Saturday, October 11, 2014

Will Work: Caring for Myself, Family and Country


Americans have yet to address healthcare efficiency as a priority. Health care reform offers an enormous potential for boasting the economy's prospects. If we can emulate Canada and only spend 11% of GDP on health care we would save $950 billion a year.[1]
 
In the last five years I have been taking care of all aspects of my Dad’s affairs.   

The estimated economic value of unpaid work by some 42 million family caregivers in 2009 was $450 billion according to AARP. ...the total Medicare spending in that same years was $509 billion ...nearly $ 3 trillion was estimated in lost wages, social security benefits, private pension for men over fifty caring for their parents. Met-life estimates roughly $350k for woman and $284K lost for man for a typical fifty -years and over caring for their parents.[2]
 
Due to being self-employed just a few hours a week has allowed me insight as my father’s advocate.  

A large part of my father’s life was devoted to bettering the healthcare system in the U.S. and it was indeed a challenge.   Now he is nearly  91, I find as I care for him and myself it is no accident of our present healthcareless situation.

Many years ago, the Washington Post referred to my Dad as “the unobtrusive shaper of law.”  He spent over four decades of his life writing major healthcare legislation as a Congressional lawyer and researcher, including being a member of staff on the House Ways and Means Committee assisting with all facets of Medicare, Social Security, Disability Insurance reform and other endeavors.

Recently I applied to work for Encore.org since I have for 15 years looked for full time work.  My expertise is in pollution prevention and recycling oil, paper and other secondary materials. My past efforts in lessening waste and advocating resource conservation has not translated in any job offers. Interestingly, my home town is where the first Civilian Conservation Camp helped begin to employ millions during the depression.  

Presently our economy totals 15 trillion dollars.  U.S. total healthcare expenditure is $2.7 trillion or 18 percent of GDP.  It is forecast to reach 34 percent of GDP by 2040.  In 2010 Americans spent $1.3 trillion on healthcare. Multiple chronic illness cases that are just one percent of healthcare expenditure consume 21 percent of this total amount.  The last tier of 50 percent of patients accounted for 2.8 percent of spending last year.  Contrary to popular opinion only 10 percent of healthcare dollars are spent in the last year of life.  While there is increased spending in the last few months approaching death, it is not the massive percentage of medical care dollars that is widely believed.

Healthcare spending is forecast to account for nearly 20 percent of gross domestic product (GDP), or one-fifth of the U.S. economy, by 2021.  It’s been estimated that wasteful spending may account for between one-third and one-half of all U.S. healthcare spending.  The largest area of waste is ‘defensive medicine’, including redundant, inappropriate or unnecessary tests and procedures. Other factors that contribute to this excessive spending include non-adherence to medical advice and prescriptions, alcohol abuse, smoking and obesity.

A chief factor of the high costs is that in the United States-- compared with other industrialized nations--we do not monitor or intervene in medical pricing, aside from setting payment rates for Medicaid and Medicare for older people and the poor. We allow for this government waste.  Many other countries deliver healthcare on a private fee-for-service basis, as does much of the American healthcare system.

Why is there not new employment opportunities making our health care more efficient and less wasteful? How is medical overspending monitored?  Who is questioning what care is of benefit and whether it is truly needed?   Whose role is it to make our medical care more efficient?   How can we determine what tests and procedures will benefit the patient in question?  Do certain operations, medications and devices add to the better quality of life of the given patient?  The bottom line is that we the people must act in reducing these galloping healthcare costs.

Why do Americans pay more for medical care than other people in other countries?  Ironically, we prescribe more expensive procedures and tests whether or not other countries operate a private or national health system. There is a need to best account for who is responsible for controlling healthcare costs including lawyers, doctors, insurers, hospitals, drug makers, and patients.

The United States spends about 18 percent of its gross domestic product on healthcare: nearly twice as much as most other developed countries. The Congressional Budget Office has said that if medical costs continue to grow unabated, “total spending on healthcare would eventually account for all of the country’s economic output.” Federal spending on government healthcare is cited as a primary reason for long-term deficits.

American medical companies can set charges for their products without marketplace competition and government intervention. Contrary to the economic laws of supply and demand, many healthcare products can remain overpriced and even increase in price over time instead of dropping. For example, the price of a total hip implant increased 300 percent from 1998 to 2011 according to Orthopedic Network News.

Presently many payments are negotiated between a doctor, hospital or pharmacy, and an insurer. Insurers have constrained ability or incentive to get the best price, and they can raise premiums to cover costs.

Who is advocating for the consumers? While doctors may agree that they have a responsibility in containing costs, actually doing this is another matter.  They also cite awareness of the costs of tests/treatments they recommend. 

Most physicians may agree to strive in the best interests of their individual patient’s; however, what specific procedures and tests they give them is all over the board.  Whether they focus on cost management and also juggle what is in the best interests of their patients is questionable. Physicians are concerned about financial losses as a result of cost reduction efforts.  While employers are educating their patients to healthcare costs, many doctors advocate for better healthcare cost management.

Greater awareness of medical costs and understanding the true price of such care will lessen overspending.  Changing doctors, consumers’ and insurance companies’ attitudes regarding lesser costs and motivating better care given limited resources is a huge social and economic issue requiring common political will. 

