Rauser Health Review

This Just In From the Congressional Budget Office

2009-06-17T16:16:00.004-05:00

Blogs by definition are supposed to be short. Indeed, this one will be very short.

If you have any interest in health care reform and what will or will not work, you must read the just released Congressional Budget Office document entitled 'Health Care Reform and the Federal Budget'.

It may take you 30 minutes or more to carefully read and understand this 16 page tome. If however you are overwhelmed by the politics of health care reform and confused by the disparate points of view, would a 30 minute investment of time be worth it to get to a modicum of reality?

I beg you to read this CBO paper. Please! Then ask your friends to read it. I dare you to ask your local and state legislators if they have read it. Transformational health care public policy should be based on unfiltered unbiased information. Get informed now. Then get involved.

Thank you.

Spending on Health Care: A Couple of 'Trick' Questions

2009-05-08T15:45:00.011-05:00

Do you know what the average life expectancy is in the United States? Now, do you know what the average life expectancy is in Canada or Great Britain? One more; do you know the average life expectancy of practitioners of the 'Christian Science' faith?

As a percentage of our GDP, we in the U.S. spend far more than any other country. Those that practice 'Christian Science' by definition spend hardly anything. I'd wager the life expectancy of all three populations is about the same. So can one conclude the amount we spend on health care does not translate to a longer life . . . . . or even better outcomes?

I think we spend so much more on health care as a nation is largely because as the richest country in the world, we can! (Perhaps I should use the past tense as something about our current financial crisis suggests we may never again have the luxury of such excess.) The 2.6 trillion dollar question becomes, who will be the governor of how much we spend going forward? And related to that, is it "fair" for some to have unlimited health care resources while others will not?

Many countries allocate their defined health care budgets equally throughout the entire population. Long waits and rationing are the means by which the budget is not exceeded. Those that can afford to do so, just go elsewhere and pay for whatever care they want and can afford.

Health care research and technology has evolved to the point where it will bankrupt our country unless limits are set. I wonder if all the talk about ways to reform health care is just a stall tactic until we dare to take on the ultimate question: how much should we spend on any one life? Our country's history suggests we will develop a unique and very special way of solving this most vexing riddle.

Penny Wise And Pound(s) Foolish!

2009-05-06T22:11:00.003-05:00

The local papers are reporting on school districts cutting various programs in an effort to balance strained budgets. On the chopping block: physical education! How can that make sense?! With child obesity almost epidemic, shouldn't we be spending more time in schools teaching the values of exercise and nutrition? (Was there ever a more rhetorical question?)

Every health care reform proposal includes wellness and prevention as a top priority. Employers have assumed the responsibility for promoting wellness but why not start at an earlier age. This should be a top legislative priority.

Health Insurance Renewals for Small Groups: Mid Year 'Report Card'

2009-05-05T17:29:00.003-05:00

Our Agency works with many small businesses who have health insurance primarily on a fully insured basis with one of four insurers. We've pretty much completed January 1 thru June 1 renewals so I asked for a comparison of last year's renewals to this year. Here are the mid-year results:

2008 +17.31% vs 2009 +16.86%; clients of Insurance Co. A

2008 +20.26% vs 2009 +22.08%; clients of Insurance Co. B

2008 +16.40% vs 2009 +19.88%; clients of Insurance Co. C

2008 +10.61% vs 2009 + 8.45%; clients of Insurance Co. D

All Clients Combined: +16.96% 2008; +19.18% 2009

The above increases are almost always reduced to single digits after plan design changes and/or underwriting with a new insurer. Never the less, what does it say about 'our' insurer's ability to "manage care" if during such troubled economic times and with all the political pressure to contain costs, premium increases like these are still needed to cover more expensive health care and greater utilization!?

Results like these are used by many as proof we need to move to a government run plan as the pace of health care inflation is clearly unsustainable. But such a conclusion misses the more important point. Simply changing payers will either lead to the bankruptcy of the government or rationing of care. Fortunately, as serious reform talk heats up in Washington, the brightest prospects for meaningful "change" address systemic reform of the way we deliver health care.

And might I add that under our current system, at least I have the option of moving to Insurance Company D!

