I guess I’m fat?

So I got my wife a Wii Fit Plus for Christmas this year and we’ve had a blast playing it. I want to go on the record as saying I am the snowball fight champion and the trick is to bob and weave a lot to throw off the other mii’s accuracy. But we’ll save video gaming tips for another blog entry.

Here’s the point of my blog entry today. The Wii Fit tells me I’m overweight. To add insult to injury, it made my little character have a big belly like I’m the front-runner for Santa at Macy’s next year.

I am 5’8″ and 168 pounds at 39 years old. It tells me my BMI is 25.5 and that makes me fat. It’s hard to know my revulsion to this notion without looking at me, but without any tinge of pride I have to say I don’t know a single person who would describe me as “the fat guy”. In fact, most 39 year olds I know wish they had my 33 inch waist and 70ish resting pulse.

So I start asking myself, where does the Wii Fit get off telling me I’m fat? It turns out that like in most cases where something really absurd is discovered, this is from the federal government.

Anyone else who is of enviable weight and waistline can go to the Centers for Disease Control website and be told you are fat also. This is a great consolation for me since even non-wii owners can be incensed like I am. (link)

Why does this matter? Because Democrats are just about to put the government in charge of your healthcare (including the provision that no future Congress can change it). Since their leader cornered the market on the word “audacity” it shouldn’t surprise us. I expect that the Health and Human Services guidelines on health care delivery will mirror their weight limits. Since the CDC site says “People who are overweight or obese are at higher risk for chronic conditions such as high blood pressure, diabetes, and high cholesterol.”, I expect them to either micromanage my life to their moronic standard to “bend the cost curve” or find a way to punish me for being so abnormal.

There is some good news to all this. The Wii Fit says it will like me again if I get to 145 pounds. If I get there I’ll also get a free set of horned rim glasses and a lifetime supply of pocket protectors so I can fit in with all the other 5’8″, 145 pound geeks out there.

TSA and Government Healthcare

In an earlier post I compared how government run health care would look in America by comparing the Transportation Security Administration takeover of airport security screening. I had another experience this past week that concerns me more.

Like most men, I wear a belt. I wear the same belt when I travel because it doesn’t have a lot of metal on it. The first 20 times I wore the belt I got through security without any problem. Then one day the metal detector goes off. I ask a simple question to the TSA guy – any idea why this is going off when it has never done it before? His response is an annoyed “just take the belt off”. I took it off, got through security without further incident and expected that from then on I would have to do the extra step to help protect America from belts. Well on my flight home there were no problems with the belt and I wore it five or six more times before it went off again.

Why is this a problem? We TSA would be better because they would do a more consistent job across all airports. It simply isn’t the case. They are as inconsistent across the many airports I travel and the private people were before. The current promise is for “Universal Health Care”. That somehow the state marketplaces will set a specific standard and all of the sudden everyone will get the same treatment. How has that worked with the TSA? It hasn’t. The question is why hasn’t it?

Implementing the same standard across many locations is commonplace in many organizations. The difference between when a private organization does it and when a government organization does it is that the private organization’s local implementers get some benefit by going with the program. It may be more efficiency or better cost sharing or even just favor with their boss. When the government does it, it’s just related to someone in an ivory tower gaining more power for his or her own portfolio, not empowering local implementers or helping them achieve some benefit. That’s why TSA people, post office clerks and DMV employees are grumpy after changes occur. The changes almost never have any benefit for them. Even when the change is intended to benefit the “customer”, without any incentive to the local government employee, there’s no reason to care whether it is implemented well or not aside from personal work ethic which isn’t normally so high in these jobs (although I certainly have appreciated the few exceptions I have witnessed).

Americans are being lied to about how some kind of “Public Option” will benefit all people living in America equally. The reality is that the same variability you see in the TSA will happen in government health care. People will find out about it and stop going places where their “free” healthcare stinks, creating huge backlogs where it is actually good and all healthcare will suffer.

