Taenia saginata

If the rising costs of medical care are driving insurance rates upwards, what are the effects on a public insurance program, such as Medicare? Given that many private insurance policies are paid for by employers, what effects do rising premiums have on the competiveness of American companies?
America's rich uncle, Warren Buffet, describes the rising costs we've discussed as a tapeworm.

There are two recommendations for treating this parasite when it resides in humans, niclosamide and praziquantel. Here are two recommendations for treating the tapeworm Mr. Buffet describes.

As previously mentioned, insurance is a financial derivative. The underlying product is medical care. The price of a health insurance policy reflects the expectations of where our medical system is headed.

There are several means for a physician to bend the cost curve down: strike the problem on the head, cut it across the middle, or grab it by the tail. At the head is the supply problem, a shortage of doctors and nurses. Even after red tape is cleared at our medical schools, there are still seven years of production time required to mint a new physician. Sounds too tedious, and this topic is already sufficiently dry. So, we’ll skip that for now.

Let’s look towards the other end, the tail. Here, consider the expenses of caring for a chronic disease, especially one growing in prevalence. To maximize our impact, we'll get specific. The predictions of a sharp rise in the number of patients with End Stage Renal Disease (ESRD) suggest lowering the cost of dialysis treatment would be a high impact win. If accomplished, the cost projections to care for renal failure would decrease and the premium to insure a patient with early ESRD could be lowered. Furthermore, those patients with risk factors for ESRD would also have lower cost projections. Quickly name two risk factors for kidney disease, "obesity...diabetes," and you’ll recognize two other growing demographics.

So my first treatment to bend the cost curve down is to focus on a single treatment which has enormous costs. Imagine a house of cards stacked high atop a table. The card at the top is the present. Moving down a spreading base, are all the future medical outcomes which may happen. Lowering the cost to care for dialysis patients is akin to pulling a bottom card out from underneath this house. If we lower the outlook on the total cost of dialysis, many other cost projections will come cascading down.

Dialysis technologies, already available, produce high quality outcomes when used by skilled practitioners. Because they cost less to administer, more extensive use would make ESRD more affordable to treat. Additionally, quality improvement informs physicians how to lower the peripheral costs of ESRD: the increased incidence of preventable infections, and the extensive use of lab tests which often overlap due to a lack of coordinated care.

That's a sketch of the first treatment strategy for rising health insurance costs. Specific medicine will be more difficult to determine and prescribe. This is why it's called: Quality Improvement research. We can also look at the middle of the problem, and target our patients teetering between two demographics: fit vs. overweight, pre-diabetic vs. diabetic. The logic for why this would be effective is the same as the house of cards analogy, but the tactics are a separate discussion.

However, when the improvements start to take hold, we can then cold-call those would-be executives of a non-profit health insurer; tell them to start scouting office space.