Health Insurance Issues with Dave

The Entertainer

2012-03-13T10:46:00.002-07:00

I was on a cruise, over a thousand miles south of the Florida coast, when Rush Limbaugh chose to waddle into the fray. Watching CNN as we were dressing for dinner, we thought that we were going to get a break from the stories of the horrific shooting rampage in Chardon when the anchors moved on to other topics. First it was the announcement of the death of Davey Jones. Then it was the death of reason in the ongoing health care debate. El-Rushbo had spoken.

The delivery and payment of health care in this country is already over politicized. We have more than enough emotion and not nearly enough facts. Logic and intellectual honesty are notably absent in most of the discussions. The Republican presidential candidates have studiously avoided anything that even approached a solution. They have all vowed to repeal Obamacare as if that wouldn’t create more problems than it solved. And into this we add Rush.

Where do we begin? Let’s start with a clear statement. Calling Sandra Kay Fluke, a law student four days older than my daughter, a “slut” and a “prostitute” because she vocally supports the President’s health care legislation is abominable. She is a civilian, a private citizen. She isn’t a public figure, someone who willingly subjected herself to this kind of derision or scrutiny. And no, it may not be right to say such things about public figures, but we do. Ms. Fluke should have been off-limits, like the nameless group of men that had testified about women’s birth control the week before.

So the predictable occurred. We put an important national debate on hold while we discussed the relative merits of a radio talk show host. The people that hate him, and Gosh there are plenty who do, got riled up and went after his sponsors. His defenders, a little more reserved than usual, assured us that Rush was just being Rush. There was a certain amount of merit on both sides. There is nothing the political right hates more than to be defeated by the use of the free market. And in all fairness, Limbaugh, ignored in the Republican presidential primary and uninvolved in the national discussion, desperately needed attention. Any attention. Everyone won, even Ms. Fluke. Her brand, her name recognition, is huge. She is assured of a much brighter future thanks to Rush Limbaugh.

What didn’t happen, what was stopped completely, was an intelligent, honest discussion of the issues. So let’s try to kick start the process.

Here are a couple of the stories you might have missed:

We have discussed the Pre-Existing Condition Insurance Plans that the Patient Protection and Affordable Care Act (PPACA) created for the unhealthy uninsureds. The federal government’s actuaries predicted the average cost per enrollee at $13,026. They weren’t even close. The average cost now predicted for each enrollee in 2012 is $28,994! It is that kind of predicting that gives most of us pause as we contemplate the President’s health care program and future liabilities.

Senator Mitch McConnell (R-KY) has decided that he sees no reason to vote on the repeal of the PPACA until after the November election. It is important to remember that he has never seen a reason to offer an alternative to the President’s plan or a workable way to modify the legislation.

Add to this the date March 26, 2012, when the Supreme Court will begin to hear arguments about the Patient Protection and Affordable Care Act, and we have more than enough to keep us busy. In fact, we are much too busy to waste time on an entertainer.

DAVE

www.bcandb.com

The Guy With The Scalpel? He's My Attorney!

2012-02-13T11:56:00.000-08:00

Frank O. had been an agent for over twenty years the day I started with Prudential in October of 1979. My desk was next to his. Fifteen months later I was his manager and my desk was in a private office. I asked to spend a day in the field with Frank, not because he needed me, not even because he wanted me. At best, Frank tolerated me. No, I needed to learn what he was doing and how he had survived for so long as an agent.

The first stop was a longtime client of Frank’s. Climbing up the front steps, I noticed that my employee was walking to the side door. The side door? Frank reminded me that we were not related to the client. We weren’t family. We weren’t their friends. We were service providers and service providers enter via the side door.

It was at that moment that I realized how little I knew about the insurance business.

I was reminded of that humbling experience as I watched President Obama and Health and Human Services Secretary Kathleen Sebelius stumble, again, as they attempted to control the delivery and payment of health care. The biggest difference was that I, at age 26, realized how much I had to learn. Our President and his staff seem surprised that their frequent missteps are so apparent and so unacceptable.

My last post, The Ongoing Religious Battle, addressed the Obama administration’s decision to classify Birth Control Pills, IUD’s, the Morning After Pill, and some forms of Sterilization as preventive Care. The Patient Protection and Affordable Care Act (PPACA) includes a provision that preventive care is FREE. That is the government’s definition of affordable, FREE.

The predicted firestorm erupted. The Vice-President and other committed Catholics in the administration had warned of problems. The White House Chief of Staff resigned. Last Friday the President announced his solution. As long as you don’t care about the moral implications, the money, how insurance works, or intellectual honesty – it was the perfect compromise.

Everything is still free. The insurance company will pay for it.

(Before we go any further, let me assert that I am totally in favor of most forms of birth control and voluntary sterilization. Let me also remind you that this has nothing to do with me, personally. This is about us, all of us.)

It only took a few hours for the double talk of the compromise to become apparent. Senator Roy Blount (R-MO) quickly released a statement via email. It stated, in part:

It’s clear that President Obama does not understand that it isn’t about the cost – it’s about who controls the religious views of faith-based institutions. President Obama believes that he should have that control. Our Constitution states otherwise.
Just because you can come up with an accounting gimmick and pretend like religious institutions do not have to pay for the mandate, does not mean that you’ve satisfied the fundamental constitutional freedoms all Americans are guaranteed.

A little dramatic? Perhaps. I suspect that the Supreme Court will be the final arbiter as to whether this crosses the line. But, Senator Blount was absolutely right when he called out the President for his sleight of hand.

The insurance companies are just going to pay for Birth Control Pills, IUD’s, the Morning After Pill, and certain forms of sterilization? Really? How do they show that on their books? These are claims that are eventually paid by the employer. And of course, large employers, such as hospitals and universities, are often self-insured. The insurance company simply processes the claims and organizes the market.

President Obama decided that insulting observant Catholics and other people of faith wasn’t enough. He decided to insult our intelligence, too. The President declared that insurance companies should pay for Birth Control Pills, IUD’s, the Morning After Pill, and even sterilizations from company coffers because it will save them money. By eating these costs, the insurers won’t be paying for unwanted, unplanned pregnancies. Ignoring the fact that it isn’t the insurer’s money or responsibility, perhaps we should take this to its illogical extreme. If we want to save money and eliminate unwanted and unplanned pregnancies, why don’t we have the insurers hand out chastity belts? Of course that’s silly, but it is no less honest nor illogical as the President’s suggestion.

It is time to remind you that none of this is about contraception, women’s rights, or even preventive care. It is about creating an environment where private insurance becomes unaffordable and only a government solution will work. Whether that is by accident or on purpose is for you to decide. But if you have someone restructuring the delivery and payment of health care in this country who doesn’t understand the basics of the market and insurance, you might as well have your attorney remove your appendix.

DAVE

www.bcandb.com

The Ongoing Religious Battle

2012-02-01T11:18:00.000-08:00

Can you force your employees to live YOUR creed? More importantly, can you make it unpleasant and expensive for your employees to break your personal religion’s rules? The answer, as it is so often, is Yes and No.

Preventive Care is a key benefit of the Patient Protection and Affordable Care Act (PPACA). Katherine Sebelius, Secretary of Health and Human Services, recently decided that Birth Control Pills, IUD’s, and the Morning After Pill are all FDA approved forms of contraception and as valid a part of preventive care for women as mammograms and Pap tests.

The PPACA therefore forces employers to not only cover Birth Control Pills, IUD’s, and the Morning After Pill, but it also eliminates the copays for these items. They are free to the insured employee. This shifts the cost for these items to the insurance which in turn shifts the cost to the employer.

So, if you own a factory and you are opposed to these forms of birth control, you will soon be paying for your employees’ pills. Fair? Most of us will say Yes. We don’t want our employers to dictate moral positions to us.

But what if we aren’t talking about a factory? What if we are discussing a church or a church funded organization? Is there a difference? According to the Obama administration, the answer is No. Every employee has a right to preventive care and preventive care includes birth control. The Supreme Court may disagree.

We are constantly trying to define property rights in this country. Ron Paul takes the Libertarian position that the government doesn’t have the right to force you to conform to other people’s wishes. If you don’t want to serve African-Americans in your restaurant, the market should push you to reconsider, not the law. That is one extreme. The other extreme has the government involved in many of the day to day decisions of businesses. This involvement manifests itself in smoking bans in bars, the elimination of trans fats in restaurants, and forcing businesses to not only provide health insurance, but to determine the very nature of the coverage. This is where we are again.

Where is the line? Can the Catholic Church, which is adamantly opposed to most contraceptives, limit access to its priests, nuns, and church employees? Can the Church limit access to the employees, Catholic and non-Catholic, of its schools? What about Catholic hospitals that may employ hundreds of non-Catholics? How much influence is the employer granted?

The Supreme Court, in a 9 – 0 decision, recently ruled that the First Amendment “gives special solicitude to the rights of religious organizations” in how they treat their employees. This decision was reached in response to a lawsuit brought by a teacher who had been terminated by her employer, a Lutheran school. Chief Justice Roberts challenged “government interference with an internal church decision that affects faith and the mission of the church itself”.

Will the Patient Protection and Affordable Care Act allow you to provide access to birth control for all of your full-time employees? Yes. Will you as an employer pay for it? Yes. Will you be forced to provide access if you don’t want to? If you are a business the answer is still Yes. If you are a church or a religious based institution, the jury is still out.

DAVE

www.bcandb.com

The Great Great Contest

2012-01-16T08:24:00.000-08:00

The new president of the Ohio Jaycees, back in the early 1980’s, was a good old boy from the southern part of our state. We’ll call him Bubba. I was a state level officer and had been very involved in the other guy’s campaign.

Bubba was a nice enough guy who was incapable of stringing four words together without saying the word “great”. No other superlative, just “great”.

The Ohio Jaycees were holding a state-wide meeting and Bubba was going to give a fifteen minute presentation. I created the Great Great Contest. I divided an oversized sheet of cardboard into a thousand numbered squares and allowed the guys to predict how many times Bubba would say “Great”. Each block cost $1. Half would go to the winner. Half to charity. You could hear the crowd counting throughout Bubba’s speech.

Bubba isn’t running for President, but I think about him every time I watch the Republican hopefuls debate. Which candidate will be the first to say that he will “Repeal Obamacare”? It is a race. I half expect Mitt Romney to be mouthing the words as the cameras focus on him during the introduction.

There are two more debates this week. Get out a sheet a paper and keep score. Who gets to be the first to promise to “Repeal Obamacare”? Who says it the most? How many times are Obamacare, and its orphaned cousin, Romneycare, decried in each debate? You may need a large piece of paper.

Now grab a post-it note to score how many times any of these candidates propose an alternative. My prediction – ZERO.

This blog has been clear. The Patient Protection and Affordable Care Act (PPACA) is a terrible overreach and a badly written bill. The numbers don’t add up. The stated goal, the motivation for this whole endeavor, was to cover the uninsured. The PPACA has not solved that problem. But, what does repealing it accomplish?

The PPACA is almost two years old. Businesses and insurance companies have spent millions of dollars to comply with the ever-changing regulations. President Obama was clear, prior to the bill’s passage, that “if you like your current health insurance plan, you can keep it”. That didn’t happen. The cost to maintain a separate series of “grandfathered” contracts compliant with the contradictory regulations emanating from Katherine Sebelius’s Health and Human Services was beyond reason. One by one, the insurers eliminated all of their old contracts. If you repeal the PPACA, do you have to go through the expense of changing the majority of the group and individual health policies in our country?

The PPACA made preventive care a mandatory benefit. Does that stay or go?

The PPACA allows children to stay on their parents’ insurance until age 26. How many pregnant 24 year olds would lose coverage if you suddenly repealed the PPACA?

Would the repeal of the Patient Protection and Affordable Care Act eliminate the health policies that were created for the chronically uninsured?

You get the idea. The PPACA may be a mess, but it, just like the problems it purported to fix, exists. Repealing the Presidents’ health care plan without having a well-crafted replacement might be worse than retaining it.

This blog has consistently doubted the Republican’s sincerity about repealing the PPACA. I view it as a safe fundraising ploy. It would take way too much effort to create a viable alternative. There is no risk to denigrating legislation disliked by over half of our populace. Creating an alternative would expose them to the same type of scrutiny and probably the same results. Even modifying the law was more effort than the Republican House could muster.

Bubba said “Great” 123 times. The winner received $140. Bubba isn’t running for President, but I am convinced that he was one of Michele Bachmann’s speechwriters.

DAVE

www.bcandb.com

Clear As Mud

2011-12-30T12:06:00.000-08:00

When is selling not selling? Where is the line between helping your customer and primarily helping yourself? Determining that becomes harder each day.

One of my clients needed to talk. She had received a disturbing phone call at her home and wanted to know if she had handled it correctly and if I knew the back story. Mary (not her real name) was contacted by a national pharmacy. We’ll call the pharmacy chain Mega Rx. Mary was advised that her insurer would no longer cover medications for her and her family from their local Mega Rx. Since they knew that Mary would hate to loose access to Mega Rx, they would be happy to connect her to someone who could help her find an insurance policy that would allow her to retain them. All she had to do was stay on the line. Mary thanked them but said that she already had an agent and hung up.

Think about this for a second. The national drug store chain had fought and lost a battle with a national insurer. They were mining their records for anyone who had that insurer and had had a prescription filled in the last year or so. And if Mary was gullible and not paying attention, she might have somehow been talked into different insurance that would have definitely covered Mega Rx, but might not have covered her doctor, or given her and her family the same level of coverage.

The appointment to change individual health insurance policies usually takes an hour in my office and involves a lot more than whether or not Mega Rx is in the network. This silliness is taking place under our current set of rules. The states and the federal government are still writing the new rules. Some people don’t think we really need licensed agents. Why not let anyone sell insurance?

I just spent twenty minutes completing my application to renew my license to sell life and health insurance. I had to prove that I had completed 21 hours of continuing education and 3 additional hours of ethics training in the last two years. I actually had a total of 42. That does not include the 7 to 9 hours per year for Medicare products or the mandatory additional training for long term care coverage. I then attested that I haven’t been convicted of any crimes, haven’t had my insurance license suspended or revoked, and that I don’t owe back child support. This is true. You can not sell insurance in the State of Ohio if you owe back child support. I paid my $5 and I should get an approval notice some time next week.

All states have seen a value in licensing insurance agents. It is obvious that one value of the requirements is to weed out the part-timers. The public is better served by committed professionals who are willing to take the time and effort to stay current. And though insurance agents (me included) will never be confused with rocket scientist, we do serve an important function in the market as we help the insured public acquire coverage and navigate the process to get the most from their contracts. The insurers long ago (begrudgingly) accepted our value.

This brings us to the Patient Protection and Affordable Care Act (PPACA). The authors of this legislation did not believe that the public is capable of calling an insurance agent or company or shopping online to purchase health insurance. Since finding health insurance was so difficult, insurance exchanges, a marketplace, would be created in each state. As you can see from the Obama administration’s website, the exchanges, an additional layer of bureaucracy, is going to save you money. And how will you get to the exchange and who is going to help you choose the right type of policy for you? That would be the Navigators.

The PPACA is pretty sure that almost anyone that can fog a mirror is capable of doing my job. Any employee of trade association or union can walk you through the process. In fact, the PPACA spends more time on the notion that the Navigators can not be compensated by the insurers than it does on training or qualifications.

A well publicized letter from David M. Casey, Senior Vice President of MAXIMUS, a company that specializes in Medicaid enrollment, details the Patient Protection and Affordable Care Act’s aversion to professional insurance agents.

John Doak, the Oklahoma Insurance Commissioner, is succinct in his judgment. He has consistently challenged the federal government’s intrusion into insurance regulation and health insurance. He has asked what kind of training the Navigators will have in insurance products, health information privacy regulations (HIPAA), or ethics. And of course we already knew the answer, none.

The other question is “Who will be paying the Navigators”? You have two choices. Either the Navigators eventually become employees of an endlessly growing government program, or they are employees of organizations who have something to gain by you and I being steered into one policy versus another. And that brings us back to Mega Rx. The major pharmacy chains are currently exploring ways to have employees become Navigators under the future exchange program. Will they be impartial? Will they be looking out for your best interest? Will the sun rise from the west tomorrow morning?

This is too easy and way too transparent a case of conflict of interest. What if a major insurer is donating money to your local trade group? The employee of that trade group would work to navigate people to that company’s policy. There is a lot of money involved. This won’t be subtle. And it won’t be easily traced.

So when you get that phone call from the drug store, or the doctor’s office, or the Chamber of Commerce, and you will one day, ask yourself why. Slow the process down and try to determine who is getting paid and for what.

In the interest of creating transparency and simplicity, we have failed at both.

DAVE

www.bcandb.com

The Day After The House Burned Down

2011-12-15T17:13:00.000-08:00

This is a post about someone with cancer. I have not met Ms. Ward, nor do I think that I ever will, but I wish her a successful recovery. This post may take issue with some of her choices and many of her conclusions. These differences should not be interpreted as personal. They are not. Too many of our discussions have devolved into the personal as they abandon fact and reason. This blog champions a polite discussion of the facts.

Spike Dolomite Ward has cancer. Ms. Ward is a forty-nine year old married mother of two. She lives in California. This past Sunday’s Plain Dealer included an article she wrote that initially appeared in the Los Angeles Times. Ms. Ward explained why she hasn’t had health insurance for over two years. Trust her, it is not her fault.

The key element, the point that requires ten paragraphs to justify, is that she has been saved by President Obama and the Patient Protection and Affordable Care Act (PPACA). How you ask? Will the President be administering the Chemo? No, but close. As we have discussed before, the PPACA included the creation of guaranteed issue policies that cover pre-existing conditions for people who have been uninsured for over six months.

Significant medical condition like cancer? Check.

About to have lots of expensive treatments? Check.

Uninsured for over six months? Check.

Insurance now seems like a really, really good idea? CHECK.

I completely understand the need to purchase homeowners insurance now that my house has burned to the ground.

Please read Ms. Ward’s article. It is entirely possible that the laws in California are very different from those here in Ohio. It is also possible that there is a touch of exaggeration and hyperbole in those first ten paragraphs. Don’t get lost in the details. They aren’t relevant. This post is about the uninsured and the individual mandate.

We are, or at least should be, responsible for our choices. Ms. Ward is not alone. There are millions of uninsured Americans. The poor have Medicaid, a program that should have received a lot more attention in the last two years. It is the working poor that are falling through our system’s cracks. There is also a large segment of the population who simply choose to spend the money on other stuff. I refuse to speculate as to Ms. Ward and her family’s status.

Ms. Ward is correct. Her life choices, her insurance choices, her and her husband’s job choices could have had devastating consequences. Instead, someone else, you, will pay the bills. Any solution that includes guaranteed issue and the complete coverage of preexisting conditions must include a mandate that requires everyone to have insurance.

The individual mandate has been both championed and disparaged by everyone from Newt Gingrich to Barack Obama. One day they embrace it. The next day they flee from the concept. As an agent, as someone in the system for thirty-three years, I am convinced that requiring people to participate is the only way a guaranteed issue plan would work. This is not limited to private insurance programs. A government plan is just as dependent on universal participation. That is why Medicare Part B and Part D penalize late enrollees.

All of the candidates expressed their hatred of the individual mandate at last week’s Republican debate. I understand. They are running for president. But the time has come to stop telling us that you hate “Obamacare” and to instead offer a realistic alternative. Better yet, there are lots of serious people waiting to hear any viable option that doesn’t include an individual mandate.

Whether or not an alternative is ever proposed and passed, we wish a full and speedy recovery to Ms. Ward. And we wonder how in the world we can afford all of the other Spike Dolomite Wards we are going to be supporting.

Discipline

2011-12-05T09:56:00.000-08:00

We all know people who have invested in $2,500 clothing racks. OK, the store called the equipment an exercise bike or a treadmill. But sitting idly in the bedroom with clothing draped over it, the apparatus is obviously a clothing rack. What a waste of money! If only these people had the discipline to take full advantage of their investment.

Recent studies performed by researchers at Duke University have proven that the above problem may not be shared by physicians. If a doctor purchases equipment, such as expensive heart-testing or imaging equipment, they use it. In fact, it appears that these doctors may be using their equipment regardless of whether the patient needs the testing or not.

That’s what I call discipline.

USA Today reported this past week about a Duke University study of 500 MRI scans that had been performed on patients with lower back pain. The researchers were trying to determine whether doctors who own the equipment order more tests than those who don’t. You bet they did. Almost twice as many normal results (106 vs. 57) were found on scans ordered by doctors with an economic incentive than by those who didn’t.

The article notes that MRI scanning equipment carries a price tag of over $1,000,000 and that the patient or insurer is charged about $2,000 per test. Once you’ve got the equipment, you might as well use it, just to be safe.

Consumer Reports carried a similar story in early November. Duke University researchers reviewed the health insurance records of 18,000 health patients. The original study was published in the Journal of the American Medical Association.

“…the researchers found that patients of doctors who billed for both technical and professional fees – an indication that the doctors owned the medical equipment themselves – were more than twice as likely to undergo a nuclear stress test and more than seven times as likely to undergo stress echocardiography than patients of doctors who did not bill for those fees.”

A July 25th article in Washington Post notes that unnecessary tests don’t just waste money. There are also the risks of false positives that lead to further unneeded procedures including surgery.

Whether we are discussing lower back pain or heart problems, the patient is always his/her best advocate. But when you are in pain or when you have been diagnosed with a heart problem and coming to terms with your own mortality, are you going to ask the doctor if a test is really necessary? Or, are you going to do what you are told, especially if the test is being paid by your insurance?

This is part of cost containment. It doesn’t matter whether insurers or the government is paying the bill. An aging population is going to have more conditions, not less. And doctors, unchecked, are going to order more tests, not less.

There are doctors that will point to the risk of lawsuits as for their motivation to order so many tests. Yes, tort reform is also an important part of cost containment.

As of today, December 5, 2011, there has been precious little done to control costs. The authors of the Patient Protection and Affordable Care Act may not understand why the price of health care continues to rise. But then again, there are lots of suburbanites who don’t understand why they haven’t lost any weight. They bought the StairMaster. It is in their bedroom. Under the towels.

DAVE

www.bcandb.oom

Heads You Win, Tails I Lose

2011-11-18T16:08:00.001-08:00

It is November in Northeast Ohio. Homeowners are faced with an annual decision – buy a new snow shovel, buy/tune up the snow plow, or hire a plowing service. I was lucky enough to have always had a snow service when I had my house in Shaker Heights. For $250 a guy in a pick-up truck would magically appear every time there was as little as 2” of snow on my drive. He would clear the drive and make it safe for me and my family. Sometimes he would even sweep the snow off the walkway. $250 for six months. If it snowed only three times - $250. If it snowed thirty times - $250. I wasn’t purchasing the number of times he visited. I was buying peace of mind and security. And if it never snowed in Shaker Heights? Let’s not be silly. One year’s easy winter would surely be followed by a snow belt classic.

If you believe, as I do, that the Patient Protection and Affordable Care Act (PPACA) is designed to change who pays for health care in our country, then you had been waiting anxiously for yesterday’s decision from the Obama administration. Florida has aggressively fought the President’s legislation from day one. The latest salvo was a special request for a waiver of the 80% Minimum Loss Ratio (MLR) regulation. This special waiver has required a mound of paperwork and nearly a year of preparation.

And the verdict from the Centers for Medicare and Medicaid Services (CMS) was (drum roll please) - - - Come back in 30 days.

First, what is an 80% Minimum Loss Ratio? In the simplest of terms it means that for ever dollar of premium an insurance company receives, it must spend 80 cents on health care claims. That leaves 20 cents for taxes, administration, reserves, marketing, advertising, and profits. If the consumer has a good year and has fewer claims, the law requires the insurer to issue a rebate of the excess premiums. If the consumer has a really bad year, oh well.

I think you can see where this is going. Most of my clients are small businesses with fewer than ten employees. Some have only one or two employees. Many of my groups have little to no claims per year, while several of them more than make up the difference.

If a small business consists of three families, each paying $1,000 per month, we have an annual premium of $36,000. What happens if one of the spouses has a quadruple by-pass at $180,000? Where does the insurer get that money if it is returning excess premiums each year to the healthy clients?

The goal is to have a loss ratio between 65% - 80%. This goal is for the entire book of business, not on a client by client basis. We are pooling the risk, sharing the possibility of major accidents and illnesses among a large group of people. The MLR regulation effectively ends that. And in the end, it effectively ends private major medical insurance.

Insurers are threatening to pull out of the states that don’t get the federal waiver. At the very least, they will be forced to significantly restructure their product offerings. It is not an idle threat. This is all part of the process that began in March of 2010.

The Supreme Court will soon hear arguments about the individual mandate, a concept championed by Newt Gingrich and Bob Dole in the early 1990’s and pilloried by the Republicans today. This is a side-show. The Minimum Loss Ratio rulings will have far more impact on who pays for your healthcare in 2015.

I could have purchased a “pay as I go” snow service when I was a homeowner. What I couldn’t afford back then and can’t afford now is “pay as I go” healthcare.

DAVE

www.bcandb.com

An Angry Mob

2011-11-03T09:49:00.001-07:00

The National Journal, a non-partisan Washington based news magazine, published the story as if it was news. Poll: Majority of Voters Want Medicare Funding Left Untouched The first paragraph noted that 83 percent of the respondents oppose cuts to Medicare and higher beneficiary copayments. 70 percent believe that the government should be more active in fighting waste, fraud, and abuse in both Medicare and Medicaid. It wasn’t until the second paragraph that we got the rest of the story.

The poll was commissioned by Fight Fraud First. One of the members of the collection of groups that created Fight Fraud First just happens to be AARP, the same organization that sponsors an endless series of television spots scaring and/or rallying senior citizens.

So we have three questions.

Is it at all surprising that 83% of the population (assuming that the poll wasn’t weighted with seniors!) want as much money and benefits as they can get with little or no charges?

Would you expect a poll conducted by an organization named Fight Fraud First to release the results of a poll that didn’t strongly endorse the concept of fighting fraud first?

Was this news?

Since the first two questions are obvious, allow me to answer the third. NO!

We want painless solutions to all of our problems and we are at least 83% convinced that someone else should pay for the debts we have all created. I’m not sure if this mindset can be traced to the concept of paying for two wars by shopping or if it is simply more prevalent in today’s society, but it is everywhere we look.

I was in New York City a few weeks ago and had a chance to visit the Occupy Wall Street. Yes, it did remind me of the anti-war protests of the late sixties and early seventies. But at the risk of ticking off most of my readers, I have to tell you that there is little difference between the Occupy Wall Street crowd, a Tea Party rally, and a group of Libyan soldiers firing their rifles straight up into the air with little regard to where the bullets will land. Within each group is a small core that understands and can discuss the issues. There is also a larger faction that has a propagandist’s view of the group’s concerns, but is totally committed for the moment. The rest, the vast majority, have nothing better to do and no place better to be.

The links in the above paragraph will provide you with plenty of laughs whether you are on the Right or the Left.

In a perfect world, in the ideal democracy, those masses gathering at Tea Party rallies and camping out at Occupy sites around the country would be engaged in intellectual policy debates. These citizens would be working hard to find solutions to our country’s economic woes.

That is not happening.

What we have, instead, are people desperately attempting to assert their relevance. It appears to be very easy to confuse one’s self-interest with what is allegedly in the U.S.’s best interest. And this leads us to the current health care debate.

The Patient Protection and Affordable Care Act (PPACA) attempts to change who pays for health care, but does nothing to control the cost of care. Changing the payer doesn’t solve our problem of spiraling health care costs.

The current financial debacle has forced some in Congress to start thinking about reigning in costs. This has resulted in the special interest groups to snap into action.

The American Hospital Association has a woman staring into the camera, and our souls, decrying any cuts that could endanger her father’s health.

AARP’s commercial supposedly speaks for 50 million seniors who are united to oppose any cuts and will vote, as one, against anyone who dares oppose them.

The A.M.A. (American Medical Association) is spending big bucks to remind you that doctors are on your side.

Luckily, as Ohio residents we have been spared the finger pointing and shouting of the Republican presidential primary ads. Better Iowa than us.

The next year is very important. Will the PPACA survive? My guess is still Yes. The rules and regulations are being written and imposed now. It will be very difficult to simply reverse all of this, even if anyone wanted to, in January 2013. What you need to watch, what you need to ask are what cost containment measures, if any, are being implemented?

There is a lot of noise out there. People are marching to retain the life they think they have. Or they might be marching to claim their share of the American largesse that has eluded them. Many of these same people will soon be whipped into action to save their local hospitals or to protest a cut in nurses’ wages. The one constant throughout all of this will be the absence of personal sacrifice.

Ask people to pay more? That might create an angry mob.

DAVE

www.bcandb.com

Pulling The Plug

2011-10-19T15:11:00.000-07:00

This blog has campaigned for transparency, honesty, and basic accounting principles. This isn’t a Democrat or a Republican issue. This isn’t Left or Right. Asking for our elected officials to perform at a higher level may, at times, appear child-like and naïve, but why would we work so hard, investing our time and money, if we didn’t believe that we were trying to help our country find our best leaders?

Flying to New York this past weekend gave me extra time to read. I need to share an opinion piece from The New York Times and a memo from Health and Human Services. This will take a few minutes. It will be time well spent.

Jane Gross, author of A Bittersweet Season: Caring for Our Aging Parents and Ourselves, discussed the last years of her mother’s life in The New York Times. The article, How Medicare Fails the Elderly, detailed the medical care Medicare paid and the hundreds of thousands of dollars of services that depleted the family’s savings. It was brutal. Ms. Gross lays bare the inefficiencies of a system that rewards unwarranted expensive procedures that may more successfully enhance the medical provider’s life than the patient’s. Please read the article. It is a difficult read and there wasn’t a happy ending.

