Category Archives: Healthcare System

A Headline You Didn’t See

In the past couple of weeks do you recall seeing this headline?

“Painkiller Overdose Deaths Triple in Decade”

Maybe?  Not really?  What about this one?

“Vitamins May Lead to Premature Deaths”

Ah yes, you remember hearing something about that.

A few weeks ago I discussed a new study’s conclusion that vitamins lead to premature death.  It was widely covered.  This week, I only saw one report pertaining to the first headline.  That strikes me as odd.

Why the difference?  Is there a media bias against vitamins?  I ran a google search to see if the difference was real or perceived.

I searched painkiller overdose and vitamins and early death over the past month.  There were nearly twice as many results for the vitamins (700,000) as the painkillers (375,000).  I understand a simple google search isn’t scientific.  But that’s a huge difference.  What gives?

Honestly, I don’t know.  I’m a big proponent of vitamins, so naturally I suspect some sort of bias.  Where this bias comes from I don’t know.  Perhaps because vitamins are less regulated than prescription medicines they seem less safe.  It’s clear, however, regulation doesn’t always mean safer.

Since 50% of Americans take vitamins, a “Vitamins can kill!” headline grabs more eyeballs.  In today’s media, it’s all about eyeballs.  I’d certainly say that plays a major role.

Is there anything else?  An agenda more sinister lurking beneath?  That answer isn’t clear.  But, to me at least, this type of bias can’t continue to be denied.

Am I nuts?  Thoughts?  

Why you wait at the doctor’s office

Today, we’re going a bit off the diet and nutrition norm and giving some insight into a common gripe about our healthcare system, waiting at the doctor’s office. 

We’ve all spent too long sitting in the uncomfortable brown upholstered chairs with the wooden arms reading 3 month old issues of TIME Magazine.  If the wait is long enough we may even curse that the puzzles in the Highlights magazine were already completed

We shouldn’t have to wait 30 minutes before being taken back to an exam room, only to wait 15 more minutes until the doctor arrives.  It’s aggravating.  Especially if you took time off work or have a sick kid with you.  So what’s the deal?  Is the doctor’s office just that badly mismanaged? 

Well, maybe.  But most likely it’s other factors.  And although it may not help calm the seething frustration, it can be useful to know exactly what is causing the delay.  The delay is caused by….sick people. 

Ok, duh.  There’s sick people in a doctor’s office.   But it’s not just sick people, it’s actually sick people not knowing how sick they are.  Let’s first look at how a typical doctor’s office sets appointments:

  • A typical office appointment schedule works like this.  For each type of appointment (i.e. wellness exam, acute illness, chronic illness checkup)  a certain number of minutes is allotted.  Say, 15 minutes for a chronic illness exam, 30 minutes for acute illness, 45 minutes for wellness exam (full physical).
  • Each doctor’s office sets its own allotments and appointment ratios.  For example, in a typical day there may be allotments for 5 chronic illness exams, 2 physical exams, and 10 acute illness exams.  They may also leave time for emergency appointments.  Each office is slightly different, but most follow this general pattern.

So, if the doctor’s office has allotted 15 minutes for a chronic illness and the time spent with the patient runs over, the next scheduled appointment will be late.  Why does an appointment run late?  Well, as we said the patient doesn’t know how sick they are.

          An Example: Farmer Dave comes in to see the doctor for his twice yearly blood pressure check.  Typically this appointment is for the doctor to check Farmer Dave’s blood pressure, ask questions about how he’s feeling, or maybe review the log of his blood pressure readings the doctor asked him to record since their last meeting.  Everything looks fine. 

But, while performing his usual exam, the doctor notices something strange about Farmer Dave’s heart sounds.  Since Farmer Dave is only there for his blood pressure check (a 15 minute allotment), he’ll have to schedule another appointment to address the potential heart issues, right?  Of course not.  Now a 15 minute appointment may turn into an hour exam.  And, you’re left sitting in the waiting room discovering an artery-clogging recipe for Chicken a la King in a really old issue of Southern Living. 

Farmer Dave is just one example.  There are dozens of other reasons an appointment may run over.  A doctor getting called to the hospital for an emergency is another common schedule busting problem.

This info may serve as little comfort when you’re being inconvenienced.  So check back for Friday Focus when I’ll give ways to minimize your time spent in the waiting room.

So this Individual Mandate I keep hearing about….?

This is an occasional post covering healthcare systems in the US.