TSA Healthcare

I think it’s instructional when considering the government intervention on our health care system to consider how well they’ve done in other interventions. It would be especially interesting to just look at how the federal government has done in managing AIG or General Motors/Chrysler but I’ll leave that for another day because I can’t get one example out of my mind.
Many of you know I fly a lot. I won’t make it this year because of the economic downturn, but I’ve been a Platinum flyer on Continental when I lived in Cleveland and Delta now that I’m in Atlanta for most of the last 10 years. As such, I’ve had the chance to appreciate airport security both before and after the switch to government airport security following 9/11. I’m not impressed.

Prior to the government takeover of airport screening companies competed on merit to do the job. The argument that airports just bid it out to the lowest bidder says more about how silly government procurement rules are than the actual screening system. Companies knew they were pulling from basically the same labor force so the value they tried to add was with management teams that were expert or offered better service. For example, one firm hired a gentleman named Hovan Franko, an Israeli who was an expert in identifying non-verbal clues that someone could be up to no good. He trained not only his screeners, but airline counter people and others in the airport. It was a great and innovative service promoted by the free market.

Fast forward to today. While the government said the Transportation Security Administration was necessary to ensure consistent screening practices across the country and raise the quality of screening generally that simply hasn’t happened. I’ve lost count of how many airports I have traveled through since the TSA took over (well over 30) and I can attest to the fact that there is no consistency across them. Even when they eventually adopt the same rule, it might happen months apart. (For the record, the TSA people in Salt Lake City are by far the worst I have ever dealt with.) Most airports say nothing about a hair cream I have in my travel bag but never use. San Francisco told me it had to be inside my 1 quart plastic bag. The screeners at Canton/Akron actually argued with me that it was a liquid or gel and I had to explain third grade science to them. I’ve gone through security with a belt on several hundred times but this morning the machine went off and I had to remove it (same exact belt I went through security with three times in the last three weeks). Some make you remove a sweatshirt and others done. Some take 30 seconds to scrutinize your ID and boarding pass (as if they really knew what they were looking at) and some don’t care. To this date, none has told me the 1 once size Purell I have in my computer bag would have to go in my 1 quart plastic bag.

Some say, sure they’re inconsistent but the quality of screening has gone up. Well they would be wrong as well. Just about every audit of TSA performance done shows they perform at the same level and in some cases worse than the private security people did. Nobody should be surprised since in many cases it’s the same exact people doing the job. How about their management? Are there any Hovan Franko’s at the TSA? Not really. The best example is the whole 1 quart plastic bag fiasco. They implemented the rule five years after taking over because the threat of liquid explosives was so great. Think about this for a minute. Liquid explosives have been around for more than a century and they’re just now seeing that it’s a threat? Either they let us fly in great peril for five years or the whole thing is made up to boost their control over us.

Why is this a good case study for healthcare? There are a lot of reasons but I will outline a few.

1) They will be slow to react to new trends. Just like it took them five years to determine that a decades old threat was applicable to airport security, the government run health system will be slow to respond to health trends. They have no motive to do anything proactively.
2) People will generally sink to the level the lowest performers around them. Government employment generally is not where high performers go. There are lots of great reasons to work for the government and great government workers, but really ambitious people don’t go there. As the good people see weak performers linger on without any consequence they will get weaker just as has happened at the TSA.
3) The power will go to their heads. Ask anyone who travels today whether TSA people have let the power go to their heads. Their arrogance is amazing and the notion of customer service is completely absent from most of them. This will show up in call hold times, bureaucratic responses and stonewalling on answers. (of course I could use just about any government agency to make this point, not just the TSA).
4) They will lower standards to hire people willing to do the job. Remember the “high” standards originally proposed to be a part of the critical TSA? They wanted people to be citizens with a high school diploma. While both were used as criticisms of the privately run screening system, both requirements were eventually dropped for the TSA.
5) Rather than see costs come down, costs will go up as the inability to use private resources creatively forces more staff to be hired to meet gaps in coverage and skills.

I could go on but I won’t. Just think about every government office you’ve ever visited. Are the people who work there self starters? Are they driven by customer service? Are they quality minded? I’m not asking are there some people there who are these things but would you describe the whole office that way? I cannot think of a single place where I would.

