How Boomers Can Change the Healthcare System

Wow…..that’s quite grandiose, eh?  That we as a generation could CHANGE the healthcare system as we know it?

It isn’t, and we can.  Here’s how.

I’ll start with the problem in the system that is within our control.  A big chunk of what’s wrong with healthcare is not being discussed: that too many doctors have long since abandoned quality care for quantity billable hours.  Here’s the result and how each one harms the system:

  • When we feel that our doctor cares less about us than his/her bottom line, we are more apt to sue when things go wrong – we believe they do not have our best interest/care at the core of their work, as a result it is much easier to believe malpractice, malicious or otherwise;
    Harms the healthcare system through higher levels of frivolous lawsuits
  • When doctors are not taking the time to truly listen, learn about us, automatically get our records from our other doctors and collaborate with them on our care, the result is the need to order tests and lots of them – when you work in a vacuum, you need to gather information to fill that void, information that often can be gleaned from other sources rather than more tests;
    Harms the system through needlessly perpetuating tests, not based on our tendency to sue, but their tendency to do too little discovery on their own, using their medical arts training
  • Speaking of working in a vacuum, doctors today take a full-blown silo approach, attending to only their tiny specialty piece of our personal health-needs puzzle, as though their part of the body is completely disconnected from the other parts (not to mention the emotional/psychological aspects of our physical health) – it isn’t – all of the body’s parts work in concert, and specialists need to consider other systems/parts that impact their specialty’s – but too few do;
    Harms the system by again creating the need to order batteries of tests; also lends to more misdiagnoses, the need to see more doctors until you find someone who might put the pieces together for you, and mistrust that fuels lawsuits
  • Overbooking is the medical mantra – thus doctors expect us to wait for sometimes an hour, before being seen for a pre-scheduled appointment; beyond the facts that if we ran our businesses like that we wouldn’t have one and the practice is clearly disrespectful to us (treat our time as far less valuable than theirs), the most important problem here is that the person making decisions about our healthcare issues is in such a rush, there is simply no way s/he can do a quality job;
    Harm to the system is increased misdiagnoses or no diagnoses (once the most obvious cause for your symptoms has been ruled out, the medical shoulders shrug and you’re left still not knowing what’s wrong with you…or you’re sent to yet another specialist) both of which increase our costs (more doctor visits/tests), and once again, increase the lawsuit tendency.

Now here’s what we can do to fix it because, as I mentioned above, this is within our control:

  • Insist on better care – do not accept poor quality medical practice, as the more we accept it, the more of it we’ll get; let any doctor you see know upfront what you expect from him/her, and be prepared to seek other practitioners if you don’t get it – do not settle for mediocrity as though you have no choice
  • Insist that your doctors talk to each other, that your records be shared, and that your doctor listen to all of your concerns and existing medical needs/issues, regardless of the body part you’re there to address – neither they nor you know what’s impacting what until you discuss it
  • Do not wait more than 15 minutes to be seen – unless the doctor has an emergency or they’re fitting you in on an emergency basis – let the scheduling person know this intention when you make your appointment, and make checking on the doctor’s timeliness a part of your doctor-choosing decision; then follow through if they do make you wait longer than the time you’ve agreed to wait – let them know you’re leaving, and give them one more chance to do it right by making another appointment (if you wish); usually your return visit will be handled much better…
  • Become a well informed consumer/partner in your care – go to your appointments prepared, understand as much about what’s happening to your body as you can rather than fully depending on the doctor whose only half-listening anyway, insist on explanations for their recommendations, benefits/down-sides, etc. rather than blindly accepting what they decide – I have provided my doctors with alternatives they’d not considered as a result of my due diligence
  • Do not agree to tests with which you don’t feel comfortable or, after some research you believe to be unnecessary – you’d be quite surprised by how many tests you’ll find are more about CYA for the doctor vs. your well-being, once you’re more fully informed

We Boomers have no problem asking for what we want, we are the best educated generation so our research skills are excellent, and we are unwilling to accept the “status quo” (these are just 3 of our generational characteristics that come in handy, here) – much more so than any other generation, including our childrens’.  We can use these abilities to change the expectations we have of the medical professionals in our lives, thus changing the way our own doctors work with us.  By using only those doctors who meet all the above criteria, we are putting our dollars to work supporting best medical practice, not worst.  

And with 78 million of us, that will have a huge impact.  Over time, those with the best practice approaches will thrive, the rest will not. 

