The Reformation of Healthcare – Part I

I foreswore using bad language in the New Year, so suffice it to say that the healthcare system in this country is a catastrophic mess that will one day collapse of its own onerous weight.   I liken the current system to a giant ball of tangled twine.  Trying to untangle the mess to make the system work is nearly impossible and even trying to fix the system is bound to hurt someone.  Obamacare may have been well intentioned, but it has made things worse.

The first thing that should be perfectly clear is that healthcare is different than any other marketplace. There are numerous players, including doctors, hospitals, specialist providers, government, insurance companies, drug and device companies, pharmacies and lawyers, who theoretically work as advocates for good patient care. At the center is supposed to be the patient.  But let’s face it, from a purely free-market capitalist business perspective, all the players in the industry are going to do what is in their own best interest and those interests are frequently in conflict with what is best for the patient or the healthcare system itself.

When you need medical services, you’ll pay almost anything to save or extend your life!  You don’t go to the emergency room for a heart attack and negotiate your treatment cost before submitting to by-pass surgery!  Obtaining life-saving services at the nearest hospital is what you do.  It’s not like shopping for a car, where at least you have the option of walking out or postponing your purchase, if you don’t agree to the price.

The other thing to recognize about the healthcare system is that most of the dollars we spend are at the end of life. Five percent of the population accounts for more than half the annual cost of healthcare. Eighty percent of the population in the United States is healthy and does not spend significantly on healthcare. 

Today we have a system that revolves around reimbursement rates for services rendered (a fee for service system). That came about thanks to the creation of Medicare, which started in 1966 with a $75 billion budget.  This year Medicare will cost us nearly $600 billion. That is quite a number and a major reason we are running a gigantic federal deficit. Medicare and Medicaid currently account for 23 percent in Federal spending.

In today’s system the question healthcare providers most what to know is “who is paying” for services to determine what can be charged. If you are a Medicare patient, you pay one price, if you are privately insured, you pay a different (usually higher) price, if you pay cash, that’s yet another price.  If you have no insurance, you pay full boat, file for bankruptcy, and the provider writes it off a ridiculously inflated amount as uncollectible. Onerous medical bills are the single biggest reason people file for bankruptcy in this country.

Imagine if you went to the grocery store and the Cashier had different prices depending upon how you are paying.  The scene would play out something like this. Cashier: “And how are you paying for your groceries today: cash or card?”  Shopper: “I’ll pay by card.”  Cashier: “In that case your groceries will cost $1,000. Just slide your card here.” Shopper: “Hold on a second, what if I pay cash?” Cashier: “If you are paying by cash, the bill comes to $200.”

The concept of charging different prices depending on who is paying or how you are paying is ludicrous, but that is essentially how our system works today.

Why does the payer matter?  Because different insurances offer different reimbursement rates negotiated with providers.  Medicare offers non-negotiable, take it or leave it reimbursement rates, decided by committee, on a fee for service basis. Never mind that the reimbursement rates Medicare offers may not reflect market forces of supply and demand. Keeping rates low is politically popular, so the government has, by fiat, for example, reduced the rates it pays primary care physicians to the point where no physician can make a reasonable living working on his own in private practice, as they once did.

What results is, effectively, invisible medical breadlines.  We don’t see people lined up outside a doctor’s office waiting to get in, but try to get a non-emergency appointment to see a primary care physician and you’ll find the earliest date is three months hence, if you can get in at all.

The system is beginning to fail at the worst possible moment as more and more qualified physicians retire along with the aging baby boom population. You are already beginning to see nurse practitioners substituting or being mixed in with fully licensed, board certified medical doctors. This is not a knock on nurse practitioners, but a recognition of the reality that we simply don’t have sufficient numbers of fully qualified people entering medicine to look after our aging population.  It’s a looming disaster unfolding before our very eyes.

  

To be continued…..

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Planning for the Future

I have frequently written about the need to plan your life and not be a floating feather on the breeze, as the life of Forest Gump was portrayed.  It seemed Forest always landed in the right place at the right time.  Despite his physical and mental challenges, he lived a kind of charmed life that most of us would envy.  Forest had no long-term plans.  For him, “life was like a box of chocolates…you never know what you’re going to get”. The fictional character is rewarded by blessings and good fortune as he floated through life. Life tragedies become new opportunities as he proceeds from one phase of his life to the next.

