The Older Brother Gets a Checkup and Reconfigures the Medical Establishment

Well, you folks have kept the drumbeat going, improving your health, spreading the word about Fat Head and healthy eating, driving the numbers  on Hulu and Netflix, and DVd sales.  All of which gets Tom invited to places like the Ancestral Health Symposium at UCLA to present his “Science for Smart People” speech.

So he’s already gone again and I’m already back again.  You have no one to blame but yourselves.

First, a quick housekeeping note.  It sounds like Tom’s going to be severely out of pocket for the next few days and the comments on the site are already piling up.  In the interest of keeping the dialog here moving, I’m going to approve the ones that I don’t think require his attention.  If you’ve submitted one and don’t see it, please be patient.

I was going to put up a post about some amazing BLT’s The Wife and I make — including low-carb options — along with some hints on bacon and avocados ( I know, add a couple of eggs to the bacon and avocados and you’ve got the whole paleo food pyramid, right?).

But I had an interesting experience this week and I thought I’d share it.  It’s not nutrition or food, but it is about your health, so here goes…

This past Wednesday, being a guy over 50 who generally manages his health by avoiding doctors, I finally went to a new doctor.  It took an hour and a half, which was amazing.

Normally, there’s nothing amazing about spending an hour and a half at the doctor’s office.  In fact, that would generally fall under “completely normal.”

You know the drill.  Get there 15 minutes early so you don’t lose your place, spend 15 minutes refilling out the same paperwork you filled out the last ten times you were there and letting them copy your insurance card again (OMG, you didn’t change insurance companies, did you?  Start over!)

Half an hour after your appointment time, the nurse escorts you back to the exam room and spends five minutes asking you some questions, writing your answers, and taking some measurements (height, weight, blood pressure, etc.).  The nurse disappears and hopefully after only another fifteen minutes or so your doctor comes in and asks you most of the same questions again.  She’ll determine a few tests for the lab to do.  If you’ve got a particular ailment, she’ll probably want a few extra tests.  Then off she goes.

You get escorted to the lab, wait there for fifteen minutes, a tech spends another ten or fifteen minutes drawing blood or whatever needs doing, then back you go.  After another wait — again, fifteen minutes qualifying as a lucky day — your doctor returns, spends up to several minutes reviewing your test results with you, and then tells you that you need to be on statins.  Har!

So what’s so different about spending an hour and a half at my new doctor’s?  Well for starts, I spent the entire hour and a half — brace yourself — with my doctor!  This is him — Dr. Craig Backs


Craig has over 30 years experience as an Internal Medicine Physician, is a past president of the Illinois State Medical Society, and recently returned to private practice after a stint as Chief Medical Officer at Saint John’s Hospital in Springfield. Good person to know.

Almost the entire time was spent with Dr. Backs, except for maybe the first three minutes, which I spent in his reception area, which looks like this…

The seating is comfortable, but this is probably about as crowded as it’s going to get.  More on that in a minute.

And when the nurse came to take me back to the exam room?  Well, that didn’t happen.  He doesn’t have a nurse.  Anything that has anything to do with my medical experience, he does.

Also, we spent the first hour of that hour and a half sitting here:

 

Since this was my first visit, we spent an hour not only going over my medical history, but also any current complaints (coincidentally, I happened to be having a flare-up of sciatica from old injuries) and my goals regarding maintaining and improving my general health.  We also spent some time on my conviction of the benefits of, and my personal results from moving to the low-carb lifestyle.  With a couple of short detours into politics and economics, of course.

Craig has been a personal friend for years (his son and The Oldest Son went to school with each other from preschool through high school, and remain close friends).  As a result, I’d recommended Gary Taube’s Good Calories, Bad Calories in a social conversation before he started his new practice and he read the whole thing.  Craig is not a low-carb or paleo (or anything else) physician, but he was comfortable with my decisions about nutrition and health.  He’d also support a patient intent on the low-fat approach.  Imagine that — a doctor who wants to help his patients work their way towards their health goals on their patients’ own terms.

After building the foundation of our doctor/patient relationship, we moved into a standard exam room for the actual physical, including all of the usual equipment, although most of them were hooked up so they would load results directly into his laptop and my medical records, which are now all electronic.  This all took most of the other half hour, including some helpful suggestions on addressing the sciatic flare-up.

[It also unfortunately included the usual test for a guy over fifty, which I was not able to get Dr. Backs to waive for an additional fee.  I suppose it’s nice to know your doctor has professional integrity, but it’s even more important that their hands aren’t too big, if you get my drift.  Sorry — just had to throw that in as a final shout-out to Kenny M — Tom’s vegetrollian stalker!]

In case I come up with another question or problem, in addition to his office number, I’ve got Dr. Back’s email address.  And his cell phone number.  Not because he’s a personal friend, but because he’s my doctor.  When I called to schedule my first appointment, I asked when I could get in.  His office manager asked when would it be most convenient for me?

As I said, none of this occurred because Dr. Backs is a personal friend — it’s all part of his practice that any patient receives.  By now you should be wondering how this could all happen.  The answer is very simple:

Because I pay him.

I know that may sound strange in a society that’s reached a point where most people think that either their employer or the government is responsible for providing health care for them.

Instead, this is how Craig’s practice operates:

I pay an annual fee for his services.  It’s a little more than my cable/internet service bill is for the year, but not enough to be called “concierge health care.”  Craig’s term for it is “personal medicine.”

For that fee, I get my annual checkup and his email and phone numbers.  There’s a nominal fee for additional office visits (probably a polite way to discourage hypochondria overuse) and I pay for any lab work.   I also get a commitment from Craig that he’ll limit the number of clients his practice will accept, probably no more than 500 to start.  I won’t be dealing with nurses, physician assistants, or — under normal circumstances — answering and message services.  When I have a problem or question, I’ll be talking directly to him.  The fee covers kids in the household (up to a certain age), and also any friends or family who are visiting from out of town.

I don’t have to worry that some insurance company is going to tell me I’ve got to pick a new physician because Craig is no longer on the “preferred provider” (low bidder) list.  Or that any tests or treatments Craig suggests are dictated by an insurance company policy manual instead of my doctor’s judgement.

Since I’m paying a decent fee up front, Craig doesn’t have to payroll an entire accounting and clerical staff to code, process, submit and follow up on insurance and government reimbursement claims.  He doesn’t have to wait until the state scratches enough money together to send him some percentage of money he’s due.  He doesn’t have to wonder if the feds are really going to cut his reimbursement rates for seniors by 30 percent next year.  He can also respond and help with many patient issues via email or phone.   This is something many physicians are understandably hesitant to do, because they’re still using their time and putting themselves on the hook for liability concerns, but reimbursement in the insurance systems all center on an office visit.

