Healthy Living Brings Fiscal Gains: Insurers Weight in on Employee Well-Being

It is a well supported fact that being over weight puts one at a greater risk for serious medical conditions, including diabetes and heart disease. In terms of health care coverage, this fact results in higher premiums to compensate for one’s increased probability of requiring more medical attention. With rising insurance costs, the trend toward employer promoted wellness programs, as a means of encouraging beneficial behavior, is taking root across corporate America. Through such programs, including for example, gym access and lifestyle counseling, businesses strive to decrease medical costs and increase employee productivity (see wellness image above). With this new trend in play, corporations are seeking more personalized employee information as a means of checking up on their staff’s health. However, when this tracking process becomes a means of discrimination, offering subsidized premiums only to those employees abiding by the corporate outlined healthful guidelines, has the process not become too invasive? To discuss these contentious issues, I delved into the world wide blogosphere and responded to two relevant posts, with my comments reproduced below. The first blog, entitled Consumerism Commentary is authored by Flexo, whose site aims to educate individuals on their financial decisions. In the post, Higher Health Insurance Premiums for Overweight: Discrimination?, the author comments on the New York Times article, Extra Weight, Higher Costs, questioning whether basing employer health insurance costs’ on one’s body-mass index (BMI) is a just measure. Moreover, at the AccountabilityCentral.com site, blogger Michelle Andrews considers the invasive pitfalls and potential benefits of employer sponsored healthfulness, in a post entitled, America’s Best Health Plans.

Higher Health Insurance Premiums for Overweight: Discrimination?
Comment:

Dear Flexo,

I find your discussion of discrimination in terms of employee health care coverage costs based on one’s BMI to sponsor an insightful viewpoint (see BMI chart to right). The figures linking one’s medical costs to weight are truly dramatic and eye-opening and knowledge of such statistical evidence should be broadcast across the nation, as a means of raising a red flag to the millions of ‘affected’ Americans. Concerning your posed question of discrimination and reasoning, stating that “overweight individuals cost the company more in health insurance costs” than do normal weight individuals, I do not wholly feel that charging obese individuals more for employer based health insurance is hypothetically unfair. However, as to whether or not this is just, I am less willing to consent. According to Damon Darlin, author of Extra Weight, Higher Costs, as referenced in your post, heavier individuals accumulate higher medical bills and pull in lower wages over their shortened lifetimes. Due to their chronic disease, they are at an exceptionally increased risk of suffering from expensive and potentially debilitating ailments such as arthritis, diabetes, diabetes, and heart disease. In terms of fiscal content, these disorders cost around $80 billion annually, for the over 97 million obese and morbidly obese Americans. With 85 percent of this monetary burden being covered by insurers, tax payers, and the government, the inclination toward increasing coverage costs for individuals with a BMI of 25.0 or above is understandable. Individuals battling obesity and the related conditions do not need the added stress of funding these newly acquired ailments due to the implementation of health care related economic discrimination. Although many of their health problems are catalyzed by being over weight, inculcating these individuals with higher premiums will neither dramatically lower governmental healthcare spending nor curtail the obesity epidemic. It will however, likely lead to an increase in the number of uninsured Americans. Rather, the cause of obesity should be the topic at hand, not the resulting symptoms and ailments. The external reward of fiscal gain due to a ‘normal’ BMI will never consistently overcome the temptation toward unhealthy eating habits for bingers, but the intrinsic reward of benefiting one’s own health and well-being may. Thus, while on paper it may seem logical to ‘overcharge’ the overeaters, it will not solve anyone’s problems.

