By Evan Falchuk

You know what a good day is?  It’s one where you feel like you made a difference in someone’s life.

By this standard, yesterday was a an incredible day.  We got to meet Michael Sanders, 3, and his wonderful family, as they shared with us how we at Best Doctors had helped Michael’s parents save their son’s life.

Aside from the the Boston Herald, this story was seen on Boston’s WHDH-TV (NBC), and on MSNBC.com. Here’s a clip from Boston’s Fox affiliate Fox 25.

Among the top-tier blogs, big Boston blog Universal Hub also carried the story.

By Evan Falchuk

Over at The Corner, Ramesh Ponnuru theorizes that people want more control over how they spend their health care dollars:

[Ezra] Klein’s argument is that if employees understood that the employer’s alleged share of their health-care costs are really part of their wages — and if they saw it on their paychecks — they would be more supportive of cost control. I agree with that. But I assume he means (based on his examples in this op-ed) that they would be more supportive of cost controls imposed by HMOs or Congress. I think they would be more inclined to favor turning over control of health insurance from their employers to themselves, and making the cost-quality trade-offs for themselves with their own money. Under the status quo, those trade-offs are made by other people and the fact that it’s the employees’ money is obscured.

It sounds nice in theory.  But in practice it seems to be exactly wrong.

Here’s why.

For years, employers have been trying to get employees to “mak[e] the cost-quality trade-offs for themselves with their own money.”  They’re called “high-deductible” or “consumer-driven” health plans.  Under these plans, which are much less expensive than traditional plans, employees have responsibility for as much as the first few thousand dollars of health care expense.

In theory, these plans make a lot of sense.

With a traditional plan, you pay for those first few thousand dollars anyway, in the form of premiums.   Since you probably don’t use anywhere near that much health care in a year, you save a lot of money right away if you’re healthy.  Even if you’re sick, it can work out pretty much the same, since the money you would otherwise pay to the insurance company goes to pay for your medical bills.

Your employer saves money, too.  It may still pay for half or more of your premium, but since the premium is lower, its total expense is less.   Some people think these plans can even help transform the health care system.  If large numbers of people are armed with these kinds of plans, they will demand that doctors and hospitals offer a high quality, cost-efficient care.  It all sounds great.

The trouble is, employees don’t see it that way.

When given the choice, people don’t enroll in these plans.  Studies suggest the reason is that employees don’t want to be health care consumers.  For example,  one study found that people in traditional plans were more likely to be “extremely or very satisfied” with their coverage, because they liked the lower out-of-pocket costs.  Another study found that anywhere from 20%-40% of employees preferred to pay a higher premium in order to keep their health care costs “low and predictable.”

It means making a plan like this available can be tricky business.  Still, some companies have just gone for it: getting rid of their traditional plans and replacing them with high deductible-type ones.  This can be so perilous for employee morale that experts in the benefits community call it the “nuclear option.”

So, then, is it true that people want more control over their health care costs?

The answer is clearly “no.”  People want more control over their health care, but they don’t really want to be involved in the process of paying for it.

Whether this fits into a rational calculation of economic self-interest, I don’t know.  But in health care, people don’t always deal with things in the most rational ways.

By Evan Falchuk

Some reading from the weekend:

1.  The state of Hawaii wants to opt-out of the federal health care reform.

2.  Health care and politics: a bad mix.  Eighty-one percent of those surveyed disagree with new scientific mammogram recommendations.  You think politicians will make sure the science doesn’t become public policy?

3.  A Massachusetts health plan and a hospital system try an alternative to fee-for-service medicine.  Will it work?

4.  A depiction of an especially grisly medical mistake.

5.  Speaking of grisly: Turbaconducken.

By Evan Falchuk

Here’s a round-up of some recent posts worth reading from around the web:

1.  Market failure -> New entrants?

Paul Levy is the CEO of Boston’s Beth Israel Deaconess Medical Center, and he blogs regularly about how he sees health care from that perspective.  He is always insightful and candid in his observations about health care.  In this post, you can read how the uncompetitive market for private insurance looks from the perspective of the CEO of a major, Harvard-affiliated teaching hospital.  By the way, although he never mentions who the “dominant provider,” he means Partners.  And although he never says who dominates the Massachusetts insurance market, he means Blue Cross Blue Shield of Massachusetts.

