like a nutrition expert I know says, “Diabetics are happy people. It’s the starving super models who are mean.” Sugar makes for a sunnier outlook but can reek havoc on the endocrine system. Eventually, the body gets tired of trying to adjust to the swinging. Some people avoid the very foods they need, too. For example, many vegetarians avoid meat because they feel disgusting eating it while suffering low energy. They need meat–they often also need to resolve the hidden digestion issue. Their bodies aren’t breaking food down properly to get the nutrition.
I.E. it’s not what you eat, it’s what you absorb.
5. Eating unhealthy is easier. People are busy….grabbing carbs–chips, cookies, candy bars, etc. is convenient.
6. Some people need to face the truth: They would rather eat that ding dong (they love ding dongs) than be thinner. I had a diabetic patient tell me, “I’d rather drink Coke and die, than not drink Coke.” Okay, then. I gave advice with that in mind. There were still other things he could do to help himself.
7. Metabolism is closely related to hormones. It IS hormonal. So, especially as we age, our vitality is closely related to our levels of hormones which relates to our activity levels. It’s circular. If the cycle can be broken either by exercising or by intervening with hormone therapy, often a person can get the positive reinforcement needed to press on with the efforts.
8. Weight loss is a very individual thing. What works for one will not work for another. I got into it with the leader of a dance troop who encouraged everyone to eat mostly vegetables and only chicken. Only problem was that one of the dancers was borderline anemic and thrived on red meat. She needed it in a way others didn’t. People need to do what works for them. As my mentor told me, “One person’s pleasure is another person’s poison.” When it comes to diet, it is most definitely true. Also, when and how a person eats is also individual.
Here are some principles (keep in mind, I struggle with this too. I’m healthy, but I am by no means thin.):
1. Start with protein. Start the day with protein–eggs are good. You’ll feel more “full” all day.
2. Eat regularly. That is, don’t stress your blood sugar system by waiting too long between meals and putting your body into a calorie hoarding state.
3. Eat protein with everything. It will regulate your blood sugar and fill you up.
4. Eat socially. Have company.
5. Sit when you eat.
6. Stop eating before you feel full.
7. If food is your non-stop focus, food isn’t the issue.
Anyway, my two cents. Somewhere between obsessive skinniness and obesity, there’s a healthy balance. Genetics plays a big part in longevity. Being at a healthy weight can enhance your genetic potential. These days, I see way more people obsessed rather than living joyfully. Making food a god, either by avoidance or over-indulgence is wasteful. Food is meant to not only be functional but also a sensory and sensual delight. The irony is that for all the focus and fear, people are not getting thinner or healthier, they’re just more miserable. If you’re gonna be fat, might as well be happy!
About Those Fat People
Wednesday, July 29th, 2009On my radio show tonight, on RFC [10EST, 9 CST], I talk about exactly what Megan McCardle says here:
These aren’t just a way to save on health care; they’re a way to extend and expand the cultural hegemony of wealthy white elites. No, seriously. Living a fit, active life is correlated with being healthier. But then, as an economist recently pointed out to me, so is being religious, being married, and living in a small town; how come we don’t have any programs to promote these “healthy lifestyles”? When you listen to obesity experts, or health wonks, talk, their assertions boil down to the idea that overweight people are either too stupid to understand why they get fat, or have not yet been made sufficiently aware of society’s disgust for their condition. Yet this does not describe any of the overweight people I have ever known, including the construction workers and office clerks at Ground Zero. All were very well aware that the burgers and fries they ate made them fat, and hitting the salad bar instead would probably help them lose weight. They either didn’t care, or felt powerless to control their hunger. They were also very well aware that society thought they were disgusting, and many of them had internalized this message to the point of open despair. What does another public campaign about overeating have to offer them, other than oozing condescension?
Government-run health care is a way for the government to control every aspect of your life from cradle to grave. The control won’t be scientifically based, it will be based on whatever moral high horse whomever runs the government agencies decides to ride. There are very compelling reasons to oppose government run health care: we can’t afford it, it will stifle innovation, it discriminates against the elderly and poor, and it is a scheme (ill-advised at that) to redistribute wealth. But the biggest reason to oppose it boils down to civil liberties.
When the government controls health care, they control you.
What Will Doctors Do?
Monday, July 20th, 2009It is important to note that the AMA (American Medical Association) does not represent all doctors. In fact, many doctors belong to other organizations more suited to their specialty. One such organization the Association of American Physicians and Surgeons, does NOT endorse President Obama’s health care plan. In fact, many members of this organization prefer to not participate in Medicare and Medicaid.
