Health insurance offers a way for individuals to pay in advance for health care needs they may require. This is due to a shared or socialized system in which everyone pays an equal amount of cost whether healthy or sick. This is called a premium. The insurance carrier rates or premiums are set through the Affordable Care Act so that not more than 20% of premium fees go towards administrative costs of the insurance itself. The remainder of the 80% goes towards healthcare costs of patients that are insured by that insurance company. While you may be enjoying a relatively healthy life without the need to visit a doctor, your neighbor, co-worker, or family member who just broke their ankle, had a heart attack, or was diagnosed with a terminal condition has a much greater cost for their healthcare.

Hence through medical insurance we have entered into a social contract to pay for and provide care for all Americans. Healthcare is a necessary service for every individual and health has an inherently high value to the individual. This along with constant drive for scientific innovation has escalated potential costs of healthcare services significantly over the past 50 years. Currently we have health insurance companies as one of the mediators in cost between patients and health care systems or medical offices. It is not the only cost control mechanism though.

Our strongest current driver of reduced healthcare spending appears to be a patient deciding not to utilize care due to relative high cost associated with going to the doctor for evaluation in comparison with that patient’s income level. Cost may not be the only factor in keeping patients out of the medical office, but I feel it is not ethical for it to play a significant role. Cost as a reason to avoid care is subject to a wide variety of factors including patient income, patient medical knowledge base, and the underlying likelihood of seeking or avoiding care in the first place regardless of cost. Most importantly this driver of care utilization from a patient perspective is not based on medical knowledge or recommendation.

I strongly feel that we should have best practices, standards of care, quality innovation, and appropriate care that are standardized across the country so that patients won’t have to wonder if going to the doctor is the right financial decision for them. Establishing these care guidelines is a role that a national health care system could play.

Rather than care recommendations steering appropriateness of care, what I see more frequently is the patient that avoids care because consciously or unconsciously they understand that the cost of a primary care doctor (including all associated costs of staff, resources and overhead) is between $400-$800 per hour depending on the practice setting. Hourly rates between $20-$40 represent a significant percentage of income for workers in our country. So the cost of an hour of time spent with your doctor would equate to between 10-40 hours of work if your income falls in this range as a patient.

Health insurance deductibles and out of pocket costs commonly reach $3,000-$5,000 per year for an individual or $5,000-$10,000 per family. Premium costs can double this expense for individuals and families. It is true that ACA subsidies can reduce premiums, but the ACA  subsidy does not touch the deductible portion of patient expense. Based on these rough calculations an individuals healthcare premium and deductible costs can easily equal between 4 and 12 weeks of work. For a family that calculation could reach between 6 and 24 weeks of work per year!  This calculation does not even take into account the financial effect of the potential for lost wages due to illness or injury.
So how would a nationalized healthcare system manage healthcare costs? Most importantly it would aim to control healthcare costs without relying on such a strong financial deterrent for patients to avoid medical care. The high deductible health insurance plan is putting patients in the position of avoiding care due to their own financial calculations, not medical advice.

Certainly we need to have a system that would reduce medical costs going into the future. I suggest that a nationalized healthcare system is one means in accomplishing that goal. We could create a system that aligns the right service to the right patient at the lowest cost. I am not arguing against competition as a driver of quality and innovation. Rather, I am acknowledging that competition as it currently functions in the healthcare system has a main driver of financial outcomes. The current model aims to provide care for the largest market share of patients that consume the lowest cost of care.

What would a national healthcare system look like that did not require patients to plan to save between 4 and 24 weeks a year of their incomes for healthcare expenses? How could reducing this financial burden improve our economy? How could we fund a health care system with these factors in mind and have it work effectively and efficiently while still driving innovation and improvement? These are the questions to which I return. I believe that further nationalized standards of care and a standardized national administration process that partners with private health organizations may be part of the solution.