The memo is also about an ending. Kathy Greenlee, CLASS Administrator, sent a memo to the Secretary of Health and Human Services, Kathleen Sebelius, recommending that the program be suspended. CLASS is the acronym for the Community Living Assistance Services and Support Act. Ms. Greenlee was forced to report that there was no logal way to make this program work.

This was not a shock.

The CLASS Act was an important part of the Patient Protection and Affordable Care Act (PPACA). It was important to consumers because it promised to help pay for long term care. It was even more important to the President because, through a bit of accounting sleight of hand, the CLASS Act generated a $70 billion dollar surplus during the first ten years. That money would cover $70 billion dollars of deficit from the PPACA. See, revenue neutral!

Ms. Greenlee was forced to admit that the numbers did not add up. A voluntary program that didn’t have any underwriting couldn’t be actuarially sound the way the law was written. With no public funding available and healthy people not forced to participate, the independent actuaries predicted disaster. Thankfully, the program will be pulled now before any more money is wasted.

The need for long term care planning and the cost of that care are the themes that tie these two readings together. My fixation on transparency is why I have brought them to your attention.

DAVE

www.bcandb.com

Perfectibility

2011-10-03T07:15:00.001-07:00

Prohibition was about human perfectibility, that humans can be perfected. You could have the perfect marriage if you could eliminate alcohol. from Ken Burns' Prohibition

I watched Ken Burns’ Prohibition on PBS last night. A group of people decided what would be best for everyone else. Armed with moralistic fervor inspired in equal parts by their G-d and their fear of others (immigrants and non-whites), they campaigned to eliminate someone else’s vice. And they succeeded in part until they failed entirely.

There is a shocking parallel between the Prohibition movement of one hundred years ago and today’s health care debate.

Part of what drives the current discussion is this concept of perfectibility. If only the profit motive was removed from the delivery of health care, if access was unlimited, then no one would die before his/her time.

Can you really remove profit from health care?

How unlimited is unlimited?

When is it our time?

The simple answers are - NO!, Who knows?, and Gosh, what a silly question.

Doctors need to be paid. Medical equipment suppliers need profits to build their businesses. Pharmaceutical companies risk millions to develop new compounds that may cure illnesses and alleviate pain and suffering. The insurers play a role in all of this, too. Eliminate them, the market organizers, and their function will have to be performed by the government. You may debate whether that would be more efficient that the businesses, but to deny that money is a key element in the delivery of health care is to deny reality.

Heart transplants? Liver transplants? Any age? Any health status? Should a 75 year old overweight diabetic with bad lungs from years of smoking stand in the front of the line waiting for a new heart? There have always been, and always will be, some limits to access. What we have not had, as a country, is an open, honest discussion about limits. We are not talking about death panels. We are talking about realistic expectations. What is society’s responsibility to the sick and injured?

The last part of this is the most difficult. Who amongst us wants to address our own mortality? No amount of health care would keep us alive forever. We are not machines. Yet there are people who claim that changing our health care delivery system will magically enhance our life expectancy.

Which returns us to this concept of human perfectibility. Can we improve the payment and delivery of health care in the United States? Absolutely! The first steps will be transparency and an honest discussion about achievable goals.

Now would be a good time to start.

Shell Game 2.0

2011-09-15T15:30:00.000-07:00

It is important to remember that everything works in theory. Communism, in its purest form, is just as effective as Capitalism, in theory. Reality is a much different story. The Russians and Chinese are now embracing many of the benefits of Capitalism just as the U.S. faced-down the Robber Barons and put an end to such practices as child labor a hundred years ago.

Reality has a habit of rudely poking holes in theories. My favorite piece of Swiss cheese is the Patient Protection and Affordable Care Act (PPACA). Today we are going to revisit the Preexisting Condition Insurance Plan, the stop-gap measure to provide access to coverage to the long-time uninsured.

Eighteen months and millions of dollars later, it might be difficult to recall that the main justification for completely remaking our health care system was to provide coverage for the uninsured. Remember the uninsured? They were of real concern two years ago. The PPACA was supposed to cure this problem.

Last June, in a post entitled The Shell Game, I discussed the five billion dollars the federal government had allocated to the Preexisting Condition Insurance Plan. Of more local relevance, $152,000,000 was given to Ohio for the four year interim program. Even though Ohio had about 17,000 chronically uninsured, state officials were thrilled that $152,000,000 would help 5,000 people get insurance. I felt that they were a touch optimistic.

Theory, meet Reality.

How’s the program working? Initial projections from the Office of the Actuary of the Centers for Medicare and Medicaid had as many as 375,000 uninsured Americans rushing the states and jumping at the opportunity to acquire heavily discounted coverage. As of April that crush was only 21,454. Ohio, with almost 1800 enrollees, is one of the most successful programs. Don’t worry. We may not insure that many people, certainly no where near the governments rosy projections, but all of the money will be spent.

Sunday’s Cleveland Plain Dealer detailed the difficulties Ohio and Medical Mutual of Ohio, the state’s contractor, are having difficulty raising prices and limiting access. The biggest problem was that no one was prepared for the shocking reality that really sick people rack up big claims.

Now we’re paying actual claims and those claims have come in much higher – the loss ratio is much higher – then had been projected, said Carrie Haughawout, assistant director for health policy for the Ohio Department of Insurance.

The claims for 1800 people were more than what they thought 5,000 unhealthy people would incur? That is hard to imagine. The simple math in last year’s blog post showed that premiums for a 60 year old male would need to be around $800, with the subsidy, to have a chance of covering the cost of care. The Ohio High Risk Pool is charging between $416 and $458 for a 60 year old non-smoker! That isn’t even close.

The PPACA does not include any meaningful cost containment. There is also no underwriting and no exclusions for preexisting conditions in the PPACA’s planned future which begins in 2014. So, as theory invades reality, one day all of these incredibly unhealthy individuals will be moved into the common risk pool. How will this impact the premiums you or your employer pays for health insurance?

The theory is that the unhealthy will disappear in the sea of doctor avoiding, health obsessed, average Americans who will hardly notice the difference of adding a couple hundred thousand chronically ill individuals into the mix. And besides, now they will be paying premium instead of just invading the E/R and counting on the kindness of strangers to pay their bills. Yeah, right.

The High Risk Pools, the Preexisting Condition Insurance Plan, was a dry run for the future of the PPACA. No real planning. Not nearly enough honest, transparent public discussion. An idea that meant well, but was underfunded and was neither properly explained nor promoted. The Preexisting Condition Insurance Plans were projected to do so much at what may have almost seemed like a reasonable amount of money. Instead, we have another program that has fallen tragically short.

Reality, meet Theory.

DAVE

www.bcandb.com

Just a reminder, this post also now appears in the WordPress format on my website. It appears that more people are reading it there and that is where most of the comments are posted.

The Future Is Fine. I'm Concerned About The Present.

2011-09-08T15:48:00.000-07:00

I'm sitting outside of Club Isabella waiting for a friend. There are six medical students at a near by table enjoying food, friendship, and a moment away from their daily stress. What do they talk about? They joke and laugh about doctors and classes, routines and procedures, and their daily grind. They are an interesting group. Two are women. Four appear to be of Asian descent. One, a tall thin white guy with his baseball cap on backwards, appears to have been delivered to us from Central Casting. They wave and shout to their friends walking by. They are incredibly normal.

I find this terribly reassuring. At 56, I am looking at the people who will be caring for me 20 years from now. They are bright, engaged, and sound like they are actually enjoying their work. This is important. If all of this work, time, and effort is just to get a title, a job, and a paycheck, they will never be fulfilled. And they probably won't be very good at the practice of medicine. One can only hope that their discussions of cadavers (over dinner!) is a precursor of great careers.

This concerns me, the general happiness of physicians, because so much is changing in the practice of medicine. Many previously independent doctors are now, in 2011, employees of the major hospitals. Some have adjusted to this change. Some doctors embraced this. Many, however, have not. Being an employee, even a highly compensated one, is not the same as being your own boss. There is a certain freedom in being an independent business owner. And other doctors, like radiologists, have seen specialty treated like a commodity.

I'm not ready to have my health dependent upon the lowest bidder.

Our young doc-to-be's at the next table have not experienced any of this. There is no transition for them. Medicine will be a corporate enterprise for them, complete with signing bonuses and holiday pay.

How will this impact the way they practice medicine? For one, they will have been initiated, from day one, into a system that allocates a specific number of minutes per patient. They will be instructed in profitability. They will always know the origins of their income. And once you are in this system, how hard is it to change employers? If, or when, the government becomes the major or single payer of health care, would these doctors even notice?

Hard to say.

We face a looming shortage of primary care physicians and gerontologists. I didn't ask any of the future docs what they wanted to practice. I only wonder if their future employers will bother to ask.

DAVE

www.bcandb.com

ACT 1

2011-08-15T14:35:00.001-07:00

“…the only way affordable access can be achieved is for every citizen to have some type of health insurance.”

Barack Obama? Nancy Pelosi? No, that would be too easy. The above sentiments were voiced by the former Republican leader of the Senate, Dr. Bill Frist in September 2009.

And that is the problem. Democrat and Republican leaders know that mandating insurance, whether it is from an employer or individually purchased, is a core requirement to meaningful reform. If you accept that the system we had on March 22, 2010 was unsustainable, then getting everyone to participate is an integral part of any solution.

Is the individual mandate of the Patient Protection and Affordable Care Act (PPACA) constitutional? It depends on who you ask.

On Friday, August 12th, a three judge panel with the 11th Circuit Court of Appeals ruled against the President and the mandate. It was a split decision. Two of the judges, Joel Dubina a Bush appointee and Frank Hull who was brought to the bench by President Clinton, issued a 207 page ruling that clearly stated their opposition. “This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.”

Judge Stanley Marcus, also a Clinton appointee, noted that his peers had ignored “the undeniable fact that Congress’ commerce power has grown exponentially over the past two centuries”.

The White House was quick to point out that insurance rates will skyrocket if all of their changes (free stuff) are implemented without the individual mandate. In other words, if insurance is guaranteed issue and preexisting conditions don’t matter, healthy people won’t bother to buy coverage. This would create a pricing death spiral.

This recent decision is just another step towards the inevitable Supreme Court showdown. In an evenly divided Court, Justice Anthony Kennedy becomes the swing vote. What will he decide? Darned if I know. My guess is that he will note that the individual states have the power to impose this mandate, but that the federal government does not. But that is just a guess.

And, if you have been reading this blog for awhile, you know that this ruling has no impact on my prediction of our final destination.

The federal government, the states, the insurers, and businesses have spent millions of dollars to comply with the PPACA. The Republicans may have won the House last November, but as predicted, they have not taken even the smallest of steps to modify this legislation. Their Bill – H.R. 2 Repealing the Job-Killing Health Care Law Act was neither serious nor constructive. This train has left the station.

If the mandate is struck down, but all of the benefits are retained, rates will continue to climb and the federal government will be forced to offer a competing Public Option. The Public Option will be designed like Medicare Part B, an optional benefit that covers doctors, testing, etc… that almost 90% of all Medicare Beneficiaries accept. There is a heavy fee for failing to purchase Medicare Part B when it is initially offered. Seniors aren’t forced (mandated) to take Medicare Part B. They are just screwed if they don’t. That’s constitutional!

The insurers will dump the individual and small group market on the government and concentrate on the far more profitable supplemental products.

So here we are in August 2011, seventeen months into the PPACA. All of the players are following the script. I suggest you get another popcorn. This show has just begun.

DAVE

www.bcandb.com

WAR!

2011-07-29T16:45:00.000-07:00

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 29^th, 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.

DAVE

www.bcandb.com

More Free Stuff

2011-07-24T12:34:00.000-07:00

“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 Cleveland.com. 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.

DAVE

www.bcandb.com

me Me ME

2011-07-05T14:05:00.000-07:00

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?

DAVE

www.bcandb.com

Team U.S.A.

2011-06-13T06:26:00.000-07:00

Before we begin – The Tony Award Show is serving as background noise as I write this. The Dallas / Miami game may be on, but not in my home. I want the Mavs to win, or more importantly, I want the Heat to lose. I don’t want to invest two hours of my life cheering for someone to fail. That negativity isn’t healthy. For that matter, investing all of your energy praying for the other political party to fail is not only unhealthy for you, it can be devastating for the country.

It is only fair to warn you, dear reader, that this is another post about Medicare. Click. I just lost half of my readers. Medicare is boring and about old people. Since most of my readers are under 65, most don’t care about a program designed to provide health care to senior citizens and the permanently disabled. The average American has a notoriously short attention span. We need good guys and bad guys, winners and losers. There is little interest in nuance and detail.

The path to a true solution is built with patience, compromise, and lots and lots of detail.

Medicare was created in 1965. The business of health care has changed significantly in the last forty-six years. We are living longer, getting lots more treatments, many of which didn’t even exist in the mid-60’s, and we are taking an incredible amount of medications.

Senior citizens, in 1965, were thankful that the U.S. Government was coming to their rescue. Medicare filled a need. That need was very real. Today we take Medicare for granted and whine about copays and deductibles. Medicare is the ultimate entitlement program. Ask everyone on Medicare. They will tell you that they are entitled to all the medical care they could possibly need or want.

How do we pay for this? How do we control costs? Can we limit care without being accused of creating death panels? How much should the U.S. Government pay a doctor, a lab, a hospital? Does a doctor in Akron, Ohio really get paid the same amount as a doctor in Manhattan? Can a government really make all of these decisions, and thousands of others, efficiently?

The answer – Maybe.

The citizens of most of the developed world depend on their governments to make those decisions. We, emphatically, do not. We want choices. We want to feel like we are in control. We just want someone else to pick up the tab.

If Medicare is to survive, the government will need to get control of the cost of care. The insurance companies have had some success in this area. Medicare has not. The government will have to get control of fraud and abuse. The insurance companies have had some success in this area. Medicare has not. As long as the doctors have lobbyists, the hospitals have lobbyists, the labs have lobbyists, and the pharmaceutical companies have Congressmen, meaningful change will not happen easily.

There are almost 50 million Americans on Medicare. The influx of baby boomers with our growing life expectancy means that more and more people will be dependent upon a government that is unprepared and unwilling to change until forced.

Representative Paul Ryan’s plan is to pass the buck. Instead of controlling medical costs or even working with the medical providers and insurers, Representative Ryan would send you a check and tell you that you are on your own. If you view his plan as simply a starting point to a long discussion, then it has some (small) merit. If you view this as the ultimate answer, you might need new glasses. Dumping all of the decisions and problems on to the backs of our senior citizens is not the answer.

So how do we move forward? It will take a Presidential Commission comprised of serious, well-known and well-respected Democrats and Republicans. We desperately need to remove the politics from this if we are to have any chance of success. Some of the questions are:
* Medicare begins at what age?
* How much does it cost?
* Will the price be adjusted by age or assets (means testing)?
* How do we control medical expenses?
* Is every test a doctor orders necessary?

This is a partial list. It will take a fair amount of courage to answer those questions. It will take a historic effort to implement the final recommendations.

And when that time comes, when a bi-partisan group has created a workable framework to save and preserve Medicare, it will be our job to cheer for their success. Because their success will be our success. And their failure would be devastating.

I just snuck a peek. Five minutes are left and Dallas is up by 7!

DAVE

www.bcandb.com

Cliffs and Tsunamis

2011-05-25T15:32:00.000-07:00

The patient was being prepped to be transferred to Hillcrest Hospital. It was at this point that the attorney, a senior citizen covered by a Medicare Advantage policy (Medicare Part C) objected. In pain, he had been rushed to Hillcrest. After some initial testing, he was packed up and delivered to Ahuja Medical Center, the new University Hospital facility. And now the administrators wanted to send him back to Hillcrest, part of the Cleveland Clinic system.

What medical condition would cause two of the most advanced hospital systems in the country to treat the patient like a hot potato? He had a tummy ache. Seriously. It wasn’t the medical condition. It was the insurance.

The attorney and his wife had purchased a Brand X Medicare Advantage contract. The company has a well-defined network of providers in its home market several counties from here. There was nothing wrong with the product. The Federal government certified and approved it. Our hospitals were unsure of the network, which meant that both hospitals were unable to determine that they would be properly paid.

Let’s stop and review this:
* Educated consumers evaluated their insurance choices.
* All of the products were government approved.
* Two of the largest, most successful, hospitals in the country reviewed the coverage.
* The insurer’s “Home” territory is less than 100 miles away.

The patient could have been treated by either hospital. There was no reason to transfer him. None.

Representative Paul Ryan would like to reform Medicare. The Democrats claim that he is trying to kill Medicare. Pictures of little old ladies being pushed off cliffs will be on your TV by this weekend. This is, of course, a gross exaggeration. Mr. Ryan would never push elderly people off a cliff. He would, however, lecture tsunami victims for their inability to out swim the wave.

Mr. Ryan introduced his Roadmap for America’s Future in 2008. he has had three years to refine it. He has had three years to learn how to explain it. He has failed on both counts. His Medicare plan does not involve vouchers. In truth, Representative Ryan appears to have borrowed the worst parts of the Medicare Advantage program, Medicare Part D (Rx), and the Charter School Voucher initiative, thrown all of these ingredients into a malfunctioning blender, and poured his concoction into a couple of broken martini glasses. Delicious.

I have read the Congressman’s website several times. I wanted to ask him a couple of questions, but his site only accepts emails from residents of his district. If he wants to be a national leader, he should be nationally accessible.

The current Medicare Advantage program allows senior citizens to acquire coverage online, by phone, by mail, or through a specially trained and licensed agent. There is no difference in price. The attorney went it alone. He was never in any real danger. He was always covered, but there had been better options. Representative Ryan’s plan is far more complicated and it doesn’t carry any guarantee of success. It is important to note that the attorney and his wife CHOSE the Medicare Advantage route. They could have stayed with traditional Medicare and purchased supplements. Mr. Ryan eliminates that choice.

The good news is that there are no cliffs involved. But Paul Ryan thinks that you better learn how to swim.

DAVE

www.bcandb.com

Two Questions

2011-05-14T10:24:00.000-07:00

The second most frequently asked question of an insurance agent is, “Why did my policy lapse?” The answer is because you didn’t pay the bill. The absolute winner, the question that I am asked at least once a day is, “Why did my rates go up?” There isn’t a simple answer to that question.

Some of the factors that may contribute to a premium increase for an employer are:
* Increased Utilization
* Aging Population
* More Mandated Benefits
* Medical Inflation
* New Insurance Taxes

That is not a complete list. There are more. But today’s post isn’t about price increases. It is about one of the ways to impact costs.

The May 2011 edition of Employee Benefit Adviser, which is not nearly as boring as it sounds, included an article about two employers enjoying 0% renewals this year. We are going to look, briefly, at J. J. Keller & Associates, Inc. of Neenah, Wisconsin.

J. J. Keller & Associates, Inc. is a privately held company with about 1,100 employees. Keller helps companies navigate through the minefields of government regulations. The company enjoys a stable workplace environment. 60% of the employees are over age 40 and the majority have worked for the company for five years or more.

Keller’s commitment to Wellness includes:
* Company sponsored Weight Watchers at Work
* Smoking Cessation programs
* Fitness Challenges
* A Walking Trail available during breaks
* In-house Food Service
* Workout Facility
* In-house Wellness Center staffed by a Nurse Practitioner

You get the idea. They have made the complete and total commitment. J. J. Keller has everything in place for a successful program. Even the fact that it isn’t a publicly traded company helps. Does this mean that the health insurance rates are going to decrease? Are they saving money?

The article doesn’t answer either of those questions. My guess is NO on both counts.

Medical inflation, alone, is going to impact costs at close to 10% per year. Maybe more. The Patient Protection and Affordable Care Act is taking a toll, too. But the most important issue is that we are not discussing machine maintenance. We are talking about human employees, flesh and blood. We are going to get sick or injured. We are going to have claims.

A properly designed Wellness Program can mitigate the type and amount of claims by controlling behavior. Ongoing claims for diabetes, heart disease, stroke and cancer are budget killers. Many of these conditions are controllable through education, medication, and behavioral modification. The Keller program is designed to improve morale and awareness. From here, today, it appears to be working.

There are some local stars in the wellness universe. Kaiser Permanente is returning to its HMO roots. After a bit of soul-searching, the company realized that it was attempting to be all things to all people. Kaiser has recently declared that it will return to its core competency – an integrated medical practice whose mission is to keep people healthy. With a focus on Prevention, Kaiser hopes to reestablish itself as a unique option in the marketplace.

I recently met with Jamie Field of University Hospitals. Ms. Field has created an incredible wellness program for Northeast Ohio employers. She and her team will conduct Health Fairs, Wellness profiles, and Health Screenings at the worksite. The pricing tells the story. U.H. has made the decision to perform community outreach. For example, $20 per employee includes on-site health screenings for:
1. Blood Pressure
2. Blood Sugar
3. Cholesterol
4. BMI
5. Bone Density

Employees who fall outside of the normal range on any of the tests are given useful information designed to answer immediate questions and to spur productive steps towards help or control.

Will this lower the employer’s group health insurance rates? No, at least not anytime soon. But if the goal is to help someone before they have a stroke, heart attack, or other major claim, then a wellness program could be very useful. And yes, it could improve employee morale.

The purpose of group health insurance is to attract and retain good people. A wellness program, one designed to help and educate, could complement your efforts.

The results may be happier employees. You may have healthier employees. But the insurance will still lapse if you don’t pay and the rates may still go up. I'm hoping just a little.

DAVE

www.bcandb.com

Of Course It Is A Good Idea. I’m Not Paying.

2011-05-06T12:11:00.000-07:00

One of the new benefits of the Patient Protection and Affordable Care Act (PPACA) is that dependent children, even if they are married, can be covered on the their parents’ policies until they reach the tender age of 26. Ohio upped the ante and made it 28. Employers are rejoicing.

A provision was built into the law that prevents an employer from passing any of the extra cost of insuring an adult child onto the parental employee. If the employer pays 75% of the cost of insuring a five year old girl, the employer must pay 75% of the cost of insuring a twenty-five year old woman. There is a huge difference in these risks. Neither the State of Ohio nor the US government is concerned.

The insurers are passing the additional cost to cover these adults, much like the other new benefits, to the policyholders. Individual (non-group) contracts are rising. Group policy premiums are climbing. Some employers are absorbing the difference. The recent hike in gas prices will quickly end such largesse.

I am seeing employers tackle this problem by raising their deductibles and co-payments in an effort to retain reasonable premiums. Other clients are asking their employees to pay a larger portion of their premiums. This would appear to be inevitable.

As the costs continue to mount, there are still those who want more. Can we include the spouses of the married children? Shouldn’t we include grandchildren? I’m reminded of my friend Jack who didn’t quit smoking. He simply quit buying!

There are no FREE benefits. There are no Free physicals. No Free colonoscopies. No Free coverage for dependent children. We are all paying for this, directly or indirectly. If this, any of this, makes sense as part of some greater public good, say so. It is time for our political leaders to publicly state their values. We need to be asked to support their choices with out money.

We’ve had subterfuge and deception. Let’s try something entirely different – honesty and transparency. I’m paying. Let me feel like I’m getting my money’s worth.

DAVE

www.bcandb.com

Predictability

2011-04-21T13:31:00.000-07:00

10:05. Not Bad. I was right on time for my 10 AM appointment. It had taken me years to do this, to break my habit of arriving early, or at worse, exactly at the scheduled moment for certain clients who are always late. There is a certain comfort in predictability. If we have a chance to prepare, we can deal with almost anything.

Security – Consistency – Predictability

One place Americans beg for a measure of predictability is in the delivery of health care, especially for senior citizens. Sadly, the only consistency of late has been the unrelenting fear mongering delivered by both political parties. And my prediction is that there is no end in sight.

This blog has tackled Medicare numerous times over the last two years. The February 5, 2010 post includes a complete break-down of Medicare Part A and Part B. The Doc-Fix, Medicare Fraud, the need for private coverage, Medicare Advantage policies, and even hospital reimbursements have been addressed. There is no need to rehash any of that today.

Both the Democrats and the Republicans agree that Medicare needs help. Their only other area of agreement is the political value of Medicare. Seniors vote. Each side is willing to manipulate Medicare’s funding, physician reimbursements, and even plan design to garner those votes.

The Democrats have spent much of the last two years demonizing insurance companies. One of their favorite targets is the Medicare Advantage program. Instead of having traditional Medicare, plus a Medicare Supplement that may cost $150 a month or more, and a Medicare Part D (Rx) plan for another $50 + per month, a senior may choose a Medicare Advantage policy that might not cost him a penny. The federal government pays the insurer a set amount to handle all of the senior’s health bills. Medicare Advantage policies may include office and hospital co-payments.

The low monthly premium, or in many cases the total absence of premium, is very attractive to some seniors. In exchange, there may be a network of preferred providers and the possibility of lots of copayments should the senior require multiple hospital stays and doctor visits.

Medicare Advantage policies are not for everyone. Approximately eleven million seniors have chosen this option.

This administration has bemoaned the very existence of Medicare Advantage policies since they took office. Part of the President’s plan has been to cut funding for this program. This week the administration reversed itself and plowed an additional $6.7 Billion into Medicare Advantage.

You may have heard that there is an election next year.

The Republicans have dabbled in Medicare politics, too. Medicare Part D (Rx) was created, in large part, to insure the reelection of George W. Bush in 2004. Their new found interest on deficit reduction arrived long after they created this program.

Representative Paul Ryan is now talking about eventually moving all seniors into a voucher program. I have yet to see the details, but is sounds a whole lot like Medicare Advantage. The Democrats have already begun the campaign against this. They paint a picture of frail, elderly Americans forced to return to work to pay for their insurance. The Republicans are claiming that this is a necessary major step to controlling costs and reducing the deficit.

It is all great theater, but there is precious little truth in any of it. And, there is no security, consistency, or predictability. The cost of care, unaddressed in any of this, continues to rise. Our seniors, our medical providers, and even the insurers suffer from the uncertainty of this process.

If I could monetize frustration, I would be rich.

Instead, I just learned that my client forgot about our appointment. I only predicted that she would be late, not a total no show at her own business. Her employee and I just negotiated an appointment in my office at 2 PM.

I’m positive that she will arrive before 3.

DAVE

www.bcandb.com

The World's Worst Lobbyist

2011-04-07T14:09:00.000-07:00

She was making a joke. It was her second joke/witticism in the last twenty minutes. And like the first time, I didn’t laugh. I’m not a good fake laugher. At least I smiled. Busted! She again noticed that I wasn’t laughing. Her protests may also have been attempts at humor. Oh well. I had no trouble convincing her that I was not an experienced lobbyist.

About seventy-five members of the Ohio Association of Health Underwriters were at the State House to voice our concerns about pending legislation. The Lieutenant Governor, Mary Taylor, who is also in charge of Ohio’s Department of Insurance, came to talk with us. Even Democrats like me appreciated what we heard as long as she didn’t stray from our particular area of concern.

Like any health insurance agent program, the day began with coffee, juice, and platters upon platters of cakes and pastries. The morning program consisted of several speakers who detailed Ohio’s attempt to deal with the Patient Protection and Affordable Care Act (PPACA), the new exchanges, and where we, professional insurance agents, fit into this evolving system. Next was lunch and another couple of speakers. By three o’clock we were more than eager to meet with legislators for our pre-set appointments.

There were heavy hors d’oeuvres and cocktails waiting for us at the five o’clock finish line. Being a health insurance agent isn’t necessarily healthy, but it can be fun.

I met with two Democratic State Senators and a Republican member of the Ohio House. While waiting for my appointments I bumped into representatives of the credit unions, service unions, YMCA’s, and other interest groups. I found our elected officials to be incredibly generous with their time. They were sincerely interested in talking with me, not at me. They appeared to be committed to doing the people’s business.

I’m not sure that I was up to the task.

I was supposed to talk insurance. The states can not wait to see if the PPACA will be defunded or struck down by the Supreme Court. All 50 states are attempting to create a mechanism to comply with the law that will best serve their particular population. 50 plans. All different. All based on a law and a set of assumptions that could change at any moment. Ohio’s options and my clients’ needs were my topics. All three legislators veered into other areas.

The Republican and the Democrats wanted to talk about S.B. 5, the bill that was pushed through last week. The Republican appeared to be shaken by the vitriolic push-back. The Democrats were shocked by the over-reach of the newly elected, and incredibly partisan, Republican Governor. The similarities between S.B. 5 and the PPACA are striking. In each case the party in power passed a highly partisan, one sided piece of legislation that is opposed by close to 50% of the population. The victory is short-lived. The Democrats paid dearly at the polls last November. The Republicans in states like Wisconsin and Ohio will probably pay for their impudence this November and next.

My message was that whether you love or hate the PPACA, it is our job to make this legislation work for our clients and all Ohioans. The best use of our time and efforts will be programs that will provide greater access and information. That was the message. I don’t know if I was successful in delivering it.

I might have been more effective had I been able to laugh at those jokes.

DAVE

www.bcandb.com

PPACA at 1

2011-03-24T12:12:00.000-07:00

March 23, 2011

It has been a full year since the Patient Protection and Affordable Care Act was signed into law. A lot has changed in the last year. Were any of those changes good for you?

In the last twelve months:
* Insurance Rates have increased.
* Changed and new policies now cover preventive care without copays or coinsurance.
* Children, Only policies were taken off the market.
* People who have significant preexisting conditions and who have been uninsured for over six months can purchase coverage.
* The Democrats lost the House of Representatives and a large number of state houses.

Confusion and uncertainty have dominated the last year. Polls show that a majority of Americans dislike the PPACA, but a majority also dislikes the Republican’s plan to repeal the law. Much like Iraq, the public doesn’t want to be here, but is afraid to leave without a plan.

A Plan. The government doesn’t have any idea how to reform the payment and delivery of healthcare. The people in charge do not appear to be up to the task. And, do all of our so-called leaders have clean hands? Are we being provided an accurate view of the problem and the possible solution?

