Sunday, April 26, 2009

"Main Street" Health Care Reform- Pay Cash, Bid for Discounts

Last week, I opened a discussion about our nation's struggles with health care. My heart went out to the comments from readers, who have life threatening illnesses, and cannot afford the care they need. It's clear no one's happy out there, and the demand for change is rightfully at a fever pitch.

The frustration is not one-sided. Many doctors and health care providers are unhappy and downright angry. They hate the bureaucracy and demands of the insurance industry that drains staff time, pays them a fraction of what the service is worth, and takes them away from patients.

Dr. Cara Barker, a popular Featured Contributor at Huff Po wrote:


"After 41 years a a clinician, I am seeing increasing numbers of us look to other venues to provide what we can without the nonsense that we call the health care system. What we've got is a disease care system, not health care.


I just left an international training and met doctors, nurses, psychologists, etc. who have been outraged by the intrusion of third party payers, (for profit) who have eroded, along with pharmaceuticals, really good care. It costs an average of $150-$250K just to get through the training. With catastrophic liability insurance costs, people like my colleague, Dr. Shapiro, (Ob-gyn) are leaving their practices. Many are not able to take a paycheck, just to keep providing care. No wonder we are looking in other directions to attend those who want wellness."


No one can run a business and consistently lose money - so what are the alternatives? How do we take health care reform to Main Street? Many doctors are leaving insurance reimbursement behind, and offering their services for direct payment. One option for general care is through 'concierge medicine.' Heard of this one yet? It's like an old fashioned doc for a modern price.

For an annual fee of around $2,000/year, you can buy into your doctor's practice, and enjoy the luxury of being seen anytime you want. Concierge doctors drastically limit the number of accepted patients, so they can be available to take your calls, advocate for your needs and give you the personal attention you deserve.

Some complain the concierge docs must be greedy little worms to charge so much to see their patients, but let's dig a little deeper. The field of general medicine is one of the most challenging to make a living. Many have had to leave their practice, or take up side work, to stay alive. The reimbursements are so low, they are forced to quadruple the amount of patients seen in an hour.

What used to be a 20-30 minute check up is now relegated to about 5-10 minutes. Ever sat in an exam room with a stupid paper gowns for about an hour, waiting for the doctor to finally come rushing in? The experience is less than pleasant as they zoom through the appointment in about 4 minutes, and then dash out again.

I spoke with Dr. Lisa Sanders about some of these issues and challenges. Sanders is a former Emmy award winning broadcast journalist with CBS, who launched a second career in medicine. She practices and teaches Internal Medicine at Yale, writes the popular "Diagnosis" column in the NY Times, and is the inspiration and medical consulting producer for the hit Fox TV show, 'HouseMD.'

"The medical stories on the show are based on facts, and the character of 'House' is pure Hollywood,"
Sanders jokes.
"I have been amazed how many people tell me they wish House was their doctor,"
she says more seriously.
"When I ask them why they would want such a nightmare, it seems people can look past his grouchy exterior, and it is being the center of medical attention that they crave."
Dr. Sanders takes care of the very poor in her clinic, and acknowledges she could not survive on what she earns seeing patients, if Yale did not provide her a salary. She shared an example of a typical day:

"One day I saw about 10 patients. Many of them had very complicated issues, with a lot of medicines to review, and I only had about 20 minutes. Guess how much I got paid for those patients? About $40.00 each. At the very end of the day, someone came in with an in-grown toenail. Guess how much I got paid for that? About $350 - almost as much as all the other patients combined."
I asked her what does this mean for doctors to survive?


"I guess I would have to be removing a lot more toenails."

Another new idea to put patients and doctors back together, sans insurance, came from a few cutting edge doctors, seasoned dot.com exec's and investors; who created an online marketplace for health
in a website called PriceDoc or www.pricedoc.com. They currently offer services for dental care, vision, cosmetic, walk-in clinics, chiropractic and alternative health. The site just opened in the Seattle market, and is generating a buzz.

