Sources for 2/17: Making Health Pay

Last week I wrote about sources. This week I divided them by subject. The section on health features interesting articles re our health care debate. We cannot really address health care or any social program w/o considering the behavior and incentives of those involved. We are responsible for each other and we are responsible for ourselves. Where is the boundry?

I recall the joke re a man who prayed to get rich by winning the Power Ball lottery. Each day w/o a win, he grumbled to the Lord about his lack of good fortune. Finally the Lord answered back, "Do me a favor and buy a ticket." It makes a very good point. Others cannot help those who will not help themselves. It gets worse when big bureaucracies, be they large firms, big charities or - worst of all - big government get involved. Such originations by necessity create tangles of rules to determine who gets what. These rules can make it difficult for good people to get what they deserve while creating opportunities for crooks and malingerers to play the system and making everything cost much more.

In "Get Healthy or Else" we think about some of the limits of what we can (should) require of people. How do we handle a smoker whose bad habit increases the cost of health care for everybody else? How much sympathy should we have for self-inflicted sickness & how much sickness is self-inflicted? That might be an easy call for some, but everything we do in life either increases or decreases our health risks and lifestyle is becoming the most important predictor of health outcomes. But there are always tradeoffs. The guy who rides his bike to work might have wonderful cardiovascular health until the day he gets hit by that bus.

"Consumer-Directed Health Care: Early Evidence Shows Lower Costs, Mixed Effects on Quality of Care" talks about some of the more direct tradeoffs in health care. Sometimes good health is not a sufficient incentive to live a healthy life. Health is a classic problem of effects being unclear and separated in time from causes. Exercise requires up front payment for for rewards that will come incrementally and not for a long time. A bad habit like smoking show no immediate effects. Sometimes the best way to create incentives for health is to make the cost more explicit in dollars and cents.

Other sources are below.

Weekly News Interest Index Launched

Security, War on Terror
Modernizing Military Compensation
War on Terror
House Iraq Vote Spells Trouble for War Effort

Education, Income & Welfare
Income Inequality Reality
Utah’s Revolutionary New Voucher Program
Workers Reject Card Checkoff, Prefer Private Ballots

Health, Social Security & Budget
Taming the Deficit
Get Healthy or Else
Seeing Past a Red Herring in the Medicare Debate
Consumer-Directed Health Care: Early Evidence Shows Lower Costs, Mixed Effects on Quality of Care

Environment & Climate Change
Global Climate Change & Wildlife*

Politics and Election 2008
How Reliable are Early Presidential Polls
The Leadership of George W. Bush: Con & Pro

Foreign Policy & Economics
Iran’s Dire Oil Straits
Iran's Developing Nuclear and Missile Programs
Iraq: Milestones since the Ouster of Saddam Hussein
Nuance in Chavez's Rhetoric Tells of Future Plans for Region
Rafsanjani and Ahmadinejad Are Posturing to Succeed an Ailing Khamenei
The War of the Persian Succession Intensifies
U.S. Enemies Put Innocents at Risk
What Trade Deficits Really Mean
Winning with Smart Power

Posted by Jack at February 17, 2007 3:38 PM
Comments
Comment #208581

This is just an anedcote, but since it’s my anecdote, I can attest to its veracity, for all that’s worth. Some years ago the company I worked for closed the branch office in which I worked. I worked at home for a few years, but finally the inevitable happened: I was laid off. I was offered health coverage under COBRA, but for my daughter and me, it would cost something around $500 a month. No way could I afford that after losing my job. So I bought coverage for my daughter through a local company and went without coverage myself. It was risky, but I was in good health, and I didn’t believe I had any good options. However, a year or so ago, I decided I just couldn’t keep rolling the dice, so I went to the company that covered my daughter and inquired about coverage for myself. I was shocked to learn I could get good coverage for about $160 a month. It wasn’t as good as the coverage I had from my employer, but it wasn’t bad — $1,000 dedeuctible, $15 co-pay, $10 prescriptions (after $1,000 deductible).

I realize that for those with health problems that insurance can be ruinous, but I wonder how many people there are like me just didn’t realize that health insurance can be relatively inexpensive.