Vice-President Biden sent an email today to me and millions of other Democrats. He was eager to celebrate this anniversary. The bulk of the email was the story of a young child born with significant health problems. According to our VP, the family is no longer worried about the child’s future due to the passage of this legislation.

I am glad this child’s parents are no longer worried. Of course, if the child is really that disabled, he would qualify for SSI benefits and his health would be covered by the government or the parent’s policy. Nothing changed.

Only in government is over-promising and under-delivering a given.

It has been a year. The Doc-Fix and the 1099 Problem are still unresolved. The Individual Mandate might not be constitutional. The Democrats and the President are stalling in the hope that the PPACA will become accepted, if not loved. The Republicans made a faint attempt at repeal and then returned to their #1 focus, abortion. Regulations and rules are now in the hands of the bureaucrats. The final result may be as clean and organized as the tax code.

The PPACA link in today’s blog is the current amended version of the legislation as of December 10, 2010. Millions have been squandered by insurance companies and major employers attempting to comply with the ever-changing regulations. Those costs will be passed along to you in higher prices for insurance, food, and other necessities.

We can only hope that there will be more clarity and an actual plan by this time next year.

DAVE

www.bcandb.com

A Clean Bill Of Health

2011-03-13T09:12:00.000-07:00

Before we begin this next installment of Health Insurance Issues With Dave, we must briefly mention New Hampshire State Representative Martin Harty. When confronted by constituent Sharon Ormond about planned cuts in local mental health, Representative Harty opined that “there are too many defective people”. He went on to express his wish that we could ship the disabled, the retarded, and people with physical disabilities to Siberia.

Yes, Representative Harty is a fershimmeled 91 year old. Yes, he will serve one, and only one, term. I bring this up to again note that the moment health care is placed into the hands of politicians; the good, the bad and the Harty’s, medical treatment is politicized.

***

I had my annual physical this week. I ran in Tuesday morning and had my blood drawn. On Wednesday I spent over a half an hour with Dr. Ken Goodman who performed a thorough exam and an EKG. Let me brag for a second. The results were excellent. The costs for all of this, however, may surprise you.

I haven’t seen this year’s bills yet, but I have last year’s. Last year the Cleveland Clinic billed me and Medical Mutual of Ohio $802.78. MMO has a contract with the Clinic, so they only paid $417.13. I was left with a bill of $32. That is my policy. Technically, preventive care exams are completely covered on my policy, but the Cleveland Clinic always runs a blood test that isn’t part of the package. So I am always left with a small charge.

Many of my clients have similar coverage. Many, but not all. The new law, the Patient Protection and Affordable Care Act, has changed that. All non-grandfathered health insurance policies now cover preventive care completely. How will that impact your policy?

In the simplest of terms, we are adding $417 to $803 of claims and the cost to process the paperwork to your policy. That is up to $67 per month. You and I understand that that will have an impact on your premium. It is true that only a fraction of Americans will take advantage of their free physicals. So you can get yours and hope that all of your friends skip theirs.

The federal government operates in a parallel universe. Their numbers are far different. The Department of the Treasury released interim final rules and regulations on July 19, 2010. This link takes you to thirty plus pages of the Federal Register. Section 5 details Costs and Transfers.

The government determined that individuals with employer-sponsored insurance have, on average, $264 in covered preventive care services. Of that, $240 was paid by insurance and $24 was paid by the patient as a copayment. Making this change, mandating that the exam is totally free, will only result in a $24 shortfall.

My exam, which doesn’t cover all of the stuff that falls under the new law, was a lot more than $264. Yours will be, too. That’s a gap of at least $153. If your current plan covered less than $264 of preventive care, or even no preventive care at all, your gap is much higher. Who will be charged for your free physical? You, of course, will be funding your free exam through higher health insurance premiums.

I believe in the value of routine physical exams. I have been poked and prodded annually for over twenty years. I also believe in routine auto maintenance and oil changes for my cars, but I don’t expect State Farm to cover them. I made a conscious decision to purchase a health insurance policy that includes preventive care. I chose to pay extra.

I believe that you are smart enough to make your own decisions, too. But, the government believes that the benefits of an annual exam, especially the opportunity to have a doctor educate you on the dangers of smoking and obesity, are too important to leave to chance. OK. Sell that.

It is time for the government to explain to the American people how much this program is going to cost us. The answer is not $24. If this really is beneficial, if it is truly warranted, the facts will win out. I believe in the American people. I trust our judgment. We will spend money if we understand why it is in our best interest. But the PPACA has been sold to us as a way to lower our costs and premiums.

That is clearly not true.

My numbers were great. Blood Pressure – 107/74! Resting heart rate of 65. No medications. Anticipated bill - $35. I hope your numbers are just as good, if not better. Diet and exercise can help to control your blood pressure. There may be no way to control that last number, the cost, under the new legislation.

DAVE

www.bcandb.com

This blog post is now appearing on my website in a word press format. Those of you who use a reader might prefer that format. http://bcandb.com/cunix/?p=80 Please let me know what you think.

Promises Promises

2011-02-25T12:17:00.000-08:00

When is a contract a contract? When is a promise a promise? The answer in 2011 is “It Depends”.

Public employees have contracts. Some of their contracts promised adequate wages with really good fringe benefits and generous retirements. Almost all of their contracts guaranteed stability. Governments; cities, states and the feds, and public institutions such as schools, often took the easy route. Our leaders and elected officials pushed these payroll costs back twenty or thirty years when funding would be someone else’s problem. This strategy was so popular at the steel mills and the auto plants that it had to be a good idea.

The future is now.

Vice-President Dick Cheney once said the deficits don’t matter. And they didn’t. To him. In 2011, after ten years of unfunded wars, unregulated banking, and reckless spending, we are in a real mess. We could reassess our priorities and then align our income (taxes) to pay our bills, but that would be difficult. That would take courage. Instead, we tear up contracts, de-certify unions, and cut heating oil subsidies for the poor.

What does all of this have to do with the delivery of health care? After all, this is Health Insurance Issues With Dave. In a word, everything.

The recent election gave us Republican governors in Wisconsin, Ohio, etc… Elected to create jobs and right their ships of state, these new governors have chosen a different path. They have decided to target their public employees and to eliminate the unions that represent them. We are being told that these contracts are too expensive to honor. We don’t have the money. Their jobs, and the incomes that paid their bills, will disappear. The pensions they were promised may be gone.

Why is this different than government’s promise of health care? We haven’t properly funded the health care we have promised to the poor and the elderly. We have deferred the expenses and punted every time a difficult decision has been on the table. A quick example is the Medicare Doc Fix.

In an effort to make a dent in the fiscal mess that is Medicare, a decision was made in 1997 to control the escalating costs of medical care. The Sustainable Growth Rate was a payment formula designed to keep doctors’ rates in check. Unfortunately, the formula didn’t work in the real world. The adjusted payment rates would have forced a large number of doctors to not accept Medicare and to leave the system. One option would have been to correct the formula. Another option would have been to scrap the Sustainable Growth Rate and start over. Congress, Republicans and Democrats, chose a third option. They passed periodic fixes to the bill and pushed the tough decisions back for someone else to handle. The Sustainable Growth Rate was passed in 1997. How much have we saved to date? Nothing. The implementation is still getting postponed every month.

Is the Doc Fix a good idea? Would the Doc Fix solve Medicare’s problems? Probably not. But if Congress doesn’t get Medicare’s costs and funding under control, we will eventually be facing the same problems, and the same decisions, that the states are grappling with today.

Can the federal government be entrusted with more responsibility for our health care? What promises are too important to break?

DAVE

www.bcandb.com

Are We Serious About Change?

2011-02-09T08:22:00.000-08:00

I wasn’t expecting a letter from State Farm. Of course, the news wasn’t good. My insurer regretted to inform me that I was never going to be reimbursed. Hit by an uninsured motorist (Mr. Popularity – March 6, 2009), I was forced to pick up my deductible and part of the car rental expenses. That money was gone. In a final act of irresponsibility, Ms. P. had her debts discharged through bankruptcy.

Ms. P. was driving illegally. She did not have insurance. Had she followed the law, she either wouldn’t have been on the road, thus not hitting me, or her insurance would have paid for the repair of my car. Her insurance. Instead, State Farm spent thousands and I lost about $800. Since bankruptcy is a matter of public record, I could, if I was a glutton for punishment, learn who else got screwed by Ms. P. Banks? Retail stores? Did she go on a shopping trip before she ran to the courts for relief?

Why should you care? Her refusal to follow the law and to pay her debts costs you money. We are covering her debts. And there will be more.

1 o’clock. No Oliver. No surprise.

Oliver may be the poster child for the uninsured. He is in his late fifties, disabled from an accident, and officially under-employed. He gets by through the kindness of his family members. One has him working part-time in a small business. Another helps with the rent. Insurance was to be paid by his little sister. All he has to do is show up for our appointment and give her the bill when it arrives with the policy.

Oliver was covered, briefly, last year, but he was too busy to get the bill to his sister. He has been too busy to get here to my office. He is just busy. Odd how much time it takes to do nothing.

Oliver’s family can’t force him to have free insurance. Who will pay when Oliver seeks medical care? Who will cover his next surgery? YOU, of course.

There is much to dislike about President Obama’s Patient Protection and Affordable Care Act. It was poorly designed and even more poorly explained. But, it is the individual mandate that is being attacked by Republican judges. And without a legal requirement to be in the system, to be responsible, we can not move forward. We can not improve the delivery of health care, guarantee universal access, and control costs if we don’t require everyone to participate.

Federal District Judge Roger Vinson recently ruled that the PPACA is unconstitutional. He wrote that Congress couldn’t require Americans to buy insurance. He also determined that this provision, the individual mandate, could not be severed from the rest of the law. The second part of his ruling strikes down the entire bill.

As a non-attorney, I will not discuss the merits of Judge Vinson’s ruling. Is he right? Will he be upheld or reversed on appeal? What will the Supreme Court decide? It is important to remember that all rulings are subjective and reflect the Court and their time. Previous Supreme Court decisions have, in retrospect, been all over the map.

So let’s skip the law for a second and talk about people. There are lots and lots of Ms. P.’s and Olivers, far more than any of us might want to admit. I encounter the intentionally uninsured daily. They are healthy young people who are convinced that they are incapable of getting sick or injured, even though they ski, ride motorcycles, or engage in other hazardous activities. Some are just selfish people who have never pulled their own weight and never will until forced. And some are simply weak-willed who can’t walk past shiny new things.

We also have the unintentionally uninsured. We have 50 and 60 year olds who have lost their jobs and group health insurance and can’t afford food, much less insurance. There are any number of sick and disabled who need our help. Helping the unintentionally uninsured was supposed to be the goal of the PPACA.

Ms. P. chose to drive a car without insurance. Almost all of us will one day need health care. It won’t be a choice. U.S. hospitals are not going to deny care. We aren’t going to barricade the Emergency Room doors to keep out the uninsured. So what we are discussing is money. How are we going to pay for care? How do we pay for doctors, hospitals and prescriptions?

We understand, or least most of us do, why drivers must be forced to carry insurance. Requiring people to be responsible for a portion of their health care expenses is just as reasonable. We will never have 100% participation. Just as there are a small but dangerous group of uninsured motorists, there will always be people who evade the system. They will fly under the radar right up to the moment that they need care.

Don’t like the individual mandate? OK. Tell us how you will improve our system without it.

DAVE

www.bcandb.com

Give Us Something We Can Use

2011-01-24T15:28:00.000-08:00

“Mr. Cunix?”

I recognized that voice.

“This is Belinda Prinz from Congresswoman Marcia Fudge’s office.”

Regular readers know that I have mentioned my Congresswoman a couple of times in my two blogs. We also know that Congresswoman Fudge, or her staff, are regular readers. Ms. Prinz even commented on the August 30, 2010 post, Choosing Sides.

Belinda Prinz must have drawn the short straw. There is no doubt that she considered herself fortunate that she reached my voicemail instead of me. Her assignment was doomed to failure. She was on a fool’s errand and the longer she talked, the more apparent it became to her.

One of Congresswoman Fudge’s other staffers had called the Beachwood Chamber of Commerce and had talked with our Executive Director, Wayne Lawrence. He suggested that she call me. What did the Congresswoman want?

“We would like to know the name of a small business that can now provide insurance benefits to its employees because of the tax credits in the Patient Protection and Affordable Care Act. We want to tell their story.”

Yes, Congresswoman Fudge is desperate to find someone, anyone, who has benefited from last year’s legislative train wreck.

Let’s think about this for just a second. We would need to find a small business that
* Didn’t provide health insurance
* Wasn’t motivated by the tax deductibility of health insurance premiums
* Doesn’t pay its employees very well
* Is making enough profit that the tax credit is irresistible

Does that sound like any business you know? Of course not. Will Congresswoman Fudge or one of her cohorts find a couple of examples somewhere in this country? I like their odds. Still, it might be worthwhile to research the details when they trot out their success stories.

It is far easier to find the victims of last year’s legislation. There are businesses that fear my phone calls, worried that this year’s renewal rates will be more than they can spend. My restaurants and other clients that employ lots of unskilled and semi-skilled workers are very worried about the planned tax/fee/penalty to be assessed to businesses that don’t provide group health insurance. The saddest and most immediate blow was dealt to parents.

Proponents of the Patient Protection and Affordable Care Act love to note that children are now guaranteed issue. Insurance companies can no longer refuse to cover a minor due to preexisting conditions. Fearing the inevitable dumping of unhealthy children from group (employer sponsored) policies to individual contracts, the insurance companies simply stopped selling Child,Only policies.

The few unhealthy uninsured children of families that neither qualified for group health insurance or Medicaid are still uninsured. This will not change for another couple of years, if ever. But the negative impact was immediate.

Janet (name changed) works for a large property management company. Her employer’s new policy, as of February 1st, will cost her only $60 per month. That is the price for just her, the employee. The premium for her and her two daughters would be just a touch over $500 per month. Employers across the country are cutting back. One way to save money is to pay only a portion of the employee’s health insurance. If the employee wants to cover a spouse and children, he/she will be charged the difference.

A year ago I could have written great coverage on Janet’s two healthy daughters for less than $200 per month. Janet would have stayed on the employer’s plan, placed the girls with Anthem or MMO, and saved over $2,000. Janet even had the option of choosing a higher deductible and saving even more. Today? Nothing!

Janet has two options. She can stay on her employer’s plan and work for the insurance or she and her two daughters can purchase a fully underwritten individual (non-group) policy. She chose a high deductible health plan that will cost her $194 per month for the three of them. Is this the best solution? Of course not. But Congresswoman Fudge and her friends killed the best solution last March.

I didn’t return Ms. Prinz’s phone call. I don’t know of any businesses or employees who have benefitted from her boss’s efforts. And I have no reason to believe that our Congresswoman has any interest in learning about the collateral damage.

Besides, we know they are reading this. We just don’t know if they care enough to make any changes.

DAVE

www.bcandb.com

Hyperbole – Fun For The Entire Family

2011-01-13T15:37:00.000-08:00

The members of the House of Representatives were sworn in this week. The Republicans are now in the majority. Representative John Boehner (R-OH) is the new Speaker. Will their first major issue be the economy? The deficit? Jobs? Our young men and women dying on foreign soil? Don’t be silly. Just as the Democrats rushed past the necessary in favor of health care and health insurance, the Republicans are ready to vote to repeal “Obamacare”.

The Republicans have excitedly drawn a line in the sand. This expression couldn’t be more apropos. The common understanding is that they have marked off their territory and will defend to the death their beliefs. But we all know that this vote, and the days of debate that will precede it, are a terrible waste of time. The Republican House will pass a bill that the Democrat controlled Senate will ignore and the President would quickly veto.

The Republicans have excitedly drawn a line in the sand. Take that literally. As everyone who has ever had the pleasure of visiting a beach knows, drawing a line in the sand is a temporary act that has no value. Your line, or if you are really ambitious, your sand castle, only lasts until the next inevitable wave washes it away.

The reopening of last year’s health care debate has allowed both sides to erect and knock down their favorite straw men. If it were not for the recent tragic events in Arizona, we would have had the debate and vote this week. Instead, we are treated to a week of accusations and recriminations. Health care will have to wait till next week.

But the posturing has begun.

The Republicans talk about tyranny, about forcing citizens to have insurance to pay their medical bills. They also point to a huge new federal government program, much like No Child Left Behind, that will impose new costs and responsibilities on the states. There is nothing worse than a poorly designed, unfunded program created by the other side.

The Democrats are relishing this debate. They love to point out that children are now guaranteed issue and that their preexisting conditions must be covered. The Dems just conveniently forget to mention that Child Only policies no longer exist in most of the country. If the policy still existed, it would be wonderful for a limited number of families. Instead, lots of healthy children can no longer be covered at a reasonable price.

Other new benefits include free Medicare physicals for seniors and that adult children can now stay on their parents’ policies until they are 26. We don’t need to do scientific polling to learn that people like free stuff. Who pays for this free stuff? Well, you do of course.

The other big defense of the Patient Protection and Affordable Care Act (PPACA) is that its repeal would cost us money. Senator Sherrod Brown (D-OH) has been citing the Congressional Budget Office’s estimate. This, too, is a moving target. The Senator has used a CBO figure of $232 billion of savings over the next ten years. Some sources have soft-peddled this down to a more believable $100 billion while others have reiterated the $230 billion guesstimate.

How does the federal government profit under PPACA? Part of the money comes from unrealistic cuts in Medicare. The oft-maligned new 1099 regulations, a set of rules to attack the underground economy, account for $18 billion. Another moneymaker is the tax/fee/penalty imposed on businesses that don’t provide employee coverage by 2014. The Democrats are also counting on the tax on so-called Cadillac health plans to generate a chunk of change.

None of these revenue sources stand on their own merit. The 1099 rules are already on life support.

The House Republicans have yet to creatively and constructively begin the difficult task of restructuring the PPACA to address our system’s deficiencies. The Democrats are defending the indefensible because they can. Meanwhile, businesses are spending money to comply with laws that are still changing and the only thing we all share is uncertainty.

If you are forced to watch C-Span next week, I suggest you hit the mute button.

DAVE

www.bcandb.com

Christmas Cookies? What Would Your Boss Say?

2010-12-20T15:44:00.000-08:00

The insurance industry and the federal government appear to be at war. They aren’t. Sure, there are times when a Congressman or the President may by vilifying my industry or some CEO is denigrating an entire political party, but these are just words and much of it is for show. As Sam Donaldson once remarked, “This is Washington. Only the amateurs get mad.” The government needs the insurers. And we all need the government.

The government / insurance industry partnership manifests itself in a number of ways. Today we are going to explore WELLNESS.

In my March 23, 2009 post, Protect Me From Myself, I discussed how my industry has been pushing Responsibility. If you would only take better care of yourself, quit smoking, and exercise more, your health care costs would decrease and your insurance might be more reasonable.

Allegedly, 75% of all claims are due to lifestyle. That’s our number and we are sticking to it.

The government has decided to test the theory. Employers are being encouraged to institute Outcome Based Wellness Programs. The employer hires an outside contractor to come in the factory or office, mostly factories, and meet with each employee. The goal of each interview:
Complete a comprehensive health care questionnaire
Record the employee’s height and weight
Take the employee’s blood pressure
Draw blood for comprehensive lab tests

Armed with this information, the wellness company can now coach the employee to quit smoking, lose weight, or better monitor his/her blood pressure. The employer is allowed to set goals for the employees and charge up to 20% more for the company’s health insurance for non-compliance.

One of these contractors, Bravo Wellness, has a helpful DVD that explains the concept. The featured employer set goals for his employees targeting:
Blood Pressure
Cholesterol
Body Mass Index
Smoking Cessation
He penalized the employees who either fell short or chose to not participate.

Programs like this require both the carrot and the stick. Employers are encouraged to incentivize (pay) their workforce to take the initial exam and screenings. People don’t rush to disclose their health information. One contractor told me that the going rate was $300. Armed with this info, the employer can institute programs to encourage better behavior.

According to the National Association of Health Underwriters Corporate Wellness Certification Program, the return on investment (ROI) on Wellness is projected as:
34% - Increased Presenteeism
25% - Reduced Medical Costs
36% - Reduced Absenteeism
5% - Reduced Disability and Workmen’s Comp claims

Seventy percent of the projected return on investment of Wellness programs are from a reduction in absenteeism and an increase in presenteeism. In other words, fewer people will call off work and those who do show up will be more focused and productive if you have a Wellness program. The other thirty percent comes from reduced medical, disability, and Workmen’s Compensation costs.

Are there enough measurable gains to make this worthwhile for an employer or is this just a gimmick? The answer – it depends. A small employer, where the owners interact with the workforce on a daily basis, might find the intrusion into the employees’ personal lives uncomfortable and inappropriate. Large employers might have no difficulty imposing a company’s lifestyle values, such as no smoking or a 27 BMI, on their faceless workers.

And that brings us back to the government. We are getting mixed messages from this administration. As the federal government berates insurers for charging extra for preexisting conditions, it also welcomes penalties for lifestyle conditions such as uncontrolled cholesterol. This may be the test run for future government run health care programs. Will the federal health plans charge these people extra? Will the feds equate a 22 BMI with a good driving discount? Will Uncle Sam be monitoring your weight?

There’s a plate of Christmas cookies on the table. Did you ask your boss or the government if two would be OK?

DAVE

www.bogartcunix.com

Priorities

2010-12-05T09:33:00.000-08:00

Retiring Representative John Shadegg (R-AZ) has been a frequent guest on Morning Joe, MSNBC’s morning news and talk show. The show’s namesake and principle host is former Republican Congressman Joe Scarborough. Mr. Shadegg has always been particularly candid on Morning Joe. I caught his November 30th appearance.

Congressman Shadegg extolled the virtues of the Bush tax cuts. He warned of dire consequences if taxes reverted to the rates of the 1990’s, even if only for people making over a million dollars per year. Actually, he was most concerned about those in the top tier.

How would we pay for continuing these cuts? These tax cuts were temporary because we couldn’t pay for them nine years ago. But reducing the tax rate was supposed to be such a powerful economic driver that the resultant job creation would have more than offset the short term loss of revenue. That hasn’t happened yet. But, according to Congressman Shadegg, continuing the Bush era tax cuts will ensure a reduction in unemployment.

Congressman Shadegg’s empathy was highly selective, especially when it came to the unemployed. He was very concerned about the tax cuts that could create jobs, but not terribly worried about those people who are actually unemployed. When it came to extending the unemployment benefits for the victims of the worst recession in seventy years, Mr. Shadegg suddenly became focused on every dollar coming to and leaving from Washington. He was positive that we couldn’t afford to continue benefits to the out of work. He implied that it was a waste of money. He opined that the unemployed wouldn’t stimulate the economy since they would just hoard the money.

Mike Barnicle: “Let’s get back to what you said about unemployment checks. People don’t spend that money?”

Representative Shadegg: “No, they will spend as little as they can because they’ll hold on to it as long as they can. In reality, they don’t create jobs.”

Yes, this is Health Insurance Issues With Dave and yes, the above has everything to do with the delivery of health care in this country. Watching Representative Shadegg the other day reminded me of why I have always been concerned about single payer, government run health care.

If nothing else, the last ten years have shown us that you may have to be thirty years old to serve in the U. S. Senate, but you don’t have to be an adult. Ten years ago, at the end of a major financial growth spurt, instead of saving money for the upcoming lean period (think Joseph’s interpretation of Pharaoh’s dream), we cut taxes. When we were attacked and went to war, our youth were asked to sacrifice twice, first in blood and secondly by being saddled with incredible debt. We then invaded Iraq, but still didn’t ask the American public for any sacrifice.

Somewhere along the way we screwed up the housing market, forgot the real purpose of banks, and sold our financial soul to China. And now we have well over 10% of our workforce unemployed and we are debating whether their food and shelter are national priorities.

Ten years from now. Twenty years from now. At some point when we have all been herded into a government run health care system, will your surgery be a future Congressman Shadegg’s priority? Will this government program, unlike all other government programs, be properly funded?

You don’t have to like Medical Mutual, Anthem, or UnitedHealth Care. You may even be really ticked at the annual rate increases. But, your policy will perform as per your contract and the insurer will always have the money to pay your claim.

Keith Olbermann has been highlighting the current mess in Arizona. Governor Jan Brewer has eliminated coverage for transplants from the State’s Medicaid program. Arizona can’t afford transplants. The eighty-some people who were waiting for lungs, kidneys or livers aren’t her priority.

The President and Congress have a lot of issues to tackle in the next few weeks during the lame duck session. Tax Cuts. Unemployment Benefits. Estate Taxes. Don’t Ask, Don’t Tell. A war or two. And, Harry Reid wants to talk about gambling. They all have their own agendas. Compromises will be made. Some bills will be signed.

And somewhere in Arizona there is a young woman with Cystic Fibrosis waiting for a lung…

DAVE

www.bogartcunix.com

The Blind Leading The Visually Impaired

2010-11-18T17:50:00.000-08:00

The “grandfathered” rules have changed. Let the celebration begin! Ok, maybe not.

New information was released this week further detailing which companies can or can not remain grandfathered. This is an amendment to the interim final regulations that were issued on June 17, 2010 by the Department of Health and Human Services, the Department of Labor, and the Department of the Treasury.

This is the link to the thirty-five page summary.

This is the quick version of what changed: Businesses are now allowed to change insurance companies as long as nothing else substantially changes.

My posts of August 2nd and August 16th provided a quick list of requirements to retain your grandfathered status and how difficult that may prove to be. A key point of contention was that unions could change insurers, but small businesses and individuals could not, even if the insurance company left the market or made significant changes to its products. This amendment reverses that for businesses, but not for individuals. Heck, it’s a start.

The rules, this one, the set issued in June, and all future regulations, are subject to change or reversal. Long term planning is based purely on educated guesses.

The enforcement regulations and delineation of potential penalties will quickly follow.

My prediction: The forms, the cost to remain in compliance, and the penalties will all be far more expensive than simply opting out of private insurance for small business. Paying an annual “No Insurance” penalty (TAX) to the federal government will be cheaper and easier.

You are now up to date. This really is the blind leading the blind. No one really knows how this is going to play out. We are all guessing. Some of us may be better guessers than others, but no one really knows for sure. The recent election may have a real impact on the Patient Protection and Affordable Care Act or it may not change a thing. That can be said of every variable. All we can do, as business owners, as employees, as health care consumers, is to pay attention and hope for the best.

It is time to review the process.

March 23, 2010 – Congress passed and the President signed a far-reaching piece of legislation that affects 1/6 of our economy and the health and well-being of every American.
June 17, 2010 – The Departments of Health and Human Services, Labor, and the Treasury issued rules that apply to all business and individual health insurance policies, RETROACTIVELY from March 23, 2010. The rules also allowed for Public Comment.
June 17, 2010 – Some businesses and individuals learned that the changes they have made, or have been forced to make, preclude grandfathering from the new regulations. Businesses enact new plans accordingly.
November 16, 2010 – New rules. You might have been grandfathered after all, but now that you have made other changes, you aren’t!

Sometime in the next three to six months – Final rules will be issued.

Next Steps:
* Compliance
* Enforcement
* Penalties

Once the rules are final, how will the government and your insurance company know that you are complying? My guess will be FORMS. The Patient Protection and Affordable Care Act, with the onerous 1099 requirements, is a printer’s dream. Clients are already asking if there will be notarized affidavits required to certify their status. Not yet, but that could be coming soon.

Change can be useful. Change can be difficult. Ill-conceived, disorganized, rushed change is bound to cause unnecessary stress. Yes, this really is the blind leading the blind, but we appear to be going around in circles and there isn’t a whole lot any of us can do about it. Relax. Concentrate on your business. This isn’t war. Bullets aren’t flying. We will get through this. Together.

DAVE

www.bogartcunix.com

National Greatness and David Brooks

2010-11-15T10:46:00.000-08:00

Today’s Health Insurance Issues With Dave is being replaced by the latest New York Times column from David Brooks. The Title is National Greatness Agenda. It is, on the surface, more about politics than health care or health insurance. Dig deeper dear reader. If we are not more responsible, if we don’t get our government’s finances under control, none of these new government mandated and totally unfunded programs will survive.

As the health care debate reignites, it is time to once again demand transparency, accountability, and clear, definable goals.

We may all agree that we are a great nation, but are we willing to work towards National Greatness?

http://www.nytimes.com/2010/11/12/opinion/12brooks.html?ref=davidbrooks

DAVE

www.bogartcunix.com

OK. Now What?

2010-11-03T09:52:00.000-07:00

Barry, my friend the CPA, is undoubtedly smiling. Barry formed a Tea Party of one, almost twenty years ago. His goal was to always have divided government. As long as the Democrats or Republicans were restrained, were kept from controlling both Houses of Congress and the Presidency, there would be some level of gridlock. Only the most important legislation could be passed. The moment either side had real power, all Hell broke loose. Last night was a good night for Barry and the many people who long for a smaller government.

This blog, however, is about health insurance and health care, not politics, so I will leave the list of winners and losers to others. Politics do play a huge role in how health care is delivered in this country and an even larger part in the foreseeable future. And health insurance, health care, and our system of entitlements had equally large roles in last night’s results. They are intertwined. The Republicans took the House last night. They almost captured the Senate. How will this impact health care?

The short answer may be “Not Too Much”.

President Obama came to office in the midst of a financial meltdown. He had three paths in front of him – a Crisis, a Disaster, and an Issue. He faced a divided country and had the chance to invest his political capital into only one. The Crisis was the economy and unemployment. The Disaster was Americans fighting and dying in two wars. The Issue was health care and specifically the uninsured and underinsured of our country. He chose the issue and spent the majority of his first two years and political good will pushing through an unpopular, poorly designed piece of legislation.

The Patient Protection and Affordable Care Act succeeded in energizing the opposition. Even centrist Democrats and Republicans were outraged by this combination of government overreach and intellectual dishonesty. Democrats representing swing districts, like John Boccieri, were pressured into supporting a bill that almost single-handedly caused their defeat.

