On Healthcare and Death Panels

I very nearly wasted a lot of time and (digtital) breath last week on a post about the townhall meetings and the swastika painting that occurred in my current homebase (Smyrna), but I didn’t.

My post was full of ire and invective and vitriol; the same kind of stuff I was condemning and I don’t like wearing the hypocrite hat any more than anyone else.

So, instead of bringing a torch to the already burning pyre of “debate” on the topic of healthcare and “death panels”, I’ll share a couple of pertinent (in my mind) anecdotes.

First and foremost, my mother-in-law is a hospice nurse. Has been for 20-some years.

She’s kind and nurturing and knowledgeable; the perfect person to help people transition to whatever lies beyond this earthly life.

In knowing her for over 14 years, the overriding thesis I have gleaned about hospice is this: we put so much emphasis on conception (and contraception) and birth and abortion and other issues related to children/infants/fetuses, it’s a travesty that so few of us plan for the eventuality of our own ultimate demise.

Sure, no one wants to talk about death, but it’s coming for all of us whether we want to admit to ourselves and our loved ones or not.

But hospice and end-of-life counseling are incredibly misunderstood. In the reductive world of soundbites and political football, weighty issues are ultimately reduced to either “fighting” for your life or “giving up”.

I don’t want to talk about Kervorkian or Schiavo here, I want to talk about the rest of us. You and me. [If you truly want to jump down those rabbit holes, be my guest]

Yesterday’s New York Times has an incredibly in-depth article on doctors who provide palliative care and a profile of both the healthcare professionals and patients involved. It’s worth your time to read the whole thing.

For my own part, Jenn and I have both affirmed to one another (though we need to get a real will and a living will on paper) that neither of us want to be kept alive on machines as a long-term solution. If the quality of my “life” is determined by a machine keeping my organs humming while my brain is dead that’s not really “living”, that’s being undead.

Additionally, we’re trying to live our lives with as few regrets as possible so that when the time comes, we can say goodbye gracefully and with dignity, not at the whim of some resident surgeon all too eager to play God when he/she doesn’t really know us or our families.

We haven’t been shy about saying this out loud, during family gatherings and holiday time, to either of our families and we’ll discuss it with our kids as they get old enough. It’s that important.

If we took the time to plan out how we told the family we were pregnant with our kids and who we invited into the delivery room to welcome our kids into this world, don’t we owe them the same courtesy to discuss how we’d like to leave this world: who should be there, what we’d like said and done afterwords?

Anyhow, I’m off on a rant, and I’m sorry. The point here is the discussion and that you (and everyone you know) have it.

If you’d like to see some more substantive debating about the actual proposed laws and whether or not they constitute “death panels” see last night’s Daily Show [via Andrew Sullivan].

And for a funnier (in my opinion) take on the whole enchilada, see Dana Gould (on Bill Maher) (embedded below):

Oh and here’s my mother-in-law’s take on that NYT article, copied with her permission via email:

Wow. What an article. I found myself wanting to talk to Mrs Magliore. I met people like that all the time and almost always they knew exactly what was happening and just needed someone to say it out loud for them and then give them the OK not to persue treatment. It’s the opposite of what you would think. You are not taking away hope at all, you are acknowledging what the person already knows and letting them know you are not going to run away but that you will walk with them the rest of their path.

Lastly, this napkin presentation is pretty cool (Thanks, Thomas!)

Stay healthy!

My affinity health care plan

I’m fairly certain that one of the issues President-elect Obama will tackle during his tenure in the White House will be health care. It was a centerpiece of his campaigning, an issue that swayed voters whose main concern was health care towards him, and it’s a very disjointed system.

So why don’t insurers and underwriters – the companies big and small and the individuals involved – work towards something better? If capitalism and competition can cure all ills (pun intended) why do we see so little innovation within health care and so much new thinking about therapies, drugs and procedures.

It just doesn’t seem like the business side of health care is moving at the same pace as the technologies to affect such care.

That’s why I’m going to go out on a limb and suggest a proactive approach that any HMO, PPO, Hospital, Doctor or Nurse can take to the bank: a loyalty/affinity program.

I know it sounds strange, but hear me out. Consumer goods and services companies have been all over this trend for the past 20 years, so why not graft some of the same critical thinking and business acumen – if not the exact implementation – on to health care.

Let’s use Starbucks as an example:

  1. If you’re Starbucks, you want people to drink more coffee, so you start selling gift cards and then you move on (recently) to a new type of affinity card intended (as I understand it) for your highest users, your brand evangelists, your top 1% of 1%.
  2. You give them discounts, sure, but you also give them access to cool, exclusive products and services that only they can enjoy. You make it feel exclusive. Membership has its rewards.
  3. On top of all the pampering you give them gifts that are meant, in the parlance of Seinfeld, to be gifted or re-gifted. You invite these people to widen your circle of influence by helping you find like-minded consumers who may not love Starbucks right now, but could be swayed through word-of-mouth or incentivized to Drink. More. Coffee.

All standard-issue business school stuff, right. It’s a loss-leader, but what you lose in incremental revenue via the discounts you gain back in increased consumption and broadened influence. In my TV background, we’d say this is a use of a Low Reach/High Frequency marketing message.

Or something like that.

Anyhow, what does this have to do with health care? Glad you asked.

Sick people cost more to insure and more to care for than do healthy people. I’m way over-generalizing, but I think you get my point.

So what should we do about people getting sick? We all get colds or have accidents or, loathe though I am to admit it, AGE!

I’m proposing that someone, everyone – maybe Kaiser Permanente or United Healthcare – start issuing a “frequently healthy” card and reward people who take all those preventive steps that we all love imagining for ourselves but so rarely do.

I’m talking:

  • A discount/reduced co-pay for well visits if you bring in an Honor Roll slip from your Gym/Athletic Club that says you worked out 15 (or more) out of 30 days in the month.
  • Prescription drug or over-the-counter coupons if you get a Flu shot at the start of Fall/Winter.
  • Access to specialist like Nutritionist and Stress or Work/Life classes and coaches if you maintain a certain BMI or you lower your body age through V02 monitoring or body composition.

Look, I’m no expert here and I surely get great health coverage (though costs are rising) from my employer, but it strikes me as odd that Kaiser will go to all that trouble to get Allison Janey to say “Live Well” and “Thrive” for their ads, but that no one has thought about putting together a solid “healthy person retention” program.

Or maybe I’m wrong and all kinds of these things exist. But I don’t think I am.

I think that if insurers really cared about optimizing their business, they’d realize they need to help people optimize themselves. Healthy people with healthy habits tend to stay healthier.

I’m going to be anti-blogger and not even attempt to link to any facts or figures because I’m both too lazy and too in-love with my own idea.

What say you? Am I way off base or have I stumbled upon something?

Also, is the system – and I’m including both for-profit companies and their access to government-funded initiatives such as Medicare and Medicaid (which I’m not so up-to-speed on, but my mother-in-law the Hospice Nurse is) – too complex to allow for such a simple idea? That is, are insurers actually better served by healthier people or do they enjoy charging more and making more money from progressively sicker and sicker people.

Who knows. Maybe this entire post is a boondoggle.

Let me have it.