June 28, 2005
Eliminate the Sick People

Imagine your extended family. You just won $500 million in a lottery. You invite your relatives to all sit down at the table to divvy it up (yeah, I know...keep it yourself but go with me on this).

Think that is going to be easy!?!? Nope, Aunt Maggie needs this much for her house and Uncle Al needs this much for his farm and little Suzy needs new braces. You decide to give Grandma Lorraine $20 million and then Uncle Bert screams that he is getting a raw deal with his paltry $15 million share.

Same at St. Paul right now. Minnesota is a mere three days away from a government shut-down. And The Wife®, who works at the Minnesota History Center, would be affected. So this stalemate is being monitored closely with both of us siding up with Governor Pawlenty to keep the budget down...even knowing what it could do to The Wife's® job prospect.

Let's face it. Government has gotten too big in America. One out of five Minnesotans is state employed. And most, if not all, state employees have several sweet healthcare benefits in which they pay very low premiums compared to the rest of Corporate America.

This brings me to the basis for this very non-football blog entry. I can speak because my knowledge is in the field of healthcare having been a licensed drug dealer for 22-years and am currently employed by a healthcare company.

Some background....my company is a leader in managing prescription drug benefit programs that are designed to drive down the cost of pharmacy healthcare for private and public employers, health plans, labor unions and government agencies of all sizes. It is second only to Hewlett-Packard for customer respect, according to The Customer Respect Group's 2005 survey rating the online presence of Fortune's top 100 companies, and the only site in the healthcare industry to make the top ten.

So, here is a scenario. You are paying as high as $100 drug copays and/or have $2000 yearly deductibles, while the state employees have $10 drug copays and no deductibles (per The Wife®). What does that mean?

Let's say you are a state employee and you smoke. You do not exercise. You are now obese and develop adult onset diabetes. You develop emphysema. You then require eight medications a month which cost $700 (recall I am a pharmacist and I see the true costs). You have a sweetheart health benefit so you also don't give a damn so your out-of-pocket costs amount to $80 a month with the state (us tax payers) picking up the $620 remaining costs.

In the real world, the rest of us would pay $700 until the deductible has been reached and then we'd pay, yes, $700 since each medication costs over $100.

Feel jaded yet?

Nearly two-thirds of the residents of United States are overweight, and since 1991 the incidence of obesity has risen from 12% to over 25%. Obesity-related diseases, like type II diabetes, hypertension, arthritis, heart disease, and cancer are consuming most of our healthcare dollars. Spending on hospital and outpatient care is 36% higher and medication costs are 77% higher for obese people than for people in the normal weight range. Obesity has the same impact on chronic health conditions as does twenty years of aging; which exceeds the impact of smoking or problem drinking. Presently, each year, 300,000 deaths are attributed to obesity, and this epidemic costs our country $118 billion.

Try to imagine what will happen to healthcare expenditures over the next three to five years when many of those who are now simply overweight become diabetic? And in five to ten more years when these diabetics develop kidney failure necessitating dialysis, and coronary artery disease requiring acute hospitalizations and heart surgery? Over the next five or ten years costs will skyrocket to the point where no one will be able to afford health insurance under the present model. Can we stop what appears to be an inevitable rise to “unaffordable healthcare for everyone?”

I believe the answer is yes – but not unless we change our focus of effort. Higher premiums, fewer benefits, lower physician reimbursements, more doctors, drugs, and hospitals have not been, and never will be, the answers. The only effective and permanent solution to our healthcare crisis is to reduce the commodity: sick people. By taking this approach everyone wins: the insurance companies spend less money and the insured have healthier, happier lives with lower premiums. The money saved can be spent to more fairly compensate physicians and other healthcare providers for their dedicated work.

But how do we get to the point of eliminating sick people? People have to become more responsible for their health. Go back to my $700 a month example. If you have no incentive to get better, because of the low healthcare costs, you will just continue to lead the life-style that necessitates the high healthcare costs that are severely taxing the state coffers.

But if you became responsible for paying 50% of the costs, it might give you pause to change your lifestyle and become responsible for your health. In turn that would lower your healthcare costs and decrease the burden on the state.

Don't you think it is time for Minnesota to make their employees responsible for their own health?

Posted by maasx003 at June 28, 2005 08:45 AM | TrackBack
Comments

Seriously dude, stick to football.