One quibble I would have with Levy is this.  He’s right, the BI Deaconess is at a disadvantage compared to Partners in terms of its negotiating leverage with Blue Cross, but the BI Deaconess is still one of the best hospitals with some of the best doctors in the world.  Perhaps it’s more of a statement of the high quality of academic medicine in Massachusetts that a hospital like his can be considered second to anyone.  I’ve posted previously on some of Levy’s good work on health care quality here.

2.  Duty Hours, the ACGME and the Surgeons.

At Medrants, Dr. Robert Centor talks about how well-intentioned duty-hour limits on surgical residents are leading to a poorer quality educational experience for surgical residence.  It puts the quality of care these doctors will deliver at risk.  Money quote from Dr. Centor:

I want a physician who trains in a tough, demanding residency.  You cannot learn medicine without appropriate volume. No one makes you become a physician.  If you want a less stressful residency, then you can choose one.

He thinks residents should be able to choose, rather than being placed in a one-size fits all kind of a program.  He still thinks we may be surprised at what kind of training most would prefer.

3.  Reality Check: Doctors Can’t Fix Everything.

On the Commonhealth blog, Dr. Annie Brewster writes a heartfelt and meaningful post about how sometimes there are no easy choices – or good answers – in medicine.  She says she is writing the post as much to convince herself of her point as she is her readers, which I think is always a sign you are about to read something very thoughtful.  Go there and read the whole thing.

4.  Why Errors Happen.

A new study takes strides in creating a taxonomy of diagnostic error in medicine.  This was interesting.  A study was performed that asked doctors to recall instances in which they had made diagnostic errors, and to classify what the cause of the errors were.  Three quarters of all errors were either because the clinician neglected to properly order a follow-up, or because the clinician failed to properly assess data.

5.  Should the character in “Glee” that uses a wheelchair actually be played by an actor who uses a wheelchair?

I have no idea.  But I feel obligated to link to any story about my brother’s show that is published in the “Health” section of a major national newspaper.  By the way, the character, named Artie, is played by an actor named Kevin McHale.  No, not that one.

6.  Did you know?

Did you know that outside of Washington, DC, on September 1, 1926, a baseball team made up of Ku Klux Klansmen played a game against a team of local Jewish all-stars?

You do now.  The Klan won, 4-0, but the game was called by rain in the 7th inning.

By Evan Falchuk

There’s a case for killing Granny?  I guess so, or at least according to Evan Thomas’ article in the most recent Newsweek. Thomas, after sharing the story of his mother’s last days, concludes that death is the key to health care reform:

Until Americans learn to contemplate death as more than a scientific challenge to be overcome, our health care system will remain unfixable.

Does everything need to have a political spin on it nowadays?

But let’s take Thomas’ advice and talk about death.  Not “death panels,” not the politics or the cost of end-of-life care.  Just plain old death.

I was reminded recently of how fragile life is.  It made me remember something I read after our oldest child was born.  I realized that one day she would learn the truth about death.  And I thought how bad that was, and how I wanted to protect her from it.  But then, by chance, I happened across this interesting little saying.

When your children are young, all you think about is that you don’t want them to die.  But when they get older, all they think about is that they don’t want you to die.

It touched me, and it made me think about how my responsibility to protect my children extended even unto and beyond my own death.