That reception area will continue to be lightly populated, as it doesn’t have to be sized and used as a revenue queue/holding pen like under the current medical paradigm, where contracts and reimbursement rates mean if the pipeline isn’t full and the doctors aren’t seeing 30 or more patients a day, they’re losing money.  Craig  won’t have to order batteries of tests to give him information that he can instead glean with the time he can now spend with each patient.

I believe that this is to health care what the real and local foods movement is to eating and nutrition.  That is, this is a modern adaptation to get back to the fundamentals that we lost in the march towards bigger, faster, cheaper.  It costs more, but the quality difference is obvious and meaningful.

I’ve always said that although we can all use experts, the bottom line is no one can care about your kids, your money, or your health as much as you can.  Personal medicine is a trifecta.

See you in the comments.

Cheers,

The Older Brother

 

 


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90 thoughts on “The Older Brother Gets a Checkup and Reconfigures the Medical Establishment

  1. konst

    Ok this sounds great, is there a movement, or any other source that lists doctors offering this type of service in my area?

    I would love this service if I could find one near me.

    Cheers

    See my response to Michel P, but if I’m interpreting your email correctly, you’re in the UK. I don’t know how the system there corresponds to ours on this side of the pond.

    — The Older Brother

  2. Michael P (@PizSez)

    That’s awesome! How do I find a doc like that?

    I didn’t really go through a replicable search process.

    I’d seen stories about it on the coasts, and the business model resonated with me. I had no idea it would come to Springfield, be what I consider very affordable, and pioneered by a close friend to boot. When I saw Craig at a New Years party and he said he was going to try that as a business model, I demanded to get to be one of the first to sign up.

    I’d say Google it for your area. You might check with your state or local level Medical Association to see if they have lists you could get some names from. If you currently have a good relationship a physician, you may ask if they’ve considered it or have a colleague who is/might.

    I have a strong feeling that once a little momentum starts, a lot of the really good Internists/GPs will migrate to this to reclaim their independence from bureaucracies, insurance companies, government red tape, etc and be able to do what they went into medicine to do.

    Cheers!

  3. ThatPaleoGuy

    Wow, that is an awesome business model for a physician. I wish we had that here instead of the typical European way of doing things. That is the gov’t taking a huge monthly fee from you and your employer, adds additional tax money to the fund and pays only for basic services which get more restricted every year. With an immense bureaucracy, of course!

    We’re getting there in this country.

    That’s why I wanted to have everything in place outside the government run system before it really hits the fan.

    Cheers!

  4. konst

    Ok this sounds great, is there a movement, or any other source that lists doctors offering this type of service in my area?

    I would love this service if I could find one near me.

    Cheers

    See my response to Michel P, but if I’m interpreting your email correctly, you’re in the UK. I don’t know how the system there corresponds to ours on this side of the pond.

    — The Older Brother

  5. Michael P (@PizSez)

    That’s awesome! How do I find a doc like that?

    I didn’t really go through a replicable search process.

    I’d seen stories about it on the coasts, and the business model resonated with me. I had no idea it would come to Springfield, be what I consider very affordable, and pioneered by a close friend to boot. When I saw Craig at a New Years party and he said he was going to try that as a business model, I demanded to get to be one of the first to sign up.

    I’d say Google it for your area. You might check with your state or local level Medical Association to see if they have lists you could get some names from. If you currently have a good relationship a physician, you may ask if they’ve considered it or have a colleague who is/might.

    I have a strong feeling that once a little momentum starts, a lot of the really good Internists/GPs will migrate to this to reclaim their independence from bureaucracies, insurance companies, government red tape, etc and be able to do what they went into medicine to do.

    Cheers!

  6. laffin

    Love the idea of it but it would seem to only be truly affordable for people who are fairly healthy to begin with or who have the income to afford paying out of pocket for any services they need outside of what the doctor includes in his annual fee.

    I would love to be able to take the money that is deducted from my pension check each month for health insurance and give it directly to my doctor. But, that really only works if you are healthy and don’t need bloodwork every week, like I do (that out-of-pocket cost would be prohibitive if I didn’t have insurance to cover it). Or have more serious medical conditions that require more than just a quick check-up and a few prescriptions written out.

    I think as it relates to insurance or continuing medical conditions, the personal medicine approach is fairly agnostic.

    I think if a client had a chronic condition that required frequent physician visits, Dr. Backs would make some accommodation. Professional discretion is built into the contract. He may or may not make hospital visits (no fee) at his discretion depending on if he feels it’s relevant to your health. If you request, he may come to your appointment if you have to go to a specialist (no fee). He may even make an honest-to-God house call if he thinks that’s the best way of addressing a health issue. Where have you heard of that happening in the last decade?

    This approach is about a two-way relationship that’s healthier but still profitable (think local foods model), not maximizing revenue under tightly squeezed margins (think Big Food).

    If your blood work is being covered by insurance under a standard physician relationship, I don’t see why it wouldn’t under a personal medicine relationship.

    Frequent office visits in conjunction with lab work may be a function of your doctor’s inability to get compensated for reviewing results without an office visit, where some of that could possibly be done via phone/email?

    If you’re interested, you may want to have a conversation with your doctor.

    — The older Brother

  7. Debbie

    I love this idea as a medical model too, and since I’m moving to another state at the end of this month it would be really cool to find a new provider in my new area who practiced this sort of medical model. But I wouldn’t even have a clue what to use as google search terms!

    Caitlin’s post mentions MDVIP. I’d try “concierge health care” with your location. Also check with the state or local Medical Association.

    Cheers

  8. chuck

    very cool stuff. that is great. i recently did a post called “self sufficient health care”. people need to become more financially responsible for their health care. only then will they make real lifestyle changes to prevent expensive health issues.

    http://escapetheherdblog.blogspot.com/2011/07/self-sufficient-healthcare.html

    Great post. It really illustrates that the more personal responsibilities we try to offload to government, the worse off we become.

    As many have said during the health care “debate.” if you think it’s too expensive now, just wait until you see how much it costs when it’s free!

    — The Older Brother

  9. ThatPaleoGuy

    Wow, that is an awesome business model for a physician. I wish we had that here instead of the typical European way of doing things. That is the gov’t taking a huge monthly fee from you and your employer, adds additional tax money to the fund and pays only for basic services which get more restricted every year. With an immense bureaucracy, of course!

    We’re getting there in this country.

    That’s why I wanted to have everything in place outside the government run system before it really hits the fan.

    Cheers!

  10. Tuck

    My doc recently went the same route.

