Dear Mr. President,

You are a very smart man.  Please read this article by Alan Reynolds that appeared in the September 7th printed edition of Forbes magazine.

Sincerely,

WhatisanHSA 

When Is Bribery Morally Acceptable?

There was a fine article in the August 24 edition of Forbes Magazine entitled Healthy Bribes.  It asks the question whether companies can save money by paying their employees to do things like stop smoking or lose weight. 

When I left my former employer (the mother ship) I had a two Nexium per day acid busting habit.  My stomach was eating me alive.  I took on a high deductible health plan with an HSA.  I changed my eating habits and began a regular exercise routine (now a habit).  In addition to losing 30 lbs, I no longer needed the Nexium, a drug which I believe would have cost me a couple grand a year (perhaps someone would like to comment on the retail cost of Nexium).

As for the Forbes article; one example cited the case of a gentleman who, for annual bribes totaling about $300 dollars, was motivated to lose a bunch of weight and keep it off.  He changed his diet and began exercising, his cholesterol returned to normal and he was able to kick his “Lipitor habit” to the tune of $1,000 per year.  His employer, through its employee “bribery”/wellness program has managed to keep its health care costs flat for the past four years.  Not bad when health care costs in the world around them have risen significantly over the past several years.

The jury is still out on healthy bribery in terms of its long term cost savings ability, but as a guy who went from junk food and Nexium to a much healthier lifestyle, the quality of life is better day in and day out.  And that’s worth a lot.

 People are motivated by all different things.  Some by the stick and others by the carrot.  As folks are asked to carry more of their health care burden directly, I believe “bribery” programs will prove to have positive long term benefits.

Dr. Zane Pollard, A Voice of Reason In The American Health Care Debate

A good friend forwarded the letter below to me, written by his uncle, Dr. Zane Pollard of Atlanta.  Dr. Pollard is a pediatric ophthalmologist associated with Children’s Health Care of Atlanta who I gathered from the letter below would just as soon be taking care of his patients, as becoming a voice in the current health care debate.  But his is a voice of thoughtful and reflective reason. And his letter worth reading and consideration. 

In Dr. Pollard’s world, which could be all of ours if we do not let our voices be heard, government has not demonstrated that it has the capacity to manage with any kind of efficiency or compassion something so complex as our nation’s health care.  A fact they have demonstrated time and again over the past decades.  

Friends:

I have  been sitting quietly on the sidelines watching all of this
national debate on healthcare. It is time for me to bring some clarity to
the table and, as your friend, by explaining many of the problems from the
aspect of a doctor.

First off the government has involved very few of us physicians
in the healthcare debate.  While the American Medical Association has come
out in favor of the plan, it is vital to remember that the AMA only
represents 17% of the American physician workforce.

I have taken care of Medicaid patients for 35 years while representing
the only pediatric ophthalmology group left in Atlanta, Georgia that accepts
Medicaid.  Why is this?  For example, in the past 6 months I have cared for
three young children on Medicaid who had corneal ulcers. This is a
potentially blinding situation because if the cornea perforates from the
infection, almost surely blindness will occur.  In all three cases the
antibiotic needed for the eradication of the infection was not on the
approved Medicaid list.  Each time I was told to fax Medicaid for the
approval forms which I did. Within 48 hours the form came back to me which
was mailed in immediately via fax and I was told that I would have my
answer in 10 days. Of course by then each child would have been blind in
the eye. Each time the request came back denied.  All three times I
personally provided the antibiotic for each patient which was not on the
Medicaid approved &n bsp;list.  Get the point-rationing of care.

Over the past 35 years I have cared for over 1000 children  born with
congenital cataracts. In older children and in adults the  vision is
rehabilitated with an intraocular  lens. In newborns we use contact lenses
which are very expensive. It  takes Medicaid over  one year to approve  a
contact lens, post  cataract surgery. By that time a successful anatomical
operation is wasted, as the child will be close to blind from a lack of
focusing for so long a period of time. Again  extreme rationing.  Solution – I
have a foundation here in Atlanta supported  100% by private funds which
supplies all of these  contact lenses for  my Medicaid and illegal
immigrants children for free.  Again waiting for the government would be
disastrous.