Health Care Cure

I wrote on someone’s Facebook page recently that it would be amazing what would happen if instead of these “comprehensive” health care reform plans (which are really mostly needless government meddling) Congress should decide what issues have 60-70% support and draft/pass one bill per month for the next several months. We’d have a better system that does repair some undeniable problem areas without utterly destroying a system that isn’t particularly broken for 85% of the population.

This post highlights some of what I think those areas are and invites others to chime in as well. When I say 60 – 70% support, I don’t mean me and the 60-70% of people who are closest to me politically – I expect some ideas would not sit well with me but have good solid support from the center-left “coalition”.

1) Let insurance companies sell health insurance across state lines. Even hometown newspapers agree this is a good idea. (http://www.chicagotribune.com/news/opinion/chi-perspec0823insuranceaug23,0,2946061.story). It’s no surprise the Wall Street Journal supports it. We need to let the marketplace compete in real terms and stop forcing people to buy coverage they don’t want or need just because they have the misfortune of living in a certain state. Different regulatory requirements from state to state impede innovation because a company’s investment to creatively solve a problem can only be used in a fraction of the population. It also drives away hungry start ups who can’t compete with well established incumbents in one state. Granted the incumbents got there because they offered a consumer option that was better than the alternative, but that’s not the point here.

A separate but related point is that providers should be able to offer services across state lines. The Mayo Clinic offers remarkable service via tele-medicine to Qatar, but is not permitted to do it in North Dakota because of silly state regulators.

2) Decouple health insurance from (specific) employment. I understand that health insurance companies underwrite the total number of lives in an employee pool, but seriously if they insured me at $X when I worked somewhere they don’t lose any money to continue that same coverage after I leave. It would be so easy to extend COBRA benefits duration to double what it currently is as an interim step so long as you had all the rights as an employee (e.g. not being treated like a month to month customer). Experts have been saying this is an issue for 30 years for lots of reasons.

3) Pass tort reform that would apply to every state as demonstrated in California (very blue state) and Texas (very red state). Premiums have plummeted in these two places by simply capping non-economic damages to $250k (still a lot of money).

4) Do something to control insurance companies ability to revoke coverage from people once they get sick. Clearly if someone lied on an application they should still be able to bump them, but if the information was available to the company at the time they offered coverage and the company still elected to insure the person, they should be prohibited from dropping coverage. (P.S. Very grateful to a very liberal friend of a friend who pointed out to me that this issue – known as rescission – is a bigger problem than I ever realized.)

5) This isn’t something I’m very much in favor of, but there seems to be good support for creating a government funded high risk pool to let insurers hedge their bets against the kind of people they typically deny coverage for, especially those with pre-existing conditions.

6) Repeal the medicare payroll tax and the accompanying joke called “earned income tax credit” which just aims to repay lower income earners for what the government took from them in the first place. Rich people are already funding poor people’s social security and medicare so let’s just stop kidding ourselves. (okay – this is just something I made up but I will never understand why we tax people like crazy just to give them their money back so they can have a free ride)

7) Prohibit doctors from taking payment from medical device manufacturers so they do not focus on their meal tickets instead of better, cheaper or less invasive technologies/procedures. There are huge conflicts of interest in this area, especially in orthopedics but other practice areas also.

8 ) Find a way to promote total case management over the duration of an illness/condition. This would mean better cooperation between providers, capping the total monies available to all parts of the health care delivery system to help ferret out waste such as rerunning tests and doctors visiting patients on rounds not because of medical necessity but simply because they had free time and a charge code. It would help the problems of fragmented care and medical errors tremendously. (5x as many Americans die every year from medical errors than from being uninsured).

8a) We need to transform the current year by year pricing mechanism to a multi-year model. Paying for per patient per procedure on a yearly basis penalizes innovation, quality, results and entrepreneurship. No other segment of our economy acts so counter-productively. Creating a multi-year system will provide incentive to do something in year one that would reap medical and financial benefits in year 3, driving down overall costs in the process.

9) Promote transparency of provider quality so we can make educated consumer choices like we do everything else. I actually believe this is the #1 problem in the whole system – we live in a free market system but none of those principles exist in health care delivery. Paying doctors on results of their performance not number of procedures would be an attractive way to accelerate this idea.