America’s Best Health Plans
Comment:

Dear Ms. Andrews,

I find your post very thought provoking and timely, as employee healthcare costs continue to spiral out of the workplace. I definitely agree that our nation as a whole would largely benefit from a move toward preventative medicine and away from our current treatment based system (see image to the left). Statistical evidence for this cause can be seen in its potential to decrease American-based medical costs and productivity loss by a staggering $1.1 trillion, according to the Milken Institute, as discussed in your post. The notion of the work place as acting as a catalyst in such a movement toward preventative medicine is both exciting and daunting. With the potential of “workplace wellness” benefiting millions of employees across the country, a large percentage of individuals involved in the workforce will be shifted toward a brightened “overall health picture.” However, with this comes the potential for overly eager and thus highly invasive employers, raiding the employee personal sphere by subjectively promoting healthful programs for the employer’s fiscal gain, via the lowering of employer coverage output costs. This double ended dagger requires much care and guiding legislation to assure there is no workplace discrimination against those who do not wish to part take in such corporate sponsored wellness programs. Wellness targeting obesity in particular, could have hugely beneficial implications, both for the individual and for the healthcare economy, as was stated that “Spending on [ ] obesity-related maladies alone drove 34 percent of the increase in medical spending” in the past decade alone. The methodology of enacting the wellness programs however, will determine their success. Staging them as a checkpoint system, in which one must meet certain ‘healthy’ criteria such as a certain BMI or cholesterol, to avoid monetary fines, will send the program for a nose dive. This setup, I agree, is overly invasive, as employers should not have access to this personal employee health information. An employee should not be penalized for their dietary habits, “blood sugar, cholesterol, and blood pressure” as was the case with the Clarian Health Partners. When deciding whether or not to have that extra bag of chips or to reach for the non-fat milk in lieu of the whole milk, one will not stop to consider the extra $5 surcharge on their employer subsidized health coverage. Further, regardless of legislation, preventing discrimination against ‘unhealthy’ individuals would be inevitable, with business run wellness plans aimed at lowering employer healthcare costs. The employee benefits, including access to healthful programs, such as gyms, nutrition advice, and psychological counseling, as well as lowered premiums may outweigh the downsides of the system for some. As discussed in your post, permanent behavioral modification must come from within. Therefore, wellness plans are incredible attributes to the workplace in general, but extreme caution should be taken when they are given a personal price.

Dental Decay: Lack of Access Leaves Millions without Care

As dentistry accepts an increasingly business-oriented system, access to oral health care is waning for millions of Americans. This so-called “boom time” for dentists, with their costs surpassing inflation, has resulted in a curtailment of the gains made in dental care from nearly a half-century ago. Although many dentists argue that a majority of Americans have sufficient access to dental care, statistics suggest otherwise. In a recent study conducted by the Centers for Disease Control and Prevention (CDC), nearly 30 percent of both adults and children have untreated cavities and dental decay, a significant increase compared to findings spanning the past three decades. These values constituting over 100 million people lacking dental insurance, however, are not evenly dispersed across income brackets, but are rather largely influenced by lower and middle income individuals, who have been most affected by the rising dental care costs and dentist inaccessibility. This system leaves millions of individuals lacking even rudimentary coverage, disregarding superfluous cosmetic dental procedures. Further, the severity of poor dental care should not go unnoticed, as fatality is a potential outcome. One practicing dentist feels “Charity is not a health care system” and dentists deserve their booming fees. Regardless of cost, though, the current dental care system is failing millions of Americans, particularly children, without adequate access to it. Thus, all medical insurance packages should include dental plans. Further, both private and public dental plans require modification to assure access and affordability to all Americans.