More Small But Encouraging Signs Of An Economic Recovery

2009-04-07T09:20:00.008-05:00

Yesterday's mail included one of those 'check' packets from my Master Card vendor; you know the ones I mean - the blank checks that offer you the opportunity to more easily spend money you don't have! As I tore them up, it occurred to me it had been several months since I had received one of those mailings. Coincidentally, later in the day I called a bank where I had financed an auto on a routine service issue. At the end of the call, the customer service representative offered me a new "Platinum" credit card with a significant limit and "no annual fees"!

Although almost inconsequential, would either of these occurrences have happened just a few weeks ago? Hopefully it's a sign the credit markets are loosening and more evidence the economy is turning (along with the stock market rally.) I know we're far from being out of the woods but for those of us looking for any good news to assuage the angst of recent months, it may be worth sharing. What about you? Have any good news?

It doesn't seem to have much to do with health care . . . . . . . . or, does it!?

A Dose of Good Economic News

2009-03-03T14:25:00.003-06:00

We all know the media never reports on 'safe landings' thus the daily news about the economy is almost exclusively awful. And such negativism seems to be feeding on itself. Well here's my own positive anecdote which will (hopefully) give you reason for a little optimism.

I was in the Twin Cities over the past weekend and drove to Bloomington to visit the IKEA store across from the Mall of America. As I got near my exit, traffic was backed up onto the highway. It took me about 20 minutes just to navigate the short distance from the interstate to the IKEA parking structure; which, if you have never been there, is a huge two story garage . . . . and it was full! When I finally got into the IKEA showroom it was a mob. I can't even begin to estimate the number of people. I've never seen anything like it. And we're supposedly "in the greatest economic downturn since the great depression?!?!" Not from what I could see.

I didn't even bother going across the street to the Mall. The traffic resembled Miller Park on Opening Day except I'm sure there were even more people shopping at just these two venues.

Take heart friends. There are people spending money. Don't believe everything you read.

Wisconsin State of the State Address

2009-01-29T08:45:00.003-06:00

Governor Jim Doyle did yeoman's work last night delivering somber news about Wisconsin's budget issues which are sure to be exacerbated with the state of the economy and shrinking revenues. No one appointed me as the Siskel & Ebert of political speeches but I just thought he struck the right balanced tone.

My personal interest was in what ways he would address health care. Would he take on big, bold new programs? (Apparently not.) Would he be content with Wisconsin's achievements at covering the uninsured? (Only a couple of states do better.) Would he finally allow state tax deductions of HSA contributions? (Not a peep.)

Beyond the message itself, to get the full value of the State of the State address, one has to watch the audience reactions to the Governor. (You can easily do so at our state's version of C-Span, Wisconsin Eye.) Getting Republicans to applaud (much less stand to) a Democratic Governor's proposals is no easy task but when that does happen, it surely must foreshadow legislation that will quickly pass. Such was the case for the proposal to require health insurers to cover autism treatment. I wish in a free market certain carriers would offer this coverage and have a competitive advantage for doing so but since ample time has been allowed for that to happen, I'm ready to concede there may be a need for this mandate . . . . . . . . even though it will have an effect on premiums. (Fortunately, there are many ways to reduce costs that can more than offset a new mandate; those ideas are also percolating in Washington and Madison.)

All in all, I agree with the Governor that tough times create opportunity. After the first bipartisan standing ovation, it seemed several others more easily followed. Perhaps this was symbolic of the realization (only now?!?!) that the time for divisive rhetoric has ended. At the end of the speech, everyone went off to various receptions. I would have preferred if they had rolled up their sleeves for a long night of work!

Do Retailers Woes Foreshadow Health System Closings?

2009-01-23T02:31:00.003-06:00

There was an interesting article at Forbes.com this morning speculating about which giant retailers might follow Circuit City or Linens & Things into bankruptcy or at least dramatically reduce the number of locations. The big names mentioned certainly gave me pause. The article described this contraction as the "inevitable counter punch to the days of fighting hand over fist for market share during an era of loose credit and minuscule interest rates".

When reading that line I couldn't help wonder if the same dynamic is responsible for our local health systems sudden cessation of expansion projects. Did retailers lust for market share also drive health systems to needlessly expand beyond our capacity to sustain them?

Many have argued that building new hospitals drives up health care costs. For them it must logically follow, that as one or more health systems fail, costs will come down. Something tells me it won't be that simple!

"HIGH" DEDUCTIBLES PUT INTO PERSPECTIVE

2009-01-19T06:49:00.003-06:00

Health systems (hospitals) feeling the pinch of the new economy are at least in part ascribing their cash flow problems to difficulties collecting from patients insured by the high deductible health plans I often recommend. Allow me to offer some perspective.

