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.
"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.
Here are some snippets from an email I received from the US Department of Health and Human Services today:
"We know that the health care crisis impacts every American, but our mothers, daughters and sisters are paying a particularly heavy price. Today, 21 million women and girls are uninsured. Women who try to purchase insurance find that the private market is often stacked against them. Premiums in the private market for young women are often higher than they are for men. In some states, insurance companies can legally discriminate against women, and leave them with higher health care bills or inadequate coverage.
We know America's women can't afford to wait for comprehensive health reform. Roadblocks to Health Care reports:
In the individual insurance market, women are often charged higher premiums than men during their reproductive years. Holding other factors constant, a 22 year old woman can be charged one and a half times the premium of a 22 year old man.
In a recent national survey, more than half of women (52%) reported delaying or avoiding needed care because of cost, compared with 39% of men."
Why are women charged more? Among other things, because we can get pregnant and pregnancy in the US is very expensive. We therefore use more health care and are charged more or denied insurance coverage. But here is the crazy part, folks: women cannot self-impregnate!
Not long ago, I received a very personal lesson on the wacky state of preventative health care for maternity. As an otherwise extremely healthy person with a good track record for taking care of myself and little in the way of worrisome health risks, I'd gone the way of financial prudence. I purchased a health plan with a high deductible, but with inexpensive co-pays on doctor's visits and alternative medicine as well as discounts on pharmaceuticals, should I need them.
This was all working out very well. I continued to do my part for the team by taking good care of myself, paying my insurance company dutifully and not using any medical care! I was mentally prepared should a catastrophe befall me. I figured, should that happen, my piddly $5k deductible would seem like chump change in comparison to what I would otherwise have had to spend out of pocket for catastrophic care. All those years of paying unused premiums to my carrier would have been put to good use!
Then, about 6 months ago I developed a small "medical" problem. That's right. I got pregnant. Ok, so this is no catastrophic illness or disease condition, right? I mean, there are more than 6 billion people on earth and, unless I am mistaken, pregnancy is the way we all got here. As a scientist, I will grudgingly agree that pregnancy looks suspiciously like a highly evolved parasitic infection. Yet, unlike malaria - for instance - my health plan wasn't ponying up any cash for pregnancy vaccines or other preventative measures against this "disease."
So, it was one $20 co pay with my primary care doc, the cost of a pregnancy confirmation test, and then I was on my own. At that point my options were to start clocking maternity care against my catastrophic deductible. After meeting that limit I'd pay 30-70%. After doing the math, I realized that if I ended up in a hospital for a routine, healthy birth, with no serious complications, that I would most likely end up paying $7,500+ out of pocket for my "disease." Compare this to a $2000-2500 bill if I pay cash for a home birth with a certified nurse/midwife, including all prenatal scans and labs and two months of well baby care, and it left me scratching my head. Now if there were complications (need for surgery, premature birth, gestational diabetes, preclampsia, etc.) that led to a need for emergency medical intervention then, as I said, there is not much room to gripe over the deductible when so many dollars and someone's life are on the line. Yet when all signs in my case (and in the case of nearly 75% of pregnancies that come full term) point to a completely normal, healthy pregnancy and birth, I am perplexed about how this situation serves any sort of greater good.
In my case, I simply opted to pay the midwife out of pocket and should an emergency arise, well, it's an emergency - deductible be damned. Yet I think about all of the women whose partners may have left them; women whose partners lost their jobs; women who have lost their own job and are not sure how to afford COBRA, but would be denied individual coverage due to their "pre-existing condition"; women who are short on the cash to be able to afford the relatively less expensive but still cost prohibitive bill for good prenatal care and who end up with very costly bills later on down the line due to having delayed or avoided care.
And these mothers who were impregnated by partners who - in most cases - will not be denied coverage or see rate increases due to their partners' "disease," are left unable to pay and to pass on the costs to the remaining payers in the current insurance system - thus becoming contributors to the astronomical rise is insurance rates. These are not some handful of bad people "out there." If you are reading this blog, breathing and have a pulse right now then you have a pregnant woman to thank.
People are not going to stop making more people, people. It just isn't going to happen. So what are our options when it comes to taking pregnant women off of the bad apple list with regards to health care costs?
Provide safe, effective and affordable contraception and family planning services to women of reproductive age (yes, this means after menarche) .
Ensure that health plans rapidly identify and direct high risk pregnancies to maternity care and coaching programs that help manage behavioral risk factors and more closely monitor pregnancy through birth.
If you are an employer providing maternity benefits and health insurance for your employees and spouses, make sure you emphasize prental care and maternity benefits offered by your health plan. Consider setting aside lactation rooms to encourage breastfeeding mothers to pump so that they can continue to feed their babies breastmilk (which has health benefits for the mother and child).
