Fixing HealthCare with Common Sense

What it will finally take is anyone’s guess. Our candidates for public office are great at talking a good game, but what ultimately it will take is a combination of “Common Sense” (written in 1776 from Founding Father Thomas Payne*) and a return of major corporate ethics, with effective, consumer driven oversight and simplified regulation.

It is likely the best solution, easiest to implement without burdening us with bigger government. I say let companies like Geico, Progressive and others that market auto insurance direct to consumers into the ring. Let consumer choice drive them to cut costs by uncoupling dollars from non-benefits payment. Give them simple rules to follow, nationwide, exempt from state lines. This could be huge, and would not take any dismantling of our major delivery systems.

Remember, Medicare runs on 4% administrative overhead, but currently private health insurers are closer to 25%. Much of this goes to the questionably ethical profiteering of extreme proportions, exorbitant salaries for executives and contributes to ridiculously poor provider reimbursements.

And, how about adding return of premium benefits to reward the healthiest while not penalizing the seriously ill. This is a tremendously powerful idea that would reap huge benefits for the consumer. It’s already done with disability and some other types of insurance and mutual insurance companies regularly pay dividends to payees. So, Lets make sure that some of insurance premium dollars can be returned if consumers stay healthy.

Lets also finally de-link health insurance from employers and employment benefits once and for all. This has been an absolute catastrophe. Even the Boston Globe recently acknowledged this. The extreme burden on US businesses of all sizes from health care premiums is well known. The trickle down benefits to business, like the automakers, municipalities and others could also be a huge economic stimulus.

Uncoupling health insurance benefits from employment would make consumers ultimately more fiscally savvy and responsible. This could quite likely increase their wages simultaneously as employees would now purchase all benefits outside of their work. Uncle Sam can help with deductibility and tax exemptions, maybe larger in the beginning to help foster the transition.

I also believe that there should be real consumer dollars available for CAM (Complimentary and Alternative Medicine) that can be used in the treatment of our most common and non-life threatening disorders especially if the consumer does not utilize more expensive traditional pathways for the same condition. Back pain and headaches are two very real examples that both happen to be still the most common reasons for doctor’s visits, and are at least in part linked to stress and unhealthy lifestyles.

This mechanism alone would foster consumer education to choose their own healthcare pathways without taking an additional financial hit in addition to premiums.

Any effective system must simultaneously provide equitable reimbursement and other incentives to all licensed doctors of all disciplines as well as ancillary providers for our society to keep great healthcare providers in the system.

This must include simplified reimbursement schedules, equal across the professions for identical procedures. I strongly favor a diagnosis-based system with utilization review only for those cases outlying the norms. This could be a technological piece of cake with a national electronic healthcare database for all Americans.

Of course, there are other issues that need to be simultaneously addressed. These include malpractice provisions (some experts suggest in a separate healthcare “court” in addition to capped awards). Better awareness of poor outcomes vs. malpractice by society at large would really help as well.

Drug costs, competition and widespread availability of tested alternatives to prescription drugs all need to be handled. Again, a consumer driven Wal-Mart type of distribution may be what already does it.

So, how can we help? Lets make sure we educate ourselves first and foremost as to what’s wrong with our current system and push our lawmakers toward better consumer choices. Take a real hard look at their differences on these topics when you vote and support any politician, as some are huge. Let your patients know who these consumer friendly elected officials are in your area are too.

Utilize cost effective preventive screenings in your practice, and advocate the same for our families. Lets make sure we teach our kids and our patients all the rewards of better health choices like non-smoking, stress management, diabetes prevention, relationship choices including illicit drugs and sexual behavior, and permanent weight control.

How it will all turn out is anybodies guess. I continue to be as vocal about these issues with my patients and community, and urge you to do the same.

Not Unlike Thomas Payne did over 200 years ago.

(*Society in every state is a blessing, but Government, even in its best state, is but a necessary evil; in its worst state an intolerable one: for when we suffer, or are exposed to the same miseries BY A GOVERNMENT, which we might expect in a country WITHOUT GOVERNMENT, our calamity is heightened by reflecting that we furnish the means by which we suffer.)

