Jon Lowder

Sick

I just finished reading Sick: The Untold Story of America's Health Care Crisis---and the People Who Pay the Price,  Jonathan Cohn's surprisingly balanced book about America's health care system.  Unfortunately for Cohn I think a lot of people will confuse his book with Michael Moore's unbalanced film Sicko, so they probably won't bother to read it despite the painfully long sub-title that seems to be symptomatic of all non-fiction books published these days.

When I say that the book is surprisingly balanced it's because I kind of expected it to be a screed against the evil insurance companies, pharmaceutical companies and hospitals, but in reality it provides a nice historical perspective on the development of the modern US health care industry and uses half a dozen anecdotal cases to signify how real people are affected by the system.  Where I think Cohn earns his stripes is in not laying the blame for the current health care situation at any one group's feet, but rather pointing out how the actions of the various players (insurance companies, HMOs, government, hospitals, pharmaceutical companies) are logical given the climate in which they exist. 

Not that Cohn doesn't have an opinion.  He thinks that the fundamental flaw with the US health care system is that it doesn't treat health as a function of the common good.  He's very much in favor of some form of universal health care, and he seems to favor France's model over Canada's, the UK's or other industrialized nations, but he doesn't prescribe specific plans.  Rather he points out that even though we spend 16% of our resources on health care we put too much of a burden on the poor and middle class.  He says other industrialized nations spend less and provide more coverage for all of their citizens.

Throughout the book Cohn explores both sides of the health care debate as described as universal vs. non-universal health coverage.  He acknowledges some of the free market arguments, but de-bunks many of the sound-bite arguments you hear from the non-universal crowd: long lines in Canada, lack of resources in the UK, sub-standard care.  Just as an example he points out that the UK's problem isn't universal care but the fact that they are trying to have universal care on the cheap.  Ends up they spend just 7% of their resources on health care.

Cohn also spends some time explaining why efforts by health care reformists have failed to get universal health care passed in the US.  Of course he focuses on Hillary Clinton's failed efforts in the early 90s, but he also looks at earlier developments under FDR, JFK and LBJ.  In fact the story of how Medicare and Medicaid came into being is absolutely fascinating if for no other reason than to show that our current crop of politicians aren't much different from 40 years ago. 

By the way, Cohn thinks that if things keep going the way they have been lately then health care reformers have a better shot in the near future than they've had in at least a generation.  Without getting too much into the details lets just say that in '92 the average person still had adequate health coverage through their employers, but now that many middle class Americans are paying a very hefty price for their coverage AND can easily imagine themselves being devastated by a serious illness they are much more likely to support politicians who promise to take that very fundamental worry away.

There's a lot for people to argue about in the book, but that's what makes it a worthwhile read.  Heck, the guy provides literally dozens of pages of citations and notes at the end so you can't say he hasn't done his homework.   And for those who might wonder what I think it's that I agree that we need some form of universal health care.  It fascinates me that as a society we seem to have no problem with the concept of paying taxes to fund our armed forces, our police and firefighters and our roads, but somehow it's a problem to pay taxes to secure a basic level of health care for every citizen.  I also don't think the system has to be 100% government administered, it can be some sort of public-private hybrid, but I do think that if we are going to continue to be the most prosperous nation in the world then we'll need to make this change.

And here's my own anecdotal evidence that there's serious need for change: I have a relative who shall remain unnamed that is anything but poor or needy yet after retiring from her "career job" faced health care expenses so high that she took a retail job that paid minimum wage in order to secure health care benefits until she turned 65 and when she turned 65 she had a Medicare party. I'm told that Medicare parties are very common in her circle of friends.  So if government-provided health care is such a nightmare why are these middle and upper-middle class folks so happy to get it?

Are Novant and WFU Baptist Medical Center Non-Profits in Name Only?

I had an interesting email exchange with a reporter from the Winston-Salem Journal about the hospitals that Novant and WFU Baptist Medical Center are proposing to build in Clemmons (Novant's) or Advance (WFUBMC).  When I wrote that I'd really like to see Baptist build a new hospital on the site in Mocksville where it currently has an old hospital that by all accounts is old and in need of mothballs, she replied that Baptist can't afford to build there because it is hemorrhaging money and market share.  I'm sure she's right about that and I understand the business implications in both companies' building proposals, but I think one issue that needs to be discussed is the fact that both companies are non-profits.  As non-profits shouldn't the companies' goals and agendas involve more than market share and profit?