In January of 1970 my father died. He had the same kind of brain cancer that Senator Kennedy now has. Dad had two surgeries over four months and was hospitalized most of the time before he succumbed. He was insured by a major medical plan with a $250 deductible and a lifetime limit of $50,000. I remember that so well because we actually worried about paying for his treatment if the cost exceeded his coverage. In the end, it did not.

Now adjust that $250 deductible by the consumer price index over 39 years (or if you really want a shocking calculation use a medical inflation index); to represent the same percentage of out of pocket expense, health plans today should have a deductible of $1500 or more!

What about the quality and cost of treatment for a malignant glioma in 2009 versus 1970. Senator Kennedy has already outlived my Dad but surely with a cost that would (again) be bumping up against the much higher $2-5 million lifetime limits of today's policies.

Health systems (indeed Medicare, Medicaid and we as individuals) face financial peril not because the insurance plans used to finance care have higher deductibles; they (we) are in trouble because we can not afford the underlying cost of delivering care.

Deductibles and coinsurance are actually very old plan design tools used to engage consumers in the cost of their care. Now that such engagement is actually happening, those health systems that deliver quality care at lower costs will survive and prosper despite today's economic conditions.

CAN THIS BE RIGHT: A Physician Office Visit Is Worth Just $26?!

2009-01-16T04:28:00.005-06:00

Surely I must have heard this before as people have been talking about low Medicare/Medicaid reimbursement levels for years. Somehow though, when I heard this number the other day it just seemed so ridiculous: primary care physicians are paid just $26 from Medicare for each (1/2 hour) office visit.

What behavior does this low reimbursement produce? Is the doctor motivated to jam more patients into every hour? Does the doctor have time to discuss preventive medicine and lifestyle changes? Is it easier - and more profitable - to instead 'prescribe' other tests, services and drugs that produce additional revenues?

And, if the more profitable revenue streams must come from services performed in a hospital setting, isn't it logical that physicians would align (sell) themselves to larger health systems?

At the root of many of our health care cost problems is a perverse system of government payment levels. Although private insurers pay more for like services, it is not all that much more and still off a model that is fundamentally flawed.

Is there a better example of how government is the problem, not the solution?!?! I'd love to hear more from other physicians about additional ways in which government and insurers incentivize incorrectly. Oh, but that probably won't happen as long as their contracts include 'Gag Clauses'!

MPTV Health Care Report January 2nd: What Surely Must Have Been Left on the Cutting Room Floor

2009-01-06T03:45:00.002-06:00

Milwaukee Public Television aired a 27 minute report over the weekend entitled "Critical Condition: The Wisconsin Perspective". Featured were three individuals with serious health conditions. While it appeared all three were coping pretty well with the physical aspects of their illness (two cancers and MS), the focus of the show was the financial impact. I am so blessed to have good health but that is not the case with many friends, family members and clients so I do not want to trivialize how difficult dealing with illness can be. Having acknowledged that, the MPTV production - and so many others like it - repeatedly attributed the cost question to "affordable" health insurance.

For example, one of the featured individuals was working in California when her cancer was diagnosed. It wasn't clear to me her reasons for returning to Wisconsin but she did so without health insurance. Why didn't she have insurance? The report didn't ask that question but instead vilified health insurers for not wanting her as a customer with a 'pre-existing condition'. (Presumably it is also just wrong to deny someone homeowners insurance after the house is on fire.)

Maybe this particular featured patient returned to Wisconsin because our legislators have already provided at least two remedies for the uninsured; guaranteed issue of coverage for all small businesses (defined as having 2 to 50 employees) or our HIRSP Plan which stands for Health Insurance Risk Sharing Pool - again, a guaranteed issue policy for individuals who have been turned down by insurers.

And here is where what must have been left on the MPTV cutting room floor did the greatest disservice. Premiums for small group health insurance and the HIRSP Plan are strictly regulated by the state; they are "unaffordable" not because of insurers administrative costs and profits (combined, only 14% of the total premium) but because of the underlying delivery of health care. Not once in the 27 minute report were the costs of surgery, chemotherapy or miraculous life saving drugs revealed or discussed. Not once.

