What Big Teeth You Have!

Insurance might have first have been conceived when Babylonian traders made loans to the caravan trade that were reimbursed with interest after their safe arrival to market; Hammurabi’s Code gave legal weight to the practice in about 2100 B.C. Greek and Phoenician cultures used a similar system for their sea-going trade. Funeral expenses were assumed by the Romans, who even extended death benefits to survivors. Medieval trade guilds in Europe protected their members from shipwreck and arranged ransom payments to pirates when needed.

The first known insurance contract was drawn up in Genoa in 1347, and ushered in an era when marine insurance was offered by all of the maritime nations of the world.

In 1693, Edmond Halley, famed astronomer, created the first mortality table, based on statistics and compound interest, making it possible for insurers to rate the value of a human life.

Health Insurance is a relatively new idea in the United States. Before the innovations of the 20^th Century, medicine was virtually powerless against the forces of nature. Insurance companies couldn’t calculate health risks and so couldn’t formulate premiums. A house burning down or the loss of a life were concrete enough to determine a payout, but chronic disease and/or an ongoing complaint were too ephemeral for computation. Sickness Insurance was available, but it covered lost pay during the course of an illness, not the myriad costs of being unwell. Lives were shorter and most healthcare was delivered in the home by a general practitioner because there was very little available in the few hospitals to be found that wasn’t available in most people’s kitchens. Hospitals were originally conceived as places to serve the poor; it was cleaner and safer to stay home.

Several advancements conspired to change American’s relationship with the world of medicine. In 1904, the American Medical Association formed the Council on Medical Education with a view to standardizing requirements for gaining a license to practice medicine. So stringent were these new measures that between1910 and 1922, 307 medical schools closed down because they weren’t producing qualified doctors (JAMA, 8/12/1922). The resulting decline in licensed physicians at a time when the country’s population was exploding (due, in large part, to unprecedented immigration and a baby boom) gave doctors the highest average income of any profession. In 1900, there were 1.7 doctors per 1000 population, a number that remained virtually unchanged until 1970!

In 1913, the American College of Surgeons was founded, and they instituted new standards for the accreditation of hospitals. In 1918, only 13% of 692 large hospitals were accredited. By 1932, 93% of 1600 hospitals made the grade.

A new-found respect for the “Science of Medicine,” opened during this era, with the progress and development of vaccines and technologies, bolstered by the improved credibility of the physicians and institutions that dispensed care. Gone forever were the days when you were born and died in the same bed at home, and gone, too, are the days when the average person spent $290 per capita (1929) on healthcare. Now we spend an average of $5556 per capita (2004, Kaiser Family Foundation Health Stats).

In 1929, the great granddaddy of health insurance was created to offer pre-paid hospitalization policies. The guidelines of this venerable institution were designed by the American Hospital Association in order to manage price competition between hospitals, and evolved, over time into Blue Cross. Simultaneously, the American Medical Association, with accusations of Socialist National Health Programs on their lips, countered with their own primitive version of Blue Shield. This allowed them to continue to “price discriminate,” or charge their patients based upon what they imagined they could pay. Established as non-profit organizations, Blue Cross and Blue Shield continue to enjoy this designation today, despite an excess of revenue over expenses. The American population flocked to join the Blues and commercial insurance companies, witnessing their wildfire success, began to offer their own health plans. In the 1950s, these commercial plans could boast more members than the Blues.

During World War II, the Stabilization Act limited wage increases to defray competition over the sparse workforce, so employers offered insurance plans as an enticement. Legislation also allowed payroll tax exemptions to both the insured employee and their employer. By 1958, 75% of Americans had some form of private health insurance.

According to the New York Times, Harry Truman attempted to create a national health insurance system in 1945, and 75% of Americans thought it was a good idea. Unfortunately, special interests such as the American Medical Association and southern politicians defeated the plan because of their fear of loss of revenue and the specter of integrated hospitals, respectively.