Today the United States spends 5.6 percent of the national healthcare spending, or $113 billion, on mental health treatment.  Most of this goes toward prescription drugs and outpatient treatment. Our country had 156,300 mental health counselors in 2010, and access to mental healthcare is pathetic compared to other types of medical services.

It is difficult to find any peace of mind with our mental healthcare system. For example, how depression, anxiety and other ailments directly affect our bottom-line can only be speculated.  Also, the degree to which such mind states related to obesity and other major diseases today is difficult to track.  Loss of worker productivity and other indirect costs for mental treatment, therapy and other associated facets of mental illness are difficult to fully measure. 

Mental healthcare is expensive, with 45 percent of the untreated citing cost as a barrier. A quarter of the 15.7 million Americans who received mental healthcare listed themselves as the main payer for the services according to one survey that looked at those services from 2005 to 2009.

Greater information regarding expensive treatments with no proven benefits allows the public to better evaluate their treatments options. If consumers, the patients, can see prices before services are provided, that can help create better value.  Presently patients see little of what their full medical costs are. Improved quality data on hospitals and doctors could better the medical marketplace.  Patients with insurance pay a tiny fraction of the bill, providing scant disincentive for spending.

Presently my health care consumes well over one-third of what I earn.  For many decades I worked in resource conservation.  Medical overspending today is just another reason to champion the value of waste reduction. Perhaps I can create some potential employment opportunities in advocating better healthcare management practices, or even stress management options to the greater public.

I have spent thousands of hours exploring diverse areas of stress management and mental wellness. For several years I taught mindfulness meditation at my local hospital right across the street from the National Institute of Health here in Bethesda, Maryland. Every day I exercise and best focus on how to foster my own well-being.  I also do this for many family and friends.

For last 18 years I have learned to better address my anxiety.  I have been fortunate to be able to cope with a more and more demanding world. I have been reluctant to share my plight with my HMO and spent out-of-pocket tens of thousands of dollars of my own money to manage my own mental health.  This exploration has been my most valuable financial investment since I have become more mindful as to how to keep appearances up and costs down. However, stress and increasing global tensions continue to augment as our population and social conditions evolve. It is wise to question how we going to fix our healthcareless system so as to prosper in years to come.

The sooner we Americans face this opportunity the better we will be.  I wish to employ myself in caring in this very careless time.  All Americans are mutually tied in what happens in healthcare.  Our very well-being and future prospects forces us to courageously agree to transform this wasteful crisis—into a new frontier of opportunities.  If only we can collectively care together will such new jobs emerge.  I will work to better care for myself, my family and country.




Saturday, October 04, 2014

Climate Intelligence?


Recently a friend of mine asked me to talk to another friend about climate change.  Friend X, a highly educated individual does not believe that humans impact our weather.   So my response was three-fold.  First, I would challenge friend X to see what our military has observed in the last few years.  Secondly talk to the other experts where roughly 97% of the scientific community agreed on such a thing in the past.   Finally, let’s see what the insurance and financial industry experts say about this warming. 

Several years ago a number of retired generals and security experts presented national-security study. Using the military's risk-assessment practices, 11 retired generals and admirals issued a report saying that climate change creates massive instability around the world.

"The impacts of climate change will be huge — deserts move north, coastal areas threatened, the dislocation of people," said retired Adm. T. Joseph Lopez, who commanded peacekeeping forces in Bosnia. "I'm a student of instability, and instability is the enemy.”1   

Below is what NASA writes regarding scientific opinion on climate change;

Ninety-seven percent of climate scientists agree that climate-warming trends over the past century are very likely due to human activities, and most of the leading scientific organizations worldwide have issued public statements endorsing this position. The following is a partial list of these organizations, along with links to their published statements and a selection of related resources.2

Finally, insurance actuaries and underwriters document the increased property damage and challenges to provide coverage to their clients.  A LA Times June op-ed opinion states;

A number of recent studies by the Insurance Information Institute have singled out Florida as having the most exposure to the combined impacts of climate change, but its governor, Rick Scott, and Sen. Marco Rubio are on record dismissing the threat. And yet everyone can see that sea levels are rising.3

I challenge anyone to explore what the military, scientist and the finance community is doing.  Just read in Forbes magazine in May below;

“The heavy losses caused by weather-related natural catastrophes in the USA showed that greater loss-prevention efforts are needed,” says Munich Reboard member Torsen Jeworrek.

He says that the United States suffered $400 billion in weather-related damages in 2011 and insured losses of $119 billion, which were record amounts. In 2012 — and despite Superstorm Sandy — losses were well above the 10-year averages at $165 billion total, of which insurers paid $50 billion. In 2013, insurance companies paid out, globally, $45 billion in claims, says Zurich, adding that the United States accounted for $19 billion of that.4

Climate change is no longer a question of “if” rather how much and what it “will” cost us.



2 http://climate.nasa.gov/scientific-consensus/
4 http://www.forbes.com/sites/kensilverstein/2014/05/18/rift-widening-between-energy-and-insurance-industries-over-climate-change/