In control of health

After I wrote the chapter in my book on Googlified insurance — thanks to the wisdom of the crowd in the comments here — I tried out the ideas on a couple of insurance executives. “You may be mad,” one of them emailed later, “but you had some good ideas.” Actually, my readers did.

I proposed a scenario in which the community of the insured gained responsibility for its own health, which would require insurance and medical companies to hand over control to them, to be fully transparent with data and information, and to provide services the community could use to improve its health and reduce its own costs.

Let me play out two implications of this with my own health situation. First, a case of cutting costs:

Because of my afib, I have to take Coumadin, a blood thinner. I am required to go to the medical group every 2-4 weeks for them to prick my finger and make sure the dosage is OK. In some people, it can be variable and volatile. Not in me. I’ve been on the same dosage with the same effect since I started. But they keep bugging me to come in. They yell at me.

When I get there, I’m offended at the waste of money. There’s a nurse who sits at a computer and judges my results and then types and types and prints out a sheet. There’s an assistant who does nothing but prick my finger and then marks up that printout. It takes them two people to do what my diabetic mother does many times a day on her own. They charge me a $20 copay each time I do this. I shudder to think what they charge the insurance company. It’s like watching a government bureaucracy in white coats.

My point: If my interests and those of my community and insurance company were aligned, I would put up a fuss and whistleblow this boondoggle. If I knew it could have an impact on my costs, I’d report this to the insurance company. If I knew my community had the power to do something about it, I’d tell my tale in a community forum and gather critical mass around imposing efficiency.

But my interests are not aligned with the insurance company’s. They are out to screw me. They think I’m out to screw them. The doctors who are screwing us think we’re all screwing them.

By the insurance company holding onto the power in this relationship, it screws itself. We have no interest in helping them. If, instead, they enabled the community and each of its members to take control of health and costs, if they acted as a true service to the community’s and its members’ needs, then they all would benefit — except perhaps for the unnecessary and now jobless assistant and the doctors who can no longer skim a profit on this scam.

Second example: I’m tussling with my cardiologist about the dosage of the drug I take that stops my fibrillation (the poetically named Rythmol). I’m on a high dosage but it’s working well (knock wood). The doctor says he wants me on a lower dosage, but the last time I tried I nearly went into afib and had too many palpitations (and I couldn’t concentrate under the pressure to get my book written). The risk of the drug is that even as it stops afib, it can cause afib. The risk of not taking the high dosage is that I can go into afib — and the more you get afib, the more afib you’re going to get. The risk, either way, is getting more cumulative bouts of afib. I’ve already had enough to make me a life-insurance risk, which is to say that the condition was not sufficiently managed early on when I got it (after 9/11/2001) and before I went on Rythmol.

[Note, as an aside, that my life insurance company is screwing me for a condition that I got from 9/11 and it’s a company run by and for military people. I wonder how they treat Iraq veterans. More on that another day.]

There’s a health decision to be made here. It’s about balancing risks. The only way to make that decision is to look at as much clinical data as is available and judge that against the comparative risks and against my personal experience. The doctor will come to a conclusion based on his education and reading and a few minutes’ consideration in my case.

But the decision is properly mine. My health should be under my control. It is ultimately my responsibility. But the system is not set up for me to make that decision. It is not set up to inform me or give me control.

At Davos last year, I sat at a table with a bunch of doctors who complained about their patients going to the internet to get what they said was misinformation. They didn’t want the internet to get in the way. They wanted to remain in control. I told them they were looking at this the wrong way. Instead, I said, they should point their patients to what they though were the best resources.

Doctors, I said, should act as curators of information for patients. That’s not what doctors do. They don’t have the means or, they’d argue, the time. Insurance companies offer some information to patients, but it’s lite and not too valuable. (Did you know you should eat less? Not smoke? Exercise? No, really?)

If insurance companies and doctors tried to empower patients and their communities to take control of their health and the costs surrounding them, if they gave us information about both the medicine and the business of it, they might succeed. Right now, no one does.

  • http://robertdfeinman.com/society robertdfeinman

    Do you really think that you have enough expertise to read some medical reports and come to a better decision than your cardiologist?

    Determining a course of treatment is something where an individual should be involved when it comes to risks vs rewards, but evaluating the efficacy of treatments is putting too much reliance on an untrained individual (oneself).

    The old saying: “A lawyer who defends himself has a fool for a client” seems to apply in spades to medicine.

    If your doctor tells you that A has a 10% chance of harm and a 30% chance of helping and B has a 20% chance of harm and a 50% chance of helping then you should be able to decide your level of risk. But for you to read the medical literature and determine that the risk is 10 or 20% isn’t wise.

    As for the silly paperwork, most of that is caused by the need to document things to private insurance companies and the absence of a national computerized database. Ask around and find out how things are done in rational countries like Canada.

    If you think the blood tests happen too frequently then you might be right, but it is a small inconvenience which practitioners feel is worth it because insufficient monitoring can have such dire consequence. Another example where the patient can’t evaluate the entire history of treatment and goes by anecdotal observations.

    If you would like some of your health prejudices cleared up, or if you just want to rant in a different forum I suggest visiting:

    http://www.healthbeatblog.org/

  • Lockbourne

    _________

    Correct.

    But more precisely — it is our corrupt ‘political system’ that blocks your choice & control.

    Purchase-decisions on health products & services items should be like any other consumer decision.

    However, foolish government policies over many decades imposed an absurd “3rd Party Insurance” economic & regulatory structure on the entire American health industry. This mindless bureaucratic legal structure prohibits normal, efficient interaction among buyers & sellers… imposing huge costs and waste.

