Fiscal FactChecker: 16 Budget Myths to Watch Out For in the 2016 Campaign

I have written several times that we need to do something about our debt crisis, as the problem is only going to get worse. I liken it to having a water problem in your house. If you don’t fix it now, it will get far worse later on.

In addition to The Concord Coalition who I have mentioned before, a sister nonpartisan group to their effort spawns from the Committee for Responsible Federal Budget called Fix the Debt. The Board of Directors of the Committee include some big names who served in various government, think-tank and business roles. The Fix the Debt group was founded by former Chief of Staff Erskine Bowles and former Senator Alan Simpson of the Simpson-Bowles Deficit Reduction Committee.

I will provide a link below, but wanted to summarize a piece called “Fiscal Fact Checker: 16 Budget Myths to Watch Out For in the 2016 Campaign” which is dated August 6, 2015. Those myths are:

Myths about the National Debt

  1. We can continue borrowing without consequences
  2. With Deficits falling, our debt problems are behind us (this is expected to reverse in 2015-16)
  3. There is no harm in waiting to solve our debt problems
  4. Deficit reduction is code for austerity, which will harm the economy

Myths about Taxes

  1. Tax cuts pay for themselves
  2. We can fix the debt solely by taxing the top 1%
  3. We can dramatically lower tax rates by closing a few egregious loopholes
  4. Any tax increases will cripple economic growth

Myths about Health Care and Social Security

  1. Medicare and Social Security are earned benefits and therefore should not be touched
  2. Repealing Obamacare will fix the debt
  3. The Health Care cost problem is solved
  4. Social Security’s shortfall can be closed simply by raising taxes on or means-testing benefits for the wealthy

Myths about easy fixes

  1. We can solve our debt situation by cutting waste, fraud, abuse, earmarks and /or foreign aid
  2. We can grow our way out of debt
  3. A Balanced Budget Amendment is all we need to fix the debt
  4. We can fix the debt solely by cutting welfare spending

In addition to the above, I wanted to reiterate two global trends that impact the US as well. First, per the World Health Organization, we are the most obese country in the world, as well as having the highest costing health care system in the world. The Affordable Care Act has helped, but we are over-tested, over-medicated and future train wrecks waiting to happen This will create continued cost pressures on Medicare, Medicaid and the subsidies under Obamacare.

Second, per the World Economic Forum, we are an aging population. We are not as bad off as places like Japan, Greece, Portugal, Spain, etc., but as we age cost pressures on Social Security and Medicare/ Medicaid will heighten. For people in their 60’s, the average cost of health care is roughly twice that of folks in their 30’s. The aging is actually hitting some of our states and municipalities with increased retirement liabilities relative to fewer workers being hired. Detroit, Stockton, and Birmingham have all filed for bankruptcy, with this being a contributing cause, plus states like Illinois, New Jersey, etc. are having significant retirement cost pressures.

Please check out these two websites and see who is involved in these nonpartisan efforts.

http://www.concordcoalition.org/

http://www.fixthedebt.org/

Also ask your Senators, Congressional representatives and Presidential candidates what they plan to do about this. Like climate change and the global water crisis, we can no longer wait on action.

Prevention and Wellness – we are train wrecks waiting to happen

As a retired benefits professional, both as a consultant and manager of an employer benefits program, I have been involved with numerous healthcare prevention and wellness efforts. I have worked with wonderful colleagues who put in motion terrific ideas and measured their success. And, if not working well, they tweaked or scrapped them, as the key is to prevent illness and injury. The reason – we are train wrecks waiting to happen. If we don’t take care of ourselves now, issues will manifest themselves later.

March is national Colorectal Cancer Awareness month, so you may have seen more commercials on getting a colonoscopy. There is no better preventive exercise than getting a colonoscopy whether you are male or female. At the age of 55, I have had the “pleasure” twice and each time they have found pre-cancerous polyps, which they can and did remove during the procedure. If you are over the age of 50 and have not had one, please see your doctor. The worst thing is the cleansing liquid that you need to drink the afternoon and evening before. The procedure itself is twenty minutes in length.

Each October, we celebrate Breast Cancer Awareness month. Unlike colonoscopies, mammograms should start at an earlier age, especially if you have a family history. And, unlike colonoscopies, reading a mammogram is science and art. It takes a trained eye to read them and there are some false readings. I have two suggestions. First, start early with self-examination. If you don’t know how, ask someone who does. You know your body better than anyone, so you may sense something is amiss.

