Happy New Year

I remember as a child, my first grade teacher had the door of our class room at Chelyan Elementary decorated with cartoon like pictures of an old man standing next to a baby.  The imagery was to show the comparison between the old and new years.  1982 wasn’t a particularly good year for me as I had lost my grandfather in December, so the idea of a new start hit me even as a 6 year old. 

Every year, we celebrate the seemingly arbitrary beginning of the Julian calendar, which is a relic of the Roman Empire and Julius Caesar.   January 1st or New Year’s Day for some is just another day.  For many, it can be a new beginning in so many things.  People everywhere resolve to be wealthier, healthier, happier, and better for the new year.  Far too often, those resolutions go by the wayside within weeks of the new year.  People give up on the budget, the new diet, fall into traps that get in the way of their happiness and feel lesser because of it.    This year I have a few goals of my own. While trying to be healthier and happier, I hope to just realize how blessed I am each day. 

Thank you to those of you who read these posts, listen to the Appalachian Health Podcast, or watch Live Healthy, Live Well, West Virginia.  I hope the material I cover with friends, colleagues, and guests will enrich someone this year.  With a little divine intervention, everyone reading this will be a little richer, a little healthier, a little happier, and a little better.  Here’s to a great 2020.  Happy New Year.

County Health Rankings: What can we do?

In the above diagram, if you look at the left, it shows that policies & programs can influence health factors which will then influence health outcomes.  At the top, health outcomes are basically half and half length of life and quality of life.  We all want to have longer more fulfilling lives.  The thing thats missing from this is that there should be another arrow atop health outcomes.  It should say cost, because better outcomes can mean lower costs to healthcare.

The factors portion is what’s interesting.  Only about 10% of factors comes from the physical environment. In West Virignia we really get beat up on rankings of housing and transportation because we are a rural community and have a lot of poverty.  

The next section is social & economic factors.  This is 40% of the factor scores.  Educated citizens make better choices.  We should all make certain physical education & health classes are taught at a young age and continued throughout the K-12 education for our youth. It might not hurt to bring home economics back either.  Family & social support and community safety make up the rest of this.  There is nothing you can substitute for family & social support or for community safety.  Any investment in these will eventually lead to better outcomes.  And remember, better outcomes means lower costs.

Clinical care is only 20%.  Access to care is driven a great deal by employers providing health insurance and other benefits like sick leave.  Quality of care is up to providers.  We are fortunate in West Virginia to have some truly high quality providers in such a small rural state.

The last block you see going up is health behaviors.  It is 30%.  If you use tobacco, investment in a cessation program will pay you back.  Diet and exercise are also big drivers.  Having a limited use of alcohol and limiting drug use can help tremendously.  If you are sexually active, and not in a monogamous relationship there are risks that you may be taking.  Talking with your healthcare provider about the risks and how to mitigate them may save you from certain sexually transmitted infections.

More than half of the factors listed above are things you can help your employees with.  This investment in their health will pay dividends.  Keep in mind these are long term investments and they don’t happen over night.

If you’re further interested in how these are calculated or how your community is graded versus the rest of West Virginia or the rest of the county, go to https://www.countyhealthrankings.org and you can see the data in an easy to use format. 

Invest in Your Health

In 1962, economist Selma Mushkin discussed the additions to our economy by investments in health.  She discussed the effect of a reduction in the death rate on the rate of economic growth from advances in healthcare.  Fast forward to today.  The United States spends more than any other developed country on healthcare, however life expectancy at birth is 2 to 3 years lower.  Any other investments that we make, we look at the dividend paid or the final yield and wonder are we better off than where we began. Why don’t we look at our investments in healthcare?

Healthcare further complicates itself as a business. There is a third party in most of the transactions and contracts.  The third party in this transaction is your health insurance.  They negotiate rates with the employer, or more often tell the employer what they’ll pay.  Then the insurance company will negotiate rates with the health care organization that has the supply. 