Those in Seattle can type in a desired service, and a list of providers pops up with background information, credentials, and a list of what each procedure costs. This alone is revelatory. Where else can you go to compare the prices of a regular dental check-up, lasik surgery or laser hair removal? Here's the biggest twist: some of the procedures are available for a discounted "Make An Offer" option, similar to Priceline.

Sarah Ames is a 27 year old resident of WA who is employed, but does not have dental insurance, and wanted "Invisalign" braces. She called two dentists in her area for price quotes, and then found out about PriceDoc.com via a friend from Facebook. She searched the site, and found a price that was lower than the other two dentists- plus an option to "Make An Offer," from Dr. Tulay Kent. She did, won the bid - and ended up saving $1700. Wow, not bad!

Dr. Kent is a well respected dentist in Seattle,and said she loved that potential new patients can review her credentials, services, and prices online, and believes it will help build stronger relationships. When asked about the "Make An Offer" option, she explained the reduced fees are still comparable to insurance payments, yet without the hassle. This allows her staff to focus on the patients and handle more important projects.

People can't afford health care, and the entrepreneurial spirit will help us get there, both in big steps and small steps. It's time to tear down the walls and create a new marketplace for our health based on trust, experience and fairness.

"Main Street" Health Care Reform: Pay Cash, Bid for Discounts

Last week, I opened a discussion about our nation's struggles with health care. My heart went out to the comments from readers, who have life threatening illnesses, and cannot afford the care they need. It's clear no one's happy out there, and the demand for change is rightfully at a fever pitch.

The frustration is not one-sided. Many doctors and health care providers are unhappy and downright angry. They hate the bureaucracy and demands of the insurance industry that drains staff time, pays them a fraction of what the service is worth, and takes them away from patients.

Dr. Cara Barker, a popular Featured Contributor at Huff Po wrote:


"After 41 years a a clinician, I am seeing increasing numbers of us look to other venues to provide what we can without the nonsense that we call the health care system. What we've got is a disease care system, not health care.


I just left an international training and met doctors, nurses, psychologists, etc. who have been outraged by the intrusion of third party payers, (for profit) who have eroded, along with pharmaceuticals, really good care. It costs an average of $150-$250K just to get through the training. With catastrophic liability insurance costs, people like my colleague, Dr. Shapiro, (Ob-gyn) are leaving their practices. Many are not able to take a paycheck, just to keep providing care. No wonder we are looking in other directions to attend those who want wellness."


No one can run a business and consistently lose money - so what are the alternatives? How do we take health care reform to Main Street? Many doctors are leaving insurance reimbursement behind, and offering their services for direct payment. One option for general care is through 'concierge medicine.' Heard of this one yet? It's like an old fashioned doc for a modern price.

For an annual fee of around $2,000/year, you can buy into your doctor's practice, and enjoy the luxury of being seen anytime you want. Concierge doctors drastically limit the number of accepted patients, so they can be available to take your calls, advocate for your needs and give you the personal attention you deserve.

Some complain the concierge docs must be greedy little worms to charge so much to see their patients, but let's dig a little deeper. The field of general medicine is one of the most challenging to make a living. Many have had to leave their practice, or take up side work, to stay alive. The reimbursements are so low, they are forced to quadruple the amount of patients seen in an hour.

What used to be a 20-30 minute check up is now relegated to about 5-10 minutes. Ever sat in an exam room with a stupid paper gowns for about an hour, waiting for the doctor to finally come rushing in? The experience is less than pleasant as they zoom through the appointment in about 4 minutes, and then dash out again.

I spoke with Dr. Lisa Sanders about some of these issues and challenges. Sanders is a former Emmy award winning broadcast journalist with CBS, who launched a second career in medicine. She practices and teaches Internal Medicine at Yale, writes the popular "Diagnosis" column in the NY Times, and is the inspiration and medical consulting producer for the hit Fox TV show, 'HouseMD.'

