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The ‘Wisdom’ of Healthy Living

Healthy Living sign with mountains backgroundIt appears that some things never seem to change – especially when it comes to living a healthy life.

I recently picked up a monthly periodical that was entirely dedicated to the wisdom of living a healthier life, including in-depth insight about nutrition, weight control, hypertension, heart disease, emotions, chronic ‘tiredness’ and a host of other factors affecting our physical and mental well-being.

Interestingly, the publication spent over half its content on just one person, Vic Tanny, who, at the time, was considered to be America’s greatest crusader for obtaining better health and moving the U.S. into a more physically-fit nation. Tanny, I learned, founded the Vic Tanny Gyms.

Vic Tanny? I was not aware of this man, nor his efforts.

All articles within the publication effusively portrayed Tanny with such glowing accolades concerning his numerous accomplishments that it left this reader wondering if the publication was more of an infomercial than well-balanced journalism. One example: “Vic Tanny has wrought more changes in the concept of the gymnasium in twenty-five years than all the physical educators of the preceding two thousand years combined!”  Wow!

Tanny is also full of confucianisms that reflect on how we must approach our lives to receive two of the greatest blessings – good health and good intellect. He passionately links our fortunes of good health to what we eat, the regular exercise our bodies require, and our emotional health – all directly linked with one another. Here are just a few examples of the philosophy he shares about health:

We have been guilty of neglecting our heritage of strength, allowing our national physical fitness to degenerate by lack of physical activity.

The modern diet creates flabbiness and obesity, especially if overeating is combined with insufficient exercise. It may safely be asserted that obesity is a disease.

Exercise is essential to human life and health. Daily exercise, properly taken, would restore many semi-invalids to health.

We cannot buy health; we must deserve it.

It seems reasonable to believe that if people exercised their entire bodies as constantly and vigorously as they habitually use their minds, their physical and mental strength would endure equally.

Vic Tanny

Vic Tanny

Tanny was not talking about the problems of today – 2015 – but sounding the battle cry one-half century ago!  The particular periodical that I was reading, Wisdom Magazine, was published in May, 1961. Similar in size to LIFE Magazine, Wisdom first appeared in 1956, typically featuring world-renowned Yousuf Karsh photos of famed intellectuals and artists on both covers and on the main inside feature. The articles were full of rich content about art, biographies, business, education, government, history, law, literature, medicine, music, philosophy, religion, science, world affairs – you get the picture. Wisdom Magazine truly fulfilled its promise of being “The Magazine of Knowledge and Education.” Unfortunately, Wisdom met its fate in 1964 and is no longer published.

The world has greatly changed in 54 years, yet, when it comes to the health of Americans, the problems we face today with diet and exercise are nothing new – only the numbers change. In 1960 America, 54.2 percent of adults were not overweight or obese, yet by the year 2000 (40 years later), only 29 percent met this measurement. Conversely, over 14 percent of Americans were either obese or extremely obese in 1960. Today, this number is about 35 percent.

Tanny was on to something back in the 1940s – 1960s. As for Tanny?  His legacy is primarily known as being the American pioneer in the creation of the modern health club. His clubs, however, folded in the mid-1960s, with many locations becoming part of the Bally Total Fitness Clubs.

Tanny died in 1985 at the age of 73 due to – heart failure, precisely the fate he wished for Americans to avoid.

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The ‘Cost’ Diversion
Stuck in the Middle

Clowns to our leftRecently a song came on the radio that I have heard countless times in the past. But this time, it struck me in an odd sort of way. The song, ‘Stuck in the Middle with You,’ was a 1972 classic written and performed by Gerry Rafferty and his group, Stealers Wheel. The lyrics that jumped out at me?

….Clowns to the left of me,
Jokers to the right, here I am,
Stuck in the middle with you.

So what does this have to do with employee benefits? Well, most likely, not a darn thing!

However, when I think about our continued healthcare woes in this country, the song clearly resonates in the right side of my brain.

We are stuck in the middle of the same confusion eminating from the past. In my view, very little seems to change in healthcare. We appear to only re-label past concepts and initiatives and masquerade this as ‘progress.’

So what are these concepts and initiatives?

Managed care, integrated care, bundled payment for care, value-based care, accountable care, patient-centered care – get the picture? If these concepts are so important, and I believe they are, WHY weren’t they emphasized decades ago? Have we erroneously assumed that we were ALREADY receiving these wonderful ‘care’ packages from the bloated premiums (and taxes) we have been historically paying? In one word, yes!