A national healthcare system of standards and administration is the healthcare equivalent of a peace treaty in the nuclear arms race of healthcare costs. Creating this framework would take the inappropriate burden of deciding if significant costs are medically appropriate away from the ill and suffering patient. Without agreed upon process of administration and medical practice, we have a problem of wildly varying costs in the healthcare marketplace. We can do better!

Samuel Hanson Willis, MD

This post is gonna be a little bit meta. It may be a bit hard to follow, but I really do believe it contains some ideas that are important to share.

The concept of a human creation that goes awry and wreaks havoc on humanity is not new. It is postmodern and shows up in cinema notably in the film Blade Runner(1982) in the form of a Cyborg. Keith Haring is credited with performance art that presaged reality TV as the overtaking, steering, and destroying our cultural heritage (Acts of Live Art, Club 57, 1980). Now nearly everyone feels the pressure of how social media forms have changed the way that we socialize.

A less obvious form of a human creation is civilization itself. Within civilization, the structures we have created to help the world run smoothly and benefit humanity include governments, organizations, corporations, and social expectations. Part of what makes it difficult to analyze aspects of civilization is that we take for granted that the way that things are is a given and a constant. In reality, humanity has created and theoretically has the ability to change any of these cultural institutions.

I have observed over the past several years that my peers are now increasingly in positions of authority. Our generation, sometimes called Generation X, is increasingly occupying the realm of leadership that is responsible for steering our organizations, corporations, and governments. I find this an incredibly welcome scenario.

We grew up in the 1980s. Our rebellion was not without a cause, it was not against a war, it was against conformity. From the late 70’s to the early 80’s we lived and breathed a culture of being different and questioning conformity. Many of us that are considered part of Generation X inherently understand and do not shy away from the need to question why and what for when demands are made of us.

If we can harness that ability amongst our leadership generation and use it to confront the tension between what an organization or corporation desires and what humanity requires we will be improving the world dramatically.

It is strange to consider that people can create an organization or system whose inertia and needs are so strong that the very same people that created it become overtaken by its demands. I’ll let you think about that for a while. If you have trouble thinking of what this could look like, share this article with some friends and see where your conversation goes. Ask the question, “What does it look like when the needs of an organization or system conflict with the humanity that it is meant to serve?”

I am advocating that we question our assumptions about the demands of our cultural systems. Harness the abilities of those in our generation who have a yearning to not conform, and implement changes against system pressures to steer our organizations so that they serve people better. We can all play a part in this change by carrying an awareness that our humanity matters. It matters most. It matters more than money and more than the success of a business. We must create the world based in the values that we hold dear. Money is not a value, it is a tool. We can use this tool to support our values. This idea is partly what drives social entrepreneurship, but this type of leadership need not be isolated to new businesses and endeavors. This very same thinking can help shape organizations and systems that have been around for decades or more. It may require difficult decisions of leadership, but our generation that grew up in the shadow of punk rock just might be able to save the world.
Now talk amongst yourselves!

– Samuel Hanson Willis, MD

It is not infrequent for me to hear people remark that they see the cost of organic foods as being too expensive or unaffordable. It is true in some cases that this is unavoidable, but it is also true that there are ways to reduce costs for organic foods just as there are ways to reduce costs to non-organic foods. This is article is not a list of the only ways to do so, but it hopefully will help you to get started in thinking about connecting your values to what you eat through how you spend money on food.

I will not get into the marketing of food in this article, but it is worth noting that sometimes purchasing foods that are labeled as organic adds great value and nutrition, while other times the added nutrition, environmental benefit, or health benefit is minimal when compared to the extra cost. This is a decision you will have to make on your own, but it is a topic perhaps worth researching.

I will start out by sharing a somewhat surprising statistic. In 2012 the National Resources Defense Council reported that the average American family throws away nearly half their food every year. This was estimated to be an equivalent of $2,275 a year per family!

Perhaps the most sound recommendation in light of this startling statistic is to practice consuming the food we buy. Perhaps just buying foods in quantities that will not go bad before they are used will save you money. I don’t know about you, but I could explain a small fraction of that waste in cooking gone bad. Burnt food or misread recipes has disappointed me on more than one occasion, but improving cooking skills is enough of a topic that it deserves its own essay.

