Spending In Retirement

[Martha]

....It seems to me that the real crisis in US healthcare is that we need so much of it. On any given night between 50 and 75 percent of the patients I care for in the hospital are there because of their unhealthy lifestyle choices. I work in orthopedics and the overwhelming majority of my patients who have elective joint replacements are morbidly obese. A great number of the other patients are heavy smokers, non-compliant diabetics and drug and alcohol abusers. If we want to get healthcare and insurance costs under control we need to do whatever it takes to MAKE people live healthier lifestyles. We are way beyond the point where voluntary measures will suffice. I know it would take serious changes but it could pay off big time in reduced medical costs.
jc
RN, BSN

I read in the WSJ a couple of days ago an article about people who were morbidly obese and had bariatric surgery. As a result they lost a tremendous amount of weight. But there are a significant number who are becoming alcoholics a year or so after the surgery. These are people who had an eating problem and not a alcohol problem.

Addiction is a major health problem, whether addiction to alcohol, drugs, gambling or food.

How much is this a physical problem, an inbalance in the system that causes such a strong need for food or alcohol?

The medical profession has to know that a lecture on bad habits isn't going to cut it.

I know people worry about "medicalizing" all sorts of variants in the human condition. But I think we need a little more emphasis on treatment of impulse control disorders like over eating.

 

[Scrooge]

My ideal retirement job may be working for Doctor Kavorkian after he gets paroled.

Careful, JC! Kevorkian will be 79 in 2007 when he becomes eligible for parole again. What if he slips during one of his, er, operations and hurts a patient? You'll be up to your neck in malpractice suits! 

 

[REWahoo]

Careful, JC! Kevorkian will be 79 in 2007 when he becomes eligible for parole again. What if he slips during one of his, er, operations and hurts a patient? You'll be up to your neck in malpractice suits!

I don't think you are going to have to worry about it:

Kevorkian is being held at the Lakeland Correctional Facility near Coldwater in southwestern Michigan. He is eligible for parole in June 2007 but his attorney, Mayer Morganroth, has said he doubts he will live that long.

In court papers, Kevorkian's defense lawyers say he weighs 113 pounds, resembles a "walking cadaver" and "can barely walk and no longer has the energy to read or write."

http://abcnews.go.com/Health/wireStory?id=2186646

 

[haha]

Oh sorry, back on topic:

We are going to have a hard time parting with the health ins. dollars.  We are seriously considering not buying any for a while. 

Big risk, Shiny. WA has some pretty good rates, esp if you take a high deductible. You guys may be young, but what about a seriuous injury from an underinsured driver or hit and run?

IMO, first insurance, next savings, last retire.

Ha

 

[Scrooge]

In court papers, Kevorkian's defense lawyers say he weighs 113 pounds, resembles a "walking cadaver" and "can barely walk and no longer has the energy to read or write." [/i]

Well, yes, but then what else could his lawyer write in "court papers"? "My client, who claims to have killed 130 people, is healthy, happy and ready to go back to practicing as soon as you folks let him out of here?"  

 

[jclarksnakes]

..The good Doctor Kavorkian does not have to be too healthy to write the prescription that will get the job done. All kidding aside. Have you ever wondered why Hospice patients often die soon after the Hospice Nurse makes the first or second in home visit? Many times in ICUs MDs together with family do make the right decision and take patients off ventilators and let them go peacefully. This is a part of medicine that is mostly kept quiet because we as a nation are unable to make rational end of life decisions.
...IMO bariatric surgery is a last resort for people who are too lazy to exercise and/or too soft of will to diet. Rather than turning to alcohol many of the patients I have seen lose large amounts of weight in the first 6 months after the surgery and then regain much of it over the following year. The fact that medicare and many insurance companies pay even a penny for this surgery is criminal. Most everyone in America weighs exactly what they WANT to weigh.
jc

 

[Rich_by_the_Bay]

All kidding aside. Have you ever wondered why Hospice patients often die soon after the Hospice Nurse makes the first or second in home visit?

Cause they're terminal?

 

[shiny]

Big risk, Shiny. WA has some pretty good rates, esp if you take a high deductible. You guys may be young, but what about a seriuous injury from an underinsured driver or hit and run?

I know you are right. Its just that when I look at it, it all seems like a big scam in which I don't want to participate. I'm hoping that things will get better rather than worse.

 

[SteveR]

Making the decision to end a human life is not always a cut and dried choice.  The sliver of hope of a recovery for the terminal person and the finality of ending the life of a loved one makes this a very complex and emotionally charged event.  Until you have had to make that decision you have no idea what it is like.  