In 1965, the government passed Medicare and Medicaid with funding from income taxes, payroll taxes, trust fund interest, and, of course, enrollee premiums. Medicare Part A is a compulsory hospital insurance program with automatic enrollment at age 65. Part B is supplemental medical insurance for physician services, made palatable to them by allowing them reimbursement at their regular rates. Medicaid provides medical resources for the indigent; originally available only to those Americans in receipt of public assistance, Medicaid pays out based on each state’s per capita income. Families that make too much money for Medicaid might qualify for State Children’s Health Insurance. In the early 80’s, the government reworked Medicare so that doctors were reimbursed according to a set fee schedule based upon a diagnosis.

Our legacy is an astronomically expensive, unwieldy and largely incomprehensible crazy-quilt that covers our elderly and provides tax shelters for the rich.

Health insurance might be thought of as a gigantic casino. We are welcome to pull up a chair at the blackjack table and plunk our money down on the chance that we might draw 21 and beat the house. Of course, despite the jingle jangle of loose change that you hear all around you, the chances of this are slim. The insurance company gambles on the notion that they can collect more in premiums than they’ll have to pay out in benefits. More often than not, they’re right.

Health insurance reform is up against some of the most powerful industries in Washington, DC. The website www.publicintegrity.org reports that of the 1,291 lobbyists listed as representing pharmaceutical corporations and their trade groups in 2004, 52% were former federal officials; these people have the ear of the FDA, the House, Senate and the Department of Health and Human Services. This is the same group that shepherded the Medicare Modernization Act of 2003 through Congress, creating Medicaid Part D to cover prescriptions at taxpayer expense. Their investments in Washington are enormous, although not when compared to their profits. As a result, they call the shots that allow astronomical pricing, that prevent people from going to the doctor when they need to, and that cause people to skimp on and even skip medications.

According to www.Health-Insurance.org, health care and insurance dominated the Washington lobby, generating an average of $2.79 billion in 2007, more than any other Washington lobby and exceeding all previous records for total lobby dollars spent. Under these circumstances, it is hard to envision a time when the politicians who are supposed to have our best interests at heart don’t put the lobby ahead of the people.

It would seem that, in the institution of Medicare, we already have a federal health insurance plan, but until those of us under the age of 65 are covered, it doesn’t do as much good as it could. “If reform fails again, we’ll be on the way to a radically unequal society, in which all but the most affluent Americans face the constant risk of financial ruin and even premature death because they can’t pay their medical bills.” (New York Times, 6/13/2005).

In the long run, a vast population of uninsured Americans will be – and indeed, already is - more expensive than solid, preventive care. Until our health insurance is more concerned with our health than their profits, each of us faces a yawning abyss of insecurity. In the more than four thousand years since Hammurabi recognized the prudence of caravan insurance, it would seem that we have not evolved beyond the notion that a basket of spices or a camel saddle is worth more than a human life. It’s time for Americans to rise up and take the bite out of health insurance. As a group, we’re bigger than they are, and it is completely within our grasp to tame the beast.

Pharmaceutical Waterloo

Caveat Emptor is a Latin axiom meaning, “Buyer Beware,” and is sound advice for anyone taking medication of any kind.

Today, heart disease is the number one cause of death in the United States, but in 1900, influenza, pneumonia, tuberculosis and diarrhea were the leading causes, followed by heart disease – perhaps because rampant infectious diseases carried many people off before they were old enough to contract it. Reputable physicians conducted their war against disease with the paltry compounds available to them at the time, such as mercury for syphilis, quinine for malaria, and a variety of herbal remedies.

Fast forward to the new millennium: more than 3-1/2 Billion prescriptions are written in a single year (according to The National Center for Health Statistics, an average of more than 10 per person!) and out of those, 1.5 Million Americans are harmed by their prescriptions. 200,000 people actually go so far as to die because of them. When one stops to consider that an average of 42,682 Americans die in auto accidents each year, this is a staggering number. We’re paying more for the privilege, too. A 2005 study conducted for Senator Gutneckt’s (R-Minn.) office shows that a 30-day supply of 10 popular prescriptions costing $455.57 in Frankfurt, Germany, costs $1,040.04 in Rochester, Minnesota. US News & World Report estimates that Americans pay somewhere in the neighborhood of 60% more for pharmaceuticals than any other industrialized country in the world.

