Are Insurance Companies Adding Value?

Check out this article from the New England Journal of Medicine published in 2003.  It compares the administrative costs for the United States healthcare system and the Canadian healthcare system.  Though the data is about a decade old, the implications are just as provocative, perhaps more provocative, at this time of fervent debate and bombastic rhetoric.  Here is a link to the article http://www.pnhp.org/publications/nejmadmin.pdf

In the midst of such strident posturing we are ignoring certain fundamental themes.  So, I pose the following question.  What value is the health insurance industry adding to the landscape of providing comprehensive health care to our nation?

Performance Anxiety and Beta-Blocking Medicine

Someone recently asked me about anxiety that had erupted since she started having to speak to strangers to grow a MLM business she had just started. The answer I provided may be helpful to others.

Your anxiety is tightly bound to the context, having to speak in front of people you don't know about the business. This is an important and distinguishing feature from certain other anxiety disorders where there is not always such a clear and solitary cause or provocation of the anxiety.

There are two distinct features to anxiety of this sort. The involves the acute anxiety brought on during (or in proximity to) an occasion when you must speak to people about the business. There is a second kind of anxiety that involves anticipation of the situation of having to speak to others about the business. The second variety of anxiety involves the fear, expectation or dread that you will experience a surge of anxiety. These two different aspects to your anxiety call for slightly different approaches.

Remember that racing heart, tremor, rapid breathing (often somewhat more shallow), feeling flushed, mild sensations of lightheadedness, and the subjective sense of anxiety are symptoms that are mediated by two chemicals, epinephrine & norepinephrine. These chemicals are released in response to a perceived threat. They provide the physiological basis for the fight or flight response. There is a class of medicines, beta-blockers, that effectively block the peripheral effects of these chemicals (increased heart rate, increased blood pressure, tremor, etc).

There are some other aspects of your history that may be pertinent. Below are listed some of the items that might typically be explored in an initial visit.

Past History

If you have ever had a previous history of acute anxiety attacks, particularly attacks of anxiety that arose without a clear provocative stimulus, this may have bearing upon the approach to treatment. I would also have potential implications for your children (in that they might be slightly more at risk of experiencing panic attacks sometime in their lifetime.

Family History

If you have family who have experienced acute anxiety attacks, that may be relevant. As you can imagine, persons with anxiety symptoms are embarrassed by their symptoms so it is not unusual for family to keep their symptoms and suffering to themselves.

Past Medical History

Although I asked you about a history of irregular heartbeat, let me encourage you to check your pulse the next time you are feeling the acute anxiety. It is unlikely that you have an irregular heartbeat but sometimes a person may notice an occasional dropped beat or irregularity to their rhythm. If you noticed something like b-b-b- - - b-b- - - b-b-b-b-b-b- - - b-b (a slight pause) that would be worth noting and mentioning to your physician. When your heart is examined it may be that a murmur or click is heard. This may occur with persons who have a mitral valve prolapse, a condition that is usually not serious but is associated with panic attacks.

Your anxiety is similar to stage fright and there are accomplished performers who sometimes use beta-blockers to suppress the symptoms of their anxiety. Beta-blocking drugs include agents like Inderal (propranolol), Tenormin (atenolol), and metoprolol. Your doctor will tell you if you have any contraindications to taking these medicines (for example, rhythm disturbances of your heart or asthma)They interfere with the action of epinephrine and norepinephrine. Consequently, they can slow heart rate and lower blood pressure, suppress tremor, reduce flushing, etc

Ideally, these medicines will permit you to suppress the symptoms of anxiety which often cause persons to feel embarrassed thereby aggravating the anxiety. Once you are assured that you can master the situation that makes you anxious, you may not need to utilize the beta-blocker.

Another approach involves the use of anti-anxiety medication, like Xanax (alprazolam), Ativan (lorazepam), Valium (diazaepam). These agents are effective in reducing anxiety by their effects on the brain and the regions that are responsible for anxious perceptions and flight from a noxious stimulus. Many individuals considering using these medications express concern about their potential for tolerance and addiction. Ideally, they would be used for short-term relief to help a person refrain from avoidance of whatever situation is challenging them (in your case speaking in front of others). If you were to resort to using this, then it would also be episodic. Provided you are using these agents on an occasional basis there is little risk of becoming physiologically dependent. Of course, if you come to believe that the only thing likely to give you relief is a medicine in this class it can foster a sort of psychological dependence.

Keep in mind, whether it is a beta-blocker or an anti-anxiety agent you use, you will also be continuing to push yourself to get through those difficult situations and you will continue to use rational self-talk to combat the anxiety. It helps to know that the best rational self-talk may provide little relief when a person is experiencing persistent anxiety.

As you grow more familiar and comfortable speaking to others, you may find the anxiety subsides. I urge you to keep in mind that mastering anxiety is something that really builds self-esteem. Not all anxiety is bad. When you find yourself able to speak to others about the business without feeling overcome by anxiety, you will discover again the value of mastering anxious impulses.

I hope others will find something helpful in this post.