Saturday, December 19, 2009

The feeling is mutual...

Well, it's snowing outside and I feel a little lazy today so it's time for baking Christmas (or is it Holiday) cookies and finding my soapbox. Yes, it's healthcare again that is on my mind. I guess that since I am not dating anyone right now, I spend too much time watching MSNBC and C-SPAN and I get caught up in public policy debate. The more and more I think about it, the public policy thoughts are probably the reason why I am not dating right now (I know, healthcare mandates and Medicare expansion are so alluring, right?). Anyway, here we go...

If we look to insurance as a sustainable model, premiums that are paid in should, over the long run, equal claims paid out. The cost of operations is covered by investment earnings on accumulated premiums. Thus, by including lower risk participants to the insurance pool, accumulated premiums are higher and investment earnings are sufficient to cover administrative costs and even expansion of the business. I am therefore puzzled, confused, some might even say be-fuddled why health insurance companies need to be in the public equity markets. The dual masters of insurance company management (policy holders and shareholders) lead to inefficient delivery and care decisions first driven by quarterly earnings results and quality care second. Healthcare is so vital to quality of life that the customers should not and cannot be separated from interests of ownership of the insurance company itself. Therefore, the insurance model for healthcare needs to follow some of its compatriots in the life insurance field. Health insurance companies need to be owned in a policy holder mutual company format.

Mutual companies align the interests of policy holders and ownership by allowing the policy holders to OWN the insurance company. Any excess profits can be returned to policy holders or held in reserves for future claims. Policy holders also have a say in management of the insurance company on an equal footing with all other policy holders. Overall, the company is capitalized of the policy holders, by the policy holders and for the policy holders (sorry Mr. Lincoln). This gives patients an ACTUAL VOICE in their care.

"Nice Adam, how do we do this?" you may ask. Well, we can vote with our feet. By flocking to providers who are mutuals, we can develop policy holder investor pools to align interests between patients and carriers. Legislation will, of course be necessary, but we can create a force that can be heard.

I realize this is short on details, but the concept of aligning interests is essential to long term sustainability. I will add more details over time, but for now, that is all I have to say about that.

Monday, December 7, 2009

Back in the saddle...

After the holiday week in which I only ran on Thanksgiving morning and the afternoon following that (I only got in 12 miles over the week) and taking all of last week off (worked out of town two days and was buried in the office the rest of the week), I finally got back to work this morning. This was monumental for me on two counts... First, I usually like to ease into the morning and secondly, I expected any workout after a week off to be utterly disappointing from both a progress as well as pain standpoint.

I usually get up early in the morning (5-ish) and like to start the day with NPR and some strong coffee. Getting to the office by 6 and settling in HAS BEEN my routine. It does not usually include movements other than bowel, so working out in the morning was a little bit of a shock to the system. I made sure that I was wearing my sweat pants to keep body temperatures up and started out with a quick quarter mile just to get the blood pumping. Then, about 40 minutes of PT (calesthenics (?) and stretching - 120 crunches variations, 6o push ups, 100 jumping jacks, etc.) and finishing up with an easy 3 mile jog. After all of that, I can say that I felt okay. Also, my time on the road was pretty good, even though it felt like I was really taking it easy. I got the run in under 9 minutes per mile; not very far, but good time nonetheless.

You will note that easing into the morning HAS BEEN my routine. I realize that this is only the first day, but I think this will work out pretty well for me. By not being afraid to try something new; kind of like meeting new people and being open minded, I found that a change in my routine was not as bad as I thought it would be. Anyway, tomorrow is 5 miles and a 1.5 mile swim. Wednesday is PT and lifting (circuit training to shock the system), Thursday is PT and 4 miles, Friday is 10 miles and Saturday is lifting, PT and swimming. Sunday I sleep. New things aren't always good, but I won't know until I try them. Excelsior!!!!!