The top ten pharmaceutical companies make more in profits than the rest of the Fortune 500 combined. Considering that they spend 2.5 times as much on marketing and administration as they do on research and development discredits the picture that they paint of themselves as a righteous industry largely subsisting on crumbs while their research and development departments gorge on the rest of the feast.

The pharmaceutical companies are privately held, multi-national corporations, and, as such, are in the business of making money, mostly by shaking down the American public. Other industrialized countries subsidize their citizens’ healthcare, so insist that drug prices are kept in check, while the consumers of this country are bilked for higher prices than anywhere else on earth and kept in a state of fear. Why should it be that a company with manufacturing plants in more than 50 countries across the globe should declare drugs coming out of Canada dangerous and beyond the scope of regulation? Shouldn’t one, then, be wary of any drug manufactured outside of the United States and imported over international borders?

In fact, approximately 86% of all drugs sold in the U.S. are manufactured outside of our borders. Among the most popular, Prevacid, is produced in Japan, Lipitor and Viagra are produced in Ireland and Nexium is made in both Sweden and France.

Consider:

• The Center for Drug Safety says that 26.5% of all patients experience an allergic reaction from prescribed medication.

• Newstarget.com headline on 2/20/2006 website: “Statistics prove prescription drugs are 16,400% more deadly than terrorists.”

• An average RX costs $68.26.

• An average name brand RX costs $111.02.

• An average generic brand RX costs $32.23.

• A study conducted by Brigham & Women’s Hospital in Boston July of 2005 found that 4.2 million hospital visits were for the treatment of an adverse drug event (15 visits per 1,000 Americans).
• The pharmaceutical industry has the largest lobby in Washington, D.C.­, the industry employs more lobbyists than there are Congress members.
• The pharmaceutical industry’s principal output is minor variations or combinations of old drugs—“me-too” drugs. These drugs cash in on already established, lucrative markets. For example, Pfizer’s Lipitor, is the fourth of six cholesterol-lowering drugs of the same type.
• According to Families USA, older adults account for approximately 40% of every dollar spent on prescription drugs and consume 34% of all prescriptions dispensed.
• The Federal Interagency Forum on Aging Related Statistics says that Medicare enrollees with 3 or 4 chronic conditions filled an average of 44 prescriptions a year, while those with 5 or more filled 60.

The bottom line as far as the solicitous hearts of the LifeSpan team are concerned is the fact that approximately 40% of all people who enter a nursing home do so because they are unable to take their medications safely at home. 50% of prescriptions are not taken correctly and so contribute to or create problems for the taker. Contraindications, or the prescribing of incompatible drugs, are a growing risk as we get older and see more than one doctor. Unsavory interactions are even reported with the combination of vitamins/herbs/minerals and prescriptions. There is too much for the average person to know about all of the things that can go wrong, to keep straight the voluminous information necessary to safely wrangle prescriptions, and to get the best medicinal bang for the buck. Unlike you, we are medical people and we know one thing beyond a shadow of a doubt:

You are safer and your long-term prognosis is better when you stay in your own home, so an educated and judicious approach to pharmaceuticals might just save your life.

While there are legitimate wonder drugs, one would be wise to be skeptical of an industry that prescribes the lion’s share of its cures for indigestion, erectile dysfunction, high cholesterol and other important problems that are just as easily cured - for free and without medication of any kind - with simple changes in diet and behavior. A LifeSpan Care Manager knows that the old adage about an ounce of prevention being worth a pound of cure is true.

Guinness Is Good For You, Too!

Research into the connection between beer and wine and health started with the detection of the French Paradox, a phenomenon characterized by the fact that although they smoke more, exercise less and dine on a comparatively high fat diet, the French rate of heart disease is about 1/3 that of America; red wine was named as the reason for the dichotomy.