Inadequate access to dental care can be blamed for both severe and preventive oral health problems. According to the National Survey of America’s Families (NSAF), there was a similar level of unmet need for children with either private or public insurance, or 5.7 percent versus 7 percent respectively, less than half the value for children completely lacking insurance. The reasons behind these findings are twofold. Privately insured individuals, particularly children, may lack sufficient dental coverage, whereas publicly insured individuals likely have difficulty locating Medicaid participating dentists. Untreated patient’s then, spill over into publicly financed clinics, resulting in month-long waits for even urgent oral procedures. Although lack of knowledge concerning appropriate dental visitation may be a factor contributing to poor dental health, it is both lack of access to dental care and inability to afford oral health care that stand as a definitive barrier between people and brighter smiles. For this reason, restructuring of the Medicaid dental policy as a means of increasing dentist participation is crucial. However, this public insurance coverage only includes individuals of families whose income falls below 200 percent of the federal poverty level (FPL). According to the Urban Institute, in a study authored by Genevieve Kenney, Grace Ko, and Barbara Ormond, such insurance limitations leave “17 percent [of children with] unmet need,” who do not qualify for Medicaid, yet are unable to afford private insurance. This finding underscores the significant correlation between income and insurance coverage as “these disparities help to explain the somewhat unexpected finding that children in the middle income groups receive the least dental care.” Therefore, extension of the State Children’s Health Insurance Program (SCHIP) to include the uninsured youth could initially ameliorate their unmet dental needs, although supply barriers and minimal oral coverage under such policies remain.

Lack of sufficient care significantly affects developing children. According to the Kaiser Commission on Medicaid and the Uninsured, tooth decay, a chronic childhood disease, affects five times more children than asthma. More astounding is the 68% of children with decay in permanent teeth, as analyzed by the CDC (see diagram above). Such an ailment results in children missing over 51 million hours of school annually and can have severe medical consequences such as ear and sinus infections, diabetes, heart and lung disease and further lack of attention can be lethal. Fatalities due to lack of dental care are tragic and unnecessary with simple preventative measures such as drinking fluorinated water and applying sealants. But not all children have equal access to such treatment, with Caucasian children more likely to report that their teeth are in excellent condition than are minority children as depicted in the graph to the right. Increased federal funding in dental plans is necessary to assure a routine $80 cavity never costs someone their life, as was the case for a 12- year old boy in Maryland.

The business of dentistry should come second to the essential medical services it provides. However, with the decrease in both dental schools and graduating dentists dropping from 5,750 professionals in 1982 to 4,440 in 2003 and an increasing population, this capitalistic-orientation seems to be a trend for the future. These figures suggest that there is a 1: 1,750 dentist to citizen ratio, for the 1520,000 practicing dentists in the United States. To reverse this trend, the government needs to subsidize dental schools in a similar manner to the way it does medical schools. The latter can send interns to hospitals that are federally funded for training, to offer their students applied instruction; however there is no comparable system for dental schooling. Thus, the current system requires significant funds to train a dentist.

With their dwindling numbers, dentists are cumulatively making more money now than ever recorded, while working fewer hours. To combat increasing dental fees and lack of access to care, some individuals advocate the work of dental therapists who are trained as dentists, without the general medical training. This practice will likely not be instated within the United States in the near future, as the American Dental Association vehemently argues against the "two-tier system [this would create], where some people have access to dentists, while others must settle for less-qualified practitioners.” But is not some basic care better than none at all? It seems that the ADA is nurturing the business side of dentistry, eliminating any potentially more affordable options for dental care and thereby securing the rising fares of fully trained dentists. At the very least, to initiate increased dental care access and to level the playing field, Medicaid should offer more competitive reimbursement rates. These rates, along with increased state and federal funding for wise dental policies is essential to extend access and assure all adults and children have the means to maintain a healthy dental hygiene. The double standard of care, with treatment provided to select populations should no longer be acceptable in the United States.

Bush Sinks the SCHIP: The Future of Children’s Health Care Determined by Income

Medical care should constitute a basic human entitlement, especially for children. The extent of such publicly subsidized health coverage however, is the $83,000 question. That is, do children of families with an income over 400 % of the federal poverty level (FPL), or $20,650 annually for a family of four, deserve government funded health insurance? The State Children’s Health Insurance Program, or SCHIP, created in 1997, was designed to reduce the millions of uninsured children of working class families. According to the current SCHIP policy, a plan which must be reinstated every decade, children whose families fall within 200% of the FPL are entitled to government subsidized insurance plans. Increasing funding to this plan was proposed, but President Bush (pictured below) sank this SCHIP revision with his recent withstanding veto, arguing the proposal’s call for further governmental support would result in a socialized health care system. Increasing medical spending in the aid of millions of children by increasing tobacco taxes, as the recent proposal suggested, seems laudable. That is, until one considers the potential “crowding out” phenomenon, whereby private insurance markets are weakened, likely due to the cheaper rates and availability of public insurance. To assure all children unable to afford coverage are taken care of, SCHIP should continue to be a fully subsidized program, coupled with a tax break for individuals and employers to bolster employer subsidized health coverage and moderate private insurance sales.