Last  week I had a lady bring her child t o me.  They are Americans but
live in Sweden as the  father has a job with a big corporation. The  child
had the onset of  double vision 3 months ago and has been unable to
function normally because of this. They are  people of means but  are
waiting 8 months to see the ophthalmologist in Sweden. Then if the child
needed surgery they would be  put on a 6 month waiting list. She called me
and I saw her that day. It turned out  that  the child had  accommodative
esotropia (crossing of the eyes, treated with glasses that correct for
farsightedness) and  responded to glasses within  4 days , no surgery was
needed.  Again rationing of care.

Last  month I operated  on a  70 year old  lady with double vision
present for 3 years. She  responded quite nicely to her surgery and now is
symptom free. I also operated on a 69 year  old  judge  with vertical
double vision.  His surgery went very well and now he is happy as a lark.  
I have  been told – but of course  there is no healthcare bill that has been
passed yet – that  these  2 people because of their age would have  been
denied  surgery and just told to wear a patch over one eye to alleviate the
symptoms of double vision.  Obviously cheaper than surgery.

I spent  two years  in the  US  Navy during the Viet Nam war and was
well treated by the military.  There was  tremendous  rationing of care and we
were told specifically what things  the  military  personnel and their
dependents could have and which things they could not have.  While in Viet
Nam, my wife  Nancy  got sick  and got essentially no care at the Naval
Hospital in Oakland, California. She went home and went to her  family’s
private internist in Beverly Hills.  While it was expensive, she received an
immediate work up.  Again rationing of care.

While 99% of  physicians went into  medicine  because of the love  of
medicine and the  challenge of helping  our fellow man, economics are still
important. My rent goes up 2% each year and  the salaries of my employees
go up 2% each year. Twenty  years  ago ophthalmologists  were  pa id $1800
for a cataract  surgery and today  $500. This is  a 73%  decrease in our
fees.  I do not know of many  jobs in America that have  seen this lowering
of fees.

But there is more  to the story than  just the lower fees. When I came to
Atlanta there was  a  well known ophthalmologist who charged $2500 for 
cataract surgery as he felt he was the best. He  had a terrific  reputation
and in fact  I had my mother’s  bilateral cataracts  operated on by him with
a wonderful  result. She is now  94 and has 20/20 vision in  both eyes.
People  would pay his  $2500 fee.  However the government came in and
said that any doctor that  does  medicare  work can not  accept  more than
the going rate  (now  $500)  or  he or she would be  severely fined.  This
put an end to his  charging  $2500.  The government said it  was illegal to
accept more than the government  allowed  rate. What  I am driving at is
that those of you well off  will not be able to go to the head of the line
under this new healthcare  plan just because you have money as no physician
will be willing to go against the law to treat  you.

I am a pediatric ophthalmologist and  trained  for  10 years  post
college to become a pediatric ophthalmologist (add  two years  of my
service in the Navy and that comes  to 12 years).  A neurosurgeon spends  14
years  post  college and if  he or she has to do the military that would be
16 years. I am not entitled to make what  a neurosurgeon makes but  the new
plan calls for all physicians to make the same amount of payment. I assure
you that  medical students will not go into neurosurgery  and we will have a
tremendous shortage of neurosurgeons. Already the top neurosurgeon at my
hospital who is in good health and only 52 years  old has just quit  because
he can’t stand working with the government anymore. Forty-nine  percent  of
children under the age  of 16 in the state of Georgia are on medicaid so he
felt he just could not stand working  with the bureaucracy anymore.

We are being lied to about  the  uninsured.  They are  getting care.

I operate  on at least  2  illegal immigrants each month who pay me nothing and
the children’s hospital at which I operate charges them nothing also.  This is
true not only on Atlanta, but of every community in America.

The bottom line is that I urge all of you to contact your congresswomen
and congressmen and senators to defeat this bill.  I promise you that you
will not like rationing of your own health.

