Benefits Buzz

Was Denis Leary Right About Preventative Care?

Denis Leary had a great line from his Broadway show/CD "No Cure for Cancer".  It goes a little something like this:

"I love these little facts. "Well you know. Smoking takes ten years off your life." Well it's the ten worst years, isn't it folks? It's the ones at the end! It's the wheelchair, kidney dialysis years. You can have those years! We don't want 'em, alright!?

The Leary premise is quality over quantity.  If the late years aren't good ones, the theory goes that you may as well do what you want.  No mention of the cost of health care during the late years.  That doesn't translate too well into comedy, especially the Leary version of comedy.

Not to worry.  Arthur Garson's got you covered in this column from Governing Magazine, where he and Carolyn Englehard argue that preventative care just doesn't pay out:

"If you're among those who think prevention saves money, and will help reduce the overall cost of medical care, you're not alone. But while an apple a day might keep the doctor away, at least for awhile, it also might cost more than you think. Preventive medicine can help avoid costly illnesses earlier in life, only to increase the population of elderly and infirmed people who will most likely require expensive treatments for other illnesses later.

Even worse, unhealthy habits such as tobacco smoking may actually save money in the long run as people who smoke die earlier and use fewer health care dollars. "This doesn't make sense," you say, "Smokers are less healthy than nonsmokers." That may be true, and smokers do use up to 40 percent more medical care while they are alive. A recent study from Holland showed that, on average, smokers die at age 77 and save $100,000 in lifetime medical care costs compared with non-smokers who die at 83.

The same is true for people who are obese. While obesity-related conditions such as Type-2 diabetes, high blood pressure and heart disease are associated with high medical expenditures, the costs that are saved by preventing obesity will only be offset later in life by diseases unrelated to obesity that accompany living a longer life. In the Dutch study, obese people die at 80 and save $50,000 compared with non-obese people who die at 83."

Wow, there it is.  It's cheaper to allow people to make their own decisions about lifestyles because we don't have to spend money on them once they're gone - it's cheaper overall to let them do what they want. 

What the column doesn't explore is ramifications of preventative care for employers.  The ten years at the end are largely funded by the government.  What about the 5/10 year ROI scenario for employers that invest in programs that get people to stop smoking or drop their blood pressure.  Is the ROI there for the companies that choose to do that?

That's the million dollar question (literally) for employers in America.

Focusing on Surgery - Part of the Reason Effectiveness Trails Cost in the USA?

I've always been amazed that the USA always shows up in the mid-teens regarding outcomes/effectiveness of care when compared to other industrialized nations.  All the money we spend, and we trail Europe? 

One reason might be a over-reliance on surgery, which we've been trained is the path to take when you're serious about getting healthy.  A recent BusinessWeek article focuses on this tendency in the USA using heart disease and prostate cancer as examples:

"Each year, more than 1.3 million Americans have their clogged arteries widened with a tiny balloon and then kept open with slender mesh tubes called stents, made by companies like Johnson & Johnson (JNJ) and Boston Scientific (BSX). The total bill for these angioplasties is more than $21 billion a year. But while many patients and doctors firmly believe that angioplasties prevent heart attacks, the data say otherwise. A series of studies—the newest published in the June 11 issue of The New England Journal of Medicine—finds that stable patients with chronic heart disease who have the procedure get little benefit compared with similar patients treated just with drugs, such as Pfizer's (PFE) cholesterol-lowering Lipitor and other statins, and aspirin. "There are still many patients who undergo angioplasty without really understanding that it will not reduce chances of heart attacks or death—though it will reduce symptoms," says Dr. Judith S. Hochman, director of the Cardiovascular Clinical Research Center at the New York University School of Medicine.

That's why there's a growing effort, led by physicians, health insurers, and even state legislatures, to make sure patients truly understand the medical evidence about angioplasty and other treatments and procedures. Once informed, the patients are encouraged to make their own choices. This idea goes by the somewhat clunky name of shared, or informed, decision-making. Instead of being routinely whisked in for a prostate screening PSA test, for instance, men would first be told that major studies have failed to show the test saves lives. What's more, the test increases the chances a patient will undergo surgery or treatments that cause incontinence, impotence, and other problems. "The fact that PSA screening is more likely to cause mischief than save a life is not intuitive to patients or even physicians," says Dr. Paul J. Wallace, medical director for health and productivity management programs at health-care provider Kaiser Permanente, which is testing this approach.

