According to a recent longevity survey those residing in the United States are living longer than at any time during our country’s recorded existence. This new finding throws all of the former actuarial tables for retirees into the garbage can and adds yet another conundrum to the already plateful of potential health related issues the Feds have to consider. Formerly, the word “retirement” was a concept based on a rather limited remaining lifespan and applying to those who would do less, require fewer resources, and simply go away without using many, if any, health care resources. But that was then and here we are today.

Many of today’s retirees are, in fact, doing more of whatever they can physically and financially afford to do, and this often equates to a substantial increase in the use of available medical resources. Apparently, the president and his administration are very concerned about this discovery and have created a task force to investigate the implications of this newfound longevity because it is already having an impact on the federal budget. From what has been learned to date, the task-force has been directed to determine what U.S. residents are doing with their 10 or more years of healthy, active retirement and how they’re paying for it. In effect, the government now wants to know what the current wave of Baby Boomers are doing with their time and money and what impact these activities are having on the economy and the litany of federal resources. It would be easy to assume that the Feds want this information for use in determining how to craft more responsive and supportive programs for retirees. But call me skeptical; I believe the information will be use to craft more stringent Medicare and Social Security restrictions and even greater tax gathering options through the Internal Revenue Service. Of course, all of this is being accomplished under the guise of “We want to serve you better…” Oh yeah, trusting the government to have our best interests at the top of their “to do” list is also right at the top of the list for most Americans these days.

As fodder for my skepticism, here are some entries on an interim report from this task-force that has already identified a number of potential critical points that impact the health care overhaul:

1. After retirement, people typically avoid performing any mandatory, scheduled functions that were related to their prior professions or areas of expertise. Those who are forced to re-enter the workforce most often do so in jobs that are totally unrelated to their former career fields and in part-time positions.

2. Retirees spend an average of six hours per day watching television after retirement. Many spend another one to two hours using their computer.

3. After retiring, people gain an average of 47 pounds within five to ten years which further deteriorates their health and ability to perform active, worthwhile endeavors. Gaining weight has been deemed the single most deadly activity of all for retirees, and it far outpacing broken hips and Alzheimer’s disease.

4. Vehicle driving mileage more than triples for retirees until health related issue impede it, although many people qualify for and retain a driver’s license long after they become hazardous to themselves and other on the road.

5. There’s a five fold increase in retiree prescription medications for depression, impotence, and indigestion when compared to those remaining in the workforce.

6. With an abundance of free time and the onset of boredom, the prevalence of alcohol over-consumption increases dramatically after retirement. For example, the average retiree over the age of 50 drinks his or her weight in alcohol every six months.

7. Another unfortunate yet prevalent downside for retirees is the incidents of suicide or attempted suicide when compared to statistical data for the general population.

There’s already been an alleged interim report given to the President, and here are some of the purported recommendations presented by the task force:

1. All retirees residing in the United States would be required to submit a Life Plan to the Government containing a detailed list of activities each retiree intends to become actively involved in within 12 months after retirement. Maybe the Feds are planning to appoint a Retirement Activities Czar with duties similar to those of an Activities Director on a cruise ship.
2. All retirees whose plans list “watch television” or “travel regularly in a motor home” would be flagged. There’s no explanation regarding why such listings might be considered suspect or require further review. The first thing coming to mind is that the Feds might be concerned that retirees could actually use some of their free time to become better informed about the shenanigans being pulled in Washington. Oh no, an informed population of voters—what a catastrophe.
3. All citizens below the prescribed age of retirement (whatever official age that may be as determined by the government) would receive notification that the approved retirement age has been indefinitely rescinded. In effect, if the majority of the population is either retired, out of work because the economy has failed to acceptably recover and there simply aren’t enough jobs, or getting by on some sort of government run public support program, the country will inevitably become bankrupt and the dollar with be worthless in the global marketplace; America could cease to exist as we’ve known it.
Until such time that the alleged task force renders an official report to the President, those who’ve have already signed onto the retirement rolls can continue easing back in their recliners, flipping through the non-government controlled cable channels at will, occasionally dozing off without fear of some form of penalty, or even renting a motor home without a security clearance and hitting road to see what may prove to be a fleeting vestige of the county.