In the real world, of course, we don’t bank on winning the lottery to achieve our goals. We realize our dreams and ambitions through our own hard work and determination.  It’s nice to be lucky, but we don’t count on it. In the normal course of our life we figure out the steps necessary to succeed and, one by one, take those steps toward realizing our goals.

The life you lead has a lot to do with the choices you make.  Luck plays a part, and I know I am blessed, but as my father would often say, “you make your own luck”. I would add, “… both good and bad”.

When I was diagnosed with lung cancer, the cruelest side effect was my inability to plan ahead.  I was stuck scheduling my life around treatments and doctor appointments. I could not think past the next month, not knowing what would come next.  It took time for me to look beyond a year, and ever since I won back my life, I have not stopped planning for what comes next.  It’s a blessing to once again have the ability to plan for the future. No one is going to live forever, but we will live longer and happier lives if we wake up each day with purpose.

I have exactly 1728 days to my retirement date of October 16, 2020. Between now and then I am planning to continue to live an active life and travel as much as I can.  But I am not waiting until I retire to hit all the travel destinations on my bucket list. What if I relapse before I retire? What if my health declines to the point where I can’t travel anymore? I don’t want to take the chance of not living out some of my life’s ambitions.

Growing up I wanted to work in international business and travel the world. I realized that ambition in the first half of my career.  Circumstances lead me to leave Japan and return to the US to be near my parents here in Florida.  But my dreams of living an international life have never really faded.

Yoko can attest to the fact that I frequently wake up dreaming about Japan, a place where I lived a good portion of my adult life. But I also have a deep desire to see other places around the world.  When I worked in Tokyo, I frequented countries on the Pacific Rim, including China, Korea, Hong Kong, Taiwan, The Philippines, Thailand, and Singapore. I still want to take the Trans-Siberian Railroad from Vladivostok to Moscow.  I have also dreamed about riding horseback in Mongolia, visiting India and Nepal, and going on an African safari.  I also want to walk the Camino de Santiago in Spain. Maybe one day I will. 

My daughter June and her betrothed are planning a fall wedding in Jackson Hole, Wyoming this year.  It is one of the most beautiful spots on the face of the earth, where we once had a second home.  I am looking forward to an intimate wedding celebration with our closest friends and family this fall.  June will be the last of my three daughters to get married, marking another milestone in my post-cancer life.

Today I made reservations to take a 15 day tour of the Holy Land. The excursion takes us to Egypt, Jordan, and Israel, following the biblical path of the exodus. After that we plan to fly to Dubai for a little rest and relaxation before returning home. Yoko and I have talked about going to Middle East for years. We’ve now finally made plans to do it and I’m pumped for yet one more life adventure!

Behavior Change for a Healthier Life

Every year I write about the New Year resolutions I have adopted.  It’s a good tradition to encourage people to work on improving their life in just one or two ways. This year my resolution is to become a better person in every way I can. I know what my faults are and I am trying to correct them.

For motivation I have resolved to read a daily devotional from the bible and to eliminate swearing and bad language from my vocabulary – especially on the golf course! Most important, I am working to improve the relationship I have with my family, starting with my wife and children, who I love.

I quit smoking as a result of a New Year’s resolution 10 years ago, so I know that making a resolution can change my behavior and my life for the better.

In prior years, I resolved to do things like become healthier through aerobic exercise. I have still not made aerobic exercise a habit, although I am walking about a mile every day in my daily routine.  I am resolved to double the distance by walking the dog twice a day instead of just once.  I am tracking my progress with the iPhone Health app.

I am also trying to reduce my weight, which had inched up to 184 pounds.  I want to get back down to 170.  I’ve already lost 9 pounds by eating right, reducing my intake of alcohol and sugary drinks, and walking a bit every day. Right now my body mass index is 24.6, just barely under the benchmark to being overweight.  Getting down to 170 should not be hard if I follow the Japanese saying to “eat 80 percent of full”, endeavor to eat a balanced diet three times a day, and do some light exercise, like walking.