The cost of health insurance will not be reduced by tinkering with the size of pools or further regulating underwriting guidelines to guarantee access. MPTV should do its next health care feature dissecting the waste fraud and abuse in the delivery of health care, accounting for 86 cents of every premium dollar and where the real savings are to be found.

So, Was McCain On To Something?!

2008-12-08T15:56:00.003-06:00

Both the weekend edition of the Wall Street Journal and the Sunday Journal Sentinel featured stories on how the economy - more specifically job losses and/or company closures - could have profound impact on those counting on their employer for health insurance.

Those facing a job loss at least have COBRA rights to continue coverage, albeit at premiums that may be a challenge when incomes are lost. Even more difficult were stories about people whose employer declared bankruptcy. If the Group Contract ceases to exist, then there can be no COBRA. Imagine being in the middle of expensive cancer treatments only to learn your employer has shut down. No COBRA! No insurance!

Is there merit to the idea all individuals should own their own insurance? Certainly many employers could/would still continue to subsidize premiums but "job lock" would be a thing of the past. It's too bad John McCain couldn't articulate such a common sense idea. Everyone would choose from the broad array of policies offered by insurers as opposed to the handful of options offered by one employer.

When it comes to buying health insurance, you can do so as an individual or through your employer. Coming soon: will you be able to buy insurance through the state or federal government? Stay tuned . . . .

The Day After An Historic Day

2008-11-05T15:28:00.004-06:00

Wednesday November 5th. My first appointment; an employer/client with a staff of 16 (average age, 35). I'm delivering their health insurance renewal. It's a 4.4% increase without any changes to deductible or co-pays. (I wish they were all this good!) After the increase, the annualized billed premium per covered employee will be $4,960.

This afternoon we are delivering another renewal to a client with 156 employees (average age, 41). They are getting an 11.7% increase but after switching to a new provider network - with the same insurer and a 99% overlay (match) - we end up with a 5.2% increase. With no other plan design changes, after the renewal, the annualized billed premium per covered employee will be $7,027. Note: I did not cherry pick these two groups because they have exceptionally low costs. They just happen to be on my calendar today and in fact, across the board, our clients pay on average an annualized premium of $5589 per employee. Premium sharing between employer and employees further reduce our client's cost by about 25%.

I share such detail because yesterday's election results included advisory referendums from 22 cities and counties across the state on the question: "Shall the state legislature enact health care reform legislation by December 31, 2009, that guarantees every Wisconsin resident affordable coverage as good as what is provided to state legislators?" By about a 74% margin - it wasn't even close - all 22 voted 'Yes'.

Have the voters spoken? Figures available on line show that 81,440 employees covered under the Wisconsin Employee Trust Fund cost taxpayers $950,775,000. Despite the size of the pool and the state's obvious 'buying power', that works out to $11,675 for each employee; about double - but sometimes triple - what our small business clients are paying. Would the results of the referendums have been the same if the wording defined "affordable"? [Everyone wants their children to have a good education but referendums asking for millions to build new schools more often than not are rejected.]

As soon as January, the new majorities in the State Assembly and Senate will be eager to respond to the voice of their constituents. We've asked for change so by golly, change we're going to get! "Affordable health care as good as what is provided to state legislators" will be at the top of their list. Every client I work with has a different take on what health coverage is "good" and what premiums are "affordable". The great thing about my work as a broker/consultant is the choices I bring to each situation. Those who will be crafting reform legislation would do well to model their ideas on the results achieved by small businesses and not state employees. To do otherwise would bankrupt an already cash strapped state.

Digging Out From A Dung Heap of Empty Rhetoric

2008-11-04T04:28:00.002-06:00

I don't know squat about the economy. Or foreign policy. Or so many of the issues that have been "debated" ad nauseum in countless national and local campaigns. I DO know quite a bit about the delivery and financing of health care. In some cases, candidates have had two full years to vet this issue but instead, all we have had is sound byte "solutions" that expose real naivete or indifference or worse!

Today, finally, it comes to an end. In the business community where I serve, there is a palpable tension over economic uncertainties of historic proportions. It feels to me like a simmering pot of resentment; one that may certainly have a bearing on today's election returns but will more probably boil over if the winners are not the real leaders we so badly need.

We should pray for a little divine guidance!

Bubbles Burst: Dot Com, Then Housing, Then Credit Markets. Next Up: Health Care?