    I’m hoping (and expecting) that the many health issues that I had over the last 5-6 years won’t reoccur thanks to my new diet, but I’m hedging my bet. 😉

    I learned that he’s an excellent doc during that period, so I want to continue the relationship, even though it’s going to be more expensive. You do get what you pay for, generally.

    It is a financial sacrifice. When Craig and I were talking about this before he got up and running, he used what I considered an excellent analogy of sending your kids (which we did) to parochial schools. Yes, you could go to the public schools for “free,” but if it’s really something you consider important and feel there’s a qualitative difference, you work it out as a budget priority.

    As I said, the annual fee works out a bit over my annual basic cable/high speed internet cost. So when I ask myself if my health or “The O’Reilly Factor” and “30 Rock” reruns are more important to my long-term life goals, the perspective changes a bit.

    Cheers!

  11. Lisa

    I guess “personal responsibility” may just becoming back in style! Thank God!

    That’s just crazy talk!

    Cheers

  12. Jo

    I have heard about this type of doctor and it sounds very interesting. What happens if you need to go to a hospital? Do you have some type of insurance coverage for that?

    Glad you asked. My post was getting so long I decided not to go into all of the details.

    I had in fact already gone to what I consider the only viable model for health care — I have a high deductible insurance policy, combined with a Health Savings Account (contributions to this account, that you pay medical expenses out of, are tax-deductible and you always own the account — no “use it or lose it” provisions). I have myself and The Youngest Son covered (The Wife has employer paid premiums), but we go out of pocket up to the annual deductible ($5,000 is the most common, we’re at $10,000). My monthly premium as an old fat guy with a dependent is about $375.

    So if I have to go to the hospital, or a specialist, or need lab work, etc. that gets paid out of my HSA account goes against the out-of-pocket (of course, if I get hit by a bus, the insurance will kick in).

    Obamacare is doing everything it can to eliminate this approach to insurance, however, because it gives people control and responsibility over their own health care and detaches it from dependence on employment or the government.

    I consider adding personal medicine to cover our primary care needs as the last piece of our health care puzzle, but it works with any insurance system you’re working under. Dr. Back’s office will send advice of charges to an insurance provider (in case you can count it towards a deductible or if they administer your HSA/MSA).

    I do believe that the annual fee is payable out of the Medical Savings Account (check with your accountant or benefits department if you have a Medical Savings or cafeteria plan), but I don’t think it counts towards a deductible on most policies.

    — The Older Brother

  13. Caitlin

    Yeah, my boyfriend’s physician shifted to this type of practice. I guess you would call it “concierge medicine” but it’s totally worth it. Any issues come up, you can email or call Dr.’s cell phone. Also, the BF gets so twitchy when he has to wait around other people, especially whining children, for too long that an empty waiting room saves my sanity too. If commentor above is interested, the network is MDVIP (hope it’s okay to post that) Check the website and see if there is a physician in your state.

  14. Lori

    Your doctor kind of sounds like my veterinarian, except that I pay as I go and we don’t need 90 minutes for an appointment. In fact, Theodore Dalrymple wrote on article a few years ago on dogs getting better treatment in Great Britain than their masters:

    http://online.wsj.com/article/SB10001424052970204908604574334282143887974.html

    If anyone wants to know the name of a practice such as this in the Denver area, I’ll find out from my parents. Their former doctor went to this model and they dropped him. They insist their doctor be in the neighborhood and take their insurance; that their doctors mis-schedule their (semi-weekly) appointments and make them wait for hours doesn’t seem to matter.

    I know a few years ago some journalists in Canada pointed out that since it took six months to get an MRI, people were going to veterinarians (they have the same MRI equipment) as a walk-in and getting them done same day for a fee.

    Very embarrassing to Canada’s vaunted government run health-care system. So they immediately fixed the whole thing by making it illegal for vets to do MRI’s on people. Oy.

    Cheers

  15. Anne

    I see a complementary MD and her visits are about 1 hour long. She does not bill insurance but she is worth every penny. I still have to have my 5 minute PCP as she is about 100 miles from me and is not a PCP.

  16. laffin

    Love the idea of it but it would seem to only be truly affordable for people who are fairly healthy to begin with or who have the income to afford paying out of pocket for any services they need outside of what the doctor includes in his annual fee.

    I would love to be able to take the money that is deducted from my pension check each month for health insurance and give it directly to my doctor. But, that really only works if you are healthy and don’t need bloodwork every week, like I do (that out-of-pocket cost would be prohibitive if I didn’t have insurance to cover it). Or have more serious medical conditions that require more than just a quick check-up and a few prescriptions written out.

    I think as it relates to insurance or continuing medical conditions, the personal medicine approach is fairly agnostic.

    I think if a client had a chronic condition that required frequent physician visits, Dr. Backs would make some accommodation. Professional discretion is built into the contract. He may or may not make hospital visits (no fee) at his discretion depending on if he feels it’s relevant to your health. If you request, he may come to your appointment if you have to go to a specialist (no fee). He may even make an honest-to-God house call if he thinks that’s the best way of addressing a health issue. Where have you heard of that happening in the last decade?

    This approach is about a two-way relationship that’s healthier but still profitable (think local foods model), not maximizing revenue under tightly squeezed margins (think Big Food).

    If your blood work is being covered by insurance under a standard physician relationship, I don’t see why it wouldn’t under a personal medicine relationship.

    Frequent office visits in conjunction with lab work may be a function of your doctor’s inability to get compensated for reviewing results without an office visit, where some of that could possibly be done via phone/email?

    If you’re interested, you may want to have a conversation with your doctor.

    — The older Brother

  17. Linda

    Interesting, however, not a single doctor available in this plan here in Iowa. Also, if you have to pay for your own lab work, that has got to be extremely expensive, right? And how does Medicare fit into this plan?


    As for Medicare, it’s like Dr. Back’s parochial school analogy I cite in another comment. Sometimes you just have to make a decision on whether the quality difference justifies paying for something you could get for “free.” Any prescriptions and lab work would process through Medicare like charges under the “normal” paradigm.

    People seem to have the impression that lab work is included in their office visit charge. The insurance policies and billing models I’ve experienced always break lab work out separately, regardless of whether they’re performed by the physician’s or an outside lab. Check your Explanation of Benefits (EOB) on your next insurance claim. Those would still go to your insurance just like any other.

    Craig is getting arrangements made with two or three labs that he can refer lab work to at reasonable rates. Also, with an HSA or MSA plan or if you’re paying as you go, amazing things happen if you know the magic phrase, which I’m going to let you in on for free.

    When you show up (or preferably call ahead first), ask them how much the test is going to be. Expect a little confusion because this hardly ever gets asked since most people think it’s “free” because their insurance is “paying for it.”

