The Government Is Not in the Business of Keeping You Healthy

Is the Government in the Business of Keeping You Healthy?  No.  What makes anyone think that the government can develop a health plan that can do what Medicare doesn’t even do? As usual, government has it all backwards. Look no further than the government run Medicare program to see how much government understands the health care business.

When seniors first turn 65 and are eligible for Medicare, they are offered a one-time “Welcome to Medicare” physical exam. This “welcome” benefit isn’t free as seniors will have to pay20% of the Medicare-approved amount and has to be completed within six months of enrollment.

Think back to the advice of your doctors over the years.  How often do they recommend you get a physical?  Typically the answer is once a year.  This is how physicians have felt over the years and a recent study showed that 88% of physicians still give annual physicals.

Just like with Medicare, under the Obama Health Care Plan there would still be only one physical exam covered for those over age 65.  There is no mention of any covered physical exams for those under 65 except for some preventive measures.  They do mention the following on page 428 and repeated again on page 484:

An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying
the 5-year limitation under paragraph (1).

There is no other mention of the words “physical examination” in the rest of the 1018 page plan.

While it is true that studies have been performed to show that an “annual” physical exam may not be necessary, their conclusion was not that they weren’t necessary, but rather 80% of the preventive care occurs through other office visits throughout the year.  Even further, according to Ateev Mehrotra, MD, MPH, assistant professor of medicine at the University of Pittsburgh School of Medicine and a policy analyst at RAND Corp., “no major North American health-related organizations recommend the routine annual exams.”  I’m sure this is news to most reading this.

But Douglas K. Owens, MD, senior investigator, VA Palo Alto Healthcare System and professor of medicine at Stanford University, says that “If they are getting them (preventive services) as part of their routine care, that is great.  If not, a periodic health exam may be a good avenue to get them.”

So the conclusion from these studies and that of the MD’s is that yes, routine physical exams are necessary but there is a need to reduce repetitive preventive services and the interval between exams may be dependent upon family and personal history.

How Do Periodic Physical Exams Relate to Current Medicare and Proposed Obama Health Care Plans?

There’s an interesting caveat to this “one” physical exam currently offered through Medicare and continued with the Obama Health Care Plan.  It doesn’t include most laboratory tests. This means that the physician doesn’t have the necessary information needed to spot or diagnose preventable conditions.  What are the results of this lack of screening?  The undiagnosed contition gets worse and costs the system more.

In other words, its a self defeating prophecy.  It’s a system that is set up to treat the disease after the fact rather than preventing it to begin with.  This is the fallacy known as government health care.

Granted there are things covered by Medicare at present that would be continued under the Obama Health Plan.  This includes:

1. Colorectal cancer screening

2. A pelvic exam and pap smear for older women

3.  A yearly mammogram for women

4. A bone density test for women

5. Yearly prostate cancer tests for men

6. Diabetes screening as needed

7. Yearly glaucoma tests

8. Cardiovascular screening (but you need to talk with your doctor to see if you qualify)

9. Ultrasound screening for abdominal aortic aneurysm for certain individuals

10. Pneumococcal and influenza vaccines and their administration and hepatitis B vaccine and its administration for certain individuals

But what about all these other preventive service recommendations  outlined by the U.S. Preventive Services Task Force (USPSTF) in their “Guide to Clinical Preventive Services, 2008?”  How is it that none of these recommendations by the Medical Doctors (MD) who make up the task force are “covered” under Medicare or the Obama Health Plan?  Isn’t being proactive with preventive services the key to staying healthy and thus not needing the expensive services later in life?

Perhaps individual responsibility and taking control of one’s own health care is the answer.

John Mackey, CEO of Whole Foods implemented a plan to do just that.  Since the odds are against you needing any type of catastrophic coverage, he has implemented a high deductible plan ($1,000) for his employees and provided them with Health Savings Accounts to handle the little things (even those things that aren’t covered under most insurance plans like Acupuncturists and Chiropractor’s) including preventive care (see attached Appendix).

If the employee doesn’t use the money in the account, it keeps growing.  It’s their money.  The company decreased its costs at the same time as they no longer had to pay the higher costs for the lower deductible plans.  All companies should be doing this.

So why aren’t physical exams and many preventive measures part of any current (Medicare) or proposed (Obama Health Plan)?

Costs.

According to the aforementioned Dr. Ateev Mehrotra, “If every U.S. adult got an annual physical, the U.S. health care system would need to provide up to 145 million additional visits annually, the researchers estimate.”

But What Would It Really Cost to Cover Preventive Care?

There are 921,900 physicians in this country according to the AMA’s Physician Characteristics and Distribution in the U.S., 2008.  If only half of these physicians, to use a conservative estimation, were to conduct physical examinations on these 145 million people, it would amount to one extra person seen a day (given time for vacations and golf outings on Wednesdays).

So doing the financial calculations, if it cost $7.8 billion to pay for 44 million folks who received Preventive Health Examinations (PHE) and Gynecological Health Examinations (GHE) according to the Preventive Health Examinations and Preventive Gynecological Examination Study,  then it would cost approximately $25 billion more for the additional 145 million to receive these preventive measures.  Since these numbers can only be assumed to be correct, and don’t account for all preventive care screening that the USPSTF recommends, lets add an additional $60 billion to the $25 billion making it a total of $85 billion available for preventive care, the same amount that was given to AIG.  And if that’s not enough, we’ll hold an additional $65 billion in reserve, the same amount which incorporates the additional amount given to AIG.

So to recap, on the one hand we have the U.S. Preventive Services Task Force recommending preventive care services and on the other hand, no government current or proposed Health Care Plan offering many of these preventive services, including periodic physical examinations.

The result: treating the disease rather than preventing it which costs the system and consequently taxpayers more.  Just look what’s going on with Medicaid as an example of what is to come should Obama’s Health Care Plan come into fruition.

Perhaps if more people got physical examinations on a regular basis, the cost of health insurance wouldn’t be so expensive.  As usual, the U.S. government has it all backwards.  Can we really expect them to keep us healthy when its clear they don’t want to prevent us from disease with little more than a few preventive care measures and no periodic exams?

I’m not for government involvement in Health Care.  But if they were to eventually be involved, you’d think they’d understand Benjamin Franklin’s advice; “An ounce of prevention is worth a pound of cure.”