Second, if you do get a mammogram and get a positive result, don’t panic and do the follow-up with an oncologist.  Even if the oncologist says everything is OK, it is worth the trouble and expense. If you get a negative (or there may or may not be an issue) mammogram and feel it is not correct, get another one. In the mid-1990s, we ran a mobile mammogram (thanks Mary!), which conducted 11,000 screenings for our employees, irrespective of whether they signed up for the employer healthcare plan. We detected 9 cancers. That is nine lives who may have been saved, which makes the cost savings to the employees and employers meaningless when compared to a life saved.

While these are of critical importance, most people die from heart disease, including and especially women. So, every month should be heart disease awareness month. One of my old Global Health and Wellness colleagues said one of America’s greatest exports is obesity. We have shared with the world our affinity for fast food and each nation has made it their own adding other unhealthy items to the menu. In Mexico, you can get a burrito with your Big Mac at Mickey D’s. I should add the US is the most obese country in the world according to the World Health Organization with over a third of Americans with a BMI greater than 30, although Mexico is giving us a run for our money.

There are a number of programs and diets that attack people, especially women, from TV and magazines. Dr. Oz is great, but he has a new idea on every day, so you are blitzed by information and are hamstrung on what to do. You cannot do everything Dr. Oz suggests. So, here are a couple of simple ideas that we each can do (please do more if you are and can), that will help you with your heart health.

Walk to better health. That’s it. Walk after dinner or to run errands. Walk the dog or with a friend. Even if for only five minutes, just walk and you will see a difference.

See a doctor for a preventive or wellness check-up.This will be one of biggest benefits of Obamacare. People will now go to the doctor for preventive visits. High blood pressure and high cholesterol can be managed, but you have to know.

– Eat smaller portions. This is the most sustainable diet you can do. Start by leaving “bites for the cook” when you eat. Just don’t overload your plate or when you eat a snack, put the product in a small bowl and don’t eat from the bag or container. We keep lightly salted mixed nuts and small fruits (blueberries, grapes, e.g.) around and use them as snacks rather than chips.

There are many more ideas I could throw out, but let’s stick with those three. Since I retired, I graze during the day eating five or six small meals – the three main meals and usually two or three snacks. I try not to overeat at any of them. I would encourage you also to eat more calories earlier in the day and try not to eat too late, so your body can burn the calories.

I would ask my readers to share their ideas as well, but my main purpose is to suggest small steps that you can do and sustain. Diets will eventually fail unless you make changes that you can live with each day. Walking is easier to start and continue and, if you miss a few days, you can easily pick it up again. Best wishes on keeping your train on the track and avoiding the train wreck later in life.

 

 

Our Healthcare Industrial Complex

I have borrowed the phrase that President and former General Dwight D. Eisenhower made in reference to being wary of the power of the “military industrial complex.” Of course, he was alerting us to the business of war and the profit that could be made by being forever prepared to do whatever battle is needed. He was right then and he is right today, as this business is still a very powerful lobby. Yet, the purpose of this post is to help define why the US is #1 in the world in healthcare…cost that is…while being #37 in healthcare quality, both according to the World Health Organization. The reason is our Healthcare Industrial Complex.

Two weeks ago, “60 Minutes” did a report on HMA, which is a for-profit national hospital chain that owns a significant number of hospitals in the US. The source of the report is an interview with approximately 100 former physicians with HMA as well as a former Medicare/ Medicaid fraud expert who was in their employ. Their stories are remarkably similar and corroborated by the expert who eventually resigned. The problem they raised is the culture which required Emergency Room (ER) physicians to admit as many emergency room patients into the hospital as possible, even if they did not need to be admitted. They shared goal sheets and emails which highlighted ER physicians who did not admit a sufficient number of patients. Those who failed to remedy this shortfall were terminated.

Why would HMA impose these requirements? Money. The hospital made more money when patients were admitted. The ER doctors noted in the interview when you admit a patient who does not need care, you are actually exposing them to things they need not be exposed to such as the risk of infection or error. In other words with no upside on care improvement, they are only exposed to the downside risk. Yet, this is not unique to for profit hospitals. Even a non-profit hospital has a gain/ loss equation and the goal is clearly to take more money in than you spend. So, the same pressures exist in non-profit hospitals to admit more patients from the ER.

You may say that cannot be true, but in October the Readers DIgest released a story by Michelle Crouch called “50 Secrets Your Surgeon Won’t Tell You.” These are a compilation of comments by named and unnamed surgeons in the US which are consistent with the above theme to make money on the business of healthcare.

