How to save money while improving our health

With historic legislation that went into effect  March 2010, 32 million legal residents of the US should now have health insurance of some kind.

This is wonderful but it does nothing to address the question of what eats up to $ 2.3 trillion or 16% of our GDP. Here are some of my ideas about things that we can do to reduce cost without compromising quality.

1. Focus more lifestyle issues like nutrition and physical activity
In the United States we spend around 10% of our income on food. In the rest of the developed world it is closer to 20% (and in places like India, it might be as high as 50%).The ample availability of  inexpensive high-calorie food does not mean that it is nutritionally complete. Why is it that we spend more on medical care than we do on food ( and its the other way around in Europe and Japan)? Couple that with our sedentary lifestyle, and we have a lethal combination. We would do a lot better with a more plant based diet and 60 minutes of physical activity a day than by taking more pills to prevent health problems. Putting healthy people on Crestor ( at $3.50 a pill) is unlikely to be a wise move.

2. Tort reform
Defensive medicine results in testing worth millions of dollars simply because a doctor who has been through the harassment and humiliation of a lawsuit spares no expense not to go through the same experience again. And yet Obamacare does nothing more than lip service to address this issue.

3.Comparative effectiveness research
Figuring out which treatments actually work and sticking to those can save us millions. But there are numerous vested interests in promoting expensive interventions that add little or no value. Research may not be enough to change attitudes shaped by years of brainwashing by aggressive marketing.

4. Creating more accountability
By rewarding healthy behaviors and discouraging unhealthy behaviors, we need to foster more individual accountability for our own health. Insurance is good for catastrophic illness. Consumers need to have "more skin in the game" in decisions about fancy imaging tests and generic vs. brand name drugs so that we can all be more responsible stewards of shared resources.

5. Aligning consumers, providers and the money managers ( insurance companies)
There is often a disconnect between the patient-doctor partnership and the hospitals and insurance companies because of conflict of interest. For example, the patient and doctor might want a longer stay in the hospital but the hospital makes more money from a shorter length of stay.


6. Focus more on wellness
By encouraging people to take better care of themselves: be it by meditation, hypnosis, biofeedback, massage we can build more resilience and better health. We need to shift the focus to self-care: that is the essence of health.

7. Stop looking for nails just because you have a hammer
Over-treating either at the end of life is inhumane and expensive. Medicalizing normal conditions by changing the definition of normal is a deceptive way of selling more drugs or tests. Suggestive advertising has created new diseases and syndromes out of everyday experiences stemming for lack of self-care.

Watch more TV: pop a pill for every ill

Kids these days know way more than they need to about erectile dysfunction, PAD, dyspepsia, fibromyalgia, osteoporosis, and eyelash lengtheners. They grin when they see the couple with an unexpected "Cialis moment" coming on and they suppress their laughter when they hear about erections lasting for 4 hours!

Most of these ads are so stupid and vague that it seems impossible to understand the purpose. And yet there is plenty of evidence to show that they work! For every dollar spent on direct consumer advertising ( DTCA), the drug companies make $4.20! Which means that for the $ 5 billion (yes, that's billion with b), that they spent in 2007, they made over $21 billion! That's a phenomenal return on investment! (Interestingly, the US and New Zealand are the only two countries in the developed world that allow DTCA).

There is absolutely no doubt that DTCA results in patients making unwarranted requests, while promoting  un-necessary fear of side effects. Needless to say, these ads always promote drugs that are newer, much more expensive and with limited or unknown safety track record.

They all end with the standard line "Ask your doctor if XXX is right for you". The patient promptly makes an appointment to discuss whether the "little blue pill", "the purple pill", or "the one with the butterflies" can be prescribed for them because they heard about it "somewhere". A significant number of times, physicians at least partially fulfill these requests to accommodate patients where they would have otherwise chosen an equally effective but less expensive and safer alternative. Or even a non-pill alternative like healthy life-style, God-forbid!

The fact of the matter is that the average visit with a physician last between 16 and 21 minutes. There is little time left for the physician to address misconceptions induced by DTCA. Physicians cite concerns about patient satisfaction and the therapeutic relationship as reasons to accommodate somewhat unreasonable requests. Doctors often fear that denying  requests could result in declining patient satisfaction.

During the past two decades, there has been an irreversible change in the nature of the doctor–patient relationship. Patients are seeking much more medical information and are actively participating in decisions affecting their health. Intruding into this trend has been the rise of direct-to-consumer promotion, which, in its initial thrust, bypasses primary care doctors and other physicians. Although increased access by patients to accurate, objective information about tests to diagnose and drugs to treat illnesses is an important advance, confusion arises when commercially driven promotional information is represented as educational. And the majority of easily accessible information is motivated by interests other than improving the patients' health.

So, the next time you see an ad for a drug on TV, change the channel! And please don't try using eyelash lengthener on your penis!

Lawsuit Bankrupts Brain Surgeon

I recently heard a story from a friend that his neurosurgeon brother in law had lost a medical malpractice suit and the jury had awarded $ 18 million to the plaintiff. This neurosurgeon had performed back surgery and the plaintiff had developed foot drop ( a common and generally non-disabling complication of back surgery in which one foot does not lift fully while walking and therefore drags. As a work-around, one can wear a device that keeps the foot supported while walking).

Certainly, it was an unintended and untoward outcome and we need to have reasonable checks and balances to ensure patient safety. Thus, this plaintiff should have been owed some retribution for the mishap. But he was claiming that his quality of life was so significantly altered, that he was owed 18 million dollars!

And he found a smart, charismatic and convincing trial lawyer to fight on his behalf. This lawyer was a great orator and an ace debater. He succeeded in convincing the jury by using all the weapons in his command.

The neurosurgeon was devastated (his malpractice insurance would cap out and certainly not cover such a ridiculous amount) and he was then on his own! He would never earn 18 million dollars even if he gave them every penny he earned till he was 118 years old!!

We hear about hospital bills bankrupting people all the time. What about trial lawyers? And the real victim here is a brain surgeon--literally!!

According to recent reports:
Obama's latest proposal "incorporates the best ideas from Democrats and Republicans, including some of the ideas that Republicans offered during the health care summit, like funding state grants on medical malpractice reform," Obama said this week.
The president agrees with medical profession that defensive medicine, doctors ordering unnecessary tests to protect themselves, is pushing up the cost of health care.
Obama is only proposing to give the states $25 million for planning grants and demonstration projects, not national reform.

If the president ever shows some genuine interest in real tort reform--which will require a significant change in his alignment with the trial attorney lobby; that will be the change I can believe in!

Otherwise, I am starting to think it was just the change in my pocket that he was talking about all along!