Support legislation that accomplishes all of the above and funds community health education centers that provide outreach, education and services to uninsured populations - eliminating a cost barrier which might keep pregnant women from seeking care until it is too late.
If altruism isn't your bag, then consider that early prenatal care helps all payers in the health insurance game by lowering costs shared by the pool. And if you are still feeling the glow from that gift that had your mom in tears last weekend, then - hey - do it for the lady who loved you enough to endure nausea, swollen feet, ill-fitting clothes and a whole lot more to bring you into this world.
Editor's Note - It's hard to be humble when you're bloggin' straight out of Portland, Oregon. Tanya Barham is the Founder and CEO of Recess Wellness, a company where all the staff works like little elves at Christmastime to transform their client's workplaces into healthy, happy, productive places akin to Santa's workshop at the North Pole. Seriously. Of course, Santa's fat, so they still have work to do.
Generally speaking, I like to know the nutritional data of the food I eat. I'm more hung up on fat grams than I am calories, because generally I think my calories are under control for my activity level.
With that in mind, I respond well to seeing nutrition information at fast food outlets, and I think it's good business for those outlets, especially for return business from me. If I know I can get something I like that's relatively healthy, by sharing that data, those chains have generally won loyalty from me over time.
That's how I roll. BUT, I'm not sure restaurants should be required to provide that data, because I think 80% of the folks ignore it anyway. Here's a snapshot from Forbes of what's going on in West Virginia, not known as a health mecca, regarding the posting of calorie/nutrition data:
"West Virginia state Sen. Dan Foster should have known his bill to require restaurants to post calorie counts was in trouble Tuesday when he walked into a House of Delegates committee room and found lawmakers scarfing down doughnuts and breakfast sandwiches from fast-food locations.
Before Foster could defend the bill, delegates were asking questions with their mouths full of complimentary food from fast food restaurants that had been laid out on a committee table before the meeting. Ninety minutes later, the committee voted to kill the measure, which was billed as a way to combat the state's obesity epidemic.
"It's disappointing," Foster said. "The industry certainly spread their message."
Foster, a Kanawha County Democrat and physician, had been one of the bill's most passionate supporters. He helped secure its passage in the Senate and attended the two House committee meetings on the bill, answering questions from delegates about its intent and provisions.
"They clearly don't want people to know the calories, otherwise they'd do it voluntarily," Foster said.
A call to the West Virginia Hospitality and Travel Association, which lobbies for restaurants and opposed the measure, was not immediately returned Tuesday. In previous meetings, lobbyists from the group have said that most large chain restaurants provide nutrition information, whether on the Internet or at their physical locations.
The bill would have applied to restaurants with more than 15 locations nationally. The goal was to post calorie counts on menus or menu boards in a bid to steer West Virginians toward healthier food choices. West Virginia has the second-highest obesity rate in the country, and ranks high in linked ailments like diabetes and high blood pressure.
Members of the House committee said even the watered-down version created by the committee's amendment would hurt free enterprise. "I worry that what's in here is blaming the cause of all obesity on restaurants," said Delegate Daryl Cowles, R-Morgan."
Would the bill have made a difference? I doubt it. I think the folks who are drawn to healthy lifestyles provide return business loyalty to outlets that provide the information, and the obese generally ignore calorie/fat data in the same outlets.
If the obese ignore the data, there's really not an ROI for the burden of providing the data.
"This Is Why You're Fat posts reader pictures of the incredible calorie bombs they've discovered, like The Hamdog, "A hot dog wrapped in a beef patty that's deep fried, covered with chili, cheese, onions, served on a hoagie bun topped with two fistfuls of fries and a fried egg." Really, it's about efficiency. Who has time for all those meals when you can just eat one and get all the calories you need for the next couple of days?"
Check out the site for the gore-related pictures. You'd like to think this could be used in a wellness campaign, but at the end of the day, it probably does more to create a cult of personality related to horrible foods people eat when dining out, and the ability to upload a photo makes it cool to the end user.
The end user would be you. This is why you're fat (they said it, not me...)
I work for a Veteran's Health Research organization so naturally we get November 11th off each year as a holiday. Not so for me this year. Instead I attended a "Wells Fargo Health Solutions Seminar with Dr. John Abramson".
In 2004 Dr. Abramson wrote a book called "Overdo$ed America The Broken Promise Of American Medicine--How The Pharmaceutical Companies Are Corrupting Science, Misleading Doctors, And Threatening Your Health (And up in the left hand corner there is a little balloon that says "The Truth About Vioxx, Celebrex, Statins, and More). OK, that's all you need to know--end of POST--just READ THE BOOK... In it he totally busts Big Pharma and a lot of the so-called research findings that come out of studies funded by Pharmaceutical companies. I know this isn't necessarily news to many of us, however the facts and statistics he lays out, and analysis he uses to derive his conclusions are very compelling. In person he is an impassioned speaker on behalf of reasonable, sane, effective health-care reform. Do away with the expensive drugs and procedures as routine, matter of course
From the book, pg 209-210...