I spent the Christmas and the New Year holidays in Japan with my wife and her family. The last time I was in Tokyo was August of 2004.  On this year’s trip Yoko and went on a nostalgia tour all our old haunts to see how things had changed. That day I walked nearly 17,000 paces.

The first thing I noticed was how clean the city is. There is no garbage in the streets or cigarette butts on the ground. No one is smoking and to the extent there is anyone smoking in public, it is behind a designated smoking area.  That is a vast improvement from the days I lived in Tokyo, when people smoked everywhere and anywhere.  Even my brother-in-law, who was a devoted nicotine addict, has finally quit.  Cigarette smoking is no longer socially acceptable in Japan.

I averaged about 8000 paces a day walking around Tokyo, versus about 3000 paces a day on average since I’ve returned.  My 3000 daily paces at home includes 1700 paces walking the dog. If I didn’t walk the dog, I’d only be walking 1200 paces a day!

I don’t think I saw an overweight person in Japan the whole time I was there. People look healthy and it appears that they are consciously cutting back on unhealthy habits.  It got me to wondering why we can’t get our act together here.

We have become one of the most obese societies in the world, despite the movement to improve nutrition and exercise. Unhealthy lifestyles is leaving to high healthcare costs. Dr. Thomas Weiss, CEO of Naples Community Hospital says “we (the hospital) needs to get out of the repair business and into the maintenance business.”

The reasons we are obese are obvious: overeating (portions too large); too much sweets and processed foods vs. fresh fruits and vegetables, high stress in our daily life, lack of exercise in our daily routine, and our increasingly sedentary lifestyle thanks to technology (i.e. too much screen time).  The jobs we have today are not as physically taxing as they once were.

For the past few years I have been a member of CHIP (Charlotte Health Improvement Partnership) whose mission is to improve the overall health of Charlotte County. Recently I suggested that CHIP consider undertaking the “Blue Zone Project”, which is based on the findings of Dan Buettner who travelled the world for National Geographic to see why people in certain locations around the world tend to live longer and happier lives.

Buettner was looking for the commonalities that made Blue Zones healthier places to live. After identifying 5 of the world’s Blue Zones, Dan and National Geographic took teams of scientists to each location to identify lifestyle characteristics that might explain longevity.  They came up with nine factors that appear to be the common elements for producing longer, happier lives.

It is natural to want to improve your life to be both healthier and happier.  The beginning of a new year is a great time to resolve to do better. If you are looking for a new year’s resolution to improve your life visit www.bluezone.com  and learn about the Power 9. It is time to get involved and get healthy!

Giving Thanks to All

I haven’t had a chance to say THANK YOU to everyone that supported our efforts this year to raise lung cancer awareness and promote screening and early detection.  Right after the November 7^th 5K Run/Walk, Yoko and I went on a four-day cruise to the Bahamas'. When we got back, I took off for a weekend in Columbus Ohio to reunite with college friends.   After that came Thanksgiving. We visited Orlando to see two of our daughters and share the weekend with their families. Yes, I have been in “go mode” pretty much non-stop since the race, so I’ve had no time to write!

I still don’t have a final accounting, but as of this date I think our 5K Run/Walk raised something on the order of $55,000 and netted $30,000 thanks to the support of our sponsors, 38 fundraising teams and our 50 volunteers!  Every cent we raise helps the cause of promoting lung cancer screening and early detection in order to reduce lung cancer mortality and save or extend lives. 

The Lung Cancer Research Council had a few small but exciting successes in 2015.  We partnered with The National Comprehensive Cancer Network (NCCN) to produce the Non-Small Cell Patient Guide, which is now being distributed nationally.  Our next project with NCCN for early 2016 is to sponsor their Lung Cancer Screening Guidelines for Physicians, which will also be distributed throughout the country. NCCN is the world’s foremost leader in producing screening guidelines.

I recently had lunch with the CEOs of both Millennium and Fawcett Memorial Hospital to talk about what more we could do to increase lung cancer screening here in Charlotte County.   Millennium has now has built lung cancer screening questions into their electronic medical records and has installed low-dose CT equipment in several locations, including Port Charlotte and Naples.  The group is expected to be up-and running to schedule patient screenings this week. Please speak with your Millennium Group Physician about getting screened.