    Once they give you an answer, calmly look them in the eye and say:

    “That sound a little high. I’m paying for this out of my own pocket and I’ll pay you today (cash or check.debit card from your HSA/MSA) — is that your best price?

    If they’re smart (and most are), they’re considering having money in their hand compared to billing an insurance company or government agency at maybe 50% or less of their “list price,” then re-billing it after there’s some “problem” then waiting for a couple of months to get their money. If they don’t drop at least 10-20% on the spot, find another provider. Most people are still nice human beings, especially in the medical field. I’ve had them waive half of the fees or not bill one or two procedures when they understand I’m having to spend my own money and they’ll get paid on the spot.

    Tell everyone you know.

    Cheers!

  18. Debbie

    I love this idea as a medical model too, and since I’m moving to another state at the end of this month it would be really cool to find a new provider in my new area who practiced this sort of medical model. But I wouldn’t even have a clue what to use as google search terms!

    Caitlin’s post mentions MDVIP. I’d try “concierge health care” with your location. Also check with the state or local Medical Association.

    Cheers

  19. chuck

    very cool stuff. that is great. i recently did a post called “self sufficient health care”. people need to become more financially responsible for their health care. only then will they make real lifestyle changes to prevent expensive health issues.

    http://escapetheherdblog.blogspot.com/2011/07/self-sufficient-healthcare.html

    Great post. It really illustrates that the more personal responsibilities we try to offload to government, the worse off we become.

    As many have said during the health care “debate.” if you think it’s too expensive now, just wait until you see how much it costs when it’s free!

    — The Older Brother

  20. Firebird

    I saw something like this on Bill Moyers Journal a couple of years ago. It was concentrated in poor areas, especially in the south. If I recall, the insurance industry tried to have the government shut them down.

    Something like what? If it was Bill Moyers, it would’ve been a puff piece for socialized medicine.

    — The Older Brother

  21. Tuck

    My doc recently went the same route.

    I’m hoping (and expecting) that the many health issues that I had over the last 5-6 years won’t reoccur thanks to my new diet, but I’m hedging my bet. 😉

    I learned that he’s an excellent doc during that period, so I want to continue the relationship, even though it’s going to be more expensive. You do get what you pay for, generally.

    It is a financial sacrifice. When Craig and I were talking about this before he got up and running, he used what I considered an excellent analogy of sending your kids (which we did) to parochial schools. Yes, you could go to the public schools for “free,” but if it’s really something you consider important and feel there’s a qualitative difference, you work it out as a budget priority.

    As I said, the annual fee works out a bit over my annual basic cable/high speed internet cost. So when I ask myself if my health or “The O’Reilly Factor” and “30 Rock” reruns are more important to my long-term life goals, the perspective changes a bit.

    Cheers!

  22. Firebird

    In fact, here is Bill Moyer discussing health care with Wendell Potter (37 minutes)

    http://youtu.be/7QwX_soZ1GI

    Okay, I watched the first ten minutes.

    The reformed exec who went through an entire career flying on the corporate jet and cashing all of the bonus checks, has a crisis of conscience when he figured out that people who can’t or won’t take a financial stake in their own health don’t get very good health care. And when the government or a business forces health care decisions on individuals based on who the lowest bidder is, quality doesn’t seem to be at the top of the list.

    I already knew that.

    Don’t happen to see any parallels between the Great Unwashed Masses in the Moyer’s piece being treated like cattle and the difference in food between the local farmer’s market and what people buy with their food stamps, or what low-income kids get for their school lunches (and now breakfasts), do you? And the problem is who?

    I didn’t mention it as an explicit benefit, but one of the nice things about personal medicine is I’ll never have to sit in a waiting room with a bunch of these economic illiterates. Lord knows they’re everywhere else; at least this way when I need medical care they’re not forming a queue in front of me.

    Thanks for the laugh!

    — The Older Brother

  23. Jo

    @ Linda

    Even though I have insurance coverage, I order some of my own lab tests from an online company. For instance, I asked my doctor about checking my vitamin D levels and since my insurance wouldn’t cover it she told me it would cost approx. $200. I already knew that I could purchase this test online at a cheaper price so that is what I did. The regular price is $59 through directlabs dot com. I actually got it cheaper than that because I purchased it during one of their monthly specials. You order the test and pay the online company and they email the paperwork to you to take to a local lab. You have to use labs that they specify (this particular company uses LabCorp). I know there are other online labs, but this is the one I use. Also, you can purchase the test (or multiple tests) and use them later in the year if you want to take advantage of a special price but don’t need the test at that time.

    You gotta love the beauty of the marketplace when it’s allowed to function!

    The takeaway is to shop around. That includes prescriptions, labs, and medical services.

    There’s a growing concept here towards what’s called “medical tourism,” where people are going to other countries for elective procedures. They’re usually perform in clinics by U.S. trained and certified expats or foreign nationals. They savings more than pay for airfare, hotels, and an enjoyable vacation scheduled around the procedure.

    I’ve also heard of people near non-volatile parts of the Mexican border routinely crossing over for excellent dental and other services at pennies on the dollar.

    Cheers

  24. Lisa

    I guess “personal responsibility” may just becoming back in style! Thank God!

    That’s just crazy talk!

    Cheers

  25. Jo

    I have heard about this type of doctor and it sounds very interesting. What happens if you need to go to a hospital? Do you have some type of insurance coverage for that?

    Glad you asked. My post was getting so long I decided not to go into all of the details.

    I had in fact already gone to what I consider the only viable model for health care — I have a high deductible insurance policy, combined with a Health Savings Account (contributions to this account, that you pay medical expenses out of, are tax-deductible and you always own the account — no “use it or lose it” provisions). I have myself and The Youngest Son covered (The Wife has employer paid premiums), but we go out of pocket up to the annual deductible ($5,000 is the most common, we’re at $10,000). My monthly premium as an old fat guy with a dependent is about $375.

    So if I have to go to the hospital, or a specialist, or need lab work, etc. that gets paid out of my HSA account goes against the out-of-pocket (of course, if I get hit by a bus, the insurance will kick in).

    Obamacare is doing everything it can to eliminate this approach to insurance, however, because it gives people control and responsibility over their own health care and detaches it from dependence on employment or the government.

    I consider adding personal medicine to cover our primary care needs as the last piece of our health care puzzle, but it works with any insurance system you’re working under. Dr. Back’s office will send advice of charges to an insurance provider (in case you can count it towards a deductible or if they administer your HSA/MSA).

    I do believe that the annual fee is payable out of the Medical Savings Account (check with your accountant or benefits department if you have a Medical Savings or cafeteria plan), but I don’t think it counts towards a deductible on most policies.

