Better Records

Our medical records system has to change. In this one area, I actually agree with Mr. Obama, but only in part.

I went to the Dr. recently and spent the majority of my time there writing down my medical information. Very little time was actually spent with the doctor. Then he spent 2 minutes reviewing my medical history and then talked to us. When I go to another doctor for something else, I will need to repeat the procedure, but he won't see the information that the previous doctor wrote because the records are separate. I might even leave something off by mistake (or intentionally). This has got to change. In an age where information is so easily stored and accessed from anywhere in the world through a simple web browser, there is no reason not to have one source for all my information.

We have to move to a single record per person for all medical issues and history. I don't mean a single repository for all records, but one place for my records and possibly another for yours. Read on...

If all my records were in one place, then any doctor that I give approval to can view them and see all my history immediately and without duplication or error. He will have accurate and current info on my history, conditions, treatments, prescriptions, etc. I don't have to worry about forgetting something or worry about him not understanding something because it will all be in one place.

However, I do have some caveats about this.

• This must be developed privately and not by the government. Have you ever accessed a government web site? They are difficult to use and not as good as most corporate sites. The government should not attempt to develop this technology but instead should simply reward the company(s) who do. Set up a development competition so that whoever meets all the requirements within the time frame will be rewarded nicely. Even if a $100 million reward was posted, this would still cost far less than the current estimates for the government to develop.
• There must be open competition so that there might be 2 or 3 good records storage providers competing for our business. This is critical to keeping the quality high and costs low. A government built technology will be stale and never keep up with technology.
  
• The records must be portable so that if I want to switch providers, I simply export/import to a new record provider.
  
• The records belong to the person (owner) only. No one else can access the information except those to whom permission is granted. When a doctor needs to see the records, he/she must be granted access permission from the owner. Same for family members.
• Neither the government nor the insurance industry will have access to these records unless granted by the individual.
  
• When access is granted, it will only be for a limited time (maybe a week or month). This goes for Doctors as well.
  
• All access to the information will be traced and recorded - visible to the owner so that he/she knows who and when their records were accessed.
• The providers will need to keep a subset of our records for their records. This is simply a legal CYA for them but it could be used for research if permission is granted by the owner.
• The owner will not be able to modify a doctor's notes, comments, or prescriptions. This will prevent the patient from hiding something, like getting duplicate prescriptions or conflicting medicines.
  
• Security must be at the top of the list. Lots of people are concerned about this, but this is not an insolvable problem. Easy - no, but it is doable.
• It must store images (MRI's, xrays, etc), prescriptions, doctor's notes, nurses notes, owner notes, questions, scans of older records, etc.
  
• It must not store billing information. If someone is having trouble paying, then that must be handled separately and not be visible by the provider.
  
• It must be easy to use and intuitive. This is a good reason to keep the government out of it.
• The monthly cost can be paid by the owner/individual through subscription fees. However, someone will probably be able to be profitable through advertising or some other means.
• HIPAA laws must change to support and adjust to storing information this way.

The list of requirements will surely grow since I am no expert here, but do have an opinion. Did you know that Google is currently running a beta of health records? I poked around there and didn't get the sense that their first go around will be life changing. I think that IBM is also working on a solution and probably a few other big players. This is good - let the competition begin.

However, do not let Uncle Sam develop it or think they own it. That would be horrible! Let it be done privately on the open market. This is a better way.

A Better Love

On Valentine's day, there is lots of talk about love, about candy, flowers, cards with hearts on them, etc.  But what is love really?  I ran across this video on the statesman.com web site today and couldn't help but be amazed as people's definitions, or attempts to define love.  Watch it...

Now, contrast this to the one who created love.  He defines it this way.  It's not only a better love, it's the best love anywhere at anytime, period.

Socialism or bust

That's what the President and his men think. Socialism or bust. They apparently don't believe in free enterprise and true capitalism. They believe that a socialist economy, where the government controls corporations and banks, is better than free enterprise and letting the natural consequences of peoples corruption and mistakes occur. Or why else would they want to print nearly a trillion dollars to "stimulate" the economy? Why else do they think they can make the country better by creating more government jobs? They apparently think that the government is a god that can save everyone from all trouble!

This whole thing was caused by lending money to people who couldn't afford to pay. Now the government is going to borrow tons of money with no reasonable way to pay for it. There's an old saying that goes "If a bank lends $500 to a man who can't pay it back, the man suffers. If a bank lends $5,000,000 to a man who can't pay it back, the bank suffers." But what if the government borrows $1,000,000,000,000 and can't pay it back? Everybody suffers.

I really believe that the government cannot spend this country into prosperity. That is really upside down economics. What this country needs is confidence. Confidence that the government is not going to go broke. Confidence that inflation won't hit double digits in the next few years. Confidence that real change is ahead. Instead, we get the same thing from Washington - the same spending without knowing where the money is coming from, the same adding to an already humongous debt without a plan to pay for it. This is not change, but simply more of the same, just with bigger numbers attached than ever before!