It’s a nice philosophical point, but there are very practical things each of us can do to fulfill this responsibility.  Here is my list of just a few of the very important things we all should do to plan for our deaths:

Buy life insurance

If you’re young and in reasonably good health you should be able to buy a term life insurance policy for a few hundred dollars a year.  You should do this so your family can have your earning potential replaced in the event of your death.  Find a good insurance broker and make sure you get coverage that suits your needs.  Even if you have a pre-existing condition (like a chronic illness) a good broker should be able to find you some kind of coverage.  You won’t be able to buy any coverage at all if you become acutely ill, so don’t wait until it’s too late.

Make a will

This is so much more than just planning for your family’s financial future.  For example, if you have children, have you figured out who will take care of them if both you and your spouse die?  There are many important and potentially difficult conversations that go along with this kind of planning – but you’re much better off having them now.  After you die, those left behind will end up fighting out these issues not knowing your wishes.  Find a good lawyer to help you.

Make an advance directive

You need to think about what kind of medical care you want if you become incapacitated and unable to decide on your own.  Do you want to live for 30 years on a ventilator, unconscious?  Do you want to undergo extensive and painful treatments if you don’t have much hope of a meaningful recovery?  Don’t leave your family alone trying to make that decision for you, wondering what you would have wanted. Write down what your wishes are.

Appoint a health care proxy

Pick someone who you trust to make your medical decisions for you if you are unable to do so.  Write it down and make clear what you want that person to do, so if the time comes there isn’t any dispute among your family as to who is in charge.

There are many other things you can do, but to me these are four of what I think are the most important things you can do to prepare for your death.  Maybe some commenters can add some more that I missed.

Now, with all that said and done, I will still disappoint Mr. Thomas.

Why?  Because I still prefer to think of death as a scientific challenge to be overcome.  And you know, I’m glad that many other people feel that way, too.

Especially the people who make medical breakthroughs – I’m really glad they feel that way.

By Evan Falchuk

AllBusiness’ Nancy Germond writes about health care quality in her Risk Management for the 21st Century column.  Best Doctors gets prominent billing:

Employers are buying Best Doctors services as an employee benefit to ensure their employees receive a higher quality of medical care, according to Falchuk. “If you feel unsure about your diagnosis or treatment, you are entitled to feel confident.”

Also, at Wired magazine, Curtis Silver interviewed me for his blog, Geek Dad.  We talked about using social media in business and how important it can be for your family, too.

Everyone struggles with work-life balance.  We care deeply about our business and our families.  And the realization is this: you have as much of a moral obligation to build a successful business as you do to build a successful family life.  Technology and social media help make this possible.  I wish more people saw it that way.

In both cases, read the whole thing.

UPDATE: The Wall Street Journal reviews my brother’s new TV show, Glee. They like it.

The Boston Globe, too, with a mention of Best Doctors and the work we did to help my brother with his health crisis last year.

By Evan Falchuk

Bad news in the paper today: health care costs are expected to rise another 10.5% next year. It’s a serious problem that affects businesses and families across the country.

But the headlines miss something important: the rate of increase has been steadily slowing.

Are we already bending the health care cost curve?

Here is a chart of the rate of increase in health premiums for a PPO plan beneficiary from 2002-2009 (all data are from today’s Aon press release):

The data for other plan types are similar.  What’s happening?

Aon’s Chief Medical Officer Paul Berger says it’s because of the variety of measures employers have taken over the last several years to implement programs to improve their employees’ health.  He emphasizes there is still much more to be done.

He has a point. It’s something we have seen in our survey of major employers, and in the work that leading employers like EMC and Genzyme are doing.  It’s what my company does, too.  Employers are getting increasingly sophisticated at understanding what drives their health care expenses and are developing increasingly effective ways at addressing them.

So, yes, of course, we need reform of our health care system, and of course rising health care costs are a serious concern.  But American employers are doing something about these problems all on their own.

By Evan Falchuk

In our survey of major U.S. employers, we found very little interest in medical tourism.

But there is a great deal of interest in it among the major media – the Wall Street Journal, the New York Times, and today, Forbes (via the Associated Press) have done major stories on it.