When this information was aired on an episode of 60 Minutes in 1991, American wineries lobbied for the right to call their products health food and general consumption of red wine increased by 44%. Perhaps an extreme reaction, but the French Paradox did lead to a whirlwind of research that concluded that one or two glasses of red wine or dark beer each day is advantageous. Each of these beverages is loaded with flavonoids which have beneficial effects such as a reducing the tension of the blood vessel walls, raising good HDL cholesterol, lowering bad LDL cholesterol, inhibiting the production and development of tumors, inhibiting the formation of blood clots, and controlling a high white blood cell count. Free radicals and anti-inflammatories protect against heart attack, and new evidence seems to find dark beer and wine efficacious in fighting heart failure, stroke, osteoporosis, prostate cancer, tooth decay, upper respiratory tract disease and even dementia.

In Ireland, where Guinness is King, an extensive body of lore exists about the miracle curative of the beer. There is no way to confirm that Guinness was ever served to blood donors, post-operative patients, nursing mothers or race horses, but in the 1930s, the SH Benson Advertising Agency came out with the ‘Good for You’ campaign, based upon market research that revealed that people felt good after drinking a pint. In a marketing move that would never be allowed today, Guinness advised, “Seven glasses, 7 days of the week and 7 beneficial reasons to drink it (for strength, nerves, digestion, exhaustion, sleeplessness, its tonic effects and the blood).”

Like Coors Light, Guinness is 4.2% alcohol (compared with Budweiser’s 5%) with 210 calories and 17 Carbs, while red wine is 10% - 16% alcohol but only 102 calories for a five ounce glass and only 2.41 Carbs.

In his book The Wine and Food Lover’s Diet, Dr. Phillip Tirman, a specialist in sports medicine, says, “…statistics show that moderate wine consumption is associated with lower risk of stroke, heart disease, and diabetes, among other ailments. One explanation is that wine appears to increase the ratio of “good” HDL cholesterol to artery-clogging “bad” LDL cholesterol. The antioxidants found in red wine, in particular, reduce the oxidative stress on cells, which in turn appears to reduce the risk of certain cancers.”

This Saint Paddy’s Day, when Irish eyes turn to you and smile and say, “Sláinte,” or “To Your Health,” there may, in fact, be no small “In Vino Veritas,” or “Truth in wine.”

“Love Is Good For You,”

trumpets an article written by the staff of the venerable Mayo Clinic (2/6/2006, www.mayoclinic.com), and here’s why:

Stress kills. Your cardiovascular, hormonal and immune systems are negatively impacted by stress, making you vulnerable to disease. A happy partnership is an extremely effective stress management tool because you have more hands on deck, more solutions, more money, and a sense of responsibility to your partner that affects your behavior for the better.

A decades-long study still underway at Ohio State University examines how our personal relationships bring to bear on our health. Positive interaction between partners caused lower levels of the stress hormone cortisol, which in turn allowed the compounds and cells responsible for repairing injured tissues to expedite their healing process.

Professor Linda Waite of the University of Chicago, in an address to the Population Association of America, explained that the health benefits of marriage are so strong that a married man with heart disease can be expected to live, on average, 1400 days longer (nearly four years!) than an unmarried man with a healthy heart. This longer life expectancy is even greater for a married man who has cancer or is 20 pounds overweight compared to his healthy, but unmarried, counterpart. (Linda J. Waite, “Does Marriage Matter?” Presidential Address to the American Population Association of America, April 8, 1995; Linda Waite, “Does Marriage Matter?” Demography 32 (1995): 483-507).

Although new studies prove that good relationships are critical to our health, the current medical model, one that requires doctors to process patients as though they were Model Ts on Henry Ford’s assembly line, does not address the isolation and loneliness of an immense part of the national population. LifeSpan advocates for our clients like they were family, and we are pleased to report that the effect of our counsel has garnered some remarkable results.