Posted by: Trent at February 17, 2007 5:43 PM
Comment #208585

The cure for smoking and alcoholism are easy Jack. Classify them as illegal drugs because they are both addictive and potentially very dangerous to our health. Of course we both know this will never happen because of the tax revenues, and jobs they generate. It seems kind of ironic, eliminate these vices,improve health and hurt the economy. The same logic applies to all the fatty food enterprises that market to us all. We can live without them, but they can not survive without us. We could demand that those capable of doing so live close enough to their work place to walk or ride bycicles. But then the energy market suffers at the expense of good health. It seems that a clashing combination of business profits and the need for all to pursue healthier lifestyles are probably the biggest obstacles.

In order to establish effective boundaries would require revamping business and individual habits. How one would go about initiating such complicated measures is well beyond my comprehension. I seriously doubt any one person, politician or organization has the means or the balls to pursue and effectively orchestrate such a huge undertaking. There is a health crisis in this country and it needs to be fought from the bottom up. It will take decades if not longer to mold a society that is health consious from a business and individual perspective. In the meantime we need to find a way to take care of our own while business and the individual work at improving our nations health.

Posted by: ILdem at February 17, 2007 6:11 PM
Comment #208589

Ildem

Actually the problem of our health is one of success. We have so effectively addressed all those infectious & contagious diseases that used to attack people promiscuously. As a result we are left with lifestyle related ailments and the general problems of old age.

Re business making money, business spends fortunes trying to figure out what people want to buy and give it to them. If people want healthier food, firms will give it to them. In fact, it already has. It is easy to go into any ordinary supermarket and buy nothing but healthy food. What is interesting to me is the bimodal nature of healthy food. The healthiest food you can buy is either among the cheapest or the most expensive. You can buy enough peas and beans for about a dollar to make healthy soups that will last all week or you can pay the big bucks for the officially packaged healthy foods.

We tried to outlaw alcohol, you may recall with mixed results. Cigarettes provide an excellent example of a successful social program. Not many intelligent people smoke anymore. In fact health is becoming more and more a smart/stupid divide.

I have noticed that the fat unhealthy guys (I mean the bulgy fat guys not the strong looking fat guys) are almost never in charge of anything. I think the arrow of casualty is that people who cannot plan ahead or discipline themselves both get fat and do not get ahead. So you tend to get the healthy, wealthy and wise in one group and those w/o those attributes in the other.

Posted by: Jack at February 17, 2007 6:31 PM
Comment #208591

Jack

I think lifestyle related ailments pretty much says it all in regards to the problems facing this nation. Education and lifestyle changes are the obvious fixes. But these are not fixes that can be effected on the quick. So long as there are profits to be made and fatty foods available it will be a very slow change from poor diet to good in this country. It is a two sided problem with the business industry being as much at fault as the individual. And if government had any balls they would not have turned the cigarette industry into a social program. They would have eliminated it alltogether. I do totally agree that anyone with todays knowledge who smokes is probably just plain stupid. I do not know the numbers but I am amazed at the amount of young people who I see smoking. I have to believe the numbers are less than they were in our younger days.

As for fat people and wealth, I saw a study once that concluded that good looking people get the jobs and the money as a general rule of thumb over the often better qualified not so beautiful people. I am not sure what this says about our society. Perhaps vanity plays a bigger role than we think. Or maybe it is just a survival of the strongest gene thing.

Posted by: ILdem at February 17, 2007 6:54 PM
Comment #208594

Here I would have thought Jack would be grateful for the smokers and the fatties. Less time for them to want to collect social security and use Medicare. :)

Posted by: womanmarine at February 17, 2007 7:05 PM
Comment #208599

About 3 decades ago my health care provider was CIGNA. When I first signed onto CIGNA they put me through a battery of tests. The result was a 9 page readout of the chemical/metal makeup of my body and how I fell into the ranges of each. This I believe is a very good tool for doctors to do preventive maintaince. They can see on a persons readout where they are deficient or overrange on any number of chemicals/minerals and be able to do a better job of diagnosing chronic problems. This would contribute to fewer doctor/hospital visits and bottom line hopefully a healthier life.