Posted by: Neil at June 28, 2005 09:08 AM

Neil: As I've stated on this blog numerous times it is NOT a football only blog. This is not a website. It is a blog, a diary of my thoughts which MOST of the time will be Vikings but will have a mix of family, home, politics, and other life events posted.

Seriously, do you think anyone can write Vikings 365-days a year? What, you'd like me to write a silly piece on the Best Vikes Running Backs from 1962?

I think you can handle a few non-football posts now and then.

Posted by: Brian Maas at June 28, 2005 09:11 AM

So we need to shoot the sick people then? That would reduce the number of them wouldn't it?

Posted by: Cheesehead Craig at June 28, 2005 09:42 AM

CC: Only the ones at Lambeau ;)

Now, go borrow a book from Shane.

Posted by: Brian Maas at June 28, 2005 09:51 AM

COD: How dare you express your personal opinion on your own webpage? I have some "friends" who I might sic on you for this!

You and I could have some interesting discussions about how each of our professions contribute to the high costs of healthcare.

Posted by: SBG at June 28, 2005 11:08 AM

Brian, I can't argue with your reasoning. Increase out-of-pocket expenses and people will surely take more of a personal interest in their own health. But I am unconvinced that state employees are solely to blame for our current situation or that sticking it to them will alleviate the situation. While 1 out of every 5 adults are state employees are all of them taking advantage of the system like you suggest? Are even 10% of them taking advantage of the system? What would be interesting is if we could see some statistics concerning doctor and hospital visits of state employees vs. non-state employees. Are state employees visiting the doctor way more? Or maybe you have some stats on prescription drug usage of state employees vs. non-state employees?

I think we could all take better of ourselves. I also think state employees have a pretty sweet deal. But there is no way I could afford paying 50% of my family's medical expenses. If I'm not taking advantage of the system, should I be punished? Maybe that's too harsh of a word ... would an incentive based scale work on some level, where people that use the system have to pay more?

I have no idea. This post was very interesting and thought provoking, especially considering I am a person that looks longingly at Canada's universal health care...

Posted by: Shane at June 28, 2005 11:24 AM

SBG: Yes, I thought it best to create a highly controversial post ala what you and Shane did recently and take some heat myself for a day or two. That way, you two can get back to 'normal'.

Posted by: Brian Maas at June 28, 2005 11:34 AM

Shane: Oh, where to start where to start. Best thing is to pick this up at the dinner party. Too much to cover here but here's a few short follow-ups.

Shane Writes: But I am unconvinced that state employees are solely to blame for our current situation or that sticking it to them will alleviate the situation.

Brian: It's not sticking it too them. It's bringing them into alignment with the rest of us.

Shane: Are state employees visiting the doctor way more?

Brian: Yes, they are. And they typically just use the emergency room which is a higher cost to the state.

Shane: Or maybe you have some stats on prescription drug usage of state employees vs. non-state employees?

Brian: That's not the point. You are going to have high Rx usage in any sector of the population. It's that the state ends up paying much-much more for the drug since the employee has a low copay. It's not that way in most of the corporate world. Example, a one-month supply of Pulmicort, a inhaled corticosteroid, costs $320. In the states world, you pay $10 and the state pays the $310 balance. In my world, I pay a $50 copay and my company then pays $270.

Shane: If I'm not taking advantage of the system, should I be punished?

Brian: If you aren't using it, you aren't punished. Your premium stays the same...you just have a higher Rx copay when you do need a Rx.

Shane: would an incentive based scale work on some level, where people that use the system have to pay more?

Brian: Already in practice. Most plans have a 3-Tier benefit so you can still keep costs low. For example you would pay $10 for generic, $25 for a brand, and perhaps 40% for a lifestyle drug (such as Viagra for impotence).

Shane: I am a person that looks longingly at Canada's universal health care...

Brian: NOOOOOOOOOO! No, no, no. You think we have issues now? Why do you think we have Canadians coming HERE for medical procedures? I've worked with some of the most prestigious medical directors in the country. They all say the Canadian system is flawed.

Again, we can pick this up in person. Especially after a few cocktails. Maybe Craig can rent a jumper for us that night and we can work it out "outside"....but then we'd all just turn on the Cheesehead anyway.

