Health or Medical?

24 April 2009 - I added a reference to " Medical Waste" in the main blog

4 April 2009 - I added a reference to the Medical Industrial Complex in the main blog

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Monday 22 September 2008 - By now, my opinion is that the new law in Massachusetts (see below) has had a disastrous effect on our finances. For just two of us, the premiums alone are now over $1300 per month, about the same as our mortgage!

Then, earlier this year, I heard an interview on Tom Ashbrook's On Point program on NPR. His guest was Shannon Brownlee, the author of a new book, "Overtreated." I read a review of it on the New York Times web site. I went right out and bought a copy. In the book, she exposes the root causes of the continued rise in medical costs now being paid by everyone, including individuals, businesses, local governments, etc.

I had already thought of the term "Medical Industrial Complex" by that time, and discovered that she uses this same term in her book. I made a diagram to show what I mean by that.

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May 2007 - I produce a video program on local cable TV, called "The Commonwealth, Insurance, and You" to help others understand the implications of the new law, especially for the self employed, artists, etc.

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Sunday, 9 April 2006 - Massachusetts government just passed a new law, this past week, to go into effect a little over a year from now (July 2007). It mandates that everyone living in Massachusetts will have to buy medical insurance or pay a penalty to the state. The bill sets up a state bureaucracy to manage the whole thing.

I call this "medical insurance" because essentially, they can only insure you against medical costs. Sure, some companies offer policies with so-called "health club" membership benefits, but it's really a side issue. So far, there is no way for an insurance company to "ensure" that you stay healthy.

As a self employed person who is without such insurance as of this writing, I am skeptical. But what choice do I have? If I don't like the plan, I can either write to my state representative and wait for them to change it, or I can move out of state. But with all the press the plan is now getting, that might not even work as other states may quickly adopt 'copy cat' plans. Perhaps taking up residence on a south sea island makes more sense.

OK, forget that. The question is, what do I want instead. I don't want to hang around without any medical insurance because I could eventually need medical care, and it looks to be prohibitively expensive. Perhaps the libertarians would recommend that I save money in my own bank account for my medical "rainy day" or the anarchists would tell me that there should be no banks, so my alternative is to store gold under my mattress and post an armed guard outside my door?

But wait. What about my health? In a way, there are four parts to this:
• Lifestyle - what I eat, how much I sleep, what exercise I get, my mental attitude (stress or calm) etc.
• Prevention - steps I take, such as washing my hands, and public policies to protect me from the spread of disease, occupational hazards, etc.
• Analysis - checkups & tests to determine if I develop a medical condition, hopefully in the very early stages
• Treatment - medical care to heal me if I'm found to have a disease or condition

So the current thinking is to create a big pool of people in order to spread the risk. That's how insurance companies think. The bigger the pool of people the better. So-called 'single payer' plans want to have a pool as big as the entire country, almost 300 million people. But right now, lifestyle, prevention, and analysis are largely left up to the individual. So, some people pose a much greater risk because they lead an unhealthy lifestyle, avoid prevention, and seldom report for analysis.

Seatbelt laws are an example of this. Seat belt laws fall under the 'prevention' category I spoke of above. If we have a law that you must wear one, then we are trying to take that decision away from the individual and make it a state requirement. The reasoning is that we're all burdened by the cost of medical care for injuries sustained in collisions and it's not "fair" for some people to neglect to put on their seat belts, then run up a huge hospital bill if they suffer injuries in a collision.

But seat belts are only one of many prevention factors that contribute to our overall health. We're not going to go so far as to hire "hand washing police" to stand by every sink and basin in the country, ready to issue a ticket if you don't wash you hands at the appropriate times, right? (Or, imagine the bedroom police, making sure every man is wearing a condom before the potential exchange of bodily fluids!)

So, I have a proposal. It's not a solution to every problem. But it might be something to try. That is, think small instead of big. Instead of 300 million, try a much smaller number, such as 10.

Perhaps we call this group of ten people a "health support group." The 10 people actually meet face to face on a regular basis (as often as they like, but at least once every 3 months, let's say). They pay monthly into an account, then draw from that account for costs of analysis and treatment. But most importantly, they discuss lifestyle and prevention factors at their meetings. They conspire with each other to find ways to eat a healthy diet, find a balance between exercise and relaxation, support each other when it's time to face scary analysis appointments, and perhaps even accompany each other when treatment is needed.

Such small groups may have to be 'backed up' by some kind of 'sick care insurance' in case the cost of treatment for unfortunate events exceeds the group's savings account balance.

So, what do you think? Comments are welcome.

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