We’re getting change all right, and so far it doesn’t remotely resemble what we were led to believe it would be.

Who’s your doctor when you’re hospitalized?

When I was growing up we had a family doctor who actually made house calls whenever necessary and would follow up to make sure the treatment worked for getting us “back to normal.” These same doctors performed routine adolescent surgical procedures involving overnight hospital stays such as removal of our tonsils, and we always got ice cream afterwards. We also saw them at the hospital the morning after the procedure to evaluate whether or not we would be discharged or have to stay another night. If the latter was the case, they’d stop by again on their way home after being in their offices all day. That was simply the way things were in medical practices back then, but this is now and everything has changed, or evolved as we’re told.

Today hospital stays for routine surgical procedures are almost a non issue; most are performed in the doctor’s office or in a nearby ambulatory surgical facility that gives the appearance of being an actual hospital operating room complete with appropriate medical staff personnel, but without the overnight stay option. Being hospitalized for even one evening is a big event now, and you can forget about seeing the doctor who actually ordered you there unless that person also happens to be the surgeon. Otherwise, the next time you’ll see your primary care doctor is during a follow up visit to his or her office.

But if you happen to see an actual doctor during your overnight hospital stay it will almost assuredly be a hospitalist or inpatient specialist as they’re known in some parts of the country, a relatively new breed of medical practitioners. These physicians are on call 24/7 and because they’re omnipresent in the hospital, medical industry experts say they’re more familiar with resident staff, consulting doctors and optional testing procedures than area family practitioners or primary care doctors. The origin of hospitalists can be traced back two decades, although the name was not decided upon and coined nationwide until 1996. Hospitalists now form the hub of in patient medical care and coordinate in patient services with nurses, specialty consultants and discharge planners routinely and efficiently.

On average, a hospitalist works about 55-60 hours per week, is usually salaried by the hospital, managed care company, private practice or group of practitioners and bills the patient’s insurer directly through the hospital administrative system. The salaries range from $100,000 to $200,000 a year depending upon the part of the county where they’re employed with the ones in large metropolitan area hospitals receiving more money. While many hospitalists earn less than private practice physicians, they aren’t burdened with any administrative and personnel staff related issues and perform only direct medical care functions for hospital patients.

According to statistical projections made by the Society of Hospital Medicine, a national hospitalist trade group headquartered in Philadelphia, a decade ago there were fewer than 100 such medical specialists; but by the year 2015 there will be an estimated 30,000 hospitalists assuming the care of inpatients across the country.

Hospitalists or hospital medicine is advancing toward becoming the dominant type of inpatient care in all categories of hospitals. Today approximately one-half of all U.S. hospitals having 200 or more beds have a hospitalist program in place. Estimates are that virtually every hospital in the country will have a hospitalist program operating within the next 10 years. A recent report by the Washington, D.C. research group, the Center for Studying Health System Change indicates that in the larger metropolitan markets such as Phoenix, Los Angeles and Miami, most medical groups have already relinquished care of admitted patients to hospitalists.

In the majority of cases, hospitalists are internists by training who treat inpatients from admission through discharge, replacing the primary care doctors as their physicians of record. They provide in-depth case workups, conduct regular daily visits as needed, only one of which is compensated via insurance billing, and coordinate all patient care provided by every staff member from nurses to essential outside specialists.

In reality, hospitalists appear to be relieving congestion and outright patient gridlock in overloaded emergency departments by routing patients to the next appropriate level of care, and, when critical, by admitting uninsured, underinsured and otherwise unassigned patients who don’t have primary care doctors. They also relieve some of the in-house resident physician patient load whose long hours have undergone mandatory reduction under new federal government and local training guidelines. A hospitalists overall comprehension of and familiarity with hospital operations and staff personnel allow them to rapidly recognize gridlocks and reposition patients in and out of facilities more efficiently. It is becoming irrefutable that having hospitalists based in the hospitals result in faster treatment and critical action on test results than primary care or family physicians can provide.

As anticipated, the core of the hospitalist movement is consistent financial evidence derived from multiple studies confirming that these specialists save money. The hospitalist program is said to improve outcomes because hospitals have a viable rationale to use an industry standard called “best practice” guidelines.