Yes, our society frowns on the ending of a life regardless of the circumstances. The whole issue around Terri Schaivo should be evidence of that. After all "They Shoot Horses Don't They?".

We are allowed to show more compassion for our pets than our loved ones. Thank goodness for legal instruments like Living Wills and Healthcare POAs to provide a means to end the pain and suffering when there is no hope left.

 

[Martha]

..
Most everyone in America weighs exactly what they WANT to weigh.

I understand how as an RN you must be frustrated with what may seem to be self inflicted illness. But I hardly think people who are morbidly obese want to be fat.

One of the most major values we have as Americans is self reliance and individualism. Holding people "personally responsible" is our solution for everything, from being poor to being sick. Given our epidemic of obesity I think we should spend less time finding fault and more time trying to figure out what works to help people lose weight.

 

[jclarksnakes]

Martha,
....Do morbidly obese people want to be fat? No, of course not. Did they want to do what would have kept them from becoming fat? No, not from what I see. Are they willing to do what works to lose the weight now that they are fat?  No, not from what I see. What works is diet and exercise.
jc

 

[Scrooge]

Its just that when I look at it, it all seems like a big scam in which I don't want to participate.

Different people object to different things on ideological grounds: the income tax, the War on Drugs, military recruiters on campuses, etc. However, translating your ideological preferences into actions that can leave you sick and/or bankrupt is a whole different story. I hope you think twice about all the ramifications before you go down that path!

 

[haha]

One of the most major values we have as Americans is self reliance and individualism.  Holding people "personally responsible" is our solution for everything, from being poor to being sick. Given our epidemic of obesity I think we should spend less time finding fault and more time trying to figure out what works to help people lose weight.  

Agree. Willpower, self control, time horizon probably vary as much as any other human traits. When as much as 25% of our population is obese(or maybe more, I don't follow this area), it is a little ridiculous to say that each one of these people is personally responsible for being fat. Go to a park, see all the fat 8 year olds. Are they personally responsible for being fat?

When I was a boy, there were 0 fat kids in my entire grade school. Only one fat boy in small southern HS, then no really fat boys or girls in a large big city HS that I transferred to. Some of the boys would show up for summer football practice with too much gut from too much beer over the summer, but 2x a day football practice in 90+ heat would fix that pretty quickly. Some of the girls were curvier than is currently fashionable, but I didn't then and would not now consider them fat. Just really attractive.

One difference that I can see is that usually Mom was home cooking good meals for my generation. And TV was just getting started up its learning curve of how to sell junk food to kids. Another thing is that our parents were not afraid that some perverted killer would kidnap us and kill us if we went about alone. In summer, we left after breakfast, often with a sandwich, and came back in time for dinner. Otherwise, out until lunch, then back out until dinner.

When my kids were little, I could see that I couldn’t safely give them the same freedom, so I took it on myself to run them around a good part of every day. I could do this because I was around, first working from home and then retired.  And my wife was home too, and both of us made home cooked meals- esp her.

Still, as adults one of my sons is very lean, the other struggles with his weight. So even in the same family, genetic issues are a real factor.

I don’t think Finland would put up with **** like this for its children. But there I go, getting all Scandinavian again.

Ha

 

[shiny]

Different people object to different things on ideological grounds: the income tax, the War on Drugs, military recruiters on campuses, etc. However, translating your ideological preferences into actions that can leave you sick and/or bankrupt is a whole different story. I hope you think twice about all the ramifications before you go down that path!

I agree that its not for the marginally FI.

 

[Rich_by_the_Bay]

I think that some obesity is just a result of laziness and lack of discipline. Heck, if I ate everything I'd like to and never exercised, I'd be obese, too.

But there is another side to it, and many morbidly obese people probably fall into this category: there may be a biochemical imbalance that makes it difficult for them to restrict calorie intake. Maybe being stuffed with hostess cupcakes by your mom all your childhoo resets your barostat. Chemicals like leptin and ghrelin respectively inhibit and stimulate appetite sometimes to the point of extreme urges which are irresistible. Will they lose weight if they restrict calories? Absolutely -- everyone will.

Back when there was a delicate balance between food supplies and needs, this was less important since you had few calories available and lots of necessary activity just to survive. In modern society the disease emerges because those built-in constraints no longer exist. The predisposed are now vulnerable.

In most it is a combination of upbringing, eating habits, exercise and a million other things. But I think we need to realize it's not always just a matter of doing the right thing. For some, they really can't without help.

I shake my head, too, at the apparently lazy slob downing his second Big Mac. Gotta take some responsibility for your own health. Just hard to distinguish those who can and don't from those who just can't. We don't yet always know how to tell them apart.

