Lifelong Learning and Workplace Learning: Relevant Education for a Knowledge-Based Economy

Introduction

Education is a human right issue for both personal enrichment and development. The Namibian Constitution made a provision for all people to have access to education. This is also supported by goal 4 for Sustainable Development Goals of the 2030 Agenda for Sustainable Development. Goal 4 aim to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all. Today’s world is ever changing rapidly, in terms of social, economic, political and digital connectivity and usage. The changes requires individuals to adapt and adopt by acquiring relevant new knowledge, skills, attitudes and competencies in a wide range of settings to remain relevant and unlimited. Lifelong learning opportunities would enable the acquisition of such relevant new knowledge, skills, attitudes and competencies, for individuals to meet life’s challenges, remain relevant and sustain their lives, communities and societies in this digital world.

According to Toffler (1970) “the illiterates of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn and relearn”. Lifelong learning is about learning, unlearning and relearning through acquiring and updating all kinds of abilities, interests, knowledge and qualifications from the pre-school years to post retirement.

Learning means the acquisition of knowledge or skills through study, experience, or being taught. Unlearning is seen as deleting and replacing obsolete knowledge. Relearning means learn material that has been previously learned and then forgotten. Lifelong learning activities promote the development of knowledge and competencies that will enable adaptations to knowledge-based societies, while at the same time valuing all forms of learning. Lifelong learning (LL) is therefore an indispensable guiding principle of educational development.

The commonly understood definition of lifelong learning is ‘all learning undertaken throughout life which is on-going, voluntary and self-motivated in the pursuit of knowledge, skills, attitudes and competencies for either personal or professional reasons.

What is Lifelong Learning?

The provision of learning through formal, informal and non-formal learning opportunities throughout people’s lives with the purpose of fostering continuous development and improvement of knowledge and skills needed for employment, community service and/or personal fulfilment. As could be deduced from this definition, lifelong learning is all-encompassing and integral to the vision of a knowledge-based economy and/or society. Lifelong learning can enhance our understanding of the world around us, provide us with more and better opportunities and improve our quality of life.

Types/categories of lifelong learning learners

• Skill-seeking – Learners who need to attain new or improved skills for the purpose of bettering themselves and be able to solve the challenges they face (or meet in the future) in their lives.

• Problem-centred – Learners who only want to learn specific skills needed to deal with a specific problem that they have encountered or might encounter in their particular life situations.

• Task-centred – Learners who only want to concentrate on tasks directed towards reaching some specific goals or solving a specific problem.

• Life-centred – Learners with great experience background and faced with a variety of issues in their everyday life and want to focus their attention on real-world/life challenges/situations and solving real-world problems. They also want to focus on applying newly gained knowledge and/or skills to everyday and real-world situations.

• Solution-driven – Learners who are interested in focusing their efforts to solving problems in real life situations, especially those found in their immediate communities and/or environments or dealing with tasks directed towards reaching specific goals or solutions.

• Value-driven – learners who require guidance why they should participate in learning endeavours and what benefit is there for them. These learners need to be motivated by other to explain to them why they should learn.

• Externally motivated – Learners who are motivated by such factors as better jobs, better salaries, and increased promotional opportunities.

• Internally motivated – Learners who possess strong internal motivation to learn, such as developing their self-esteem, confidence, recognition, career satisfaction, gaining skills to manage their time better or improving the overall quality of life for their families or communities or both.

• Active learners – Learners who are just willing to participate in the learning process (they could be internally or externally motivated or no motivation at all).

• Hands-on – Learners who prefer learning by doing rather than by listening and interested in being provided with opportunities to apply their newly gained skills right away.

• Self-directed – Learners who perceive themselves to be independent and responsible for their own learning, planning and directing their own learning activities. According to Fisher, King and Tague (2001) a self-directed learner takes control and accepts the freedom to learn what they view as important for them.

• Expert /experienced-based – Learners are practicing (working) in a specific field and want to gain knowledge/skills in that specific field for the purpose of improving their practice. These learners bring real-life experiences to the learning situations, thereby influencing the learning process and make it relevant.

