Friday, July 29, 2011


It was war. Ugly. Bloody. And there was plenty of collateral damage. Angela F. Braley, Chair, President, and CEO of Anthem/WellPoint, dug in her heels. She was, after all, the leader of the largest health insurance company in the country. Thirty-four million Americans counted on HER company. Last year’s revenues were $57.8 billion dollars. Yes billion, with a B. And yet, she was fighting a board room coup.

Ken Goulet, Executive Vice President and CEO of the Commercial Business Division, had his own ideas of how the company should be run. His area accounted for twenty-seven million Americans, 80% of the WellPoint’s medical insureds. He and the Executive Vice President and Chief Financial Officer, Wayne DeVeydt, saw a need for an immediate rate increase to protect long-term financial security. They wanted more money in the company coffers, and they wanted that now. Ms. Braley disagreed.

The disagreement erupted at the Board meeting. Angry words were exchanged. Ms. Braley demanded spending cuts and changes in benefits. Goulet and DeVeydt tried to force across the board premium increases. Claims were suspended as the company attempted to sort out its finances and determine a prudent path to take. Insured’s were advised that their policies would be reactivated once a decision was reached, passed by the Board, and signed by the CEO. Until then, the best one could hope for was good health, a quick resolution, and a reasonable rate increase once the bill arrived.

The above is, of course, total fiction. Those are the names and titles of WellPoint’s leaders. The revenue and membership numbers are accurate, too. But the idea that an insurance company would hold up benefits while sorting out an internal conflict is just me being silly. Real businesses are too responsible to behave that way. No, the only place people’s lives are put in jeopardy like this is with the government.

Today is July 29, 2011. The Republicans just passed John Boehner’s bill. The Speaker of the House, the leader of the Republican majority, needed over 24 hours to get an almost meaningless piece of legislation approved by his own troops. In the end, the only thing he accomplished was the final destruction of his own reputation and position. This bill is Dead On Arrival at the Senate. Boehner knows that. His Republican members know that. And the Senate is incredibly clear about the bill’s status. There was only one reason to pass this legislation – political theater. If Boehner could have passed the bill with little effort, with all of the Republicans and a smattering of Blue Dog Democrats, he would have been in position to consolidate power and force a deal more to his members’ liking. Now? Who knows?

I don’t think we are going to default. I certainly hope we don’t. I keep thinking that the adults are going to step in at the last moment and resolve this. At the very least, I keep thinking that this will be kicked down the curb till next March.

Until this is resolved, seniors dependent on Medicare and countless others wait and wonder. Will they be paid next week? Will they be insured next week? Will the government shut down? We have states that have or are close to shut down. Why not Washington? With so many people campaigning against the federal government, what would happen if enough people got elected who wanted to dismantle the great social safety net?

And thus we return to my question – is your health care too important to be entrusted to politicians? This isn’t an unqualified endorsement of insurance companies, just a simple question. John Boehner? Harry Reid? Nancy Pelosi? John McCain? Which of these people would you like to have managing the nation’s health care industry? Which do you want in charge the next time you need a kidney?

Let me be clear, the insurance industry is only as good as the regulations that control it. Ask my friend John about his claims from Hurricane Katrina. Health insurance claims are far less aggravating then car or home insurance claims, but rules and regs play a large part in that. Financial stability comes, in part, from the laws the companies are forced to abide.

So, on Friday the 29th, the idea of Anthem not paying my clients claims is ridiculous. The idea that my friends and neighbors are being threatened by a government default that may or may not cover their claims isn’t ridiculous. It is shameful.


Sunday, July 24, 2011

More Free Stuff

“Unintended pregnancies carry health consequences for the mother - psychological, emotional and physical – and also consequences for the newborn”, said Dr. Linda Rosenstock, panel chairwoman and dean of public health at the University of California, Los Angeles. “The overwhelming evidence was strongly supportive of the health benefit” of contraception.

The above paragraph was part of an Associated Press story that appeared Tuesday at The headline was Panel urges no co-pay insurance coverage for women’s birth control.

Last year’s Patient Protection and Affordable Care Act (PPACA) included a provision for preventive care. Most health insurance plans are now required to cover a list of preventive care exams and tests without any co-payments. FREE! The costs for these services are simply shifted to the insurance company who eventually shifts them back to you or your employer in the form of higher premiums. Knowing that recommendations over and above mammograms and Pap tests would be controversial, the issue was shipped over to the 16 person panel at the Institute of Medicine.

The panel recommended that the following female-specific items be included under the free preventive care benefit:
* All forms of contraception – Birth Control Pills, IUD, and emergency contraception (the morning-after pill)
* At least one “well woman” preventive care visit annually
* Annual HIV counseling and screening for sexually active women
* Annual counseling on sexually transmitted infections for sexually active women
* Screening for and counseling about domestic violence
* Screening every 3 years starting at age 30 for the virus that causes cervical cancer
* Screening for diabetes during pregnancy
* Support for breast feeding mothers, including the cost of renting pumps

The recommendations didn’t have a 16-0 endorsement. Anthony LoSasso, a senior research professor at the University of Illinois School of Public Health, objected. He noted the absence of a cost-benefit analysis. But since money wasn’t relevant, the Rosenstock led panel pushed through their wish list.

There is a very good chance that Kathleen Sebelius, the Secretary of Health and Human Services, will incorporate these recommendations into public policy in the next few weeks. There is an even better chance that Kathleen Sebelius, the Secretary of Health and Human Services, will be attacking the insurance companies next year when your rates go up.

