Friday, July 15, 2016

How will we survive… not with incremental change…

Consider the $3 Trillion healthcare bill that we had last year…. These are all the costs of generating or curing, hopefully healthy people in the USA, each and every year. For those who know a little about numbers, the “Rule of 70” tells us that if the cost of healthcare continues at the average annual rate of 6%... the cost of healthcare in the USA in 2027 will be about   $6 Trillion… that’s $6,000,000,000,000.

That is also over 17% of the USA GDP... that is a GDP that is growing at an annual rate of less than 2.5%.
So, what will the GDP in the USA be in 2027 if it continues to grow at the 2.5% rate. Simple compounding gets us to $23 trillion, or so. By that time, 2027, healthcare will be over 25% of the GDP of the USA. Interestingly, the Federal Government budget is only $3.7 Trillion.

Healthcare costs for the nation seems to be completely unsustainable! Yet, we continue to work in the government as if we can just print money to keep its part floating… but what can the folks who are spending from their own bank account do?

The current model in the US, with the highest per capita costs in the developed world is also getting the poorest quality… aside medical research and cancer survival rates, the USA ranks 10th or worse in each other category (see the graphic below). Again, if the dollars are unsustainable, what will happen to what is already among the worst outcomes… especially when we are paying out over 2 times what the other counties are paying?

The incremental changes we discuss in the government generally keep the ecosystem currently in place for healthcare in the USA the same as it has been since the 1950’s. Doctors, Hospitals, Pharmaceutical companies and Insurance companies are the focus. Regulations and standards are based on keeping them profitable, under all circumstances… regardless of quality. The system is not working!

The focus needs to be on the patient. The patient needs to be in control of her file and able do decide what is best for her and her family. This is not the case today, as anyone with an experience bordering on or including a catastrophic event. If other countries can do it (again, have a look at the chart below), then the USA can do it, too.

But it needs to be brave!

But it needs to be brave!

Saturday, July 9, 2016

Wisdom, why is it missing in our lives…

Wisdom is the ability to think and act using knowledge, experience, understanding, common sense, and insight. Yup, I lifted that from my favorite web spot, Wikipedia.

How does one come by having wisdom, without going through the gambits of life, growing up… making mistakes, doing some things right and so on? For centuries this came from parenting, grand parenting, experience and education. There is the sense that the devolution of the family unit has contributed negatively to the transition of wisdom from one generation, to the next. Parent to child and grandparent to grandchild… missing in many families due to distance… in miles and culture.

If this is correct, and if wisdom has value to society, it is likely that the shortage will be in the first thirty years of people’s lives. Also, one can posit that the accumulated wisdom in the last 30 years of people’s lives might also go to waste since it can’t be handed down to grandchildren for the same reason…

Some would have us believe that all of the lost valuables like a grandparent spending quality time with a grandchild teaching an old technique like woodcarving, or talking about family history are useless… I disagree. That allows the genes passed along to be enabled with memories, ideas, creativity and so on.

Parents talking with their older children about keeping an even temper, about how to treat people and how to make life better, also can have a deep impact on how they develop into adulthood. These things play out later in life… and when absent occasionally result in deep rooted problems for next-gen families… money and health problems are examples often of not listening to or having access to wise counsel.

Many of these conversations don’t happen today. It is reflected in many ways, and unfortunately may also be the cause of the dysfunction we are seeing in parts of our society today. Clearly people not being able to absorb change in our society and environment may also be those not having had good family passage of wisdom… or willingness to listen for wise counsel… or a willingness to look for it.