• Independent – Learners who are more self-reliant and learn by utilising previously gained knowledge, skills and work experience in order to accomplish things for themselves. These learners rely on their own personal experiences, strengths and knowledge in seeking answers to problems and to solving such problems

Why do we need lifelong learning?

• Upgrade job

• Start a business

• Learn about a subject or to extend their knowledge

• Meet new people

• Develop self-confidence

• Participate in social networking

• Develop personal skills

Individual’s capacity for lifelong learning

• Capacity to set personal objectives in a realistic manner

• Effectiveness in applying knowledge already possessed

• Efficiency in evaluating one’s own learning

• Skills to locate the required information

• Effectiveness in using different learning strategies and learning in different settings

• Skills to use learning aids and resources, such as libraries, media and/or the internet

• Ability to use and interpret materials from different subject areas

The benefits of lifelong learning to society

From those critical statements regarding the importance of lifelong learning it emerges that lifelong learning holds both private and public benefits. The benefits of lifelong learning to society, business and the individual include, among others:

• The economic benefits of lifelong learning both for employment purposes and high earnings are regarded by many as the most important. People who have no jobs engage in lifelong learning in order to gain employable skills and to make a living. Those with jobs engage in lifelong learning so that they can upgrade their skills to be able to be promoted to higher positions in their jobs and earn more money.

• Enhanced employability which means lifelong learning adds value to the person’s ability to gain productive employment and make greater economic contribution to his/her organisation and to society as a whole. This is because lifelong learning enables more people to gain skills and competencies required for the job market.

• Reduced expenditure in unemployment and other social benefits and early retirement (in countries that have those benefits), which means if there are more people with skills and being productive government will concentrate the limited resources to developing infrastructure and create jobs rather than spending it on people who are unable to find work or not willing to work. Infrastructure development means more good educational and health facilities as well as roads and other transport infrastructure for promoting economic development. More jobs means there are more people contributing to government income through taxes and supporting the overall development of the country.

• Reduced criminal activities in societies that have high unemployment rates (Namibia is a good example) of which many of the criminal activities are due to citizens who have nothing productive to do, but having a lot of time on their hands to be idling and/or engaging in mischievous and unproductive activities. Lifelong learning opportunities enable people to gain useful skills and competencies so that they are more employable and there are plenty of opportunities for people to be engaged in productive and worthy causes. We are told that criminal activities are on the increase in societies where there is high unemployment, high illiteracy and /or less educated citizenry as well as where there are high levels of poverty.

• Increased high social returns in terms of civic participation and community involvement in activities that are aimed at improving the standards of living of all people in society. Lifelong learning enables citizens to be active in community development activities and thereby improving their health and well-being as well as generating and nurturing creative ideas for business and innovation development. Lifelong learning also increases high social returns in terms of civic participation and community involvement, for instance volunteering for good causes in their communities and societies thereby enabling government to save through increased civil society involvement.

Career development in the age of lifelong learning

Lifelong learning has been more linked to improving work activities through improving workers’ attitudes towards work and their productive capacities. Workplace learning whether formal, non-formal or informal is targeted to career development of employees. Lifelong learning helps people to develop their potential and the knowledge, skills, attitudes and competencies required for the job market. They are required to constantly learn at the workplace. For the lifelong learning system to work at the workplace, where learning is mainly informal, there must be a self-regulating system that enable employees to access relevant information about the labour market and development in the economy. It has been proven across the world that people who are educated are more likely to find decent employment than those with no education. This mean that lifelong learning is currently being used for career development and progress in the labour market as much as it is being used for leisure and community development purposes.

Career development is an important aspect for the labour market as all employees aim for higher salaries, promotions and other incentives that comes with one’s job or employment contract.

Eraut (2007) found that most of the workplace learning of mid-career professionals is largely done in an informal way through consultation and collaboration. The joy of learning and the opportunity to apply the newly acquired skills to the workplace are the best sources of motivation for learning in one’s life.

Approaches to learning at the workplace

Eraut (2004) have identified five approaches for the knowledge, skills, attitudes and competencies for lifelong learning at the workplace.

