Healthcare Revisited – Health Education

Healthcare Revisited – Health Education

We spend about $8 billion a year on health education and yet average health in our country is not improving. Obesity & overweight continues to increase, and longevity is decreasing despite our best efforts to extend life (we currently rank 57th in projected longevity). It is not unusual that a person’s medical cost will be more in the last year of life than all of the preceding years combined.                                                                                                             

The key to health is the condition of the immune system. Admittedly, there are hereditary factors that predetermine certain events, but even in these instances, longevity will improve with a high functioning immune system.  Defenders of the current health education program claim that the condition would be even worse if we abandon education.

I am not proposing that we abandon efforts to improve health, just that we refocus our efforts and reduce spending. I would eliminate spending at the Federal level and Cap the overall spending at $4 billion. I would push the spending down to the community level. Communities could apply for grants that require 1/3 local funding (in-kind services allowed) which would be limited to a maximum of $5 per capita per year (a city of 50,000 could apply for a maximum annual grant of $250,000. The proposals must contain both exercise and healthy eating components. The maximum duration for any grant proposal would be three years. After that, the community would be expected to maintain and fund the effort locally.

I would also aggressively address the obesity issue in two ways. There would be a phase-in period of 3 years. Persons that are currently obese would be given three years to reduce their BMI to 32 or below. Source: https://www.medicinenet.com/script/main/art.asp?articlekey=11760

“BMI (Body Mass Index) of 30 and above. (A BMI of 30 is about 30 pounds overweight.) The BMI, a key index for relating body weight to height, is a person’s weight in kilograms (kg) divided by their height in meters (m) squared.”

The only exception would be in the rare cases where obesity is a result of a medical condition or disability, and in all those cases would require a physician certification. There would be heavy financial penalties for false or forged certifications. Obese persons who bring their BMI to under 32 in the 1st year would receive a $1,000 tax credit in year two and year 3. Those that achieve the goal in year two would receive the credit in year 3. Commencing in year four all persons with a BMI of 32 or over would be subject to a $500 annual Income tax penalty. The penalty would apply to each obese person in the household. Further, obese persons would not be eligible for any federal government subsidies such as food stamps (EBTs).

The single most effective activity for improving and maintaining the immune system is an effective exercise regimen. What you consume is important, but exercise is the key. An effective exercise program involves a minimum of 30 minutes a day that includes elevating the heart rate to at least 50% above the at-rest rate. Example: if your at-rest rate is 60 bpm then ensure that your exercise rate is at least 90 bpm. For the average person, this would mean brisk walking at about 3.5 mph. You can easily gauge your walking speed by the distance covered in 30 minutes which would be 7/8 mile (1,400 meters) at 3.5 mph. This rate of speed will likely not be possible for many obese persons, but it is one that is attainable in less than 30 consecutive days of walking. This routine will easily take a person with a BMI of 35 to below 32 in less than six months as long as their caloric intake does not increase. Walking is free; it only requires time. My favorite reference on this topic is a video called 23 ½ hours at https://www.youtube.com/watch?v=aUaInS6HIGo.

Healthcare Revisited – Insurance Companies

Healthcare Revisited –   Insurance Companies

I am not convinced that putting a middle man into providing health care makes much sense? If they can do it more efficiently, it does, but the facts are disturbing as you can see from the following:

Health Care Premiums Also Used for Lavish Salaries, Luxury Items, Underwriters

Nov. 3, 2009,  By KATE SNOW, ELIZABETH TRIBOLET and SUZAN CLARKE via

A significant portion of health insurance premiums goes not for actual medical care but for private jets, generous CEO salaries, and underwriters who decide when to drop patients who become too expensive, according to a Senate committee report.

Sen. John D. Rockefeller, D-W.Va., chairman of the Senate Committee on Commerce, Science and Transportation, wrote to 15 of the biggest health insurance companies in August, asking them to provide information on how much of policyholders’ monthly premiums was spent on medical care versus the amount that went to administrative costs and company earnings.                                                                                                                   Such figures are known in the insurance industry-speak as “medical loss ratios.” But when insurance companies balked, saying the information was confidential and proprietary, Rockefeller’s investigators went digging through public documents and found that much of policyholder premiums were going to nonmedical costs.                                                                                                                       The insurance industry has long pointed to federal data that says about 87 percent of every dollar that people spend on premiums goes toward actual medical care, but Rockefeller’s investigators found the average for the top six insurance companies is closer to 82 cents on the dollar for medical care.                                                                                                                      That five-point difference represents billions of dollars. And when investigators broke down the information by insurance type, they found that people who buy individual insurance from those companies rather than being part of a small or large business, get the least bang for their buck. On average just 74 cents of every premium dollar for individual coverage goes to medical care. Coventry Health Care had the lowest figure at 66 cents”

I suspect the health insurance companies are excited by the Affordable Care Act. Now all of us must have health insurance, and we pay the penalty if we refuse!  We are better off taking the middleman completely out of the process.                                                                           That said, I am not in favor of completely decimating private medical insurance as long as they can provide comparable and competitively priced services. The fact that Medicare’s administrative costs run less than 2%. The average costs and profits for insurance companies at 26% is telling.                                                         How are the baseline countries handling health insurance? I am confident that an efficient system similar, to one already in place in another country, can be implemented by us.

Healthcare Revisited – Hospital Costs

Healthcare Revisited – Hospital Costs

(source: https://worldofdtcmarketing.com/hospital-care-is-the-largest-driver-of-u-s-health-prices/)

Total health care spending in America was approximately $3.5-trillion in 2017, and about 32% of that amount — or $1.1-trillion — is spent on hospital services.”

Hospitals are an area where our costs are completely out of whack! I have no idea why we are so out of line with the other countries.

There are numerous documented examples of hospital financial abuse in this country. Overcharges for OTC medications, overprescribed testing, and phantom charges are among these examples. In the U.S. we pay more for hospital services than in all other countries. Do we receive superior care in exchange? Considering where we rank in terms of quality of care, it is doubtful.

This area cries out for some serious baselining. I have not been able to locate the cost of a hospital day for all of the baseline countries. But there is little doubt that they all have a lower per day cost than the U.S.

I am reprinting this chart to illustrate the issue. It contains the numbers for a couple of baseline countries, France and Spain.