In thinking about this I came to the realization that although I've worked in the non-profit industry for a long time I really don't know what non-profits are supposed to be.  I decided to do a little research and when I Googled "history of nonprofits in america" the first listing was a 1998 USIS article titled Nonprofit Organizations: America's Invisible Sector written by Dr. Lester M. Salamon, director of the Center for Civil Society Studies at the Johns Hopkins University.  He provides a basic definition of non-profits:

As a first step in this process, it is necessary to clarify exactly what the nonprofit sector is. In the United States, 26 different types of organizations are identified as worthy of tax exemption, ranging from business associations through charitable organizations and social clubs. Behind these 26 categories, however, lie five critical features that all these entities share. To be considered part of the nonprofit sector, therefore, an entity must be:

organizational, i.e., an institution with some meaningful structure and permanence;

nongovernmental, i.e. not part of the apparatus of government;

non-profit-distributing, i.e., not permitted to distribute profits to its owners or directors, but rather required to plow them back into the objectives of the organization;

self-governing, i.e., not controlled by some entity outside the organization; and

supportive of some public purpose.

While all organizations that meet these five criteria are formally part of the nonprofit sector in the United States, an important distinction exists between two broad categories of these organizations. The first are primarily member-serving organizations. While serving some public purpose, these organizations meet the interests, needs and desires of the members of the organization. Included here are social clubs, business associations, labor unions, mutual benefit organizations of various sorts and political parties.

The second group of nonprofit organizations are primarily public-serving organizations.  These organizations exist exclusively to serve the needs of a broader public. Included here are a variety of funding intermediaries such as charitable, grant-making foundations; religious congregations; and a wide range of educational, scientific, charitable and related service organizations providing everything from nursing home care to environmental advocacy.

This distinction between member-serving and public-serving organizations is far from perfect. Nevertheless, it is sufficiently important to find formal reflection in American law. Thus, public-serving organizations fall into a special legal category -- Section 501(c)(3) of the U.S. tax code -- that makes them eligible not only for exemption from federal income taxation and most state and local taxation, but also for tax-deductible gifts from individuals and corporations, that is, gifts that the individuals and corporations can deduct from their own income in computing their tax liabilities. It is these organizations that most Americans have in mind when they think about the "nonprofit sector" and it is these that we will focus on here.

If we accept this definition, and I think it's pretty good, then we accept that both Baptist and Novant are public serving organizations.  And since a requirement of non-profits is to plow their profits back into meeting their objectives then a natural question would be "Are Novant and WFU plowing their profits back into their mission?"

Originally I was going to detail a bunch of numbers from both organizations' 990 filings.  These are the forms that non-profits file with the IRS (kind of like an individual's 1090) and they highlight the non-profit's financial performance for the year.  But instead of getting into the details I'm going to provide you with links to the filings (see the bottom of this post) and simply say that without question both organizations are highly profitable and both could probably stand to spend more money on the community no matter what they say about how much they write off in serving the indigent and poor.  Believe me, they show a healthy profit even after accounting for those expenses.

So given that Novant and WFUBMC are already profitable should they look only at market share and profitability when building these facilities?  Baptist wants to build in Advance because they say they will be serving Davie county and the majority of Davie lives in that area.  Maybe, but it's also true that the majority of high income Davie residents live in Advance and it's no secret that they'd like to poach some of the high income Clemmons residents from Novant as well.  Novant claims that they already serve something like 60% of the residents in the area proposed to be served by either hospital so it makes more sense to give them their shot in Clemmons, but if Baptist gets to build their hospital those numbers could change.

The reality is that Novant and WFUBMC are businesses that happen to be designated non-profits, or in other words they are non-profits in name only.  If they were non-profits in the sense that I think an average person with common sense would think of a non-profit then they wouldn't dicker about the Downtown Health Plaza and they would spend more money on operations that serve poorer and more rural communities.  They would also acknowledge that they already make plenty of money off of their existing operations in Winston-Salem and actually look at how they can serve communities in need and not just at market share. 

I'd like to see the state offer Baptist and Novant the following deal:  you can build your hospitals if you agree to set them up as for-profit subsidiaries that will allow the counties to collect property tax OR you can build your hospitals if you expand/improve your facilities and services in at least two rural operations.  With the first proposal the state would be saying to the organizations that we're going to call a spade a spade, and with the second they'd be pushing the organizations closer to fulfilling their intended roles as non-profits.  Of course I'll be ice skating in hell before either happens.