The debate over healthcare reform rages.  A little over a year ago the Patient Protection and Affordable Care Act was signed into law by President Obama.  Since then, much of the fight over implementing the new law has centered on the so-called “individual mandate” provision of the law. What is it? Why the debate? And how does it affect you? Class is in session.

What is the individual mandate?
The individual mandate states that starting in 2014 every American must have health insurance. If you currently do not have insurance, you will be required to purchase a minimal coverage plan or pay penalties.  Think of this like the law requiring liability coverage if you operate a motor vehicle.

Individuals making up to 400% of the federal poverty level (currently the federal poverty level is $11,800 for individuals and $24,000 for a family of four) will receive monetary help to buy coverage.  The less you make the more help you’ll receive.

So, what’s the point?
The idea for the individual mandate is to provide insurance companies with additional customers to offset the insurance rule changes the law set forth. These rule changes include: Insurance companies can no longer, not accept someone for pre-existing conditions, drop patients for getting sick, and set lifetime limits on benefits they will pay.

The Debate…
All those in favor say aye
Supporters say the only way insurance companies would agree to the new regulations would be to increase their risk pool. Meaning they needed more healthy paying customers to offset their increased losses from the new rules. Requiring all citizens to purchase insurance is intended to provide these new customers.

Those opposed…
The primary argument against the individual mandate is the federal government cannot require citizens to buy a privately offered product or service. Opponents are worried if the federal government makes this requirement, it will open up a Pandora’s box of other requirements. This is the crux of the lawsuits contending the individual mandate is not constitutional.

(In the case of the auto insurance requirement, individuals can opt out of the law by simply not operating a car.)

As you can imagine, there are multiple other arguments regarding the overall scope of the law and how the individual mandate affects its stated goals. However, I believe the arguments listed above are an accurate reflection of the primary issues being contended.

How it affects you.
Theoretically, if you already have employer based insurance the individual mandate will not effect you. In fact, the new rules on insurance companies will help. Unfortunately, things rarely work out exactly according to theory. Over time, the total effect of the individual mandate is unclear.

If you don’t currently have insurance, the individual mandate will require you to purchase minimal coverage or face penalties.

I hope this post allowed you to at least have a better understanding of what all the arguing is about. (And it didn’t bore you too much.)

For more information on the healthcare law check out this website.  To hear more opinions on the implications of the law try these blogs. One from the right, and one from the left.

Healthcare and Business: Like Peanut Butter and Pickles

For the first Healthcare Thursday I’m going to keep it simple.  Healthcare is excruciatingly complex, but today I want to boil it down to an odd analogy.

I have a unique perspective having been trained in both healthcare and business.  From my perspective, healthcare and business go together like peanut butter and pickles.

Stay with me here. The goal of healthcare (at least as far as most in the field are concerned) is treating patients. Making them better or more comfortable.  It’s a noble goal, and the siren song to which all healthcare professionals respond.

In business, the goal is quite different.  The primary goal of business is to maximize profits.  This is taught in business school.  Without a doubt, there are businesses with altruistic goals. They may sacrifice some profit for the social good.  And, of course, there are non-profit businesses. But, without exception, a shareholder owned firm in the United States has one goal: maximize profits.

Here’s where we hit trouble.  Now we have goals that, although not completely at odds, mix in a manner that may not be all that appealing.  Hence, healthcare and business go together like peanut butter and pickles.

I’m sure there’s people who LOVE peanut butter and pickle sandwiches. (Didn’t Elvis? Or was that peanut butter and bananas?)  Likewise, some healthcare organizations blend together the moral goals of healthcare with the profit goals of business quite well.  Most, though, find the mix a little odd or confusing.

Essentially, this is the crux of the healthcare argument.  Where do we find that right mix of peanut butter and pickles to highlight the best of each, and maybe even complement each other? 

If all we care about is peanut butter (healthcare), everyone will get every treatment they want for free, but we may bankrupt the country.  If we choose just pickles (business), only those that can afford treatments will get them, and we’ll have millions of people suffering needlessly.

What’s the right mix? 

Of course, this is an over simplified analogy.  There are a dizzying number of interwoven issues that effect how peanut butter and pickles taste together.  (Chunky or creamy? Dill or half-sour? Between bread or dipped?)  

But understanding the competing, yet potentially complimentary, goals of healthcare and business gives a base to decifer the debate that rages over healthcare policy in the United States.

Perhaps someday Americans will like nothing more than the comfort food we simply call, PB&P.