    — The Older Brother

  26. Caitlin

    Yeah, my boyfriend’s physician shifted to this type of practice. I guess you would call it “concierge medicine” but it’s totally worth it. Any issues come up, you can email or call Dr.’s cell phone. Also, the BF gets so twitchy when he has to wait around other people, especially whining children, for too long that an empty waiting room saves my sanity too. If commentor above is interested, the network is MDVIP (hope it’s okay to post that) Check the website and see if there is a physician in your state.

  27. ThatPaleoGuy

    Having a plan with very high deductibles for the really bad things and an HSA for all the small things sounds interesting. But what if you get a disease which requires expensive medication for years? If you’re having $10k deductibles and your expenses always meet that, that’s some serious spending…

    I’m happy to report that I don’t have any first-hand knowledge in that type of situation. I just switched from $5,000 deductible to $10,000; the rationale being that I’ve made it 54 years without a major disease that would require continuous treatment, and the $150 less a month on my premium (just checked — mine is about $340 a month) means if I don’t jump up to $10,000 out of pocket more than once every three or four years, I still come out ahead.

    I’d say if it’s a continuing condition, you’d be able to make some arrangements to minimize the financial impact — buying the maximum prescription available towards the end of your contract year, shop on-line (see Jo’s comment),etc. All of the pharmaceutical companies have some type of compassionate availability program. If there’s enough money involved, it may even justify a trip to Canada, Central America, or somewhere else to stock up.

    Ideally, people would sign up for these plans with the lower $5,000 deductible when they’re young and healthy, fund the heck out of their HSA for years, then there’d be plenty of funds available even in the event of a midlife chronic illness with a higher deductible. BTW, once an excess of funds is built up in the HSA, they can be invested in mutual funds, stocks, etc. within an HSA, much like an IRA. Also, once you’re over some age (maybe 65), you can also take withdrawals as simple taxable income with no penalty — again, just like another IRA. A great way to fund long-term care if the need arises later in life.

    If a large part of people where on this type of plan, the market pressure would be tremendous to lower costs.

    Cheers!

  28. Lori

    Your doctor kind of sounds like my veterinarian, except that I pay as I go and we don’t need 90 minutes for an appointment. In fact, Theodore Dalrymple wrote on article a few years ago on dogs getting better treatment in Great Britain than their masters:

    http://online.wsj.com/article/SB10001424052970204908604574334282143887974.html

    If anyone wants to know the name of a practice such as this in the Denver area, I’ll find out from my parents. Their former doctor went to this model and they dropped him. They insist their doctor be in the neighborhood and take their insurance; that their doctors mis-schedule their (semi-weekly) appointments and make them wait for hours doesn’t seem to matter.

    I know a few years ago some journalists in Canada pointed out that since it took six months to get an MRI, people were going to veterinarians (they have the same MRI equipment) as a walk-in and getting them done same day for a fee.

    Very embarrassing to Canada’s vaunted government run health-care system. So they immediately fixed the whole thing by making it illegal for vets to do MRI’s on people. Oy.

    Cheers

  29. Anne

    I see a complementary MD and her visits are about 1 hour long. She does not bill insurance but she is worth every penny. I still have to have my 5 minute PCP as she is about 100 miles from me and is not a PCP.

  30. Linda

    Interesting, however, not a single doctor available in this plan here in Iowa. Also, if you have to pay for your own lab work, that has got to be extremely expensive, right? And how does Medicare fit into this plan?


    As for Medicare, it’s like Dr. Back’s parochial school analogy I cite in another comment. Sometimes you just have to make a decision on whether the quality difference justifies paying for something you could get for “free.” Any prescriptions and lab work would process through Medicare like charges under the “normal” paradigm.

    People seem to have the impression that lab work is included in their office visit charge. The insurance policies and billing models I’ve experienced always break lab work out separately, regardless of whether they’re performed by the physician’s or an outside lab. Check your Explanation of Benefits (EOB) on your next insurance claim. Those would still go to your insurance just like any other.

    Craig is getting arrangements made with two or three labs that he can refer lab work to at reasonable rates. Also, with an HSA or MSA plan or if you’re paying as you go, amazing things happen if you know the magic phrase, which I’m going to let you in on for free.

    When you show up (or preferably call ahead first), ask them how much the test is going to be. Expect a little confusion because this hardly ever gets asked since most people think it’s “free” because their insurance is “paying for it.”

    Once they give you an answer, calmly look them in the eye and say:

    “That sound a little high. I’m paying for this out of my own pocket and I’ll pay you today (cash or check.debit card from your HSA/MSA) — is that your best price?

    If they’re smart (and most are), they’re considering having money in their hand compared to billing an insurance company or government agency at maybe 50% or less of their “list price,” then re-billing it after there’s some “problem” then waiting for a couple of months to get their money. If they don’t drop at least 10-20% on the spot, find another provider. Most people are still nice human beings, especially in the medical field. I’ve had them waive half of the fees or not bill one or two procedures when they understand I’m having to spend my own money and they’ll get paid on the spot.

    Tell everyone you know.

    Cheers!

  31. Princess Dieter

    When my endo stopped taking my insurance, I paid to see her. Out of pocket. And I didn’t get this kind of attention.

    I’d PAY the annual fee for this. Worth it. A doc that is looking, talking, checking me and keeps consistent tabs on me as needed. Yes, worth paying out of pocket. Worth SAVING UP FOR, even.

    Can he move to Miami for me? Does he know a similar doc (preferably female, as I like lady docs, personally) in the Miami area?

    I’m sick of the waiting up to an hour (or if it’s a Latino doc of the old school mentality, like my sis’s, anywhere up to 6 hours–sometimes more–to be seen) to be seen for 15 mins and have to justify my Primarian eating as they insist on statins.

    Thanks…

    I’ll ask Craig if the organization that helped set him up has any referrals in other areas. Check out the other comments for other suggestions.

    Cheers!

  32. Firebird

    I saw something like this on Bill Moyers Journal a couple of years ago. It was concentrated in poor areas, especially in the south. If I recall, the insurance industry tried to have the government shut them down.

    Something like what? If it was Bill Moyers, it would’ve been a puff piece for socialized medicine.

    — The Older Brother

  33. Firebird

    In fact, here is Bill Moyer discussing health care with Wendell Potter (37 minutes)

    http://youtu.be/7QwX_soZ1GI

    Okay, I watched the first ten minutes.

    The reformed exec who went through an entire career flying on the corporate jet and cashing all of the bonus checks, has a crisis of conscience when he figured out that people who can’t or won’t take a financial stake in their own health don’t get very good health care. And when the government or a business forces health care decisions on individuals based on who the lowest bidder is, quality doesn’t seem to be at the top of the list.