The past success of SCHIP as a whole is statistically significant, though its beneficial effects could likely be extended. For example, the percentage of uninsured children from households with incomes below 200 percent of the federal poverty level dropped from 23 percent in 1997 to 20 percent in 2000. This percentage takes into account the thousands of youth without coverage who are eligible for SCHIP though have not joined the program, bringing the total enrollment to over 6.6 million individuals. Further, through such a policy, the number of uninsured children has been lessened by a third. However, eight million American children remain uninsured and without access to essential primary medical treatment; that is, without utilizing emergency medical services which are fiscally inefficient medical facilities funded by tax payers. Many of the children lacking coverage come from middle class families stuck in a ‘health care limbo,’ unable to either qualify for public medical assistance or afford private medical insurance. To offset such astronomical numbers of unassisted youth and grant coverage to an additional four million children, a rare bipartisan revision was recently approved by the Congress and House, whereby $35 billion would be allocated to the SCHIP program according to the former versus $50 billion by the latter. However, the House and Congress were unable to overturn the President’s veto of this initiative, accentuating the need for health care revision, when noting the current statistics of children in need of coverage.

According to the Census Bureau, in 2006 the number of uninsured individuals below the age of 18 increased by 710,000 with 70 percent of them coming from families with incomes at or above 200 percent of the FPL as depicted in the green and blue plots in graph to the right. In this income bracket, the children do not necessarily qualify for the SCHIP benefits, as each state determines the specifics and implementation of the program, though may not offer coverage to children from brackets around 300 percent over the FPL. Compared to 2005, 2006 saw an increase in the number of uninsured individuals, largely due to the decline in employer coverage across all income brackets. For example, according to the Kaiser Commission on Medicaid and the Uninsured, even if businesses are able to remain profitable by spending an average of $12,106 per family for health coverage, premiums for employees have nearly doubled in the past seven years, resulting in a $3,281 personal expense required. Clearly, these out of pocket expenditures would fall heaviest on families in the lower income brackets, although these children are able to apply for SCHIP, along with Medicaid or government subsidized health insurance. Together these programs have partially off set the decline in employer funded insurance for lower income youth. Therefore, as health care costs increase, resulting in more employers being unable to offer health insurance to workers, public funding is more essential. Rising premiums would similarly strain the fiscal status of middle class families excluded form the current SCHIP program, who may be unable to afford these rising costs. Decreases in employee subsidized health plans, coupled with minimal Medicaid or SCHIP coverage augmentation, underscores the necessity for low and middle income health policies to be restructured.

The outcome of this insurance coverage issue will significantly influence the government’s role in health care. This is a role that the Bush administration wishes to minimize, suggesting that an increase in the SCHIP program would merely allow government coverage to take the place of private insurance. In other words, it would become government run health care for middle class citizens, a program leaning toward universal coverage. Critics argue that with public coverage comes long waits, the increasing difficulty in finding doctors accepting such insurance, and an increased potential for granting medical care access to illegal immigrants. Although SCHIP is necessary for lower and lower middle class families, throwing more money into this program is not necessarily the solution. Rather, it should be coupled with tax incentives for employers and individuals opting for private insurance, both of which are necessary to sustain the private health insurance sector. Putting the SCHIP issue aside, legislation is essential to assure all children are covered, regardless of their families’ income bracket.

