managing health (care?)

Apart from rent (in NYC), buying health insurance is my most costly monthly expense.  It’s been that way since I’ve been self-employed for the last 11 years.  If I lived in another part of the country, it just may be that health insurance would be more costly than rent.  When we work for larger corporations, we usually don’t worry about health-care coverage because we’ve asked the employer to make it part of our compensation.

As many of us have come to realize though, the industrial revolution is over.  The days of long-term, secure jobs are gone.  The economy has made many switch their mindset from looking for a job to creating a job.  Many of us work for ourselves and many more will be doing the same in the future.  That means we can’t simply look to someone else to provide health-care coverage.  We’ll need to pay for coverage as an expense.  The coverage though,  is just so damn expensive, more than it needs to be.  The system is whacked with so many inefficiencies and twisted incentives that costs are approaching prohibitive.

So how to control, or manage, health care and its cost?  That’s a trillion dollar question.  As one of the guest speakers to a panel discussion I was invited to last week by Dow Jones (the session starts at minute 9. yours truly caught entering during 1st minute) said, the system needs to turn into one of managing health, rather than managing health care.  That means that we need to re-configure the system so that we hold a long-term view.  Most of us make less-than-optimal lifestyle choices during the first half of our lives, and end up paying for those choices during the second half.  That’s what all the data shows.  By far and away Medicare, (the government), pays the vast majority of health care expenses.

It’s hard to imagine that the total US health care expenditure is greater than France’s entire economy, and that 10% of the people use up 2/3 of the total health care dollars.  Health care is becoming a much larger slice of our economy than we can afford.  If we don’t do something soon, we’ll all be working for the primary goal of keeping each other healthy or alive.  Those won’t be dollars well spent.

One of the decisions we need to confront is the amount we should spend keeping each other alive.  An example one of the panelist used this past week: if a 90 year old person fell ill and we could spent $100 to keep him alive for another six months, would we do that?  Yes, of course.  If we had to spend $100 million to keep him alive for another six months would we do that?  Of course not.  Both sides are ridiculous amounts, but somewhere in between there is an answer that we’ve got to come to terms with.

How much do we, as a society, commit to spending toward end of life to keep life going?  Almost half of us die in a hospital, 1/5 in the ICU.  An interesting article recently appeared in the NY Times and WSJ addressing the issue of the dying well.  A big part of that is how we manage health, and our health care.

We each have obvious incentives to manage our individual health, but that may not be obvious by what we shove down our gullets.  There’s been a lot of focus on eating better and we’ve made some headway, but we still need to drive health education to an early age.  If, as a society, we spent as much on health education as we do on marketing less-than-desirable food and pharmaceutical fixes, we’d be tons lighter and a whole lot healthier.

In the meantime, there is nothing to stress over.  But if we are inclined to stress, we may be adding to our longevity cost-free by taking Kelly McGonigal’s advice, and making stress our friend.

Changing health care policy and how we manage it is probably more difficult than pushing an elephant uphill.  If we get behind it though, we may find a way to better manage how. Until then, since no one else is forking over the costs, I’d better develop the appetite and swallow health care as a growing slice in my expense pie, and then manage it with care.

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