Enabling Healthy Decisions

USAToday had a good article about Healthcare this morning on the front page. I think the article makes some key points that many of us would prefer to think won’t come about.

Imagine that healthcare benefits went the way of the pension and basically disappeared. After a transition period, I am sure it would be fine, but the short-term impact, chaos, and safety net issues would be significant.

The article mentions several ideas being discussed in DC, both of which would likely cause employers to lose their ability to write this off as a business expense:

• A health insurance market in which people buy policies on their own while armed with tax credits or deductions or
• A market where people are able to buy insurance through group-like “exchanges,” with some government oversight.

A few statistics in the article include:

• The percentage of all employers offering health insurance in the past eight years peaked in 2000 at 69% and has fallen steadily since, hitting 60% this year, according to an annual survey of employers by the non-partisan Kaiser Family Foundation.
• Among small firms of three to nine workers, the percentage offering insurance has dropped even more — from 58% in 2001 to 45% this year.
• From 2001 to 2005, the number of uninsured U.S. workers rose by 3.4 million.
• Almost 19 million workers — 17% of all employees — were uninsured in 2005, according to the Kaiser Commission on Medicaid and the Uninsured.
• A household earning $40,000 this year would have to pay 8% of its pretax income to cover the average share paid by workers — $3,281 — for a typical family policy offered by employers, which this year cost $12,106. That doesn’t include deductibles and co-payments that those with coverage must pay.

“People should be nervous,” says Len Nichols, an economist at the Washington think tank New America Foundation. “People aren’t so afraid of losing their jobs as (of) not being able to afford health insurance even with a good job,” he says.

The whole scenario makes me think of a worse case scenario like you get from your cable company or phone company. You are one of millions of customers. Especially if you are not a profitable customer. What is their incentive to serve you and make you happy. What are you going to do – go someplace else?

With the restrictions on pre-existing conditions and without some government oversight, individual insurance would not be a model I would actively embrace. We have seen homeowners insurance companies discriminate against people with claims. It would expose a problematic set of misaligned incentives.

I was reading USA Today on Tuesday while I was flying and was pretty shocked to see the results of a survey of over 37,000 school children by Pride Surveys that showed:

• 4.9% of 4^th graders
• 8.6% of 5^th graders
• And 12.9% of 6^th graders had alcohol in the past year.

With little kids, this is pretty scary. Some of it is peer pressure, but at this age, parents can play a strong role.

“There is a fairly sizable amount of literature showing that the earlier people start to drink, or even have their first drink, the more likely they are to have problems later in life with alcohol, drugs, delinquency, risky sexual behavior (and) motor vehicle accidents.” John Donovan, associate professor of psychiatry and epidemiology at University of Pittsburgh Medical Center

I might as well post these back-to-back.  This is from a story I read in Golf Digest which surprised me.  It was a clip at the end of a story on whether there was a problem with steriod use in golf.  (For the money they can win, don’t tell me someone isn’t trying steriods or other solutions to go after it.)

This story by a Dr. Grant T. Liu talked about a class of drugs he called “mind enhancers” which increase focus, dampen emotional extremes and reduce anxiety. 

• Beta Blockers which are blood pressure medicines sometimes used by people to deal with stage fright. 
• Amphetamines which are used to treat ADD and promote alertness and focus.  (He says they’re already used by students for SATs and final exams.  Things have changed since we simply used no-doze to stay awake for all-nighters.)
• Antidepressants which combat stress and help people control emotions.
• Benzodiazepines which are used to treat phobias such as fear of crowds. 

“If there’s no enforced drug policy, it’s hard to believe that players wouldn’t experiment with these drugs for nonmedical purposes to try and gain an advantage.”

Obviously, if a player had a legitimate medical condition, they should be allowed to take the drugs even if it had a side effect that was beneficial. 

I have included some articles like this before.  Money magazine always does a good job of coming up with these, but they are a little scary sometimes.

We all know that errors are possible, but error rates and calling them “common” is worrisome.  For example, they say “patients sometimes wind up sicker than when they arrived”.  And, they also say to “avoid hospitals late at night and in July”.

“At least 1.5M patients are harmed each year from being given the wrong drugs”  [one person per US hospital per day]  Institute of Medicine of the National Acadamey of Sciences

One reason these mistakes persist: Only 10% of hospitals are fully computerized and have a central database to track allergies and diagnoses, says Robert Wachter, the chief of medical service at UC San Francisco Medical Center.

Although I agree, I find it troubling that one of the article’s recommendations is that “patients should always have a friend, relative or patient advocate from the hospital staff at their side to take notes and make sure the right medications are being dispensed”. 