• Group learning: participation in group activities such as team-working towards a common goal or outcome or group set up to work on special projects or for a special purpose. These circumstances will force members of the group to learn communally in order to accomplish their tasks.

• On the job training through social learning activities allows employees to observe others and learn as they learn new practices, new perspectives as they work alongside each other on a routine task or specific project.

• On the job training through understudy / deputizing allow employees to learn from those with more expertise than them but working in the same organisation / institution.

• On the job training by external expertise (consultants) through performance audits, consultancies, workshops.

• Assessment activities such as monitoring and evaluation are some of the approaches used by organisations to enable employees learn about their progress and address gaps.

Work processes through which employees learn better

• Group participation process: through asking questions and participating in decisions;

• Tackling challenging assignments/tasks/ roles;

• Through being supervised, coached and being mentored, shadowing and or reflecting;

• Working alongside colleagues, locating resource persons within the organisation as well as listening and observing others;

• Through problem solving, trying things out, suing models or mediating artefacts and learning through mistakes;

• Consultation with other employees and management;

• Visiting other sites/attending conferences and participating in short courses;

• Working with clients;

• Consolidating/ extending/ giving and receiving feedback;

• Working/studying for a qualification, working for a reward.

Factors affecting modes of learning in the workplace

Learning factors

The factors that enable employees to be proactive in seeking learning opportunities

• Challenging and value of the work: under challenged and over challenged might impact negatively on the person’s ability to learn;

• Feedback and support;

• Confidence and commitment; and

• The ability to recognise learning opportunities

Work context factors

The factors that attract the employees to the organisation and motivate them to learn and contribute to the goals of the organisation.

• Feedback and support (especially during the few months in a new job);

• Allocation and structuring of work;

• Encounters and relationship with people at wok; and

• Expectations of each person’s role, performance and progress.

Suggestions for employers

Promote Media and Information Literacy (MIL) to enables employees to be informed readers in today’s hyper connected world.

MIL enables employees to interpret the complex messages they receive in today’s hyper connected world.

References

Eraut, M. (2007). Learning from other people in the workplace. Oxford Review of Education, 33 (4), pp.403-422.

Eraut, M. (2004). Informal learning in the workplace. Studies in Continuing Education, 26, pp. 247-273.

Fisher, M, King, J., &Tague, G. (2001). Development of a self-directed learning readiness scale for nursing education. Nurse Education Today, 21, pp. 516 -525.

Toffler, A. (1970). Future shock. New York: Random House.

Reassessing Worksite Wellness After All These Years: Still Medical or Blossoming Into REAL Wellness?

INTRODUCTION

One advantage of stayin alive beyond expectations (i.e., reaching a state of perennialhood) is increased wisdom and, sometimes, witnessing desired changes. That’s the hope, in any case, attributable to decades of increasingly prescient observations and greater openness to alternate experiences. What better time than later life to reexamine opinions and beliefs? Why finish with that old time religion or other fossilized attachments political, social and so on? Oftentimes, these hardened impressions are outdated or otherwise ripe for reforms. Or not.

In any case, many might benefit from periodic scrutiny of long held views. On occasions, some opinions, even biases, could be in need of amendments, or at least refinements.

A personal example is a long held claim that worksite wellness programming has been and remains overly medical, dating back to the modern restart of the wellness movement in the early 1980’s. Particularly with respect to three of the four dimensions of REAL wellness, worksite programming has ignored systematic efforts to promote positive mental skills, such as reason (critical thinking), exuberance (joy and added meaning) and liberty (expanded personal freedoms). The other dealing with exercise and nutrition (Athleticism) has received ample attention at worksites and elsewhere.)

Is there credible evidence of a turn toward REAL wellness, recognizing that such initiatives might be addressed by other terms?

Some colleagues more attuned to workplace best practices and innovations have urged a reassessment. I’m told there are REAL wellness priorities and programs underway that promise results.

Spurred on by an invitation to appear on a webinar of a leading worksite wellness organization to discuss the book Not Dead Yet (NDY). I decided, in true stayin alive fashion, to explore what’s new in corporate wellness.