Furthermore, how can you trust a physician that works under these
conditions knowing that he is controlled by the state.  I certainly could not
trust any doctor that would work under these  draconian conditions.

One last  thing, with this new  healthcare plan there will be a
tremendous shortage of physicians.  It  has been estimated that
approximately  5% of the current physicia n work force  will quit under this
new  system.  Also it is estimated that  another 5% shortage will occur
because of decreased men and women wanting to go into  medicine.  At the
present time the US government has  mandated gender equity in  admissions to
medical schools .  That means that  for the past  15 years  that  somewhere
between 49% and 51% of  each entering class  are females. This is true of
private schools also  because all private schools receive  federal fundings.
The  average  career of a woman in medicine now is only 8-10 years and the
average work week for a female in medicine is only 3-4 days.  I have now
trained  35  fellows in pediatric ophthalmology.   Hands down the best was  a
female that I trained  4 years  ago – she  was head and  heels above all
others I have trained.  She now  practices only 3 days a week.

Zane Pollard, MD

Humana’s Grant Harrison – Biking off Bootys

This is the second time Grant Harrison has crossed my proverbial bike path and provided me an opportunity for some gear shifting around the topic of health.

As luck would have it, I was at the club this morning, working out on the stationary bike.  My “club” as it were, consists of a mounted bike and a Wii Fit located down in a small corner of my basement.  As I perused the September issue of Fast Company magazine, there was Mr. Harrison, biking across some Kentucky Blue Grass with a brief article advocating fun for health.

I ran across a Mr. Harrison and the folks at Humana’s Innovation Center many months ago through Twitter.  I was first intrigued by a couple of their guys’ command of social media (specifically Twitter) but more importantly their approach to health. 

Honestly, besides the 47 page legal document I got when I signed up for my Humana High Deductible Health Plan, I really had no exposure to Humana or the Innovation Center.  I still do not know too much about them, except they keep popping up.  The short story, is that this merry band of innovators at Humana get to focus not on all the crappy things about insurance that people hate, but they are thinking about the “health” in health care.  And I like that.

Because I have become an avid biker (although I do not consider myself a cyclist because I refuse to ride my bike looking like a Mardi Gras float) since leaving the corporate health gravy train a few years back, I especially like the fact that Grant and his team are focused on getting folks out of cars and onto bikes through an innovative distribution system of rental bikes.   Anyway, part of the pitch behind their bike program is that when we find fun activities that happen to be healthy, it is a double win.  And as Grant says, “you unlock this feeling of being a kid again.” 

And as I say in my pitch, “not only is it fun, but you can literally tell your friends, I biked my ass off today” and mean it.

I think finding fun activities that are healthy is a great concept.  For folks with HDHPs and HSAs, an important part of the equation is living healthy.   The key is finding those things that you can do on a consistent basis that are both healthy and fun.

AKA Dr. Feelgood

It seems to me, from the barrage of sound bites I hear of President Obama, that an underlying thread in the health care debate is this notion that everything he is trying to do is about making people feel good.

Need a knee replacement?  Take a pill.  Feel gooooood.

Got no insurance?  Jump on the new plan (whatever that is).  Feel good.

Got no money?  No problem.  Feeeeeeeel good.

Hear me speak.  Doesn’t it sound like gravy?  Feel gooooooood.

Worried about dying?  See a counselor.  Feel good.  Well, maybe not too good.

It seems like a lot of Obama’s messages have to do with him wanting us to feel good about what he is doing.

Maybe, besides donning him with the title of “Dr. Feelgood,” one of the best solutions for change in the way we think about our health is to take a play from the real Godfather’s playbook.  Get up offa that couch, and dance til you feel better.

In the meantime Dr. Feel good has been turned loose and let go.

It’s Raining Squirrels.

Last week I came rolling into my driveway after a trip to the sporting goods store where nearly $60 was extorted from my wallet in the name of a pair of football practice pants for the boy.  You’d think my middle school son was going into the friggin’ NFL or something.  Being on a tight budget did not make that pair of pants easy to swallow but that quickly became the least of my problems.

