Kurisko & Co

You don’t want to miss this wide-ranging conversation with perhaps one of today’s foremost experts on healthcare systems. Health actuary and retired Milliman Principal Mark Litow spoke with Joyce and Gayle about how healthcare systems work, the main disconnects in the US system, and how reform efforts have led to the numerous problems we face today, including poor doctor-patient relationships, unaffordability, generational inequity, workforce challenges, and long term unsustainability.

Mark leads the Concerned Actuaries Group or CAG (www.concernedactuaries.org), and he went into detail about how CAG has modeled the US healthcare system. The model focuses on six signals that together form a comprehensive view of the system: cost, coverage, access, health status, economic impacts, and long-term sustainability. The six signals are modeled across all markets, such as Medicare, large employer group, uninsured, and individual. The idea is to model each mutually exclusive population group based on the type of medical coverage they have, as incentives and behaviors will vary by these groups. The model projects the results of a reform into the future and compares it to a continuation of today’s healthcare system. As a powerful testament to the model’s predictive ability, Mark explains how it forecasted a 60% increase in individual insurance premiums after the implementation of the Affordable Care Act. Individual market premiums actually increased between 55 and 60%. The CBO’s model, in contrast, predicted an increase of 10-13%.
Our conversation touched on the proper role of insurance and the effects when subsidies are too low or too high; Mark mentioned work he did in South Africa, modeling the healthcare system and developing a new insurance plan that was successful until the political winds changed. Finally, Mark talked about the actuarial profession and how it has changed over his career. He takes very seriously the obligation of actuaries to speak out if a social insurance program is poorly designed or will have significant negative unintended consequences. He noted that regulatory filings were a small part of what Milliman actuaries did when he first worked there, but by the end of his career, filings comprised about 2/3 of the work. The political pressure on actuaries to soften or remove assumptions that lead to unfavorable projections about pending legislation and regulations has increased as well. It is important for actuaries to hold true to our actuarial principles and our responsibility to the public.

We extend a big thanks to Mark for sharing a bit of his knowledge with us today.

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Gayle Brekke, FSA, and Joyce Cheney (aka Kurisko;)) are joined by Dr. Lee Kurisko, a Canadian radiologist who left practice in Thunder Bay, Ontario, to pursue a career stateside after becoming disillusioned with Canada’s centralized approach to healthcare delivery. His firsthand knowledge of waiting lines, physician and staff shortages, and outdated imaging equipment forced a change of heart from the great confidence he initially felt in Canada’s healthcare system. He soon discovered greater efficiency and less rationed care in the U.S. and while our current system is not without challenges, he feels it is far superior to Canada’s system. Canadians, Dr. Kurisko explained, are indoctrinated into the notion that government should provide healthcare and that U.S. citizens are being left in the cold because the government does not directly arrange and pay for all medical treatment. He shares how the Canadian cultural ethos takes considerable pride in the government’s role in healthcare. Indeed, surveys suggest that Canadians remain very proud of their system even though approximately 17 percent lack access to a primary care physician. This ethos is even more puzzling when you consider that in Canada, a primary care referral is needed in order to receive specialty care; those who do not have a primary care physician also do not have access to specialty care in Canada.

Dr. Kurisko’s move to the United States was in part driven by exhaustion, where he and his two colleagues daily confronted 10 to 14 hours of workload meant for 13 radiologists. He states that because governments are constrained by budgets (vs. profits seen with private enterprise) – it leads to a severe and perverse form of rationing which is not only impractical but immoral as well. The view that healthcare is a right necessarily implies that medical providers’ freedoms can be curtailed; after all, someone must provide the discounted or free service that another person claims a right to receive.

The inherent complexity seen in healthcare pleads the case for bottom-up solutions that lead to less rationed, better quality care. He suggests that because healthcare is so important, it behooves us to consider limiting the role of government.

Dr. Kurisko advocates for an uninterrupted doctor-patient relationship without arbitrary price controls. He suggests that a better value proposition is possible if we embrace transparent pricing that facilitates the delivery of a desired service – just as we do with other goods and services provided in the United States. In that sense, healthcare is not special. Our conversation touched on “proper” insurance, which only covers large, unexpected losses and preferably is purchased individually and not through an employer. Over-insurance (that is, using insurance for routine, inexpensive care) causes excess testing and other excessive utilization, which of course, contributes to out-of-control spending. Lastly, he emphasizes the need for supply-side solutions associated with charity care to address our nation's indigent patient population. How to induce or layer such change within our current system, vexed with bureaucracies and vested interests, remains to be seen. But it is a challenge we should not shrink from in light of Medicare insolvency concerns and ever-growing healthcare demand that continues to eat up a larger percentage of our GDP. At least we have greater clarity on what to avoid as we promote a more bottom-up approach to healthcare reform, thanks to Dr. Kurisko’s insights about the issues confronting Canada's healthcare system.

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A recent study in BMC Medical suggests an increased risk of hip fractures with plant-based diets. Dr. Kurisko analyzes the data and comes to a different conclusion.

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In this 3 part series, Lee Kurisko, MD, discusses the flaws in Dr. Peterson's argument in favor of eating a Carnivore Diet.

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Dr. Michael Klaper is the Executive Director of MMF (Moving Medicine Forward). He is a distinguished physician, consultant, and educator with over 40 years of clinical experience helping patients regain their health through plant-predominant nutrition and positive lifestyle practices. He is also a long-standing member of the American College of Lifestyle Medicine.
His career highlights include being on staff at the world-famous True North Health Center, which is known for medically supervised fasting and a WFPB diet to achieve weight loss and, in many cases, disease reversal.
Dr. Klaper has lectured extensively at medical schools across North America, Europe, and Australia. His enlightening presentation, "What I Wish I Learned in Medical School About Nutrition," speaks to medical students about plant-predominant diets’ abilities to prevent and reverse common Western diseases, like hypertension, obesity, Type II diabetes, and many inflammatory states.
You will not want to miss out on this enlightening conversation with Dr. Lee Kurisko and Dr. Michael Klapper concerning the link between our food, health, and the environment.
Learn all about plant-based nutrition here:
https://moving-medicine-forward-masterclass.teachable.com/p/mmfmasterclass11-1
Our free ebook: Quickstart Guide to a WFPB Lifestyle, can be downloaded here: https://www.kuriskoandco.com/submission

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