A WEBINAR

On October 30, I participated in a hour-long webinar with Dr. Paul Terry, senior fellow and editor of the Health Enhancement Research Organization (HERO). The theme was Thriving & Flourishing (At Any Age)! The initial focus was the 56 tips for successful aging described in the book. Sharing the webcast podium with me was Susan Bradley Cox, one of the eighteen world triathlon champions over age 75 profiled in NDY.

A CAUTIONARY NOTE ON PERSPECTIVE

Under the best of conditions, the impact of worksite wellness will necessarily be incidental relative to the larger issues employees face. Social determinants such as deficient educational levels, poor housing conditions, dysfunctional cultural influences, economic pressures, crime, mental and physical disabilities and much more are more consequential but not malleable by worksite wellness. While important, it’s helpful to realize that macro changes in society and the environment should be a priority, not to be overlooked while promoting worker wellbeing. A few health promotion classes and other initiatives to encourage good health skills and practices during the few hours per week available for worksite programming should not distract from the larger issues that most affect quality of life.

This point was made by economist Thierry Malleret at the 2019 Global Wellness Summit in Singapore October 15-17:

Skyrocketing costs of healthcare, housing and education are decimating the US middle class and causing rising inequality and anxiety-and the phenomenon is not limited to the US. But when it comes to social and environmental progress, the US appears as a significant, underperforming outlier. According to the Social Progress Index, the US is the only developed country that is backsliding, both in absolute and relative terms, compared to its peers. It now ranks 26th in social progress, while Norway comes first.

Many (e.g., Benjamin Libet, Dan Wegner, Thalia Wheatley, Sam Harris and a majority of contemporary scientists) marshal evidence to support the view that free will is a myth, that determinism prevails. If so, this takes the zing out of oft ballyhooed enthusiasm for self-responsibility, and witticisms such as P.J. O’Rourke’s crack that no drug, not even alcohol, causes the fundamental ills of society. If we’re looking for the source of our troubles, we shouldn’t test people for drugs, we should test them for stupidity, ignorance, greed and love of power.

THE HEALTH ENHANCEMENT RESEARCH ORGANIZATION (HERO)

HERO is a national think tank whose mission is to advance best practices in employee health promotion. HERO provides leadership in research and education on the impact of worksite wellness, on best practices for positive health outcomes and on the role and nature of healthy cultures for successful employee performance.

Over the course of several years, Paul Terry has extended polite and always collegial invitations to consider more charitable assessments about worksite wellness. In the weeks leading to the webinar, while seeking to better appreciate positive (i.e., REAL wellness-like) programming, I reviewed HERO’s archived interviews with worksite leaders, as well as the organization’s annual forum proceedings, research studies, think tank meetings, scorecard initiatives, briefs, blogs and news releases. All impressive, to be sure.

After receiving an advance partial draft of this article, Paul offered the following:

It’s a tall order to summarize all the ways that workplace health is aligned with REAL Wellness as it’s been occurring for a long time and has already apparently eluded your observant proclivities. I’ve pasted an editorial below that will be published in January. I think the ‘Pillars’ exemplify the liberty and reasoning aspects of your philosophy. My editorials are open access. In the past years I’ve written about voluntariness and autonomy (liberty), about parsing between facts, truth and empirical evidence (reason and liberty) happiness and meaning and life purpose in an interview with Richard Lieder and Vic Strecher (reason and exuberance). In each editorial I feature cases and examples of how the private and public sector are increasingly collaborating to achieve these REAL approaches.

All that strikes me as encouraging and welcome news. The theme of the recently concluded HERO forum was Thriving Organizations Achieving Well-Being Through Collaboration. Much attention was focused on the Federal government’s Healthy People 2030 initiative, a science-based rendering of 10-year national objectives. The goal of Healthy People continues to be improving the health of all Americans.

Based upon short (under six minute) expert interviews conducted at the last HERO conference with national figures in worksite wellness, a further glimpse into REAL wellness-related initiatives in corporate programming can be sensed.

EXCERPTS FROM EXPERT INTERVIEWS

Krystal Sexton, head of Human Performance and Care at Shell, identified psychological characteristics of employees who most impact organizational performance. Such Individual qualities include hope, optimism, resilience and self-confidence; team dynamic factors that matter most are those that tend to lift people up, provide role clarity and find common ground.