In addition, hospitalists claim they gain considerably greater experience dealing with higher acuity patients with whom primary care doctors have infrequent exposure. In effect, hospitalists are likely seeing a hundred times more specialty or rare cases such as pneumonia or various other severe, potentially life threatening illnesses per year than primary care doctors and they feel comfortable managing these cases, according to a lead hospitalist I spoke with at a large southwest region hospital. In his opinion, treatment becomes easier and more effective because of avoiding the necessity for having to deal with numerous area primary care physicians who formerly performed hospital visits to check on their patients.

However, there are legitimate concerns about these relatively new positions unnecessarily fragmenting patient care for the sake of efficiency and, of course, money. As a specialty that’s been in place for just over a decade and yet to be recognized by the American Board of Medical Specialties, there are inconsistencies among the practitioners and programs that need to be addressed. For example, primary care or community doctors are frequently at odds with hospitals and hospitalists over what they perceive as “The Big Brother Syndrome” and being told how to manage their patient’s care. In effect, there’s a lot of professional animosity or the “us” versus “them” in the medical arena. Primary care doctors tend to believe that hospital administrators only care about the bottom line, the financial balance sheet, as opposed to what’s actually best for each patient. The argument that many hospitalists are too inexperienced because of having recently completed internships are thereby ill-equipped to treat patients with complex diagnoses and/or multiple conditions that actually require far more costly outside specialty consults than may be necessary when seasoned medical doctors are functioning in the program. The average hospitalist has been practicing hospital medicine only four years which does call into question their ability to respond as effectively and independently as being reported by many hospital administrators. Some hospitals are establishing in-house ongoing training for newer physicians entering the hospitalist ranks; in effect, a medical mentorship program appears to be forming that can tailor training to historical hospital or area needs.

Conversely, hospital administrators believe that primary care doctors fail to comprehend the extreme financial pressures associated with operating a medical facility. It seems the jury is still out regarding a decision about whether or not hospitalists actually save money and provide better in-patient hospital services than before or if they can survive the stress and potential burnout associated with having to treat a perpetual onslaught of acute care patients.

As of this date, no legislation has been proposed at the federal level or in any state that would regulate or otherwise affect the operational procedures currently being practiced by hospitalists around the country. This means there is no standardization or definitive oversight among hospitalists anywhere in the nation.

For the immediate future, you can expect to see a hospitalist if you’re staying in the hospital overnight, so you and your family members shouldn’t expect to chat with the family doctor anywhere other than in his or her office. But you can make sure that the hospitalist will be in close contact with your primary and specialty care doctors to collaborate and ensure that appropriate follow-on care takes place after discharge.

If you have questions or concerns about the hospitalist program in your area be sure to discuss this issue with your primary care doctor. Nobody wants to go to the hospital, but these days you need to prepare for the possibility just for peace of mind.

You’ve probably seen the latest hype coming from General Motors (GM) touting their revolutionary Volt automobile available for sale next year, the greenest hybrid car yet because it’s expected to average 230 miles per gallon during city driving. Of course, I was shocked and rightfully so after further research revealed a few unreported facts.

It seems the Environmental Protection Agency (EPA) offers some fairly wide latitude in the way automakers can calculate miles per gallon averages prior to the actual sale of a newly designed vehicle. They’re also fumbling for a formula that accurately calculates mileage for hybrid vehicles. For example, with a gas-electric such as the Volt, GM used a creative method to measure mileage that averaged overall distance covered by combining the two sources of power—electricity and gasoline. Add to that the glossed over driving restrictions the automaker employed to come up with their triple digit calculation and the noteworthy avoidance of mentioning that the EPA hasn’t actually tested the car. By now you’re beginning to get a glimpse of the blurry picture of this costly little transportation marvel that will hit the showrooms with a sticker price of around $40,000. You can buy a very nice used car and a lot of gas for the amount of money.

The Volt’s battery pack is a lithium-ion offering a maximum driving range of about 40 miles that can be recharged in a typical 110v wall outlet. Also under the hood will be a little gasoline engine that assumes the power needs of the car, with substantial limitations such as Interstate highway speeds and steep hills, while concurrently powering a generator that creates electricity and recharges the battery on the roll. GM’s marketing hype states that drivers could travel for days without ever using a drop of gas. That’s nice, but how many people travel less than 40 miles on a perfectly flat road at 20 miles per hour getting back and forth from work, grocery shopping, doctor visits, and various other around-town treks?