Ice Cream for Breakfast . . . and other diet tips

Since the ancient Greeks, thinking persons have touted the idea of MODERATION IN ALL THINGS - Hesiod, Euripides, Plato, Cicero, Chaucer, Moliere, Lord Byron, Montaigne, Ben Franklin, Oscar Wilde, Mark Twain, and even Henry Kissinger have weighed in on the merits of self-restraint and we are inclined to agree. One should absolutely have ice cream for breakfast, but not every day.

Good health is a question of the general condition of the body and mind with reference to soundness and vigor. We digress from here to a very clinical punch list of measurements delineating the various bodily systems, but in truth, and aside from chronic sickness (which, for the sake of discussion, is precluded from this particular diatribe), it all comes down to how content you feel in your own skin. Does your body keep up with your ideal of life? Are you comfortable in your clothes? Does your immune system ward off most of the bugs that you encounter? Are you happy? A preponderance of negative answers to these questions means that you are not enjoying good health.

For weight loss, the bottom line is that you need to ingest fewer calories than you burn, while not losing muscle tissue that would lower your caloric requirements. (This is why many diets only work for a short time. Starvation diets without exercise deplete muscle tissue as well as fat tissue. This effectively lowers the caloric requirement of the body, as you burn more calories when your muscle mass is larger).

One of the tricks of the trade for ensuring this outcome is to write down everything you eat, and keep track of how many calories you’re taking in. Then simply walk, run, cycle, ski, skate, or dance off those calories. Staying active is the main point, and you don’t even need to join a gym to do so. It helps to have a partner (or a support group, a la Weight Watchers) who will assist you to stay on track.

Our favorite recommendation when it comes to using a weight loss product is Hydroxyproline. This is an amino acid (not a drug, but a food product) that is derived from gelatin or collagen. It is marketed via a multi-level marketing scheme as Calorad (tagline: “Lose weight while you sleep”) and Hydroxycut in drug stores. Used as directed, it assists in lowering cholesterol and blood sugar, prevents the progression of arthritis, and assists most users to lose weight.

Taken on an empty stomach just before sleep at night (one tablespoon in 7-8 oz. of water), this food product uses adipose (fat) tissue to produce connective tissue. Connective tissue covers every muscle fiber and nerve strand. It comes together to form tendons and ligaments, and provides structure to every organ in the body. Connective (or soft) tissue injuries require lengthy healing time because as we age, our body’s ability to manufacture this tissue erodes, and because soft tissue is poorly vascularized (that is why it is white, not red like muscle tissue). Those who want to build muscle tissue can take this supplement in the morning as well, before exercising. It will tend to cut the appetite when taken in the morning, and may speed the weight-loss effort if it is taken in lieu of breakfast.

Like all amino acid supplements, some loose stool may result if large portions are taken. Otherwise, the only other side effect for most people is that they sleep more soundly. Further supplementing with Vitamin C assists this product to work better. Interestingly, the use of statin drugs robs the body of naturally occurring hydroxyproline.

There’s No Place Like Home for the Holidays

The Holidays are inextricably tied up with the idea of Home. For many families, a beloved friend, spouse, parent, child, or family member are unable to stay at home because of health considerations. Loss of autonomy is an anguish-causing consideration for the individual and their family. Add to that the danger inherent in a hospital or medical facility, peace of mind is lost, and this loss is more acutely felt during this season.

I remember being horror struck, as a child, upon learning that elderly Eskimos who could no longer contribute to their community were pushed out to sea on an ice floe, but in many ways, the healthcare model of our times resembles this ancient practice: we are abandoning our elderly into a sea of confusion and misinformation.

According to the CDC, life expectancy increased dramatically during the past century, from 47 years for Americans born in 1900, to 77 years for those born in 2001. The reasons people live longer include a better understanding of cleanliness and hygiene, pharmaceutical advances such as vaccinations and antibiotics, and unprecedented progress in medical knowledge. The reasons people die have evolved from infectious diseases which strike suddenly and kill quickly such as Cholera, TB, and acute illnesses such as foot and mouth disease, to chronic diseases and degenerative illness which cause lingering pain, disorientation and despair. In order of the number of victims, the leading chronic diseases suffered by Americans 65 and older are:

• Heart Disease
• Other (falls & injuries, obesity, etc.)
• Cancer
• Stroke
• Respiratory Disease
• Influenza & Pneumoni
• Diabetes
• Alzheimer’s Disease

Infirmity is not an unavoidable byproduct of aging. Most of the chronic diseases from which we suffer in this brave new world are preventable. Still, the Merck Institute of Aging and Health notes that the average 75-year-old suffers from no less than three chronic conditions and uses an average of five prescription drugs. We believe that the added years should reflect a quality of life at least equal to the quantity of time inferred.