Links:

North Carolina Baptist Hospital 2004 990
WFU Health Sciences 2004 990
WFU BMC 2004 990
Novant's 2004 990

Notes from My Afternoon as a Non-Reporter at a Public Meeting

As I wrote last week I spent about 5-6 hours listening to people speak at the public forum regarding the proposals by WFU Baptist Medical Center to build a hospital in Advance and Novant to build one just four miles from Advance in Clemmons.  According to the Winston-Salem Journal about 700 people were there, which I think is as accurate a count as any.  Following are some notes and observations from the afternoon:

• When I first got there I stood in the atrium outside the meeting room and watched the proceedings on a television for a few minutes.  I was holding a steno pad since I wanted to take notes and I also wanted to be prepared if I got an important business-related call.  I guess I looked like a reporter because a tall, snow-haired gentleman in a suit that probably costs more than my annual salary approached me and nodded hello while giving me the stink-eye.  I nodded back and waited for him to introduce himself.  When he didn't I put out my hand and said, "Hi, I'm Jon Lowder."  He shook my hand and said, "Yes."  That's when my prick-o-meter alarm started clanging.  Then he said, "You look like you might be a reporter" to which I replied, "No, I just carry this in case I get an important call."  He didn't seem to be buying it and he just walked off and joined his colleagues from WFU.
  
  Just after that a nice young lady from Novant approached and asked me if I was there to speak.  I said that yes I was and she gave me a green sticker that all the Novant supporters were wearing on their chests.  I put it on my shirt, but since I hadn't taken off my jacket you couldn't really see it.  I went inside and found my cousin, a Novant employee, and made my way to the side of the room where she was sitting.  I decided to lean against the wall and wait until the speaker was done before disturbing anyone to sit next to my cousin and that's when I realized that I was standing next to a reporter (I could tell by her steno notebook and the fact that she seemed to know shorthand) and when I looked up the snow-haired prick gentleman was watching me.  That's when I decided to whip out my notebook and pretend to write furiously for a few minutes while glancing at him intermittently.  A guys got to have a little fun in life.  After he left I went ahead and sat down.
  
• Listening to 150 people say essentially the same thing is very boring.  The reporter was smart and bugged out after number 20.  I was in for the long haul.
  
• If I ever want to be a reporter, or even dream of being a faux-reporter, I need to learn some form of shorthand. If not I'll be the king of paraphrasers.
  
• Two paraphrases leap to mind.  First, when the folks from WFU were given their 10 minutes to respond to some of the citizen comments their VP said that they were shocked when they heard the outgoing mayor of Clemmons say that his citizens welcomed the Novant-proposed hospital and maybe his saying that is an indication of why he got his butt kicked in the election a couple of weeks back. 
  
  The second was from the Davie county manager who was invited by WFU to use some of their response time to share a personal story to help explain what all this is about.  He said that after they'd publicly announced the deal with WFU he was approached by Novant representatives and he asked them how they could have the gall to approach him after what they did to another local hospital (Stokes County).  He said their reply was that it was all about market share.  He then said he told them that it wasn't about market share it was about the people of Davie County.  If this had been a Q&A I would have asked the guy if he thought WFU didn't care about market share as much as Novant, because if they didn't they would be building the new hospital in Mocksville or another central location in the county and not on the eastern edge that happens to be home to the county's wealthiest component and just a stone's throw from the western Forsyth population centers of Clemmons and Lewisville.
  
• Yes I was there to back Novant, but I was also there to say that I would like to see both hospitals built and preferably for Baptist to build theirs in Mocksville near the current Davie County Hospital.  I wasn't the only one of that opinion.
  
• The guy running the PR campaign for Novant was Mike Horn of Horn & Stronach.  He's a former mayor of Lewisville and a current town council member.  It's probably not a coincidence that several representatives from the town council testified in favor of Novant, but they should anyway since it would be the better option for Lewisville residents (in my opinion).
  
• It's interesting seeing people who's public lives become entwined in their private and professional lives.  Winston-Salem's mayor gets questioned every once in a while about his dual roles as mayor and president of the Winston-Salem Alliance, and seeing a town council member like Mike Horn wearing his other hat as PR pro was also interesting.  He didn't speak himself on behalf of Novant, but since many of the speakers had been recruited by either side (WFU or Novant) it wouldn't be a stretch to conclude that he probably asked his fellow leaders in Lewisville and Clemmons to appear.  Again, I'm not saying anything untoward was going on, it's just always interesting to me to see how people who serve in public office balance their duties with their private lives.
  
• The people from Novant and Baptist were all well-behaved. No catcalls, no booing, only intermittent boosterism.
  
• A few of the public speakers mentioned the astronomical costs of healthcare in their comments, but no one from Baptist or Novant addressed that in their responses at the end of the day.  We need a public hearing about that.
  
• One's butt tends to go numb after four hours of sitting.  And if that's the kind of thing that's representative of what reporters do day-in and day-out then they can have it.
  