As I pulled in, out of the corner of my eye, I noticed a blur with a long tail moving quickly from the vicinity of the garbage cans by the house toward the wood pile.  It was dark, and from under the wood pile the reflection of two beady eyes, sparkling in my headlights, peered out at me unaware of the wrath about to be unleashed.

I’ve lived in my home for about 20 years and have never seen a live non-bushy tailed vermin on my property.  Once there was evidence in the crawl space of an intruder, which basically led to the encapsulation of my home in quarter inch wire mesh and a spitload of poison.  The second sighting was the “clean up on aisle 19” a couple years later when we noticed the smell permeating in the kitchen was not jambalaya. The kitchen sits above the crawl space.  Suffice it to say, the wire mesh and poison were holding up well.

 Anyway, I went to Home Depot the next morning and spoke to some dude there who turned me on to these little green cubes made by Real Kill that I think are designed to turn vermin inside out.  The package included a dozen of these babies.

 When I got home I put two by the garbage and two by the wood pile.  The next morning, three of the four were gone so I set out three more.  I went to get my mail that afternoon and damned if all 4 weren’t gone (that’s 7 baits if you are keeping count). So I put out two more (I reduced the perimeter of my assault to the garbage cans only).  Next morning, they were gone, so I put two more out and then we headed away for the weekend.

 Now here’s the thing, I’m starting to wonder if my property has been overrun by an unseen army of long tailed vermin or if squirrels are going to start dropping from the trees.  When we returned from being out of town, the two goodie bars were gone so I put the final treat out.  I was pleased the next morning when it was still there.  It remained there through two more nights but then disappeared.  Now I’m out of bait.  And still wondering.

 Back to Home Depot for more reinforcement.

 If you have read this far, you may be scratching your head and asking where is this going and what does it have to do with Health Savings Accounts? You may be thinking, “better him than me.”  You may be wondering, “where can I get a deal on those little green cubes?”

 Let me start with the first question.  In consumer driven health, and specifically if you have a high deductible health plan with an HSA, often times with your health, as the saying goes, the best defense is a good offense.  It is good to take care of your “house” even when everything appears to be fine or if there are just minor indications of problems.  You will likely save yourself a lot of headaches down the road if you take good care of your health.  You will also likely save yourself money by not letting your problems get out of hand.

 As for the second question, you can certainly get the green cubes at The Home Depot, but if you want to get a good deal AND at the same time put a little bit $ into your Health Savings Account in the process, you can go purchase them online at Home Depot through www.myHSArewards.com.   My HSA Rewards is a program that enables you to earn a % back of your everyday purchases of thousands of goods from major retailers that is then deposited into your HSA.  Definitely check it out and see how it can work for you.

….and you thought with all the talk of vermin, this article was going to be about politics ;- )

Free Our Health Care WOW!!

Over the past almost 60 days, the link to the “Free Our Health Care NOW” petition has been the 5th most clicked link out of the 200 or so postings on this site.  Which means you (if you were one of them) helped contribute to the over 1,012,000 signatures to date on the petition.  I first stumbled across the petition in Forbes Magazine in early June, and several radio talk show hosts have helped blow the doors off this thing by encouraging folks to give some thought to their health care as well as the general and future health of our nation. 

Like a snowball down the side of a mountain, the engagement of the American public in the discussion around their future health care has been profound in my opinion, and the snowball has an enormous amount of momentum which will hopefully influence, in a positive and productive manner, the ultimate outcome of the debate.

If you have already taken a look at the petition and it represents a vision of healthcare with which you approve, I would encourage you to share it with as many friends and colleagues as possible (please feel free to send the link to this posting or straight to the petition).  If you have not yet seen the petition, have a look below and you can take it on your own from their.  Be a part of keeping  the momentum going through September and as long as the debate continues.

Over 1 million signatures.  I would say this is definitely a Free Our Health Care WOW kind of moment.

http://www.freeourhhealthcarenow.com