What this country needs is encouragement and incentives to save money, to buy things with cash not credit, to invest money, and to be generous to those in need. Our current tax system punishes people for saving and investing by taxing their interest on savings and capital gains. Our income is taxed like it belongs to the government instead of to us. We need a new tax system that rewards people for doing the right things.

I've read about a better way of doing taxes called the Fair Tax. You should buy the book and read it too. It would be real stimulus and, in my opinion, would be real change that would encourage saving, investing, and would eliminate the dreaded income tax.

In the meantime hang on, because our government will again be sending us money that it doesn't have so that we can buy things made in foreign countries. Why don't they just send us a coupon for a new car from Ford, GM, or Chrysler? This might prop them up for a while!

He would be sixteen

He would be 16 years old tomorrow.  Except he's not.  He never took his first breath.  I would be taking him to get his drivers license. I would be worried about his safety, about him wrecking my car, about him driving too fast, about the music being to loud and distracting. Except I'm not.

It's amazing to think back about our excitement of his coming birth. We tried so long and hard to get pregnant. Spent thousands on infertility medicine, Dr's visits, and procedures. It took many attempts over 5 years and finally she was pregnant. On June 1, 1992 we got the news. I called my Dad and told him - we both wept in our happiness on the phone.

Thirty nine weeks later he was born.  But not like we dreamed. Vasa Previa took his life. We were shocked and very upset. In my anger, I punched a hole in the Dr's wall. Not a great response, but it was how I felt.

God sustained my wife and I through it all. He'll do it again, I'm sure. Now I look forward to seeing him in Heaven.

Brandon - I love you and miss you.

Dad.

The Swiss way to Health Care

I still can't get this health care topic off my mind... I've been reading about the Swiss health care system and it sounds very interesting. I won't go into a ton of details because you can more read about it here, among other places. I don't particularly care for their price fixing/negotiating but it is a place to start. Their employers don't pay for insurance but the individuals do. The Swiss are required by law to carry insurance, but they shop around for different plans that compete for your business. This seems a step in the right direction, but not yet there all the way.

Author Regina Herzlinger addresses the health care issues in the U.S. in her book "Who Killed Health Care" and has some great ideas about overhauling our current system. I'm just a regular Joe (not a plumber), but Regina is a Harvard Business School professor and she understands that we need a consumer driven model. I'm ok with employers subsidizing the premiums, but not with limiting our choices. Would we be ok with our employer picking our houses for us? Of course not, so why are we ok with the choice of one health insurance plan that is typically offered?

Angie's List is a pretty interesting website because they allow you to read and post reviews of various service providers including doctors and hospitals. This is a great way to provide visibility into the quality of care (and even the cost) by hearing about people's real experiences with their care. Doctors who have poor bedside manners will either have to change or go out of business. This would be good! Angie's List just needs to catch on a bit more for this to be truly effective.

I'm still convinced that a consumer driven free market approach will provide the missing transparency to the costs of care along with healthy competition for our business. Let's not be content with a government run, centrally controlled, and price fixed nightmare. I'm afraid that this may be what our new congress and president will want to offer us this coming year. Ugh! There really is a better way.

Better Copays

To continue in the same vein of trying to find ways to decrease health care costs, I want to address another issue - copays. Copays are designed to share the cost of a doctor's visit or a drug prescription between the patient and the insurance company. This (slightly) helps a person think twice before going to the doctor over something trivial or having a prescription filled that they may not really need. Have you ever had a precautionary script given to you? Just in case you need it you can have it available to you. If it wasn't for the copay, you might just fill it and let it sit on your shelf for two years.

But the problem comes when it is time to shop around for your prescription. Who does this? Not me. I like my pharmacist, so I go to him. It costs me the same $10, $30, or $55 irregardless of who fills it - my favorite pharmacist or some other one down the street. I almost never know the actual cost of the medicine (what the insurance company pays). It might cost less at another pharmacist, but I don't know because I don't ask and I don't shop around. It's all the same to me - just the copay!

Now if my portion of the copay was tied to the actual cost of the drug, if I could save money because one pharmacist charged less for the medicine than another, then I would be very inclined to go to the cheaper pharmacist or ask for less expensive drugs. Simple market dynamics in action. So, instead of having fixed copays, I think we should pay fixed percentages of the cost of the medicine. Example: if my insurance plan had a 20% copay for drugs, then I would certainly shop around and buy the drugs at the store with the lowest price. I would even ask my doctor before he writes the script about options that cost less than the latest and greatest high dollar drug that he is probably getting a kick-back on.

Case in point - I can get my generic drugs at my local pharmacy for a simple $10 copay or I can go to Walmart (and now other places) to get a $4 generic. Guess what? I will endure the hassle of going to Walmart to save $6 per prescription! Why? Am I cheap? Maybe cost suddenly matters when it affects my wallet! I've even brought Walmart's list of $4 drugs to my doctor and asked him if there was anything on the list that would work for what was ailing me! It works!