Unfortunately, this and the other interviews did not identify specific company wellness programs that addresses these drivers of company success. I’ll look on the bright side and assume there must be training for all that promotes specific agendas.

A video of and follow-up telephone and e-mail communications with Jessica Grossmeier, HERO’s Vice-President of Research, revealed the nature of the HERO scorecard. The instrument is designed to help organizations discover best practices for promoting workplace wellbeing. It identifies opportunities to improve and measure progress.

However, Ms. Grossmeier noted that the current version of the tool only addresses the Athleticism element, but invited suggestions about future iterations of the Scorecard. One resource was cited as an effort to help industry professionals develop more critical thinking skills. HERO has since provided more detailed examples of how to apply these critical thinking tips to findings in a number of research studies.

The Expert Interview Series on HERO’s YouTube Channel features additional short videos of national leaders who spoke at the recent HEROForum19′ gathering on the Achieving Well-being through Collaboration theme.

• Nico Pronk, Dushanka Kleinman and Mary Pittman on Healthy People 2030: Objectives for the Nation and the Role of Business.

• Sara Singer, Stanford professor on four pillars of a culture of health and the role of internal and external collaboration.

• Brian Castrucci, President and CEO of the deBeaumont Foundation on the business case for private sector and community partnerships and collaboration.

• Andrea Walsh, JD, President and CEO HealthPartners on the benefits to business of community health, on reducing stigma of mental illness and the imperative of partnerships.

• Matt Steifel, Kaiser Permanente on the relationship between social determinants of health and the role of these factors in workplace health and well-being initiatives.

• Karen Moseley, President, HERO on the role of collaborations and measurement development on what’s next and mission critical for HERO.

• Paul Terry, Senior Fellow, HERO, on new study findings released for the first time at HEROForum19′.

WHAT TO MAKE OF WORKSITE WELLNESS AFTER CONDUCTING THIS CURSORY, SKETCHY AND YES, PERFUNCTORY REASSESSMENT?

Before going any further, let me express gratitude to Paul Terry for extraordinary assistance that made possible this quick tour of contemporary developments and meaningful advances in the art and science of worksite health promotion. The links alone should be of value to many who might not otherwise have discovered these informative resources.

What’s amazing is that Paul provided this guidance while hiking down and out of the Grand Canyon, communicating only by carrier pigeons and mirrors to relay data to HERO headquarters in Minneapolis. (The part about hiking in the Grand Canyon is true.)

So, did I benefit from this periodic review of my notion that worksite wellness has done too little to promote wellbeing while focusing too much on identifying and modifying risky habits? It seems so. As all study authors note at the conclusion of their research reports, further studies (and generous grants to fund same) are imperative.

It was certainly beneficial to learn more about the work the HERO organization is doing in this field. HERO is to worksite wellness what the National Wellness Institute once was to the promotion of the wellness concept and the Global Wellness Institute is for the concept today — a worldwide promoter of research, initiatives, roundtables, annual summits, discussions, gatherer of wellness evidence and sponsor of bold initiatives, such as The Wellness MoonshotTM: A World Free of Preventable Disease. In their own words, the GWI informs and connects key stakeholders capable of impacting the overall wellbeing of our planet and its citizens. Not incidentally, GWI makes all of its valuable information and resources available at no cost, which allows anyone, anywhere, access.

In conclusion (at last), this review has made me more informed and much more interested in learning more about new developments in worksite wellness relative to REAL wellness. Again, thanks to all who contributed, directly and otherwise.

A REFRESHER ON THE CONCEPT OF WELLNESS

Wellness initially took root as a lifestyle, a way that individuals make informed choices to establish and sustain positive levels of mental and physical health beyond the absence of illness and disease. The lifestyle is founded on personal responsibility, disciplined habits and skills related to effective decision-making, enjoyment of life, exercise, nutrition, stable emotions, personal freedoms of mind and body, ample meaning and purpose, a supportive culture and environmental awareness, among other life-enriching qualities. In a work setting, safety might also be promoted, in the form of freedom to speak freely without fear of retribution.