"The medical stories on the show are based on facts, and the character of 'House' is pure Hollywood,"
Sanders jokes.
"I have been amazed how many people tell me they wish House was their doctor,"
she says more seriously.
"When I ask them why they would want such a nightmare, it seems people can look past his grouchy exterior, and it is being the center of medical attention that they crave."
Dr. Sanders takes care of the very poor in her clinic, and acknowledges she could not survive on what she earns seeing patients, if Yale did not provide her a salary. She shared an example of a typical day:

"One day I saw about 10 patients. Many of them had very complicated issues, with a lot of medicines to review, and I only had about 20 minutes. Guess how much I got paid for those patients? About $40.00 each. At the very end of the day, someone came in with an in-grown toenail. Guess how much I got paid for that? About $350 - almost as much as all the other patients combined."
I asked her what does this mean for doctors to survive?


"I guess I would have to be removing a lot more toenails."

Another new idea to put patients and doctors back together, sans insurance, came from a few cutting edge doctors, seasoned dot.com exec's and investors; who created an online marketplace for health
in a website called PriceDoc or www.pricedoc.com. They currently offer services for dental care, vision, cosmetic, walk-in clinics, chiropractic and alternative health. The site just opened in the Seattle market, and is generating a buzz.

Those in Seattle can type in a desired service, and a list of providers pops up with background information, credentials, and a list of what each procedure costs. This alone is revelatory. Where else can you go to compare the prices of a regular dental check-up, lasik surgery or laser hair removal? Here's the biggest twist: some of the procedures are available for a discounted "Make An Offer" option, similar to Priceline.

Sarah Ames is a 27 year old resident of WA who is employed, but does not have dental insurance, and wanted "Invisalign" braces. She called two dentists in her area for price quotes, and then found out about PriceDoc.com via a friend from Facebook. She searched the site, and found a price that was lower than the other two dentists- plus an option to "Make An Offer," from Dr. Tulay Kent. She did, won the bid - and ended up saving $1700. Wow, not bad!

Dr. Kent is a well respected dentist in Seattle,and said she loved that potential new patients can review her credentials, services, and prices online, and believes it will help build stronger relationships. When asked about the "Make An Offer" option, she explained the reduced fees are still comparable to insurance payments, yet without the hassle. This allows her staff to focus on the patients and handle more important projects.

People can't afford health care, and the entrepreneurial spirit will help us get there, both in big steps and small steps. It's time to tear down the walls and create a new marketplace for our health based on trust, experience and fairness.

Sunday, April 19, 2009

How Do We Beat the Health Care Blues?

Anyone out here have the health care blues these days? Can you name someone who is just thrilled with their health insurance policy and the simplicity of meeting all their health care needs? The Obama administration is attempting to tackle a gigantic mess with the national health care crisis, and so many lives are hanging in the balance. The words nerve-wracking, frustrating and hopeless come to mind.

It is difficult to obtain full statistics about how many people have either lost their health insurance, been downgraded to a lesser plan with higher deductibles, or are crossing their fingers and not buying any at all. As of the 2006 census, over 47 million Americans were uninsured, and some speculate that post-recession the numbers are over 50 million. There are over 105 million Americans without dental insurance, and over 17 million people aged 19-30 years old who are the 'invincibles:' deliberately taking the risk not to buy health insurance and hoping they won't get sick.

Many of the writers here try to inspire you, give you tools to cope, and lessons to thrive through tough economic times. Certainly there is nothing more disruptive to positive thinking, setting clear goals and pursuing a dream than fearing that one bad accident means you can lose your house in medical bills, or that if a child develops leukemia, you may have to file for bankruptcy. The serpent of fear creeps through almost every income bracket. One medical malady could spell financial ruin - how do we deal?

The US is already the most stressed out nation on Earth, and the #1 cause of death is heart disease. Stress does not help heart conditions, and a majority of the issues that bring us to the doctor are stress related. What do most of us do about stress? Eat more (obesity), drink more (alcoholism and liver problems), exercise less (osteoporosis), eat the wrong sorts of foods (high cholesterol), or smoke (lung cancer). We all know these aren't the best choices. I know when I'm stressed out of my mind, a baby lettuce salad or a snickers bar is no contest, and an hour of TV is much more appealing than working out.

