Water is more valuable than gasoline or gold. Millions of people in recent history have lived their entire lives without ever seeing an ounce of gold or using a gallon of gasoline but no one can live more than three days without water. All humans need a reliable source of water. It is a life-or-death issue. Healthcare is more like water than anything else that we use. For most of us, the time will come when we need good healthcare just as much as we need safe water. Your life depends on clean, pure wateand it depends on healthcare. Without good healthcare, I would have surely died of large cell lymphoma in 1990 when I was 43 years old. That is a rapidly growing cancer that is always fatal without treatment.
As you elaborate on this in subsequent posts, one question you might address is, “How would what you’re proposing differ from existing systems, such as Medicare, Medicaid and the VA medical system, all multi-billion-dollar, taxpayer-funded operations run by both elected and appointed officials, similar to the municipal services you cited?”
Another facet might consider & compare existing concierge, direct-pay medical clinics that have been around in recent decades and continue to multiply, grow and compete with existing systems.
Finally, what about end-user (or patient) responsibility? I rarely go to the doctor because I take good care of my health. When I do go, I often see morbidly obese people who obviously do not take care of their health, I understand the frustration that many doctors have expressed about revolving-door patients who never follow their advice for improving their health. Some, if not many, of these people are unable to pay, or choose to not pay, for their medical services. This gets passed on to those who do pay and drives up their costs.
Thank you for your exploration of this topic. Clearly an area that needs more thought and practical creativity for better outcomes.
These are national programs grounded in a central bureaucracy and the old usual care system for managing chronic diseases. I am talking about a local system that is managed by local officials to meet local needs. The governing body should include people who depend on the system. I treated the patients that you describe for forty years. Very few of the people that I saw wanted to be fat or sick. Our health care messages are extremely confusing. Patients who receive best practice instruction do much better. If we find a way to care for their diabetes and high blood pressure, they won't need very expensive dialysis, stroke care, bypasses, and nursing homes. Everybody wins. Better care is less expensive care.
Whether national, regional, state or local, human nature struggles with the same temptations & inefficiencies.
The better systems in any organization are designed to mitigate this reality as much as possible -- i.e., by routinely managing its operations as closely, wisely & transparently as possible.
I look forward to following your thoughts on this topic and learning more about good examples that are currently doing better than the status quo, both in terms of costs & outcomes.
I agree with all of your caveats. We can have better healthcare. Costa Ricans live longer than we do by combining their public health and personal health systems. They are not nearly as prosperous, but they are healthier. Check out this fascinating article that a nursing leader Kathleen Bartholomew sent me today. It is exactly the model we are talking about.
Impressive outcomes from improved daily hygiene & personal necessities and basic medical care.
It will be interesting to see the eventual outcomes of the Covid jabs--administered in most cases without true, informed consent. 🫣
It appears that most deaths still result from preventable causes, largely risky lifestyle choices & habits, with abortion still the number one cause of death. (See the list at the bottom of the opening page for Worldometers.info.)
I like the concept of the water system, except to say that, living in NYC, our thoughtful leaders are still poisoning our excellent NY water with fluoride. I am from Holland originally, where they briefly introduced fluoridation after the war, under American influence, but in the sixties they abandoned it again, after it became clear that the science was bunkum.
As to healthcare, I think the better model is that the first tier should be geared to prevention, and it should be organized as a mutual society, i.e. a member owned network, supported by tax credits for low income people, but it should be all about lifestyle medicine. We now have better testing available (Premier Heart's Multifunction Cardiogram (TM), talk to me!), which offers high-res diagnosis and prognosis for the entire cardiometabolic function, with a 10-minute non-invasive test, and with 90-100% accuracy. It should become the standard of care for early detection of all heart problems and also diabetes, for it can pick things up early, when lifestyle changes can still easily prevent or reverse the onset of problems. This is at the heart of almost all chronic diseases, which are driving up healthcare cost by being mistakenly medicalized when they should be addressed with lifestyle changes. That accounts for 80-90% of healthcare costs, if you can only eliminate half of that, you can solve the country's economic problems.
That first tier of healthcare should also include exercise and meditation schooling, and, importantly, 2nd opinions for anything that that happens in the second tier, which should be a proper insurance plan. The level of deductible in the 2nd tier should be based on the maintenance of adequate biomarkers as determined by the annual physical, so that unhealthy lifestyles are reflected in the insurance cost, but people are not excluded from healthcare.
