Getting Serious About Medicare

There is no question that we have to do something about Medicare (Obamacare, if you wish).  It is already twice the size of any other developed country (% of GDP) for worse results.  It is growing faster than the economy is growing and is on track to bankrupt the country.

Washington is FULL of blather about what to do and it is all simply that BLATHER.  There are three facts that have to be dealt with and they all have very specific actions that can be taken.

Fact One:  The majority of healthcare expenditures are made at the end of life.  Different studies define both topics differently, but every study agrees on this fact.  Here are just two examples; 1) the cancer drug Provenge costs $93,000 and that extends live for an average of four months!  The cancer drug Yervoy costs $120,000 and extends life for an average of three and a half months!  This list goes on and here are some of the truly inexpensive actions that should be taken to reduce the cost of the end of life and to provide some level of dignity and control to the individual.

*Pay for living wills.  Give people a say in how they want it to end.
*Pay for Do Not Resuscitate documents.  They give an unconscious person a say in how things work out.
*Pay doctors and qualified medical personnel to discuss end of life issues well in advance when emotions are under better control.
*Pay for home health care.  Nothing could be more humane or less expensive.
*Pay for hospice care when home care is no longer possible.

Fact Two:  Americans are over weight.  One third of all adults are over weight and another one third are actually obese.  Obese children are a national epidemic.  Over weight is a huge medical cost since it usually lead to diabetes, which is a life long, horribly discomforting and expensive disease.  Here is what the Harvard Health Letter has to say on the topic.

Why weight matters in calculating diabetes risk

The risk for developing diabetes follows a continuum. The higher your blood sugar level, the greater the chance that you will subsequently develop diabetes.

If your fasting blood glucose is between 100 mg/dL and 126 mg/dL, you have what's known as pre-diabetes. (A fasting blood sugar level of 126 mg/dL is defined as diabetes.) An estimated 57 million Americans have pre-diabetes and, therefore, are much more prone to developing diabetes. Like people with diabetes, those with pre-diabetes tend to be overweight, have high blood pressure and abnormal lipid levels, and have a higher risk for cardiovascular disease.

Fat is more than just a storage site for extra nutrients. Fat, or adipose, tissue also functions as an endocrine organ, producing hormones that affect appetite and insulin action.

So far, scientists have found that fat cells produce the hormones leptin, resistin, and adiponectin. Leptin is normally released after a meal and dampens appetite. Resistin and adiponectin both affect cells' response to insulin. (Too much resistin may cause insulin resistance; too little adiponectin may do the same.) Although the appetite regulation system is complex and scientists are still deciphering the roles of individual hormones, it's becoming clear that excess body fat disrupts the normal balance and functioning of these hormones, thereby contributing to insulin resistance and setting the stage for diabetes.

Fat location also matters

The risk of added pounds is especially high when the excess weight is distributed around the abdomen—often referred to as an "apple" shape—as opposed to around the hips, called the "pear" shape. Excess weight around the waist also puts you at risk for a condition known as metabolic syndrome (see "What is metabolic syndrome?").

Fat can accumulate both under the skin (known as subcutaneous fat) and around the abdominal organs or viscera (known as visceral fat). A large belly suggests the presence of this harmful visceral fat, which produces hormones called cytokines that contribute to insulin resistance. For instance, animals that are obese and insulin resistant have high levels of a cytokine known as TNF-alpha. Some research suggests that this hormone may also play a role in people with insulin resistance.

Other research suggests that visceral fat may affect levels of glucocorticoids, steroid hormones that also contribute to obesity and insulin resistance. Furthermore, fatty acids (the breakdown products of fat) may play a direct role in insulin resistance when they are distributed in muscle, making muscle more resistant to insulin's action. Although further research is needed, it is becoming clearer that fat—especially abdominal fat—adversely affects insulin action and contributes to the development of diabetes.

What is metabolic syndrome?

More than 50 million Americans have metabolic syndrome, a term used to describe a constellation of risk factors for heart disease and stroke. Diabetes (or pre-diabetes), high cholesterol, high blood pressure, and obesity (especially abdominal obesity) are all part of the syndrome, which is diagnosed if you have three or more of the following attributes:

• a large waist size (greater than 40 inches in men or 35 inches in women)
• blood pressure that is 130/85 millimeters of mercury (mm Hg) or higher
• HDL (good) cholesterol that is less than 40 mg/dL in men and less than 50 mg/dL in women
• triglyceride level that is 150 mg/dL or higher
• fasting blood glucose level of 110 mg/dL or higher.

Some experts believe insulin resistance could be the underlying problem in metabolic syndrome. In addition, if you have diabetes, your risk for eye, kidney, and nerve disease increases dramatically, along with your risk for vascular disease affecting your heart, brain, and extremities.

What the government can do about this epidemic is not entirely clear because some well thought out projects have not produced the results that were expected while some others did.  The Plate replacing the Pyramid is probably a small step in the right direction, but the basic truth is that we have to learn how to eat better.

Fact Three: There is enormous waste and inefficiency in our medical care system. We need research into why exactly the same procedure at the Mayo Clinic in Rochester, Minnesota costs $100,000 and $200,000 at the UCLA Medical Center.  We need to find out which procedures and which drugs are effective and which are not.  We need to make medical records digitized and widely available.  The consultancy, McKinsey, estimates that we can save $300 Billion annually from simply using 21st Century tools.

When you hear the jerks in Washington talking about these three facts, and what to do about them, you will know somebody is serious about fixing Medicare.  Until then, they are just trying to screw you.

Hear that Paul Ryan?