AMERICA S HEALTHCARE SOLUTION

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MIKE STATHIS

A

MERICA

’

S

H

EALTHCARE

S

OLUTION

C

ONTENTS

I

NTRODUCTION

P

ART

I:

T

HE

P

ROBLEM

1

Healthcare: An Overview

1

2 America’s Healthcare Crisis

17

3 Why So Costly?

41

4 Economic Impact

59

P

ART

II:

A

TTEMPTS AT A

S

OLUTION

5

Medical

Insurance

77

6

Physicians

103

7

Employers

127

8

Government

141

P

ART

III:

THE

S

OLUTION

9

Healthcare

Policy

163

10 New Standards of Health

183

11 Role of Technology

203

12 Adoption Barriers

223

13 The New Physician-Patient Relationship

235

P

ART

IV:

I

NVESTMENT IN

H

EALTHCARE

14

Managed

Care

Organizations 247

15 The Opportunity

265

16 Change is Here

281

Final

Thoughts

299

Notes

303

Appendix 337

References

375

A

MERICA

’

S

H

EALTHCARE

S

OLUTION

E

XPANDED

C

ONTENTS

I

NTRODUCTION

P

ART

I:

T

HE

P

ROBLEM

1 HEALTHCARE: AN OVERVIEW

1

The Good Ole Days 2 Times Have Changed 3 A Brief History of Medicine 6

Ancient Medicine 7 Two Centuries of Achievements 8 Sanitation & Sterilization 9 Vaccine Revolution 10

Antibiotics 10

Biomedical Revolution 11 The Digital Age 12 The Medical-Industrial Complex 13 Disease Management 15

2 AMERICA’S HEALTHCARE CRISIS 17

Most Expensive in the World 17 Mediocre Results 19

Why So Many Have Been Misled 20

Low Life Expectancies 21 Propaganda from Drug Companies 23

Myths about Low Life Expectancies 24

Inadequate Access 25 Archaic Hospital Structure 26 Provider-Patient Mismatch 26 Inadequate Safety Studies 28 Control in the Wrong Hands 28

Misaligned Interests 29 Lack of Transparency 30 Poor Free Market Dynamics 30 Healthcare is Linked to Employment 31

No Focus on Prevention 32 Massive Fraud 33

Waste 34

No Accountability 35 Overemphasis on Technology 36 Chronic Disease Crisis 37 It’s Not All Bad 40

3 WHY SO COSTLY?

41

Blame Game 43 Scapegoats 44 Tort Myths 44 R&D Costs 44 Illegal Aliens 45 The Truth 45 Drug Costs 46 Lifestyle-Enhancement Drugs 48 The Real War on Drugs 50 Me-too Drugs 51 Marketing over R&D 52

Drug Reps 53

Tainted Research 55 Legal Monopoly 56

4 ECONOMIC IMPACT

59

America’s Healthcare Bubble 61

Unfair Trade 62

Outsourcing 64

Pension Freezes 65 Consumer Economics of Healthcare Inflation 67

Boomer Liability 71 Medicare Insolvency 71

Healthcare Outsourcing 76

P

ART

II

A

TTEMPTS AT A

S

OLUTION

5 MEDICAL INSURANCE

77

HMOs and PPOs 80

Managed Care Disaster 85 Big HMOs, Huge Profits 88 What’s the Purpose of Insurance? 89

Uninsured in America 90 Affordability of Health Insurance 91 Lack of Insurance Affects Everyone 93

Why Are the Uninsured Increasing? 93 Dangers of High Deductable Health Plans 95

Being Uninsured Harms America 96 Medical Bankruptcy 96 Are You REALLY Insured? 98

Those Without Are Charged the Most 100 The Insurance Scam 100

Uniqueness of Health Insurance 101 The Insurance Industry’s Secret 102

6 PHYSICIANS

103

America’s Medical-Industrial Complex 103 Physicians as Businessmen 105 Physicians as Entrepreneurs 108 MIA: The Physician-Patient Relationship 110

Electronic Medical Records 112

Prevention 114

Failures in Compliance 115 Division of Labor Healthcare 116 Addressing Patient Limitations 117

Wellness 117

Benefits of Wellness Programs 118 American Medical Association 119 Addressing the Physician Shortage 120 Restructuring the AMA 122 For-Profit Medical Schools: A New Trend? 124

7 EMPLOYERS

127

Free Trade Has Increased the Uninsured 129

The Healthcare-Employment Link 131 Medical Costs Threaten Your Retirement 134

Corporate Control of Healthcare 138 Employers’ Role 139

8 GOVERNMENT

141

Public

Healthcare 141 Medicare 143 Medicaid 144 HIPAA 146 Costs of HIPAA 148 Violations of HIPAA 148 Federal Funding for Telemedicine 149 Health Savings Accounts 149 Parallels with Wall Street 151