How did we get here, and what happened to the local town doc who came with the black bag and stayed for Sunday dinner? The incredible rise in health care costs has made us utterly dependent on the insurance industry. We don't even know what standard procedures cost anymore. How much does it cost to have your tonsils taken out? How much to correct sleep apnea?

Time Magazine's health writer, Karen Tumulty, wrote an article in March about her personal experience of the health care crisis when her brother, Pat, paid for personal insurance while unemployed, avoided going to doctors despite not feeling well, and sadly found that his kidneys were failing at age 54. A few weeks of tests cost him over $14,000, and this did not begin to cover the treatments required. To read the full article, click here:

Tumulty writes:

"Pat represents the shadow problem facing 25 million people who spend more than 10% of their income on out-of-pocket medical costs. They are the underinsured, who may be all the more vulnerable because, until a health catastrophe hits, they're often blind to the danger they're in. In a 2005 Harvard University study of more than 1,700 bankruptcies across the country, researchers found that medical problems were behind half of them -- and three-quarters of those bankrupt people actually had health insurance. As Elizabeth Warren, a Harvard Law professor who helped conduct the study, wrote in the Washington Post, 'Nobody's safe ... A comfortable middle-class lifestyle? Good education? Decent job? No safeguards there. Most of the medically bankrupt were middle-class homeowners who had been to college and had responsible jobs -- until illness struck.'"
Fear often has a paralyzing affect. Why aren't we, as Americans, angrier at this strangle-hold for basic human needs? Why do we let the insurance companies get away with tens of millions of dollars in bonuses being paid to their CEO's, knowing most of that money came from denying care to the sick and helpless? ABC's 20/20 ran a story on Friday about how AIG continues to pamper their exec's with spa vacations, while denying 43% of the most serious health claims of injured contract workers in Iraq.

In next week's article I will highlight a few ways our nation is taking health care back into our hands, putting doctors and patients back in front of one another, and taking action while we wait for an overhaul.

In the meantime, how do we beat the health care blues? Here are a few tried and true 'words of wisdom':

1. "An apple a day, keeps the doctor away." How many of you actually EAT one piece of fresh fruit every single day? How about the recommended daily intake of 5-6 fruits and vegetables per day? Come on, it's hip to 'go raw.'

2. "An ounce of prevention..." The world of alternative medicine has skyrocketed, and for many, it helps. Naturopathy, acupuncture, herbs and chiropractic care have helped millions recover from stress related illnesses and ailments.

3. "I get by with a little help from my friends." The Beatles were so right. Study after study shows the health benefits of developing strong social connections. If you need a drink, go out with friends. The laughs will do more for you than the vodka. If you want to get in shape, forget the gym and walk, bike or run with a buddy. If you want to eat, invite friends over and share a meal together. Stress reducing hormones are released when we are in close proximity to others.

4. "What the world needs now... Is love, sweet love." How often, on a given day, do you experience: awe, joy, curiosity, bliss, wonder, love or amazement? It is no accident that books on 'Happiness' are all the rage; increasing positive emotions boosts health across the board. Take the 'positiviy ratio' test by Dr. Barbara Fredrickson, to see how you evaluate an average day's emotions.

Friday, April 10, 2009

What Do a Rabbit, Colored Eggs and Candy Have to Do With Jesus? The History of Easter Revealed

Ever stopped to wonder how bunnies, eggs and scavenger hunts are related to Easter's religious celebration of Jesus dying on the cross and rising again? Strange bedfellows they are. I never had any idea as a kid. No one seemed to question the whole odd mix: why would a rabbit have a basket of eggs in the first place, and how that tied in to crucifixion and resurrection was another matter. Let's explore some Easter myths while popping a few chocolate Cadbury treats, shall we?

I grew up in a vaguely Christian family, and today am sort of a floating generalist. Our kids celebrate Jewish and Christian holidays, and are exposed to Buddhism, Hinduism and Native American practices. God has many names to us and we are not members of a church.

