http://biz.yahoo.com/ap/061028/america_the_bankrupt.html?.v=4
David Walker, US Comptroller General, who brings credit to my profession so sullied by the mischief of CFO's of Enron, WorldCom (and others), is doing a fiscal wake up tour. This is worth a read for any who wish to have an overview of some important issues.
I’m particularly interested in the Medicare part of it, most particularly the bolus of baby boomers heading toward Medicare. Having spent a few years in the disease management industry, I will tell you that the increasing incidence rates in chronic diseases is horrifying. Why does it matter?
It’s important to know that other people’s illness affects your pocketbook. Insurance companies spread the risk; they do not absorb the risk. And when risks are spread through the system, healthy people have to bear the burden of increased costs. Mind you, the risk is not pro-ratably spread, but it is spread nonetheless.
There are 6 major chronic diseases: diabetes, coronary artery disease (CAD), congestive heart failure (CHF), chronic pulmonary obstructive disorder (COPD) and asthma. Two additional conditions, hypertension (high blood pressure) and hyperlipidemia (high cholesterol) are also on the rise. Among the 8 conditions, there is high co-morbidity—meaning folks with multiple conditions. A person with coronary artery disease may also have diabetes, hypertension and hyperlipidemia. The prevalence rates (the % of people who have the disease) varies among the conditions and there is and varies among geographic area. For example, the Midwest has a notably smaller prevalence rate of asthma than the South.
Did you know that lifestyle is a major contributor to the increasing incidence rate (the number of NEW people who have the disease) of chronic diseases? Yep lifestyle. You can see it by going to the mall or the beach and looking at the bulging waistlines. The big three lifestyle variables are exercise, weight and smoking. Each of these lifestyle components is controllable by individuals. Other factors include age and genes, neither of which we can control.
The 80/20 rule is alive and well in health care spending. 20% of the folks will drive 80% of the costs. Here’s a couple of tables that lifted out of a paper that you can find here. http://content.healthaffairs.org/cgi/content/full/hlthaff.w3.603v1/DC1
In Exhibit 1, it is notable the differences between the top 20% and the top 1, 5, 10% respectively. The very sick are very expensive.
Now look at Exhibit 2.
Of the top 5% in spending per beneficiary, 47% have CHF and 35% have diabetes. Chronic diseases are acetylcholene to health care costs.
The numbers are so large, that small changes yield big payoffs.
4 comments:
Don't forget to mention the tons of money Terry "the punk" MacAuliffe made on Global Crossing, before it went the way of Enron. And I will not go into Arkansas commodity trades...this time.
Medicare, which you address nicely, is a topic that deserves serious, non-partisan discussion. I have followed my mother's 97 year journey and have had generally very good experiences with her Medicare and medi-gap insurance ($486.00 every two months).Services are performed, bills are paid, statements are received and followup letters requesting us to verify treatment to prevent fraud arrive shortly after the bills are posted for payment. Her Part D prescription is great. Herein lies a story. The State of Illinois (Democratic - you know where this is going already)passed a bill to pay the senior Medicare Part D coverage, using United Health's program which is AARP's (who lobbied Illinois to use that program). Her premiums were estimated at approximately $27.00/month. She moved from Illinois to Ohio in March...and I can't get Illinois to stop paying her insurance premiums. Calls, letters - I even had my attorney bet me he could stop them...he lost, I received a great lunch with a premium cigar. As a Republican who does not wish to be either a victim or freeload
off others, I can see from this small slice of political largesse that the government is not going to cost contain health care. I will get it changed, although my mother, an FDR Democrat, loves the freebie.No wonder the Dem. governor is under investigation, along with his cronies, on other corruption charges. To sum up, my mother is benefitting from Medicare very well.And she will continue eating butter, making gravies, eating beef and pork, sausage, baked goods and fried chicken in lard.Rambling on...
some of our organic friends will die prematurely eating diseased veggies, or keel over and die while jogging. The point being: Genes are especially important in assessing health habits and directing life regimens. We are not at that point yet in medicine, although three of my cousins who are physicians think we are not far away (one is Barak Obama's Cook County campaign coordinator...FYI). Let's not be too too hasty trying to pinpoint Medicare solutions or one's lifestyle effect until we master The Law of Unintended Consequences.
YOUR HAVE MANY GOOD THINGS TO SAY. I RESPECT YOUR EFFORTS HERE.
T_ Thanks for your post. "The point being: Genes are especially important in assessing health habits and directing life regimens."
The increasing prevalence of metabolic disorders (obesity/hypertension/hyperlipidemia) are not due to gene mutations but behavior mutations, specifically dietary and exercise related, though I grant you that genes may well help stave off risks when one's behaviors are not accommodating. I'd also posit that behaviors can mitigate risks when one's genes are not so accommodating.
Note that my intent is not to mandate, but rather to educate. These recommendations are widely accepted in the medical community and the intended results are well documented though not widely practiced, even by me. I realize that is a bit of hypocrisy that I need to address!
So I'll stand by my simple recommendations as being things that each of us can practice. They are not hasty and require no mastery of the Law of Unintended Consequences, unless there is some ill-aboding consequence of a populace that consumes less in medical services.
And to your mother, may she continue to enjoy good health.
No mandates? I thought you were a liberal. Is this the first step towards redemption?
I'm in court the next three days. I hope you have a new POST in your very nice blog by the time I return.......You are too good to lead us mere mortals without regular tidbits of your substantive expertise.
I suspect that a unintended consequence of the way health insurance pays so much of our coverage, starting from almost the first dollar, is that many of us don't have the incentive to pursue health as we should.
You're absolutely right: small changes yield big, big benefits. ("Big doors open on small hinges.")
My father surprised his doctor by controlling his diabetes with diet and exercise; he never took the drugs his doctor wanted him to take.
When I developed high cholesterol a while back, my doctor wanted to put me on medication immediately.
I refused.
Instead, I altered my eating, including: adding much more fiber to my diet; healthy Omega 3 oils; almonds; walnuts; garlic; salads made with olive oil (and including onions); fatty fish (like salmon), and fruits and vegetables rich in vitamin C and beta carotene.
I was retested about eight weeks after I started my regime. My doctor was stunned, honestly stunned. My cholesterol count, which had dropped considerably, was still a tad on the high side, BUT my HDL level was so high -- over 100 (50 is considered to be very acceptable; 60 excellent)-- with the result that my HDL/LDL ratio a tad over 1 (4 and under is very acceptable.)
He told me that he had never, ever seen an HDL count so high in all his years of practice and, of course, felt that there was no point in taking Lipitor or other medication.
Result? My doctor and I don't discuss the M word (medication) anymore.
btw, one should be mindful that all medications are, in a certain sense, unnatural -- which is why one risks side-effects and potential negative health effects in taking drugs. You'll see a long list of potential side-effects associated with Lipitor in the company's advertising.
This is not to say that sometimes drugs are life-saving -- they can be -- but nothing is more life-saving than good health practices.
It's not a lot to ask of us: watch our diets; exercise moderately; get regular screenings if we're at risk for anything.
Also add to the list: regular sleep; moderate alcohol consumption; no smoking; stress avoidance.
For the record, neither I nor any of my siblings has diabetes; my father and two of his siblings did and, I believe, so did his father.
My siblings and I are definitely at risk, but almost all of us pays attention to our diets and weight.
Has that attention played a protective role for us? Who knows?
I suspect it has.
I like your site very much. Thanks for putting it up for us.
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