2008-10-20T08:28:00.003-05:00

As a kid, when things seemed to be going the wrong way, my father always advised patience: "the pendulum may be off to one side now but as surely as time itself, it will swing back soon enough". It has been hard to watch the economy implode these past couple of weeks. (And, at the same time, I have been preoccupied trying to be an out of state care giver for an ailing mother.) For a brief interlude anyway, blogging about such dramatic turns of events seemed inappropriate. (Although the sudden expertise I have acquired in long term care could well be a source of new commentary soon.)

As the credit markets adjust to this crisis, doesn't it seem eerily obvious that what lies ahead for health care is similar to what we have just witnessed? Are warnings that unsustainable health care cost increases producing meaningful change? Or are many of the alarmists simply using the problem to advance an agenda? At $2.2 trillion and rising, one sector of the economy simply can not so dominate GDP. Medicare and Medicaid will implode. Local governments and businesses will perish under the weight of expensive promises that can not be kept.

When the out of control health care cost pendulum begins its swing back to sanity, will it be a violent swing as we just witnessed in the credit markets? Or will it be a more deliberate movement? Will government be the dominant force for change or will markets learn by this episode and preempt government control?

One thing is certain. All the campaign rhetoric about "lowering" health care costs is about to end. (Thanks goodness!) The time has come to explain HOW!

Insurers Really Ought To Stop "Cherry Picking" Applicants!

2008-09-19T17:08:00.006-05:00

Here's an actual email I got from a business friend the other day:

"Jon, I never had dental insurance and am looking into family coverage. My spouse needs a $3000 procedure. Any thoughts on whether I should get it and any suggestions on policies?" signed, Mary. (Not the real name but every other word is exactly as I received it.

Here is how I wanted to reply:

"Mary, as a friend and an experienced financial advisor, I would expect you to have a little better grasp of the concept of insurance. You see, buying dental insurance for your 55 year old spouse with a newly diagnosed dental problem is sort of like calling State Farm for homeowner's insurance after the garage is on fire! Now I can only assume you weighed the pros and cons of "never" buying dental insurance over the years. Would you care to guess at the premiums you have saved over that time. Here's just a ballpark figure: family dental at $50/month (a very low number at today's rates) over 30 years = $18000. I would have thought at least some of that money - surely $3000 - might be in your HSA, right?

"Here is what I think you should do. Call someone in Madison or Washington and complain about your inability to get dental coverage because those greedy for-profit insurers "cherry pick" applicants. Demand that government should finance your coverage because it is after all a right. And then when the government responds by putting out of business the agents and insurance company executives who have brought consulting work to you these past 30 years, you - like us - can find a new line of work. See you in the unemployment line."

Of course, I'm reluctant to actually send this reply to my friend. (I'll just post it for everyone to see!!) It does illustrate a related point. High deductible health insurance on a young healthy person can be purchased for less than the cost of monthly cell phone service. Yet millions of young Americans badly prioritize and chose to be uninsured. Later on in life when their health goes south, they consider insurers that underwrite risk to be unfair.

That's a crock!

The Trouble With Health Care Cost Surveys Is That They Don't Survey Health Care Costs!

2008-09-18T16:31:00.006-05:00

Lot's of headlines again this week over the release of another new "survey of employer health care costs". Surveys released in the fall help businesses develop strategies for their year end health plan renewals. Details always include median premium figures for single and family coverage, deductible levels, expected cost increases and on and on.

Here's a request to those who conduct the surveys and those who report on them: Please, please, maybe you should conduct a survey of health care cost increases. As just an example, I'd like to see what a normal pregnancy cost 10 years ago and what it costs today and an explanation for the increases. Or, I'd like to see a figure showing the cost per hospital admission 10 years ago and the same figure for today. Instead of surveying the cost of providing employee benefits, wouldn't it be more enlightening to shed a little light on the cost of care?
______________________________

As I turned the pages of my paper reading about this survey, I couldn't help notice the number (and size) of ads from hospitals and clinics and physicians extolling the wonders of their services. Try as I might, I couldn't find a single figure on the cost of those services. Now, do you suppose there just might be a connection between the survey results of employer's health benefit costs and these ads for health care? I'm not suggesting that advertising health care is a bad idea but maybe we ought to demand to know the cost!! (And yes, something about quality and outcomes would be nice, too.)