It seems I am not alone in that vague religious category. According to John Meacham- in his Newsweek article, "The Decline of Christian America" :

"the percentage of people who say they are unaffiliated with any particular faith has doubled in recent years, to 16 percent; in terms of voting, this group grew from 5 percent in 1988 to 12 percent in 2008--roughly the same percentage of the electorate as African-Americans. (Seventy-five percent of unaffiliated voters chose Barack Obama, a Christian.) Meanwhile, the number of people willing to describe themselves as atheist or agnostic has increased about fourfold from 1990 to 2009, from 1 million to about 3.6 million. (That is about double the number of, say, Episcopalians in the United States.)"

This article was the subject of a hot debate on Hardball with Christopher Hitchens and Kenneth Blackwell and featured on Friday at the Huff Po. For me, the depth of our faith is a highly personal matter, and can change in its form and intensity as life takes its often bumpy course. Yet, what about the depth and quality of our holidays? So many have become empty- devoid of meaning and filled with consumerism.

In graduate school I studied the historical progression of religion from the first Sumerian myths over 3,000 years ago, and explored the impact on our collective psyche. It is interesting to note many Christian holidays blend together with more ancient or "pagan" holidays celebrated for thousands of years prior. Before Moses was around to have the first Seder, or Jesus walked the Earth, we celebrated the rites of Spring at this time of year, with the perfect balance of light and darkness, called the Vernal Equinox.

I love learning about these ancient celebrations, and exposing them to my children. They do not interfere with any specific religious faith, but add a broader context and history to the occasion. The Vernal Equinox is on March 21st and on that day, there is an equal amount of light and darkness.
As an adult, thinking about balance during the Spring is highly appealing to me. A time to quiet down, toss out what is weighing me down and center myself for the rising energy of Spring. How motivating to know from that day forward there will be a little more light outside than the day before. Regardless of your faith, this is a practice of worthy note.

It turns out the celebrations of modern Easter's egg-toting-rabbit evolves from a mythic German goddess named Ostara, (Oestre / Eastre) who was the Germanic Goddess of Springtime. According to the Encycolopedia Mythica:


"In ancient Anglo-Saxon myth, Ostara is the personification of the rising sun. In that capacity she is associated with the spring and is considered to be a fertility goddess. She is the friend of all children and to amuse then she changed her pet bird into a rabbit. This rabbit brought forth brightly colored eggs, which the goddess gave to the children as gifts. From her name and rites the festival of Easter is derived."

All other European words for "Easter" derive from the Hebrew word "pasah," to pass over, thus reflecting the Christian holiday's Biblical connection with the Jewish Passover. I find it ironic the holiest day in the Christian faith, dedicated to celebrating the Son of God, is named after a goddess.
According to www.godchecker.com: Ostara was very popular with the Anglo-Saxon people, who worshiped her under the name Eostre.

Yet there is something odd about how little there is written about her; the myth only resides in one area, and is recorded to exist for a fairly short period of time. Most Sumerian, Greek and Egyptian figures like Isis, Kali, and Demeter were widely worshiped for thousands of years, and many of the stories had moral components or attributes to emulate. What's the moral element of the Easter bunny? Something about it just doesn't fit with other myths.

Was it all a joke?

Recent research suggests that the Ostara myth was potentially invented during a mischievous moment by the Venerable Bede. This well-known monk mentioned her in connection with the pagan festival Eosturmonath in a book written in 750 A.D. -- but extensive research has failed to find a trace of her prior to that. Talk about the "stickiness factor" of Malcom Gladwell's book The Tipping Point. Imagine: a famous monk makes up a weird story about a goddess who never existed who turns a bird into a rabbit that lays colored eggs; and it morphs into a mega-watt holiday celebrated the modern world over.

Wow. Bet that gets your bonnet in a tizzy. Imagine the irony in making up a goddess myth, which becomes linked with the "greatest story ever told," and simultaneously serves as a mecca of commerce for Hershey's, hat makers and basket weavers. For those who are devoted Christians: does this affect the power of His word and His teachings? No, but come on; it is a pretty darn good story.

A little food for thought this holiday weekend! Whatever you celebrate: Happy Passover, Happy Spring and Happy Easter to everyone. Enjoy the sweet balance you find with your family, friends and the emergence of Light. And please save some of those marshmallow chicks for me!