Physicians know the healing power of vacations because they take them every year. My best favorite doctor takes one week with his whole family and another week with his wife alone. And one day he smiled sadly at me and acknowledged that if I could take a good vacation it would be more restorative than half the things he could do for me. Of course, I can’t take a vacation because I’m poor, but I can go to the doctor because the taxpayers will foot the bill.
I did take a vacation—once. (We stipulate here that, according to my psychologist, visiting family does not constitute a vacation.) A couple friends and I drove to Boston. We went to the Hard Rock Café, saw The Phantom of the Opera, followed the Freedom Trail, and went on a whale watch, which afforded one of the small, extraordinary moments of my life. Driving back home, I thought, “Wow! So this is what it’s all about—you just get completely away from everything and when you return, you’re right and ready to get back into the fray.”
So here’s what I propose: if your Medicaid/Medicare spending is less this year than it was last year then you get half the savings to spend on a vacation.
Let’s spend a minute on motivation and incentive. Incentive means that something good will happen if you do better; motivation is that something bad will happen if you don’t do better. If you come into work early, we will put you in line for promotion. If you come into work late, we will fire your ass. It’s the old carrot-and-stick routine: you can either move forward to eat the carrot or move forward to get away from the stick, but either way you will move forward.
Medicare and Medicaid (M&M) function entirely on the theory that you will be motivated by getting beaten with a stick. (Maybe private insurance does, too. I haven’t had any for several decades, so you decide if the Vacation Plan can be applied to your private insurance.) In some cases, what M&M say is that if you don’t show improvement then they will cut your services. In all cases, M&M offers no incentive for the patient to work to get healthier. They just keep rewarding you every time you go to the doctor and get a new prescription.
Under the Vacation Plan, the patient has an incentive. Some years ago, I spent a week in the hospital. Afterwards I called a travel agent, quoted the amount billed to Medicare, and asked, “Where in the world could I go for that amount of money?” She replied, “You could fly to Maui and spend a week at the Ritz.” So let’s see, Maui or the hospital, choose one . . . What would (or wouldn’t) you do to get that vacation?
Would you engage in proper diet and exercise to get your diabetes under control? The Great Government Accounting Office would be toting up the bill: fewer doctors’ appointments, less money spend on medications—what other savings would there be? How about you go to the sleep specialist, get your sleep apnea properly treated, and your cardiology and psychiatry costs go down? If you cut down—or cut out—your smoking, how would it affect your medical expenditures? If you made changes in your employment to reduce your stress, how would your health improve? What is the reduction in medial treatment if your food comes from an organic farm versus the drive-through window? What’s making you sick and what can you do about it?
You can’t think of anything you can change? Then go ask the neighbors. They’ve been watching you and I’ll bet they’ve got lots of recommendations. Look for options; look for alternatives; try something new and different. Check out the healthiest people you know and ask them about their lifestyle choices.
And for every year that you reduce your health care costs you get a check for one-half the amount you didn’t spend. Last year Medicaid spent $29,000 dollars on you, but this year you started walking to your doctor’s appointments instead of taking a Medicaid taxi. The savings were $1,500 so you get a check for $750.
My original plan was that the money had to be spent on a vacation. (And for these purposes, we will include visiting family as vacation time. Haven’t seen your mom in South Carolina for six years? You better believe it is healthy and therapeutic for both of you if you to go visit her.) But maybe it isn’t necessary to stipulate that the money has to be spent on a vacation. If you are smart enough and responsible enough to successfully reduce your medical expenditures, then you are also wise enough to spend your incentive money however you please without Big Daddy Government looking over your shoulder.
Ideally, the result would be that people would get on a healthy life plan that, over time, would result in healthy people: non-smokers and non-drinkers who get plenty of rest, eat nourishing food, and exercise vigorously. A healthy population!
Realistically, there would be people who would play the system: get a vacation this year and then next year go to the doctor’s every time you sneeze to push up your medical expense billing, then the following year you could drop back and get a big incentive payment. No way. There would have to be a law of diminishing returns. Something like if your expenses go down this year but up next year, then you wouldn’t be eligible for an incentive payment for two years.
Under no circumstances would any person’s eligibility for Medicare and Medicaid payments be cut. Under the Vacation Plan, nobody would ever be denied access to treatment. You can keep going to doctors and taking drugs just like you always have. Consider people who have very limited medical options, such as people with multiple sclerosis or muscular dystrophy. Some diseases are incurable and all the doctor can do is buy time and make things less awful. The Vacation Plan would never interfere with that.
The Vacation Plan is for people who are sick because of their lifestyle choices. Some people choose sickness—and let their over-taxed neighbors pay for it. The Vacation Plan is for people who want to choose health but need a little nudge to get going. The Vacation Plan is the carrot.