Recently I viewed a re-run of a movie with Robert De Niro and Anne Hatheway as the stars, called The Intern. At one stage he said in-character as Ben Whittaker “you are never wrong to do the right thing”… how could he know that, except that he had over forty years of experience in business. He was, by being the intern (in reverse), passing this wisdom on, to his “boss”. This is a great example of passing on wisdom to person who never had parenting or management because she started the business right out of college (à la Mark Zuckerberg, Bill Gates, Steve Jobs).
So, what do we do about this lack of wisdom hand-me-down thing? Honestly, I am not sure. 
I know in business there is the potential of using the “Intern” idea. I disagree with the use of 
‘consultants’ who are working with strategy … I was involved in some of that and failed in my
opinion, to be of great utility. But as a supporter of a young executive, perhaps I have had 
occasional experiences that were more successful. I think similar things can happen between 
youth and senior who would stand in occasionally for the missing grandparent. Similar to the
very successful Big Brother and Sister programs… only one extra generation beyond.

Wearable personal monitoring apps and devices… if not used to develop actionable information, what good are they?
There are as many viewpoints on this issue as there are people utilizing the devices… many are actually using them to improve performance. For example, a runner might use a device to not only time a training run, but to manage her heart rate during wind-sprints and track the data with an eye to reducing heart rate while increasing speed over the training period.
My Samsung device monitors my activity by the hour, alarming me to get up and move if I am inactive for the previous 60 minutes. The goal here is to allow circulation of oxygenated blood to the extremity muscles and allow your heart to pace up, your lungs to expel gases, your organs to remove toxins and so on… all good. Later in life this helps avoid leg cramps and poor circulation.
Sleep monitoring is interesting, as well… My Band from Microsoft lets me know my sleep habits. When normally I get my 8+ hours of sleep it tells me that my early sleep was not of high quality… not Stage 3 SWS or REM so to speak (the former helps the body regenerate and the latter, regenerates and organizes the brain and memory). Then it comments that among other things, having an alcohol drink in the hours before going to sleep will disturb several hours, until that toxin is run through the liver and kidneys enough to get it out of the blood stream… then in fact, the better Stages III and IV, and REM occur. When I don’t have a drink for a few evenings, sure enough, sweet dreams early in the rest period. I suppose this is actionable monitoring in which I should participate… hmmm, do drink or not to drink alcohol before bed?
So, in some ways, wearable devices can be useful… but only if we take action, based on the information they are developing. Much of that information has to be trended in order to be useful. If the app doesn’t trend the data, or we don’t record it manually, it usually is useless. As well, if one is going to use it with weekly interfaces with a coach, or with a visit to a physician, it is a must to have trended data… allowing us to know if we are getting better, getting worse… is the new normal being too high or low…
Recently my blood pressure which I have been trending for over three years started to trend higher. My resting heart rate had also begun trending higher, from rest rates around 45 up to 60 and BP moving to 135/90 from 110/70. The trending wasn’t constant when looking at a daily plotting.
I had a cardiac check-up scheduled, so I took my data with me… I had a suspicion that my new work and all the flying I was doing had something to do with it, so I also plotted my flight schedules against the trend lines. Sure enough the daily increases in BP and HR a couple of days following extended flights were significant… and causing the trailing averages to go up. A new medication and pressure stockings for flights put everything back to my target pressures on average and daily… that’s action based on a wearable. When I stop flying for work again, I will return to the past meds and tactics.

If we are not using the information, why have it… I suppose my Microsoft Band or Samsung Gear II look cool… but not as cool as keeping things in a healthful status. It is something that we should work on… how to put all this information to use. There are Bluetooth weight scales, blood pressure and heart rate cuffs, pulse
oximetry, and ec(k)g t-shirts that are simple, cheap and useful in allowing us to better inform our caregivers about our healthfulness. You can input things like coffee and calorie consumption, exercise calories burned, sleep data and so on… again, all useful for when we become symptomatic… or even before if the physician knows how to interpret the data. We should put them and new ones coming, to use… and take action to achieve our best possible healthfulness quotient.


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Grad. Saint Mary's University, 1975, got into the medical device business initially in sales, then various management positions up to president, all in Medical Devices. I prefer therapy products over diagnostic, but they are all fun, and in a way have defined my life. I have now evolved, with help from my 35 year partner Lynnda with whom I now share every hour. I am into staying healthy, photography, kayaking, bicycling, gardening and two books a week. I wish I had gotten to this stage earlier!