Prerare To Be Surprised

2008-09-05T04:12:00.003-05:00

General perceptions often are that health insurers profit only at the expense of their policyholders vis a vis denied claims. This week industry trades reported second quarter results for managed care companies. As a percentage of revenues, earnings for three of the larger managed care companies were as follows:
* Humana 2.0%
* United Health 3.3%
* Wellpoint (Blue Cross) 4.3%

For your consideration: Are those 'excessive' earnings? As a business owner, would you be content with that ROI? More fundamentally, do you believe the profit motive creates incentives to run a health insurance company efficiently; ie. to compete on price and value? There are many who believe government would actually be more efficient than the private sector. Should one become dissatisfied with the financials of their insurer - say for example the executive compensation packages are unacceptable to you as a consumer - isn't it relatively easy to change companies? But what if, after switching to a government run health plan, we become dissatisfied with the inefficiencies of bureaucratic malaise. How do we change plans then?

As a final thought, I'd ask you to compare the above earnings of those who finance health care to the health systems who deliver care. I'm fairly certain you will be surprised.

Tit For Tat: Health Care Consolidations Continue

2008-08-20T16:43:00.005-05:00

There is news today of the demise of yet another independent physicians group. It seems they need the bargaining power of the large health systems to survive the payers pressure for ever lower reimbursements. Not surprisingly, the pace of provider mergers has pretty much been matched by payer consolidations.

In the S.E. Wisconsin marketplace where I do business, we're down to just a handful of mega providers and just as few payers (insurers). Did anyone get the upper hand in this progression? Are we on course for the ultimate consolidation to just one payer - the government? I'll bet providers will just love those fee schedules! And would health insurers be looking for new work?

Perhaps belatedly recognizing the folly of this arms race, provider and insurer websites are blossoming with information on price and quality. Have you looked recently? There are also nascent enterprises such as OutOfPocket.com - an independent health care transparency search engine - that will keep the pressure on. Think of a time when consumers have information and they (finally) make the market. The cycle of consolidations is likely to be broken and health care costs may actually come down.

Healthy Dining On the Fly

2008-08-16T03:33:00.003-05:00

I clipped an item from the Wall Street Journal a couple of weeks ago about "the Calories Lurking in Restaurant Food" (Health Journal 7/29/08). There was reference to a website - HealthyDiningFinder.com - that proved useful just this week as I found myself looking for restaurants while on the road.

Believe it or not, you can enjoy a good meal and consume just 750 calories (or less) in the process. Check it out for yourself.

Health Care Referendum: Let's Try A Little Truth in the Wording

2008-08-15T08:35:00.003-05:00

There have been reports in recent days about a group collecting the required signatures to get Advisory Referendum on ballots in Oshkosh, Eau Claire and Douglas County; now Oak Creek and South Milwaukee have joined this "statewide movement".

Following is the language of the resolution being promoted by Citizen Action of Wisconsin: "Shall the state legislature enact health care reform legislation by December 31, 2009, that guarantees to every Wisconsin resident affordable coverage as good as what is provided to state legislators?"

Wisconsin has one of the lowest rates of uninsured residents in the entire country and under Governor Doyle's leadership, Badger Care was expanded this year to make health insurance more easily accessible at low cost to virtually every child in the state. The Citizen Action "movement" is simply a thinly veiled attempt to promote the "Healthy Wisconsin" Senate Bill that failed to advance in the last legislative session. Apparently these folks think it a good idea to try and mandate the most expensive (state employee) coverage and then pay for it with a huge new payroll tax on all employers - a tax that would more than double insurance costs for most in the private sector. Where would this "feel good" movement be if the Board of Directors of Citizen Action included the businesses that would have to pay for it?

Without a little truth in the language of the referendum, I suppose a gullible public fed up with high health care costs will 'vote' their support of this measure. Heck, I think we should also vote for $2.00 a gallon gas and "a chicken in every pot"!

Coming Soon; Another New Hospital Near You!

2008-08-07T13:46:00.003-05:00

Here in the Milwaukee area - as is happening all over the country - we learned yesterday of plans for yet another new hospital. The news reports centered on the need for another facility and the impact on costs. Perhaps a more pragmatic view of this news would be beneficial.