    I already knew that.

    Don’t happen to see any parallels between the Great Unwashed Masses in the Moyer’s piece being treated like cattle and the difference in food between the local farmer’s market and what people buy with their food stamps, or what low-income kids get for their school lunches (and now breakfasts), do you? And the problem is who?

    I didn’t mention it as an explicit benefit, but one of the nice things about personal medicine is I’ll never have to sit in a waiting room with a bunch of these economic illiterates. Lord knows they’re everywhere else; at least this way when I need medical care they’re not forming a queue in front of me.

    Thanks for the laugh!

    — The Older Brother

  34. Jo

    @ Linda

    Even though I have insurance coverage, I order some of my own lab tests from an online company. For instance, I asked my doctor about checking my vitamin D levels and since my insurance wouldn’t cover it she told me it would cost approx. $200. I already knew that I could purchase this test online at a cheaper price so that is what I did. The regular price is $59 through directlabs dot com. I actually got it cheaper than that because I purchased it during one of their monthly specials. You order the test and pay the online company and they email the paperwork to you to take to a local lab. You have to use labs that they specify (this particular company uses LabCorp). I know there are other online labs, but this is the one I use. Also, you can purchase the test (or multiple tests) and use them later in the year if you want to take advantage of a special price but don’t need the test at that time.

    You gotta love the beauty of the marketplace when it’s allowed to function!

    The takeaway is to shop around. That includes prescriptions, labs, and medical services.

    There’s a growing concept here towards what’s called “medical tourism,” where people are going to other countries for elective procedures. They’re usually perform in clinics by U.S. trained and certified expats or foreign nationals. They savings more than pay for airfare, hotels, and an enjoyable vacation scheduled around the procedure.

    I’ve also heard of people near non-volatile parts of the Mexican border routinely crossing over for excellent dental and other services at pennies on the dollar.

    Cheers

  35. ThatPaleoGuy

    Having a plan with very high deductibles for the really bad things and an HSA for all the small things sounds interesting. But what if you get a disease which requires expensive medication for years? If you’re having $10k deductibles and your expenses always meet that, that’s some serious spending…

    I’m happy to report that I don’t have any first-hand knowledge in that type of situation. I just switched from $5,000 deductible to $10,000; the rationale being that I’ve made it 54 years without a major disease that would require continuous treatment, and the $150 less a month on my premium (just checked — mine is about $340 a month) means if I don’t jump up to $10,000 out of pocket more than once every three or four years, I still come out ahead.

    I’d say if it’s a continuing condition, you’d be able to make some arrangements to minimize the financial impact — buying the maximum prescription available towards the end of your contract year, shop on-line (see Jo’s comment),etc. All of the pharmaceutical companies have some type of compassionate availability program. If there’s enough money involved, it may even justify a trip to Canada, Central America, or somewhere else to stock up.

    Ideally, people would sign up for these plans with the lower $5,000 deductible when they’re young and healthy, fund the heck out of their HSA for years, then there’d be plenty of funds available even in the event of a midlife chronic illness with a higher deductible. BTW, once an excess of funds is built up in the HSA, they can be invested in mutual funds, stocks, etc. within an HSA, much like an IRA. Also, once you’re over some age (maybe 65), you can also take withdrawals as simple taxable income with no penalty — again, just like another IRA. A great way to fund long-term care if the need arises later in life.

    If a large part of people where on this type of plan, the market pressure would be tremendous to lower costs.

    Cheers!

  36. Drew @ Willpower Is For Fat Pe

    When the alternative is the current U.S. healthcare system, then yeah, just about anything can be better. But plenty of countries have systems that provide better care than we get here, and it costs less at the same time. Costs less, works better … isn’t that what the market should select, if the market were working correctly?

    If a service like this were available locally, I might use it, but only if I could also have coverage for major expenses. My wife is pregnant right now. There’s no way I want to pay out of pocket if anything should go wrong.

    The thing to keep in mind is that there hasn’t been a free market in health care in this country for decades.

    There is cheaper high quality care in other countries, like Panama, that have doctors trained here but operating outside the stifling U.S regulatory and tort systems. However, there’s no other country I would want to be in if I needed immediate world class health care. Sure you can get your prostate ripped out cheap in Cuba — just ask human crapbag Hugo Chavez — but if you really need best in class medicine, people come here. And pay for it.

    They provide “better care” in countries with socialized health systems because they score differently. Seriously, how could anyone think this is the one thing government can really do well? The exact same systems that insists you need good carbs, that saturated fat will kill you, and that you should take statins to keep you healthy.

    Do you know that if your wife went into labor in the 6th month of pregnancy in most countries, that they would simply make her comfortable and explain that there’s nothing they can do. It’s not that the technology isn’t invented — we have it here — it’s because they aren’t about to spend that kind of money on a preemie. Since in all of the countries where health care is “free,” they don’t count that as a viable pregnancy, it doesn’t go in the infant mortality equation. Their infant mortality rate in this n=1 hypothetical case would be zero, and their health care spending would be almost nothing.

    Here, they do everything they can, which uses tens of thousands of dollars of resources. So if they save your baby and lose another, we get an infant mortality rate of 50% and a smug lecture on how much more we spend on health care even though our outcomes are worse; because their infant mortality rate is zero and they spend nothing.

    That’s the beauty of the system. Government comes in, and the more it screws things up, the more people blame “business” or “greed.” It’s a self-perpetuating death spiral. Interesting to watch as long as you can do it from a safe distance.

    Cheers!

  37. Firebird

    Older brother, what you are experiencing with your doctor in “concierge” care was covered in a Bill Moyers Journal, and I apologize for You Tube not having that clip so I may share it with you and other readers of this blog. What it said, and I will reiterate, is that the same kind of service that you speak of is out there in this country, mostly in poor, rural areas, and the insurance industry is applying pressure to these doctors to try to shut them down if they refuse to take part in the insurance system.

    Sorry for not being clearer.

    Oops. Maybe I should’ve watched the last part of the Moyers link you posted, but I don’t see how an insurance company could pressure someone like Craig out of the business. Was what you’re referring to contained in the video of the link you posted in your last comment? If it was, please let me know where it’s at on the timeline. I’ve made it through the first half, but 15 minutes is about the most I can take of Mr. Sancti-Moyer-ous. He’s in the same intellectual heavyweight class as Morgan Spurlock and Michael Moore.

    The poor aren’t going to be signing up to pay for health care out of their own pocket, concierge or otherwise, so the market is completely different.; so again, I’m not seeing the connection between people in poor rural areas and the personal medical care relationship I’m paying for.

    Cheers!

