There are plenty of “survivalists” out there who stock their basements with canned goods, getting ready for some unexpected (and unlikely) apocalypse.

Meanwhile there are things that are much more likely to happen to you, like getting sick, which many of us don’t prepare for at all.

So to help you get started, here are five important tips on how you can become a health care survivalist.

1.  Take care of your chronic conditions. Whether it’s high blood pressure, diabetes, high cholesterol, depression, asthma or any other kind of ailment, do what it takes to manage your own care.  Take your medications and follow your doctors’ instructions.  Why? Because if you don’t, your condition can get worse and lead to even more serious problems.  As much of a pain as it may (literally) be, there’s a reason the old saying “an ounce of prevention” still resonates today – because it’s true.

2.  Live a healthy lifestyle. Everyone gives you this advice, but with studies showing that 42% of Americans will be obese by 2050, it doesn’t seem to be getting through.  Denial can wonderfully appealing;  but when it comes to your health, it can also kill you.  Stop smoking, exercise, and eat right.  You may find that your employer has programs in place that will help you do all of those things, and many of them work.  Why not give one of them a try?  You can’t improve your life all at once, but you can start.  Your life will be happier if you keep yourself healthy.  So, rather than whistling past the graveyard, jog past it.

3. Make sure you are well-insured. You may not have the greatest insurance plan through your job, but there are things you can do to protect yourself on your own.  For example, most insurance doesn’t pay the full cost of long term care.  This is the kind of care you might need if you end up needing home nursing care or have to live in an assisted living facility.  That can be very costly.  You should buy long-term care insurance to cover these expenses and serve as a cornerstone of your health care survival plan.  Studies show that 60% of seniors will need long term care at some point in their lives – and Medicare doesn’t cover it.  Oh, and it’s not just a problem of the elderly.  About 40% of people getting long-term care are between 18 and 64.

There are other kinds of insurance you can buy, too, depending on the state in which you live.  These might be plans that supplement your health coverage, or cover other expenses of illness.  The best advice:  research your options, find an insurance broker you trust, and figure out a plan that helps protect you from the financial toll of illness.  Also keep in mind that your employer may offer, on a voluntary basis, a number of these kinds of programs at cheap prices – check them out and see if they make sense for you.

4.  Know your family history. It’s a little hard to believe in the 21st century, but it turns out that an old-fashioned knowledge of your family’s medical history can be some of your best protection.  It can help your doctor know whether you have a higher risk for certain illnesses.  And it can also help him or her know whether that symptom you’re complaining about is a sign of something other than what it seems to be.  A surprising study recently showed that a family history can be better than even genetic testing at predicting your likelihood of disease.   The Surgeon General has a neat tool that can help you get started. The more you know about your family’s medical past, the better off you and your doctors will be in your medical future.

5.  Ask Questions. No matter how well you prepare and try to protect yourself, at some point you may still end up seriously ill.  Hopefully, if you’ve taken good care of yourself and have all of your information in order, you’ve put yourself in the best position to make it through.  But there’s still so much more you can and should do.  The world is full of well-intentioned, highly skilled, and hard working doctors.  The trouble is, they work in a system that makes it very difficult for them to do their jobs.  So, ask questions, and use every resource available to you to make sure you’re getting the right medical care.

Marketing pros say their top priority is social media.  But in industries like health care benefits it’s not really happening.  Benefits thought leaders have been on the sidelines, just when their voices are needed to be heard the most.

Now, for those who think social media is for kids, or for people in super-edgy industries, it just isn’t so.  Watch this short summary video of a round-table on social media I participated in recently (disclosure: my company, Best Doctors, works with the company that sponsored it, PAN Communications).

The forum was moderated by the on-line Editor of the Harvard Business Review, and included key marketing leaders from HP Hood, Novell and Forrester Research.  The video gives an interesting insight into just how much is really going on in social media in corporate America – and how much you’re missing if you’re not taking part.

So, if you’re on the sidelines:  Get in the game.

One good place to start is to listen to my (completely free!) social media 101 webinar.  Remember, to participate in social media, you don’t need to say anything.

All you need to do is listen.

“We want our employees to spend their time on real issues,” said Charlie Salter, VP of Benefits at ConAgra.  He means it.  Charlie and ConAgra have built their health care benefits around some simple concepts that are yielding impressive results.

How impressive?

Close to flat health care cost trend since 2007.

Charlie’s work is part of a growing trend among America’s most innovative companies:  designing health care benefits in ways that have a real impact on quality and cost.  It’s why I asked Charlie to share the podium with me in Boca Raton this morning.  ConAgra is showing it’s possible to control health care costs by helping people do the right thing.