Republicans have campaigned against the PPACA. Some have implied, some have even promised, to repeal this legislation. Can this legislation, passed only seven and a half months ago, be reversed? And, more importantly, do the Republicans want to?

NO and NO.

The Patient Protection and Affordable Care Act is not going to be repealed or reversed anytime soon. Oh, I’m sure Speaker-designate John Boehner will run a bill through the House. It will be great political theater. And, it will be risk free. The legislation won’t get through the Senate, and even if it did, it would be vetoed by the President.

I sincerely doubt that the Republicans would want to repeal this legislation. This is a fundraising bonanza. Campaigning against PPACA is far more profitable than solving the problems that necessitated the law.

So, we have a bad bill and the real possibility that cynicism may rule the day. Plus, we have yet to mention the insurers who have already spent millions to comply with the new rules and regulations. I firmly believe that the insurers have devised a path to real success under a government run health plan where they provide supplementary coverages. The major insurance companies would then have no desire to repeal the law.

We are quickly approaching the next calendar triggers of the health care legislation. It is possible that the Republican lead House of Representatives, far more interested in extending the Bush era tax cuts than anything else, might tackle meaningful reform in early spring. In a yet to be exhibited act of political maturity, the House could even draft a bill to limit and refine the PPACA. Such legislation could be passed by the Senate and signed by the President. It is possible. I leave the question of probability to you.

We had a major governmental change last night, a massive swing from the left to the right. What has changed in regards to the delivery of health care, the affordability of health insurance and the access to needed medical care? Alas, not much.

DAVE

www.bogartcunix.com

How Much Will Free Cost You?

2010-10-19T14:20:00.000-07:00

I looked at the Medical Mutual form again. Yes, I was a bit flustered by the beautiful woman with the deep dark eyes sitting there, next to me, in my office. But thirty-two years of experience kicked in and I continued to study the form. The numbers did not make sense. It took a call to the insurance company to solve the mystery.

I understood the answer immediately. Natasha’s health insurance policy renews November 1st. One premium, $510.96, is for her current “grandfathered” policy covering her and her college student son. The non-grandfathered version of the same policy is $547.75, a difference of $36.79 per month.

Welcome to the next phase of the implementation of the Patient Protection and Affordable Care Act. New provisions became effective on September 23rd. Like day following night, new prices became effective on September 24th.

In my post, Addicted to Other People’s Money, I wondered how much the new free basic preventive care services would cost us. We now have the initial price tag.

First, let’s detail what changed on September 23, 2010. The two key elements are Essential Benefits and Preventive Care. The definitions, below, come courtesy of Medical Mutual of Ohio. The email quoted in my July 20th post from Mrs. Obama bragged of even more comprehensive (expensive) benefits.

Essential Benefits: The law requires plans to remove lifetime limits on what the government defines as “essential” benefits. The law will also prohibit annual dollar limits, but not until 2014, which allows insurers to phase lifetime limits out by implementing annual dollar limits that will be incrementally increased each year until 2014. Essential benefits include: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services (including behavioral health treatment), prescription drugs, rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management and pediatric services (including oral, vision and hearing examinations).

Preventive Health Services: Plans may not impose any cost-sharing requirements (e.g., copay, coinsurance or deductible) on preventive health services, as defined by the U.S. Preventive Services Task Force, when administered by a network provider.

Quick summary:
Essential Benefits become limitless.
Preventive Care Services become free.

Natasha (all names changed) and her son would be forced to pay $431 more over the next year for this. Another client, Paul, had a much more expensive experience. His new Anthem policy was effective September 20th. The premium for Paul, his wife, and two children for a high deductible contract is $402.55 per month. Since he had already paid his September and October premiums for his old policy, he wanted to re-date the new policy to November 1st. The premium for the exact same policy, enhanced with the new Free benefits, would be $480.77, an increase of $78.22. Are these new provisions worth almost $1,000? Not to Paul. And probably not to you.

So here we are, less than a year into the new law, and we are already seeing the impact of the new Patient Protection and Affordable Care Act. It is harder, not easier, to insure Americans. Insurance is more expensive, not less. And the words Cost Containment are still missing from the President’s vernacular.

The September 23rd changes are just becoming effective. More mandated changes are due for January 1st. And the rules are still being written, on the fly, as we reinvent the delivery of healthcare. I’m just hoping that nothing else is Free. We can’t afford free.

DAVE

www.bogartcunix.com

By the way, Jeff, my business partner, was concerned that this post was too dry and contained too much detail. I told him that I could trust my readers to not only plow through a fact laden piece, I could even count on some of you to add pithy, timely comments.

We Have To Destroy This Village To Save It

2010-10-04T07:53:00.000-07:00

Insurance is real. My job is to work with real people, everyday, to solve real problems. I get angry and frustrated when the theoretical and the hypothetical invade my space and get in my way. Yes, I have an agenda. All but the apathetic have an agenda. The undeclared and disorganized agenda of the national Democrats interfered with my work this week. And I am more than just a little upset.

Jimmy (yes, the name is changed) is a healthy eleven year old living in Greater Cleveland. I have no idea where his dad lives. Jimmy lives with his mother, Wendy, a woman who has not worked since her unfortunate skiing accident of a few years ago. Jimmy’s major bills, like school, are paid by a generous aunt. Jimmy is uninsured.

Wendy had insurance for her son and herself, but she let it lapse in August. She didn’t pay the insurance and she didn’t tell her sister until last Monday. Why are the dates important? Because now we have a problem.

Wendy’s sister would have kept the old policy active, had she been notified in a timely manner. Though Wendy has recovered, for the most part, from her serious injuries, she is difficult to insure at this time. Due to the new health bill, we can not write a Child, Only policy on Jimmy. We could two weeks ago. A comprehensive policy on a healthy eleven year old used to be around $100 a month. That policy no longer exists.

Proponents of the new health care legislation, the Patient Protection and Affordable Care Act, love to cite the new provisions for covering children. No underwriting. No limits on preexisting conditions. Totally free preventive care. How do you price that policy? How do you properly build reserves for the sudden, and massive, shift of risk as parents currently paying for underwritten policies move to blindly issued contracts? You can’t. The insurance companies eliminated all Child, Only policies.

How many unhealthy kids are there? How many of my clients, small businesses in Northeast Ohio, are paying higher premiums because the owner’s child has a heart condition or a genetic disorder or some other ailment that requires substantial care? LOTS. And if the insurers didn’t play self-defense, if the companies unthinkingly threw open the doors and took all of them at a standard rates, the results would be devastating.

So where does that leave Jimmy, our healthy eleven year old? I can write, for the moment, short term, catastrophic coverage on Wendy and Jimmy. G-d forbid insurance. It is the best I can do. Governor Strickland, realizing the mess Washington has created, signed an emergency order this week to force the insurance companies to have a special “open enrollment” for Child, Only policies. Medical Mutual of Ohio, Anthem Blue Cross, and UnitedHealth Care have yet to determine how to comply with this order or how to price the product.

We had a health care system. It was uniquely American and it served 80% to 85% of us. It was hardly perfect, but it was ours and, like it or not, it reflected our values and our tastes. We needed to improve the system we had to better serve all Americans. Instead, we are in the process of dismantling our method of paying for health care and interacting with our medical providers.

Jimmy is just, to use the proper term, collateral damage.

DAVE

www.bogartcunix.com

Random Thoughts Column

2010-09-27T14:32:00.000-07:00

A few short posts about life as I know it.

Sprinkling a Little Holy Water

Boundaries. I noted a few weeks ago in my other blog, Again? Really?, that neither Reverend Kenneth Chaulker nor I should comment on the Catholic Church’s ongoing problems. I was reacting to his letter in the Plain Dealer. My suggestion was to leave the discussion of Catholicism to Catholics. Last Friday’s Plain Dealer gave us an opinion column from Sister Simone Campbell, the executive director of a Catholic social justice lobbying group based in Washington, D.C. If I compare her level of understanding of the real world issues involved in the health insurance debate, I am now qualified to lead Mass.

Just as I might be able to mouth the words in Latin, Sister Simone Campbell provided us, the readers, with another copy of the talking points from the Democratic Party’s campaign. About a third of the essay is a defense of the politicians who voted for the bill and an attack against those of us who have yet to be converted.

There are real discussions taking place around this country among business owners who will be forced to pay higher premiums, taxpayers asked to subsidize unfunded mandates, and legislators challenged to justify their decisions. Sister Campbell, like me in a church, is just another kibitzer.

Addicted? We’ve Got a Cure!

A series of emails arrived last week to alert me about an issue that could affect my clients. The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) applies to group insurance plans covering 50 or more employees. The law went into effect last October. The rules were issued three months later in January 2010. I printed the key email, a white paper from Milliman, the independent actuarial and consulting firm, and noticed an important sentence at the bottom of the page:

This document was sponsored and commissioned by Pfizer, Inc.

Pfizer? The name of the paper: The Mental Health Parity and Addiction Equity Act: Key Elements and Implications for Smoking Cessation.

Plan sponsors and their service providers and advisors need to be diligent when identifying insured benefits to be compliant with MHPAEA. For instance, it is easy to overlook smoking cessation benefits: they are covered by the act because they are a treatment for nicotine addiction, a substance use disorder.

Now it makes sense. Smoking isn’t a bad habit. It is a sickness. And we’ve got prescriptions for that. Guess who makes them?

The Good News – You’re Living Longer
The Bad News – That’s Gonna Cost You

John Hancock, a leader in Long Term Care Insurance (LTCi), recently announced a price increase. A careful study of all of their long term care claims (both group and individual) of the last twenty years forced them to make this decision.

Morbidity is up. Mortality is down.

Long Term Care Insurance pays when the insured is unable to perform two out of six of the Activities of Daily Living – bathing, dressing, using the toilet, transferring (to and from bed or chair), caring for incontinence, and eating. Hancock has seen an increase in claims and the claims are lasting longer. People are living longer after they begin to receive benefits. More people are living to an age where claims are almost inevitable.

The higher than anticipated utilization proves the need for the product. It also forced the reevaluation of the premium. John Hancock has been selling LTCi for less than thirty years, but has already paid out more than $3 billion in claims.

Why should you care? Because, insurance isn’t as easy as it looks. For every profitable line, there are types of coverages with very thin margins. And we want our insurers to be here, solvent, when we need them to write that check to us or our family. The insurers must maintain secure reserves. Their books have to balance. Their numbers have to be real.

All of the wishing and praying in the world can’t change the nature of basic mathematics.

DAVE

www.bogartcunix.com

By the way, I know that Mass is now done in English, but just as I prefer Hebrew in the synagogue, if I was going to celebrate Mass, I would go for the Latin.

If You Don't Know What To Do, Do Nothing

2010-09-17T08:47:00.000-07:00

My business is on hold. I’m not talking about the phones. I’m not talking figuratively. Literally, a major portion of my business is on hold. There is so much uncertainty, so little clarity, that I am, for the next few days, unable to write new individual health insurance policies through the largest insurers in this area.

I first noticed this about a week ago. One of my Anthem clients has a policy renewing October 1st. The new premium wasn’t too bad, but she wanted to know about other options. I couldn’t locate the link on their website. Admitting computer illiteracy, I sent a request in to Agency Services. I was shocked by Anthem’s response. The link was removed because there are no options. I was asked to resubmit my request after September 23rd. Anthem is waiting to see what the federal government is going to do.

Thirty-two years in the business and this is the first time I’ve ever seen an insurer tread water. I decided to run a quote for her as if she was a new client. My software said “Tilt”. Anthem’s online quoting had this note: “Plans and rates effective 9/23/10 and after will be available as soon as our Health Care Reform compliant plans are available for sale." If you need a new health insurance policy, Anthem is not an option. At least, not today.

Medical Mutual of Ohio is still quoting. In fact, MMO will quote their entire product line, but all applications with an effective date of September 23rd or later won’t be issued if children are to be included in the plan. Family policies are put on Underwriting Hold. The applications aren’t declined. They certainly aren’t issued. These potential policies are in limbo.

What can the insurer’s do? The Patient Protection and Affordable Care Act is a shell of goals and half-baked concepts. The rules and regs are still being written and many will apply, retroactively, to March 21, 2010. And, the insurers had better not complain. Kathleen Sebelius, the Secretary of U.S. Health and Human Services, is threatening any insurer who informs its clients of the actual costs associated with this scheme.

We have discussed the whole grandfather issue in previous posts. Grandfathering separates which business might escape some of these new rules for awhile and who will be impacted immediately. Businesses covered by Aetna don’t have to waste anytime studying the grandfather provisions. Between the recently written regulations and a couple of Aetna’s decisions, no Aetna small group health policy qualifies to be grandfathered.

Children are a key part of next week’s problems. Can they be underwritten? Can the insurance industry really cover every preexisting condition for every child, with no limits, without raising the price of policies? How much is enough? Who is going to pay?

Since we have never had an honest discussion about price or goals, we have arrived, six months into this grand experiment, at a crossroads. Some form of nationalized health care still appears inevitable, but the President and Congress refuse to put their cards on the table. Without taking the time to clearly define the goals and costs, we are at the first of several predictable impasses.

The insurers will be happy to sell supplements to the future government health plan. UNUM has already released the first plans specifically designed for that. Assurant and UnitedHealth One have new accident and dental policies. What are they supplementing? The federal government has done a great job of pressuring the insurance companies, but it is ill prepared to handle its part of the program.

So, a major portion of my business is on hold. If you and your family need coverage as of October 1st, I may, or may not, be able to help you. I hope to know more by next Thursday.

DAVE

www.bogartcunix.com

True Equality

2010-09-11T14:36:00.000-07:00

The Heck with building better highways for better Negro marchers. What we need is to get our fair share of the crooked contracts that build those highways.

Godfrey Cambridge

How do you define equal opportunity? In Cuyahoga County, the right last name and a lack of scruples guaranteed a safe and secure government job. These positions may not have paid very well, but attendance appears to have been optional.

I am happy to report that you don’t have to settle for county money. The federal government is dedicated to equal opportunity for all Americans willing to engage in criminal activity. If you are ready to make serious money, Medicare Fraud could be your big break.

A recent report on 60 Minutes detailed the scope of Medicare Fraud, how easy it is to steal from the U.S., and our government’s inability to control a program that insures almost 50 million Americans. It is estimated that WE, the U.S. taxpayers, are losing about $60,000,000,000 a year to Medicare Fraud.

Medicare Fraud could be overbilling or double billing. Unfortunately, it is most often the filing of claims for goods or services that were never provided. These aren’t errors. We are discussing the theft of billions of dollars.

The politicians will tell you that they are doing a great job. Sure Medicare Fraud is a huge problem, but they are holding Summits and making arrests. Kathleen Sebelius, the Secretary of U.S. Health and Human Services, posted her August 26th speech at the Stop Medicare Fraud Summit. Read her speech where she described band-aids like an excited four year old.

Last Friday The Miami Herald reported that Ernesto Montaner was sentenced to four years in prison and Jose Varona , three. The two men were also ordered to repay a total of $4 million. They were billing Medicare for rehabilitation services that never took place. Montaner’s father, the brains of the group, is in Costa Rica. What the story doesn’t say is how much money they really stole and what, if any, will ever be repaid.

Medicare Fraud is out of control because the government won’t allocate the necessary resources. Congressmen, like Anthony Weiner, often cite Medicare’s overhead as only 4%. As noted in the February 5, 2010 posting of this blog, Mr. Weiner has even claimed a preposterous 1% overhead.

* Let’s pretend that 4% is accurate.
* Let’s pretend that much of Medicare’s actual expenses don’t fall into other parts of the federal budget.
* Let’s forget about all of the costs shifted to our law enforcement agencies and courts.

Medicare paid approximately $430 billion in claims last year. $60 billion went to thieves. That is 14%! That money didn’t go to care. That money didn’t go to prevention. That money wasn’t even spent on taxable salaries. It is money, your money, flushed down the toilet.

The new health care bill, the Patient Protection and Affordable Care Act, attempts to level the playing field. Insurers are being forced to reduce their overhead expenses. Part of the savings will come from a reduction in agent compensation (ouch). Home Office personnel will also be cut. But the insurers, unlike the government, will never pay out 10% or more of their claims to crooks.

As long as there are cars, there will be ample opportunities to scam big money as a construction contractor. But I think if Godfrey Cambridge was delivering that stand-up comedy routine today about equal opportunity, he would want to know whether Blacks in Detroit or Los Angeles were getting their fair share of the Medicare Fraud largesse.

Rest in Peace Mr. Cambridge. Everyone’s getting their cut.

DAVE

www.bogartcunix.com

Herding Cats

2010-08-30T09:48:00.000-07:00

My friend Mitch, who lives in Montreal, was stuck overnight in Cleveland. Mitch used to live on Solon. He misses his friends, our shopping, and our health care – in that order. While visiting him at the airport Marriott, he once again regaled me with his stories of fighting for the attention of Canadian doctors and hospital staff. He hopes to return to the U.S. one day. He is counting on our system to still be here for him.

Mitch and my friends on the far right are very worried that we will one day have a single payer, rigid system like Canada’s. My one word answer is to RELAX. If you would like proof that their fears are in vain, I give you an article in yesterday’s Plain Dealer.

The story, a reprint of a New York Times article, was about medical marijuana. Medical marijuana is legal in some states, illegal in others. It is banned by some employers while ignored by others. The federal government has raided distribution centers while giving lip-service to states’ rights.

We are Americans. We could never tolerate an absence of choice. We would never accept a one-way, the only way, type of health care system. We are contrarians by nature. Our rules constantly change because we are constantly changing.

The short article included a brief description of Nick Stennet’s employment problem. Mr. Stennet told his employer about his health problems and his daily use of medical marijuana. He was later fired when, surprise, he failed the drug test. The lawyers should have a field day with this.

The laws in Rhode Island might be like the laws in Hawaii, but very different than those in Utah or Alabama. People in Maine choose to live in Maine, not New Hampshire. And California is constantly at war with itself. That’s us. This is the essence of the United States.

Rigid? Choiceless? Single-payer with no other options? That’s just not our style.

DAVE

www.bogartcunix.com

As Seen In The Plain Dealer

2010-08-16T15:03:00.000-07:00

My last post on Health Insurance Issues With Dave generated a lot of responses. Some people were frustrated with yet another under-publicized provision of the Patient Protection and Affordable Care Act. Some used my article as an opportunity to complain about the Democrats, in general, and the President, in particular. But the phone calls all went something like this:

Dave, OK I’m scared. This doesn’t apply to me, right? I’m grandfathered.
No, it does and you aren’t!

There was an excellent article about the rules to be eligible to retain grandfathered status in the August 8th Plain Dealer Forum Section. It was written by Michael P. Coyne. The article tied in so well with my blog and my clients’ concerns that I felt compelled to write a Letter to the Editor. This appeared Saturday, August 14th.

Michael P. Coyne's article about "grandfathered" health plans (Forum, Sunday) shed some light on the challenges small businesses face with the Patient Protection and Affordable Care Act. Please let me add a real-world example.
A client called recently to verify that his plan still qualified as "grandfathered." It didn't. He employees about 25 skilled and semiskilled workers and has always provided health insurance. His June renewal with a major carrier included a rate increase of 23.7 percent. Luckily for his employees, another carrier with a little better coverage was less expensive. The employees won. The employer won. Everyone is happy -- except Washington.
You lose your "grandfathered" status if you change insurance carriers.
"Why should I be punished?" my client asked. "They now have better coverage."
The answer, of course, is simple. None of this is about coverage.

Is it really that simple? Yes. Unions can change insurance carriers without forfeiting their grandfathered status. Businesses can not. Will this affect the client’s employees and how he does business? Definitely. I’m positive that this legislation will have a significant impact on the payment and delivery of health care.

The rules may be written on the fly, but the outcome appears to be predetermined.

DAVE

www.bogartcunix.com

By the way, special thanks to those of you who followed ALL of the links in the last post. Even the most serious of topics needs a little levity.

Don't Cry Uncle, Stay Grandfathered

2010-08-02T07:59:00.000-07:00

Grandfathered - The right to stay under the old rules and regulations that new policies must follow. The more onerous the new rules and regulations, the more desirable it is to be grandfathered.

The new rules are coming. In a rush to change the delivery and payment of health care as quickly and as irrevocably as possible, Congress made the Patient Protection and Affordable Care Act effective the day it was signed into law, march 23, 2010. The rules have yet to be written. The U.S. Departments of Treasury, Labor, and Health and Human Services are issuing interim final rules. Nothing is set in stone, except that all of the rules they create will apply to all group and individual health insurance policies that aren't grandfathered.

Policies on the books as of March 23, 2010 may be grandfathered, may be exempted from some of the new rules. Which rules? Who knows? The rules and regs are fluid. The insurers are being pressured to institute some changes "voluntarily".

How important is grandfathered status? There is no way to assess the value at this point, but the government is attempting to make it very difficult to maintain. So difficult in fact, that the rules to keep that status got my attention. When Washington erects this many roadblocks, and a damaged bridge isn't involved, you might want to see what is on the other side.

The following, courtesy of Medical Mutual of Ohio, is a synopsis of the Interim Final Rule for the maintenance of the status of a grandfathered plan. The following changes will cause individual and employer plans to no longer be grandfathered:
* A merger, acquisition or similar business restructuring, if the principal purpose of the action is to cover new individuals under the grandfathered plan.
* A substantial elimination of benefits to diagnose or treat a particular condition.
* Any increase in cost-sharing percentage requirements (such as coinsurance) above the level in effect as of March 23, 2010.
* An increase in the fixed-amount, cost-sharing requirements (e.g., deductible or out-of-pocket limits) above the level in effect on March 23, 2010, other than copayments, that exceeds the sum of medical inflation plus 15 percent.
* An increase in copayments above the level in effect on March 23, 2010, by an amount that exceeds the greater of the sum of medical inflation plus 15 percent or $5, adjusted annually by medical inflation.
* A contribution rate decrease by an employer or employee organization of more than 5 percent below the contribution rate on March 23, 2010, for any tier of coverage and any class of similarly situated individuals.
* The addition of an overall annual limit on the dollar value of benefits if the plan was not imposing an overall annual or lifetime limit on the dollar value of benefits on March 23, 2010.
* The addition of an overall annual limit on the dollar value that is lower than the dollar value of the lifetime limit on March 23, 2010.
* Any decrease in dollar value of the overall annual limit (regardless of whether the plan had an overall lifetime limit on March 23, 2010), if the plan imposed an overall annual limit on the dollar value of all benefits.
* A change in health plan carriers (changing a third party administrator has no effect).

Almost any change made since March 23, 2010 disqualifies your plan from being grandfathered. Did you know that in April when you raised your deductible? Have you changed your copays lately? Even replacing the exact same benefits with a different insurance carrier causes you to forfeit your grandfathered status. This isn't about you, your business, or your employees. It certainly is not about making your current policy more effective.

Will there be any benefit to having a grandfathered health plan? I don't know. But, the government thinks that there will be a real value and Washington is working very hard to take it away from you.

DAVE

www.bogartcunix.com

Addicted To Other People’s Money

2010-07-20T15:30:00.000-07:00

Three minutes. Citizens are allowed three minutes to address the Beachwood City Council at regularly scheduled meetings. This isn’t a Q & A. If the Councilmen deign to respond to the concerns raised or answer the questions asked, it will happen whenever they choose. The agenda designates this as Citizens’ Remarks. The microphone is yours. You have three minutes.

I used to attend every Council meeting. A special entry was added to the City’s agenda, Chamber Report, for me to address Council. But I am no longer the president of the chamber of commerce and I have other ways to spend two Monday evenings a month. I forced myself to attend last night’s (July 19th) meeting.

The City of Beachwood is ready to take a 33% income tax hike. Beachwood would jump from one and a half percent to two. City revenues are down in these tough economic times. The goal is to tax the people who work here, but can’t vote, as opposed to the people who live here and can. I was at the meeting to watch City Council sing and dance.

I had no intention of speaking at the meeting until I saw item 9 on the agenda:

An Ordinance extending a Contract with Medical Mutual of Ohio (MMO) for renewal of health insurance coverage for City employees, declaring the existence of an emergency condition regarding health insurance coverage and further waiving competitive bidding.

I read that paragraph several times. This was easily one of the most ridiculous things I had seen in thirty-two years in the insurance business. Ticked off, I waited for the Citizens’ Remarks portion of the meeting.

I began by clearly stating that I don’t work with municipalities. My interest was strictly that of a taxpayer. I noted that there are no insurance emergencies. The City had plenty of time to get bids from countless other insurers. Anthem? UnitedHealth Care? Aetna? They simply didn’t bother. Why would they? They’ve got us to pay the bills.

As the meeting dragged on, we eventually learned that the City never negotiated with the employees to accept a less expensive policy. The City never negotiated with the employees to increase their contribution. Beachwood hasn’t solicited for bids in years. The Mayor and Council can’t help themselves. They are addicted to other people’s money.

Other people’s money is a common addiction. I was thinking about it earlier yesterday as I was reading an email from Michelle Obama. Yes, I’m on her email list. She and other members of the White House send me emails all of the time.

Anyway, Michelle (she calls me David) wanted me to know about all of the great ways that the new health care bill was going to help my family and lower costs.

So much of what makes this law great is its emphasis on preventive care--right now, too many people aren’t getting the check-ups or the screenings they need to stay healthy. Twelve percent of kids haven’t seen a doctor in the past year. And 59 million adults--and 11 million children--depend on an insurance plan that does not cover basic immunizations.

Health reform is changing that. Under this new law, all new private plans will provide basic preventive services--things like childhood immunizations and checkups, mammograms, colonoscopies, cervical screenings, and treatment for high blood pressure--absolutely free of charge. No copay. No deductible. No co-insurance needed.

Does this mean that America’s doctors will be providing free exams? Will labs dedicate entire months to free blood work? Will pharmacies dispense free blood pressure medications? Of course not. Our medical providers expect to be paid for their time and efforts. Rightfully so. These tests, services, and products aren’t free. Your insurance will pay for them. And you will pay more for your insurance.

Nothing is free save your mother’s love. But when you are addicted to other people’s money, you lose sight of the real cost of anything. There is always someone there to pick up the tab. And eventually the addicts forget that there is a cost. But actions have consequences. Goods and services and not free.

Beachwood, and countless other municipalities around the country, will get a crash course in effective budget management. They may even be forced to make some tough decisions. The new health bill has already begun to force business owners to make tough decisions. The only Americans unaffected are like my email buddy, Michelle, the ones addicted to other people’s money.

DAVE
www.bogartcunix.com

The Blind Squirrel

2010-07-06T13:27:00.000-07:00

Should all businesses provide health insurance benefits to their employees? As a guy who makes his living selling group health policies to employers, you might think that I would answer with an emphatic “YES”. In theory, all businesses should provide benefits. In practice, not necessarily.

Sunday’s Plain Dealer included an article about the White Castle hamburger chain and the unintended/intended consequences of the recent health care legislation. According to the article, White Castle has been providing health insurance coverage to its full-time employees for a very long time. And, they are more than generous, paying 70% to 89% of the cost. By these measures, White Castle is a good corporate citizen.

But it is not enough. The Patient Protection and Affordable Care Act imposes a $3,000 per employee penalty on companies whose workers pay more than 9.5% of household income in premiums for company provided insurance. “White Castle estimates that this new rule could cost as much as 55% of its yearly net income."

Before we go any further, it is important to note that a recent study found that 78.9% of all statistics were created at the moment of their citation.

So I may not be certain about the actual pain White Castle may experience. Of course, when Nancy-Ann DeParle, Director of the White House Office of Health Reform, is quoted later in that same article that 97% of the nation’s companies won’t pay any penalties, I am equally skeptical.

Let’s talk real numbers. There are lots and lots of people earning $9 an hour. Is that right? Should they be paid more? I don’t know. You hire them and let me know. Today we’ll simply work with reality.

$9 an hour times 35 hours per week times 52 weeks per year equals $16,380. This person could only be charged $30 per week to participate in the company health plan. Anything more and the employer is charged $3,000 per employee. Restaurant worker, Retail employee. Clerk. There are a lot of people earning less than $20,000 per year. Their employers have a problem. Or a choice.

Will employers absorb even more of the rising health insurance premiums? Will employers make do with fewer workers? Or, will businesses cancel their private insurance and pay the lower $2,000 per employee penalty for not providing coverage?

The cheapest option, even less than providing high quality health insurance to its employees, may be to pay the $2,000 per employee penalty and to cancel the benefits. This just funnels more people into the government plan.

The article also quotes Steven Kreisberg of the American Federation of State, County, and Municipal Employees Union (AFSCME). Uniquely unqualified to address the concerns of any business, Mr. Kreisberg assures us that the young and healthy will simply opt out of their employers’ plans. The employers would then save premium dollars by paying $2,000 per employee per year for nothing. Forgetting that businesses hate to spend money for nothing, we still understand that taking the young and the healthy out of the employers’ groups will only make their premiums skyrocket.

The structure of these penalties only make sense if the ultimate goal is a government run health care system.

There were other experts and ax-grinders quoted in the Plain Dealer article. One was the number one Republican in the House of Representatives, John Boehner (Oh). Mr. Boehner is the George Hamilton of national politics. While Mr. Hamilton’s movies feature his tan and a lightweight plot, Mr. Boehner’s TV appearances tend to feature his tan and his lightweight logic. I have always thought that his job was to keep the seat warm till a real leader emerges. I am not a fan.

Imagine my surprise when I read this quote from Mr. Boehner. “The irony is that in the name of expanding health care coverage, the administration is making it harder than ever for unskilled workers to get started in the workforce.”

Sure the populism is feigned. But truth is truth. In a rush to achieve a goal with little thought to the consequences or collateral damage, this administration has begun to implement its health care takeover. And, as per Mr. Boehner, it is true. Even a blind squirrel can eventually find a nut.