We often confuse action with progress. The busier we appear to be can only indicate that meaningful improvement is being made, right? But if we are making progress in receiving quality care at an affordable cost, many national experts would agree this progress is glacial at best.

As a country, we remain so fixated on cost and coverage issues – necessary components to be sure – but we lose sight when these issues are most divisive with policymakers, political parties and the general public. This ‘diversion’ will only result in political gridlock. Gridlock is a great friend to the status quo, in addition to those who stand to prosper while little is accomplished. Obamacare has polarized the political process to the point that little can be accomplished in Washington due to a healthy dose of gridlock – a battle that has, at best, reached a stalemate.

Self admittedly, I also perpetuate this focus on cost by keeping it a focal point in many of my blogs – using our annual study results as the crutch. By taking our focus away from the real drivers of cost – unhealthy lifestyles, lack of accountability, poor care coordination, little transparency in cost and medical outcomes, patient harm due to preventable medical mistakes, healthcare waste – we allow the diversionary tactics to succeed at keeping the status quo intact for the foreseeable future. We are led to believe that to ‘fix’ our healthcare system, we must address cost, coverage and compliance components through insurance (and create mythical faceless villains to advance agendas) – all reliant on the political process – and gridlock.

Republicans want to repeal and replace Obamacare, yet offer few realistic specifics. Democrats appear to protect and defend Obamacare, and hint that “some changes need to be made,” – but what are they? Both parties are unwilling to address the key drivers because the huge elephant in the room continues to underwrite the cost of the status quo. Since 1998, four of the top seven spending lobby organizations represent the healthcare industry. Between the four, almost $1.2 billion has been spent ‘educating’ those who are elected. Gridlock causes uncertainty, but not for those who gain from this uncertainty.

The masquerade of containing medical costs has successfully distracted meaningful focus from the value we should be receiving in healthcare. Our country continues to play a high-stakes game of Poker, but in doing so, the deck has been stacked in favor of those players who control the game. We know healthcare is big business, and key players obviously feel entitled to our premiums and tax dollars.

In his televised farewell speech to the nation in January 1961, President Eisenhower openly argued that our country has a looming ‘military industrial complex’ that will suck up our money and resources if we fail to contain it. The same can now be said about our medical infrastructure – except this is so much bigger – and infinitely more serious.

We must reach beyond the endless discussion and distractions we have about who pays and how much. The cost, compliance, coverage and political discussions are no doubt important, but these are inextricably linked to the quality and safety of medical care we expect to receive, but in too many cases, do not. Cost is not the problem, it is merely the undesired outcome of the issues that we do not have the political courage to solve. By not having the public outcry for these changes to be made, we can only expect to receive the same pitiful results.

The national fixation on cost and coverage is perhaps the most successful diversional tactic used in our card game by the clowns on the left and the jokers to the right.

So here we are, stuck in the middle with each other.

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Listen With Your Eyes
Small Employers Beware!

Listen to your EyesPercentages can matter. But when depicted in bar graphs, they seem to matter more – or at least become more digestible to understand.

Do smaller employers receive larger premium increases to their health plans when compared to their larger counterparts? The short answer to this question is ‘yes.’ Being community-rated with other like-size employers certainly has a great impact, as does paying state-required premium tax for being fully-insured. Small employers have fewer options to alter their benefit plans and lack critical scale to explore various funding arrangements that are available only to larger employers.

Using results from our last six Iowa Employer Benefits Studies© (2010 – 2015), we found the three smallest employer size categories (2-to-9 employees, 10-to-19 employees and 20-to-49 employees) were more likely to receive annual double-digit increases from their insurance vendors when compared to the other three-size categories (see below).

Average Increases 2010-2015 Iowa Employer Benefits Study

From 2010 – 2015, the average annual increase for each size category demonstrates the divide between the largest and smaller employers. Employers with fewer than 20 employees averaged premium increases each year of 11.5 percent, while employers with 250-to-999 averaged premium increases of 6.3 percent. Employers with over 1,000 employees were most ‘fortunate’ by experiencing average increases of 5.6 percent.

Average Premium Increase 2010 - 2015

Over this period – and prior to making health plan adjustments – the smallest employers received premium hikes of 69 percent. The largest of employers received a cumulative increase of 33 percent, more than half of what the small employers received.

Overall Premium Increases 2010 - 2015

The implications of rising health premiums are unsettling for all employers, but especially for the majority of employers in Iowa with 2-to-19 employees, which represent 94 percent of all Iowa organizations.

Seeing is believing, so listen with your eyes.

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