Osteoporosis, Kyphoscoliosis in an 80 Y.O. Lady

An 80 Year Old lady with chronic T Spine Pain,
marked osteoporosis, kyphoscoliosis,
post kyphoplasty X2 is referred by her PCP
for evaluation and treatment.

Which tests do you order or make sure
were done? What are some possible Txs?

More on Diabetic Patient Co-Management

Of Course you should encourage your patient to monitor their HbA1c.

I like to get my patients in the habit of knowing their FBS too. As we do dietary and exercise interventions, need for meds (in NIDDM or Type II) may decrease rather quickly. I always make sure to report and document all serial changes.

Lastly, continuously stress the importance of daily exercise involving the lower body, especially brisk walking, cycling and running depending upon underlying fitness levels. Finally, the patients PCP is kept in he loop continuously to monitor, reduce or modify any medical regimes or other needs (foot and wound care, etc.)

Clinicians Corner

Jane is a 23 year old female who presents with acute headache, neck stiffness aches and pains very diffuse. She was very healthy up until 3 weeks ago. No fever, sweats, exanthem. She is extremely fatigued. She is not pregnant. Takes no meds. Non-smoker, no drugs, or drug seeking behavior. No history of insect bites or animal contact. No ill relatives.

No recent travel, she has no appetite. No relevant PFSH.

Exam is totally unremarkable except for demeanor and a sullen facial appearance. No meningeal signs. Mild chronic lumbar root signs.

A few chiropractic treatments provide Jane only temporary relief.

A complete battery of labs is next ordered.

ALSO: Her History also includes long standing myofascial neck and shoulder pain and a lumbar disc. She is hypothyroid.

QUESTIONS: Which lab tests besides CBC, ESR, CRP, RA might you order?

HINT: She lives exclusively in the Mass Coastal area.

ANSWERS: Doctor, Post on our Blog for discussion and final DX.

The first doctor with the correct lab tests wins a signed copy of “Getting to YES!”.

Clinicians Corner: Vitamin D Status

As you are probably aware, Vitamin D Status has been linked to many degenerative diseases. In the Chiropractic Office, patients with widespread aches and pains are common. Many of these patients have suboptimal Vitamin D Status.

What is the current Single best test to determine Vitamin D Status?

Managing LS Facet Arthritis

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Clinicians Corner

John is 48 years old. He has a very long history of Low Back Pain.

He says he had Chiropractic care for about 6 weeks 10 years ago, with no lasting relief. He wants to try a new appraoch, and heard we do things “different”. He wants to avoid Surgey and Epidural Blocks.

His medical Hx is significant for excission of basal cell skin cancer.
He is not diabetic.
He takes NSAIDS, only when very acute. Family Hx is positive for LBP, disabling in 2 siblings.

His exam is remarkable for a paucity of findings. Stiff ROMS, no root signs, extension is very uncomfortable.

Plain Films show very marked facet disease at L5-S1. Lets assume for this discussion his primary Dx is severe facet joint DJD.

Whats are rational Tx plans, expectations and reasoable goals to tell John on Case Review Day? How would you substantiate the need for care beyond the initial stages?

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Clinicians Corner

Clinicians Corner

Jane is a 23 year old female who presents with acute headache, neck stiffness aches and pains very diffuse. She was very healthy up until 3 weeks ago. No fever, sweats, exanthem. She is extremely fatigued. She is not pregnant. Takes no meds. Non-smoker, no drugs, or drug seeking behavior. No history of insect bites or animal contact. No ill relatives.

No recent travel, she has no appetite. No relevant PFSH.

Exam is totally unremarkable except for demeanor and a sullen facial appearance. No meningeal signs. Mild chronic lumbar root signs.

A few chiropractic treatments provide Jane only temporary relief.

A complete battery of labs is next ordered.

ALSO: Her History also includes long standing myofascial neck and shoulder pain and a lumbar disc. She is hypothyroid.

QUESTIONS: Which lab tests besides CBC, ESR, CRP, RA might you order?

HINT: She lives exclusively in the Mass Coastal area.

ANSWERS: Doctor, Post on our Blog for discussion and final DX.

The first doctor with the correct lab tests wins a signed copy of “Getting to YES!”.