The resulting reductions in lawsuits, unneeded tests, and additional doctor visits as one specialist no longer automatically sends you to another before doing all s/he can to diagnose your problem him/herself, will make a nice dent in our healthcare costs.

Make cents?

An Open Letter to My Peers…And Congress

I am:

  • a business owner
  • a centrist Democrat
  • a woman (we are still the gender majority and statistically the greatest users of healthcare)
  • a Boomer (we too are a large number & statistically the ones who have the most to win/lose w/any reform)
  • a member of the middle class (ditto above)
  • self-insured (e.g. not through my business)

As you see, I represent a broad cross-section of those most impacted by any healthcare reform, and as a Centrist Democrat, I believe in fiscal responsibility while helping my fellow Americans who fall ill and/or die every day because they have no insurance.  Useful reform requires thinking and/both, not either/or.

I wish to speak directly to each constituency, member to member.

To my fellow business owners:

When we want to address a problem that only our company/industry is in a position to resolve, we would not ignore it – we would most likely take out a loan (or shall I say would like to if banks were lending…), and get to work on expanding what we must to take advantage of a window of opportunity.  We would carefully calculate the risk and determine that if we do it right, we will not only be able to pay back that loan, but make a profit. 

The “problem” that needs to be resolved here is that clearly the competition created between private insurers alone has not only not reduced customers’ costs, but continues to increase them, so that model has not worked in our market place.  Therefore a new model is called for.   Applying this business model to reform, the Feds would become an insurer so that we “customers” can then reap the benefits that such good ol’ American competition would generate with private insurers (because they are the only “industry” in a position to do so).  There will be an upfront cost – of course.  But using that as a reason for not doing it at all doesn’t make sense.  Doing it in a way that will ultimately pay back the “loan” and then remain solvent, does.

We say that compelling private companies to compete with the Federal Government is not fair competition, thus insurers will be placed at a huge and unAmerican disadvantage.  After all, without significant government subsidies, no insurer has attempted to provide coverages that compete with Medicare.  That said, however, this model has worked in other industries.  The best examples: public and private colleges/universities; what has compelled the US Post Office to work more effectively (or at least try…) has been the private company competition to it.  There is simply no well-thought reason this model cannot also work with health insurance. 

As for co-ops, those few in existence work so well because they are non-profits – like the government, they are not in it to make money, but simply put their earnings-above-expenses back into improving their services.  Therefore, isn’t that unfair competition to for-profits that must pay huge salaries and give shareholders returns on investment?  Either way, private industry will be competing with a not-for-profit entity of one sort or another, so in essence, co-ops would be equally “dangerous” as competitors.  Then, there is the icing on the co-op concept-as-misguided cake: the fact that the plan being considered right now would be in very few States/areas, and most likely would not be available to the majority of Americans in our lifetime.   There is another glaring flaw to the co-op concept, and that I’ve covered in “to my fellow self-insureds” below.

To my fellow Centrist Democrats (&  you, too, Republicans): 

Given the above formula, you disappoint me greatly by not seeing the fiscally responsible window of opportunity here to both improve competition/significantly lower insurance costs for us with a public option, and do so in a way that will pay for itself so any upfront costs are “repaid” and on-going costs offset.  That is both social and fiscal responsibility… which is what you purport to be all about.

To my fellow(?) women:

As the greatest users of healthcare, from child-bearing to the ever increasing incidence of breast cancer, we have the most to lose with reform that does not create real and significant competition – it is only such competition that will lower costs…that is capitalism…that is the American way and it works.  As I mentioned above, relying on insurance companies, even if you can purchase “across state lines”, to lower your costs as a result would be continuing to trust an industry that clearly does not have our ability to afford them at heart.  For example, they can simply congregate in states that have far less stringent laws for coverage, and then offer a lower premium…for less coverage – this is not a savings.  They will continue to do what they do now:  the two largest health insurers held half or more of all enrollments in 40 of the 42 states studied just last year by the American Medical Association.

Without an outside force keeping their prices in check, they have proven to us over almost a century that they will simply find ways around any lesser legislation, and we will continue to pay for it.

To my fellow Boomers:

All of the above in the “women” section, plus as we age we will be the major users of healthcare, and many of us have miles to go before we qualify for Medicare (the other “public option” of which we will happily avail ourselves).  That means years of exorbitant premiums, even if insurers can no longer drop us when we get sick or refuse to cover us with a pre-existing condition.  Great – we qualify – but we still can’t afford it….