Pharma Fraud 157 Caregiver Fraud 159 Lobbyists and Medicare Part D 160

Will Obama Help? 162

P

ART

III T

HE

S

OLUTION

9 HEALTHCARE POLICY

163

Solutions 166

Price Controls 167 Helping the Self-Employed 169 Insurance as an Asset 170 Increasing Competition 171 Addressing Chronic Disease 172 Restructuring Compensation 172 Restructuring Caregiver Strategy 174 Restructuring Caregiver Education 176 Focusing on Prevention 176 Beefing Up Regulation 178 Increasing Accountability 179 Severing FDA-Drug Maker Ties 181 Healthcare-Employment Link 181

10 NEW STANDARDS OF HEALTH

183

Prevention 184

Tobacco 186

Alcohol 190

Nutrition 190

Basics of Nutrition 191 America’s Obesity Epidemic 193 Ineffective Solutions 196

Exercise 197

The Drug Myth 198 Tainted Water Supply 198

Wellness 199

Growing Momentum 200 Nutritional Therapy 200

Fitness 201

Fitness of America’s Youth 202

11 ROLE OF TECHNOLOGY

203

Benefits of Telemetry-Based Healthcare 204

Health-Income Disparity 206 Optimizing Health Using Genetics 207

Teleinformatics 208 Personal Lifestyle Assistance Device 209

Improved Safety 211 Teleinformatics Platform 212 Benefits of Telemetry 213 Remote Monitoring 214 RPM for Disease Management 216

RPM for Prevention and Wellness 217

RPM for Heart Failure 218 Landmark Studies on CHF 219

12 ADOPTION BARRIERS 223

Reimbursement 224

Poor HIPAA Compliance 226 Slow Adoption to HIT 227 Difficulties Measuring ROI 228

Licensing 228 Patient Compliance 230 Physician Acceptance 230 Payment 231 Investment 231 Privacy 232 Security 234

13 THE NEW PHYSICIAN-PATIENT RELATIONSHIP

235

Physician Profiling 236 Removing the Entrepreneurial Spirit 237

Physician-Patient Interaction 238 The Patient Experience 239 Diabetes Self-Treatment 239 Patient Prevention 240 The Digital Physician 242 Patient-Provider Benefits 244 Keeping Patients Out of the Hospital 245

Future of Disease Management 246

P

ART

IV

I

NVESTMENT

I

N

H

EALTHCARE

14 MANAGED CARE ORGANIZATIONS

247

Understanding the Chronic Disease Crisis 248

Challenges of Chronic Disease 250 Multiple Chronic Diseases 252 Disease Management 253

Inefficient Utilization of Call Centers 256

Disease Management & Telemetry 256

Home Health 258

CHF Disease Management 259 Growth of DMOs 262

15 THE OPPORTUNITY

265

Creating Free-Market Healthcare 266 Saving America’s Future 268 Economics of Wellness and Prevention 272

Going Beyond Wellness 273 Diabetes Wellness 274 Fitness Services 275 Corporate Wellness & Fitness 275 Opportunities Created by HIPAA 276 Opportunities for Wireless Services 276 Opportunities for Transaction Processing 276

How Much Will It Cost? 276 Consumer Savings 278 Costs of an HIT Platform 279

16 CHANGE IS HERE

281

Direct Investment 282 Remote Pilot Programs 284 Disease Management 284 Telemedicine Disease Management 285

Pureplay Telemedicine Firms 286 Telemedicine Management Firms 286

Current Devices 287 Healthcare Management Companies 287 Home Health & Wellness 288

Honeywell 289 Health Hero 289 Device Makers 289 Boston Scientific 290 Medtronic 290 St. Jude 290 Verichip 290

Hardware and Software Vendors 291

Oracle 291

Intel 291

IBM 292 Siemens 293 Infrastructure Providers 293 Qualcomm 293 Google 294 Microsoft 294 Broadband Leaders 295 So What’s Next? 295

FINAL THOUGHTS 299

NOTES

303

APPENDIX

337

A. Medical Errors 337

B. Global Comparison of Healthcare Spending 340

C. Global Heath Stats 341

D. Medical Insurance 344

E. Public Healthcare 350

F. Prescription Drug Use 355

G. The Obesity Epidemic 357

H. Dangers of Excitotoxins 365

I. Vaccine Controversy 368

J. Exercise 369

K. Pilot and Remote Monitoring Trials 371