DAVE

www.bogartcunix.com

The Shell Game

2010-06-28T12:28:00.000-07:00

The recently passed Patient Protection and Affordable Care Act forces the State of Ohio to re-address our uninsured. Of particular interest is our population of high risk uninsured. These individuals are very unhealthy and have not been insured for over six months. The previous options available to our high-risk pool were both mediocre and expensive. Still, many of our unhealthiest accepted the available state mandated option. Today we are talking about those who did not.

According to the report published in the Plain Dealer this past Saturday, the federal government has allocated $152,000,000 to help cover these Ohioans until the new rules kick in, about four years from now. Medical Mutual of Ohio, a local not-for-profit, won the contract to manage the policies.

This is not free insurance. The individuals will be required to pay some yet to be determined premium. What does one hundred fifty-two million get you? The State’s best guess is 5,000 insureds. Based on my knowledge of the current premiums and benefits available to these individuals, that number might be a touch optimistic.

In a post dated June 29, 2009, The Real World, I noted that Governor Strickland’s budget included a premium reduction for the open enrollment policies available to Ohio’s unhealthiest citizens under age 65. The cost for this would be borne by Ohioans who pay for their own health coverage. We would, according to the State’s actuary, pay 5.5% more to help our neighbors acquire insurance. My clients can attest to their rising premiums.

The one hundred fifty-two million dollars is part of a total five billion dollar four year program. Let’s pretend that 5,000 is a real number. For our purposes, let’s pretend that all of these numbers are real, the federal government really has five billion dollars, and we really get our hundred fifty million. 5,000 beneficiaries would get only $30,400 towards their coverage. This is only $7,600 per year, a little over $600 per month. Is that even close to the actual cost of insuring these individuals?

The current Medical Mutual of Ohio premium for the Ohio Standard policy for a 60 year old male in Cuyahoga County is $1,403.08 per month after the recent rate reduction. We already know that that is not sufficient to pay claims. Will our soon to be insured make up the $800 per month difference? And, will the new federally designed policy be as awful as our current contract or will it be more generous and costly?

This, of course, does not even begin to address the fact that there are far more than 5,000 Ohioans who are both very unhealthy and in need of a different way to pay for their health care.

There was a time, not so long ago, that we were told that one of the main reasons we had to go to war was because of the way the Taliban treated the women of Afghanistan. We have been told that the purpose of health care reform was to cover the uninsured. The selectivity of our focus and actions make both arguments seem specious. Our government is perfectly happy to ignore the abuses of cooperative tyrants who provide us with cheap oil. And we have yet to show any real interest in devising, and FUNDING, a program to truly cover our unhealthiest and uninsured.

What we have is a shell game. More and more costs are being shifted to those of us with private insurance. All the while the federal government attempts to block insurers from raising rates to cover the true costs. Books must balance, at least in business.

My predictions of a few months ago still stand.

DAVE

www.bogartcunix.com

A Knight In Shining Armor

2010-06-14T07:33:00.000-07:00

Dr. Ballard made the cover. The current issue of Cleveland Scene featured a story about Robert Ballard, M.D. It appears that Dr. Ballard, age 69, was recently fired. This was not the first time he was fired or defunded, just the most recent and, in his mind, most surprising. Scene depicts him as a good doctor, a caring physician, a practitioner committed to Wellness. He just wants a salary. Is that so awful? Forty-three years since his graduation from a Cleveland medical school and he still hasn’t grasped how and why he gets paid. In essence, he is the poster grandparent for single payer health care.

I bring up Dr. Ballard because of Scene’s cover. There, in four color, is the unemployed doctor dressed in a lab coat walking his dog. I have developed a real appreciation for lab coats.

You can’t be a real doctor, or even a real fake doctor, or even a good stage prop without a lab coat.

I was in China for nine days this past April. My tour took me to Beijing, Shanghai, Suzhou, and Hangzhou. I was at the Great Wall (amazing pictures), a Ming Tomb, and the Buddhist Temple LingYin. Other cultural/shopping destinations included a jade factory, a silk factory, and a Cloisonné factory. You get the idea. We also stopped in the offices of the purveyors of Traditional Chinese Medicine.

The doctor explained the efficacy of Traditional Chinese Medicine and we were each given the opportunity for a free exam. No blood tests. No sample jars or paper cups. The doctor diagnosed each person, one at a time, by simply taking the patient’s pulse. Then he prescribed the appropriate herbs each inevitably needed.

The doctor took my pulse and asked about my blood pressure medication. “None”, I replied. He was baffled. Me? I was totally relaxed and trying hard not to laugh. I love a good sales pitch. No blood tests. No tests at all. Why was he wearing a lab coat? Our doctor was in costume for his American audience.

My fascination with lab coats can be traced to the recent health care debate. My local Congresswoman, Marcia Fudge, was hoping that her vote was going to be news. It wasn’t. Our Congressional Representatives, even those in safe districts, need to make the six o’clock news now and then, if only for their egos and fundraising. The “White Coat Doctors”, Doctors Organized for Health Care Solutions, were ready to play their part. This is the group that instructs its members to keep their lab coats in their cars and to be ready at a moment’s notice. Their job is to show up at the press conference, coats on, and to nod approvingly. It took tens of thousands of dollars of education for these people to be stage props. But if you call them, they will ride in, like knights in shining armor.

DAVE

www.bogartcunix.com

No One Is Above The Fray

2010-05-31T11:48:00.000-07:00

Jennifer, my lovely daughter, had a wonderful orthodontist. He was the dental equivalent of Mr. Rogers. Gentle. Caring. The kids loved him. The parents respected him. We, the parents, just hated going to his office.

Jen and her fellow patients were all in middle school. They would check in and find their way back to an open room and an array of colored rubber bands. The parents would sit and wait, hoping to not be noticed by the doctor’s office manager, a young woman who had a habit of standing in the doorway and calling out to us.

“Mr. Cunix.” Uh oh. “Doctor says that Jenny should do a better job brushing her teeth.”

“Mrs. Smith.” It was someone else’s turn. “Your insurance wasn’t approved.”

I began waiting for Jen in the building’s atrium. I was not alone.

Great dentist. Happy kid. All was right in the world right up till my insurance got screwed up. I had to go in. Ms. Noisy was sure that I had a problem. I quickly determined what she had done wrong. Now she was both loud and unhappy. It was time to meet with the doctor.

With childlike innocence, the orthodontist explained to me that he only dealt with the teeth. He didn’t know anything about the paperwork. He didn’t touch it. I looked him in the eye and reminded him that he owned a business. He couldn’t divorce himself from the hard part. He couldn’t keep his hands clean.

The paperwork got better and the consultations with the parents became private.

I was reminded of this long ago confrontation by Dr. Johnathan Ross’s rant in this past Sunday’s Plain Dealer. Dr. Ross is identified as the past president of Physicians for a National Health Plan and a leader of Single Payer Action Network in Ohio. I have provided the links. Take a moment to read the article and research the groups.

Dr. Ross is positive that our health care delivery system’s only problem is our method of payment. It’s the insurance companies. If only we had a single payer system. Our costs would plummet and all would be right in the world.

“So what's the alternative? It's building on the solid foundation of our tax-financed, low-overhead Medicare system, and extending it to cover everyone without exception. The administrative savings from such a streamlined system would amount to $400 billion per year, enough to provide comprehensive coverage to all with no significant out-of-pocket expenses and with complete choice of doctor and hospital.
A single-payer system would also have the clout to negotiate drug prices and provider fees, and to allocate resources efficiently and wisely. It would possess powerful tools for improving quality and controlling costs.”

At the risk of sounding like a Saturday Night Live Skit, REALLY?

We would save $400 billion a year?
Really?

Comprehensive coverage to all with no significant out of pocket expenses?
Really?

Clout to negotiate drug prices and provider fees?
Really?

Allocate resources efficiently and wisely?
ENOUGH!

Somehow our federal government would suddenly repair its abysmal record of fraud prevention, negotiate drug prices and provider fees, and reorganize our entire health care delivery system with no increase in administration costs or personnel. G-d knows, when I think efficiency, I think Washington.

Is this all a lot of hooey? Not quite. Dr. Ross is hoping that we, like my daughter’s orthodontist, will forget that medicine is a business. Big business. Dr. Ross, and physicians like him, are offended that the insurance industry is part of their business. A large part. I don’t take it personally. Sometimes I’m offended that the doctors are a part of mine.

Dr. Ross wants to be paid better, faster, and with less paperwork and oversight. Can we take the risk out of being a business owner? Can we just guarantee him a steady, predictable income free of hassle and concern? Give him that and he promises to check the blood pressure and pulse of little old ladies for years to come.

It doesn’t work that way, at least not yet. Administrative costs are probably higher than they need to be. But we should also check out the building costs for the new doctors’ offices and hospital palaces popping up all over Greater Cleveland. All those TV commercials for the newest drugs cost lots and lots of money. The system is also fueled, in part, with unnecessary tests and expensive, futile procedures.

Attack all or attack none.

DAVE

www.bogartcunix.com

The Resurrection Post

2010-05-26T15:29:00.000-07:00

Health Insurance Issues With Dave may have run its course. My April post was designed to have been my last. I had called my shot. I had made my prediction for the delivery and payment of health care in the United States. Short of a major U-turn, the changes I have described seem inevitable. So having said what I had to say, it was time to sit back and monitor the conversation.

Published Comments – O! Don’t get me wrong, the post was well read and generated lots and lots of feedback. Sadly, the phone conversations and emails were all private. Thoughtful. Concerned. Interesting. Private. No one wanted to go on record. No one wanted to have his/her ideas examined, the conclusions challenged.

We, all of us, need to continue talking, and even occasionally listening. Well, listening may be just pie in the sky, but I will provide the opportunity for further communication.

In other words, I’m back.

I received an email from a client last week. Janet (name changed to make my attorney happy) is a member of a grassroots organization called The Ohio Project. Would I sign their petition? Did I want to participate? Their goal is to pass an amendment to the Ohio Constitution that would give Ohioans the right to opt our of health insurance, especially government mandated coverage.

I went to the site and read all of it, the amendment, the petition, even the training material. I DID NOT SIGN THE PETITION and I can not participate.

My problem was that I could not find any solutions on the Ohio Project’s website. There is a focus on being “forced” to participate in the system as a responsible player. My perspective has always been that our system won’t ever work if people can opt out up until the moment they need care. This blog has consistently delivered that message, most notably in the August 21, 2009 post. We need everyone to participate, the sick and the healthy, the young and the old.

My client’s concern, first and foremost, was to stop the government from forcing her to buy insurance. I asked Janet what plans The Ohio Project had to fix the system. She told me that they don’t have any solutions and that solutions aren’t their problem. The Ohio Project views the requirement to purchase insurance invasive and unconstitutional. I should note that Janet is well insured. Always has been. Always will be. This is a battle built on principle. Janet, and many like her, have drawn a line in the sand. This is where they have chosen to take a stand.

I strongly disagree with the members of The Ohio Project, but I welcome their participation. There is a natural progression from objecting to a government program or policy, to actively challenging said program or policy, to thinking about a more functional solution. And that is what we need. It has been said that the opposite of love isn’t hate. It is apathy. I am thrilled to have the members of The Ohio Project out and about. I am hoping that their energy will generate new ideas.

So I’m back. Let’s ride out this storm together.

DAVE

www.bogartcunix.com

Over The Tree, Close To The Front Of The Green

2010-04-17T12:49:00.000-07:00

I was lucky. My poorly hit tee shot smacked the right tree at the perfect angle and my ball landed in the middle of the fairway. It wasn’t real far from where I had started, and number four at Astorhurst is a dogleg to the left, but I was on short grass and only had one big tree in my path to the green. I wasn’t going to just try to defy the odds with my sand wedge, I called my shot. "Over the tree, close to the front of the green." Good or bad, right or wrong, I always believe that we should call our shots.

What will the new health care legislation accomplish? I have been asked daily for close to a month what I think will happen next. I’ve been working on an answer. The talking heads on TV all seem to know, and oddly enough, the results tie in perfectly with their political persuasion. The Republicans are predicting significant changes in both the House and Senate this fall. They sense real anger. I saw a liberal commentator predict that the Democrats will reap the benefit of the hoards of now grateful constituents, as if Obama and health care is the equivalent of Moses and manna.

So, I think it is time to call my shot. Everyone can be a genius in hindsight. Five years or so from now you will have the opportunity to tell me how wrong I was. I also realize that by taking a particular position and clearly extrapolating results from the recent activities of our President and Congress I will offend, or at the very least, anger, a fair number of my readers. Oh Well. I apologize, in advance, if I anger or offend. Feel free to give voice to your feelings in the comment section. I just ask that you remain civil and to remember that I have readers of all ages.

Rules to live by:
• There are no accidents
• Insurance executives are very smart people
• Insurance companies must balance their books
• Horse-trading is necessary to pass legislation
• If the above is true, then the end justifies the means

It is my belief that the ultimate goal of the Congressional leadership and the President is to have most Americans insured by a government run program and that this legislation is a major first step in that direction. It is also my belief that the major insurance companies are totally onboard.

Is that good or bad? My opinion doesn’t matter. I think the fix is in and our job will be to learn how to game the system.

I know. I know. You’ve seen the political shows where Democratic strategists talked about the insurance company windfall – 32 million new clients. What a bunch of malarkey. The young and healthy can already get cheap health insurance. They don’t need an act of Congress. The young, healthy and lazy can also get cheap insurance. Their moms call my office all of the time. Who we are about to get are the unhealthy. The initial batch have to be both unhealthy and uninsured for over six months. Since the federal government is unprepared, these unhealthy people will be funneled, initially, to the same state high-risk pools they have already avoided. The federal government has set aside 5 billion to help cover them. The insurers, recently forced by states like Ohio, to reduce the premium for their high risk clients, will simply have more losses to be shifted to the healthy population’s policies.

You may have noticed that Massachusetts refused to allow any insurance company price increases. Massachusetts is important. They are about five years ahead of the rest of us. The combination of new taxes on insurance companies, new policy requirements, and the removal of underwriting GUARANTEE HIGHER PRICES. This is very important. There are very few provisions in the legislation to limit or control the cost of health care. Since insurance is nothing more than a middleman, a negotiator, and a paper shuffler, the price of insurance is directly attributable to the cost of care. If the price of care increases unabatedly, the cost of insurance must also increase. Add in maternity and other desirable coverages and you have a hefty jump in price. This is not an accident.

As the price increases, Washington will fan the flames of discontent, blaming greedy insurers for the pain the consumer is feeling. There could be only one solution – The Public Option. If will be at that point that President Obama et al will be forced to create this alternative. Underpriced and underfunded, the public option will gain ground as the insurers reluctantly leave the market.

Why would the insurers, the Anthems and United Health Cares, be in favor of this? What do insurers do well?
• Manage risk
• Shuffle paper

Individual and small group health insurance are crappy businesses. There is lots of exposure, tons of paperwork, and a distribution system that demands way too much service. They are incredibly inefficient. If the eventual public option looks anything like the Swiss cheese we call Medicare, there will be a fortune to be made in SUPPLEMENTS. Low risk, controlled exposure, and sellable from phone units, online, and in the mail, supplemental policies are very profitable.

The federal government would be forced to contract with the major insurers to process a new mountain of paperwork. Pure profit. The contracts would be on a cost plus basis.

The final profit center for the major insurers will be for those people who wish, with the aid of private insurance, to opt out of the government system. This grouping of new products will not be price sensitive and should be particularly profitable.

The final legislation to make all of this happen will mirror the Medicare Part D debacle. Did the Republicans who pushed through Med D really care about doughnut holes or that my clients would be paying more for their medications? Of course not. Did they know that the legislation was a goldmine for the pharmaceutical industry and the major insurers? Probably not. Nor do I think that they cared. The Republicans had a goal, six years ago, to run on a new entitlement for senior citizens. They certainly weren’t going to let a little horse-trading get in the way. Expecting anything different from our Democratic leadership is unreasonable.

The end will justify the means. I am positive that most involved will feign total surprise at the outcome. They may even claim, facetiously, that they were forced by the market to act.

Again, is this good or bad? I don’t know. I am offended by the lack of honesty that I perceive. If this really is such a good idea, sell it. Go before the American people and tell us why we need to go in this direction and how we will pay for it. Since that didn’t happen, I doubt that the outcome will be all that great. Of course, any major political change in the next two years could negate all of this. That wouldn’t guarantee better outcomes, just a different cast of characters and results.

I gripped my sand wedge, swung as hard as I could, and lifted the ball up through the branches. I didn’t quite get over the tree as much as I got through it. The ball landed in the fairway just before the green.

Got to call your shots. Got to tell people what you really believe.

DAVE

www.bogartcunix.com

We Can Always Count On Florida

2010-04-06T14:02:00.000-07:00

Health Insurance Issues With Dave has been on a self-imposed hiatus. Two and a half weeks with no posts. This was my small attempt to lower the noise level. The country appeared to be suffering from health care fatigue and I decided to be part of the solution as opposed to being a part of the problem.

I’m back. I simply can not resist writing about Dr. Jack Cassell and Congressman Alan Grayson. Everything you need to know about the recently passed health care legislation is contained within the story of these two gentlemen. And yes, to tell the whole tale we need both of these otherwise well-educated, bright guys who suddenly turned stupid once they became infected by the health care debate.

Dr. Jack Cassell is adamantly opposed to the recently passed health care legislation. Why? Who knows? Could be on general principle. Could be because Congress failed to “fix” Medicare again last week and specialists, like urologist Dr. Cassell, are facing a 21% cut in reimbursements from the federal government. As I said, who knows. In an effort to share his displeasure, Dr. Cassell posted a typewritten note that read: "If you voted for Obama, seek urologic care elsewhere. Changes to your healthcare begin right now, not in four years."

Tacky? You betcha. A little heavy handed? Sure. But is it really a big deal? I don’t think so. First and most importantly, we still have a secret ballot. He isn’t asking people to tell him who they voted for in the election. He has no way of knowing whether the patient voted for the Democrat, the Republican, or failed to participate in the election process. Sure his waiting room is littered with Republican pamphlets detailing one side of the debate. But, this is still the United States. If you don’t like his politics you have every right to find another doctor.

My daughter Jennifer was born twenty-nine years ago this month in Saint Elizabeth’s Hospital in Youngstown, Ohio. St. E’s was the best hospital in the area and Jen’s mom had had problems in the past. Every single room in this Catholic hospital had a crucifix on the wall. Hope was in there for two days. Frankly, we found the wooden statues on the walls a bit disconcerting. But we didn’t make a fuss and we didn’t ask them to take them down, not even in our room. If you wanted the doctor and the facility, the religious decorations were part of the deal.

Of course, Dr. Cassell couldn’t keep this discussion at that high a level. “I think there’s a real, real problem that’s going on here in this country and unfortunately Obamacare fatally compromises my ability or any doctor’s ability to uphold the Hippocratic Oath.” Not enough hyperbole for you? How about this gem of a sign he posted above a stack of Republican literature describing the bill? "This is what the morons in Washington have done to your health care. Take one, read it and vote out anyone who voted for it."

If you are keeping score, we have doctors who won’t be able to properly treat their patients and the morons responsible. Would the other side laugh at this silliness and let the whole issue disappear within a couple of days? Of course not.

First to weigh in was Dr. William Allen, a professor of bioethics, law and medical professionalism at the University of Florida’s College of Medicine. A man with a great bio but no patients and who will not be immediately impacted by the changes in the law, Dr. Allen is quoted as saying that even though Dr. Cassell hasn’t turned anyone away and hasn’t even quizzed his patients, he is still “pushing the limit”.

Pushing the limit? Our friends on the left were hoping for a stronger rebuke. Who could be counted on to take this to the illogical extreme? The safe bet in Central Florida is Orlando Democrat Alan Grayson. He is remembered for this constructive remark about the Republican’s program from last summer, “If you get sick, America…Die quickly.”

Congressman Grayson appeared on Countdown With Keith Olbermann yesterday evening. I skipped the Duke / Butler game to watch the two of them harrumph over Dr. Cassell’s sign. Grayson did not disappoint. He planned to complain to every medical board and government authority available. In the original Orlando Sentinel article Congressman Grayson is quoted as saying, “Maybe he thinks the Hippocratic Oath says, ‘Do no good.’ If this is the face of the right wing in America, it’s the face of cruelty…Why don’t they change the name of the Republican Party to the Sore Loser Party?”

And that is the whole issue with the other extreme. Those people who disagreed with this legislation, for whatever reason, are relegated to the “right wing”. We should all be grateful that the bill passed. We should get over it and move on. An excellent example would be the way so many of us in the middle and on the left got over it and moved on with our lives after President Bush declared Mission Accomplished and ended the war in Iraq. G-d knows Mr. Olbermann hasn’t mentioned it since. We should all model our future actions after his measured response.

Vice-President Joe Biden was correct. This is a big deal. It is huge. And yet, the details are in short supply and the costs seem to grow daily. The newest exaggeration comes from the Republicans who claim that the IRS needs to hire 16,000 more agents to monitor compliance. It is probably twice more than we actually need, but it really doesn’t matter. One side will use it as a rallying point while the other side will conveniently ignore that they haven’t properly funded any new agents.

And so it goes. We are still in campaign mode. The two extremes are scoring points and wasting our time and millions of dollars of our money. In a perfect world, Congressman Grayson would suffer a mild bladder infection the next time he is back in Florida and you know who would be on call that weekend. Not that I would wish for anyone to be sick, but they deserve each other.

And we deserve better.

DAVE

www.bogartcunix.com

Co-opted and Placated

2010-03-20T09:43:00.000-07:00

Dennis Kucinich is very good at being Dennis Kucinich. An acquired taste, Dennis never pretends to be anyone but Dennis. I’m not a big fan and I seldom agree with him, but I respect his unrelenting desire to fight windmills. The Cleveland Plain Dealer carried an op-ed piece written by Congressman Kucinich on March 14, 2010 that was vintage Dennis.

Congressman Kucinich is a strong advocate of a single payer health care system. He is not bashful about this. His distrust of insurance companies in 2010 rivals his love affair with the banks and CEI in the late 70’s. He is nothing if not consistent. As a leading member of the Progressive Caucus of the Democratic Party, he added numerous amendments to the House’s health care bill that would have pushed our country in a direction most of us would want to avoid. As his extreme measures were stripped from the bill, he and his fellow Progressives swore that they would not vote for any bill that failed to include a strong public option.

We’ve discussed the public option several times over the last year. There is little need to revisit the weakness of this concept again in this post. What is relevant today is Congressman Kucinich’s adamant opposition to the poorly written bill passed by the U.S. House of Representatives and the unrestrained vitriol he unleashed on the hodgepodge that emerged from the Senate.

As President Obama and Speaker Pelosi rushed to find 216 votes to pass the Senate bill in the House, Congressman Kucinich suddenly became relevant. The Today Show and other morning broadcasts, the Sunday new shows, and the weekday opinion programs all discovered Dennis. Congressman Kucinich was going to vote NO, even if he was the deciding vote. Fox News and Michael Moore (!) applauded his gumption, though for entirely different reasons. Democratic Party leaders rushed to Countdown with Keith Olbermann and the Rachel Maddow Show to declare that Dennis Kucinich led a group of one. They sneered at his presidential runs and other solitary crusades.

What a difference a plane ride makes. President Obama visited Strongsville this week. Several local members of Congress got a ride from Washington aboard Air Force One. Air Force One, the magic plane. Do you remember the Newt Gingrich melt down after Bill Clinton gave him a ride on AFO? Dennis didn’t have a chance. By the time the plane landed, Congressman Kucinich was UNDECIDED. His move to YES was a forgone conclusion. Now cited for his leadership just a week after he was dismissed by the party’s chiefs, Dennis Kucinich was co-opted. It turns out that some strongly held positions are no match for a really cool plane ride.

My representative in Congress is Marcia Fudge. Many of my fellow insurance agents have contacted their Congressman. Most of my clients are small business owners and some of them have tried to talk to their representative. I know that other chamber of commerce presidents have called Congress. Not me. I resisted calling Congresswoman Fudge as a constituent, agent, business owner, or even as President of the Beachwood Chamber of Commerce. Why? There didn’t seem to be any reason to waste the time. Marcia Fudge’s vote was never a doubt. I couldn’t see any value in the exercise and I didn’t want to get aggravated.

I can’t explain why, but I changed my mind on Monday. Maybe it was Dennis’s conversion. Perhaps it was the mindless attacks on my industry or my disdain of smoke and mirrors. Whatever the reason, I finally contacted Congresswoman Fudge’s office on Tuesday. I spoke with legislative aide Beverly Charles.

I started our conversation by establishing my Democratic Party bona fides. Regular readers of this blog know that they are extensive.

I asked Ms. Charles a very simple question. “What is Congresswoman Fudge’s position on the health care legislation?” I was told that she was UNDECIDED. I was surprised. I talked with Ms. Charles for about thirty minutes. She was fully versed in the Speaker’s talking points. Her knowledge on the subject appeared to be a mile wide and an inch deep. She emailed her thanks the next day. I offered this blog and the opportunity to meet in person to provide more useful info.

Was Congresswoman Fudge really UNDECIDED? Absolutely not. According to the New York Times and Doctors for Health Care Solutions, she had already made her decision. DOHCS had been asked to have 75 members, all wearing white lab coats, to appear on short notice to serve as stage props when Marcia holds her press conference. This assumes that she gets a press conference. Since she was always counted as a YES, her announcement is hardly news. But my question is does Ms Charles know as much about her boss’s position on the issue as she does about this legislation, or was I simply being placated? I think we know the answer.

President Obama asked Congress for Courage at this week’s pep rally in Strongsville. There has been very little courage exhibited by this Congress.

No Short Cuts

2010-03-10T08:10:00.000-08:00

In “Dreams From My Father”, future president Barack Obama introduces his readers to his entire family. We meet both of his grandfathers, Stanley Dunham of Hawaii by way of Kansas and Hussein Onyango Obama of Kenya. We learn how these two men influenced both him and his father. The central theme of the book was about making your own way in the world, a task made more possible with hard work and clear thinking. Every corner cut resulted in failure. Every job done well led to greater success. I just finished the book while on vacation. It was terrific.

In fact, the book should be read by lots of people. I’m going to give my copy to my girlfriend’s son, Alec. Someone else who should read the book, someone else who might benefit from the lesson on “Dreams From My Father” would be the guy who wrote it, Barack Obama.

President Obama was on TV again this morning. The news was showing a clip from yesterday’s pep rally. Can’t tell you where this one was. They all look alike. The president rails against the evil insurance companies. The President complains about insurance company rate increases. Someone is brought up to cry about losing his/her insurance after getting sick and getting dropped for not paying the premium. The solution to all of our problems is to pass the BILL. Crowd cheers. Cut to commercial.

Will someone please call Barack Obama? We need the young, brilliant, hard worker to push aside our current president. We need real leadership, not just on this issue, health care, but on jobs, finance reform, national security, and all of the other major issues of our time. Right now we have slogans and scapegoats. We are cutting corners and racing towards disaster.

I’ve been busy this week and have only seen bits and pieces of Countdown with Keith Olbermann and the Rachel Maddow Show. Both had guest hosts. Here is what I saw and what you may have missed:
1. Dennis Kucinich (D-OH) said “The insurance companies are the problem”.
2. Dr. Howard Dean said “The insurance companies are the problem”.
3. Bart Stupak (D-Mi) is leading a group of 12 anti-abortion fanatics.
4. Diana Degette (D-Co) leads the Pro-Choice Caucus, 190 strong, who won’t give up any more ground.
5. If the BILL doesn’t pass, it will be all (fill in the blank)’s fault.
6. Liz Cheney is so much like her father, even Kenneth Starr is repulsed. (Nothing to do with health care, but truly weird and interesting.)

We are contemplating the overhaul of nearly 20% of our economy and the participants are locked in their little battles, digging in their heels, and shouting out their slogans. No matter how many of these shows you watch, you will never learn how we are going to provide health care for 300+ million Americans and, more importantly, how we are going to pay for it. Really. Taxes that kick in eight years from now aren’t real. Creating massive changes and hoping that the good stuff, the parts you like, aren’t impacted is simply childish.

WWOD? What would Obama do? Maybe the real question is what would the real Obama do? The guy from the book might have, like his father before him, first tried to just bluff his way through the battle. But once he encountered a set-back or two, the book’s Barack Obama would have realized that he needed to fully apply himself to the task. He would have succeeded by out-thinking and out-working his opponents. He would have built a consensus and found a feasible solution to our health care morass. Not a plan that merely sounded good, but one that actually could succeed.

We’ve seen the bluffs, the set-backs, and the short cuts. The guy demonizing the insurance companies isn’t going to get the job done. Now is the time for the other Obama to emerge. The one we elected. The one we, as a country, need.

DAVE

www.bogartcunix.com

It's Alive

2010-02-18T13:33:00.000-08:00

Time to grab the pitchforks? Are the torches ready? No. No. No. The monster is not at our gates. For the moment, it is but a rumor.

Once again, Keith Olbermann is touting the Public Option. Eleven, count ‘em, eleven US Senators want to put the Public Option back on the table and then pass it by reconciliation. Who are these eleven senators? Please, you already know.

Which US Senators make up the reliable left, the team that can always be counted on to see only one side of every issue? Let’s say them together in alphabetical order:

Michael Bennet (D-CO)
Sherrod Brown (D-OH)
Roland Burris (D-IL)
Diane Feinstein (D-CA)
Al Franken (D-MN)
Kirsten Gillibrand (D-NY)
John Kerry (D-MA)
Pat Leahy (D-VT)
Jeff Merkley (D-OR)
Bernie Sanders (I-VT)
Sheldon Whitehouse (D-RI)

To be fair, there are an equal number, or possibly even more, US Senators who are incapable of seeing anything but the other side of every issue. The reliable right is just as much a problem as the above group.