This meaning of the word is consistent with REAL wellness, the difference being that the modifier REAL introduces four specific categories or dimensions in which vital skills and positive outcomes are organized. These four dimensions can encompass all venues in which we function, such as the social, occupational and other life areas commonly put forth as wellness dimensions. (As if different skills were required for optimal functioning in varied spheres of life.) The four REAL wellness dimensions are reason, exuberance, athleticism (exercise and nutrition) and liberty.

REAL wellness should encourage and guide people to think and function rationally, to live exuberantly, to maintain physical fitness, to dine wisely consistent with factual nutritional knowledge and to live as freely as possible. The latter means becoming liberated from cultural or circumstantial elements such as superstitions, irrational dogmas and other mental and social limitations that add constraints on personal liberties.

And that’s about it, folks.

The end.

Health Care Reform – Why Are People So Worked Up?

Why are Americans so worked up about health care reform? Statements such as “don’t touch my Medicare” or “everyone should have access to state of the art health care irrespective of cost” are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system’s history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let’s try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let’s look at the pros and cons of the Obama administration health care reform proposals and let’s look at the concepts put forth by the Republicans?

Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life’s major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution.

These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better.

  • A recent history of American health care – what has driven the costs so high?
  • Key elements of the Obama health care plan
  • The Republican view of health care – free market competition
  • Universal access to state of the art health care – a worthy goal but not easy to achieve
  • what can we do?

First, let’s get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

To begin, let’s turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail’s pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

Let’s skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a “wait and see” approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

This very basic review of American medical history helps us to understand that until quite recently (around the 1950’s) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; “nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor’s offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the “perfect storm” for higher and higher health care costs. And by and large the storm is only intensifying.

At this point, let’s turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

The Obama health care plan is complex for sure – I have never seen a health care plan that isn’t. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let’s look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.

  1. Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.
  2. To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don’t comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.
  3. To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.
  4. The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.

The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide “free” (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently decided to hear arguments as to the constitutionality of the health insurance mandate as a result of a petition by 26 states attorney’s general that congress exceeded its authority under the commerce clause of the U.S. constitution by passing this element of the plan. The problem is that if the Supreme Court should rule against the mandate, it is generally believed that the Obama plan as we know it is doomed. This is because its major goal of providing health insurance to all would be severely limited if not terminated altogether by such a decision.

As you would guess, the taxes covered by point 3 above are rather unpopular with those entities and individuals that have to pay them. Medical device companies, pharmaceutical companies, hospitals, doctors and insurance companies all had to “give up” something that would either create new revenue or would reduce costs within their spheres of control. As an example, Stryker Corporation, a large medical device company, recently announced at least a 1,000 employee reduction in part to cover these new fees. This is being experienced by other medical device companies and pharmaceutical companies as well. The reduction in good paying jobs in these sectors and in the hospital sector may rise as former cost structures will have to be dealt with in order to accommodate the reduced rate of reimbursement to hospitals. Over the next ten years some estimates put the cost reductions to hospitals and physicians at half a trillion dollars and this will flow directly to and affect the companies that supply hospitals and doctors with the latest medical technologies. None of this is to say that efficiencies will not be realized by these changes or that other jobs will in turn be created but this will represent painful change for a while. It helps us to understand that health care reform does have an effect both positive and negative.

Finally, the Obama plan seeks to change the way medical decisions are made. While clinical and basic research underpins almost everything done in medicine today, doctors are creatures of habit like the rest of us and their training and day-to-day experiences dictate to a great extent how they go about diagnosing and treating our conditions. Enter the concept of evidence-based medicine and comparative effectiveness research. Both of these seek to develop and utilize data bases from electronic health records and other sources to give better and more timely information and feedback to physicians as to the outcomes and costs of the treatments they are providing. There is great waste in health care today, estimated at perhaps a third of an over 2 trillion dollar health care spend annually. Imagine the savings that are possible from a reduction in unnecessary test and procedures that do not compare favorably with health care interventions that are better documented as effective. Now the Republicans and others don’t generally like these ideas as they tend to characterize them as “big government control” of your and my health care. But to be fair, regardless of their political persuasions, most people who understand health care at all, know that better data for the purposes described above will be crucial to getting health care efficiencies, patient safety and costs headed in the right direction.