I am not suggesting that giving women information and access is bad. Far from it. The lack of concern over cost bothers me. And, this decision to explore personal habits opens us, as a society, to countless issues.

Dispensing free contraceptives as part of preventive care means, in essence, that any woman physically capable of getting pregnant, but not utilizing some form of contraception, is not following accepted medical care. Should your eleven year old daughter be on the pill or have the patch? IUD at fifteen? I believe that this is a family discussion.

Is sex a choice? Is sex too desirable to avoid?

What about gun ownership? I’ve never owned a gun. I have never fired a real gun. But I know people who feel even more strongly about their guns than I do about the wooden pen I’m using to write this post. We know that children find guns in their homes and accidentally kill themselves, siblings, or playmates. What is to keep Secretary Sebelius from incorporating a gun ownership prevention/education/safety program into every child’s preventive care visit?

It doesn’t stop there. I was a healthy kid, but I had numerous basketball injuries. Should my teenage preventive care exams have come with elbow and knee pads, or should the doctor have just given up and prescribed a 30 minute video on the horrors of knee injuries?

Football is a choice. So is riding a bike. We now require children to wear bicycle helmets. Shouldn’t the doctor just periodically dispense them as the child outgrows them? This is preventive care. The science supports the need.

And Money Is No Object.

We live in a fantasy world where there is an abundance of free stuff. The U.S. is currently fighting two or three (depending on who you talk to) unfunded wars. The party, Democrat or Republican, out of power is always more obsessed with budgets and deficits than whichever is in charge. And wherever there is a microphone you will find a politician promising something for nothing.

We’re adults. We know better. But we still want more free stuff.


Tuesday, July 5, 2011

me Me ME

I couldn’t write. I was too agitated to write. Now for someone like me who seems to write principally to vent, agitation is a useful state. Sometimes it is the starting point. But I have been handcuffed for over a week.

“If Congress really wanted to balance the budget,” I heard an elderly man say. “They could stop spending our money on things like…” an elderly woman continued. Turning my attention to the television, I found a parade of senior citizens complaining about the federal government having the nerve to allocate funds for anything other than their health, welfare, and happiness. Some of the claims were bogus, some merely exaggerations. The total of all of the alleged expenditures wasn’t enough to change anything. The commercial, sponsored by AARP, was simply one more salvo in the ongoing budget debate.

We are all in agreement that sacrifices need to be made. We are waiting for YOU to make them.

The nursing homes in Ohio feel that they are entitled to a larger and larger share of the State of Ohio’s budget. Deliver Medicaid care at home? Unthinkable. Thus we are treated to aged, decrepit seniors crying into the camera. “Please don’t take my dignity,” said the 200 year old guy wearing the Veterans of Foreign War hat. Too late. That ship has already sailed.

I heard the familiar strains of You Only Hurt The One You Love. The television screen was filled with sick people. The American Hospital Association wants you to know that cuts in federal funding will have an immediate impact on the elderly, children and the disabled. And just in case you have the sound off, their ad concludes with the camera focusing on the unhappy child in a wheelchair.

We in Greater Cleveland know how the hospitals have been suffering. It has been almost a week since a new facility opened!

We are in year two of the President’s health care reform. The Patient Protection and Affordable Care Act has succeeded in keeping a smattering of adult children on their parents’ policies. It has eliminated policies that covered only children. It has cost millions of dollars for compliance. But, the PPACA has not reformed health care.

You may not like insurance companies. Hell, I’m an insurance agent. There are lots of days that I don’t like insurance companies. But, you can’t reform health care without addressing the cost of medical care and how it is delivered. And no one is more change resistant than the medical industry when the subject is money.

Every time the government proposes a cut in the funding or even the growth of funding of medical care, we see more costs shifted to those who are covered by private insurance and the television commercials reappear. My goal is to eventually be one of those elderly actors. I bet AARP pays well.

We have yet to have a serious discussion. And it is hard to blame the doctors. Do you want to take a pay cut? Would you want to work more, see more patients, for the same money, or G-d forbid, less? Everyone involved, from the lab techs to the hospital administrators, has the same argument. And until anything happens, all of the participants are staking out their territory.

We are all in agreement that sacrifices need to be made. We are waiting for YOU to make them.

Somewhere there is someone reading this who is pounding the table and yelling, “Take the profit out of healthcare!” Balderdash. There is profit at every step. The doctors aren’t volunteers. The labs, the pharmacies, the drug companies, the equipment manufacturers, the company that cleans the linens, they all expect to be paid for their efforts and rewarded for their risks.

Of course, we could bring all of this under government control. Wouldn’t that solve everything? A recent Wall Street Journal article detailed the incredible cost (waste) when people are covered by both Medicare and Medicaid. Medicare is a federal program. Medicaid is controlled by the individual states with a partial reimbursement from Washington. There are 9.7 million patients covered by both systems. “Dual Eligibles” have disproportionately higher claims as they expose the inefficiencies of the two programs and their inability to effectively coordinate care. The examples in this article will give you pause.

The answer won’t be found in a scary commercial. Old veterans and disabled children are just stage props. We understand that there aren’t any 2011 Cadillacs waiting for us at the corner used car lot. At some point we have to decide what health care we really want and how much we can and will spend. Those tasks are still waiting for Congress, Republicans and Democrats, to tackle with the President. The business models will work themselves out, once those questions are answered.

And will someone please get the child actor in that wheelchair a teddy bear?