Before I get to actual cost saving techniques for shopping organic foods and high value foods, it is also worth noting that costs associated with eating outside of the home are considerably more than those associated with eating at home. For example at this time a 12 ounce glass of orange juice can cost $3 at a breakfast restaurant in our city. Even very expensive organic juice can be found for 32 ounces for $5. Per 12 ounce glass of juice you are saving a $1.12 just by drinking that expensive organic juice at home rather than buying a non-organic glass of juice at a restaurant.
This example is a useful one in helping to connect values of dollars spent on food to what it is that you want to be purchasing. If you are buying the experience of dining out with friends and enjoying that experience, then it is something you might not be able to recreate at home. If you are simply getting your favorite breakfast or grabbing a quick lunch you can purchase a significant amount of healthy and high quality food for less cost than a fast food lunch.

When evaluating the value of food I suggest you also consider that many people find it takes smaller amounts of more nutritious food in order to be well fed, gain nourishment, and satiate hunger. Thus, cost per item of food may not be a useful comparison if the food varies in nutritional value.

So how can one find affordable prices for high nutrition foods that ounce per ounce are more expensive than their counterparts? For those that are struggling to meet the costs of the weekly grocery bill or pay electric bills, it is important to realize that food assistance is one way that many communities across the country have banded together to help put healthy food on the table. Here in Minnesota you can connect to a variety of food assistance programs through  Nationwide similar programs exist with local, state, and federal assistance. It is not uncommon for retired seniors to struggle in this regard and thus food assistance is available to this population amongst others. Many organic cooperative stores are working with the Supplemental Nutrition Assistance Program by having items that qualify for use with an Electronic Benefit Transfer card. Even farmer’s markets are starting to accept this method of payment more widely nationwide helping make high quality food more within reach of everyone.

Perhaps one of the most effective methods of purchasing food more affordably at a co-op is by joining and becoming a member. This typically involves a purchase of ownership, stock, or membership. Typical costs to do so vary between $50 and $100. It is a one time purchase and in some cases can be refunded to you if you move to another town. By becoming a member you often receive member discount pricing which is like sale pricing on select items. This pricing is often not available to those that are not members of the co-op. Additionally, coops that are well established and financially stable often return a portion of profits each year to their members. It may be in the range of $10-$50 and varies each year based on the financial status of the co-op as well as how much you spent that year in the store. It may not seem like much, but it all adds up.

Once a member, you have gained access to discounts. It is not a novel concept to consider shopping with coupons. Perhaps just a bit more novel is to consider how to shop with coupons or discounts. I would suggest that there are two ways to shop wisely with coupons. One is to buy items that you normally buy as part of your pantry, but buy them when on discount with a coupon or membership sale. Another approach is to use coupons to buy items that you typically would not buy, but you have been curious about. They might be items that add a bit of special flavor to your pantry. This can help you create a tasty meal from items already in your home when you are in a pinch. A quick meal from your pantry can save you valuable time and money by avoiding the temptation of eating out or ordering takeout when the pantry seems low on food or you are short on time. Maybe this is a good time to explain a pantry as an approach to reducing your overall food costs.

Think of your pantry as a way to reduce food costs. What I mean by pantry is a list of items that you generally keep on hand. These items often have the quality of having a relatively long shelf life before they spoil. They also are items that are commonly used. Flour, sugar, noodles, rice, and grains are very common pantry items. Canned and frozen items can be part of a pantry concept. You might even extend the idea of the pantry to include items that add flavor to food while preferably being relatively inexpensive. By keeping fresh garlic, fresh ginger root, lemons, parsley, onions, soy sauce, fruit preserves, olives, capers or other flavors that you enjoy around the kitchen you open up a broad array of options for making fast and tasty last minute meals. Stocking a pantry with items that are discounted is thus a way to combine two approaches at shopping more affordably. Add a bit of flexibility to your cooking and eating style and you can let discounted items dictate your shopping list.