If you liken it to depression, perhaps another example of a biochemical imbalance whose manifestations overlap the range of personalities on the "downer" side, telling a morbidly obese person to just stop eating so much is a bit like telling a depressed person to just cheer up.

 

[wabmester]

I think that some obesity is just a result of laziness and lack of discipline. Heck, if I ate everything I'd like to and never exercised, I'd be obese, too.

But there is another side to it, and many morbidly obese people probably fall into this category: there may be a biochemical imbalance that makes it difficult for them to restrict calorie intake.

Maybe.   But whatever the reason, we know that obesity is bad for you and that burning more calories than you consume is the only way to not get fat.

So, I've got a dumb question.

Why doesn't insurance cover proven ways to prevent and/or reverse obesity?   I'm talking about simple things like Weight Watchers, frequent doctor follow-ups, personal trainers or gym memberships, etc.

It seems like we know the answer (even in the absense of self-motivation and/or compliance to a doctors recomendation), but nobody is pushing for proven paths towards better compliance.

 

[Martha]

Maybe. But whatever the reason, we know that obesity is bad for you and that burning more calories than you consume is the only way to not get fat.

So, I've got a dumb question.

Why doesn't insurance cover proven ways to prevent and/or reverse obesity? I'm talking about simple things like Weight Watchers, frequent doctor follow-ups, personal trainers or gym memberships, etc.

It seems like we know the answer (even in the absense of self-motivation and/or compliance to a doctors recomendation), but nobody is pushing for proven paths towards better compliance.

I read an article about how the Veteran's Administration has really turned around to provide some really good care. (Business Week maybe?) One of the things they now emphasize is preventive care. Because the patients are eligible for VA services for life, the VA is interesting in keeping them healthy from the get go. In contrast, insurance companies rarely cover anyone for more than a few years. So, on a individual basis there isn't a perceived upside to covering preventive care.

When I was in management, I thought it was in the best interest of our business and employees to pay for things such as smoking ceasation programs, YMCA memberships, and weight loss programs so we did that on our own. We actually had a number of smokers quit smoking successfully. We also had a number that have had to try and try again. But addiction is hard. Once you are addicted to something it may take a lot of help and a lot of trys to get past it.

 

[Rich_by_the_Bay]

My reluctantly cynical view: insurance carriers will cover what is profitable. Only. The more responsible carriers may take a 3-5 year view of "profitable" while the less responsible take it year to year.

We either have to mandate coverage or make it financially neutral or unsound to NOT cover such items (prevention and lifestyle modification).

Hard to see either happening in a totally free-market health care reimbursement system. Ironically, no problem with reimbursement for a hopelessly ill, unresponsive 85 year old in the ICU on a ventilator. Both sides deserve the best, but I'm not sure we can afford both.

 

[youbet]

If you liken it to depression, perhaps another example of a biochemical imbalance whose manifestations overlap the range of personalities on the "downer" side, telling a morbidly obese person to just stop eating so much is a bit like telling a depressed person to just cheer up.

Rich, I couldn't agree more with you.

I'm a disciplined person who strongly believes in a life style of personal responsibility, control and accountability. But when my youngest grandson was born with mild cerebral palsey six years ago, I began a learning curve which has opened my eyes. He just can't "will away" his limitations and those limitations profoundly effect his personality, likes, dislikes, cravings, etc.

I also have a very close friend who suffers from depression. Interesting, while immersed in one of his "funks," he obcesses about how much he hates overweight people. He goes on and on about their lack of self-control and discipline and how their appearance sickens him. Yet, when I mention, as you suggested, that he simply cheer up, quit his heavy smoking and drinking, he screams "not fair!"

Sadly, we still seem to be a long way from understanding why some folks are self-destructive and over eat, smoke, drink, commit crimes, get depressed, obcess in hateful ways, etc. And for some reason, those inflicted with obesity draw our wrath the most.

 

[Cb]

Have any of you seen any ads in running or bicycling or other cardio sports oriented magazines offering less costly health insurance to those who can substantiate their exercise regimens or meet certain athletic performance criteria?

Seems to me there ought to be a niche there for insurers...assuming the bumps and sprains associated with the exercising didn't offset the cost savings for diabetic treatment, heart disease, etc.

Cb

 

[Meadbh]

Private health care insurers don't want to pay for programs to prevent obesity, etc.  because their expenditures will not increase profits. But this is one advantage of a publicly funded health system. Ultimately, the public will pay, now or later. So there is a financial incentive to support health promotion and preventive care.