  38. Firebird

    Regarding Wendell Potter, is it only Fat Heads and low-carbers that are allowed to have a change in consciousness?

  39. Princess Dieter

    When my endo stopped taking my insurance, I paid to see her. Out of pocket. And I didn’t get this kind of attention.

    I’d PAY the annual fee for this. Worth it. A doc that is looking, talking, checking me and keeps consistent tabs on me as needed. Yes, worth paying out of pocket. Worth SAVING UP FOR, even.

    Can he move to Miami for me? Does he know a similar doc (preferably female, as I like lady docs, personally) in the Miami area?

    I’m sick of the waiting up to an hour (or if it’s a Latino doc of the old school mentality, like my sis’s, anywhere up to 6 hours–sometimes more–to be seen) to be seen for 15 mins and have to justify my Primarian eating as they insist on statins.

    Thanks…

    I’ll ask Craig if the organization that helped set him up has any referrals in other areas. Check out the other comments for other suggestions.

    Cheers!

  40. Drew @ Willpower Is For Fat People

    When the alternative is the current U.S. healthcare system, then yeah, just about anything can be better. But plenty of countries have systems that provide better care than we get here, and it costs less at the same time. Costs less, works better … isn’t that what the market should select, if the market were working correctly?

    If a service like this were available locally, I might use it, but only if I could also have coverage for major expenses. My wife is pregnant right now. There’s no way I want to pay out of pocket if anything should go wrong.

    The thing to keep in mind is that there hasn’t been a free market in health care in this country for decades.

    There is cheaper high quality care in other countries, like Panama, that have doctors trained here but operating outside the stifling U.S regulatory and tort systems. However, there’s no other country I would want to be in if I needed immediate world class health care. Sure you can get your prostate ripped out cheap in Cuba — just ask human crapbag Hugo Chavez — but if you really need best in class medicine, people come here. And pay for it.

    They provide “better care” in countries with socialized health systems because they score differently. Seriously, how could anyone think this is the one thing government can really do well? The exact same systems that insists you need good carbs, that saturated fat will kill you, and that you should take statins to keep you healthy.

    Do you know that if your wife went into labor in the 6th month of pregnancy in most countries, that they would simply make her comfortable and explain that there’s nothing they can do. It’s not that the technology isn’t invented — we have it here — it’s because they aren’t about to spend that kind of money on a preemie. Since in all of the countries where health care is “free,” they don’t count that as a viable pregnancy, it doesn’t go in the infant mortality equation. Their infant mortality rate in this n=1 hypothetical case would be zero, and their health care spending would be almost nothing.

    Here, they do everything they can, which uses tens of thousands of dollars of resources. So if they save your baby and lose another, we get an infant mortality rate of 50% and a smug lecture on how much more we spend on health care even though our outcomes are worse; because their infant mortality rate is zero and they spend nothing.

    That’s the beauty of the system. Government comes in, and the more it screws things up, the more people blame “business” or “greed.” It’s a self-perpetuating death spiral. Interesting to watch as long as you can do it from a safe distance.

    Cheers!

  41. Firebird

    Older brother, what you are experiencing with your doctor in “concierge” care was covered in a Bill Moyers Journal, and I apologize for You Tube not having that clip so I may share it with you and other readers of this blog. What it said, and I will reiterate, is that the same kind of service that you speak of is out there in this country, mostly in poor, rural areas, and the insurance industry is applying pressure to these doctors to try to shut them down if they refuse to take part in the insurance system.

    Sorry for not being clearer.

    Oops. Maybe I should’ve watched the last part of the Moyers link you posted, but I don’t see how an insurance company could pressure someone like Craig out of the business. Was what you’re referring to contained in the video of the link you posted in your last comment? If it was, please let me know where it’s at on the timeline. I’ve made it through the first half, but 15 minutes is about the most I can take of Mr. Sancti-Moyer-ous. He’s in the same intellectual heavyweight class as Morgan Spurlock and Michael Moore.

    The poor aren’t going to be signing up to pay for health care out of their own pocket, concierge or otherwise, so the market is completely different.; so again, I’m not seeing the connection between people in poor rural areas and the personal medical care relationship I’m paying for.

    Cheers!

  42. Firebird

    Regarding Wendell Potter, is it only Fat Heads and low-carbers that are allowed to have a change in consciousness?

  43. Layla

    Government health care can work perfectly fine, it did in The Netherlands for years and years, until people decided they didn’t need the government anymore, of course. Then, stuff started to go downhill.

    I’m getting a little allergic to the whole ‘governments are bad’ schtick. It’s not governments that are bad, it’s the people that make up that particular government.

    So, Dutch government used to be great, until we started looking at America. Now we’re stuck with a health care deal that I find ridiculously expensive (90 euro a month for only the very basics, against 15 euro 10 years ago) and where basically nothing is actually covered. I can’t remember the last time I had to get meds that were covered by my expensive health insurance.
    I don’t have a dental plan (too expensive), so I haven’t been to the dentist in 6 years, my teeth are rotting, I have lost bone mass in my upper jaw, due to an infection that I couldn’t afford to get fixed (the doctor said I needed a dentist, which I can’t afford) and I am only 26 years old.
    Oh yeah, you can’t decide you don’t want this, because it’s mandatory to have some kind of health care plan. Go figure.
    This all doesn’t happen to everyone here, of course, most people have enough money to pay for this stuff. I, however, don’t. And in the country I grew up in, I would’ve gotten help. Not in the ‘new and improved’ Netherlands though.

    Anyway, all of this only started because people started believing the US had it all worked out. I don’t think we will ever go back to the glorious days.

    I’m not sure how anyone talked folks into mimicking the U.S. health care system when all I ever hear is how wonderful every other one in the world is. Until they run out of money and begin to collapse. then it’s our fault for setting a bad example.

    I find your statement — that governments aren’t bad, it’s the people that make up the government — interesting. Would you suggest llamas?

    Of course governments are made up of people. Incredibly fallible human beings. That’s the only kind. And the bigger governments get, the more decisions those human beings comprising the government make for us. The more decisions they take out our our hands as individuals and make as one-size-fits-all rules for (in the case of the U.S.) 300 million people, the unhappier we get. Which is why the incompetence of government isn’t a function of which party or person is in control; it’s a function of size.

    We’ve grown ours at least $14.5 trillion beyond any moral or rational basis and it’s still metastasizing. Europe is pretty much in the same boat or worse, and we really haven’t even gotten to rough part yet.

    I wish you the best with your health issues.

    — The Older Brother

  44. Layla

    Government health care can work perfectly fine, it did in The Netherlands for years and years, until people decided they didn’t need the government anymore, of course. Then, stuff started to go downhill.