#23 – “You should know that practically all surgeons have an inherent financial conflict of interest. That’s because they are paid approximately ten times more money to perform surgery than to manage your problem conservatively,” said orthopaedic surgeon James Rickert, MD.

#31 – “About 25% of operations are unnecessary, but administrators email doctors telling them to do more….The Cleveland Clinic has said this system of paying doctors is so ethically immoral that it started paying its doctors a flat salary no matter how many operations they do, ” said Marty Makary, MD.

#33 – “Some doctors hire practice management consultants to help capture more revenue. The consultants may want the practice to sell equipment like knee braces or walkers at mark-up…or get an in office MRI. Every time a doctors does this, he becomes financially conflicted…you order more MRIs, so you won’t lose money on it,” said James Rickert, MD.

I am glad the article included the Cleveland Clinic example, as this clinic is known as one of the best in the country. The gravitation to salaried doctors has proven to both cost effective and quality improving there and elsewhere. This is one of the solutions to addressing our healthcare cost crisis in the US. The Affordable Care Act is purposed to find these best practices and make them more mainstream.

When people say we have the best healthcare system in the world, that is not true when looking at all measures of results. We are by far the most costly system in the world and have been for a while. Of course, those fully insured and with a means to pay for the finest doctors can get access to state of the art care. But, that applies to the very few, not the many. And, those who have no or little insurance have a much different experience. This is why the Affordable Care Act is so important – getting people covered, paying for care at time of use, and facilitating preventive medicine rather than reactive medicine.

I should mention that the significant majority of the comments in the Readers Digest article were care-oriented. These doctors want their patients to be successful. Here are a few:

#22 – “Some problems just don’t fix well with surgery, like many cases of back pain. My advice is grin and bear it….many people have a degenerative disk with no pain. There isn’t a lot of evidence that we’re helping very many people (through surgery),” said Kevin B. Jones, MD.

#28 – “What really keeps us up at night? It’s not making a mistake in the operating room; it’s the noncompliant patients. When patients don’t do what we tell them, bad things can happen,” said OB-gyn Kurlan Thott, MD.

#46 – “If your doctor wants to give you a stent, always ask: is this better than medicine….Having something planted in your body is not a risk free proposition,” said Marc Gillinov, MD.

#47 – “If I had any kind of serious medical condition, I’d go to a teaching hospital. You’ll get doctors involved with the latest in medicine…At a university hospital, you also have the advantage of having a resident or physician bedside 24-7, with a surgeon on call always available,” said Tomas A. Salerno, MD.

#8 – “It is better to have elective surgery early in the week because lots of doctors go away for the weekend and won’t be around to make sure you are OK…you are going to get someone who’s covering for the surgeon (over the weekend),” said an anonymous general surgeon who blogs under the name Skeptical Scalpel.

These doctors also compiled questions you should ask before surgery:

– Why do I need this procedure now?

– Who is going to be doing it, and how many times has he or she done it before?

– What are the most common complications, and how do you deal with them?

– What will the recovery be like?

– Who is going to take care of me after surgery (pulled from #7)?

These helpful suggestions among many others paint a more favorable picture. Yet, the other comments paint a picture of the business of healthcare. There is a conflict of interest these doctors and nurses are placed under to drive patients to more costly care which is more profitable to the hospital. It is not primarily motivated by better quality of care outcomes. It is more aligned with making money for the provider. With consultants advising hospital and doctors how to make more money by unbundling services, doing more unnecessary or repeated tests, admitting patients and doing more surgeries than necessary, it is easy to see why we have the most expensive healthcare system in the world.

I recall the complaints of HMOs back in the 1980s and 1990s, which were echoed by one political party toward Obamacare, saying the insurance companies or government would stand in the way of the doctor and patient. I do know these MDs at the insurance companies would show data to the hospitals and doctors showing the differences in cost and patterns of care. The purpose is to help find the more elegant care. The comment above about back surgery is pertinent. As of this post, I know three people whose doctors messed up their spines on surgeries that should not have been done or done by those doctors. This is the purpose of the intrusion. Absent that, a hospital may be forcing a decision upon a doctor that is not fully in the best interest of the patient.

I encourage you to read the Reader Digest article. I cited another one over the summer about things nurses won’t tell you. They both are helpful. But, at the center of all the healthcare is you the patient. If you cannot speak for yourself, get a proxy to ask your questions. Take better care of yourself by exercising and eating more healthfully. And, please get a second and maybe a third opinion on surgery. It is your body after all. A healthy sense of skepticism is always appropriate, so ask questions. The ones noted above are good place to start.