I am so tired of politicians screaming like a bunch of kids ... for ice cream. “Medicare for all” and “pre-existing conditions” are the latest buzz words that our leaders in Washington are shouting from dawn to dusk. Unfortunately for Washington, however, every American is different and it is impossible to design a system without consideration for these differences.
Let’s start with the term “pre-existing conditions.” I agree that health insurance companies should not be able to pick and choose who to cover after a thorough “wallet biopsy.” As an example are those with chronic obstructive pulmonary disease, or COPD, an inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It’s caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at risk of developing heart disease, lung cancer and a variety of other conditions. But COPD is treatable. With proper management most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.
The question is not whether every person should have coverage but, rather, should every person pay the same premium? For the purposes of our discussion, I would like to introduce Bill Smith, Lucky Strike and Happy Camel.
Bill, Lucky and Happy have worked together for 25 years. Bill Smith works out every day, is at his ideal weight and has never smoked a cigarette. Lucky Strike is overweight, has not lifted anything heavier than 12 ounces in many years and smokes two packs per day. For the last 10 years Lucky Strike has been advised by his family and his physician to change his lifestyle. Happy Camel had a health scare about 10 years ago and has been following his doctor’s advice. Happy completely changed his lifestyle—no more smoking or drinking, no more fatty foods and he exercises daily. Bill, Lucky and Happy have the same insurance plan provided by their employer.
Let’s assume that our buddies each pay $500 per month for health insurance. Bill and Happy have not been to the hospital in the last year and have complied with physician recommendations. But Lucky has been diagnosed with COPD and has been in and out of the hospital three times during the last year. For argument’s sake, each hospital visit had an average cost of $15,000 ($45,000 for the year).
Shouldn’t the person choosing a riskier lifestyle after being told to quit smoking and to exercise pay more for coverage if he voluntarily elects to ignore all of the warning signs? Personal choices have consequences ... and if we are going to create a new health system for our country that reduces the overall cost of health care, it must include rewards for making good choices, and some penalties for making bad choices. Screaming “pre-existing conditions” is not going to reduce the cost of health care. We need intelligent discussions on how to make a better system. Tell Washington to stop screaming for ice cream and get to work on solving real problems. Although the next thing you will probably hear is our legislators singing “99 bottles of beer on the wall...”
Risk factors for you includeHigh blood pressure; your heart works harder than it has to.
Coronary artery disease. Narrowed arteries may limit your heart’s supply of oxygen-rich blood, resulting in a weakened heart muscle.
Heart attack, a form of coronary disease that occurs suddenly. Damage to your heart muscle from a heart attack may mean it can no longer pump as well as it should.
Diabetes, increases your risk of high blood pressure and coronary artery disease.
Some diabetes medications. The diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) have been found to increase the risk of heart failure in some people. Don’t stop taking these medications on your own, though. If you’re taking them discuss with your doctor whether you need to make any changes.
Certain medications may lead to heart failure or heart problems. Medications that may increase the risk of heart problems include nonsteroidal anti-inflammatory drugs (NSAIDs); certain anesthesia medications; some anti-arrhythmic medications; certain medications used to treat high blood pressure, cancer, blood conditions, neurological conditions, psychiatric conditions, lung conditions, urological conditions, inflammatory conditions and infections; and other prescription and over-the-counter medications. Don’t stop taking any medications on your own. If you have questions about medications you’re taking, discuss with your doctor whether he or she recommends any changes.
Sleep apnea. The inability to breathe properly while you sleep at night results in low blood oxygen levels and increased risk of abnormal heart rhythms. Both of these problems can weaken the heart.
Congenital heart defects. Some of us are born with structural heart defects.
Valvular heart disease presents a higher risk of heart failure.
Viruses—a viral infection may have damaged your heart muscle.
Alcohol overuse can weaken the heart muscle and lead to heart failure.
Tobacco use increases your risk of heart failure.
Obesity presents a higher risk of developing heart failure.
Irregular heartbeats, especially if they are very frequent and fast, can weaken the heart muscle and cause heart failure.
Vincent Sica is CEO for DeSoto Memorial Hospital.