The vision behind ConAgra’s programs is simple – employees have to be responsible for managing their own care.  But, says Charlie, this is easy to say, harder to do.  “So we do as much as we can to make it as easy for people to do the right thing.”  ConAgra gives its employees a significant financial stake in their well-being, through a health plan that has a $1,500 deductible.  ConAgra supplements the plan with a health savings account (HSA) that lets workers use pre-tax dollars to pay for the deductible.  Like other HSAs, any money the employee doesn’t spend is theirs to keep.  It means employees are more engaged in health care decisions.

ConAgra also motivates its employees to understand their health risks and to take care of themselves.  For example, ConAgra pays for 100% of the cost of preventative treatments like medication for high blood pressure, cholesterol and others.  It pays for the cost of programs to help employees quit smoking and lose weight.  “It’s hard to change,” says Charlie, “but the more you can do now to take care of yourself, the better off you’ll be.”

Finally, ConAgra focuses on making sure its employees have the knowledge and tools they need to navigate the health care system.  Best Doctors forms an important part of that strategy.  Through innovative and personalized on-line communications tools, ConAgra employees are encouraged to call Best Doctors when they’re trying to deal with a medical situation.

In the last year, 31% of ConAgra members who used Best Doctors found a problem with in their diagnosis;  more than half found something wrong with their treatment.   Charlie says Best Doctors saves ConAgra more money than it spends on Best Doctors, which he likes a lot.  But what he really likes is how it fits into ConAgra’s overall approach to benefits.

It may come as a surprise to some people that major U.S. corporations are so progressive when it comes to how they deal with health care, but it shouldn’t.  Their stories need to be told, not just because they are interesting, but because they point the way forward for the rest of us.

They are proof that it’s possible to change health care for the better.

I’m speaking this morning at the 23rd Annual Benefits Forum and Expo.  This is one of the premier events in the health care benefits industry, and it’s a thrill for me to be the opening speaker on the “Health Care” track.

I’m presenting along with Charlie Salter, the VP of Benefits of ConAgra, one of our customers at Best Doctors.  The talk Charlie and I will give is called “Real Results: When Individuals are in Control of their Health Care.”

As regular readers know, good things happen when people are in control of their care.  They have a chance to make sure they’re not one of the 20% of people that end up with an incorrect diagnosis, or the more than 60% of people that end up with the wrong treatment.  It’s the single most powerful thing you can do to make sure your health care experience is as good as it can possibly be.

It’s something that more and more highly innovative companies like ConAgra are making the core of their health care benefits programs.  Not only does it improve the quality of care for their employees, it also saves the company significant amounts of money – real dollars – by avoiding misguided care.

Visit back later, I’ll share some observations after the talk.

Fortune magazine has made some news recently about the impact of health care reform on large employers:

Internal documents recently reviewed by Fortune, originally requested by Congress, show what the bill’s critics predicted, and what its champions dreaded: many large companies are examining a course that was heretofore unthinkable, dumping the health care coverage they provide to their workers in exchange for paying penalty fees to the government.

The only trouble?  There’s no way these employers are seriously thinking about doing this.

Now, I can understand why the employers would do the math.  According the reform law, penalties for failing to provide health coverage are a small fraction of the cost of that coverage.

But as with most everything else in health care, there’s much more to it than just a simple math equation.

Here’s what I mean.

Health coverage is an integral part of large employers’ total package of compensation.  Having a comprehensive benefits plan is one of the key ways employers separate themselves from their rivals, especially in competitive markets.  But it goes deeper than that.

Employers know that a healthy workforce is a more productive workforce.  So they increasingly design their health plans to help employees take better care of themselves and their families.  They do it in ways that match their unique corporate cultures, and the specific health issues of their employees.  For instance, these issues are different for manufacturing companies and pharmaceutical companies;  defense contractors and marketing companies;  consulting firms and supermarket chains (I know because my company Best Doctors provides its service to companies in all of these industries and others).

What’s important to understand is this: large employers view health coverage as far more than just some cost center they would be happy to hand over to someone else.  Instead, they view coverage as one of the important tools they can use to attract and retain talent, make their workforce more productive, and as a reflection of a culture of innovation they want to foster.  If they handle these decisions well, it’s part of what gives them an edge over their competitors.

So why is Fortune magazine reporting on this so breathlessly?  I think they — like so many others who have written or talked about health care reform — they don’t seem to know all that much about their subject matter.  The employers in the article say they’re not about to drop coverage, and there are no quotes from benefits consultants or other industry experts.  Most of the piece is laden with the familiar sound of the politics of health care reform that has characterized the last year.