A brief review of how Republicans and more conservative individuals think about health care reform. I believe they would agree that costs must come under control and that more, not fewer Americans should have access to health care regardless of their ability to pay. But the main difference is that these folks see market forces and competition as the way to creating the cost reductions and efficiencies we need. There are a number of ideas with regard to driving more competition among health insurance companies and health care providers (doctors and hospitals) so that the consumer would begin to drive cost down by the choices we make. This works in many sectors of our economy but this formula has shown that improvements are illusive when applied to health care. Primarily the problem is that health care choices are difficult even for those who understand it and are connected. The general population, however, is not so informed and besides we have all been brought up to “go to the doctor” when we feel it is necessary and we also have a cultural heritage that has engendered within most of us the feeling that health care is something that is just there and there really isn’t any reason not to access it for whatever the reason and worse we all feel that there is nothing we can do to affect its costs to insure its availability to those with serious problems.

OK, this article was not intended to be an exhaustive study as I needed to keep it short in an attempt to hold my audience’s attention and to leave some room for discussing what we can do contribute mightily to solving some of the problems. First we must understand that the dollars available for health care are not limitless. Any changes that are put in place to provide better insurance coverage and access to care will cost more. And somehow we have to find the revenues to pay for these changes. At the same time we have to pay less for medical treatments and procedures and do something to restrict the availability of unproven or poorly documented treatments as we are the highest cost health care system in the world and don’t necessarily have the best results in terms of longevity or avoiding chronic diseases much earlier than necessary.

I believe that we need a revolutionary change in the way we think about health care, its availability, its costs and who pays for it. And if you think I am about to say we should arbitrarily and drastically reduce spending on health care you would be wrong. Here it is fellow citizens – health care spending needs to be preserved and protected for those who need it. And to free up these dollars those of us who don’t need it or can delay it or avoid it need to act. First, we need to convince our politicians that this country needs sustained public education with regard to the value of preventive health strategies. This should be a top priority and it has worked to reduce the number of U.S. smokers for example. If prevention were to take hold, it is reasonable to assume that those needing health care for the myriad of life style engendered chronic diseases would decrease dramatically. Millions of Americans are experiencing these diseases far earlier than in decades past and much of this is due to poor life style choices. This change alone would free up plenty of money to handle the health care costs of those in dire need of treatment, whether due to an acute emergency or chronic condition.

Let’s go deeper on the first issue. Most of us refuse do something about implementing basic wellness strategies into our daily lives. We don’t exercise but we offer a lot of excuses. We don’t eat right but we offer a lot of excuses. We smoke and/or we drink alcohol to excess and we offer a lot of excuses as to why we can’t do anything about managing these known to be destructive personal health habits. We don’t take advantage of preventive health check-ups that look at blood pressure, cholesterol readings and body weight but we offer a lot of excuses. In short we neglect these things and the result is that we succumb much earlier than necessary to chronic diseases like heart problems, diabetes and high blood pressure. We wind up accessing doctors for these and more routine matters because “health care is there” and somehow we think we have no responsibility for reducing our demand on it.

It is difficult for us to listen to these truths but easy to blame the sick. Maybe they should take better care of themselves! Well, that might be true or maybe they have a genetic condition and they have become among the unfortunate through absolutely no fault of their own. But the point is that you and I can implement personalized preventive disease measures as a way of dramatically improving health care access for others while reducing its costs. It is far better to be productive by doing something we can control then shifting the blame.

There are a huge number of free web sites available that can steer us to a more healthful life style. A soon as you can, “Google” “preventive health care strategies”, look up your local hospital’s web site and you will find more than enough help to get you started. Finally, there is a lot to think about here and I have tried to outline the challenges but also the very powerful effect we could have on preserving the best of America’s health care system now and into the future. I am anxious to hear from you and until then – take charge and increase your chances for good health while making sure that health care is there when we need it.