• Finally, I've determined that I'll carry a steno pad where ever I go.  It scares people and it's a lot easier to lug around than a Fancycam.

Greensboro Man's Battle With Cancer and How He Shared His Journey via His Blog

A Greensboro man named Brian Stoll, whom I never met and had never heard of until today, lost his battle with cancer and passed away on July 15.  I'm not sure how I came across his blog but when I did I was captivated by how he shared his experiences from the original diagnosis until two days before his death.  His family wrote a final post on the 15th.

The blog is difficult read when you know that Brian has already lost his battle with cancer, but I think that by sharing his struggles he created a valuable resource for people who are just beginning their battles with cancer or those with a loved one recently diagnosed with cancer.  If nothing else they will get an idea of what lies ahead for them and perhaps they won't be blindsided as often as they would have been without reading his blog.

Brian was a man of great religious faith so his writing alternates between being a straightforward account of his deteriorating health and an account of how his faith is an integral part of dealing with it.  If anything his faith got stronger as his body got weaker.  Here's a sample from a post titled "Give me some oxygen, PLEASE...":

The outpouring of response from my Preparing to Die post has been overwhelming. I haven’t been able to respond to everyone yet. My lung capacity continues to shrink, making simple conversation a difficult chore. Thank goodness for email and this blog. It is so easy to communicate with everyone via the written word versus having a conversation. This brings me to my next update. My physical ability is so limited now. How so? Walking up a flight of stairs is darn near impossible. I now have to sit on the bottom step, with my back facing the steps, and “rear end” my way up the stairs over a two or three minute process. Walk outside to get the newspaper? Thank goodness my driveway is only about 50 feet long. Run around the house terrorizing the dogs while everyone else laughs? No more. Go hiking with Brookie in the mountains. Unfortunately, those days are gone. Play a round of golf with friends? Never again. This has been one of the difficult mental obstacles to overcome. I have so much time on my hands now, so I tend to sit and think about all the fun stuff I have done in my life. Brooke and I love to go hiking. It is classic daddy/daughter time, plus we both love nature and the outdoors. I can’t do that anymore. Dammit, that thought makes me very angry and sad at the same time. I am being robbed of my ability to enjoy my family. That’s not fair! BINGO! Poor, pitiful me. You selfish idiot. Why can’t you relish the fact that you WERE able to enjoy these things in your life? Do you not understand there are some people who will never go hiking, who will never see a beautiful mountain stream, and never be able to enjoy God’s wonders? Sometimes I feel so stupid. I really do have to work on getting away from the selfish junk and being thankful that God has blessed me in so many ways. The reality angel that sits on my right shoulder can really give it to me sometimes.

Another mental obstacle that I have finally succumbed to is the fact that I need a wheelchair to get around. Truth be told, I simply cannot walk more than 50 feet without getting winded. The wheelchair makes it so much easier to get around, plus it’s a real snazzy new model. Lot’s of bling,ya know? I also got a handicapped placard for my Suburban. Although I may not live to be 90 years old, I sure do feel like it now! I’m also very dependent on oxygen. When your oxygen content in the bloodstream gets below 90% you become oxygen starved. This causes panic, anxiety, disorientation, restlessness, shakyness in my speech, etc. When this happens, I feel like a fish out of water. Panic is the first thing to set in, and then I realize I can’t do anything to help myself. This turns into a very precarious situation resulting in a panicked frenzy. Kimberly will get the oxygen machine turned on and puts the tubing in my nostrils. Then she sets up the morphine nebulizer. Ah yes, the morphine nebulizer. It’s a little machine that takes small amounts of morphine and saline and turns them into a mist, which is then inhaled through a pipe. This is starting to sound like illegal drug activity, eh?!? The morphine calms down the lungs by changing the way it processes oxygen. Simply put, it helps me to breath once again. Lately I have been taking 3-4 morphine treatments a day. The events leading up to the treatments tend to be very frenzied to say the least. Never a dull moment.

In his last post Brian lamented about how he was no longer able to provide for his family and he quite openly discussed the financial devastation wrought by his cancer treatments.  I can easily imagine the frustration he felt and I'm sure it was extraordinarily difficult for him to write and ask for help, but that's what he did with his last post.  His childrens' college funds were spent on his treatment so his family set up a fund called "Breanne and Brooke's Future" at Wachovia so that people who want to can help out (just visit any Wachovia branch to make a donation if you want). 

It takes a very big man to put aside his pride and ask for help and by doing so I think Brian showed exactly what kind of man he was.  After spending just a few minutes reading his blog I truly regret that I never had the chance to meet him. 