Posted by: tomh at February 17, 2007 7:13 PM
Comment #208603

Womanmarine

“Here I would have thought Jack would be grateful for the smokers and the fatties. Less time for them to want to collect social security and use Medicare. :)”

LOL Thanks for the laugh!!

Posted by: ILdem at February 17, 2007 7:30 PM
Comment #208605

Good grief, Jack. You generalize so easily. Smokers must per force be stupid? Fat people can’t be in charge? This is similar to your belief that the poor are stupid and that their children are genetically cursed. I wouldn’t be surprised if you could find some sort of loose statistical coorelation, but what you’re claiming is hardly a law of nature.

Posted by: Trent at February 17, 2007 8:15 PM
Comment #208606

I also am not sure of the cause. But I have noticed that the more successful people tend to be better organized in many parts of their lives including diet and exercise. There is also the push. Most business and personal success has that image aspect. There is also stamina. Success often requires long hours. I manage a fair number of professionals and some of them just do not have the energy they need properly do the job.

Woman

The problem is that they tend to cost more. Many things do not actually cut years off life, but the cut life off the years. The worst case scenario is having someone who is sick and sluggish, but just will not shuffle off this mortal coil.

Besides, the smokers stink up the room and the fatties are aesthetically unpleasing.

Posted by: Jack at February 17, 2007 8:31 PM
Comment #208607

Jack:

Tsk, tsk.

“Whatever you neglected to do unto one of these least of these, you neglected to do unto Me!”

“Therefore if your enemy hungers, feed him”

What happened to good old taking care of our neighbors?

Some of these posts get pretty arrogant.

Posted by: womanmarine at February 17, 2007 8:36 PM
Comment #208608

Trent

I think there is a connection. It is not perfect. I do beleive that anybody who started to smoke since 1964 must be at least a little stupid.

My point in all this is that there is a definite clustering. You tend to find smoking, poor physical condition, a certain cognitive limitation & poverty in one package and the opposite in another. I think a lot has to do with choice. It used to be that you ate what people around you had available, few people exercised very much outside their jobs and most adults smoked. Now we make these choices and the choices have consequences.

Posted by: Jack at February 17, 2007 8:40 PM
Comment #208609

Confucius said, “The gentleman calls attention to the good points in others; he does not call attention to their defects. The small man does just the reverse of this.”

Posted by: womanmarine at February 17, 2007 8:40 PM
Comment #208610

Woman

You must believe me when I tell you that I give plenty of helpful advice to the fat, lazy and poor people around me.

Actually, you may not believe this, but my reputation at work is that of an excellent boss and a good mentor. I put on my schedule time to walk around and listen to my staff and others. Most people love to work with me and they tend to do well. A few people hate me and if they do not do their jobs, I try my best to get rid of them. There is usually causality there. In other words, I help those who want to work (I think this is around 80% of the people) and the others can find different friends and maybe different work.

Posted by: Jack at February 17, 2007 8:47 PM
Comment #208615

Woman - Confucius said lots of things. I think the Duke of Chou paid him by the word. He is kinda like the Steven Covey or the Tony Robbins of his time. His advice is often useful as a first step, but you cannot take it as the last word.

Posted by: Jack at February 17, 2007 8:52 PM
Comment #208616

That’s very circular, Jack. If I had to guess, I’d say that peer pressure is a larger factor in declining numbers of smokers than health issues. We’ve know about the dangers of smoking for decades. Your definition of success, of course, appears to be purely on economic factors. I can tell you that some of the brighest people I know pursue things other than large salaries.

Posted by: Trent at February 17, 2007 8:54 PM
Comment #208618

Helpful advice? How generous!

I don’t recall posting anything about work.

Posted by: womanmarine at February 17, 2007 8:56 PM
Comment #208621

Woman

My work is where I have the opportunity to do the most “helping” and where I most openly put my philosophies to work.

My general observation that those who talk about helping others tend to do little about it. They can boldly talk about helping ALL people because they do not really intend to help anyone. I make no pretense of helping everyone. I choose the ones where I can have the greatest effect.