Microsoft Announces HealthVault: A One-Stop Shop for Medical History

Microsoft’s recently released online venture, HealthVault (seen left), serves to further solidify an inescapable trend of the future: a fusion of medicine and the World Wide Web. As I have discussed in earlier posts, similar movements such as Health 2.0 are uniting people and bringing them health-related answers via a virtual medium. This newest endeavor, HealthVault, coupled with a personalized health search engine, serves as a “consumer-centric platform” intending to aid people in managing their medical portfolios. According to its maker, this free service functions to “collect, store and share health information” amongst patients, doctors and healthcare providers. If one can bank online, or buy a car, why not store medical records? As its name suggests, Microsoft understands security will likely rage as its toughest battle in winning the public’s approval, but easier sharing of medical information could result in earlier diagnoses. This would allow the healthcare system to move away from the treatment of full-blown ailments and toward the practice of preventative medicine. Thus, this is a battle worth fighting, provided that security concerns can be met.

HealthVault provides patients with innovative benefits that were previously unavailable, such as the accessibility of one’s own medical information (as depicted in the HealthVault graphic below). To consumers, HealthVault is “part filing cabinet, part library and part fax machine” allowing one to “navigate a complex web of disconnected interactions,” according to Peter Neupert, who is corporate Vice President of Microsoft’s Health Solutions Group. If granted access, doctors can, for example, upload lab results, view immunization records, and contact patients as a means of formulating a more solid diagnosis of a their condition. Various other applications and devices are currently being added to HealthVault in conjunction with corporations such as Diabetes Prevention Source, MedHelp, Allscripts, and the American Heart Association. With this information, along with the site’s health-specific vertical search engine, individuals will be able to make more informed decisions concerning their health practices. In the case of dependents, family members with authorized access will also be able to make more knowledgeable and helpful decisions for loved ones. If the public accepts this program, over the years individuals will have a more accurate understanding of their family’s medical histories. Such information facilitates healthier lifestyles, due to more medically aware patients.

HealthVault could act as a standardized and legible method of recording patient data which would make medical practices more efficient and thus more effective. When consulting with a new physician, a patient’s cumulative medical history could potentially be accessible, avoiding an otherwise repetitive process of seeking out this information. In addition to aiding in the move toward preventative medicine by making one’s records more cumulative, this new system could assist in the treatment of emergency victims because one’s HealthVault record could be viewed from any internet source.

This potential accessibility though may turn many users away. With the significance of the information held in medical records, a “track record on privacy” is essential to assuage consumers’ nerves. As rightly discussed by Neupert, many individuals were initially wary toward the idea of online banking with the fear of “hackers” and identity theft, however such banking is now mainstream. According to Microsoft, all information entered will be stored in an encrypted database. Access to this information by hospitals, healthcare providers, or insurance companies is granted solely with informed consent by the patient. For the consumer, a password deemed “strong” by the site’s algorithmic programming is required. Saying this although, there still remains much “emotional distress associated with inappropriate disclosure of [one’s medical] information,” as no one wants HIV test results or psychiatric records floating around the internet. With their current precautionary practices, Dr. Deborah Peel, founder of the Patient Privacy Rights Foundation feels that Microsoft is “setting a new standard for privacy protections in health information technology.” Concerning this though, Microsoft’s security track record with its products, including “Passport, Windows 2000, Internet Explorer and Media Player 9," strongly suggests otherwise. Various security breaches have resulted in the exploitation of an “Explorer security hole [ ] by intruders bent on swiping personal information from unwitting Internet users.” This particular scam involved the swindling of financial records. However, such an incident suggests the potential for similar cons, including ones implicating individuals’ highly private medical histories. With this record in tow, Microsoft’s new program should be supported with caution.

Another related factor keeping potential users from HealthVault is the fear of an insurance company’s access to online records. Before all information was in one place, an individual could selectively decide what data was transferred along to an insurance company or other doctors. Though, with HealthVault, granting symptom selective access becomes tricky. If universal healthcare is enacted in the United States an online medical record repository will likely become more popular because individuals will know information in their records will not jeopardize their policy. Further, one of the many advantages of HealthVault is that it allows patients to holds the reigns to their medical profiles. This will enable patients to make more informed and healthful decisions. Accessible and universally formatted medical records alone can help reunite a fragmenting healthcare system by allowing healthcare providers, patients, and insurers to speak the same language of medicine. However, according to Microsoft this tool will simply “empower people to live healthy lives.”