Of course, we can’t always choose our hospitals.  Where does our doctor practice.  Which one is near our house.  It would be great to have a flashing sign above the hospital that says “our error rate is only X”.  Obviously, this is what people are focused on and hopefully they are applying concepts like Six Sigma and other statistical tools to identify the reason for errors and develop a process for eliminating them. 

To read the whole article, click here. 

First off, most adults don’t provide a good example for their kids on many levels especially around eating.  It is easier to preach then do.  “Don’t eat fast food.”  “Don’t snack.”  “Eat vegetables with each meal.”

So, I struggled with an article I read last week which talked about kids menus “growing up”.  Non-alchoholic chardonnay and merlot juices – really?  Marshmellow sushi with fruit roll-ups as wrappers and a piece of candy on top.  Kiddie sushi with chicken-fingers.  On the one hand, kudos for creativity.  On the other hand, none of these jump out to me as great examples of what we want kids eating. 

It makes me think about kids drinking soda (or pop as I called it growing up).  I agree that we don’t need soda machines in the grade schools, but what good is that if we have kids growing up drinking soda.  I was at a kid’s birthday party a few weeks ago and saw a kid drinking root beer out of a bottle.  That seems a little bit unnecessary.  But, again, how many of us drink soda or coffee or other drinks other than water in front of our kids.  What should they expect?

I don’t think any of us are surprised that we feel more stress. We get 100s of e-mails. We are accessible 24×7. We get voicemails. We get letters, faxes, text messages, etc. We try to multi-task. We expect everything to be done immediately. (You get the point.)

USA Today (you can tell I am traveling) had an article about this today with lots of interesting statistics:

• 82% of women and 71% of men have experienced a physical symptom of stress in the past month (sleep problems, overeating, skipping meals, or using prescription drugs).
• 58% of married people said were more likely to fight with family members when stressed.
• 52% of employees have considered or made a career decision based on workplace stress.
• Lower income adults are more likely to experience symptoms of stress – physical and psychological (irritability, anger, nervous, sad, lack of energy).

These paint a bad picture. The article says that 32% of those responding regularly experience extreme levels of stress.

There are lots of suggestions on managing stress. AARP offers a series of information on the topic. Revolution Health offers information on stress.

And, I am sure that lack of sleep contributes to stress. So sleep more…meditate…and enjoy life.

For many people, college is a great opportunity to experiment with lots of things. For me, one of the things that I was fascinated by was different work styles. I remember one semester at University of Michigan where I:

• Worked part-time
• Took 21 credits
• Was president of my fraternity
• Was the treasurer of a magazine
• Studied for my GMAT and GRE
• Studied Czech (non-credit) in preparation for a trip to the Czech Republic
• Planned a 3-month trip around Europe

In retrospect, it was crazy. The only solution that I came up with was to make sure I never slept more than 30 hours per week. That ultimately translated to a minimum of 2 and often 3 all nighters (probably not the healthiest strategy). The next semester I tried getting a regular night’s sleep every night. My conclusion…I got more done in less hours by being more focused and making less mistakes. Not a true study, but as I learned, it seems to be supported by lots of facts.

At the time, someone was trying to convince me of a theory on life doubling which was basically to take a power nap every 3-4 hours and being able to go without any full nights sleep. (I was…and remain…fairly skeptical.)

If you look at sleep, here are some things to consider:

• “Scientists have found that sleep deprivation increases levels of a hunger hormone and decreases levels of a hormone that makes you feel full. The effects may lead to overeating and weight gain.” (USA Today)
• “an estimated 63% of American adults do not get the recommended eight hours of sleep a night, according to the National Sleep Foundation. In fact, the average adult gets 6.9 hours of sleep on weeknights and 7.5 hours on weekends, for a daily average of seven hours.” (USA Today)
• “found that the women sleeping 5 or fewer hours per night were 32% more likely to experience major weight gain, defined as an increase of 33 lb or more, and 15% more likely to become obese during the 16-year study period than the women who slept at least 7 hours per night.” (Study on Medscape)
• “You are just as dangerous driving sleepy as driving drunk.” (BBC story)
• “negative side-effects of sleeplessness may range from physical problems such as headaches, forgetfulness and lethargy to mental problems such as increased stress and depression” (Cornell article)

I wish I had known. It would appear that my grades would have been better, and I would have been thinner if I slept more. But, it is a serious problem. People are busy, stressed, and never have time to sleep. Even knowing all this, I can’t image sleeping 8+ hours per day.

I used to tell my team that since I slept 1-2 hours less then them every day (or 365-730 hours per year) that I enjoyed an extra year of being awake every decade (exact math not important). I love life and enjoy maximizing the day. The challenge is finding that right medium to enjoy it productively.