Within hours of GM’s announcement Nissan Motor Company served up its plan to roll out the Leaf next year, an electric 110v plug-in rechargeable hatchback car that will get an estimated 367 miles per gallon using the same broad latitude from the EPA’s new draft guidelines. However, unlike the Volt, this model doesn’t have a built-in generator for recharging on the fly; drivers would have to stop and plug it into an outlet after approximately 100 miles of around town driving—even less at higher speeds and if rolling terrain is involved in the trip.

As you may have anticipated, the Feds are already planning to offer the first suckers, excuse me, eco-friendly buyers, a $7,500 tax credit, but that still leaves a hefty balance of twenty-two grand for the Volt. The price of the Leaf will likely be in the same range. But by the time these things hit the streets their marketing mileage estimates could be 500 miles per gallon.

Another interesting conundrum, Americans aren’t getting any smaller, but the automakers seem to be focused on downsizing their vehicle offerings. I recently sat in one of the first scaled down models to hit the streets, the Smart Car. I’m not a big guy according to the height and weight chart hanging on my doctors’ exam room wall, but I felt like a National Basketball Association center while sitting in that thing. And claustrophobia surprisingly emerged within seconds after closing the door. My mind conjured up a collision with a monster vehicle such as a Honda Civic or Toyota Prius. To add additional anxiety, the Insurance Institute for Highway Safety, an independent, non-profit, scientific, and educational organization, hasn’t been kind in their crash test ratings for these high mileage shrunken cars. In fact, the stats are downright frightening because the odds of having a collision with another comparatively sized car are miniscule. That alone should raise the fear factor for potential buyers. My suggestion before taking the plunge into triple digit fuel territory is to check with you insurance company prior to signing the bottom line of a car purchase contract. Get their opinion of the mini-model and actual coverage costs compared to other vehicles getting mileage in the more realistic 30+ range, those having enough power to make it over a modestly steep hill more than once, and ones with realistic driving distance estimates per charge and tank of gas.

A plausible option is one of the oncoming modern diesel engine models that are offered in full sized cars and get about 30% greater fuel economy than typical gasoline engines. Not only are the new diesels quieter and cleaner emitting approximately 20% less carbon dioxide, the European refineries have also removed most of the other pollutants from their fuel. Another huge plus is that you don’t need crude oil to produce diesel fuel; it can be made from plain old coal, plant matter or common cooking oil. Seriously, a fairly large restaurant could ship much of their garbage to a modern refinery and have it turned into perfectly good diesel. Here’s another shocker; India has recently successfully turned cow patties, or cow dung if you prefer, into an energy source that has powered a diesel engine car. Talking about stepping in it, they may have done exactly that and come out smelling like freshly printed money.

It gets better yet, there’s a hybrid diesel on the horizon as well. A recent Massachusetts Institute of Technology study concluded that a combination hybrid-diesel engine could far outperform the lithium battery and hydrogen fuel cell engines on both mileage and carbon emissions, and it could become a reality within the next decade. In essence, the GM revolution may lose its charge before it gets a profitable number of cars on the road.

The critical key to success in the modern diesel technology engine will be the company that manages to come up with the cleanest burning version while maintain the power to comfortably propel a full sized vehicle at highway speeds for long distances. Here’s a hint: Pay attention to tail pipe technology and clean coal in the coming years as these will likely be the keys to success for the currently obscure fuel and engine technology.

One final prediction; crude oil is going to rise rapidly and unexpectedly and reports of availability and new oil field discoveries have been blown out of proportion, and in many cases may not exist at all. This can lead to only one thing—much higher gas prices, levels that make the almost forgotten $4 a gallon seem modest.

For now, I’m staying the course in my current five year old clunker that uses regular gas and gets a mere upper twenty something miles per gallon. My insurance company loves it because it’s loaded with safety features so my premiums are reasonable when compared to those of my neighbors who’ve already jumped ship for the higher mileage mini models. Possibly the most attractive feature about my current car is the fact that I didn’t have to get permission from the government to buy it.