To my fellow Middle-Class:

The poor will be covered – the rich can afford designer care so they don’t care – we’re the ones who will be left to live with the final results of this legislation.  So, what will reduce our costs without sacrificing the levels of coverage we need to stay healthy…or survive a devastating illness?  We’ve said we don’t trust the government to do a plan right…do we really trust insurance companies more…?  With reforms to Medicare to bring its spending under control, it becomes an excellent model to replicate. Apparently even without those controls everyone on Medicare loves Medicare and the rest of us can’t wait to get on it… If Medicare is that effective, useful, needed, it is worthy of replicating for younger Americans as an alternative to private insurance for those who qualify (which, like Medicare, would hardly be “everyone” but in fact quite limited – enough to make a real difference without creating an unfair advantage).

There is only one way we will realize not just immediate but on-going cost reasonableness while not sacrificing our coverages.  We can have both – this is America – when we want the best approach badly enough, we make it happen.

To my fellow self-insureds:

You, like me, have most likely at some point had insurance through an employer prior to buying your own for whatever reason.  Back in 2000 when I worked for someone else, I was given a choice of diminished coverages for the same employee share cost, or increased costs for keeping the same coverages.  This trend has continued and worsened for those with employer provided coverage.  To quickly emphasize this with a real example: Dawn Smith is an aspiring writer living in Atlanta; four years ago, she was diagnosed with a rare, but treatable brain tumor; her doctors are ready to remove it, but they can’t because CIGNA refuses to pay for the surgery.  This is a battle happening right now.

We know that this is then magnified 100% when we pay the entire bill ourselves, and with no more guarantee than has Dawn that we will be covered when we need it the most.

I have seen my insurance bill rise by 33% over the past 1.5 years.  This is simply unacceptable.  Yet I have the lowest-cost insurance available to me here in Florida, and the bare minimum of coverage (“catastrophic” only).  Of the “cost-reducing” options being forwarded in lieu of a public option by some members of Congress, one is the ability for us to go across state lines – in reality, that would reduce my premium very little (I’ve checked) and “co-ops” would take years to develop to the point of efficacy – that’s only after the years it will take to get them up and running…the existing co-ops being used as models have taken as long as 20 years to get to the point where they are now the models to be emulated.  You truly want to wait 20 years? 

And as for cost, co-ops may have premium increases that are less than their competition’s, but that doesn’t make those increases necessarily affordable. Washington State’s Group Health Cooperative of Puget Sound had annual increases for averaging 12.3 percent since 2000; they were 24.2 percent in 2003.

My fellow Centrist Dem’s/Biz Owners/Boomer Women/Self-Insureds, I ask you to consider my words to you peer-to-peer; they are long in coming and carefully thought out, I promise.  I have done my homework – do my own fact-finding rather than relying on pundits with a clearly self-serving motivation (ratings) on both sides of the issue.  I, like you, have the most to gain or lose if this is done…or not done…right.  I ask you to not only refuse to dismiss a public option, but insist on it. In fact, it is our only chance for reform that will be both meaningful and lasting.

Why Obama is in Fact a True Boomer

The headlines and punditry are consistent: The Boomer Generation has had its Presidents (aka Clinton & Bush) and with Barak Obama is passing the mantle to the next generation….which is…still the Boomer Generation.  Born in 1961, President Obama falls within the chronological confines of our generation (b. 1946-64), but more importantly, he really couldn’t be more Boomer in his ideals and characteristics.

Yes, I know, there’s the contrived if not fluctuating configuration called “Generation Jones” made up of junior Boomers and those a few years beyond (GenJ has been noted to start as far back as 1954, and can go up to 1970…I was born in 1954, and I promise you, I’m all Boomer). 

And I understand the drive to find some sort of label for those who are not Boomers, yet not GenXers (e.g. anyone born between 1965 & oh, say around 1967, since thereafter those born to the first boomers, e.g GenX, began arriving).  Finally, I understand, and agree, that there are many born at the end of the Boomer era, say between 1960 & 1964, who look, act and feel more like GenXers than Boomers.

But that’s not Obama.   He personifies all the things Boomers believed in, fought for, and achieved in our youth:

  • A world free of pollution and poverty
  • That all have the same rights that theretofore had been given to only a select few
  • Elimination of the corporate corruptions that keep the poor poorer, make the rich richer, and stain our nation’s policy-making and global credibility
  • Ending a war the conduct of which has damaged our reputation throughout the world

Don’t let the fact that we Boomers strayed from our ideals, mislead you younger folks to think that what Obama believes and instills in you is an idealism of a new generation. 