Another approach is to eat seasonal foods. As a doctor, I encourage you to spend the majority of your time shopping in the produce section. This is where a lot of nutrition can be found. Learning about when during the year fruits and vegetables can grow locally in your region can help you eat foods that are local, fresh, and cost less. Vegetables that are grown locally cost substantially less when they are in abundance during the harvest time. You may find that certain vegetables you only buy frozen or canned during certain times of the year and you buy them fresh at other times for similar prices.

As I write this we are ending the time of year when apples are readily available in Minnesota. I was surprised to see wide variety of cost in local organic apples. Braeburn apples were priced at more than $9 for a 3 pound bag while Fuji apples were priced at $6 for a 3 pound bag.

Sharing foods and sharing cooking is an approach that some people take to reducing costs at the grocery store. There are a variety of approaches to this technique and a variety of ways that it can result in reducing your overall food expenses at the grocery store. One example is buying a 3 lb bag of apples at the grocery store, but splitting them between two households. This way you eat all of the apples, none get spoiled, and you are not sick of apples by the time you get to the second pound of apples in one week. This approach works well with potatoes and carrots as well which are often sold at discount in larger quantities.

You might enjoy trading dishes that you make with a neighbor or friend. Making two lasagnas and trading one for a dish that your neighbor makes for example. I have even heard of some people buying produce in bulk when it is in season and then canning or freezing it together. Doing this with others can help ease the burden of the work involved in doing this labor intensive process. Why not make a party of it?

Shopping the bulk foods and spices aisles at your co-op can lead you to particularly affordable options for high quality and organic foods. When purchasing spices in particular you can save a great deal by buying just the quantity you plan on using.

Consider foods that you like which happen to be expensive when organic or locally grown as special occasion foods. This might mean you don’t buy them at the grocery, but rather combine them with eating out at a restaurant where you are already paying more for food. It may mean expanding flexibility to your eating habits and eating less meat. Protein is an essential part of nutrition, but it comes in various forms which vary a great deal when it comes to cost. I know, I might be losing you by suggesting eating less meat. Notice I didn’t suggest that you eat no meat. It is possible to have a complete and healthy diet without eating any meat, but it is not necessary.

If I lost you on the eat less meat approach, you can use a similar concept on other non-meat items. What I mean, is that you may find that certain food items are particularly expensive when purchased through organic or local sources. Examples include many dairy items such as butter, milk and cheese. In the interest of expanding your eating style and shopping in a more affordable way, you may find it possible to shift your eating such that some of these expensive items (such as meat) become condiments. By this I mean, that you think of them as more of a flavorful side item or ingredient rather than a main dish of the meal.

In order to change your eating style to accommodate this type of thinking, you might find it useful to build your skills and abilities in the kitchen. Some ideas on how to do this are featured in a section of my e-book. Yup, that’s right. I am excited to announce that some of the most useful topics I have written about to help you in your efforts to be better are now available in one handy dandy little guide. You can find the Guide to Betterness in iBooks in the store. Here is a link.

For now, I wish you well in your adventure of eating well while feeling a little less broke at the grocery store.

What if…?

What if where our food was grown, how it was prepared, who prepared it, and the intention that the person had as they were preparing it mattered as much as what we actually ate?  What if somehow love could provide nourishment in the way that we believe protein, carbohydrates, and sugar are able to do?  What if we understood that accidentally burning our meal was a sign of distraction and inattention to the food we eat and that by letting this distraction enter our lives we have lost some capacity of our food to give us the nourishment that we hope it will?  What if the intention with which our food is grown helps bring nutrition to it?

What if standing outside on a hot summer evening to water our garden helped make the strawberries, blueberries, kale, eggplant and beets that we can grow in our own backyard that much more full of nutrition?  What harm does it do to believe that the answer to any or all of these questions is that they are true?  Those of you that find these notions preposterous will challenge me to prove it.  So my challenge to those of you willing to entertain such possibilities and those that are not is to help me prove it.  Here is my challenge to all of us for 2013.

