Level Two - the Matrix
This level is often left out of the discussion or at a minimum mentioned as an afterthought. There are numerous reasons this occurs. Among them, fear of offending voters, dependence on sick patients, and a misguided understanding of the economic impact on plan design. Although there are other factors, these four are keys to understanding why the current discussion is leading our healthcare system to collapse.
In today’s political world, unlike our forefathers who went to Washington for a few weeks and then returned home to live under the laws they passed, politicians first mandate is to get re-elected. For that to happen they must do two things, operate within party lines and keep their voters happy. Currently a party is in power whose long term objective has been to create more government control over the lives of everyday citizens. Within that agenda lies nationalized health care in some form. The spiraling cost of healthcare has given this party an open invitation to legislate reform. Those who are leading the charge are keenly aware that the most popular approach to any solution is the make the public think they are getting something for nothing and, that they don’t have to make any changes in their personal or financial lives. For that reason reform sells better by making a villain out of an industry that already had a bad reputation, even though that reputation was based on misinformation and envy. The last thing a politician could do is to point at the voter and say, “You are a large part of the problem because you do not take care of yourself.” It is much easier to just say the insurance companies are greedy and try to take your money and not pay claims.
Actually, insurance companies deserve a great deal of the battering they are receiving from all sectors; but they are not the lone villain. There are plenty partners in this epic. One close partner is the provider industry – including doctors and hospitals. While it is not fair to call any of these participants villains, it is a term of endearment clocked in ignorance on the part of the public and apathetic necessity on the part of the provider community. In reality, without sick people providers would go out of business and the economy would tank. Like it or not our economy depends heavily on our being a lethargic, unhealthy population. A hospital has one objective at the end of the day – fill beds. They can do that by bribing patients away from competing hospitals by building bigger and more high-tech facilities, or they can just wait on the population to demand more services, procedures, surgeries, and drugs to take care of their ever increasing bent toward suicide by overindulgence. Either way, these are large parts of the problem and there are not being addressed.
The third section of level two is a misunderstanding of the economics of benefit design. There are strong opinions on both sides of this issue. At hand is the debate over spending health care dollars on wellness and disease management. One camp holds that the return on investment is enormous regarding wellness and managing disease. Personally, I have a tent in this camp and I admit that my view will be biased. That doesn’t change the outcomes I have encountered by applying these principals. The other camp holds that it should be the personal responsibility of the patient to take care of themselves and pay out of their pocket for physicals, wellness screening, and prevention. Employers are also hesitant to spend dollars making employees well that might just leave for a better job. They see it as wasted capital in startup cost when hiring and training a workforce. Employers have a point. But, what if every employer had to offer this benefit? Then it wouldn’t matter if an employee left, the one replacing that person would have received the benefit from their previous employer. When looking at requiring every person to have some level of benefits to overcome the preexisting illness, adverse selection issue, shouldn’t any reform also include a mandate to cover wellness and disease management? If it did there must also be a disincentive for not complying. The bottom line is that without compliance in this area and strong incentives to change behavior nothing is going to stop our unsustainable escalation of healthcare costs. Nothing.
So what is level two and how does it impact cost trends? Level two is the consumer form of slow agonizing suicide. We are slowly killing ourselves by abusing our bodies through lack of activity, poor diet, failure to have regular lab work, smoking and other known acids we pour into our systems. It is breathing recycled air instead of fresh air, and stress. The problem lies in a simple matrix. On one end of the design we imagine that there is a cure, a pill, a procedure, or a surgery for anything we can do to our bodies. On the other end of the matrix, many health plans do not cover these costs. It has been suggested that to cover these “fixes” could give an incentive to continue the abuse. Without proper design and disincentives that could be true. Regardless, deliberately choosing to ignore this fundamental cost driver is to repair the flag pole on the Titanic while the gaping hole in the hull continues to suck water into a doomed ship.
A quick look at just five facets of this problem are enough to see an opportunity to save the entire system without dismantling what does work, and jeopardizing the gains made for the past five decades. Those five facets are obesity, high blood pressure, cholesterol, stress, and as odd as it sounds with everything we know – smoking. Please look through the rest of this site and you will find a wealth of data regarding many of these issues.