His family wrote, "Keep the family in your thoughts and prayers and remember that we were blessed to have had him but Heaven is in Awe at what it has received."  The man obviously left a great legacy.

A Sleeping Pill You Won't Catch Celeste Taking

Celeste (my lovely wife) hates ingesting anything that makes her feel like she's losing control.  She doesn't mind the occassional drink, but she rarely gets drunk because she hates losing control.  Her parents never had to worry about her taking drugs because she wouldn't have been able to handle the feeling of getting stoned.  Hell, I've seen her almost hyperventilate when she's smelled someone smoking weed.

On the other hand Celeste is like most other women who have hit their 40s, have young teenagers and a pain-in-the-butt, no-good husband who snores like a bear in hibernation: she has a heckuva time sleeping.  Every once in a while she'll take a mild over the counter sleeping aid, but I can almost guarantee you that she'll endure massive sleep deprivation before she'll take zolpidem, which in the US is known as Ambien and in Australia is known as Stilnox.  Apparently there have been some pretty interesting side effects reported in Australia:

A woman taking the drug "woke with a paintbrush in her hand after painting the front door while asleep," the Adverse Drug Reactions Advisory Committee said in a bulletin published yesterday.

Another patient reportedly gained 23 kilograms over seven months while taking Stilnox.

"It was only when she was discovered eating in front of an open refrigerator while asleep that the problem was resolved," the bulletin said.

The committee also received two alarming reports "which suggest the possibility of driving while asleep."

The new study marks the first time "inappropriate or strange automatic behaviour" related to Stilnox has been noted in Australia since the drug was introduced here in 2000, although cases have been reported overseas.

The health department also received 104 reports of hallucinations and 62 of amnesia relating to the drug.

Found via Boing Boing.

Blue Cross Could Have Sent Some Vaseline Too

Remember the truism that nothing is certain but death and taxes?  I think that needs to be revised to state "nothing is certain but death, taxes and massive annual rate hikes from your health insurer".  Actually that last could probably be better stated as an "annual screwing from your health insurer".

We recieved a letter from our health insurer, BlueCross BlueShield of North Carolina (BCBSNC), that begins as follows:

Dear Valued Blue Cross and Blue Shield of North Carolina Member:

Thank you for choosing Blue Cross and Blue Shield of North Carolina (BCBSNC) for your health insurance needs. We value your continued membership and want to let you know about some upcoming changes to your Blue Advantage premiums and benefits.

Most Blue Advantage subscribers will have a premium adjustment in 2007.   This will be your guaranteed premium until January 1, 2008, unless you switch plans, add dependents or purchase additional coverage.

Blue Advantage is the most popular individual insurance plan in North Carolina and currently serves more than 315,000 members. Your Blue Advantage premium adjustment is based on the health care costs of all Blue Advantage members and is impacted by factors such as where you live, your benefit design, your gender and your age. For example, if you had a birthday in the past year that put you in a new age-bracket category, it may have had an effect on your January 1, 2007 premium adjustment.  Your individual claims do not have an impact on your annual premium changes.

Here's the thing: our premiums were about $595 a month this year, which was up about 10% over the year before.  This is a 35% increase from '06 to '07!  Celeste and I both turned 40 this year and so I went to the BCBSNC rate quote website and found that if I compared rates for us at the age of 38 and 40, the quote for age 40 was about 8% higher.  So where in the heck did the rest of the increase come from?

What kills me is that there are NO factors that say anything about our personal health choices.  Why can't we get credit for exercise?  Why can't we get credit for a healthy diet?  Why can't we get credit for our general health?  They can lump us in with the rest of the people who are individually insured, essentially treating us as a group health plan, but they give us no control over how we might control costs.  This is BS!

Here's something else that just pisses me off about this: BCBSNC is a non-profit that has been accused in the past of making too much profit and in fact they made a concerted PR push last year to point out that they were reducing their profits.  They were sensitive enough about it that they sued an advocacy group called ProCare over the group's disclosure of what BCBSNC said were confidential business sources.  Of course that doesn't mean that ProCare was wrong and one of the documents in dispute detailed how BCBSNC spent $478,000 to sponsor the US Open.  And my old employer, Atlantic Information Services, had a piece in '05 about how states, including North Carolina, are going after the "Blues" for reserves that are too high.  The point is that non-profits have reasons for existing that go beyond profits which is why they get their special status and treatment from our friends in government, and I can tell you that if the non-profits I worked with spent money the way BCBSNC seems to they'd be in a heap of trouble.