    I’m getting a little allergic to the whole ‘governments are bad’ schtick. It’s not governments that are bad, it’s the people that make up that particular government.

    So, Dutch government used to be great, until we started looking at America. Now we’re stuck with a health care deal that I find ridiculously expensive (90 euro a month for only the very basics, against 15 euro 10 years ago) and where basically nothing is actually covered. I can’t remember the last time I had to get meds that were covered by my expensive health insurance.
    I don’t have a dental plan (too expensive), so I haven’t been to the dentist in 6 years, my teeth are rotting, I have lost bone mass in my upper jaw, due to an infection that I couldn’t afford to get fixed (the doctor said I needed a dentist, which I can’t afford) and I am only 26 years old.
    Oh yeah, you can’t decide you don’t want this, because it’s mandatory to have some kind of health care plan. Go figure.
    This all doesn’t happen to everyone here, of course, most people have enough money to pay for this stuff. I, however, don’t. And in the country I grew up in, I would’ve gotten help. Not in the ‘new and improved’ Netherlands though.

    Anyway, all of this only started because people started believing the US had it all worked out. I don’t think we will ever go back to the glorious days.

    I’m not sure how anyone talked folks into mimicking the U.S. health care system when all I ever hear is how wonderful every other one in the world is. Until they run out of money and begin to collapse. then it’s our fault for setting a bad example.

    I find your statement — that governments aren’t bad, it’s the people that make up the government — interesting. Would you suggest llamas?

    Of course governments are made up of people. Incredibly fallible human beings. That’s the only kind. And the bigger governments get, the more decisions those human beings comprising the government make for us. The more decisions they take out our our hands as individuals and make as one-size-fits-all rules for (in the case of the U.S.) 300 million people, the unhappier we get. Which is why the incompetence of government isn’t a function of which party or person is in control; it’s a function of size.

    We’ve grown ours at least $14.5 trillion beyond any moral or rational basis and it’s still metastasizing. Europe is pretty much in the same boat or worse, and we really haven’t even gotten to rough part yet.

    I wish you the best with your health issues.

    — The Older Brother

  45. Rahul

    Hey has Tom reviewed this video, if he has can you link me the post and if he hasn’t plz tell him to watch it and review it, its a mind blowing film.

    http://www.youtube.com/watch?v=OEu27wZZtHI&feature=player_embedded#at=684

    “Food Inc” has been referenced on the site several times in comments. Didn’t know they had the full version posted YouTube. I know Tom is aware of the film, but I don’t recall him posting on it specifically.

    I know Joel Salatin, who I’ve posted here about, is in some of it. Thanks for the link.

    Cheers!

  46. Alexandra

    Great post, Old Brother! Sounds like a great approach, I hope that this model proves successful so that more Doctors will do it. My experiences with doctors and medical care in general had been so negative that I basically dropped out of that scene completely after my last child was born 17 years ago. (other than my dentist, who is awesome) I just bookmarked the DirectLabs web site.. that may be a reasonable way to ease back into getting some health checks on my own terms.

  47. Richard

    As a citizen of Sweden I have experienced socialized medicine first hand for 40 years now and I’m telling you from personal experience. It works great. I have been with the same doctor (you are free to choose) for 15 years now and I pay less then 50% of what you are paying through my taxes. 100% of the population is covered and what medical treatment you need is decided between you and your MD. There are NO bureaucrats involved in making decisions concerning your healthcare, EVER. What’s wrong with that?

    The stuff about children born early being left to die in “most” countries sounds like something straight from the big republican book of horror stories. I can truthfully tell you that 70% of babies born between week 22 and 27 are still alive one year later here in Sweden. I expect to find similar statistics for the rest of Europe.

    Haiti, Sudan, Afghanistan, most of Africa, Cuba and other underdeveloped countries might have practices as described in this thread, but such a comparison is of course of limited value given the absolute poverty of these countries.

    Insurance companies aren’t in it to make you healthy. They are in it for the money. As much of your hard earned money as they can possibly get. This is why it makes perfect sense to cut out the middleman. Everybody wins.

    Law enforcement, firefighting, the armed forces, schools and healthcare are best handled by government although very little else in my opinion.

    Well, we agree on the law enforcement, firefighting, and armed forces. Throw in a judicial system to address crime and adjudicate contract disputes, and we’re in libertarian world. I’ll continue to make my own arrangements for education and health care, thanks.

    Sweden is a fairly homogenous society, which makes socialized anything easier to implement and slower to reach failure.

    In the U.S., since over 50% of the population pays zero income taxes, I’m not sure how your deal works out. On infant mortality, the U.S., Canada, and the nordic countries use similar scoring, but as for the rest of the world, here’s an excerpt that cited the OECD:

    …The World Health Organization [WHO] defines a country’s infant mortality rate as the number of infants who die between birth and age one, per 1,000 live births. WHO says a live birth is when a baby shows any sign of life, even if, say, a low birth weight baby takes one single breath, or has one heartbeat.

    The U.S. uses this definition. But other countries do not — so they don’t count premature or severely ill babies as live births-or deaths. The United States actually counts all births if they show any sign of life, regardless of prematurity, or size, or duration of life, notes Bernardine Healy, former director of the National Institutes of Health and former president and chief executive of the American Red Cross. And that includes stillbirths, which many other countries do not count, much less report.

    Also, what counts as a birth varies from country to country. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) before these countries count these infants as live births, Healy notes. In other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless, and are not counted, Healy says. And some countries don’t reliably register babies who die within the first 24 hours of birth, Healy notes.

    Norway, which has one of the lowest infant mortality rates, shows no better infant survival than the United States when you factor in Norway’s underweight infants who are not now counted, says Nicholas Eberstadt, a scholar at the American Enterprise Institute.

    Moreover, the ranking doesn’t take into account that the US has a diverse, heterogeneous population, Healy adds, unlike, say, in Iceland, which tracks all infant deaths regardless of factor, but has a population under 300,000 that is 94% homogenous.

    So it may be in the big Republican book of horror stories — I wouldn’t know since I’m not a Republican — but it’s still true.

    Cheers!

  48. Rahul

    Hey has Tom reviewed this video, if he has can you link me the post and if he hasn’t plz tell him to watch it and review it, its a mind blowing film.

    http://www.youtube.com/watch?v=OEu27wZZtHI&feature=player_embedded#at=684

    “Food Inc” has been referenced on the site several times in comments. Didn’t know they had the full version posted YouTube. I know Tom is aware of the film, but I don’t recall him posting on it specifically.

    I know Joel Salatin, who I’ve posted here about, is in some of it. Thanks for the link.

    Cheers!

Comments are closed.