Mr. Olbermann and guests quickly delineated the problems with our current health care system. There are a large number of uninsured and underinsured Americans. All problems would be resolved with the Public Option. Can’t you just imagine it? As it is currently designed, the Public Option will lower the deficit, cover the masses, cure cancer, and guarantee that your home team will win the World Series.

Cue the movie clip. Details? We don’t need no stinking details. OK, enough fun, back to work.

There are no details, no real numbers, no real world plans. My past post provided a comprehensive explanation of the specific benefits of Medicare, a program designed to pay most, but nowhere near ALL, of the costs of medical care. A plan that does not cover prescriptions, a senior citizen with just Medicare is woefully underinsured. Yet with all of these holes, Medicare is still underfunded. Before we create a new Public Option, shouldn’t we first fix the current one?

The Rachel Maddow Show follows Count Down with Keith Olberman on MSNBC. Her thrust was that there was no reason to worry about the Republicans. The other party is simply not going to help. Unfortunately, she may be correct. One can spend all day listing the flip-flops of Senators as esteemed as Orrin Hatch and Charles Grassley. The reconciliation issue doesn’t bother me.

I don’t mind the use of power. My concern is what the use of power gets us. Ms. Maddow’s guest last night was Senator Bernie Sanders. He was almost frothing at the mouth at the prospect of passing this massive change to our health care system by a simple majority. He was shouting out his wish list for other reforms that could be attached to the bill. Why stop at health care? In less than two minutes he offered education reform (more $), housing reform (more $), and, well you get the idea.

What was never discussed, two shows in a row, was a single detail about this mythical Public Option. Can such a plan really work? Who knows? But if it would guarantee an Indians World Series victory, I want to hear more.

DAVE

www.bogartcunix.com

The One Year Anniversary of Health Insurance Issues With Dave, and yes, Anthony Weiner Still Hates Me

2010-02-05T11:57:00.000-08:00

Today marks the first anniversary of this blog. Please allow me to again thank Brad Kleinman and David Toth of WorkSmart for teaching a class on eMarketing and social networking for the Beachwood Chamber of Commerce last January. Their motivation and the wonderful feedback I receive from you, my readers, keep me excited about producing these posts.

On September 21, 2009 I posted an article entitled Anthony Weiner Hates Me. Mr. Weiner is a Congressman from New York City who is entirely convinced that insurance companies are an unnecessary drain on our system. He has preached from the alter of single payer government run health plans on the Rachel Maddow Show, Countdown with Keith Olbermann and the Huffington Post. Mr. Weiner even shows up on the Sunday morning shows every now and then. His extreme views make for good television. Congressman Anthony Weiner was on the Daily Show with Jon Stewart last night.

Anthony Weiner and Jon Stewart have been friends for a long time. How long? Half the interview was dedicated to the threat of exposing incriminating photos from the 1980’s each still had in his possession. That was the interesting part of the interview. The rest? Nothing terribly new.

Realizing that he didn’t have a lot of time, Mr. Weiner spoke in bullet points.
• Medicare is a single-payer system that works.
• We should extend Medicare to people 55 and older. Why start at age 65?
• We should extend Medicare as an option to recent college graduates who are no longer covered by their parents’ policies.
• We should extend Medicare as an option to people who have lost their jobs.
• Medicare has a 1% overhead vs. the insurance companies at over 30%
• We should cap what insurance companies can charge.

Somewhere in this tangle of talking points, Mr. Weiner stopped to take a breath. And here is where the friendship, or the pictures from the 80’s, paid off. Jon Stewart didn’t challenge any of his friend’s assumptions. He allowed this fact-free, totally unsupportable, completely unrealistic presentation to proceed. Jon Stewart, someone unafraid to confront, intellectually, Jim Cramer and Keith Olbermann, devolved into the Memphis Grizzlies defense and watched LeBron James drive to the hoop. Mind you, I wasn’t looking for a hard foul (continuing the basketball metaphor), but I would have appreciated an attempt to protect the basket, or truth.

This blog has dealt with the good and bad of Medicare numerous times. I’m not sure you have the patience to reread much of that. It is still vitally important to note that Medicare does serve a purpose. Medicare is an important part of our current mish-mosh of payers. And of course, anytime the government is involved in writing checks, a lot of what services are, or are not, available are determined by Washington. But Medicare was never designed to pay all the costs of health care for anyone.

Let’s talk about the specifics of Medicare. It wouldn’t be fair, easy but not fair, for me to cherry-pick this. So this is what Medicare really does and doesn’t cover.

PREMIUM – $110.50 per month, assuming you make less than $85,000 per year.

MEDICARE Part A

Semiprivate room and board, general nursing, and miscellaneous services and supplies:
First 60 days - You pay $1,068
61st day through 90th - You pay $267 per day
91st day and after while using
Your 60 lifetime reserve days - You pay $534 per day
Thereafter - YOU PAY EVERYTHING

Skilled Nursing Facility Care
You must meet Medicare’s requirements, including having been in a hospital for at least three days and entered a Medicare-approved facility within 30 days after leaving the hospital.
First 20 days - You pay $0
21st day through 100th day - You pay $133.50 per day
101st day and after - YOU PAY EVERYTHING

Blood
First three pints - You pay everything
Additional amounts - You pay $0

Hospice Medicare pays for all with very limited coinsurance
For outpatient drugs and inpatient respite care

MEDICARE PART B

Medical Expenses – In and out of the hospital and outpatient treatment such as physician’s services, inpatient and outpatient medical and surgical services and supplies, physical and speech therapy, diagnostic tests and durable medical equipment,

First $135 of Medicare approved amounts - You pay $135
Remainder of Medicare approved amounts - You pay 20%

Part B Excess Charges, the amount above
Medicare approved amounts YOU PAY EVERYTHING

Blood
First three pints You pay everything
Next $135 of Medicare approved amounts - You Pay $135
Remainder of Medicare approved amounts - You pay 20%

Clinical Laboratory Services - You pay $0

Home Health Care
Medicare approved services
Medically necessary skilled care
Services and medical supplies - You pay $0
Durable medical equipment
First $135 of Medicare approved amounts - You pay $135
Remainder of Medicare approved amounts - You pay 20%

Foreign Travel - YOU PAY EVERYTHING

Sorry, there was no way easy way to explain this policy. Above are the basics, the shell. What does this really mean?
1. There is no prescription coverage.
2. There are huge gaps as to what is and isn’t adequately covered.
3. People who rely strictly on Medicare are woefully underinsured.

How underinsured? A study released today at the fifth annual
Community Oncology Conference in Scottsdale, Arizona clearly states that “Medicare covers only 56% of the actual costs of administering chemotherapy and providing related infusion room services to seniors with cancer”. We have already discussed how Medicare has reduced the payments to medical providers. According to the report, Mr. Weiner’s favorite single payer has reduced the payments for cancer drug infusion room services by over 25% since 2004. Are the doctors silently bearing these reductions? Are you and I paying more for these and other services as the cost for care is shifted, more each day, to those of us with private insurance?

There were lots of other holes in Congressman Weiner’s presentation. I appreciated that he has now reduced this imaginary overhead expense for Medicare from the unlikely 4% that he had claimed last summer to the impossible 1% of last night. But I know that this is already too long.

There was one saving grace to Congressman Anthony Weiner’s appearance on the Daily Show. When asking Mr. Weiner about his Mayoral ambitions, he wondered aloud whether Michael Bloomberg could have been defeated. Without hesitation Mr. Weiner opined “I would beat him like a rented mule”. See, I’m not the only person Anthony Weiner hates.

DAVE

www.bogartcunix.com

I Don't Quit

2010-01-28T09:24:00.000-08:00

A threat? A promise? President Barack Obama ended his State of The Union speech with a clear statement of his personal resolve and optimism. He was forceful. He was clear. For one hour last night, Barack Obama was the guy who ran for the presidency last year. It was a strong performance.

How strong? The initial reaction on Fox News was subdued and restrained. MSNBC’s Keith Olbermann, Rachel Maddow, and Chris Matthews seemed reinvigorated and emboldened.

This blog, Health Insurance Issues With Dave, deals with one particular issue, health care, So what did the President say about our issue last night? The quick answer – not too much.

Thirty-two minutes into his speech, President Obama touched upon health care. He mentioned that he had gotten close to passing legislation. He noted that his plan was not politically popular. He admitted that they, he and the Democrats in Congress, had handled this badly. He acknowledged emerging trust issues. He dared the Republicans to offer alternate suggestions. But that’s it.

There were no specific goals. No mention of shared sacrifice. No direction. And in the end, at no point did President Obama take the time to explain what he was going to do to make changes in our health care system more possible, productive and palpable. He threw the ball back to Congress where the Democrats will muck it up and the Republicans will dig in their heels.

President Obama said that he won’t quit. Great. I don’t want him to quit. I want him to start.

DAVE

www.bogartcunix.com

Crossing The Line

2010-01-14T17:11:00.000-08:00

“They’re doing it behind closed doors!” roared Susan Robinson. “Did you hear Nancy Pelosi say that the promise of transparency was just campaign talk?”

A lifelong resident of Bay Village, a lifelong Republican, Susan Robinson (yeah, yeah, yeah I changed her name) registered as a Democrat in the spring of 2008 and voted for Hillary Clinton in the Ohio primary. It is one thing to cross party lines and to cast one’s ballot, in the privacy of the voting booth, for a member of the other party. Susan Robinson did more. She publicly self-identified as a Democrat. She has the junk mail to prove it. And now she is a sort-of Democrat, a sort-of Republican, and totally ticked off.

Disillusioned and betrayed, Susan Robinson and countless others voted for change. It was as if the voters approved Issue 6 to reorganize Cuyahoga County government and then installed Jimmy Dimora as the new chief executive.

The latest news, appropriately for this discussion leaked by a nameless Democratic official, is that the President, the Senate and the House may have reached a compromise on the plan to tax so-called “Cadillac” health plans. As always, the words compromise means that the House caved. The deal is that the tax would be on family plans that cost $24,000 per year instead of $23,000. The other part of the deal is that the employees of state and local governments and all union employees would be exempt until 2017.

Feel free to take a moment to reread the last sentence. Do you understand why a tax should apply to everyone but state and local government employees and members of a union? Neither do I. Will the law specify which unions are official skip the tax unions or will any old union do? Can we form our own unions? Can each of us create our own unique, self-contained, tax avoiding union?

We’ve now crossed the line from short-sighted and ill-advised to just plain dumb. Divisive, too.

Please, somebody tell me, what happened to helping the working poor acquire affordable health insurance?

DAVE

www.bogartcunix.com

Opposites Attract

2010-01-06T08:09:00.000-08:00

“Goals. Why do you keeping harping about goals, Dave? The President said that we are going to cover the uninsured, make health care affordable, and we can keep our current insurance. Aren’t those the goals?”

Those are goals. In that same vein, I would like to start each day with a smile on my face and a song in my heart.

Real goals, well defined and achievable, are in short supply. This past Sunday’s Cleveland Plain Dealer illustrated our current goal-less struggle.

Let’s begin on Page 5 of Section A. A Chicago Tribune story entitled “Health bills can sink even those insured” comes with a picture of a kindly older gentleman helping out at a Christmas pageant. Even though he has insurance, he is getting clobbered with the copayments from his prescriptions following his heart transplant. Forget the fact that what Mr. Fraas really needed was disability insurance because his real problem is a lack of income, the theme of the article can be found in this sentence: “Meanwhile, Fraas learned that even with good insurance, medical care can break a family’s bank.”

We have heard before how unfair it is for unhealthy people to also suffer financially. So it must be safe to say that one of our goals is really comprehensive coverage that totally protects a family, NO MATTER WHAT.

Not so fast.

On Page 2 of Section G that same Plain Dealer had “A less than-honest policy is taxing” written by New York Times columnist Bob Herbert. This editorial page article discusses one of the more controversial details of the recently passed Senate bill, the tax on so-called Cadillac health plans. An excise tax of 40% will be imposed on family policies that cost more than $23,000 per year and individual plans in excess of $700 per month.

The Joint Committee on Taxation projects that this tax will generate over $150 billion over the next ten years. How? The deep thinkers behind this scheme think that your boss will refuse to pay this tax, buy a cheaper insurance policy, and since he or she just saved so much money, you will get a raise! The government will collect billions of dollars in new income tax. You will be forced to migrate to a health insurance policy with higher deductibles and copayments. You will be forced to become a better consumer.

So our goal is to have consumers (us) pay more of our health care expenses?

What do Hollywood romantic comedies and bad legislation have in common? The plot lines always revolve around the theory that opposites attract. Just because I really enjoyed Bruce Willis and Cybil Sheppard in Moonlighting, doesn’t mean I can suspend my disbelief about this bill.

DAVE

www.bogartcunix.com

Nebraska

2009-12-31T13:03:00.000-08:00

Standing in line. I have been standing in line for over twenty minutes at the Beachwood Post Office, waiting for my turn, hoping to learn the fate of my missing mail. It is Monday, December 28th and there are only five of us in line. The women look inpatient, but remain silent. The guy in his late forties is visibly agitated. As more people join our line to see the one, and only, postal worker, Mr. Unhappy tells us that we should “get used to this. This is what life will be like once the government controls health care”.

How many times have we heard that refrain since Mrs. Clinton’s attempt at health care reform? Government Health Care will have the efficiencies of the Post Office with the compassion and customer service of the IRS! I think that statement is terribly unfair to the Internal Revenue Service. I have had to deal with the IRS, for my business, several times and found the agency professional and courteous. Seriously. The Post Office, however, can be a challenge.

The Post Office should serve as a cautionary example of what could happen if the government became too involved with the delivery of health care. How involved is too involved? I will have to leave that up to each of you. My personal opinion is that if we haven’t already crossed the line, we are probably very, very close.

At the top of this post I described the line at the Beachwood Post Office. The Post Office for 44122 is located on Green Road, about a block south of Chagrin Boulevard. Where is the Post Office for 44120? The SHAKER HEIGHTS Post Office is located on Warrensville Center Road, a few hundred yards south of Chagrin Boulevard, less than a mile away. Hell, the 44120 Post Office is located within 44122. The new Post Office was built while Stephanie Tubbs Jones was still alive and serving in Congress. It was placed next to the then Office Max Headquarters in the heart of a very powerful Congressional leader’s district.

You may be wondering whether 44120 really needed a separate Post Office or if one or possibly a few of these separate buildings could have been merged into one larger, more efficient structure. Surely you have guessed that the driving force was payroll taxes to the City of Shaker Heights and not the delivery of letters and catalogues. The more control government has in the actual delivery of health care, the more politicized it becomes. Is your representative powerful enough to make sure that there will be doctors’ offices near you?

“Dave, you’re being silly”, you scoff. “Congressmen and Senators would never exercise power that blatantly.” Ladies and Gentlemen, I give you Ben Nelson.

The Senate Democrats needed 60 votes to get their bill through. Technically, that meant that any one of them could have prevented passage. Technically but not really. Some, like our Senator, Sherrod Brown, were going to vote for this bill no matter what. They had no position to bargain.

Joe Lieberman was one of the first to stand up. He said that he wouldn’t accept a bill that had a Public Option. He wasn’t the only Senator. He was just the one who took the heat. Because he was willing to take a leadership role, he got his deal. Ben Nelson, coming from Nebraska, was willing to take the very public position of opposing any bill that might use taxpayer money to pay for abortions. Again, he wasn’t the only Democratic Senator who would have voted NO. He was the one willing to take the heat. For this he got the promise of millions of dollars. His fellow Senators offered to pick up the tab for Nebraska’s Medicaid bill. Poor people in Omaha may one day owe their free health care to the residents of Parma.

The Republican state attorney generals will eventually threaten to sue the federal government. I suspect that several Republican governors will also make noise. I really don’t think it matters since I doubt that the Nebraska deal clears the conference committee. But this is the start.

My letter carrier was on vacation and I may, or may not, start to receive all of my mail soon. One of the pieces of mail I may have missed was how our Congresswoman and Senator are bringing jobs and programs to our district. I’d sure like to see the report Ben Nelson sent to his.

DAVE

www.bogartcunix.com

Imagine My Disappointment

2009-12-23T16:08:00.000-08:00

My one and only trip to Washington DC was about twenty years ago. This is odd for someone as politically active as me. I was attending a B’nai B’rith national policy conference. What a trip! I had the opportunity to tour the White House and Senate, visit the Lincoln Memorial and Washington Monument, and talked, one on one, with several Senators. But the most inspiring person I met, the guy who made the biggest impression, was one of the featured speakers, the young Ohio Secretary of State, Sherrod Brown.

I have been a Sherrod Brown fan for twenty years. And now I am truly disappointed.

OK, Sherrod Brown and I do not see eye to eye on the health care debate. That’s not news. What is shocking, at least to me, has been the way he has argued his case. I expected more from Sherrod Brown than the factless, emotional presentations of late. This Sherrod Brown plays well to most of Rachel Maddow’s audience. He appears on her show and Keith Olbermann’s Countdown to feed the base. No Problem. Sunday, December 20, 2009, he was on Face The Nation, the venerable CBS show. It was a cringe-worthy presentation.

Bob Schieffer, the moderator of Face The Nation, tries to give his guests enough time to talk in complete sentences. Used to speaking snippets and catch phrases on television, many politicians falter when given the extra time. Senator Brown must have misplaced his index cards. He kept on talking about the evil insurance companies charging women more than men. He also briefly mentioned that age is also a pricing factor, but quickly retreated back to gender.

I touched on this very subject in my October 19th post. In the past I would have wished that Mr. Brown had seen my blog. Now I’m not so sure that it would matter. Will Sherrod Brown let the facts get in the way of a good argument?

I had a client contact me today. She was worried that her health insurance policy was all screwed up. After watching TV, she couldn’t understand why her premium was substantially less than her husband’s even though he is four years her junior. Her policy is fine, it is our politicians that are screwed up. So I ask for your patience while we discuss a real issue with real numbers.

Case Study #1
Bob and Jane are healthy 21 year olds living in Cuyahoga County. They are both single, non-smokers, and have clean driving records. They need to purchase liability auto insurance from their neighborhood Erie Insurance agent. I wasted a half hour of Brian Ritzenberg’s time. They also need a basic health policy from Anthem Blue Cross with a $1000 deductible, office visit copays and an Rx card. And while they are at it, they are each going to purchase a twenty year term policy for $250,000 from North American. Auto, Health, and Life Insurance. Nothing out of the ordinary.

Bob
Auto - $731 per year
Health - $123.45 per month
Life - $217.50 per year

Jane
Auto - $630 per year
Health - $157.54 per month
Life - $205 per year

The price of insurance reflects the risk. Young men have more accidents. They pay more for auto insurance. Young women have more medical claims. They pay more for health insurance. Some young women may need to purchase their own health insurance. Almost all young women, at least here in Northeast Ohio, drive.

Case Study #2
Joseph and Pamela are healthy 61 year olds living in Cuyahoga County. Everything, including the amount of time I wasted of Brian’s, is the same as above except for their ages.

Joseph
Auto - $358 per year
Health - $539.64 per month
Life - $1960 per year

Pamela
Auto - $358 per year
Health - $515.66 per month
Life - $1550 per year

Life insurance is less expensive for adult women, young and old. Auto insurance is the same price or less for women at every age. Health insurance is sometimes less, sometimes more. With all of the online rating services, anyone can recreate this little test from the comfort of their home or office. In other words, you know that Senator Brown’s argument is specious at best.

We have almost a year invested in this process. That means that I have been sitting here for twelve months waiting for the Sherrod Brown I met in Washington twenty years ago to show up. The current Sherrod Brown is no longer inspiring. Imagine my disappointment.

DAVE

www.bogartcunix.com

Built By Committee - Designed to Fail

2009-12-15T14:32:00.000-08:00

Senator Harry Reid is fighting a deadline. The President may have wanted a bill before Labor Day, but they want ice water in Hell, too. Reid, the pragmatist, knows the real target, December 31st. The last thing he wants is to be holding a hot potato of a health care bill in January, or worse, February.

Senator Reid has a problem.

Regular readers of this blog know that I have been asking one question from the start, What is our Goal? It is unfortunate that even though our political leaders may not have had well defined, easily explained goals, they all had solutions. Creating questions to given answers is the basis of the television show Jeopardy! Creating legislation to preconceived answers puts all in jeopardy.

It is hard to describe the pending legislation as health care reform. In fact, it is not even insurance reform. The current bills appear to reposition the government’s role in the payment of health services. Based on the numbers coming from the Congressional Budget Office, some critics think that this is just Washington once again proving that it can turn wine into water.

Let’s take a quick look at a few of the issues:

PUBLIC OPTION – Previous blogs have dealt with this particular issue. If nothing else, the Senate does not have 60 votes to pass a bill containing a Public Option.

MEDICARE OPENED TO PEOPLE AGE 55 TO 64 – This idea had a two minute life span. Nancy-Ann DeParle, the director of the White House Office of Health Reform, is quoted in the December 12th Plain Dealer. “Let me be clear, it’s not adding 55 year olds to Medicare.” If this is only Medicare-like coverage, it is really the Public Option. Please see the above.

ABORTION - Once you get the government involved, really involved, in the delivery or payment of health care, abortion is almost always the first serious question. Conservatives, Democrats and Republicans, won’t allow federal money to pay for this procedure. Liberals want to pretend that they won’t back down. Again. Couples suffering from infertility issues want to insert coverage for in-vitro into this discussion.

NEW TAXES AND FEES #1 – The pharmaceutical industry thought that it had a deal with President Obama at a very fudgeable $80 billion. The House of Representatives passed a bill that would hit the drug makers for $140 billion. The Senate’s version has yet to be released.

NEW TAXES AND FEES #2 – The Senate has proposed a new, non-deductible, tax of $6.7 billion a year on the health insurers. The easiest way to make health insurance more affordable is to add huge new costs to the health insurance companies. Makes perfect sense. To Congress. You and I might also wonder if, as the President suggested, the purpose of a Public Option was to give the insurers real competition. The best way to compete? Give the insurers huge new taxes.

NEW TAXES AND FEES #3 – The Senate has proposed a new tax on cosmetic surgical procedures. The bill currently includes a 5% tax on tummy tucks, facelifts, etc… This is a tax on medical procedures that are not usually covered by insurance. The doctors are howling. Their first line of defense is to note that the majority of these procedures are performed on middle class women with an average income of $30,000 to $50,000 per year. The second line of defense will be to add that other elective procedure, abortion, which should end the conversation.

NEW REDUCTIONS IN MEDICARE PAYMENTS - The Senate bill anticipates significant cost cutting at hospitals and nursing homes. They are so sure of this happening that they are lowering Medicare payments now. We already have Medicare’s underpayments shifted to those of us with private insurance. Reductions in Medicare reimbursements simply mean more costs shifted to us which just means higher insurance premiums. The Government’s Centers for Medicare and Medicaid Services (CMS), according to that same Plain Dealer article, states that the other option from these cuts will be the forced closing of about 20% of these institutions.

Today is December 15th, nine days till Christmas Eve. Can Reid deliver a bill for Christmas? If the President and the Democrats, and at this point it is a one party bill, enact legislation, the Republicans will have a winning campaign next fall. If legislation is blocked by the Republicans, the President and his party can paint the opposition as obstructionists who were too busy saying “NO” to help solve the problems of average Americans.

Considering how awful this legislation is, will Senator Reid win now and lose next November or has he already realized that the reverse, losing now and winning later, is much better? Is this program designed to fail?

DAVE
www.bogartcunix.com

Laying In The Gutter? It's My Fault!

2009-12-03T12:11:00.000-08:00

“It’s the insurance company’s fault that there are drug addicts walking the street.”

I did not know that. I needed the twenty year old junkie to explain this to me. After alienating her parents and step-parents, dropping off their coverage even though she is a full-time student, and suddenly getting married, she was surprised that insurance companies weren’t standing in line to welcome her in their warm embrace.

Of course, she was in my office for over a half an hour before she finally told me the truth. Thirty one years in this business has to be worth something. I could tell, I could feel that there was more than what she was disclosing. Bit by bit she released more information to me. It wasn’t until I had begun a pre-screen application that she dropped the bomb, her fourth on-going medication was an opiate blocker that costs $900 per month!

Forget everything but the math for a second. She wants to be allowed to pay $100 per month to Anthem Blue Cross so that the insurer can buy her $900 drug and three other medications. Shockingly, Anthem, Medical Mutual, et al… said “No Thanks”.

It was at this time that she informed me that her addiction is “genetic, like cancer”. Her mother is an alcoholic, so it is natural for her to have been hooked on heroin and methadone. “It is a disease. That’s what you learn at Alcoholic’s Anonymous.”

She spent an hour and a half in my office alternatively complaining about her parents who don’t want to have anything to do with her and the insurers who don’t want to have anything to do with her. She has options. Unwilling or unable to make the calls, I grabbed my phone and contacted her previous insurer, her mother’s employer, and went online to research the local university's student policy. She can be covered, but it will take some time and effort on her part.

She will not be covered.

Which part is more frustrating, the self destructiveness of the drug addiction of a teenager or the delusion that someone else is to blame for one’s behavior; the refusal to take the necessary steps to solve one’s problems or the anger that there are lifelong consequences for one’s actions? She sat there whimpering while I tried to solve her most immediate problems.

Will any of the proposed changes in Washington solve her problems? NO! Even if we have a policy that would take everyone and provide any known pharmaceutical remedy, there is no guarantee that she would even sign up. More importantly, Congress is incapable of passing a law that would force Americans to take responsibility for their actions.

DAVE

www.bogartcunix.com

By the way, Jeff Bogart,my business partner, and Michael Saltzman, my attorney, went ballistic when they read the original post of this blog. So I have made a couple of key changes to completely hide the identity of the man/woman subject of this story. I guess you can't be too careful.

The Public Option

2009-11-24T15:52:00.000-08:00

Office space was at a premium in East Podunk, Kansas. Approximately 90% of the buildings were occupied on any given day. The building owners were getting fat and sassy. There was no need to reinvest or renovate their properties. At least, that’s what the mayor was saying. How could the mayor and city council solve this problem?

The mayor of East Podunk convinced the city council to strengthen the zoning laws. The new regulations were a hassle, but the building owners quickly adapted, made the required renovations, and profitably passed the costs to their tenants. Rents went up. The mayor seethed.

An office in East Podunk, Kansas carried a certain cache. It also carried a heavy price tag. The mayor heard the complaints. None of the councilmen worked in East Podunk, not even the ones who owned their own businesses. Something had to be done to make East Podunk more affordable without reducing the quality of the office space. How could the mayor keep the building owners honest? The landlords needed competition.

East Podunk, Kansas needed a public option.

The city of East Podunk purchased a building and began to compete with the landlords. The building owners immediately noticed:
1. Their new competitor, the government, owned a building that couldn’t pass the new code.
2. Private businesses must build property tax, snow removal, and other maintenance costs into their rent. The city did not.
3. Private businesses pay property taxes which benefit the schools. Again, the city did not.
4. The city fathers of East Podunk, embarrassed by the prospect of a large empty building, cut any deal to find tenants.

Yes, the city of East Podunk succeeded in keeping the building owners honest. Honestly mad. Governments can compete, one city or one state versus another, but they don’t compete with businesses.

Building owners? Health insurance companies? You can change the names. You can change the venues. What won’t change is the behavior of government entities with too much money and too little talent.

We all live in East Podunk, Kansas.
DAVE

www.bogartcunix.com

By the way, I heard from a lot of people who wanted to post a comment to one of the last few blogs. I am trying to see if there is an easier way. My offer still stands. You may email me at thecunix@bogartcunix.com and I will post your comment for you.

Just Enough Research

2009-11-13T11:29:00.000-08:00

79.3% of all statistics are created at the moment of citation. (margin of error +/- 4%)

Last Sunday’s Cleveland Plain Dealer reprinted a New York Times column written a few days earlier by Nicholas Kristof. Forum section. Page 2, directly beneath the Darcy cartoon. The great thing about appearing on the Opinion Page is that reporting and facts are optional. Mr. Kristof is convinced that our health care pales in comparison to the incredible medicine practiced in Canada, Great Britain or even Slovenia.

I was about to put this article away in favor of a better use of my time, Sudoku, when I saw the claim that Canadians live longer than Americans (his word, not mine) after a kidney transplant. That got my attention.

Regular readers of this blog know that I am not going to disparage the Canadian health care system. I’m not a huge fan, but there aren’t Canadians dying in the streets. So, is post-kidney transplant care significantly better in Canada than here in the US? Possibly, but it just seemed too easy. I had the feeling that Mr. Kristof did just enough research.

Let’s start with the source of this information. Mr. Kristof doesn’t cite his source, but a quick GOOGLE search turns up Nicholas Skala, a staff person for Physicians for a National Health Program. Mr. Skala wrote his report for the organization dedicated to single payer health care in 2006. It has been cited numerous times by publications such as The Washington Monthly. One of Mr. Skala’s assertions was that kidney transplants were more numerous in Canada since they didn’t have the profit motive of keeping patients on dialysis. I read that twice and knew that I needed to do more research.

Population as of November 9, 2009
United States – 307,897,484
Canada – 33,838,720 about 11%

Kidney transplants performed in 2007 (last data available)
United States – 16,517
Canada – 1,200 about 7%

Not more, but less. So are US citizens 50% more likely to need a kidney transplant? Does the Canadian system cherry pick who is eligible for a kidney? There are actually several issues involved.