We can change our coverage options (higher premium, higher co-pays, etc.) to bring down our monthly premiums, and we might end up doing that, but we're also going to seriously consider a Medical Savings Account.  We've been looking at MSAs for a while, but we were kind of scared off by the "newness" of them.  I also remember reading about UnitedHealthcare getting ready to offer individual health coverage in NC (right now BCBSNC has a monopoly in the state) and we're going to check them out as well. BCBSNC has given us a lot of motivation to look at ALL of our alternatives. 

Here's my final observation about these jokers and another truism in the realm of business communications: any letter that begins with "we value your continued membership" is the setup for a royal screwing and out of kindness should be accompanied by a small package of personal lubricant.

By the way, this experience just gives me further evidence that Dr. Feld is right about the need for true competition and free market reforms in the healthcare marketplace.

BB&T to Offer HSAs

BB&T, a rather large bank based here in Winston-Salem, announced today that they will begin offering Healthcare Savings Accounts to commercial clients through their employee benefit subsidiary.  From the article:

BB&T Corp. will begin offering health savings accounts, or HSAs, to qualified clients interested in an alternative to traditional insurance plans, the company has announced.

HSAs allow account holders to make tax-deductible contributions that can be withdrawn tax-free when used for qualified medical expenses. Unlike flexible spending accounts, money left unspent at the end of a year remains in the account.  

Winston-Salem-based BB&T (NYSE: BBT) will offer HSAs to institutional and commercial clients through its employee benefit subsidiary Stanley, Hunt, Dupree & Rhine. The company will also offer the accounts to retail clients who are covered by high-deductible health plans.

Having been self-employed or owner of a small business for much of the past 10 years I've been keeping an eye on these things.  The biggest thing they have to overcome is the fear factor for people used to traditional health plans and HMOs and the sticker shock many will experience when they look at the out-of-pocket expenses before they reach their deductible limit.  They're also often confused with "use it or lose it" plans so people are worried they won't get to keep the money they don't spend.

Some view the HSAs as just another way for businesses to shift the financial burden of healthcare to their employees, but especially in the case of very small companies HSAs may offer the only way to provide any health benefits.  And for the self-employed it's definitely something they consider.  Here's some back of the envelope calculating:

Say you have a family of five, you're with a traditional health insurance company like BSBCNC and you pay $700 in premiums per month which gets you 80/20 coverage for all medical procedures (you have to cover 20%) and a deductible of $2,500 per year.  On top of that you pay $30 per office visit and $15 per prescription.  Let's assume that each person in the family goes to the doctor once a year (very optimistic) and gets one prescription per year and no one needs a medical procedure.  That means your total expenditure for the year is $8,625 and if anyone in the family has to have an operation or stay in the hospital you're talking $10,000+ per year.

With an HSA, which is tied to a high-deductible health insurance plan, you're probably looking at premiums in the range of $300 per month and a deductible of $5,000 per year minimum.  Assuming that co-pays and drug benefits are about the same your looking at saving $400 month in premiums or $4,800 year.  If you contribute the same amount per month to your HSA account that you were paying in premiums you'll end up spending the same amount of money IF someone in your family is sick and you exhaust your entire deductible. But if no one gets sick you get to keep the money you don't spend in the HSA account and roll it into the next year, kind of like an IRA.  After a couple of years you can actually reduce the amount you contribute each month because you will have built up a cushion that more than covers your deductible and incidental medical expenses.  With a traditional healthcare plan your premiums are gone whether or not you've been sick.  In other words the insurance company is keeping your money even if you and your family have been as healthy as a horse.  The icing on the cake is that your contributions to the HSA are tax deductible and my understanding is that you can pay for things like over-the-counter meds with the account as well.

One problem that HSAs have had in the past is that they're typically offered by companies that no one has heard of so it makes people nervous turning over such an important safety net to an unknown entity.  With name brand companies like BB&T getting involved I think you'll see these things take off, so if you're self employed or are a small business owner you might want to check them out.

Also posted at Lowder Enterprises blog and Winston Salem Business.

Unexpected Benefits of Being a Wetmouth

I have a few physical attributes that I find truly annoying.  First, I seem to be replacing all the hair I'm losing from my head with hair on the rest of my body, particularly my back.  I've seen guys with worse back hair (much worse) but I'm not happy that I'm starting to resemble Bigfoot.  Second is my amazing propensity to sweat.  It can be 50 degrees outside and if I walk more than a couple of blocks I'm in a full-on, shirt-drenching sweat.  It truly makes the summer miserable sometimes.  Third is my mouths ability to produce spit.  It usually doesn't bother me that much, but when I go to the dentist it's a royal pain in the ass.  If they don't have that sucker thing in there just right I can drown in a matter of seconds while the hygienist is blissfully scraping away.

