NOT BANKRUPT!

A long time ago, I was involved with some “celebrity software” called MANAGING YOUR MONEY.  The original idea was to have Julia Childs (or somebody) for cooking software, Tiger Woods (had he been born at the time) for golf software, and so on.  As it happened, the company only got two so-called celebrities: Jim Fixx — a lovely man credited with having helped launch America’s fitness revolution by demonstrating the health benefits of jogging — and me.

The two of us were pictured together in four-color ads until, about a month into actual sale of the software, Jim died . . . while jogging.

Yes, heart disease apparently ran in his family, but that’s a mixed marketing message at best (“fitness tips from the expert who, had he not practiced them himself, might have died even younger”).

Sales of Jim’s software were halted, and days later the publisher asked me to take a physical for the $5 million life insurance policy they had suddenly decided I should have.

“Oh, please,” I remember saying at the time.  “It won’t make any difference to you if I dieThat won’t hurt sales.  Dying would be fine. What you don’t want me to do, with my money management software, is go bankrupt.”

I was reminded of this today when Craig D. wrote me, triumphantly:  “Your beloved Paul Krugman has filed for bankruptcy.  I guess the people that peddle fear really don’t know how the markets work.”

He included this link, with reporting so detailed and seemingly well sourced that I had a really sick feeling — Paul Krugman IS one of my heroes — until I checked and found that the story had come from a site that describes itself as an “online satirical newspaper” whose “stories are purely fictional.”

Even so, it got picked up as real by sites such as The Prudent Investor; and it spread, perhaps abetted by people all too eager to believe it … prompting the Washington Post to set the record straight.

But these things, once launched, never die.  Professor Krugman’s fictional Chapter 13 filing may now ricochet around the Internet forever, as so many things like this do.

Still, you should know that the Nobel laureate seems entirely solvent and (in stark contrast to the satire) quite modest in his lifestyle.  I encountered him once on his way home from a fancy charity function he had graciously volunteered his time to headline.  Where did I encounter him?  On the subway platform, waiting, alone, for his train.

HEALTH CARE

Even before failing to code my way out of a paper bag with MANAGING YOUR MONEY (we had some brilliant young programmers to do that; all I had to do was ask questions like, “could it handle return-of-capital distributions?” and they would figure out a way to make it handle return-of-capital distributions), I wrote a book about the insurance industry.  Indeed, every aspect of the business — life insurance, auto insurance, credit insurance, homeowner’s insurance, flood insurance, Lloyd’s of London, insurance fraud, and on and on — except one.  I just couldn’t get my head around it: health insurance.  It was too big and complex and, unlike all the other lines, where I felt I knew exactly what was wrong and how to fix it, I hadn’t a clue.

And so it is with special admiration that I have been recommending my pal David Goldhill’s brilliant book, Catastrophic Care: How American Health Care Killed My Father — And How We Can Fix it and my pal Steve Brill’s game-changing 24,000-word cover story in Time — well worth the full read.  (Guess who turns out to be the efficient penny-pinching hero.  Medicare!)

GREAT BOOK

And now I have a third recommendation, thanks to John Seiffer, who writes:  “If you’re looking for books to understand (and ideas to maybe fix) the US healthcare system you can’t do better than The Healing of America by T.R. Reid.   He takes his sore shoulder to all the major industrialized countries (as well as India) and tries out the local health care system in each. He also does research on how the systems work, and the history of how it came to be the way it is. I was surprised at the difference in these systems, all of which have universal health care, better health outcomes than the US and lower costs.  Some have more choice than we do, some have shorter wait times, some are all private, some all public, some a mix.   What they all have in common is this:  1. They made a choice for universal coverage on moral not economic grounds;  2. They all limit the abilities of insurance companies to profit from people’s sickness.  As for his shoulder? He didn’t have the major reconstructive surgery that was recommended in some countries (but not others).  The only place that made it feel better was India where he was subjected to a week of a strange diet and regular massage. Go figure.”

It begins:

If Nikki White had been a resident of any other rich country, she would be alive today.

Around the time she graduated from college, Monique A. “Nikki” White contracted systemic lupus erythematosis; that’s a serious disease, but one that modern medicine knows how to manage. If this bright, feisty, dazzling young woman had lived in, say, Japan – the world’s second richest nation – or Germany (third richest), or Britain, France, Italy, Spain, Canada, Sweden, etc., the healthcare systems there would have given her the standard treatment for lupus, and she could have lived a normal lifespan. But Nikki White was a citizen of the world’s richest country, the United States of America.  Once she was sick, she couldn’t get health insurance. Like tens of millions of her fellow Americans, she had too much money to qualify for healthcare under welfare, but too little money to pay for the drugs and doctors she needed to stay alive. She spent the last months of her life frantically writing letters and filling out forms, pleading for help.  When she died, Nikki White was 32 years old.

Maybe the solution isn’t repealing Obamacare and leaning more heavily on a free market for private insurance.

CHEAP DRUGS

Thanks to ABC News for alerting us to GoodRx.    On your phone, this app maps the neighboring pharmacies with competing prices for the prescription you’re aiming to get filled.

THE DOCTOR-PATIENT RELATIONSHIP

Dr. Richard Feinberg: “I am still reading Steve Brill’s cover story.  One thing seems missing to me . . . the doctor-patient relationship. Patient behavior and provider performance drive the majority of healthcare cost.  What if just half the people who die from cancer each year actually had an end-of-life conversation with their doctor?  It turns out that most of our healthcare dollar is spent during the last year of life.  If we can get the laws to allow providers, patient, and family to focus more on quality of life instead of length, huge savings could be realized.  And we are discovering that doctors making home visits can be a big saver.  Think about all the ER and hospital expenses that can be prevented.  Likewise, patient health illiteracy is a major cause of inferior clinical and economic outcomes and most of our efforts to correct the problem have failed miserably. It now seems clear that patients are not going to be engaged and invested unless it is their doctor who is helping.   The doctor-patient relationship remains the centerpiece of quality healthcare. Strengthening that core will save big money.  Some analyses suggest that implementing many of the current proposals to save money will have the effect of reducing doctor-patient face-to-face time. We need to design our fixes to expand it.”

And by the way?  In my experience, face time with an unhurried, knowledgeable, caring, experienced nurse can be nearly, or every bit, as good.

 

 

 

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