One thing should be clear from the experience of the last year.  There are a lot of misconceptions about health care that make it hard to talk about thoughtfully, but which make it very, very susceptible to politics.

Fortune’s reporting gives an interesting inside look into how big companies try to figure out big regulatory changes.  But their conclusions are deeply mistaken.

Giving people “incentives” to spend their money wisely is a growing part of the solution to rising health care costs.  Give people financial responsibility for their health care decisions, the thinking goes, and they’ll make cost-effective choices.

It’s usually done by having people pay part of the cost of their employer-provided health coverage, and through things like higher deductibles and co-pays.  Today, on average, people in the private sector pay 20% or more of the cost of their coverage.  The trend is for this number to go up.

But it’s not true everywhere.

If you look in the public sector you see a different, more troubling story.  It’s a lesson in what can happen when incentives go wrong in health care.  Take New Jersey, for example.  There is a massive controversy there as the governor seeks to close an enormous budget deficit, and is proposing cuts to a wide array of state and local services.  One of the most contentious issues has to do with health care.  The governor wants state employees to pay 1.5% — that’s right, one and a half percent – of the cost of their health coverage.  Today, most state employees pay none of the cost.  This change would, by some accounts, save the state hundreds of millions of dollars a year.

Another example is here in my home state of Massachusetts.

Like New Jersey, Massachusetts faces serious problems with the cost of health care for employees of local government.  And, like New Jersey, city and town employees pay much less than their counterparts working in the private sector.  The results are very similar.

While average family health care premiums in the United States are about $13,000 a year, employees in the city of Framingham, Massachusetts can enroll in a plan that costs more than $40,000.  Numerous towns have family plans that cost over $30,000, and many others have plans that cost over $20,000.  It’s putting a great deal of pressure on spending by city and state governments.

I saw a similar story unfolding in Michigan.  I testified at the state legislature last fall at a hearing where the state was trying to grapple with this same issue.  A number of witnesses responsible for the cost of coverage at the local level apparently just didn’t have information about how much they spend on health coverage.  It was clear, however, that the number was very, very high.

So what does this tell you?  Incentives mean something in health coverage.  If no one is exposed to the actual cost of health care, it gets overused, or benefits become too rich.  It’s something to think about the next time you hear about a state or local government trying to cut its budget and taking away things that are important to you.

Prevention.  Also, prevention, prevention, prevention, prevention,prevention, prevention,prevention, prevention, prevention, and prevention.  Finally, prevention, prevention, prevention, spam, prevention,prevention, prevention,prevention, prevention,prevention, prevention, prevention, prevention.

I’m overstating it, but this was the major theme of the Employer Health and Human Capital Congress which I attended yesterday outside of Washington, DC.  It’s a major event for benefits professionals and in spite of the pending snowpocalypse, was very well attended.  I moderated a panel about how people need help navigating the health care system.  But the gap between all the talk about prevention and the reality that a lot of people are going to get sick no matter what was the talk of this group.

George McGregor (Southern California VEBA), Joanne Jones (Genzyme), Dr. Val Jones (Better Health Blog), me.

I was honored to have such a diverse panel.

First, there was George McGregor, the head of a multi-employer health care trust in Southern California.  He serves nearly 100,000 employees of school districts and their families, and spends about a half a billion dollars a year on health care.  Second, there was Joanne Jones, Senior Director of Benefits at Genzyme, a multi-billion dollar pharmaceutical company.  And finally, Val Jones, MD, uber-health care blogger, who is now practicing in an exceedingly interesting new primary care practice.

This made for quite a combination of perspectives on what happens to people when they get sick.

Once someone gets sick they are faced with a health care system loaded with obstacles to their care.  For starters, their doctors will all be strapped for time.  It’s not just because they have to see so many patients to keep up with lower reimbursements.  Part of the problem, as Val put it, is that while doctors train so hard to be good at diagnosing and treating illness, they’re asked to spend probably a third of their time on requirements from public and private insurers.  Work for which they aren’t trained and at which they aren’t very good.  All this time not spent with or thinking about patients helps create quality problems like incorrect diagnoses and poor treatment choices.  It certainly leaves patients feeling uncertain about their care.

Joanne talked about how this plays out at Genzyme.  As a leading pharmaceutical company in Boston, maybe the world’s leading medical city, employees are regularly around to terrific doctors who work with Genzyme.  And so there has developed a sort of informal social network at the company, as employees figure out how to best approach these doctors to ask questions about their medical problems or those of family members.  It’s like those doctors are used as a patch on a broken system.