1. I found the actual 2005 study which was published in the American Journal of Transplantation in 2006. The study compared post-transplant mortality among adult recipients between January 1, 1991 and December 31, 1998. Mr. Kristof’s article made this appear to be current information. It is not.
2. Canada did not have a national registry until this year. They have had a real problem matching donors to potential recipients. This will help.
3. 23.2% of the kidney recipients in the study were African Americans as opposed to 2.6% of the Canadians. As the study indicated, factors such as diabetes mellitus, age, and the number of donors of African descent may have an impact in the outcome of the report. The authors noted the lack of detailed donor data from CORR (Canadian Organ Replacement Register).
4. Is there equal access to kidney transplants in Canada? The answer is “No” according to Dr. Jeffrey A. Zaltzman of Toronto’s St. Michael’s hospital. That was published August 29, 2006. “No” wrote the Calgary Herald on November 9, 2009 when they noted that “the disparities in the medical treatment received by First Nations people compared with other Canadians have attracted growing national and international attention.”

I don’t have the research staff of the New York Times. Felicia, my secretary, and I spent a couple of hours following links on GOOGLE. I learned far more than I ever wanted to know about kidney transplants, everything from how much dialysis costs (a fortune, up to $150,000 a year) to how few transplant facilities there are in Canada.

What I learned is that Canadians who live near a major hospital and have the good fortune of a live donor have an excellent chance of survival. There are a lot more facilities and options here in the United States. In other words, the Peace Bridge is not going to be bumper to bumper with Americans searching for kidneys.

DAVE

www.bogartcunix.com

One more thing. The Kristof article also stated that “An African-American in New Orleans has a shorter life expectancy that the average person in Vietnam or Honduras. Found that too! The original report was posted on WWLTV’s website on September 18th. The Update was posted on October 22nd. The doctors noted that African-Americans are sicker longer, have lower incomes and a large portion are uninsured. It was crime and the murder rate, however, that got the most focus. Dr. Kevin Stephens, the director of the city’s health department said “All of these things work together. We just can’t fix health care. You’ve got to fix education. You have to fix the crime. Your have to fix the entire community.” It was also noted “that whites in Louisiana, on average, will live four years longer than African Americans in the state, but even that is still lower than the US average.”

I’m sorry this was so long. I just think that the details are important.

Falling Through The Cracks

2009-11-11T14:56:00.000-08:00

The three key stakeholders in the delivery of health care to our citizens are the government, the medical community, and the insurance companies. It has been the goal of this blog to show that none of these players can ever be allowed to operate unchecked.

Yes, I come to this discussion as a thirty plus year veteran of the insurance business. My experience colors my point of view as much, if not more, than my income needs. But, it is fair to ask if I have covered insurance problems and access sufficiently.

Today we tackle an insurance problem.

Joan Rogers (as usual, not her real name) was referred to me by one of my loyal readers. Joan is a self-employed professional in her late fifties. Her divorce was finalized in December 2006. She has been covered under her ex-spouse’s group health insurance policy ever since. Her COBRA ends next month. Joan Rogers is in trouble.

Ms. Rogers has several medical conditions. None are life threatening, but none are cheap to control. Her three medications have a combined cost of $7,700 per year. She does not qualify for a comprehensive individually underwritten medical insurance plan. Since she doesn’t have an employee or business partner, we can’t write a group policy. A group policy would have to take her. She doesn’t want to stop doing what she does just to get a job that provides insurance benefits. Well educated and talented, Joan wants to continue her career.

What are Joan’s options?

First, is it unfair that she doesn’t qualify for a regular policy? Joan’s prescriptions add $650 per month to the cost of her care. Her scheduled office visits and tests are hundreds more. How does Anthem or Medical Mutual build that into her rates? Do we spread her risk to your rates and mine?

United Health Care might take Joan. The policy would exclude treatment for her most expensive conditions and insure her for anything else. The premium is $320 per month. Since the policy would qualify for a Health Savings Account (HSA), Joan could put close to $4,000 in an account, take the tax deduction, and use the money to help pay for her medications. This is not a good option. She has way too much exposure.

I know what some of you are thinking. Since Joan is coming off a group policy, she is guaranteed the right to purchase an individual policy. HIPAA to the rescue.

Federal regulation guarantees that Joan can purchase a policy designed by her state of residence. Ohio has two awful options – The Ohio Basic and Standard Plans. The Standard Plan, the better of the two, has the following benefits:
• $750 deductible
• 70% / 30% coinsurance
• $5,000 maximum out of pocket each year
• $1,000,000 lifetime maximum
• $2,500 maximum benefit each year for outpatient prescription drugs

You get the idea. This is nothing special.

The Anthem premium for this policy is $2,994.95 per month. The Golden Rule premium for this policy is only $1,323.21 per month. These are not typos.

What is the answer? Damned if I know. I agonize over the uninsured and I have spent a ton of time on Joan’s case in the last week or so. And Joan is not the only person in this predicament.

Would the “Public Option” solve Joan’s problem? Hard to say. The Ohio Standard Plan is, in essence, the state’s version of the Public Option. Would the State of Ohio create a better plan the next time around or will the policy be created by the federal government? And who pays for this?

If preexisting conditions were no longer relevant and insurers had to accept all applicants, Joan’s problems are solved at the exact same moment that your problems begin. If everyone is required to have insurance, the burden is less severe.

But today is November 11, 2009 and Joan has run our of good options. There is a real need for health care reform. The question is how to correct what doesn’t work without destroying what does.

DAVE

www.bogartcunix.com

Borrowing a Good Idea

2009-10-28T06:06:00.000-07:00

A scene from the future.

Senate cloakroom. An unscheduled meeting of Senators Barbara Boxer (D-CA), Sherrod Brown (D-OH), Byron Dorgan (D-ND), Al Franken (D-WI), John Kerry (D-MA), and John Rockefeller IV (D-WV).

Dorgan: It’s not working.

Kerry: Of course it’s working. Polls show the

Dorgan: John! It’s not working. Polls? Hell John, you’ve got polls that show you won the presidency ten years ago. Barbara, you ran national commercials showing that North Dakotans were mostly covered by one health insurance company. Do you know how many we have now?

Rockefeller: Two? Three?

Dorgan: None! Your public option killed our local Blue Cross. We don’t have that many residents. We couldn’t support three or four major companies. Competition? We want our old coverage back.

Kerry: People across the country love Medicare Part E.

Franken:John, enough with that. It was fun when Olbermann came up with that. But the Republicans successfully dubbed it Medicare Edsel to seniors and Medicare Error to others.

Kerry: Nobody else calls it Medicare Part E?

All: Just you, John.

Senator Beau Biden (D-De) enters the cloakroom.

Biden: Senators.

All: Senator.

Biden: That never gets old. What’s going on?

Boxer: Byron’s unhappy with the health plan.

Dorgan: I’m unhappy? My constituents are unhappy. And you? How happy are you?

Franken:The numbers are awful. We were told that costs would go down. Happiness would go up.

Biden: Doctors still on strike in San Francisco?

Boxer: Yes, but at least most of them are back to work in Los Angeles and San Diego.

Franken:The claims are through the roof. We undercut the insurers and took their healthiest clients. Since we didn’t ask any questions or exclude any preexisting conditions, we got all of the unhealthy, too. The insurers are making money, hand over fist, selling supplements and we were left holding the bag.

Kerry: I didn’t know so many had cancer.

Boxer: Or heart trouble.

Rockefeller:Or asthma. Half the country must use inhalers.

Brown: Much of this is preventable. If we could only get people to take better care of themselves, quit smoking and drink less, we’d be OK.

Biden: Good luck with that.

Brown: Well, I’ve got an idea. I would like to initiate a trial program in Northeast Ohio. It’s based on a great idea from a few years ago. Toby Cosgrove of the Cleveland Clinic has pointed out that obesity is the root cause of much of our problem.

Boxer: Yes, we all know that obesity related claims are killing us. What’s the idea?

Brown: The Cleveland Clinic would send out three cans of Slim Fast to every household in Great Cleveland. Once people see how easy it is to lose weight, our problems will be over. And of course, since this is such a good idea, they won’t mind paying for the diet shakes.

Rockefeller:How much will it cost them?

Brown: Just $50.

Kerry: Sounds like a steal!

I hope you are reading this under the glow of a low-energy light bulb.

DAVE

www.bogartcunix.com

It's Your Turn To Pick Up The Check

2009-10-22T15:33:00.000-07:00

Forget free lunch. I want dinner.

I briefly touched upon rating differentials in my last blog. To recap, there were women complaining to Congress about paying higher individual health insurance premiums when they are young and, statistically, have more claims than young men. There was, of course, no mention that their rates would be less than their male counterparts when they get older. As Congress decides to invade my business, they will eventually scale back on the grandiose proclamations and actually have to start running their new insurance company.

Yes, insurance company. How will Uncle Sam Mutual operate? Will U.S.M. cover all of the services, tests, and procedures your current plan challenges? Every dread disease will have its teams of lobbyists and victims ready to testify at Congressional hearings. Congress will be the board of directors of Uncle Sam Mutual. Congress, the same group that a few years ago under Doctor Bill Frist's leadership attempted to diagnose Terri Schiavo, will be asked to make tough decisions. We're in trouble.

Let's take something easy - price. How will Uncle Sam Mutual price the product? Let's assume, to keep this simple, that there is only one policy.

The following determine premiums today:
1. Location
2. Age
3. Gender
4. Health
5. Habits

Residents of Cuyahoga County pay the highest health insurance premiums in Ohio. Our doctors and hospitals charge more, run more tests, and do more procedures. Forget New York or Los Angelas. If we just make all Ohioans pay the same premium, my son Phillip, who lives in Marietta, will have the opportunity to help lower my monthly cost. Theoretically, as my premiums go down, his will go up.

Speaking of Phil, he can really pitch in if age is no longer a factor. I turn 55 next February. Males 55-64 have high utilization. Age 55-59 is expensive. Premiums for men 60-64 can be down right unpleasant. Thirty-one year old males have premiums that reflect their few claims. Remove age as a pricing factor and my premium should plummet. Poor Phillip.

Before we go any further, let's do a numbers check. Remember, so far we are only talking about location and age IN OHIO. We aren't stacking the deck with national extremes, smokers with suspended driver's licenses, or the chronically ill.

We'll use a "Chevy". Anthem Blue Cross. $1000 deductible 80/20 policy with office visits and Rx Card.

Marietta - Male age 22 - $101.08 per month
Lakewood - Male age 62 - $506.08 per month

In the interest of fairness, we'll split the difference. Again, we are only looking at location and age. Gender, habits, and health have yet to be factored into these numbers. The average of these two rates is $303.58. Our mythical 62 year old is thrilled. Our 22 year old is not. Forced to pay way too much, he abandons the system. At 22, he can. What does that do to our price?

As thousands of young men in their early 20's abandon Uncle Sam Mutual's policy, the average age of the participants increases. The price, assuming any semblance of rational accounting, increases. Every time the price increases, it forces more young, healthy people off the policy. Our 22 year old's biggest problem is the high percentage of older people who vote.

According to President Obama, we need the public option "to keep the insurance companies honest". How? Will the government really begin to pay medical providers the higher insurance rates? Will the policy be as self-sufficient as the Post Office? Will all the promises to the pharmaceutical companies, the seniors, the sick, etc... be kept? Or is this just one more campaign to pass a piece of legislation?

We have only touched upon two of the rating factors. Gender, habits, and health can actually be bigger contributors to the cost to pay for someone's health care. That is what we are discussing, Morbidity. What does it cost to pay for YOUR care?

I'm looking forward to a great dinner. And by the way, it's your turn to pick up the check.

DAVE

www.bogartcunix.com

Free Is Too Much

2009-10-19T14:13:00.000-07:00

I know I've asked this before, but at the risk of appearing repetitive, What is our Goal? Is it too much to ask that before we completely restructure our health care delivery system and a major portion of our economy, we take a moment and delineate our goals?

There are a few, very few, activists and members of Congress who have the goal of eliminating all private insurance. They view the current legislation as the first step towards a Canadian-style single payer system. It is easy to lump everyone suggesting proposals that might have a negative impact on my business as proponents of "Socialized Medicine". Easy, but very wrong. It is also wrong to assume that anyone not lining up behind a significant overhaul or the "Public Option" is a right-wing nut job probably on the take from the insurance industry.

So let's look for some other goals. One I keep hearing about is that we want to cover the uninsured. Sounds great to me, but before you can cover the uninsured, you have to ask who they are and why they don't have insurance.

We know that a large number of the supposed 47 million are undocumented Americans. The President's big speech put the number somewhere between 12 and 17 million. We also know that a large number are not permanently uninsured, just simply between jobs. Some high earners choose to be uninsured. My favorite was a well known doctor at Hillcrest Hospital. For all I know, he and his family may still be without insurance coverage.

Some of the uninsured have major illnesses. Some are children, eligible for Medicaid, but their parents don't know or haven't bothered to complete the process of enrollment. And many of the uninsured are the working poor. Earning less than 200 percent of the poverty level, often working one or two low wage part time jobs. These people have fallen through the cracks. It is our responsibility to help them get covered.

But there is another group. And this is the group that concerns many of us. There are people of limited means who chose not to be insured, or at least, not today. When they need coverage, due to illness, accident, or pregnancy, they expect to be welcomed like long lost friends by the insurers, doctors and hospitals.

Let me give you an example. Pamela (not her real name) works full-time for a large specialty retailer in a Greater Cleveland mall. She is a healthy single mother in her early 40's. She stopped smoking years ago. Aside from her two pregnancies and her breast implants, she has not had any hospital stays or surgeries. Her older child is on her own. Pamela's teenager is covered by her father. Pam is uninsured by choice.

Pamela's employer has an excellent group health insurance policy. The plan includes an office visit copay, Rx card, and preventive care. Why isn't Pam covered? Why won't they take her? Neither the insurer nor the employer is to blame. The employer pays the vast majority of the premium. The employee portion for this policy is $41 per paycheck, $82 per month. Pam refuses to participate. She would rather spend the money elsewhere, preferably on e-bay.

Who pays if Pamela gets sick or injured? We do. What would it take to get her to participate in the system before she is being wheeled in on a gurney? Should she be forced by implementing a tax (We are supposed to say fees. The President and Senator Baucus love fees.) on people who refuse to buy insurance? Should her employer be required to pay 100% of the premium? Should the government, which is us, just give her free insurance? Obviously the moral imperative of being personally responsible hasn't been a motivator so far.

What happens when premiums increase? There is every indication that premiums will rise with the implementation of the Baucus bill. Will Pam's coworkers drop off the coverage as their disposable income is attacked? There are a lot of Pamela's. Each of these people has a reason why his/her lifestyle is more important than insurance right up until the moment care is needed.

I want to be very clear. I am not talking about people who have lost their group coverage, can't find another job, and have a serious preexisting condition. This year's COBRA extension was only a bandage. Our system has failed too many of these people. The working poor, wage earners struggling to survive, are also not the point of this. At one point the Republicans wanted to give the working poor tax credits to buy insurance. That isn't an answer. Immediate access to Medicaid, a state run program, and an increase in funding (taxes) is the only way I know to help them.

I refuse to believe that people choose to be poor, sick, or disabled. Just as it is our responsibility to help those who can not help themselves, it is our duty to provide for ourselves and our families when we can.

So what are our goals and how are we going to achieve them?

DAVE

By the way: Now that we are getting closer, it is time to assert YOUR Divine right to special consideration. On the October 15, 2009 ABC World News Tonight, Charlie Gibson reported about women testifying on Capitol Hill. The issue was that insurance companies were charging them more for health coverage than males the same age. The injustice! Of course, there was no mention that these same women would pay less than men for health insurance later in life or that their car insurance was less since the day they received their driver's licenses. And life insurance? Women's rates are always less than men's. Poor Charlie. He just didn't have the time to mention any of that.

www.bogartcunix.com

The Two Minute Drill

2009-09-29T12:03:00.000-07:00

OK, Dave. What do you think is going to happen with health care?
Have you read my blog?
When I get a chance, probably not for the last couple of weeks. Just give me the two minute version.

The two minute version? Health Care. Life and Death. 15% - 20% of our economy. And he wants this condensed to two minutes so that he can move on to more important things like Shaquille O'Neal's debut in a Cav's uniform.

Details. There are no details in the two minute version. But then again, there have been almost no details in the barrage of commercials (for or against anything), speeches, or news programs. We've got hype. We've got fear-mongering. We've got lobbyists. But details? Who has time for details?

There is a great commercial on television that stresses that the PLAN:
* Let's you choose your own doctor
* Won't penalize you for any preexisting conditions
* Keeps bureaucrats out of your health care
* Incorporates the best ideas from Democrats and Republicans
"That's reform we can all feel good about."

Sign me up!

Of course, this plan doesn't exist. Senator Baucus recently unveiled his version of health care reform. Over 500 amendments have been offered so far. Let's pretend that two thirds of those amendments are nothing more than intentional roadblocks, that still leaves over 150 substantive changes. How many of these will be adopted and how will they affect the final legislation? What you like about the bill today, may disappear tomorrow. Or vice-versa.

Details. Ask a dentist how the proposals pay for dental care. Obviously the dental community needs better lobbyists. Even Medicare Advantage policies only cover routine exams and cleanings. Medicare doesn't cover fillings, crowns, or major services now. Will the so-called public option provide this in the future? Who knows?

These same questions apply to care for mental, nervous, and emotional disorders, eye care, or even chronic conditions. Turn on the television and you've got Former Governor, Former DNC Chair Howard Dean begging for a public option. What would the public option cover? Don't ask him for details. That's not his job.

So I have an answer for the next person who wants the quick answer for What's going to happen? I am going to quote that famous philosopher, L.O. Annie who said, "The sun will come up tomorrow."

DAVE

www.bogartcunix.com

Anthony Weiner Hates Me

2009-09-21T15:04:00.000-07:00

Before we get started - Sunday, September 13, 2009. Fourth Quarter. Brady Quinn completed a 26 yard pass to Robert Royal for a touchdown. You may be wondering what this has to do with health insurance. The Browns offense hadn't scored a regular season touchdown since last November which was driving Cleveland fans nuts. Since the President and his team have yet to discuss mental health, I want to help out where I can.

Anthony Weiner is a Congressman for New York City. He is a survivor, the kind of guy who seized the opportunities given to him and made the most of them. His story is the success side of any and all government programs designed to help people help themselves. Though I personally can't relate to his upbringing or how it continues to impact his views on the issues, I respect his accomplishments.

Anthony Weiner hates me.

Well, not exactly. We've never met and probably never will. Congressman Weiner does, however, advocate for the elimination of all health insurance companies. As the health care debate heats up, you will find Mr. Weiner on such television programs as The Rachel Maddow Show, Countdown with Keith Olbermann, and even, occasionally, on a mainstream Sunday morning program. His article Giving Single-Payer a Second Look appeared September 7, 2009 on the Huffington Post.

His message, even if slightly exaggerated, is consistent. According to Mr. Weiner, the "United States already uses single-payer systems to cover over 47% of all medical bills through Medicare, Medicaid, the Veteran's Administration, the Department of Defense, and the Bureau of Indian Affairs." He often takes time to tell us how happy everyone is under these various programs and usually includes the canard that Medicare has only 4% overhead compared to up to 30% the insurance industry has in profits and overhead.

Where do we begin? Let's start with the 47% of us on a government run single payer system that proves that insurance is unnecessary. I won't dwell on the easy stuff - the regular television expose's of underfunding, waste, and despair that describes almost anything having to do with the Bureau of Indian Affairs and the Veteran's Administration. I used to volunteer at the V.A. in University Circle, easily one of the most depressing places I've ever encountered.

To get to 47%, Congressman Weiner includes Medicaid, a collection of State run programs for the indigent that varies in quality from the almost acceptable to the down-right shameful. Underfunded even in a State like Ohio, Medicaid's beneficiaries are treated to health care reserved for those on the lowest rung of society's ladder. Women come to my office to purchase insurance in the hope of getting better care for their children even when they still qualify for Medicaid. Is that right? No! But the States, which means our elected representatives, which means us, have not shown the willingness to tax us sufficiently to provide top of the line health care for our poorest citizens. It is either a priority, or it is not.

Let's talk about Medicare. I love my children, but I know what Jennifer and Phillip can do and what they can not. I also love Medicare. Congressman Weiner is well aware that much of Medicare's overhead falls within other parts of the government's budget. He is also well aware that even though Medicare underpays medical providers, there are real funding issues and that long-term viability is in question if changes aren't made.

But there is still one issue that Congressman Weiner completely ignores. People are satisfied with Medicare because of private insurance. Senior citizens see Medicare as the combination of the government's program and their Medicare Supplement policies. Eliminate the supplements and they would be faced with the deductibles, unpaid hospital days, 20% coinsurance, and total exposure to the high cost of prescription medication. Senior citizens are very satisfied with Medicare Advantage policies, the private insurance option Mr. Weiner and the President hope to terminate. Medicare, without the supplements, without the prescription drug benefit, would have very few fans.

Anthony Weiner may hate private insurance, but his constituents still need us.

DAVE

www.bogartcunix.com

Right or Privilege

2009-09-03T16:08:00.000-07:00

September 2012

Welcome. Welcome. Please take a seat. My name is Bill Shnorer. Thank you again for attending this pre-rally briefing. There is a sign-in sheet in the back next to the coffee and cookies.

We have plenty of signs thanks to our friends in the U.A.W. Guys, please raise your hands. Thank you U.A.W. The signs say "It is a RIGHT not a PRIVILEGE, Equal Access For All, and Our Tax Dollars Built This System". We will make sure that each of you gets a sign as you leave this room.

Friends, we are here because we care. We are here because we have been victimized by the current system. We have seen our loved ones lose jobs and go bankrupt. We have seen factories close and jobs go overseas.

And yet, does Washington care? Is Washington listening? Our concerns have been brushed aside by the industry shills and the talking heads on TV. It is time for action. It is time for you and I and our neighbors to have the same options as our Congressmen and Senators.

There are some who would say that what we are discussing is Socialism. But I am reminded of that great American, Senator Edward Kennedy, who fought tirelessly to better the lives of all Americans. He understood that the corporate CEO is no greater than the single mother in the eyes of liberty. He understood that in a democracy, we are all equal, all are free, and all are entitled to respect.

Yes, if Teddy Kennedy was alive and here, I am sure he would tell you that all Americans have a right to high quality, affordable Transportation.

It is an outrage that even today, in this country, there are still Americans without cars. Cars take Americans to work. Cars take Americans to the doctor for needed health care. Cars take Americans to the grocery store to buy food for their children. Here we are in the richest country in the world, and yet millions of us do not have access to adequate Transportation.

How can this be? Who has forced their way in between you and your auto manufacturer of choice? Who is denying you unfettered access? We look no further than the A.D.A., the Automobile Dealers Association.

Thousands of small towns across this great nation are held hostage by one or maybe two dealers who control the market. Even here in Beachwood, Ohio, you might want to buy a Ford, but we only have a Cadillac dealership.

Some of our opponents have pointed to public transportation as a reasonable alternative. Have they been on a bus? Have they waited in the rain for the Rapid? Would our Senators ride the RTA? We want no more, and no less, than what our representatives are given in Washington. And I'm told that they have great Transportation.

We built the roads, the freeways, and the turnpikes. Our tax dollars funded the very avenues we have been prevented from enjoying.

We need CARS. And we need them NOW.

This will not cost money. It will save money. Providing automobiles to every American eliminates the need for public transportation, an incredible waste of taxpayer money. We will also save the millions of dollars blown on Dealer salaries and perks. Our friends on the West Coast dream of a day when there won't be anymore Cal Worthington ads on TV.

But this is not a money issue. This is a moral imperative. We will prevail. Americans value our rights. We value our families. And most of all, we Americans value our CARS. When we see our neighbor without a car, we know that there, but for the grace of G-d,walks us.

Grab a sign. The camera crew from Channel 8 is already outside.

DAVE

www.bogartcunix.com

Stuck Inside

2009-08-21T11:15:00.000-07:00

I was standing, two Mondays ago, on the 16th fairway of Fowler's Mill Golf Course. I was attending the annual American Jewish Committee / N.A.A.C.P. golf outing and had just had my best drive. As if G-d, Himself, had finally seen enough bad golf, an impressive lightning bolt lit the sky. We jumped into our carts and were among the first to arrive at the clubhouse. Torrential rain and heavy winds ended any chance for further athletic embarrassment.

It was too early for dinner, so the nearly one hundred golfers and staff simply hung around and kibitzed. We probably talked more at this outing than at all of the previous ones combined. With the Indians tanking, the Cavs on vacation, and the Browns a few weeks away, health care reform was a major topic of discussion in every group of golfers.

My friend Leo asked how I would solve the problem. "What is the Cunix plan?" Oddly enough, I hadn't actually thought of one prior to his question. This is what I came up with that afternoon.

1. Health Insurance would be mandatory.
2. All preexisting conditions would be covered for anyone enrolling in the next year.
3. Medicaid is opened up to everyone earning up to 3 times the poverty rate, paid at a sliding scale.
4. The federal government would reinsure all shock claims in excess of $250,000.
5. All group and individual health policies would be revamped to reflect ten uniform options. All plans would include basic preventive care as well as dental and eye exams.
6. All medical providers would be required to update their record keeping in an effort to eliminate duplicate and wasteful testing and procedures.
7. Billing fraud would be aggressively prosecuted.
8. Hospital, doctor, and even prescription ratings would be independent and the results would be easily accessed by the public.

As I said, it was raining, we were stuck inside, and we had lots of time to kill.

I won't claim that this is a solution to all of America's health care woes. That would be impossible since we haven't, as a country, defined the issues. My eight points are my off-the-cuff conversation starters. I am not qualified to advise doctors on cost containment, so you won't see that here.

My suggestions only work as a whole, no picking and choosing. The insurers, the federal government, the states, and the providers all take a hit. Shared responsibility. Shared pain. Shared solution.

Warning: the following explains, with some detail, the above eight points. If you're really not interested, it's OK. Skip ahead to the last paragraph and we'll see you again in two weeks.

There are supposedly 45 - 50 million uninsured in America. There will always be uninsured. It has been estimated that between 10 and 12 million are illegal aliens. Millions more, like the uninsured motorist who hit me in January, simply choose to not waste their money on insurance. Health insurance must be mandatory for the system to work. We won't get everybody, but we'll get most.

The insurers would be put at risk proportionate to their market share with the elimination of both underwriting and any exclusion for preexisting conditions. Of course, there has to be a window when any currently uninsured could acquire coverage regardless of health. After that open enrollment opportunity of six to twelve months ends, uninsureds seeking coverage would be subject to a preexisting condition exclusion.

Affordability would be addressed in several ways. Medicaid, the state run program, would be made available to the working poor - men, women and children. Premiums would be on a sliding scale. The federal government would serve as a universal reinsurer. All claims in excess of $250,000 would be shifted to Washington. Private insurance would be less expensive since the risk would be more manageable.

Product design must be improved. We currently have too many choices. The consumers are confused. The providers claim it is too complicated. And the insurers waste too much money on administration. We need to simplify the product offerings. The Medicare Supplement model is worth duplicating. With input from the state insurance commissioners and the major insurers, health insurance options could be pared down to a far more manageable ten individual plans and ten group plans. The plans would be numbered 1-10 thus eliminating the confusion caused by product names. Plan 5, for example, would offer the exact same benefits whether you purchased it from Anthem, Aetna, or even, G-d forbid, the U.S. government.

By the way, all ten plans would cover basic preventive care including annual eye and dental exams. If we're going to do this, let's make sure we do it right.

I covered the importance of modernizing our record keeping and information transmission back in February. This cost would be borne by the providers. Better information will save both money and lives.

Medicare and Medicaid fraud are rampant. The president may want to stop unnecessary tonsillectomies, but over-coding and ghost patients are far more serious issues. We can no longer afford to ignore white coat crime.

We can be better consumers if we have more information. Which hospitals are better for heart surgeries? When will the generic medication be perfectly fine? Independent, accessible studies should be available for all Americans. We need the opportunity to make informed decisions about doctors, hospitals, and therapies.

Our health care conversation came to a merciful end with the arrival of a fabulous dinner catered by Blue Canyon Restaurant. Lucky for me, my invitation to this charity event is not contingent on my golf game or my conversation skills, just my willingness to write a check for a good cause. With any luck, next year will have more golfing and less health care.

DAVE

www.bogartcunix.com

From Birthers To Deathers And All Who Lie In Between

2009-08-09T12:09:00.000-07:00

Man, that's the second time you've mentioned that guy. He must really piss you off for you to talk about him at dinner.

Alec, my girlfriend's son, was correct. I must have been a touch agitated. I place a very high value on honesty, loyalty, and competence. Over the last couple of years I have had to deal with a number of people deficient in one or more of those qualities. One, in particular, may have pushed me a bit too far.

Lately, honesty, loyalty and competence have been in short supply in American politics. Yes, these blogs have taken issue with some of the goals of the proposals coming from the Democrats. I have certainly expressed my disdain for the President's content-free campaign. I disagree with many of Mr. Obama's assertions and proposals, but I don't, for a moment, question his motives or sincerity.

It is also possible to respectfully disagree with some of the Republican proposals and goals. There are people of good will on both sides of the issue.

Good will is not a given and civil discourse has been hard to find. It started with the so-called "Birthers", the fringe element who refuse to believe that a guy named Barack Hussein Obama could have been born in the United States. Nothing short of a time machine whisking each of them back to the Hawaiian hospital room will convince them. Easily manipulated, the Birthers were led by the usual suspects - Rush Limbaugh, Lou Dobbs, and a half dozen Republicans in Congress unashamedly pandering to the base.

The whole Birther conspiracy theory / paranoia was just an amusing side-show until a Republican Congressman lost control of a town meeting. Tapes of the event looked more like a Saturday Night Live skit than real life. The encounter quickly devolved from amusing, to pathetic, to scary. I was worried that the woman, or one of her friends, was armed.

And the Deathers may be worse. Intentionally twisting the availability of living wills and counseling for end-of life issues into a government plot to kill grandma is neither honest nor useful. Organizing mob-like assaults of public forums is a direct attack on our values.

On July 28th Virginia Foxx (R-NC) said on the House floor that the Republican plan "is pro-life because it will not put seniors in a position of being put to death by their government". Is it possible to be more counter-productive?