The notion that the best hospital is always the nearest hospital is laughable. And yet in an emergency, when you call 911, the chances are the local fire department responding will only take you to the nearest ER. Wouldn't it be prudent to be better rehearsed for such an event? Say I have an acute heart attack. On the one hand, the local fire responders could take me to a hospital only 8 minutes away but then I might lay waiting for the 'on call' team to arrive; a team that might be only slightly experienced to treat my condition. A better scenario might be to call a private ambulance company that drives me an extra 15 minutes to a facility equipped 24/7 to give me the best care possible. Despite the extra drive time, I could actually receive care faster and from a better team of experts.

Convenience is great when it comes to fast food restaurants or drug stores. But when you need critical hospital services should convenience be anywhere near the top of your selection criteria? "Shopping" for health care when you are unconscious strapped to a gurney is unlikely. But why can't you do your homework now? It could save the life of you or a loved one.

A Health Care Tidbit from the Czech Republic

2008-08-05T13:41:00.003-05:00

Visiting his home in Milwaukee, U. S. Ambassador to the Czech Republic Rick Graber spoke at my Rotary Club this noon. He talked about his experiences in nearly two years of service in Central Europe. Jumping around to touch on several topics, of course my antennae were most sensitive to his brief remarks about health care in this country of about 10 million residents.

To paraphrase what I think I heard: health care in the Czech Republic is 'free'. It is interesting however that they - like the U.S. and most countries - are struggling to deal with rapidly rising costs. Up until recently, there had been no cost for receiving care and so, the average Czech sees his/her doctor 16 times per year. "There's no charge, so why not; it's like a social event", Ambassador Graber reported. Faced with such (over) utilization, they are now trying small co-pays; a koruna per office visit. FYI: the currency of the Czech Republic is the koruna which converts at about 15.1 korunas to the dollar. It would surprise the heck out of me if a 6 1/2 cent co-pay had any impact on costs and yet the Ambassador reported the citizens are in an uproar over the new charges!

Interesting, isn't it? I've referenced a P.J. O'Rourke quote before but it bears repeating here: "If you think health care is expensive now, wait until you see what it costs when it's free!"

The Health "Blogosphere"

2008-07-29T21:00:00.005-05:00

I had the good fortune Tuesday to attend an on line "HealthCast" (webinar) sponsored by the Kaiser Family Foundation entitled "The Health Blogosphere: What It Means for Policy Debates and Journalism". Jeepers! Did I really think the RauserHealthReview was ahead of the curve . . . . . . . . ?!

I was surprised to learn HHS Secretary Michael Leavitt is a blogger. Given his enormous influence over health care policy, those with a serious interest should connect to the Secretary through an RSS feed. Ditto a Wall Street Journal Blog on health care. In fact, there are dozens of really good health care sites with a wealth of information. The Kaiser Network and WSJ blog serve as great aggregators of information from many sources while Secretary Leavitt's site - like the RauserHealthReview - is based on more personal experiences from our daily work; he of course at the very pinnacle of the health care industry while I am just a foot soldier.

Secretary Leavitt revealed he has been writing his blog since August of 2007 and now has about 2100 visitors each week; yours truly started late in May. Recent traffic is on pace for about 270 weekly visitors. (I can only imagine how many daily 'hits' the Kaiser Foundation receives at their site.) The appetite for good information on health care can only grow with the aging of America. I would sure welcome any suggestions (comments) for posts.

How To Add Years To Your Life

2008-07-28T08:38:00.002-05:00

Wellness, wellness, wellness; everyone is talking about wellness. And with good reason. The best way to reduce your health care costs is quite simply to not get sick! ("Brilliant!")

Do you put off going to the doctor for your annual exam afraid of what he/she may find? Are you wary of how your health insurer or employer may misuse the information you provide through their on line Health Risk Assessment. These are natural (most likely unfounded) concerns we can deal with another time. For today, I'd like to make you aware of a wellness 'tool' you can access right now. At no cost. And with no worry about privacy.

Please visit RealAge; a website where you will find a wealth of information on health and wellness. You can enroll as a member and take the RealAge Test. I did. It tells me I am just a few years younger than my chronoligical age thanks in part to some generally good diet choices and regular excercise. It also coaches me in several ways to take easy steps to further cheat father time.

George Carlin used to joke that "life's journey is not to arrive at the grave safely in a well preserved body, but rather to skid in sideways, totally worn out, shouting ....holy sh*t ....what a ride!" George did have a great ride but I sure wish it could have been a little longer?

Good luck on your RealAge Test. I'd enjoy hearing how you did and if it motivates you to make changes.