The question that arises next is, what happens if you get screened and a nodule is found?  What are the next steps that need to be taken?  Once cancer is found, someone needs to be quarterbacking care, since a lung cancer diagnosis will frequently involve many specialist physicians, including oncologists, radiologists, pulmonologists, radiology oncologists, surgeons, cardiologists, endocrinologists, etc.  Cancer centers, like Moffitt, generally have better outcomes for patients because they provide coordinated care.  Unfortunately, cancer centers are hard to access. What we want to create in Charlotte County is virtual coordinated care.    Millennium Physicians Group has a newly employed nurse navigator for just this purpose.  What we’ve been talking about with Millennium, Fawcett, and Florida Cancer Specialists is how to expand coordinated care throughout Charlotte County to improve patient outcomes.  I hope I’ll have more to say about this as we enter the New Year.  Suffice it to say, we are making progress and I am hopeful that more people are going to survive lung cancer in the future.

I read an article not too long ago where Goldman Sachs is predicting  that mortality from all cancers will be greatly reduced in the future thanks to cloud computing.  The results of genetic testing on tumors is being shared via the internet with an ever expanding database of patients. The result is that, more and more, figuring out what drugs will work for a given cancer is no longer going to be a just guessing game. Database evidence and highly personalized cancer care holds the promise of our finally making the progress in the War on Cancer we had hoped for when the effort was started back in 1971.

A good friend of mine came to the office a month ago and handed me a small leather-bound book he had purchased as a gift for me called “A Focused Life.”  The book is composed of 30 chapters intended to be read as a daily devotional over the course of thirty days.  I have been faithfully reading a chapter each day and praying for all those I love. Call it a coincidence, but one of the people for whom I say a daily prayer is my friend Marc Cohen.  Marc has been valiantly battling Stage IV lung cancer now for four years.  He shared with me this week that he is officially in remission. Praise God!

I also received a today message from a total stranger, Nell Yang, who lives in California. Nell was diagnosed with Stage IV lung cancer recently, after having survived a Stage I-B diagnosis back in 2011.  She writes: Had I read your book back in 2011, I would have done things quite differently. I am re-reading your book and now hanging on every word.”

Proverbs 1:33 says “But all who listen to me will live in peace, untroubled by fear of harm.” I pray all my readers have a Merry Christmas and good health and happiness in the New Year!

Ideas for Creating Awareness

Saturday November 7th is the SWFL Lung Cancer Run/Walk and Mile of Memories Memorial Walk, commemorating the start of Lung Cancer Awareness Month.  I’ve worked hard all year to make this race the biggest event it can be, but as of this writing, it may turn out to be the smallest event since I started running this race in 2009.  If you are reading this story, please come out to show your support, even if it is just to be there for the 30 minute rally at the end of the race (around 9:30 AM).

We’ve had a relatively small group of walkers and runners pre-register for the event, compared to years gone by. It’s discouraging, especially since we have a large e-mail distribution list with the names of people who have participated in the past.  I’m not sure I know why paid registrations are so low. Maybe people are just tired of running and are looking for something different to do?

I had a series of live interviews with Wink TV this morning and the interviewer, John Trierweiler, suggested that we should to do is organize a race to the top of a tall building, like they do in Chicago.  Only one problem; in Charlotte County we don’t have tall buildings.

There is an event called “Shine a Light on Lung Cancer” where advocates in Boston get building owners and tenants to leave their lights on overnight in the shape of a ribbon. It’s another good idea, but, again, we don’t have the buildings to do it. Maybe someone at Cheney Bros. new distribution facility who reads this column, could suggest to management that they project a giant white ribbon on their new building so people driving up and down I75 can see it at night?  That could help shine a light on lung cancer. How about it Cheney Brothers?

I don’t know who to talk to at the Punta Gorda Post Office, but management there needs to know that I noticed the store front was decked out in pink the entire month of October. I wonder what the Punta Gorda Post Office going to do for women with lung cancer in November? If you stop in there this month, please ask.

I know the White House was lit up in pink in October.  Since pearl white is the color of lung cancer and the White House is already lit up white all year long, could we just declare the White House to be the “Lung Cancer White” House in November?  I’m sure some creative mind in Washington D.C. could come up with something to recognize lung cancer awareness month.