But here’s something curious.

All three stories have featured the exact same medical tourist – Ben Schreiner of Camden, South Carolina.

Back in March, I wrote about how curious this was.  I guess it’s curiouser now.

Are there this few patient stories?  Based on our survey, maybe.

Whether medical tourism becomes a trend in America remains to be seen.  But since he’s appeared three times, one thing is certainly a trend – Ben Schreiner’s role as the go-to guy for stories on it.

WELCOME Instapundit readers.

This blog is about health care.  It is from the perspective of someone actually in the health care business.  It is a perspective informed by the health care system as it actually works.

And what it is really about is this:  Health care has become focused on the unit cost of care – treating it like something that can be produced on an assembly line.

But it’s not.

It is about thinking, judging, and deciding what is wrong with a patient.

The trouble is, our system systematically undervalues this process.  When your doctor can only spend 15 minutes with you, why are we surprised when things go wrong?

Proposed reforms continue to see health care in this light, hoping that through ever-more clever ways to pay for care, we can fix a problem created in that very same way.

If you read this blog, you will see not just the reality of how this works, but also the good news – the stories of patients, doctors, employers and others who are doing real and meaningful things to put right what is wrong.  You won’t hear much about it in the media – well, sometimes you will – but there are people out there changing the face of health care even faster than the politicians can.  And perhaps you will see what politicians might learn about how to actually make change.

Please visit again, join the discussion, and add your voice to this most important debate.

By Evan Falchuk

Fresh off labeling opponents of reform “political terrorists,” the Washington Post’s Steven Pearlstein says that, well, actually, “it is possible to disagree about health reform without being disagreeable.”

That’s nice.

I don’t think he means to, but Pearlstein shows one of the reasons why reform has been so contentious:  It’s because people are suspicious that they aren’t getting a clear, direct, honest story from their leaders.

They fear that buried in the thousands of pages of unread legislation is much more than just harmless changes to the health insurance market, or ways to help doctors do a better job, or to control expenses while improving the quality of care. They are skeptical, and the President’s assurances that if they like their coverage they can keep it – that they can somehow “opt out” of reform – aren’t working.

I think it’s because they keep hearing things that make them think otherwise.  The foolishness around “death panels” had such bite because it seemed like just the sort of thing you might try to sneak in as a way to fix “the most important fiscal issue we face as a country.”

I’ve knocked Pearlstein before, but he’s doing a better job of saying what reformers really want than the President and Congressional leaders.  He says reform should be a “bold national experiment aimed at redefining the doctor-patient relationship and dramatically altering the way health care is delivered.”  That’s fine, but if this is what we’re doing, we should be honest about it, and have the kind of thoughtful discussion that kind of endeavor deserves.

Absent that, people get nervous, and they have every right to be.

By Evan Falchuk

I’ve been making the point that health reform’s troubles are due to a fundamental failure of reformers to understand that health care is all about employee benefits.

At Real Clear Politics, former New York City Mayor Ed Koch shows you what I mean.  He recently had bypass surgery:

I speak from personal experience. I have been told that the cost of my hospital care, including the services of 20 doctors and 72 nurses and medical technicians over a six-week period may ultimately cost a million dollars. My private insurance policy is paid for by my law firm, Bryan Cave LLP, and because I still work full-time, that insurance policy is my primary one, not Medicare, even though I am 84 years old. Will that continue to be the case under any law signed by President Obama or will I be denied the right to spend my own money and my law firm’s for such unlimited coverage?

Koch says he think the answer is probably “yes,” but he’s very unsure.  In fact, he points to quotes from Administration officials along these lines that he says are “alarming.”

So, is the problem with health care reform politics?  Of course there is politics, but I don’t think Ed Koch is motivated by that.

No, Koch’s article illustrates something else.

If someone as sophisticated as Ed Koch is left wondering about the answer to fundamental questions about reform, how can you expect others, paying much less attention, to feel otherwise?