Likewise, if a doctor's visit copay was a fixed percentage of the actual costs instead of a fixed dollar amount, then I would seriously consider my doctor's costs and shop around to see if his billing is reasonable. Right now, I never ask because it's all the same to me - either $20 or $40.

I really think that insurance companies with their current plan designs have done a disservice to health care costs because they have removed and isolated the patient (consumer) from the costs of their care. While at first this seems nice and comfortable, a great way to get health care at predictable prices for the consumer, it completely removes any initiative for saving money. Anywhere! The patient never makes a decision based on their actual cost of care. The insurance companies have fixed pricing contracts with providers and only pay what's in the contract. Since when has fixed pricing ever resulted in a free market or lower costs? Let the airlines be an example many years ago.

There must be a simple connection between the cost of services and the patient's/consumer's wallet.Then natural market forces would then begin working on the prices that doctors and companies charge and the services that patients request. It just might be a better way.

A Better Health Plan

The President elect has begun asking for ideas on how to make our health care system better. I have a few thoughts on the topic, but they may be naive. They're also not fully complete, but are just ideas being formed. Maybe you readers can help fill in some of the gaps. I also admit that I barely understand the complex nature of the health care system. I do know it is very controversial - but we need new ideas. Also, these ideas are my own and do not necessarily represent the ideas of anyone else, including my employer...

The first thing that must be considered when you think of a new plan is understanding what is it that is broken that needs to be fixed? In my understanding of the national dialog, the two issues are 1) that many people don't have health coverage and 2) the health costs are climbing too fast. So the solution must provide a means to keep the costs down and a means to provide for those who don't have insurance. If I understand it right, the biggest reason that people don't have health insurance is that they can't afford it. Therefore, if the costs were brought down, then the number of people with coverage would naturally go up.

So when I think about how to address these issues, the following things come to mind:

• Don't nationalize it. Just look at Canada and their costs. I can't think of any good models of nationalized health care.
• Move away from the group health insurance model to an individual health insurance model.
• Under this model, people shop around and purchase their health insurance like they do for their auto or home. This will provide free market forces and competition, which means lower prices.
• Employers would provide health insurance premium vouchers to allow their employees to purchase whatever plan they choose on the open market. If the employer is currently paying $600/mo per family for health premiums, their voucher value would then be the same $600/mo.
• Provide tax incentives for employers who currently provide health insurance to their employees to continue with the vouchers for their employees.
• Provide incentives for employers who don't currently provide insurance to start providing vouchers of some value. Tax rebates or credits might do the trick.
• We are required by law to carry auto insurance. Is this going too far for health insurance?
  
• Provide incentives for people to save money themselves with their health care. One way could be high deductible insurance plans with tax exempt medical spending accounts to cover the deductible. Remove the copay for an office visit. Then each individual will begin asking how much a doctor will charge for services and maybe even shopping around for better rates. There are still the Dr./patient relationships that enter the equation and would make changing tough. But certainly for lab work, this would be easy! Then, if there is money left over in the spending account at the end of the year, it goes back to the individual as simple taxable income. Don't punish people by making it a use it or loose it endeavor (like current medical spending accounts are). Reward people for saving.
• Provide incentives for good personal health. People who smoke and people who are overweight are shown to be at high risk for lots of medical problems and expenses. These are two things that people can (usually) control themselves if they want to. Therefore, if there were incentives to quit smoking and to exercise regularly and eat right, there would be huge future payoffs in both longevity and lower heath care costs. I think the best way to do this is through significant insurance premium discounts for non-smokers and those who can show they exercise regularly.
• Structuring the health insurance industry like the rest of the insurance industry - on a risk assessment basis. The auto insurance industry charges higher premiums for those with a higher risk - like teenagers and those with previous accidents or tickets. They lower your premiums if you haven't had any claims for 5 years or if you are in a low risk age group (married and over 25). If you have extra safety devices in your car, you qualify for premium discounts. Home owners insurance premiums go up when you have a previous claim. They go down if you have a security system. These are simple risk calculations. What if the health insurance industry had similar risk factors calculated into individual premiums? Smokers would pay more than non-smokers. People who exercised regularly would pay less than those who don't, etc. People who get an annual physical get discounts on their premiums. People with lots of previous claims would have to pay a higher premium than those with no claims.
• What about people who are not employed? Their biggest front burner issue is lack of income. So they are probably on unemployment or welfare. While they are on these programs, the government could probably provide a voucher for their health insurance. I don't like this idea as a long term solution, but for a short term solution, it is palatable.

Today, I don't shop around for my family's health care - because the cost of a Dr's visit doesn't matter to me. My insurance company picks it up no matter what. This is the inherent problem and biggest disconnect in health care today. The person who chooses the provider is not the person who is paying. If we where to remove this disconnection so that each individual is connected to the cost of service and has incentives to save money and live healthy, then I think this would be a better way.

Thoughts?