Healthcare in Your Hands: The Big Three Sets a New Standard for Employers

The urgency for a healthcare system overhaul is long past due, forcing major corporations to forge their own policies. As discussed in previous posts, voters rank health care legislation as their principal concern for the upcoming election and with the corporate initiated restructuring already underway, governmental reform cannot come soon enough. To remain profitable with exponential health care costs, many corporations are rescinding their employee health care benefits resulting in a dramatic drop in employer subsidized packages from 69% in 2000 to the current level of 60% as represented in the graph to the left. Such a significant decline signals a trend grasping United States health care with “employers renouncing their decades-old role as chief healthcare buyer.” But the current alternatives to employer subsidized health benefits are grim considering the fact that without such assistance many individuals are unable to afford their premiums or private insurance. This lends itself to the increased reliance of millions of Americans including, the 47 million currently uninsured, on hospital’s emergency departments, where the cost of treatment is significantly higher than other outpatient clinics. Therefore, until universal healthcare legislation is in place, corporations need to limit their health benefit cutbacks to current and retired employees and to their spouses to prevent the further inundation of non-primary care facilities.

An example of the dramatic shift away from fully endorsed employee medical packages came late last week. Trying to close the profit margin between American and overseas automotive companies, the United States borne General Motors Corporation, one of the largest domestic employers, has revamped its employee healthcare policies in hopes of regaining its economic viability. Lead by Chief Ron Gettelfinger (pictured below), the United Auto Workers (UAW) unanimously agreed to GM’s new four year contract which will place 29.9 billion dollars into a retiree health trust fund at the beginning of 2010. The implementation of a voluntary employees’ beneficiary association, or VERBA, as this trust fund is called, is a set down from the UAW healthcare gains (which influenced nationwide healthcare employment policy) made in the middle of the last century where GM agreed to fully cover the health care costs of its members, retirees and surviving spouses. However, this was a time when domestically manufactured car sales trumped all others and offering such health care benefits did not land one of our nation’s largest employers in the red. Today foreign car companies, including Toyota and Honda, employ non-unionized workers, offering health benefits to barely 250 employees compared to the over 400,000 unionized workers, retirees, and spouses GM supplies for. With inflation increasing at an average rate of 2.5 percent per year versus the 12 percent annual health care premium cost increase, it is obvious that health care reform is necessary for any company offering such employee benefits, to turn in any profit. This corporate health policy change is about “making corporate America competitive again,” by shifting the economic health care burden onto retirees, each of whom will be given $1800 in a health reimbursement account.

Expanding on this new policy, of which a similar version will be followed by the other members of Detroit’s Big Three, including Ford and Chrysler, employees, particularly retirees, will be forced to handle their own health care. Such a system will likely limit medical service abuse by patients as they are each only given a lump sum which they must manage for their entire retirement. However, it will also land many of them in need of ‘free’ medical assistance because the cost of controlling a chronic or severe ailment is not covered by the cost of a few doctor visits. Thus, for the first time in over five decades, workers have to live with greater restrictions on their healthcare due to the limited amount of funds offered. After such funds are used, workers and their dependents will lack a fiscal health security net which, like the 16 percent of our nation’s uninsured population, will result in them receiving less preventive care, be diagnosed at more advanced stages of diseases after which they will receive less medical treatment and encounter higher mortality rates, according to the National Coalition on Health Care. Further, over $100 billion dollars is spent annually by the United States government covering the medical expenses of uninsured individuals, for preventable and earlier diagnosable diseases, often treated at expensive emergency care facilities. With a universal health care system in place, all individuals can receive medical care to decrease preventable illnesses and detect diseases at earlier stages, thereby decreasing our nation’s unnecessary emergency spending. Such a system could hypothetically allowing company’s to decrease their astronomical health care spending, thereby increasing employee’s wages while still coming out significantly ahead of their current economic standing.