Posted by: Brian Maas at June 28, 2005 11:56 AM

Obviously it's your page and you can write whatever you want. And I'm just visiting and under no obligation to come back. What I'm saying is your site is most interesting when it's about football. Or music. Or pets. Or whatever.
But if I wanted to read about politics... well, there are an abudance of (likely too many) sites out there already.
So like I said, you can obviously do whatever you want... that's just my suggestion.

Posted by: Neil at June 28, 2005 02:40 PM

Forget the jumper, let's get those inflatable sumo outfits and really have it out. I can see it now:

Shane knocks Brian down, Shane launches himself into the air and screams "This is for universal health care" as he squashes Brian.

Posted by: Cheesehead Craig at June 28, 2005 03:13 PM

I wish my critics were as civilized as Neil.

Posted by: SBG at June 28, 2005 03:32 PM

Dude, SBG, stick to pissing off Batlings :)

Posted by: Neil at June 28, 2005 03:49 PM

Ha! Yes SBG, you've got a real knack for pissing off batlings! Very good. You should see how ticked off you can really get the readers of BatGirl. That would be highly entertaining.

Brian, OK, the Canadian system is flawed, yet I have never, never, never, ever met anyone from Canada while I'm at the doctor's office. I keep on hearing Canadians are coming down here in droves to gain access to our clinics and hospitals, but yet I've never seen, met, or heard from any of them. Also, I seem to recall seniors driving into Canada to get affordable prescription drugs. Furthermore, you ask any average Canadian which system they would rather have and I would wager 95% of them will pick their own.

Isn't the statistic something like 1 out of every 5 Americans don't have access to healthcare? That is unacceptable to me. 20% of Americans can't go see a doctor? That is a system that is flawed.

I am of the opinion that universal health care would actually save us money because it would cut down on the bereaucracy currently sapping funds from our own system. One system, one bureacracy. And don't tell me the U.S. government can't handle it. They seem to do well with massive bereaucracies like the military and the Federal Reserve just fine.

I guess what it all comes down to is that you want gov't to be smaller, whereas I see the health of its citizens as a worthy function of gov't. Taxes would probably be higher, yes, but the altruistic idiot in me would be just fine with that.

The turtle is out of the shell! Now I'll sneak back in whilst you crush me...

Posted by: Shane at June 28, 2005 04:21 PM

Shane: I choose not to crush you. One of the reasons I've taken a shine to you, SBG, and even CC is that you actually listen to my side (as I do yours) and then have a open debate. Better the debate take place with a couple of pints in fron of us....but this is how it USE to be in the US of A. Now it's just polarized and if someone has something disagreeable to say the other person places hands over ears and yells "nananananananana".

And this will be my last post on this today. Time for my two favorite people to come home for supper.

I do agree we need to look at other countries for possible solutions to the healthcare crisis. But not Canada. Trust me.

Many experts would prefer a single-payer plan as the most efficient design for health distribution, but Japan has functioned well with a system of government and private insurance plans. With proper design, there's no reason the Japanese model of health care can't be imported as successfully as Japanese cars. And I say that as a German car owner who despise Japanese cars...but we'll save that for another day.

Also, doctors would not go for any type of socialized medicine where Medical personnel would become government employees. Note: Britain has socialized medicine (bad); Canada does not (good)!

Anyway, why force uninsured Americans into a flawed program that puts bureaucrats in charge of health-care decisions? One of the flaws with the proposals being considered by Congress, is that people be forced into Medicaid, the federal government's own "single-payer" health-care program for poor people.

The fact is, Medicaid's ailing and adding the estimated 40 million Americans who lack health insurance at any given time would make matters worse.

State-run Medicaid programs are in big trouble. Last year, 37 states spent more on Medicaid than they had budgeted and 20 states anticipated shortfalls in this year's spending.

If Medicaid rolls expand, the federal contribution grows, but so does the state contribution (back to that shut-down!). To many, spending more on Medicaid means less for education, law enforcement or a variety of state services. States have begun responding to these financial shortcomings by making cuts to Medicaid. They limit services, cut back on medication, curb treatment options and reduce payments to doctors.

The result, of course, is substandard care.

Things need to change but we need to move cautiously. If there were a quick fix, America would have found it by now.

Best thing for what ails you is a Guinness anyway, right?


Posted by: Brian Maas at June 28, 2005 05:36 PM

This sounds like eugenics with a capitalistic flair.

Anyways, if you want to ensure affordable healthcare look into tort reform--not legislating behavior.

Posted by: Gendo at June 29, 2005 04:19 AM
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