$12K For 25 Stitches: American Healthcare is Broken (Part 1)

Part One of several posts about how health care can be a heck of a lot better in this country.

It’s about the least surprising thing to say when talking about health and medicine in the western world: it’s totally fucked up. The system doesn’t serve people in the best way for their health, opting instead in many cases for pure survival. And that’s just the actual medical establishment, the place folks end up when something is going really wrong, whether it’s emergency trauma or the culmination of a chronic illness.

The pieces of health are not just what it takes to not “spend your last 10 years in a diaper and a wheelchair” (a genius post by Chris Kresser, who lured me into a lot of this research about 5 years ago by those very words). No, the pieces of health are far larger than just showing up at the doc’s office or the hospital when things are really wrong (or even just somewhat painful).

Emergency medicine in our society is extremely effective (and expensive), so if you are in a car crash, even if you don’t have money, you can and will get “fixed”. That means you’ll have bones pinned together, skin sewn up, fluids replaced, and (hopefully) infections prevented or addressed.

Original source: Broken Heart Source Image

Original source: Broken Heart Source Image

But even if you are faced with a relative trauma, the current state of the system can take down to slivers the savings of most average adults. Take, for example, something that happened just a few days ago at a massive health conference in Austin, TX called Paleo f(x). Darryl Edwards, one of the activity gurus, ended up with a mis-timed head butt and split open his eyelid. He didn’t think it would need intervention at first, but then he was convinced it wasn’t just a scratch by folks who kept noticing the bleeding gash.

Once he finally figured out that he really did need stitches, someone wanted him to get an ambulance. BUT. Because Darryl is from the UK, an ambulance would be about $4K right out of his pocket. Ok, so he should find someone to drive him to the ER. BUT. Emergency rooms have pretty long wait times. It was suggested, “go to urgent care”. Finally, word got around to the wife of a local dermatologist. He was taken right to their office and was taken care of, sewn right up to the tune of 25 stitches as a favor to a fellow health guru for no charge. The dermatologist told him that it would normally cost about $12K. TWELVE THOUSAND DOLLARS.

Even before the ambulance when it was looking like $4K out of his pocket, Darryl considered getting on a first class plane back to UK so that he could walk into a local doc and get things taken care of for free. The fact that someone without insurance considers a transatlantic flight in order to NOT spend about $16K on stitches is, a little, crazy.

In the next few blog posts I’ll go from panic-inducing examples like this to somewhat of a means to a solution. It involves the word OWNERSHIP. And we’ll get there.

Get What You Pay For: Reality Bites vs Awesome

This has to be the most perfectly concise summary of why it is sometimes/often/always a really freakin’ good idea to pay someone else to do something that you need done that THEY are good at doing:

“Wait, can’t I just <do that thing> myself, for free?”

Yes, you can. But you haven’t, and you never will. 

That thing can be anything. Building an exercise plan. Painting the house. Picking stocks. Researching a major purchase. Finding a great partner. Putting up your website. Negotiating business terms. Changing your car’s oil. Cooking healthy food. Going to the dentist. OK, OK, I guess you can’t literally outsource going to the dentist, but at least getting the appointment scheduled could be handled by someone else if you are prone to not doing it at all otherwise. The last part is key. It’s one thing to farm out tasks that you do get done, albeit slowly, to a faster operator. It’s another thing to hire out the tasks you will eventually get done but HATE doing (taxes!) just to take some stress off, if you can afford it.

But it is a whole new ballgame to recognize the things that need getting done if you are to get where you want to go that you simply will not do, based on your own history and knowledge of  yourself and your prioritization tendencies.

And that’s all for me for today, folks. I can’t put it any better than that. And yes, I might just pay the guy who wrote that to do what he does best so that I stop NOT doing that thing on my own time.

Nudging The Ones You Love

idea generation

Effecting change is a wish of many of us. But usually it remains a wish, and often it can become a burden, an annoyance, an irritating behavior, and a pestilence. Why? In the way-smarter-than-me words of Seth Godin (from his book Tribes, and from his blog):

People don’t believe what you tell them.  They rarely believe what you show them.  They often believe what their friends tell them.  They always believe what they tell themselves. 

I think the biggest long term impact is to somehow change their behaviors without forcing the issue. Nudge-like stuff. Change is hard. Really freaking  hard – James Altucher says so. And I like James. Because he writes silly and interesting things about dead bodies, sometimes.

In the realm of changes toward more physical activity, especially in the evening, here are some ideas I’ve had recently. Start by setting positive context for behaviors that will lead to better health, happiness, mobility, and on (which doesn’t have to mean weight loss, but could):

  • after a meal, “I feel like a short walk – want to come with me?”
  • at the end of a meal (regardless how you actually feel), “Wow, that was filling. Definitely no dessert for me.”
  • walking the dog, “want to come with me?” If NO, then other nudge-like methods, “I’m taking the dog out, want to come and talk about that house project we are working on / that crap that happened to you at work / your parents’ upcoming visit / what we want to do on vacation?”
  • either all at once or gradually, get rid of or fix visual reminders of unwanted behavior: messy environment, snack foods, dirty exercise clothes
  • YOU DO the habits that they will need to do. Set a visual, rather than verbal, example.
  • start training for something. Warrior dash, office arm-wrestling, whatever.
  • don’t personally do the bad habits they should not do: popcorn at movies, extra appetizers, watching TV all night, saying you will workout or do something physical and then bailing out. If you say you are going to work out, fucking go work out.

For lasting change, they really do have to want to drink even if you’ve led them to the water. I don’t think there is much way around this. Again, see Seth’s quote above. Robb freaking Wolf could not change members of his family who had chronic and very uncomfortable diseases that might have been reversed with lifestyle changes. That should not be depressing, per se, but rather help all of us to understand that folks need to come into knowledge from their own divination.

It has to be their idea.

Even if it’s your idea. It has to be their idea.

Let them steal it, and honestly, you BOTH will win. Honestly, isn’t what you wanted for them to change –  not for them to bow before you as a fountain of lifehacker knowledge?