Therefore, the recent agreement between the UAW and major auto companies is ominous. Although the “Big Three may not be what they once were as an industrial juggernaut…they still wield significant clout on the policymaking front,” a fearful notion for the millions of Americans currently receiving full employee medical benefits considering the recent downsizing healthcare policy changes.

Health 2.0: An E-mail a Day Keeps the Doctor at Bay

The explosion of the internet has landed our personal and professional lives ‘only a click away.’ But who knew this rampant tool would soon become our means of self- diagnosis and communication with our health care providers? With the advent of Web 2.0, the next generation of the World Wide Web, aiming to enhance communication amongst its users through social networking tools such as blogs, podcasts, wikis, and folksonomies, the nature of the American Healthcare System is readily transforming. Health 2.0 (also called Medicine 2.0) fuses Web 2.0 with the medical field allowing “ePatients” to generate their own personalized health care-related social networks and search engines. After determining the nature of one’s medical inquiry, patients can now bypass over-crowded waiting rooms from the serenity of their own living rooms by going on “e-visits” where face-to-face contact is replaced by computer screens and iPhones. In the wake of the last weeks first annual Health 2.0 Conference in San Francisco, which garnered international interest and was attended by leading technocrats from across the globe, I was instinctively compelled to wonder “How far is too far?” As a means of discussing such an inquiry, I have responded to two recent blog posts concerning the new face of medicine as can be reviewed in the following two paragraphs. The first post is in response to “Where HealthCare Meets Web 2.0” from the blog Diabetes Mine, by Amy Tendrich, an avid Health 2.0 utilizer and IT writer. In this post, Tendrich reviews the recent results of the Health 2.0 conference offering accolades for its transforming potential. The second comment refers to the post “IM UR NYC MD 24/7 4 HELP,” from the Wall Street Journal Online Health Blog by Scott Hensely who discusses the new e-structured medical practice of Dr. Jay Parkinson.

“Where HealthCare Meets Web 2.0”
Comment:

Firstly, I would like to thank you for your coverage of the fascinating Health 2.0 Conference. While your pro-Medicine 2.0 reviews understandably stem from your personal experience with this rapidly evolving movement, I would like to raise a few potential downsides concerning the direction in which it is headed. Saying this however, I would initially like to stress my acknowledgment of the significant benefits this cyber- medical community may offer to internet users worldwide. As stated in your post, “58 million or 75% of American households subscribe to broadband internet access,” a massive population of possible medical product and service consumers. These astronomical numbers alone are a goldmine for companies all wanting “a piece of the pie.” But with considerable financial gain at stake with such a large audience, the reasoning behind a companies’ involvement in the online healthcare industry must not be taken lightly. With “tech-savvy entrepreneurs” taking advantage of the “financial potential of healthcare communities on the web”, misinformation may trial in second to profit gain. On an “ultra-Democratic” interface largely devoid of content monitoring, individuals seeking medical assistance via the internet should be wary. Further with regards to the 58 million online users, where does that leave the other 25% of the population without access to these online support groups and information centers? Although Health 2.0 may benefit a large population, it sets up a dichotomy between those who have access to the online information and those who do not. As more users catch onto this new medical cyberspace tidal wave, more programs and services will likely be taken from the books to the web, further alienating the 25% of Americans, often already without access to such knowledge. Finally, as you discussed, over “20% of American internet users have created some sort of health-related content.” By uploading and documenting personal experiences, particularly those which are medically-related, one swings open the doors for the exploitation of one’s information.