There is also a conservative v liberal difference. I have some strong opinions, but I do not actually bother with things that are not my business AND most things are not my business. I rarely feel bad about things I cannot do because I concentrate on things I can.

Posted by: Jack at February 17, 2007 9:02 PM
Comment #208643

Smoking has decreased dramatically since we started taxing it and many states barred people from smoking in restaurants and bars. So I guess that shows we can place controls on the “free” market, and have it be win win for everyone. Personally, I wish our society would be a lot more hands on about the society we want to live in. If we regulated say the beef industry, prices would probably go up a little and quality a lot.

As far as smokers being dumber than non-smokers or fat people not having the energy needed to become management, I have never seen this myself.

Posted by: Max at February 17, 2007 10:13 PM
Comment #208646

Max

Beef, unlike smoking, is not necessarily a bad thing. There are many benefits from eating beef. Like most things, it depends on how much you are eating. If you want to pay more for beef, you can get superb quality. You do not need the government to do that for you. What you really want to do is take away the low priced meat. That also is usually of excellent quality. It just depends on what you want to do with it.

You might want to irradiate the meat to kill e-coli. Food poisoning is at a historical low, but we hear a lot about it and this could eliminate much of it.

You just trust government more to make the proper decisons for you.

I prefer to make my own decisions about whether to eat beef or drink beer. I am grateful for the existing health regulations, but we do not need consumption laws.

Re fat people in management, maybe we work at different paces.

Posted by: Jack at February 17, 2007 10:25 PM
Comment #208659
It gets worse when big bureaucracies, be they large firms, big charities or - worst of all - big government get involved…

Like the VA, you mean? C’mon Jack. Just because the government is involved doesn’t automatically make things bad. Remember, FEMA used to work back in the Golden Age of Clinton. Welfare was made to work. There’s no reason why government involvement in healthcare won’t work.

What we really need is to resurrect Al Gore’s Reinventing Government initiative to get rid of the waste, re-fire the half million bureaucrats that Bush hired back, and streamline the system.

John Kerry ran on a healthcare platform in 2004 that was pure common sense: offer everybody a policy through the government’s health plan to amortize the costs and bring them down; offer tax incentives to modernize the providers’ administration systems which could cut costs in half; start tracking best practices to find out which treatments are best; stop allowing drug companies to game the patent system; make doctors’ malpractice records public so consumers can make better choices of physicians; have a three-strikes-and-you’re-out rule for lawyers who file frivolous lawsuits…

None of these things are some kind of Big Brother healthcare — just common sense.

Posted by: American Pundit at February 18, 2007 12:10 AM
Comment #208677

Jack et al

Dental care should also be addressed by any approach to healthcare. Not only is it important health wise,it is also important economically to the individual. Ask yourself,as an employer,would you even consider hiring someone missing front teeth?

Posted by: BillS at February 18, 2007 10:47 AM
Comment #208679

BillS

Dental care is a superb idea. I would support funding that. That is one of those thing that people tend not to abuse. Nobody goes to the dentist for fun.

Posted by: Jack at February 18, 2007 10:55 AM
Comment #208680

Jack
“..an excellent boss and good mentor.” Ha,I suppose you have never heard of brown nosing?What you say may be true but be careful not to delude yourself. The boss employee relationship lends itself to illusion and clearly you select out those that do support your beliefs.In your shop you are allowed to do this but you still maybe missing out on some real talent.

Posted by: BillS at February 18, 2007 11:06 AM
Comment #208707

BillS

I suppose some of that is true. But I have been able to increase the effectivess of most of the places I go and the people I work with work better than before with more innovation. I have people waiting to get on my teams. I really do not care if they do not really like me, as long as they produce the results I want.

My belief is always that you should either be sincere or fake sincerity. I hope my people are being sincere, but if they are doing such a good job at faking it, I can accept that too.

BTW - I am aware that some people dislike me with a passion. I used to worry about those things, but no longer, unless they are armed. A boss who wants to be loved by all or too often questions his right to be the boss is not a good one.

Posted by: Jack at February 18, 2007 1:34 PM
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