He is bringing back to you what we started, but alas didn’t continue.  From his mixed race heritage and his decision as a young man to work as a community organizer (Boomers were the first true “activitists” as a generation), to his “laid-back” personna, he lives and breathes all that characterizes Boomers.

As Mike Phillips, a confirmed old White Boomer from Salem MA says so well:

“To those of us who marched (maybe not physically, but at least in spirit), with the leaders of the civil rights movement. With Martin Luther King, Jesse Jackson and all of the un-named others. With those who were killed, assassinated or suffered other injuries because of their beliefs.

But most of all, to the followers. Those of us who are un-named, who endured the violence and repression and vilification. Who weathered the dogs, the police, the fire hoses. To those of us who confronted the bigotry, the racism, the defamation of human beings because of the color of their skin, as we followed.”

Obama is a Boomer who, as an adult is getting it right, something many of the rest of his generation didn’t do.

He’s a Boomer, alright.  Just a Boomer who didn’t lose his youthful ideals as he reached manhood, and used them well even as he struggled to create a career and support a family.

And oh boy I couldn’t be prouder of him!

 

Top 6 Things President Obama Must Handle in the First 100 Days

We Boomers pretty much embody the nexus for the nation’s most pressing ills that must be made well if America is to once again be great.   As far-reaching as that sounds, it couldn’t be more true.

Using myself as an example, I am:

  • a business owner;
  • a mother of young adults in the work world;
  • a person who is nearing retirement;
  • a caretaker for elderly parents, and;
  • a person who is part of the generation that called for an end pollution and corporate bad behavior

These correlate to the following ills already identified as most pressing by voters and pundits alike (in order of appearance above):

  • Taxes and global trade laws
  • Job creation; adequate healthcare
  • Social Security & Medicare; retirement account capacity
  • ditto; plus Healthcare
  • Clean energy/energy efficiency

So, here is my guidance to our young and idealistic President Elect – the top 6 things to be handled in the first 100 days from a Boomer’s perspective:

  1. Economy: Ensure the proper handling of the immediate steps needed to begin meaningful economic recovery by seeking/receiving ideas from economists, not politicians, from both ends of the “how-to-fix-this” spectrum, then doing what falls in the middle-ground
  2. Healthcare: any form of “universal healthcare” is at best a long way off in this country (rightly or wrongly…) and at worst not going to happen at all in this country; ensure a first step response that will at least mitigate the outrageous costs of healthcare/health insurance, thus providing immediate relief that will go far to create a healthier populace (on which, after all, all else is dependent)
  3. Taxes: Immediately roll back or eliminate tax breaks for companies that cheat (off shore bank accounts to avoid taxes, for example), steal (eliminate jobs here in the US so their CEO’s can grab hundreds of millions of dollars in compensation), and pollute without care for the planetary result but to increase their bottom-line; rework the tax code to eliminate huge tax loopholes for those making over a certain amount (your cut-off of $250,000 is fine) so they are paying a fair ratio of income tax to income
  4. Social Security/Medicare: SS – move the cap at which SS deductions are taken, from the current $89K to $250K; Medicare – immediately establish a department that investigates/handles only Medicare fraud, as I can tell you from first hand experience that what we’re doing now is completely inadequate, and the money being greedily siphoned from this excellent program could pay for it and the department’s salaries, possibly 2X over
  5. NAFTA: do not eliminate this treaty, instead make it more effective and even-handed for all countries involved (including ours….)
  6. Job Creation through Clean Energy Sources (value added…Energy Independence): In addition to the aspects of #’s 3 & 5 above that will result in the creation of a certain amount of jobs, immediately invest in alternative energy projects and the job training needed to prepare unemployed/soon to be unemployed folks from last century industries, for those jobs.

And your foundation for all of this: Be unwavering on your determination that ideology will not trump reality, particularly within your own party.

My fellow Boomers and I were around in the heady days of the 60’s/70’s that America (if not the world…) is in process of reliving.  Unfortunately, we became “the Man” we so distrusted; we became the polluters and resource wasters we so derided; in essence, we got lost from our ideals, too busy making a living to remember the importance of sustaining life.

Do not get lost once in the Oval Office.  Keep your grounding.  Make sure that you and the youth you so inspire, don’t stop living your ideals as we did.

Build on our historic successes and don’t repeat our failures.  Then, maybe this time around America can finish what it started.