The AAPS did an internal survey and one answer was quite telling. 65% of those answering would rather treat Medicare and Medicaid patients for free than deal with the government. And, in fact, doctors like me do exactly that. I have opted out of Medicare and Medicaid. Still, finances have never interfered with care. Most doctors are the same way. Nearly all doctors have a percentage of charity patients. It’s just a fact of the business that no one minds. Most doctors go into the business to help people.
Of course, when there’s government mandated health care and all doctors must submit to certain rules, or else, what will doctors do? Here are three doctors who answer the question in their own words:
Government run health care will not only be a bureaucratic nightmare for patients and doctors, it will be a problem for quality of care. A person forced against their will to do something for the government will be providing a much different service than one who is giving care of his own free will. It’s just human nature. Doctors will have to comply with rules or be penalized.
As to why the AMA would support these sorts of government intrusions… Well, the organization, like unions, exist as much for their own power as for the benefit of their members. The leadership wrongly believes that by being on the “inside” they’ll have some control over the direction things take. It’s foolish and short-sited. No one wants to be on the outside looking in to the new plan. Being “inside” won’t matter. Some knobby-headed drone will be making decisions for physicians and that’s the way it will be.
The focus won’t be care, it will be costs the patients cause. There will be no thought about the government layers of bureaucracy costing the taxpayer their money and their life. There is already no thought for that.
Ultimately, doctors will leave the practice of medicine rather than practice this way.
Small Businesses Screwed By Dem Health Care Plan & The Poor & Middle Class Will Suffer
Friday, July 17th, 2009Head count. Reducing head count is the quick and dirty way for companies to cut costs because employee salaries make up the biggest percentage of overhead in most businesses. So, when other costs go way up, when the economy is too weak to support raising prices, what’s a businessperson to do? He must, to stay in business, reduce head count.
Usually, the employees lost are not the guys creating new products or the guys selling the products (if they sell well). Usually, the first employees to go are the support staff, the less productive, the less value-added. They are usually pay less well. That is, while the necessary decision-makers might take pay cuts, the support staff just get cut. The head guys can get their own coffee and read their own email and fax their own contracts, if they must.
And so, during the worst economy since Jimmy Carter and Disco, the Democrats introduce a Health Care Plan that will force small business owners to make very difficult decisions. If they want to stay in business during this oppressive economic environment, while being compliant with this new bill, they’ll have to lose employees. They will agonize over these choices because small businesses are like families. They know one another. They know the struggles. They’ve slipped a suffering employee something extra to make it. They’ve not paid themselves so that no one gets fired.
But everyone’s hand gets forced sometimes and the government is going to be forcing some hands. Jimmie Bise, once again, has a must-read American Issues Project post. He gives an example:
Let’s up the ante a little bit. Company B consists of an owner, who also doubles as general manager (and pays herself a rather modest $80,000 per year), and ten part-time employees who each make $35,000, for a payroll of $430,000. That’s large enough to trigger the full 8 percent penalty, which comes to $34,400. Well, that’s just about one employee’s salary, so out he goes, which not only covers the fine but also brings Company B under the $400,000 threshold, which means a potential smaller fine next year. Bonus!
Company B could easily be a car dealership, a local insurance office, a mid-sized construction company or contractor, or a retail store where the salespeople work at least partly on commission. This could be the final straw that convinces the owner to say “To hell with it.”
This isn’t just a thought exercise, though. There’s an action component as well. Look at the businesses you patronize regularly or even just the ones you drive past on the way to work. Look at your own employer, or the businesses where your friends and family work. How many of them will face the choice of firing someone to pay for the Obamacare fine or to limbo their payroll under the Democrats’ bar? Will that perpetually-cheerful cashier at the local convenience sore still be there this time next year if Obamacare passes? How about that electrician with the young wife and baby who always does great work and let you slide on a service call that one time? Shouldn’t they know what could be coming their way?
Most of the Democrats, though, are clueless about how business actually works. More importantly, they don’t care. With their focus on redistribution, what they don’t realize is that small businesses can MAKE themselves smaller, still survive, to stay compliant with egregious government rules or pay fines that cost them less than the rule.
Hopefully, all this won’t matter. Hopefully, for once, Congress will listen to the people, who are now resoundingly against Obama’s plan.
Canada’s Health Care Reveals What A “Public Option” Plan Really Looks Like
Tuesday, July 14th, 2009This Pajamas video by Steven Crowder is a must-see. It’s 20 minutes of human evidence about horrible health care. And remember, the rich will always be able to afford to pay for better care. The public plan forces middle and lower income people who have good medical care now, into a government-run abyss of waiting lists, rationing and outright denial of care.
And check out the facilities. No gleaming, beautiful waiting rooms. Cinder block, gray, socialist, misery.