    One should pay their own medical expenses in the same manner they pay any other personal expense.

    Private actuarial-based ‘medical’ insurance or loans is the answer to catastrophic medical needs.

    For the minority who truly cannot pay their own medical costs, direct assistance should be provided by fellow citizens.

    Government politicians and bureaucrats (…especially Federal) have NO legitimate role in the medical system their wholesale interference in the past 50+ years caused the disaster we all endure nowadays.

    _______

    [P.S.] … the Potomac politicians are so good at managing our health care — just wait ’til you see how they do taking control of our financial system this week !

  • Mike

    Nice post Jeff

    Lockbourne-you’re going to have to expand on this:

    For the minority who truly cannot pay their own medical costs, direct assistance should be provided by fellow citizens.

  • http://robertdfeinman.com/society robertdfeinman

    It all boils down to one’s view of the way society should be organized.

    If you regard health care as a basic human right (along with life, liberty and the pursuit of happiness) then a communal approach to providing it is required. This is the EU model, in general. Once the framing has been agreed on, the actual implementation is just a matter of historical and cultural expectations. One can have socialized medicine as was the case in the USSR, where doctors were government employees. One can have universal quasi-private insurance as in German, or one can have public insurance as in the UK (and with Medicare).

    If you regard health care as a private affair, like making a living, or deciding how much education you want then you tend to put the onus on the individual to obtain it. This leads to a system based upon private insurance to individuals or their proxies (employers). The problem with this framing is that sick people in general aren’t earning any money. In addition those who are too low on the economic ladder can’t afford insurance. And then there are those who had insurance, got sick, lost their jobs and insurance and can’t obtain it again.

    Since most civilized societies aren’t willing to put up with the most extreme consequences of laissez faire health coverage they add some communal elements as a corrective. This is what we have in the US: Medicare, Medicaid, Schip, VA and additional patches and bandaids at the state level. The result is higher costs, inefficiencies in administration and still 40 million people without coverage.

    No for-profit system can work if they are required to cover everyone at an adequate level unless their excess costs are covered by the government. That’s what has happened in other insurance areas, assigned risk auto insurance, federal flood insurance and so on.

    That free-marketeers chose to ignore the fact that there are no actual free market health systems in operation anywhere in the world is just another indication of using an impossible ideology as a cover for making profits at the government teat.

  • Daniel Freedman

    Things are very different in Canada.

    The same test is billed to the Ontario government universal, single-payer health plan at the rate of $2.12.

    The few people who aren’t covered (eg. recent immigrants during a 90 day waiting period) would have to pay $6.67 out of pocket.

    And don’t believe the all the anti-medicare propaganda from right-wing US think tanks. Last week, I got a same day ultrasound for mysterious symptoms. That turned up nothing, so I’ll have to wait for a CT scan — all of two weeks. My total out-of-pocket cost: zero. And my family doctor (affiliated with a University of Toronto teaching hospital) authorized the tests on the spot on her own authority. She didn’t have to check with an insurance company or even her own supervisor.

    Back to the google angle. My doctor decided on the CT scan after consulting a medical data base in my presence.

    In fairness, Canadian taxes are higher than those in the US. Is that bad?

    • zel

      Can I just move to Canada! It looks like the doctors are actually
      in control there and the prices are NOT unthinkable!

  • Pingback:   Business,Health,Personal,Uncategorized | Cheaper Options for Health Coverage Take Bite Out of Cobra — Recycle Email

  • Hey

    Waiting 2 weeks is a horrible idea for a CT. But it’s better than the inhuman waits for MRIs and the years that governments avoided buying PET machines.

    Health care is a service like any other and should be paid for by the consumer. We have no food insurance or government car service, so why health? Too many murderous leftists who view it as a pathway to marxism.

    When the government employs your doctor, they’ll make decisions based on the cheapest thing for the budget, rather than on your health and well being. Logan’s run is a picnic compared to the plans of “bioethicists”. A British Baroness and authority on medical ethics came out last week on the duty to die. Maoism with a smiling face, but still marching millions off to death.

    If you want to know what Canadians really feel about their healthcare, ask Paul Krugman. He got an abject lesson last week because he believed Maoist shills like D Freedman rather than real people who suffer horribly in Canada.

  • Daniel Freedman

    Waiting two weeks for a CT scan is not a horrible idea, since I have no symptoms and the only purpose of the test is to rule out something that is a 1% possibility.

    I lived for ten years in Manhattan and never got over the shock of seeing visa and mastercard symbols displayed in medical offices. The belief that health care is a commodity like any other leads to much needless suffering and death. Canadians live longer than Americans. Infant mortality rates are also lower. That’s the bottom line — and no amount of obfuscation with many other meaningless stats can obscure that.

    Health care is a public good.

  • Julie

    Enjoyed your story. I agree we should be in control of our health.
    I have been in afib now for 5 months. I had cardio conversion once and it came back about a year later. I’m on coumiadin now and beta blockers. I was doing really well on coumadin until my last check and I’m to thin now. Everytime I go to the clinic it cost 50.00. I only pay 4.50 co pay and thank god Medicare pays the rest. I feel sorry for the people who don’t have insurance.
    They have a new medicine now in Canada called Dabigatran and Rivaroxaban. Is is now available in the U. S. They suspect it will be about a year and a half before it is approved.
    I travel to Canada often and will check and see if I can start the new medicine and get off the coumadin.
    I think it will be a while before they really approve this new med because can you imagine, it would practually shut down the coumadin clnics.
    For a great web sit, go to StopAfib.org