A consultation with a professional health advocate can secure, for you and your family, the knowledge you need to save time, money and unnecessary pain and distress while negotiating the troubled waters of the modern healthcare system. You are entitled to the peace of mind that comes with knowing that you’ve done the best you can do for yourself and your loved ones.

Save Your Own Life.

An old joke goes something like this: Doctors go to school to learn how to write illegibly, and Pharmacists go to school to learn how to read what Doctors write.

Long acknowledged with a wink and a nod, the illegible penmanship of Doctors kills more than 7000 Americans every year and injures more than 1.5 million (National Institute of Medicine, 2006); many of these incidents are attributable to incomprehensible or incomplete medical records and prescriptions.

Your medical record serves as the doctor’s memory, representing your body’s history and geography, “The definition of an adequate medical record is one which enables reconstruction of the events without reference to memory and contains only the information which clinician B will require when taking over the care of a patient from clinician A.” (Dr. Gerard Panting, Communications and Policy Director Medical Protection Society, O:\Lectures\2004\A&E Conference\Article.doc)

Imagine yourself vacationing far from home and becoming sick enough to need medical attention. Without medical records, the caregivers attending to you have no way of knowing that the medication prescribed will interact badly – perhaps even fatally - with the medication you’re already taking. With access to all of your medical data, clearly and concisely presented, the outcome of this encounter would be entirely different.

Imagine yourself on the eve of a lifesaving medical procedure, when a Hurricane Katrina caliber disaster takes place, sweeping all of your medical records away, and leaving the hospital staff without the essential information necessary to proceed with the surgery. Portable medical records stored in more than one location would dramatically alter the end of this story.

Finally, imagine that you suffer from later-stage diabetes, and so in addition to your primary care physician, you regularly consult with an endocrinologist, a nephrologist, an ophthalmologist, a podiatrist, a vascular surgeon and a neurologist. That’s a huge paper trail, disseminated between seven different offices, and an overwhelming administrative task to organize and coordinate. A LifeSpan GuardianKey™ USB flash drive with each of these physician’s notes, histories, observations, records, prescriptions and prognoses would be both safer and more cost effective, ensuring fewer medical and medication errors, hospitalizations, and duplications of tests and procedures.

In 1928, the American College of Surgeons established the Association of Record Librarians of North America (ARLNA) to, “elevate the standards of clinical records in hospitals and other medical institutions.” In 1938, to keep up with increasingly data-driven decision-making in healthcare settings, the organization created standards and regulations that made their members medical record experts. Today, ARLNA has been re-christened the American Health Information Management Association (AHIMA) and they are on the cutting edge of the new age implementation of electronic medical records, as well as to the creation of a national health information network.

Broadly, AHIMA describes your medical record as a:

• Basis for planning your care and treatment
• Means by which your doctors, nurses and others caring for you can talk to one another about your needs
• Legal document describing the care you received
• Means by which you or your insurance company can verify that services billed were actually received

In a State of the Union Address in 2005, President Bush called for national standards that would enable medical information to be digitized, stored and shared electronically. “Within ten years, every American must have a personal electronic medical record,” he said. A new position has even been created within the Department of Health and Human Services to coordinate government Health-Information Technology initiatives. “The 21^st century healthcare system is using a 19^th century paperwork system. Modern technology has not caught up with a major aspect of healthcare, and we’ve got to change that,” the President said.

2015 might as well be 3015 if you or a loved one are unwell. Be an early innovator and save your own life.