"Pretending to care about our health is often just part of the drug and other medical industries' overall strategy to increase their sales. They dominate the medical journals, airwaves, newspapers, and magazines with "information" designed to convince doctors and patients that their products are essential for good health. They focus attention on the health problems and solutions that are the most commercially advantageous rather than most beneficial for our health." ...
"The truth, as we have seen, is that the benefits of medical care are real but limited, and more is not always better, and is often worse. These awkward facts get shoved into the background of our common wisdom buy the bright lights of advertising and medical news that shine incessantly on the "breakthroughs" in medical progress and the drugs you should "talk to your doctor about." By saturating our sources of information, the medical industry has convinced most Americans that the answer to almost every health problem can be found in a brand-name pill or high-priced medical procedure.
That's the bad news. And it's very bad, costing Americans hundreds of billions of dollars a year, and even worse, compromising our health and quality of life. But there is good news too--and it's enormously good: the evidence from study after study, including gold-standard randomized clinical trials, shows that we can usually do a great deal more to maintain our own health than the medical industry, particularly the drug industry, promises it can do for us."
In subsequent posts I'll discuss what Dr. Abramson suggests we can we can do, from the inside, as Benefits Professionals, to begin to make an impact and change how things are now to how they could possibly be in the future.
Editor's Note - Joan Gibson is a Benefits Analyst for NCIRE, which is the non-profit organization charted by congress back in the 80's to manage all the government funding/grants/contracts for the medical research projects happening at the SF VA Medical Center. When she's not attending a conference, you'll find her on the phone trying to squeeze usage stats out of unsuspecting targets like the NCIRE EAP vendor....
Why do I have an IV line into my arm from Starbucks? Glad you asked, this clip from MedHeadlines makes it clear:
A collaborative team of researchers from Sweden and Denmark enrolled 2,000 adults in the study 21 years ago. Participants self-reported their dietary habits, including their daily coffee consumption. After over two decades, more than 70% of the participants could be tracked for follow-up evaluations. That the research team could find 1,409 now-middle-aged participants out of the original 2,000 is considered an unusually high number.
During those 21 years, 61 people developed dementia. Of those 61, 48 developed Alzheimer’s disease.
After evaluating the effects of many health and socioeconomic factors, including high cholesterol counts, the research team concluded the participants who drank between three and five cups of coffee a day were 65% less likely to develop dementia than those who drank less. Drinking even more than five cups a day was also associated with a reduced risk of developing dementia but the number of participants drinking this much coffee was too small to be statistically significant.
So sure, I've got stained teeth, but I'll be sharp as a whip when I'm 85. Checkers anyone?
"the graphic highlights advice from my dad, a retired physician in West Virginia, who always warns us of such risks. He says, "eat better, eat less, take small bites, drive defensively with two hands on the wheel, don't climb ladders and be careful with guns." Looking at the graph if we listened to this advice we would take care of most of the larger circles"
Good advice. But what about death from hot weather? (odds of croaking from that - 1 in 13,000)
I gotta get out of the South. I don't see cold weather on the chart....
Has there ever been a harder transformation in societal expectations than the one that has occurred in the last 30 years regarding smoking? I was raised in a family of smokers, and in the 70's and 80's, as a kid, it really never occurred to me that the whole habit was dangerous. In a weird twist, it also never occurred to me that I should smoke.
I hear I beat the odds...
Then, society got cracking and made all who smoke a little uncomfortable. Don't smoke here, here or here, and just so you got the message, here's a fishbowl to smoke in at the airport with your friends.
Of course, the whole thing has been good for our health care plans. Fewer people smoking is good for what ails your PPO. I'm channeling John Lennon when I say "imagine" if the U.S. made the same shift with Crisco. Now that would really help the PPO trendline.
"The owner of a small company in Germany fired three workers because they were not smokers. It seems that their boss (evidently a smoker himself) felt that they were “disturbing the peace” in the workplace by being vocal about their smoking colleagues.
“I can’t be bothered with trouble-makers,” said the boss. “We’re on the phone all the time and it’s just easier to work while smoking. Everyone picks on smokers these days. It’s time for revenge. I’m only going to hire smokers from now on.”
Of course, being anti-smoking doesn't fall in a protected class. Here's my ridiculous list of other things that are easier while smoking:
1. Filling out a health history at your local doctor's office. 2. Helping your son bat during a father/son baseball game. 3. Engaging a fire extinguisher. 4. Typing a Blackberry message while driving, and smoking...
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!?
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