Well, I think I need to embrace my spit glands.  I just read this little item at Freakonomics:

As much as I generally dread the dentist’s chair, I always wind up learning something. Yesterday was no exception. I was asking Dr. Reiss about the causes of tooth decay—genetics vs. diet, etc. etc.—when he began explaining why toothpaste is such a bogus product. Any claims that toothpaste makes about preventing decay, whitening teeth, etc., are totally falacious, Dr. Reiss told me, because the F.D.A. can’t and won’t allow the ingredients necessary to perform those chores in an over-the-counter product that children can easily get hold of. (That’s why he recommends an antibacterial product like GlyOxide, a fairly foul-tasting but apparently effective means of killing the bacteria that cause decay.)

The other thing I learned yesterday was far more interesting, with far greater implications. He told me that tooth decay in general, even among wealthy patients, is getting worse and worse, particularly for people in middle age and above. The reason? An increased reliance on medications for heart disease, high cholesterol, depression, etc. Many of these medications, Dr. Reiss explained, produces drymouth, which is caused by a constricted salivary flow; because saliva kills bacteria in the mouth, a lack of it means increased bacteria, which leads to increased tooth decay. Given the choice of taking these medicines versus having some tooth decay, I’m sure most people would still choose the medicines—but I am guessing that most people haven’t thought about the link between the two.

So my spit is my friend!  Maybe I'll discover equally encouraging news about my sweaty ape tendencies, but somehow I doubt it.

This is Your Brain. This is Your Brain on...

So Bill Gates sets up a huge non-profit foundation with his wife that is funding some amazing projects around the world.  What has his old partner, Paul Allen done?  Well let's see. 

• He's purchased the Portland Trailblazers and Seattle Seahawks.
• He's purchased The Sporting News. (This is my kind of guy).
• He's set up his own foundation (in 1986) that's funded a bunch of stuff in Oregon and Washington.
• Oh, and he founded/funded the Allen Institute for Brain Science which has just finished creating a digital atlas of the mouse brain.  Let the smart guys over at Boing Boing explain this to you:

Researchers at the Allen Institute for Brain Science in Seattle are today celebrating the completion of a new digital atlas of the mouse brain. The achievement will likely lead to a greater understanding of how the human brain works...

Mice brains and human brains have significant differences, but are similar enough that a complete "atlas" of the mouse brain is seen by many scientists to be as important a milestone as the Human Genome Project, which mapped the DNA sequence.

Paul Allen, who co-founded Microsoft 30 years ago with Bill Gates and is one of the world's richest men, donated $100 million to create a searchable 3-D digital map called the Allen Brain Atlas. The map is the inaugural project of the Allen Institute for Brain Science...

Allen's funding helped to assemble a dream team of scientists, who methodically scanned ultra-thin slices of mouse brain with the aid of robot helpers. Those scans help to identify how individual genes are "turned on" in different areas of the brain...

Link to related text and images at Wired News.

You know I'm starting to feel a little better about all the cha-ching I've spent on Office and Windows over the entire span of my adult life.  Here's a sample pic from the atlas:

Apparently I'm Healthy, but That Doesn't Mean There's Nothing Wrong With Me

So I'm closing in on 40 and apparently that fact has caused me to jettison my normal attitude of indifference towards my health.  The result is that I've had my first physical in years and I've begun to listen to my wife about my supposed issues which led me to voluntarily participate in a sleep study on Monday night.  Here's what I've learned, first from my physical:

• God has blessed me with a good ticker.  My resting heart rate is 47 beats per minute.
• Having a hairy chest is not conducive to the pain-free administration of an EKG. Taking those little bastard electrodes off does NOT tickle.
• I'm a wuss.  When they went to draw blood and missed the first six times I almost passed out.  My doctor assured me that it had something to do with my miraculously low heart rate but I think he was just trying to soften the blow to my manhood.
• The little rubber hammer thingy doesn't have any effect when it is used to repeatedly strike me in the knee. Apparently my wife was correct in her assessment that I am insensitive.

