Rethinking Health Insurance

Health insurers have certainly been beat up in the past few months by the political candidates. In some cases, I think it's right, when insurers are withholding payments for legitimate operations that might save a life. But in other cases, I don't think health insurers are the only ones to blame.

Here is an article written by Dr. Pam Popper, nutritionist, naturopath and President of the Wellness Forum in Columbus, Ohio.

I think she is right on with some views on how insurance companies could easily become the real innovators in our move to a better healthcare scenario.

There is so much wrong with health care that it is almost impossible to fix the existing system. And, in my opinion, we are focusing on the wrong things and blaming the wrong organizations for some of our problems.

For example, health care reform often involves criticizing insurance companies for not paying for certain types of treatments. For the record, I'll state that insurance companies are guilty of many things and do their part to contribute to the poor state of health care today. But forcing these companies to pay for any treatment offered by drug companies and desired by patients may be causing our problems to worsen, not get better.

For example, I have written before about Avastin, originally approved for colorectal and lung cancers, and recently granted "accelerated approval" by the FDA for metastatic breast cancer. It's actually almost worthless for all cancers. Avastin extends life by a few months for colorectal and lung cancer patients, and about 5.5 months for metastatic breast cancer patients. The side effects, according to an article in The New York Times, include death. Offered by Genentech, the drug costs $92,000 per year. Genentech acknowledged in an editorial that it "does not claim that the drug is cost-effective for advanced breast cancer but believes it will be clearly worth the cost if shown effective in earlier stages of breast cancer."

In spite of this, Avastin has already been prescribed off-label to over 11,000 cancer patients with advanced breast cancer, and the recent FDA approval would increase the number of patients who qualify for it to 43,000. Genentech acknowledges that the drug only extends life for only a few months. Using half of the $92,000 annual cost of the drug (since patients are almost always dead within a few months), the revenues to Genentech for this drug have grown to a potential of close to $2 billion dollars per year. Where does the money to pay for this drug come from? Insurance companies and Medicare/Medicaid. And if some of our political candidates get their way, we will add universal health care coverage, meaning more taxpayer-financed reimbursement, to the pool of available funds.

This is not the only example. Billions of dollars are spent annually on unnecessary back surgeries and other procedures, mammography and other useless diagnostics, as well as drug treatments that are completely ineffective, and often hurt people. Can you blame the insurance companies for refusing to pay for this?

Unfortunately, the insurance companies also deny reimbursement for treatments that do work, such as dietary intervention. They've thrown the baby out with the bath water, attempting to deny coverage for anything different or progressive.

Insurance companies are in a great position to be innovators in the health care field if they decide t do so. They could develop policies for people who choose to practice dietary excellence and optimal habits, and reimburse these people for the counseling and other support needed to learn how to do so. There is evidence that this will work, and can save enormous amounts of money. The average patient who gets bypass surgery spends $86,364 over a 5-year period; the average patient who has angioplasty spends $63,897 during a comparable period of time. A consultation with Dr. Esselstyn (who has an excellent track record reversing cardiovascular disease through dietary intervention) costs $500; a membership to The Wellness Forum, complete with books, CD's and DVD's costs only $221. Reimbursing for these types of services and refusing to pay for bypass surgery and angioplasty unless the need is clearly demonstrated (it rarely is) would result in huge savings for both private carriers and Medicare.

I'm not upset with the insurance companies for saying enough is enough as it pertains to reimbursement for medical services that do not work. And I do not think universal health care, which will result in all of us as taxpayers shouldering more of the burden for useless diagnostics and treatment is the answer either. The answer is to continue to educate people to make different choices, and to target the purveyors of misinformation as the real culprits - our government, national health organizations, medical schools, unenlightened doctors and others who continue to promote ineffective and harmful treatment.

Review of Side Effects Movie

I finally bought the DVD for the movie "Side Effects." I have been wanting to see this movie for a long time. Dr. Pam Popper at the Wellness Forum introduced me to it, but I haven't had a chance to see it until now.

Side Effects is a movie about the drug industry. It is based on a true story, the budding career of a pharmaceutical sales rep named Kathleen Slattery, who also happens to be the director of this movie.

The story begins with Karly Hert's (Kathleen's character) start in the pharma business. The initial pay and perqs get her excited, but she isn't really good at the job for a while. Finally, she decides to tell the doctors the unvarnished truth about the drugs she's selling, being upfront about all the side effects. It works, and Karly becomes the top sales rep, earning top dollars selling their marque drug, named Vivexx (named suspiciously like Vioxx, the arthritis drug that killed tens of thousands).

Karly finds out that the drug company withheld important side effect information, and does some digging to find out the real facts. She does some great detective work and at the end, makes a difference in a big way (trying to avoid spoilers here).

The movie itself is quite entertaining. That is for one reason and one reason only. Karly is played by Katherine Heigl, who is from Grey's Anatomy on TV and recently starred in Knocked Up. Katherine is an amazing actress. She holds the entire film together. I can sympathize that Kathleen Slattery is a first-time director, and as such, she does an okay job. But the movie has many problems, which can all be traced back to the director. Awkward ten-second scenes that mean nothing, strange interviews with doctors interspersed throughout, and awful performances by almost everyone except Katherine Heigl. The actors who play Karly's boyfriend and her two bosses are especially painful to watch. Again, it's understandable that, with a budget of less than $200,000, you're not going to get great actors to surround a star, but it doesn't make it any easier to watch.

I have one more bone to pick. As a red-blooded guy, it pains me to complain about this, but why does Katherine Heigl have to get undressed on-screen a half-dozen times or more with no connection whatsoever to the plot? It seems like a very cheap way to get our attention. Yes, Katherine has a beautiful body, but even a sex-crazed guy like myself can tell when he's being manipulated.

Having said all that, my wife and I still watched the whole thing and we still liked it. We both thought it was a tribute to one of the best new actresses of the twenty-first century, Katherine Heigl.

And, setting my inner movie critic aside, the story is good and the message is incredibly important. I suggest that, if you want to buy the DVD, you consider getting a combo-pack with Kathleen's companion movie called "Money Talks," which is a documentary on the same issue of pharmaceutical companies' undue influence on doctors.

Both movies are worth watching. We all need to learn more about this issue and find out what we can do to mitigate the risks.

I'm Deleting My Post about Sicko

I made a post on this blog about Michael Moore's new movie "Sicko" and I am now deleting that post from my blog. I have not seen the movie yet and I need to do that before I make my comments.

I read some very thought-provoking comments on Moore's Website that made me realize I may be speaking out of turn.

This deletion is a result of my own research. I have not been contacted by Michael Moore's organization or anyone else, this is my own decision.

Thank you.

Why Isn't there a Car Insurance Crisis?

In this excellent article from Capitalist Magazine, writer Wayne Dunn walks us through the easy steps to creating a "car insurance crisis" just like the health insurance crisis we already have.

Interested??

If you've read my book (now available as a free e-Book), you already know what I think.

(Thanks to Props Unlimited for the great gas station artwork.)