What’s going to happen to us when we’re old?

Today’s health insurance premiums are about $14,000 per employee per year. This doubles roughly every 8 years and shows no evidence of getting cheaper. Most are predicting premiums will increase faster under health reform due to new unfunded mandates and regulations.

2020: $28,000
2030: $56,000
2040: $112,000
2050: $224,000

The median income is currently $31,100 and rises at around 3% for most of us. I wonder what’s going to happen to us when we’re 75 and need medical care most?

I propose changing our name from Gen X/Gen Y/Milennials to the Cleanup Generation.

I’m in Lucerne, Switzerland speaking at a conference today. This place is stunning.

Also interesting to note the challenges that the Swiss have in healthcare. They have a somewhat similar situation as the US:

  • they’ve been mandated to purchase private insurance since 1996
  • premiums have risen over 80% since then (our premiums double every 7 and a half years)
  • they’re getting increasingly angry about the high cost of health insurance, especially since the health insurance companies are seen as highly profitable

Switzerland has only about 8 million people but over 80 different private health insurance companies. And most everything here in Switzerland’s healthcare system is done on paper, no computers. It’s fascinating to see that everywhere, all over the world, healthcare is simply backwards. Nobody has gotten it right. I used to think that we can produce some fancy new technology using the internet to disrupt healthcare and make it more friendly and efficient, but it’s quite clear that a technological solution to a political problem will fail 99.9% of the time.

Dr. Martin A. Couney, known as the Incubator Doctor at Coney Island created the famous Incubator Baby Exhibits and charged a fee to the public to view the “Incubators with Living Infants!” A sign above the spectacle read “All the World Loves a Baby.” He simultaneously saved babies, created a revenue stream that paid for the preemies’ care, and also pioneered the field of neonatology.

In 2009, Kate Moss said “nothing tastes as good as skinny feels.”

In 1964, our Surgeon General said, smoking is bad for you. This was released when about 50% of all adults smoked. Now, in NYC, only about 12% of adults smoke. 46 years later.

Which one has the most influence over people? Pop culture vs. the surgeon general?

The issue of obesity is much, much more complicated than smoking. Smoking is one addictive behavior. Obesity is an entire ecosystem around you– your neighborhood, your means of transport, your corner store, your supermarket, your family, your culture, your attitude toward exercise, our media’s attitude toward skinny and overweight, our retail stores gradually increasing the measurements of a size to make us feel we’re not gaining weight, etc..

There is no quick fix to obesity.

So what does “quick” mean? In the world of smoking, quick meant 46 years to see a 38% decrease in a city with a very progressive, multi-factorial anti-smoking campaign. Regarding obesity, en masse behavior change takes generations. Just in the past decade, we’ve gotten the obesity conversation started. Hopefully, in 50 years and about the time I die, we’ll have seen a 38% decrease in obesity. 

It’s just important to have some perspective and keep the conversation, awareness, and inspiration going.

LinkedIn is the worst.

I deleted my account over a year ago. I went through all of the steps to delete it. I received a confirmation saying my profile was deleted. It has no value to me, just as Facebook has almost no value. These things are just unnecessary noise. If you friend me on Facebook, great, I’ll say yes, but it has no meaning to me. I had hundreds of “friends” on Facebook prior to the concept of privacy lists. The last thing I’m going to do is spend valuable time assigning 1846 “friends” different privacy settings. Facebook missed the window of utility with me.

I’ve said this before and I’ll say it again, there is no way computer algorithms can interpret the complexities of real human behavior, mores, and meaningful human relationships– especially when the entire business model revolves around selling me meaningless shit.

But it’s better than LinkedIn. Although I deleted my account over a year ago, I am still getting invitations from people who want to connect with me on LinkedIn. LinkedIn, leave me alone.

You’ll get medical care, but you’ll have to pay your own hard-earned money for service…

Buddy, my 5 year old never-been-sick dog, who likes swimming and rabbits, was on death’s door on Tuesday morning. He’d had diarrhea for a few days and then stopped eating and drinking. His eyes were so red they were almost bloody. His temperature was 105. He couldn’t walk. 

I was out of town in Houston. Kiley, who watches Buddy when I’m traveling, called me crying (she loves him so much). I told her to take him to the vet. She did. As I was heading to the airport to come back to NYC, the vet called and told me that Buddy was very, very sick and needed to go to the ER. He thought Buddy looked septic (an overwhelming bacterial blood infection) and he was very worried. Kiley rushed him to the dog ER in Cobble Hill. She called just a few minutes before my plane took off. She said they estimated a likely low end cost and a high end cost for Buddy’s care. At the low end, it was going to be $2200 for 3 nights of hospitalization, IV fluids, antibiotics, and everything else they needed to do. At the high end, it was estimated to cost $3400. They needed my card to guarantee at least the low end cost of his care. So my card was charged $2200.

Buddy made a fairly remarkable turnaround. His diagnosis: Rocky Mountain Spotted Fever, a tick-borne infection that sometimes causes a very quick demise with systemic vasculitis. I have no idea how he got a tick infected with Rickettsia rickettsii, he hasn’t been outside of Brooklyn for two months and I’ve never found a tick on him in his life. His blood vessels all over his body were wildly inflamed. Poor guy. He was super sick, miserable, and in massive pain.

But throughout the entire experience, the vet called me with every new detail keeping me up to date on every new development from blood tests to vitals to changes in his clinical appearance. 

The entire relationship between me and the vet was based on communication and customer service. 

At the end, the bill was itemized and totaled $1800. I got a refund of $400.

The difference between dog care and human care is:

I’m the customer.

I’m paying out of my own pocket for care, I’m paying for service, and I could just as easily go somewhere else next time Buddy needs good care. But, of course, the next time Buddy gets sick, I know that VERG will take super good care of Buddy and make sure they’re giving me the best service imaginable. 

Someone (update: it was blue_beetle) once said “if you’re not paying for something, you’re not the customer; you’re the product being sold.”

This is the future of medical care in America. Sure, we’ll get access to some care, but we’ll have to pay for attentive service, communication, meaningful relationships, and an overall great experience. There will soon be a widening gap between two American healthcare experiences:

  • The insurance company is the customer. This will be the dominant experience for most people because service, communication, and relationships will be too expensive. Insurance companies will pay the bare minimum to ensure you are one of the 40 patients your doctor will see that day. This is unsafe and inhumane.
  • You are the customer. This will be the ideal experience and will be expensive. You’ll have insurance, but you’ll also pay your own hard-earned cash for communication and customer service. You’ll be one of 10-15 patients your doctor sees that day. But you’ll also have a doctor that personally knows you and cares for you.

My entire career has been based on inspiring a better patient experience from my first practice to Hello Health, and to my latest projects I’ll be talking about soon. From the very beginning, I’ve fought to put the patient at the center of the experience and have built a few companies making sure this happened.

But it’s just so sad that often times dogs get better service than humans in America. Buddy is fortunate–he’s got an owner who can afford good care. But shouldn’t we all be able to afford good care? We spend almost $3 trillion a year on medical care. Where’s the value we’re getting from all this money? Shouldn’t we demand better?