Thanks Rogier. We can show the greatest impact on cost and clinical outcomes very quickly by going after the patients who have high risk, high cost conditions. We do that to show the benefit of our efforts quickly. Once we prove the impact, we will surely address patients as far upstream as we can identify them. I am very familiar with MCG and have had the test. It is good. It is not a matter of either or. We are getting sicker by the day as a country. Lifestyle improvement is critical. Lifestyle alone is not enough. The data on the benefits of optimal medical therapy using medications and are antioxidant and anti-inflammatory are proven by a large body of data.
Right. It is about motivation, though. And the idea of a mutual society, i.e. member owned, unites people and resources around prevention and disease reversal, dumping the trouble cases into the insurance pool, but rewarding those who take care of themselves. That first tier should also, besides guidance for 2nd opinions, include legal support in cases of malpractice.
What a test like MCG can do, is to advance the discovery of budding problems to an earlier time. I am dealing with a population where the average age of the first heart attack is at 43 years of age. Early detection could help change the tide. As I referred to in one article, Dr. Esselstyn famously had his aha! moment in Vietnam as an army surgeon, when he saw these 2-somethings who mostly all hat the early signs of inflammation and plaque in their blood vessels.
Great. We agree. Lifestyle management is critical. Medical management is equally critical. If you get optimal medical therapy for your artery disease after a heart attack you are ten times as likely to be alive in 5 years compared with the care that most people receive. And it is not just heart deaths, it is all-cause mortality. The first link goes to outcomes. The second lays out the process. We work with a clinic that has been providing OMT for 5 years. They provide care at half the cost compared with usual care. OMT patients are in the hospital one fifth as often and in the ER one third as often.
At 75, watching a sister get mauled, physically and economically and then subsequently die in the current system, it’s frankly very scary to think I may have to enter this broken system someday. I do my best not to do that. Unfortunately, all trust finally collapsed during the Covid scam. The working system you describe has a hard row ahead. I will keep my eyes and ears open. There is a health clinic in my small town that seems unconnected to the giant systems around me that are building big fancy hospitals and the newest buildings in cities around me are devoted to “health”. Tells you what is sucking our $$ away. Merry Christmas, Doctor.
Thanks Janet. Merry Christmas to you. Talk to the adminstrator in the clinic and show his this article and Wednesday's article that is coming. It maps out a way forward that can make a clinic like that very successful.
As you elaborate on this in subsequent posts, one question you might address is, “How would what you’re proposing differ from existing systems, such as Medicare, Medicaid and the VA medical system, all multi-billion-dollar, taxpayer-funded operations run by both elected and appointed officials, similar to the municipal services you cited?”
Another facet might consider & compare existing concierge, direct-pay medical clinics that have been around in recent decades and continue to multiply, grow and compete with existing systems.
Finally, what about end-user (or patient) responsibility? I rarely go to the doctor because I take good care of my health. When I do go, I often see morbidly obese people who obviously do not take care of their health, I understand the frustration that many doctors have expressed about revolving-door patients who never follow their advice for improving their health. Some, if not many, of these people are unable to pay, or choose to not pay, for their medical services. This gets passed on to those who do pay and drives up their costs.
Thank you for your exploration of this topic. Clearly an area that needs more thought and practical creativity for better outcomes.
These are national programs grounded in a central bureaucracy and the old usual care system for managing chronic diseases. I am talking about a local system that is managed by local officials to meet local needs. The governing body should include people who depend on the system. I treated the patients that you describe for forty years. Very few of the people that I saw wanted to be fat or sick. Our health care messages are extremely confusing. Patients who receive best practice instruction do much better. If we find a way to care for their diabetes and high blood pressure, they won't need very expensive dialysis, stroke care, bypasses, and nursing homes. Everybody wins. Better care is less expensive care.
Whether national, regional, state or local, human nature struggles with the same temptations & inefficiencies.
The better systems in any organization are designed to mitigate this reality as much as possible -- i.e., by routinely managing its operations as closely, wisely & transparently as possible.
I look forward to following your thoughts on this topic and learning more about good examples that are currently doing better than the status quo, both in terms of costs & outcomes.
My next post on Wednesday goes into more detail.
I agree with all of your caveats. We can have better healthcare. Costa Ricans live longer than we do by combining their public health and personal health systems. They are not nearly as prosperous, but they are healthier. Check out this fascinating article that a nursing leader Kathleen Bartholomew sent me today. It is exactly the model we are talking about.
https://www.newyorker.com/magazine/2021/08/30/costa-ricans-live-longer-than-we-do-whats-the-secret
Impressive outcomes from improved daily hygiene & personal necessities and basic medical care.