“IM UR NYC MD 24/7 4 HELP”
Comment:

As a pre-medical student myself, I was shocked by the arrangement of Dr. Jay Parkinson’s practice as discussed in your interview with the “freshly licensed” physician. A few key implications came to mind regarding such a set-up. Firstly, many doctors in practice are fueled by the doctor-to-patient physical contact, as it is invigorating to assess a patient, determine a problem, and be able to administer the appropriate treatment. Seeing a patient improve and knowing it was due to your assistance, I would assume to be an extraordinary and highly desired experience; one which would be largely absent from Dr. Parkinson’s practice. Medicine should not be made into a “drive-through” service, but rather belongs in a “hospital or clinic environment” where all the necessary machines, tools, and personnel are available for a successful and thorough medical treatment. Further, the doctor describes his cases as non-life-threatening such as “acne, allergies and follow-up labs” but how can one assess the severity of any type of physical ailment through an electronic medium? Moreover, without physically seeing the individual, who is liable when the patient’s description is not totally accurate and consequently unfitting medical advice is recommended? Although he deems this new techno-mediated medical service as “personal attentiveness,” it has gone too far. Making appointments via e-mail is acceptable, but diagnosing an unseen “ePatient” seems illogical and unethical. Leave e-mail and other multimedia services for the iPhone (see picture) and medical procedures for the office.

Got Health? A Political Stab at a Broken System

The exponential growth of uninsured populations and health care costs, plagued by our nation’s substandard medical policies, propels the inadequacies of this health care system to the forefront of the upcoming Presidential election. By fostering an increase from 39.7 million to 47 million uninsured Americans from 1993, including a 2.2 million person increase this past year alone, the urgency for a dramatic system overhaul chimes in as utterly cliché. However, such substantial figures are merely symptoms underscoring an encroaching American health care disaster, one for which only dramatic legislation may begin to tame.

Democratic and Republican political candidates are feverously serving up new proposals in hopes of appeasing the largely dissatisfied American public. On the forefront of such health care reviews is the proposal of New York mayor and former First Lady, Hilary Clinton, (see above) a seasoned veteran of health care reform whose 1993 proposition was politically disregarded. With promises in her recent pitch of “health care for everyone,” believing “everyone – every man, woman, and child – should have quality, affordable health care in America” her vision points in an auspicious and necessary sociopolitical direction. Insurers would be prohibited from discriminating amongst customers based on previous or chronic medical conditions or charging variable premiums based on such circumstances. To carryout such an undertaking, all Americans would be required to purchase health insurance via employment opportunities or through a partially government subsidized program. Legislation under the Bush administration granting people earning over $250,000 tax cuts would be rescinded as a means of partially funding this new system. This, coupled with an additional $56 billion dollars in government savings through advances in technological efficiencies, such as computerized record keeping as well as reduced prescription costs, would total the $110 billion a year budget this program would require to operate.

Although a move toward “health care for everyone” may seem theoretically ideal, the path to such a success is hotly debated by various political activists and industry insiders. Referring to Clinton’s proposed medical policies as “Hilarycare” detractors, including conservative presidential candidates Rudy Giuliani and Mitt Romney, liken her visions to a system of universal health care associated with socialized government intervention. With both Republic candidates proposing tax breaks to purchase insurance, the former also suggested issuing vouchers for low income families while Romney emphasized state legislative flexibility. However, across party lines, discrepancies are inescapable, with the only constant being the desperate need for change. A fellow democratic candidate of Clinton, John Edwards, proposed to require all Americans to have insurance, directly provided by employers or supported by employer payment into a government fund. Taking a stance to emphasize his view on the importance of such an issue, Edwards vows to enact legislation that would revoke the health insurance for Congress and himself if a universal plan is not approved within six months of his taking of office, a nice break from the continual generalized and seemingly empty propositions of various other candidates. Finally, another Democratic hopeful, Barack Obama (see left) feels Clinton’s plan to mandate purchasing health insurance is unsubstantiated unless insurance policy costs drop drastically.

With no two politicians mirroring the other’s views, regardless of party stance, it is evident that there is no golden ticket to heal the American health care system. Moreover, the intense controversy ensuing such an issue in the political arena detracts from the devastating results of our current system and the millions of people that are consequently neglected. A search for the perfect plan needs to come second to bettering the lives of millions in need.