Last year at this time I went to the NY Stock Exchange with the hopes of ringing the opening bell. There was a chance we could have done that, had we not gotten bumped by an IPO.  Oh well, at least Yoko and I got to see the Book of Mormon on Broadway and have some excellent meals.

Since we are having poor participation at the annual race this year, I’ve been thinking of other ways to make a statement.  One idea was to create 460 cardboard angels to sit in the stands.  These would represent the number of people we lost to lung cancer in Charlotte County this year alone. I wish I had thought of this eight years ago.  By now we could fill the stadium with those unnamed angels. 

I saw an article in the newspaper about a grieving husband suing R.J. Reynolds here in Charlotte County claiming tobacco products caused the death of his wife. The verdict assigned the wife 98% blame for causing her own death by smoking. The plaintiff was awarded $5000. That verdict pretty well sums up people’s attitude. Didn’t the jury know that R.J. Reynolds had purposely made their products more addictive?  I called Morgan and Morgan this week to see if I could bring my own lawsuit, but they turned me down flat.  I explained that I don’t want the money, just the publicity.

Anyway, as you can tell, I am raging an uphill battle. Right now it feels like I am not winning.  But it doesn’t matter.  If I am unable to light a fire under people to care passionately about this issue, so be it.  People’s indifference won’t deter me from trying, because I know in my heart that what I am trying to do does matter. 

If you want to join me to make a difference, wear a white ribbon on your lapel this month and let people know you support the fight against lung cancer. Thank you for your support!

One Day at a Time

I’ve been campaigning as a lung cancer advocate since 2009, when I organized a run/walk to raise awareness during November, which is lung cancer awareness month.  That first race was a great success, raising over $50,000 in just one day.  This year I will organize my seventh race and hope to raise $70,000 when all is said and done. In the first four years the money raised by the race was used to support the National Lung Cancer Partnership’s program to fund lung cancer research by young investigators.  In the last three years, we have used the race to fund my charity’s programs to raise awareness and promote screening and early detection.

Lung cancer screening using low-dose CT scan is now accepted medical protocol. Our mission is to make sure that people most at risk of developing lung cancer (former smokers and current smokers over the age of 55) are aware of the need to get an annual screening.

Putting on a race is a big undertaking that requires a lot of effort, day by day, all year long. We’ve been working on a new and improved website since January. The website is designed to be a resource for anyone diagnosed with lung cancer. Check it out at www.lungcancerresearchcouncil.org .

Under the tab “Support/Resources” you will find a link to the newly revised NCCN Patient Guide for Non-Small Cell Lung Cancer, sponsored by The Lung Cancer Research Council and Lung Cancer Alliance. The Guide is free and provides 122 pages of essential information about lung cancer that every newly diagnosed patient and caregiver needs to know, including what lung cancer is, how it is staged, treatment options, and making treatment decisions.  I would have been glad to have this resource when I was diagnosed. Copies of the guide is also available in print at Amazon.com.

What we are doing is a lot of effort and expense and I’ve sometimes wondered if we are making any difference. I am learning that, in fact, our efforts are beginning to make difference, albeit on a small scale.   

I received a letter by e-mail not too long ago from woman thanking me for alerting smokers and former smokers over the age of 55 about getting an annual screening for lung cancer. The column I wrote last year inspired her to get screened, which resulted in her finding early stage lung cancer last December at the age 72.  Thankfully, because it was found early, she was a candidate to have the cancer surgically removed and now has a good prognosis for living a much longer life.  It only takes something over 300 screenings of high risk individuals to find one lung cancer. By comparison, you need to screen 1000 women to find one breast cancer. The trick is getting the people at risk educated to act. By the time you become symptomatic it may be too late!

Last week I went on Facebook to promote our November 7^th run/walk and discovered 15 messages, some more than a year old, from people I did not know. I had no idea that complete strangers were trying to reach me by messenger on Facebook to talk about their lung cancer diagnosis.  One message was from a 9/11 NYC fireman’s cousin, looking for some hope. She had found my book “Living with Lung Cancer – My Journey” and wanted me to speak with her fireman cousin to give him hope. Unfortunately, by the time I responded, her cousin Chris had already passed.  