It will be interesting to see the eventual outcomes of the Covid jabs--administered in most cases without true, informed consent. 🫣
It appears that most deaths still result from preventable causes, largely risky lifestyle choices & habits, with abortion still the number one cause of death. (See the list at the bottom of the opening page for Worldometers.info.)
I like the concept of the water system, except to say that, living in NYC, our thoughtful leaders are still poisoning our excellent NY water with fluoride. I am from Holland originally, where they briefly introduced fluoridation after the war, under American influence, but in the sixties they abandoned it again, after it became clear that the science was bunkum.
As to healthcare, I think the better model is that the first tier should be geared to prevention, and it should be organized as a mutual society, i.e. a member owned network, supported by tax credits for low income people, but it should be all about lifestyle medicine. We now have better testing available (Premier Heart's Multifunction Cardiogram (TM), talk to me!), which offers high-res diagnosis and prognosis for the entire cardiometabolic function, with a 10-minute non-invasive test, and with 90-100% accuracy. It should become the standard of care for early detection of all heart problems and also diabetes, for it can pick things up early, when lifestyle changes can still easily prevent or reverse the onset of problems. This is at the heart of almost all chronic diseases, which are driving up healthcare cost by being mistakenly medicalized when they should be addressed with lifestyle changes. That accounts for 80-90% of healthcare costs, if you can only eliminate half of that, you can solve the country's economic problems.
That first tier of healthcare should also include exercise and meditation schooling, and, importantly, 2nd opinions for anything that that happens in the second tier, which should be a proper insurance plan. The level of deductible in the 2nd tier should be based on the maintenance of adequate biomarkers as determined by the annual physical, so that unhealthy lifestyles are reflected in the insurance cost, but people are not excluded from healthcare.
Thanks Rogier. We can show the greatest impact on cost and clinical outcomes very quickly by going after the patients who have high risk, high cost conditions. We do that to show the benefit of our efforts quickly. Once we prove the impact, we will surely address patients as far upstream as we can identify them. I am very familiar with MCG and have had the test. It is good. It is not a matter of either or. We are getting sicker by the day as a country. Lifestyle improvement is critical. Lifestyle alone is not enough. The data on the benefits of optimal medical therapy using medications and are antioxidant and anti-inflammatory are proven by a large body of data.
Right. It is about motivation, though. And the idea of a mutual society, i.e. member owned, unites people and resources around prevention and disease reversal, dumping the trouble cases into the insurance pool, but rewarding those who take care of themselves. That first tier should also, besides guidance for 2nd opinions, include legal support in cases of malpractice.
What a test like MCG can do, is to advance the discovery of budding problems to an earlier time. I am dealing with a population where the average age of the first heart attack is at 43 years of age. Early detection could help change the tide. As I referred to in one article, Dr. Esselstyn famously had his aha! moment in Vietnam as an army surgeon, when he saw these 2-somethings who mostly all hat the early signs of inflammation and plaque in their blood vessels.
Great. We agree. Lifestyle management is critical. Medical management is equally critical. If you get optimal medical therapy for your artery disease after a heart attack you are ten times as likely to be alive in 5 years compared with the care that most people receive. And it is not just heart deaths, it is all-cause mortality. The first link goes to outcomes. The second lays out the process. We work with a clinic that has been providing OMT for 5 years. They provide care at half the cost compared with usual care. OMT patients are in the hospital one fifth as often and in the ER one third as often.
https://pubmed.ncbi.nlm.nih.gov/20973686/
https://pubmed.ncbi.nlm.nih.gov/21331203/#:~:text=In%201996%2C%20Kaiser%20Permanente%20of,Clinical%20Pharmacy%20Cardiac%20Risk%20Service).
I enjoyed this important topic . I also look forward to the next one ! We should all get started !
Thanks Doc. Let me know if there is an opportunity to move forward in your community.
I certainly will .
At 75, watching a sister get mauled, physically and economically and then subsequently die in the current system, it’s frankly very scary to think I may have to enter this broken system someday. I do my best not to do that. Unfortunately, all trust finally collapsed during the Covid scam. The working system you describe has a hard row ahead. I will keep my eyes and ears open. There is a health clinic in my small town that seems unconnected to the giant systems around me that are building big fancy hospitals and the newest buildings in cities around me are devoted to “health”. Tells you what is sucking our $$ away. Merry Christmas, Doctor.
Thanks Janet. Merry Christmas to you. Talk to the adminstrator in the clinic and show his this article and Wednesday's article that is coming. It maps out a way forward that can make a clinic like that very successful.
Good idea.