John,

Your comment relative to the cost of Alzheimer’s disease with respect to caregivers is absolutely on target. Alzheimer’s disease not only affects caregivers, but it also complicates life for others who help manage the patient’s affairs. Boston University specifically focuses on difficult issues like when the patient has reached the point that he or she cannot continue to drive or to perform other daily functions.

You also bring up another key point: caregivers need support and help themselves. Getting them to acknowledge this is sometimes more difficult than dealing directly with patient issues. Support groups help in this regard, and the Alzheimer’s Association is an excellent resource for helping identify such groups. Recently, I talked with Jay Silverstein, the CEO of Revolution Health, who is a real visionary in thinking about how to build communities of people who can support one another with respect to medical conditions and the related resources needed to address them.

Although medical research will probably not progress fast enough to help reverse or stabilize your father’s condition, I am working with others to move it fast enough that, when our generation reaches the ages of your parents, Alzheimer’s has became a chronic, controllable condition, as opposed to the devastating degenerative disease it is today.

- mike

Thank you for your thoughtful comments on health care. You make two points to which I would like to respond:

• The current private payer system does have huge overhead, but it is unclear how much of that would exist if CMS, the Medicare administrative agency, did not mandate a great deal of detailed reporting, even for non-Medicare patients, or if states did not try to micromanage health care administrative processes. I would argue that we already have a government-regulated health care system, but we are getting the worst of both worlds: heavy regulation of the private sector which negates much of the advantage of a highly innovative private sector system, and the lack of comprehensiveness that a pure profit-driven system can create.
• I do not believe broad-based oversight boards would offset the drawbacks of a single-payer system. Having studied the Canadian system and seen how Medicare has been administered, there are multiple areas of dysfunctionality:
o Politicians invariably react to a particular dramatic coverage problem by adding coverage mandates that carve into stone a popular coverage approach at a particular point in time. Thus, in almost all states, some interest group has successfully lobbied for mandates, many of which raise serious questions. For example, I believe New York mandates coverage of fertility treatments for insured plans. Fertility treatments give couples the chance to have children that would otherwise be deprived of that opportunity, and, to the degree that the state wants to encourage couples to have children, these treatments are a good way to help that process. On the other hand, fertility treatments result in more premature births, which are much higher cost, and premature births increase the odds of developmental and health issues as the child grows. There are legitimate and serious questions about whether fertility treatments should be mandated that the state probably did not address before the law was passed.
o Medicare CMS already has oversight boards, and the pace of change for something that obviously needs change is far too slow. Medicare CMS also has a flawed methodology of focusing on individual medical events, rather than a lifecycle of care, because government budget cycles are annual. When health care is managed relative to annual government fiscal year budgets, longer-term investments in health are simply not done. When we effectively invest in health by making brand-name diabetes drugs very low cost or free, we take a current-year budget hit, but it is a great investment in health and in reducing future health care costs. A government would make the trade-off the opposite way because of budget-balancing mandates.
o Governments, insurance-based health systems, and consumer-based systems do not link health with productive capacity. Employers can and do recognize that employee health pays back in improved productive capability, and the smartest employers are able to see what investments in health can accomplish.

Thank you again for your comments.

- mike

My father has been diagnosed with Alzheimer’s and I wanted to add to your excellent comments on research and discovery that the true cost of Alzheimer’s fails to take into account the cost of care required not only for the patient but for the caregiver. My father, who is 87, is cared for by my mother, 85 (with financial and some care-giving by myself and my wife). Due to the stress and strain of day-to-day care, my mother’s general health has rapidly deteriorated. She has been hospitalized twice for being just plain rundown. She will not let other professionals care for Dad (which I admire, but sadly regret because it is harming her, and , frankly, Dad does not understand her sacrifices). He remains kind and gentle (thank God), but I am watching in real life the cost of this disease on those who care for the afflicted.

Your blog site with fresh ideas is wonderful. This is to ask a question about single payer health systems, which you oppose on the basis of dysfunctional trade-offs as occur under Medicare. On the other hand, I note many problems with our private payer system, including 30% overhead expenses and clerks deciding upon individual medical treatment.

In about two years, California will have a
single payer system before its legislature. To counteract many (but not all) possible dysfunctional trade-offs, this program has a number of policy setting boards which include representatives from consumers, doctors, hospitals and administrators. Do you think oversight and policy boards would be adequate to make a single payer system worth trying?

Ron Patten

Thank you for your insight. In reference to the link below (”Care or a cure? How should Alzheimer’s funds be spent? Lawmakers, researcher’s debate tough question”), maybe of some interest; although it’s a year old article, it does make some valid points:
http://mednews.wustl.edu/news/page/normal/7360.html

Thanks,
~PM