  1. Challenge yourself to learn to cook, understanding your cooking differently or more deeply, or understand the ingredients that you use to cook in a different way – use recipes, study the source of the food, how it is grown in general and specifically.
  2. Cook for others and do so lovingly.
  3. Grow something this year that you will eat.  Now is a great time to start thinking about what that will look like.  Will it be a planter, a pot in your home, a garden in back?  Does it require testing your soil for contaminants, or replacing the soil?  Does it require you to read a book from the library on cultivating that particular species?
  4. Find foods that are grown locally by people you might even get to know.
  5. Give yourself a weekly budget for food and find foods and recipes that fit within that budget from local sources.
  6. Find places you like to eat because you like being around the people that work and eat there.
  7. Try shopping at your local coop, exclusively or as much as possible – but stick to your weekly food budget!  If you’ve never shopped at a co-op this one might sound out there, but trust me these stores are shaped by people like you that shop there.  It literally is your store.
  8. Notice how you feel physically and mentally after different meals and eating in different locations and remember it – you may even begin to choose foods or locations based on anticipation of these outcomes of how you feel after the dining experience.
  9. Do this for a week, a month, or perhaps whole year as much as you like, as much as you can, as much as you will – and then let me know how you feel and what has or has not changed for you and your relationship to the food that you eat.

Yours in health,

Samuel Hanson Willis, MD

Family Medicine Physician

The path to healthcare reform is often described as a journey without a map or one without a clear destination.  I recently read a book by a writer who was once from Minneapolis about her personal journey along the Pacific Crest Trail.  She was at a vulnerable time in her life and in her book she eloquently describes coming to terms with challenge, difficulty, loss, and grief through the real life metaphor of traveling along the Pacific Crest Trail.  Throughout her journey she becomes lost, disoriented, threatened, scared, significantly alters her plan, and even hikes many miles using duct tape and a sock as her substitution for a lost hiking boot.

As a doctor what I find particularly striking is the authors willingness to describe personal struggles that involve subjects which carry a great deal of social stigma.  She does so in a matter of fact way that is skillful and honest.  It requires the reader to experience the reality of her life in order continue alongside her personal journey.  She writes so adeptly about these topics that she’s already 5 miles down the trail before you realize she’s done describing it.  Her book allows you to see the depths of a personal experience and at once move past it, recognizing that life goes on.  At times the author even reflects that everything in her past has brought her to the present, searching for positive meaning in parts of her past that do not automatically give her a sense of pride.

In the book, Wild, Cheryl Strayed has definitely created an enjoyable read, if nothing more – for its ability to let us live vicariously or perhaps at times as a voyeur looking at her life with a freshness and candidness that breaks us out of our preconceptions about people and what separates us.  She seems to effortlessly move from one aspect of American life to another sometimes over the course of months, sometimes in the matter of minutes.  She often moves from a predicament to an invitation by a generous stranger which brings their lives into the landscape as well as she traverses 1,100 miles of American soil.

To suggest that redesigning our healthcare system is as monumental of a task as a novice hiker taking on the tallest mountains in the contiguous 48 states (and perhaps not quite making it) and traversing the rugged trail along the Pacific Crest Trail is no more of an understatement than it is hyperbole.  I hope that we all keep moving slowly, steadily forward on our journey of healthcare system redesign.  I hope that we all demonstrate individual perseverance, communal generosity, and acceptance of life’s unpredictable nature as we do so.  I hope that each of you takes time in your life for rest, renewal, and rejuvenation.  Perhaps it will be through reading Wild, or perhaps through a walk along a local nature preserve – imagining just what it might be like to be Cheryl Strayed finding her way along the Pacific Crest Trail.