Being able to change insurance companies every year, means that insurance companies see no high value investments in your health.  In their eyes, they may see an investment they make in your long term health could mean that their competitor will receive the dividend.  As patients regularly change payers, any individual third party payer has less incentive to commit to any expensive, high value treatment, as the result may mean their competition will reap the reward.  I don’t blame them for this. Often Medicaid programs and sometimes small insurers will say that short term budget constraints keep them from paying for high value therapies.  

Hospital costs are up, healthcare administration costs are up, diagnostic costs are up, pharmaceutical costs are up, and insurance companies have less incentive to control long term costs and make you healthy.  Some people have even said this was a large driver of the opioid crisis.  For example, third party payers would pay for an opioid prescription in lieu of physical therapy for an injured patient, because the negotiated rate on the 30 day supply of an opioid was much cheaper than 6 weeks of physical therapy, though PT may have been the answer.  We’ve seen multiple pieces of legislation across the country addressing this very issue.

So, the question I get asked the most about is “Is single payer the right strategy for our country?”.  People have very strong views about healthcare.  I recall working in the Governor’s office when the Affordable Care Act was passed.  We had people calling in droves to the switch board telling us to keep our government hands out of their Medicare.  They didn’t understand that Medicare is government healthcare and the Governor had little control over it.  The bottom line is, no matter what the democrats tend to trot out, I see neither an economic model, nor a political environment where that will work.  Further, we have gone down this road for so long, I can’t imagine the federal government destroying entire companies to replace them with a federalized healthcare system similar to European models.  

The next step in healthcare reforms will be focusing on value based healthcare and perhaps eventually capitation in health plans. Third party payers are going to do everything possible to limit their share of the risk involved in healthcare. The best advice anyone can get from this is to take care of his or her own health. Its the only way you can guarantee some modicum of lower healthcare costs in the near future.

Happy Thanksgiving

Over the course of a year, we experience many holidays. If you work in state government you get more than I do off from work, and I do miss that part of government work. Some of them are merely days off, some are religious in nature. Thanksgiving has come to be my favorite. We take time off solely for the purpose of giving thanks. There’s no pressure in gift giving, or the other commercial trappings of Christmas. Just plain ol’ gratification of saying thanks for all the good things we have.

I enjoy watching football as much as anyone and my favorite dessert from my time with my grandmother was pumpkin pie. I truly enjoy arguing politics and religion with any family member that dares question me at the dining room table. But, I have to say I have much to be thankful for, even in 2019.

I have a lovely wife, who is healthy and two great dogs. We live comfortably in a nice home, and have transportation. Charleston is a great community and my home state, for all its misgivings, is full of wonderful citizens. I get to work for a great group of people and have some wonderful people that work for me. Though I could stand to get back to my fightin’ weight, I’m fairly healthy and have some great friends all across the country. I have many things that can never be taken from me like a great education (earned at WV Tech and WVU).

I’m going to publish this on my blog so you can read it and I hope you get inspired a bit this Thanksgiving, but I might just look back on it to remind myself just how fortunate I am.

Happy Thanksgiving.


The name T21 sounds like the subtitle to an Arnold Schwarzenegger sequel. However, its a public policy sweeping across states and has even received some support from President Trump. T21 or Tobacco to 21 is an effort to raise the legal purchasing age to 21. Over 500 city/county jurisdictions and 18 states have enacted this as a law.

Public policy advisors everywhere have worked to get this into law. A recent Gallup poll found that a majority of Americans agree. Last year, in a West Virginia legislative hearing, Bureau for Public Health Commissioner Dr. Cathy Slemp was asked about an exemption for military members. Dr. Slemp showed where even the United State DOD doesn’t want their young women and men smoking. Unhealthy behaviors are bad for military readiness.

The truth is recent studies have shown that these laws reduce smoking rates in young people age 18-20. The other thing we know, is that the longer people avoid picking up this habit, the less apt they are to be a cigarette smoker in the future, which means healthier, longer lives. And if you aren’t a smoker and wonder how this affects you, less smokers will eventually help with health insurance costs.

For more information, go to tobacco21.org.