This is what I learned from my sleep study:

• It is quite difficult to sleep comfortably with electrodes stuck all over your face and scalp.
• For some reason they also stick electrodes to your knees; I believe it is to make it difficult to pee in the morning, which it is.
• It is considered normal to wake up 1-5 times per hour due to changes in breathing, but it is a mild case of sleep apnea to do so 6-15 times per hour and severe apnea to do so 16-30 times.
• I wake up an average of six times per hour.  Funny enough I wake up once an hour if I'm sleeping on my side and 12 times per hour if I'm sleeping on my back.  I spend equal amounts of time on my back and on my side.
• The prescription they have for me is to learn to sleep on my side at all times.  Their suggestion is for me to sew a pocket on the back of a t-shirt and insert a tennis ball so that I can't lie on my back comfortably.  They figure it should only take 4-5 months for me to be properly trained.  This smells suspiciously like common sense to me, which of course makes me instantly suspicious.  Where's my magic pill?
• My heart rate when I'm sleeping is 45 beats per minute and my oxygen level stays above 90% which is apparently good.
• I still snore loud as hell. They couldn't prescribe anything to help my wife with that.
• In the world of the sleep study folks I'm considered a moderate snorer; I feel for anyone who has to live with someone considered a truly loud snorer on their spectrum.

I wish I'd taken a camera with me to have my picture taken with all the stuff plastered on my head.  I looked like something out of a bad 70s sci-fi movie. 

The final analysis is that it looks like I'm healthy as a horse which is a good thing. Knock on wood.  Luckily no one has looked into my mental fitness...yet.

Repairing the Healthcare System

I don't have any suggestions for repairing the healthcare system, but I'm hoping this blog does.  The blog's author is the father of Brad Feld who is one smart dude and prominent blogger.

From his first post:

However, in 2006, the patient and the physician are generally listed last among “important” stakeholders by government, insurance companies, hospitals and policy makers.

Since
the patient is most important stakeholder. The patient should be in the
forefront of policy making. The physician is second.  All the other stakeholders are in reality simply facilitators for the patient and the physician. Everything done in the healthcare system should be done for the benefit of the patient first, and not for the economic bottom line of the other stakeholders. After all it is the patients’ healthcare system! Is it not?  The demand for repairing the healthcare system and action to fix it has to be made by the patient,

There's Accountability and then There's Accountability

In an act that would scare the pants off of any doctor the Freedom of Information minister in Scotland ruled that the mortality rates of the patients of the almost 1,000 surgeons in the country could be made publicly available.  In other words each of the surgeons' success rates are now public knowledge. (Read about it here).

The head healthcare dude for the country said that he didn't understand why the data was made available "because it did not provide details of individual patient cases."  Well, I'd argue that it would then be in the best interest of the doctors to make sure that the details were made available so that the public could have some context, but it is definitely in the public's best interest to have this data available.

Now before you jump all over me here I think this is a two way street.  If we're going to hold doctors accountable (which I argue for) then we need to also protect them from frivolous lawsuits, and I actually think that this kind of "sunshine" on doctor data will help doctors.  After all if we can say that 90% of patients that have a certain procedure die (100% die without it) then we can't hold the surgeon responsible if it goes wrong.  On the other hand if 99% survive a procedure and a doctor manages to lose 10% of his patients then that's another issue.

Of course I don't see this becoming an issue in the US.  The medical establishment will fight "sunshine" laws until their last breath and lawyers will never go for anything that would put a crimp in their market.

Reading List October 24, 2005

• The Entrepreneurial Mind Set (Moore's Lore) - Dana Blankenhorn is entering the entrepreneurial realm himself and it has caused him to take that position that countries like China and India are developing more entrepreneurs, the US education system stinks and the Baby Boomers have killed the golden goose (the last are my words, not his).  It's an interesting take on our society right now.
• The Fall of the Warrior King (New York Times Magazine) - The story of Col. Nick Sassaman, his role in Iraq and how it led to his fall from grace.
• Good News: People are Social Animals (Fractals of Change) - Tom Evslin talks about why peer-driven services on line have developed, and how/if they will continue to work.

A Positive Story Involving Medicare?

According to this post on Daniel Drezner's blog, in which he references an article by Gina Kolata in the New York Times, Medicare is prepared to give doctors, free of charge, the software to computerize their medical practices.  The savings for each doctors office could be as much as $100,000.

Of equal interest to me is that the system they are going to give the doctors is called Vista, which is not owned by any company (i.e. it is open source) and is already being used by Veterans Affairs hospitals and inpatient/outpatient facilities. 

As with other open source software the real power lies in the ability for any number of developers to create improvements or new applications for the system.  Then individual users can pick which components are worth using or implementing.

One example cited is the suggestion of a VA nurse to use barcodes on prescription medications and on patients' wrist bands.  The person administering the medicine scan's the drug and the wrist band and if there's a mismatch between the wrist band and the drug the system catches it.  Programmers added this feature and it led to an 80% drop in drug errors at the VA.

Medicare has rightly identified the backwardness of doctors' offices as an impediment to an improved healthcare system.  Let's hope for all our sakes that this new system leads to improved, and cheaper, care.

**Last note** - Vista has always been available for free via a Freedom of Information Act request, but nobody knew it.