Best to you all –
Samuel Hanson Willis, MD

Family Medicine Physician

Originally published in July/August issue of Minnesota Family Physician – Reflections July 30, 2012

As a family medicine physician, I occasionally find myself in need of medical care.  I am well aware that we are advised not to provide self-care.  Indeed I find it personally difficult to remain objective when my own health or that of a loved one is in question.  In addition to following our ethical guidelines, I have found other benefits to seeking healthcare from my own doctor, not the least of which is getting better.  Experiencing the medical system as a patient is a tremendously effective mechanism for developing empathy.

I have heard patients report on the challenge of reaching a doctor by phone or having a simple question and wanting to have it answered by me, the doctor that examined the problem on its initial presentation.  Listening is a powerful tool in understanding the experience of a patient, arguably being the patient is yet a more powerful tool for understanding how powerful the patient doctor relationship truly is.  It reminds me that we are all patients in our healthcare system.  Any American who seeks care at some point in life will be a patient in our healthcare system, even those of us that are employed through some aspect of this system.   For me this is a powerful motivator to strive for constant improvement in what we do and how we do it.

An unexpected outcome of my doctor visit was having to wear a splint on my hand for 10 days, awaiting a follow-up visit and x-ray.  I quickly remembered as a right hand dominant person, just how many activities during the day require the use of my right hand.  I admit that I just might have a bit of stubborn perseverance.  I found many ways to complete the daily necessary tasks, including typing on an EMR with one hand.  There were nonetheless several tasks that no matter how hard I tried required two hands.  The most surprising of these tasks was putting on my stethoscope.

The Littman Classic II SE apparently is not designed for use by individuals with the use of only one upper extremity.  After several one handed attempts it became clear that putting a stethoscope on with one hand would result in an aggressive and resounding ear piece thwack to my nose.  It wasn’t long before I realized that I could ask my patient for help.  This simple exchange also surprised me.

I as the physician who was being asked for guidance required my patient’s participation in order to do so.  Without exception, the request was received with a pleasant response and a bond of connection.  We were helping each other so that I could help my patients.  It was a small gesture, but a significant one.  I like to think this can serve as a metaphor for us working together with our patients to improve the work we do as family doctors.  I wonder in what ways working with our patients and asking for their help can help us be more successful in improving the health of our patients.

Samuel Hanson Willis, MD

Family Medicine Physician

Originally published in Walker Open Field Blog June 21, 2012

Name: Samuel Hanson Willis
Occupation: Family Medicine Physician and Creative Problem Solver
City/Neighborhood: Windom Park/Minneapolis
Open Field Activity: Better Together: A Collective Drawing Experiment
Description: Draw: “BECOMING BETTER.” Connect with the Open Field community by sharing your ideas about what “becoming better” means to you through the act of drawing. Your drawing will be added to a collection of images by others and assembled into a digital flipbook. As the project evolves it will be visible at Check the website this fall to watch the idea take shape.
Dates of Activity: June 23, 2012 & July 28, 2012 from 2- 5 pm.

1. Fill-in-the-blank: _______________ is what we make together.

 Life is what we make together.

2. What is your favorite public space in the Twin Cities or beyond?

Twins Stadium – I’m not much of a baseball fan, but I just absolutely love being outside with 30,000 plus other people enjoying all that summer baseball at the park means.  Outside of MSP it would definitely be the porticos and piazzas of Bologna – Sunday evening stroll on the Central Plaza is one of life’s great pleasures.

3. What is the perfect Minnesota summer activity?


4. Who do you dream of attending your activity?

Anyone with a little spark of creative drawing energy.  I hope that kids and adults of all ages will contribute a drawing.  The first day coincides with MSP’s GLBT Pride festival, so I hope we’ll have some visitors from Loring park – friends new and old.

 5. What other Open Field activity are you looking forward to this summer?

As many as I can attend.  I’m particularly excited for Art Swap!

6. What is your favorite summer song?

I think that Beck’s “Que Onda Guero” epitomizes the best of summer – come to think of it, I should go dust of the CD, summer has started!