Studies show this process, using comprehensive videos and other materials prepared by groups such as the nonprofit Foundation for Informed Medical Decision Making (FIMDM), leads patients to choose conservative options more often. It reduces rates of angioplasty or prostate surgery, for instance, by 15% to 30%. Put into widespread use, the approach has the potential to trim hundreds of billions of dollars from the nation's $2.4 trillion health-care bill. Yet patients do as well or better than if they had opted for the procedures. Surveys done after the decision also show patients to be more satisfied, no matter which choice they made. "That's the kind of win that doesn't fall into your lap very often," says Washington State Senator Cheryl Pflug, a Republican.

Hundreds of Billions.  Kinda catches your eye, although the specter of making decisions in terms of who gets surgery and who doesn't would be a rallying cry for those who claim nationalized health care will take the decision out of the hands of the patient/doctor.

It'll be interesting to see this play out in the scope of nationalizing health care...

There's No Such Thing As Private Health Information in the Big Time....

Most of us get to control access to our private healthcare information.  If we're on blood thinners and we want to keep that confidential from future employers, we control it - we just don't say anything.

Not so in some professions, especially where public safety is involved.  Still, in professions with public safety at issue, your employer would put safeguards in place to ensure the disclosure of your medical issues through questionaires and full-blown physicals, but your medical conditions aren't widely known by the public.

Not so in professional sports.  Consider the case of DeMarre Carroll, as reported by SI.com:

"Former Missouri forward DeMarre Carroll earned the nickname "Junkyard Dog" for his blue-collar approach and relentless work ethic. Now he must convince NBA teams that a previously undisclosed liver disease won't keep him from being a pro.

Agent Mark Bartelstein confirmed Wednesday that Carroll, a first-team All-Big 12 pick and potential first-round draft selection, was diagnosed with a liver ailment "a couple of years ago." He downplayed the possibility that Carroll might eventually require a liver transplant.

"It's jumping the gun," said Bartelstein, a Chicago agent whose NBA clients include former Kansas star Brandon Rush and Eddie House of the Boston Celtics. "There's a possibility (of a transplant) way in the future, maybe 20 or 25 years down the road."

Carroll has been treated by Dr. Jeffrey Crippin of Washington University in St. Louis, a specialist in gastroenterology, liver disease and transplants. Crippin declined comment, referring questions to Carroll's agent.

Bartelstein said that Crippin is preparing a letter for NBA coaches, general managers and team doctors outlining Carroll's health before the June 25 draft."

In your workplace, such public disclosure would be the cause for a lawsuit.  In professonal sports, it's given that everyone has the info and the info becomes public.  Strange contrast...

Discounted Health Care for Buying Local Veggies? Is this Heaven?

I live in the mecca of local and organic produce. There are so many farmer's markets to choose from on a given week that you could eat like royalty nearly year-round and hardly step foot in a grocery store. The daddy of them all, the Ferry Plaza Farmers Market, and my favorite low-key version, The Alemany Market, are bustling year round and have arguably some of the best coffee, specialty food, gourmet treats and, of course, produce in the country. (Not that I'm biased or anything.) 

But, one of my favorite treats of the summer is my Community Supported Agriculture (CSA) veggie box. Once a week I pick up a box of the tastiest just-picked fruits and veggies. I read the info sheet on all the obscure or not-so-obscure items inside and plot out what to cook, freeze or eat on the spot (the strawberries don't always make it all the way home). I'll be the first to admit I'm a bit of a geek about this but it is so much fun--kind of like Christmas morning once a week (plus supporting the community and all that good stuff too). Unless you threw in a chef to cook the veggies for me, I would never have thought a CSA could get better. Until now.

In Madison, people are getting rebates on their health care for joining a CSA! The Madison Area Community Supported Agriculture Coalition (that is a mouthful!) has a program called Eat Healthy Rebate where their CSA members get rebates on their health plans--up to $200 bucks! This info from the Minneapolis Star Tribune:

CSAs are particularly popular around Madison, Wis. There, Physicians Plus Insurance Corp. in 2005 began offering $200 premium rebates to member families who joined CSAs. The program appears to have been the first of its kind in the country. In 2006, the first full year of the program, 972 members got the CSA rebate; heading into this season, 1,460 will qualify, said Physicians Plus marketing manager Scott Shoemaker.

If people are motivated to eat "healthier foods, exercise and practice preventive health measures, they're going to be healthier in the long run and need less health management down the road," Shoemaker said. "They'll go in to the doctor less. And costs will go down."

This is pure brilliance in my opinion. Why not pair eating healthy with lowering your health care costs -- and supporting the local community all at the same time?

This could be a great fit for employer wellness incentives too. Employees are often offered reimbursements for gym memberships that go unused--maybe for some employees those incentive dollars could be better spent on healthy eating? 

Are there other examples of pairing local agriculture with health incentives? Please leave examples--or your ideas!--in the comments below.