In another message, a woman from Boston reached out to me to tell me she was writing a lung cancer book of her own. She wanted tips on getting published so this weekend we spoke by phone.  I learned that she is a 50 year old single mother of two who never smoked.  She was diagnosed four years ago, at the age of 46, with Stage II lung cancer.  Tragically, she lost her husband in a car accident the year after she was diagnosed. She was formally a financial advisor and quit her very good paying job to be a stay at home mom.  Now she is struggling to get back on her feet financially.  She called me to thank me for giving her hope and offered to help The Lung Cancer Research Council get started in Boston.  That gave me hope this week, that we are, indeed, making progress, day by day, one day at a time.

60th Birthday Bash

It’s official.  I am now over the age of 60 and racing toward the last and best (I hope) years of my life. Yoko and I spent a very special birthday weekend at my sister’s new home outside of Philadelphia. I want to share with you some of what we did.

We left from Ft. Myers on Wednesday evening and arrived in Philadelphia around mid-night.  My daughter June, who lives in Hawaii, was waiting at the airport hotel when we arrived!  June’s joining the festivities was supposed to be a surprise, but my sister, Jane, let the cat out of the bag when she texted me asking when June would be arriving! Up to that point I had no idea that my daughter would be coming to spend the weekend! She had been in Seattle on business and decided to fly to Philly to join the celebration. God bless!  What a nice thing to do!

On Thursday morning we drove to the gravesite of my mother and father, who are interned at Whitemarsh Memorial Cemetery, in Horsham. It was the first time for me to visit both my Mom and Dad at the cemetery, so it was a tearful reunion. Dad died at the age of 76 in 2002 and Mom passed away at 90 years of age in 2014. I think about my parents every day and the sacrifices they made to raise five children.  If they were still alive, I would thank them for everything they did and let them know how much I loved them. They will always be with me in my heart.

After an emotional visit to the cemetery, we drove a nostalgic tour of the area where I grew up.  I made arrangements to see my other set of parents, Victor and Eileen Friscia, who are now in their 80’s and in failing health. I have been a close friend of their daughter since high school.  I was so close to Vic and Eileen that I considered them to be my alternate parents. I always addressed them as Mom and Dad Friscia. Their bodies are now failing, but thankfully, their minds are as sharp as ever, so we had an enjoyable visit. They were in their 40s when I first knew them and they are still in the same house 49 years later! I hope I am doing as well just 20 years from now.

I dropped Yoko and June off at Starbucks, so I could attend a meeting with NCCN (The National Comprehensive Cancer Network) based in Ft. Washington, PA.  It turns out the NCCN’s headquarters is just down the street from where my Dad worked! I consider it a God wink that, here I am, 40 years later, meeting with an important cancer organization about promoting lung cancer screening and early detection after having just left Mom and Dad Friscia who warned me about the dangers of smoking when I was in high school!  Talk about full circle!

I woke up at 5 AM Friday morning to a vibrating phone and Facebook messages wishing me a happy birthday!  The messages came pouring in from all over the world literally all day long, from people I have not seen or heard from in a very long time.  It made me realize of how many friends I have made in the many places I have lived over the years. It was nice to know so many people bothered to send a “1” for Happy Birthday, or took time to send a short personal message.

The highlight of the trip, however, was dinner Friday night, hosted by my two sisters and their husbands and including myself, Yoko and June.  We ate at R2L, a high-end restaurant on the 37^th floor of a Philadelphia skyscraper overlooking the city.  We ate and laughed and toasted throughout the night.  At the end of the evening, after desert was served, I was surprised by my daughter June who presented me a bag full of small gifts numbered one thru nine.  These were accompanied by a letter from all three of my daughters who had written nine paragraphs about things they learned from me over their collective 90 years. I was instructed to read the letter one paragraph at a time and then open the accompanying gift. 

It was the most thoughtful idea for a gift I have ever received from my children. I was choked with emotion and practically speechless as I read their touching letter.  It is every father’s dream to have children who appreciate them. To know they do so while I am lucky enough to still be alive is extra special and very poignant.