George emphasized how important it is for patients to do what Genzyme’s employees do: actively participate in their care.  He told the story of an employee of his who had been diagnosed with metastatic bone cancer.  After extensive therapy, she was given a very bad prognosis.  But then, with George’s help (he, like Joanne, had implemented Best Doctors as a benefit) she found out that her “bone cancer” was actually metastatic breast cancer.  She had gone through years of unnecessary treatment for a disease she never had in the first place.  As I’ve blogged about many times before, and as is becoming increasingly apparent with published studies, it happens a lot.  As many as 20% of patients end up with the wrong diagnosis.

Now, there’s something interesting that seems to always happen at discussions like these.

People very quickly start talking about their personal experiences.  A lot of the stories sound just like George’s colleague.  Yesterday, a number of audience members raised their hands not to ask questions but just to share their own stories or those of their colleagues.  I suppose there aren’t many places where people get to share this kind of suffering, and I can tell you, there’s a lot of it out there.  Benefits professionals like those in the audience yesterday see this problem almost as closely as doctors and nurses.  They know the employees who struggle so badly to figure out what to do when they’re sick.  And they know the hurt that comes with being powerless to help someone get out of such trouble.

So, yes, prevention is good.  If you don’t get sick, you won’t face these problems.  But in truth, lots of us will get sick, no matter what we do.  Solutions to the troubles with health care based on trying to take care of populations not individuals too often miss the point so many people talk about.  Which is that health care happens when a patient goes to their doctor looking for help.  We must break down the barriers between doctors and patients that have, as Val showed, become so high.  We need to make it easier for patients to take advantage of all of the judgment and training and skill of the doctor.  It’s what the patient is there for, and for those of us paying for health care, it’s what we are here for, too.

That’s the headline in today’s Boston Herald. It tells the story of young Michael Sanders, who was born in 2007. Michael went home from the hospital but after a few weeks in which he didn’t seem right, his mom, Denise took him to the doctor.  As the Herald reports:

A seemingly routine doctor’s visit brought devastating news: the baby had a fatal, congenital heart defect and just a few weeks to live.

“They said he would never, ever have a normal functioning heart,” his mother recalled, “and they said nothing could be done to fix it.”

The parents, Chris and Denise, got a second opinion from another doctor that supported the original finding. They didn’t have much choice. They brought hospice workers into their home, and started to make arrangements for Michael’s funeral.

At work, Denise had Best Doctors as an employee benefit. She decided to call and see if there was any hope, or if she really had to face the reality of her awful situation. “I was a little afraid to call at first,” she said, “but then I thought, at least it will confirm what I already know.”

After gathering and reviewing Michael’s records, Best Doctors consulted with Dr. Pedro del Nido, chief of cardiac surgery at Boston Children’s Hospital. Dr. del Nido told them very unexpected news – Michael had been misdiagnosed. In fact, he told them, he could fix Michael’s defect and allow him to live a completely normal life. In May 2008, he had the surgery, which went extremely well.

Today, Chris and Denise brought Michael, now almost 3, to visit us at Best Doctors, along with Michael’s big sister Katie. Michael is a very outgoing and playful 2 year-old. He attends pre-school at his family church, where I’m told Michael was greeted as a hero on his first day of school. The community had rallied around young Michael after he was born and during his surgery and recovery, and so his arrival at pre-school was a milestone in the lives of so many people.

Chris and Denise both told me they don’t know why our paths crossed, Best Doctors and the Sanders family. We are honored that they did. And we are grateful that they came to see us today to share their story, and to give us a chance to meet them and their wonderful son. I know I am also thankful for the many people at Best Doctors that helped Michael through his journey, especially Helen Thomas, one of our member advocates.

It is a freezing cold day today in Boston, but not in the offices of Best Doctors.

Michael, earlier this year in Boston

UPDATE: The local Fox affiliate in Boston is covering this story tonight at 6. And the local NBC affiliate will have it on this evening as well. Video to follow.

UPDATE 2: A complete round-up of media coverage is here.

Australia’s riskinfo.com, a leading publication for benefits advisers, released today the results of its study of the three “Best Initiatives of 2009.”

I’m proud to say that Best Doctors made the list for a program it launched with leading Australian insurer MLC.

The experience shared with Australian advisers during the launch of Best Doctors by leading UK adviser, Colin Boxall, in his capacity as an adviser and also as a father of a very sick child, served to highlight the value of this service.   Mr Boxall told advisers that in relation to receiving claim benefits for critical illnesses “… sometimes, having money is not enough.”

Congratulations to everyone who worked on this important initiative, especially Frank Ahedo, head of our European business, who spearheaded this effort.  It underscores what I’ve written about many times before – no matter where you live, or what health care system your country has, the experience of being sick is mostly the same.

Mr. Boxall said it very well indeed.

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.