The tone of these town hall confrontations is discouraging. The men and women of Congress use the August recess to meet with their constituents, to learn our issues, to hear our concerns. Organized teams, schooled in the art of disrupting a meeting, prevent the honest exchange of information.

Insurance agents certainly have a stake in the outcome of this debate. Our organization, The National Association of Health Underwriters, expressed its concern in an August 7th email:

While we understand that these issues are very sensitive and it can oftentimes be frustrating to hear legislators disagree with your views, NAHU strongly discourages our members from disrupting these proceedings in anyway. It is perfectly acceptable to express your opinions politely and respectfully disagree with your legislators, if warranted. However, we don't want you to mob the town hall meetings and participate in some of the scenes we all have seen on You Tube.

I had to read that paragraph twice. At first I thought it was ridiculous that responsible adults would have to be told to behave like adults. It looked like the sign reminding restaurant employees to wash their hands. Then I realized that like those silly restroom signs, this paragraph was necessary. It was important. We, as an organization, as a profession, had to state in English, clearly, that we are participants in the discussion, not members of a mob.

Honesty. Loyalty. Competence. My frustrations as president of the Beachwood Chamber of Commerce end April 1, 2010. And the truth is that part of my problem is that I keep expecting more out of some people than they will ever want to deliver. But Honesty, Loyalty, and Competence are the least we should expect from our elected officials. Feeding conspiracy theories and playing on the darkest fears of the easily scared is not how to fix our health care system.

DAVE
www.bogartcunix.com

Choosing Sides

2009-07-26T10:25:00.000-07:00

Mr. Cunix? My name is xxxx and I'm calling from Shaker Hts. Your client, Mrs. xxxx, suggested that I call you.

How can I help you?

I need to know if you could connect me with some people who are employed and suffering because of their high insurance premiums.

You need me to tell you about working people who can't afford their insurance? I don't think I can.

I've got unemployed people who will complain about insurance cost, but I can't find any employed people.

Let me guess. You're trying to stock the pond?

Well, yeah, but I'm not suppose to tell anyone. If we can find the right person to tell his story, he may even get to introduce the President.

Sorry I can't help. Good Luck.

The President and his team are in full campaign mode. After the scheduled photo-op at the Cleveland Clinic, Mr. Obama was taken to the friendly confines of Shaker Hts. high school. I had already declined two invitations to Thursday's event before the above call. I had been pretty sure it was going to be more style than substance even before I was asked to help stage it.

It's a campaign and I don't want to choose sides.

Really, I don't want to choose sides. Mr. Steele and the Republicans can't find it within themselves to work for a solution. Senator DeMint (R-SC) is more interested in breaking the President than the breaks in our system. Caught, he attempted on the July 22, 2009 Today Show to say that he wants to "put the brakes" on Mr. Obama's plan. He went from Senator DeMint to Senator Disingenuous.

It's a campaign and I don't want to choose sides.

I think it is safe to say that most of us believe that change is needed. The status quo is not acceptable. Costs are spiraling out of control. Our specific goals and how we will set about achieving them should be the subjects of serious debates. But we aren't having those debates. We are having campaigns.

The President's press conference started at 8 PM Wednesday evening. I got home in time to watch him. Gosh it was so frustrating, so unsuccessful that even MSNBC had difficulty cheer leading for him in the subsequent two hours of discussion. Dr. Nancy Snyderman and Chris Matthews talked more about the questions the President ducked than the ones he answered.

Candidate, I mean President, Obama promised Wednesday:
* No preexisting condition clauses
* No additional charges if you already have a medical condition
* No mandate, no requirement for participation
* Excellent patient-centric coverage when you need it right down to a dietician preparing individualized plans for every diabetic
* No interference from some administrator sitting at a computer

The first couple of points are interesting because they may, by themselves, doom the whole process to failure. Insurance is about shared risk and responsibility. Regular readers of this blog know that I was hit by an uninsured motorist in January. We can't enforce something as basic as our mandatory car insurance regulation. If we don't even try, if we don't require health insurance coverage, many of the same uninsured now will be uninsured later. Why would they bother purchasing health insurance until after they are really sick?

Dr. Snyderman and many of us were surprised by the President's insights into the practice of medicine in the U.S. "If a blue pill and a red pill do the same thing, but the red pill costs half as much, why wouldn't you take the red pill?" He also suggested that some doctors perform tonsillectomies on children for the money.

The idea that some administrator sitting at a computer won't be involved in your health care decisions under a new public plan was debunked right there. Who makes the determination that the red pill and the blue pill are equivalent? When is one better than the other or are we to believe that the only difference is the dye? And surgeries? Who will decide which surgeries are needed and which are simply for doctor and hospital cash flow? Will all of these inspectors work for free? Our cost savings depend on their volunteer effort.

We have had one goal up to now. Our goal as Americans has been to have great access to top doctors and hospitals paid for by someone else. That's the old goal. It is time for a new goal: Great access to top doctors and hospitals that we can afford.

We don't need a campaign. We shouldn't be forced to choose sides. We need details. And we need them now.

DAVE
www.bogartcunix.com

Missed It By That Much

2009-07-13T13:56:00.000-07:00

It was a Maxwell Smart moment.

Neal Spero politely told us that he had a plan. Dave Clark and I, with equal parts candor and respect, politely disagreed. Mr. Spero is the Senior VP of American Community Mutual, a mid-sized health insurer based in Livonia, Michigan. Dave and I have been two of American Community's top agents for most of the last twenty years. That is quite an accomplishment since we both work with dozens of insurers. The date was September 6, 2007. We had asked to meet with Mr. Spero to share our concerns.

My perception was that American Community was digging itself into a hole. I saw a problem with their new distribution system (who sells it) and their underwriting (who gets covered and at what price). Mr. Spero saw nothing but blue skies and calm seas.

I stopped writing American Community's individual policies last October. Their current renewals for their existing business, reflecting their staggering claims experience, came in at 33%. Mr. Spero had a plan. I can hear Steve Carell say "Missed it by that much".

This past week Senator Ted Kennedy (D-MA) and Senator Christopher Dodd (D-CT) announced that they are now able to project a cost for their committee's health care reform package - $611 billion dollars over the next ten years. The Health, Education, Labor and Pensions Committee (HELP, really, I can't make this stuff up) was pleased to get the cost down to $611 billion dollars even though that number doesn't include Medicaid expansions which put the price tag back over the $1 trillion mark.

I can hear Don Adams say "Missed it by that much".

Not that Senators Kennedy and Dodd know where six hundred plus billion dollars are coming from, but what if the real price tag is a trillion or so? That is a question nobody wants to answer.

There are ways for American Community to save itself. They will raise their rates, tighten their underwriting, and reassess their marketing and distribution. Or they will fail. I am not being cavalier about this. I want A.C. to succeed, but American Community is a business, not a person, not a government. A company that consistently has higher expenses than income ceases to exist.

What will the U.S. government do? One idea was to tax employer provided health care benefits, a bipartisan compromise that might have brought in a couple hundred billion. Other trial balloons floated have included a tax increase on high earners and a "sin tax" on carbonated beverages and sugary drinks.

How much Coke do we have to drink to make up a $1 trillion shortfall?

What's missing is a serious discussion of how we are paying for any of this. Discounts from hospitals? Shell games from big Pharma? Would you believe aliens with space ships full of cash? Sorry, it is just that I have been here before.

Let's all say this together, Tax Increase. It's OK. The world won't end and most of Congress will still be reelected. If having the government run health care is a good idea, say so, tell us the real price tag, and tax us appropriately. We're adults. We're citizens. Trust us with the truth.

DAVE

www.bogartcunix.com

Quick note: Dave Clark just called. I told him that he was included in this post. His only issue is that the American Community insurance pool isn't as polluted in Michigan where he lives as our's is in Ohio. He still loves them and does a lot of business with them. He pointed out that they are still one of the easiest companies to work with, do a great job paying claims, and still have guys like Neal Spero who would meet with agents like us. Duly noted.

The Real World

2009-06-29T12:30:00.000-07:00

FOR PROFIT HEALTH CARE MAKES ME SICK

Those sentiments were on a bumper sticker that graced a neighbor's Volvo. This was a few years ago when I was living in Shaker Heights. The fun fact? The car's owner was a physician.

I'm pretty sure this guy didn't sell suits for a living and only practiced medicine as a volunteer. He certainly didn't accept chickens and vegetables for his services. He didn't object to being paid, and judging from his house, paid well, for his services. His objection was to anyone else profiting from the delivery of health care.

Get in line.

Depending upon who you ask
* The doctors are overpaid
* The hospitals are palaces
* The insurance companies are crooks
* The drug companies are gauging us
Heck, the only people universally loved and appreciated are us insurance agents.

Yes, I'm kidding.

My neighbor the doctor was, however, right about one thing. This debate is not about medicine or the delivery of health care. It is about money. Who pays? Whose ox is gored? Who can make a small payment today to protect a major profit center for years? One of my goals is to move our conversation to include the actual delivery of health care.

One of our problems, as a society, is our complete aversion to personal sacrifice. Our state is having a huge problem balancing its budget. Governor Strickland is looking at adding fees and slots for income. To cut expenses he is taking a hatchet to any program that isn't backed by a strong lobby.

One of the governor's budget goals includes a change in the open enrollment health insurance program. Under the Federal Health Insurance Portability and Accountability Act (HIPAA), people who have lost their health insurance after eighteen continuous months of coverage, are guaranteed the opportunity to purchase a policy. This is particularly relevant if the individual has significant preexisting conditions. In Ohio, the options are the "Ohio Basic" and the "Ohio Standard". These are over priced awful policies.

Governor Strickland wants to have these policies, sold to some of our unhealthiest citizens, capped at 1.5 times the base rate. In other words, if we lower the premiums a touch, thousands of unhealthy uninsured individuals would be able to buy insurance. Isn't this great?

Well, it depends. The Ohio Department of Insurance's actuary determined that 52,000 additional consumers would purchase coverage through the open enrollment program. The problem is that the rates for policies in the standard individual market would increase by 5.5%.

Are you willing to pay 5 1/2% more so that someone else's insurance might be cheaper? If your family policy is $500 per month, we are talking about $330 per year. Regular readers know that the equation is always the same. If you increase money out, you gotta bring more money in. So will 52,000 more people be able to afford coverage? Of course not. The rate decrease for the unhealthy people, and the small increase for the rest of us, will be phased in over several years. G-d forbid you or I should have to make a sacrifice.

The debate isn't about the delivery of health care. It is only about money. That is the real world.

If you really want to know where the money is in health care. watch TV. Not the shows, the commercials. Scooters, lift chairs, and medications that run $8 to $10 a pill dominate prime time. I can track trends just by watching the ads on the evening news.

A new commercial has me a little nervous. It features lots and lots of smiling senior citizens. The reassuring voice over tells us that the reason they are so happy is because of the money they've saved due to Medicare Part D, the Rx benefit.

Other than actors, the only senior citizens that happy about Medicare Part D are pharmaceutical company retirees. Designed to enrich and protect the drug companies, insurance companies, and certain well-connected insurance marketers (AARP comes to mind), any benefit a senior citizen gets from Medicare Part D is strictly accidental. None of the rules favor the consumer. And yet, I've got senior citizens dancing across the screen and this announcer extolling the virtues of Part D. Of course, the commercial is paid for by the pharmaceutical companies.

Coincidentally, the drug companies recently met with President Obama and have proposed an $80 billion deal. That is $80 billion dollars over ten years. $30 billion will help to pay for brand name drugs for senior citizens who fall in to the coverage gap, the notorious "doughnut hole". The other $50 billion will be used to help offset expected costs associated with the uninsured.

Are those numbers real? We'll never really know. But the drug companies think they have a deal. They will make another small, difficult to quantify sacrifice in hopes of a huge payoff. Their goal is to have health care reform to be as profitable as Medicare Part D. The $80 billion deal is strictly voluntary and depends on the enactment of a comprehensive health reform package acceptable to the industry.

Again, here in the real world, we are actually talking about money not the delivery of health care. Well if we are going to talk about money, we should all be forced to use real numbers.

DAVE

Questions or suggestions for future topics?
www.bogartcunix.com

Golf

2009-06-15T16:24:00.000-07:00

Tenth Hole. Weymouth Country Club. Medina, Ohio. I had hit a surprisingly good drive. It was long, majestic, and in the fairway. My second shot on this par 5 was more than adequate. And now I was standing less than 100 yards from the pin, laying 2, with a sand wedge in my hand. I knew what I wanted to do. I wanted to hit that ball high into the air and have it land, AND STOP, within six feet of the hole.

I knew what I wanted to do.
I knew, theoretically, how to do it.
There was no reason not to birdie this hole. At worst - par.

Bogey - 6.

Back on the cart on my way to the next tee, I realized how much my golf game has in common with the President's health plan proposals. He knows what he wants to do. He knows, theoretically, how to do it. But we have every indication so far that he is not going to reach his goals.

The consequences of my blown shots are the loss of a couple of bucks and another hit to my fragile ego. Missing the mark on health care is far more significant.

Before we go any further, I should, in the interest of full disclosure, reveal that I voted for President Obama last November. I volunteered and donated to his campaign. I also have no regrets.

As an Obama supporter, I receive daily emails from the ongoing campaign. And yes, health care reform is being run like a campaign. On Saturday I was asked to "Stand with the President". His three core principles are:

* Reduce costs - Rising health care costs are crushing the budgets of governments, businesses, individuals and families, and they must be brought under control.
* Guarantee choice - Every American must have the freedom to choose their plan and doctor - including the choice of a public insurance option.
* Ensure quality care for all - All Americans must have quality and affordable health care.

So vague. So general. No detail on how this gets done or how much it will cost. I sent an email asking for more information. I'm not holding my breath while I wait for a detailed reply.

Joe Biden was on Meet The Press yesterday (June 14th). When asked by David Gregory how President Obama was going to pay for health care reform, Mr. Biden quickly mentioned a few cost savings measures. His second option was, "Get rid of Medicare Advantage".

Millions of senior citizens currently enjoy the benefits and convenience of Medicare Advantage policies. As we learned two weeks ago from my interview with the Cleveland Clinic manager, private health insurance pays the most to a hospital or other medical provider. Medicare Advantage plans do not cover all of the costs but are still much better than regular Medicare. Costs are SHIFTED to the people with private insurance. If the government eliminates Medicare Advantage plans, senior citizens would be forced to choose a Medicare Supplement and hospitals would get less for their services. This pushes an even larger burden on those people with private insurance.

This is not hard to understand. There is nothing counter intuitive. Money goes in. Money goes out. Checks are sent to doctors, labs and hospitals. Where is the money coming from? If those doctors, labs and hospitals are shortchanged, who picks up the balance?

The President has been talking about a public plan to compete with the insurance companies. This sounds a lot like me competing with Tiger Woods. Here are a couple of quick questions:

1. Health insurance companies are real businesses. Their books have to balance. Premiums are determined, in part, by claims and risk. What would determine our new competitor's rates?
2. Will the government continue to under-pay the medical providers? If so, will the doctors, labs and hospitals be allowed to shift the costs to those covered by private insurance? That, alone, would seal our fate.

My golf game, with a little luck and a lot more practice, will one day achieve an acceptable level of mediocrity. Health care reform is different. There will be no Mulligans. There is very little margin for error. We are racing towards an August deadline. What's the rush? Regardless of your personal position or goal, you must have questions that have yet to be addressed.

Stand up and demand answers.

DAVE

The Interview

2009-05-30T13:20:00.000-07:00

I ran into Corky and Lenny's to grab a quick lunch to take back to my office. I ordered a pint of chicken soup, broth only, and .20 of pickled tongue, no bread. A waitress overheard my order and whispered to the deli man "He must be a doctor". So he asked me ".20? Are you a doctor?" "No", I replied. "I'm an insurance agent, but somewhere in California my mother is smiling."

OK, I'm not a doctor, but I recently had the opportunity to spend a half an hour with a high ranking manager at the Cleveland Clinic. The gentleman was familiar with Medicare reimbursements. He asked not to be identified and I will, of course, comply. Our interest is to collect information.

My first question centered on patient demographics. I was told that the Cleveland Clinic's patients were approximately:
* Private Insurance - 50%
* Medicare - 40%
* Medicaid, self-pay, and charity - 10%

Those numbers are important. Even though the government paid care accounted for less than half of all patients, I was advised that the Cleveland Clinic spent 215 million dollars last year in charity care, Medicare and Medicaid subsidies.

The Wall Street Journal reported on May 1, 2009 that the federal government planned "to keep Medicare payments to hospitals essentially flat". There is even talk that doctor's payments may be reduced. Those were two topics my new friend wouldn't touch. Even an unidentified Cleveland Clinic employee wouldn't want to appear too negative. We could discuss the general concepts of Medicare payments.

I wanted to know how the Centers of Medicare and Medicaid Services (CMS) decided how much a particular service or procedure was worth. More importantly, why wasn't it enough?

What he explained is that CMS determines a cost for a region. Though a teaching hospital is paid slightly higher, but not nearly enough to cover the extra expenses, CMS doesn't recognize the "difference between Bedford Community Hospital and the Cleveland Clinic". And there is a difference. Doctors, training, technology - someone has to pay for all of that. Those costs are shifted to the patients with private insurance.

There is a hierarchy of payments:
* Private Insurance pays more than
* Medicare Advantage pays more than
* Medicare pays more than
* Medicaid.

Medicare Advantage, which provides better care,is reimbursed at a higher rate. Medicare pays less than 50 cents on the dollar. Again, where does the money come from?

My last question, as his secretary was dragging him to his next meeting, was "Who pays if there isn't private insurance to cover the balance?"

We're meeting at P F Chang's this week to discuss this further.

DAVE
www.bogartcunix.com

Cornered

2009-05-18T13:05:00.000-07:00

I used to smoke two packs of cigarettes a day. Some days I also indulged in a cigar or one of my pipes. I enjoyed smoking. This was at a time when smoking was permissible everywhere- work, restaurants, even while shopping. I found it calming. I would inhale deeply, especially from my beautiful natural burl pipes, and use those moments to center myself. Smoking was therapeutic. Smoking was a hobby. And, smoking was unhealthy.

We knew. I may have been in my late twenties, but I knew that smoking was a health risk. My father was smoking unfiltered Pell Mell cigarettes. He was addicted. There was no joy, no peace. He had a habit, a cough, and eventually a cancer that would cause great pain and death. I knew that I could end up just like him if I wasn't careful.

I also knew my triggers, the times or circumstances that caused me to reach for my cigs and a lighter. One of my most consistent triggers, something that would always force me to reflexively light a cigarette, was any commercial from the American Cancer Society. Their anti-smoking commercials drove my smoking.

I haven't determined whether it was the tone, the content, or simply the point of view, but to this day the American Cancer Society has this hugely negative impact on me. I stopped smoking cigarettes on January 1, 1985. I still avoid their commercials.

We are knee deep in the national health care discussion. As a life long Democrat who has served on numerous campaigns, I am well aware of one side of the debate. As a thirty year plus veteran of the insurance industry, I live the other side. The American public, addicted to open unfettered access to medical care largely paid for by someone else, is interested in the discussion, but not the commercials.

The strident, polarizing messages issued from both camps, parked conveniently on the extremes, do nothing to illuminate the issues. Chrysler didn't fail because of our health care system. Conversely, Canadians are generally pleased with their access to health care. There is a grain of truth buried within the ads from both the unions and the insurance agents. Will the American public patiently sift through the propaganda to find that truth.

There are people of good will on all sides of the health care debate. There are doctors desperately trying to balance patient and business needs. Insurance agents are intimately aware of our clients' desire for affordable comprehensive insurance and the competing challenge to finance the care. There are thoughtful government employees and elected officials whose only goal is to help the American public. And there are labor leaders and business owners convinced that one option or the another would be the best for their members or employees.

Where are these people of good will? You won't find them on the talk shows. Reasoned debate is not good TV. In fact, if television is your primary source for news and information, the only thing you know for sure is that there is a huge conflict and that eventually one side will win and one side will lose. And that's just not true. We can all lose. That would be easy. We can do nothing and let cost and access spin out of control. Or we can over-reach and ignore our strengths.
Can we all win? That should be our goal and it won't be easy.

This blog is an invitation to participate in the discussion. When those commercials come on your set, when the talking heads work harder to drown out the opposition than to advance understanding, when you feel like I did when I watched the anti-smoking ads on my television so long ago, don't shut down. Participate.

Our goals should be common ground and mutual success. What is in the best interest on the American people? How do we get there?

DAVE
www.bogartcunix.com

Quick addendum: I got stuck for two hours at a presentation by Stuart Browning, the Michael Moore wanna be from the other side. Full disclosure - I walked out before it was over. Still, I want to expose my readers to as much info as possible. Michael Moore's website is www.michaelmoore.com Stuart Browning can be found at www.stuartbrowning.net He is known for his 6 minute movie A Short Course On Brain Surgery

Getting Directions

2009-05-02T10:46:00.000-07:00

Avenue or Street? Name or Number? Four quick details and you can find your way around in Phoenix in minutes. Numbered roads run north and south. If that numbered road is also a street, such as 24th Street, then it is on the east side of town. 19th Avenue is on the west side. Indian School Road runs east and west. A perfect grid, Phoenix is easy to navigate.

Have you ever tried to explain how to get from Westlake to University Heights?

The Phoenix grid was designed first. The city of Phoenix was built within that framework. Greater Cleveland is very different. Our communities are linked by our roads. Our street system, with its twists and turns, traffic circles, and five point intersections, is organic, reactive, and responsive. New Brainard Road quickly comes to mind.

I think about our lack of north - south streets and the joy of an efficient grid every time I am stuck in traffic on Richmond Road. We have all dreamed of a better way to get around town. We just have to decide which neighborhoods to bulldoze.

Creating a health care delivery system where none existed is a lot like planning a city's grid. With limited expectations and little to disrupt, the new program would face little opposition.

Think about the delivery and payment of health care in the US. Our system is organic and ever changing. Part action, part reaction, we have evolved from a system of community hospitals and doctor/entrepreneurs to regional medical centers who employ entire teams of professionals.

Just as the medical providers have changed, so too have the payers. Blue Cross and Blue Shield associations were originally created by doctors and hospitals as a means for the patients to prepay for medical services. Health insurance quickly followed. Over the last seventy years we've moved from indemnity policies to Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and even the occasional Point of Service Plan (POS). Insurers now research everything from the most efficient ways to deliver health care to drug interaction and disease management.

Medicare brought the federal government into our system. Almost overnight, Washington went from uninvolved to a key player. Medicare pays the majority of the cost for the care of our elderly and infirm. The government decides how much it will pay for a doctor's exam,test, or hospital stay. Less than the insurance companies, less than the self-pay, government payments are accept or reject. The medical provider either accepts Medicare and its rules, its limitations, and its millions of beneficiaries, or he/she doesn't. Most providers accept Medicare.

Providers, insurers, and governmental changes have significantly impacted the way health care is practiced in this country. In many ways we have lost sight of who pays for medical services.

There are commercials on TV for diabetic testing devices, lift chairs. and scooters that are FREE if you are on Medicare. They aren't free. We are paying, probably over-paying, for all of this.

Like a drive down Van Aken Boulevard, Congress is discovering that our health care delivery system isn't a simple north-south or east-west. The New York Times reported on April 26, 2009 http://www.nytimes.com/2009/04/27/health/policy/27care.html?_r=1&th&emc=th that the shortage of primary care physicians is just one more unanticipated obstacle on the path of change. Our current system rewards specialists. A revenue neutral option would lower the reimbursements for specialists, freeing up money for the general practitioners. Needless to say, the orthopedic surgeons are not happy.

Action and reaction. Raise compensation? Add more doctors? The one thing most of us know for sure is that we can't tear down our existing system and start over from scratch. So as we debate change and what the final results will be, we must be certain that we don't neglect to map the road from where we are to that final goal.

DAVE

Questions or suggestions for future topics? http://www.bogartcunix.com/

Target Practice

2009-04-18T08:44:00.000-07:00

"I want to know what President Obama is going to do about this!"

The client was in full rant. I was seated in front of his cluttered desk. He was too agitated to sit. His Anthem Blue Cross policy, scheduled to renew in May, had taken a significant premium increase. Bill Jones (name changed to keep the attorneys impoverished) wanted me to know how unhappy he was with me, Anthem, and the entire system.

I've been doing this for thirty years. This isn't the first time I have been used for target practice. There are times you just have to let the clients vent.

What made this unusual is that Bill Jones is a licensed insurance agent! He has twenty-five successful years in the business. Even though he specializes in life insurance and investments, Bill still sells five to ten health policies each year. He knows the rules. He understands the concepts. He is a true believer, just as long as we are talking about your money and not his.

Fairness is the key issue of the health care debate. The question is always the same. Is this solution fair to me? We don't want to pay for someone else's claims, but we demand to be part of a pool, hopefully a really big pool, if we have problems.

Health policies, especially small group policies, are underwritten during the application process. The renewals reflect, in part, the group's claims experience. In part, but no where near in total. Still, unhealthy groups pay more than healthy ones. I've had clients tell me that the insurance company shouldn't penalize them just because they have had a triple by-pass, or cancer, or a three month stay at Hazelton, 0r... You get the idea. They are nice people. Money spent on their health care by the insurance companies isn't like money spent on someone else's care.

Let's look at Mr. Jones' company. Officially, the business consists of Bill and one employee. In truth, we are insuring Bill, his wife, and two kids. They take 15 prescription medications. That number increases during allergy season. Some of these prescriptions may be inexpensive generics, but even if all of the medications were cheap, think about the medical conditions these four people must have. Plus, there are a large number of office visits, lab tests and x-rays to diagnose and treat these maladies.

Given the opportunity to insure Mr. Jones and his business, Medical Mutual of Ohio, Aetna, and other companies were hundreds of dollars per month higher than the current carrier. So he will stay with Anthem.

But is it Fair? Depends. Once he cools down, and before he reads this, Mr. Jones may decide that he is getting a fair price. He is getting more in benefit than he is paying in premium. If you are a fellow Anthem policyholder, you might think that it is unfair that you are being forced to subsidize his family's coverage.

Rate increases are proof that insurance companies are doing their job. If costs increase, and they are, then premiums must also increase. That is a tad simplistic, but you get the point. If, or when, the government controls health care, will premiums increase uniformly as cost increase? If not, then the system will spiral towards bankruptcy until someone has the courage to raise premiums (TAXES) to cover escalating costs.

Some day in the future, when the cost of your health insurance increases, will you complain to your agent, your congressional representative, or the President? Which one will come to your office to listen to you vent?

DAVE

http://www.bogartcunix.com/

The Dollar-ectomy

2009-04-05T06:30:00.000-07:00

Two elderly ladies were sitting by the pool on a cruise ship.

My son paid for my cruise.
My son paid for my cruise, too.
My son is a doctor.
What a coincidence. My son is also a doctor.
My son is a cardiologist.
Wasn't the fish dry last night?

So it goes for those parents whose children attended Tootsie Tech. Podiatrists may provide needed medical care, but they will never receive the respect other physicians take for granted. Today's blog is not going to help.

The exchange that begins this piece is fictitious. The rest of this is not. My attorney, Michael Saltzman, forbids me to use the real names of the patient or doctor involved in this episode. In fact, he won't even let me mention the actual suburb where this took place.

The patient is a nineteen year old college student. He had an ingrown nail on each of his big toes. This is not terribly unusual. He went to the doctor's office, located on a side street in a small building in a Cleveland suburb, the first Tuesday of last September. He returned to the same nondescript office the next day for the procedure.

How much does it cost to have two ingrown toenails fixed?

Nope. You're wrong. Did you include the following charges:

Office visits
Surgery
Anesthesiologist
Free standing surgery center

The actual charge for two "Partial or Total Maxtrixectomy"(sic) was $8,225. Let that sink in for a second. $8,225.

No, the nineteen year old was not given gas, but the charge for the anesthesiologist was $1,100. The podiatrist charged $6,120 for the Surgery Center. I wouldn't have believed it had I not seen the bill. The doctor's fees for seeing the potential patient and performing the surgery were totaled $1,005.

My client, the patient's father, was billed $8,225, but he didn't owe nearly that much. His son is insured. Insurance companies do not practice medicine. What they do, and actually do very well, is transfer money and weed out waste, corruption and fraud.

The doctor and his facility have a contract with the insurance company, Medical Mutual of Ohio. I don't know if MMO suspects that there may be some bogus charges here or if they are reviewing their contract with this podiatrist, but even the existing contract protected my client, and by extension, you.

There was a separate $3,060 facility charge for each toe! By contract, agreed upon by the podiatrist and the insurer in advance, the total allowed was $2,142. This may still be excessive, but it is 65% less than the original bill.

The anesthesiologist's fees were reduced by 40% to $437. The podiatrist's $1,005 bill became a more realistic $631. The total contractual bill for the two ingrown nails was $3,210. Some of that was paid by Medical Mutual of Ohio. Some was applied towards the family's deductible.

What was the real cost of these two visits to the doctor and the repair of two ingrown toenails? Depends. had the family not had insurance, they would have been obligated to pay $8,225. Since they had MMO, the real cost to my client was $3,210. If he had had a different insurer, the price might have been a little more or a little less depending on the contract.

When I had the same procedure performed in a doctor's office twenty years ago the total cost was $500.

Your health insurance premiums reflect the escalating costs of procedures, testing, and surgery centers. How medical providers are paid and what they can charge for the use of their offices is a major concern as we contemplate a change in payers. Will you, as the taxpayer, be billed $8,225 or $3,210 for some future nineteen year old's visit?

Picking on the ridiculous billing practices of a podiatrist is easy. Do you want a real challenge? See if you can even get a complete breakdown for the charges of a triple by-pass.

DAVE

http://www.bogartcunix.com/

Protect Me From Myself

2009-03-23T14:40:00.000-07:00

The insurance industry has two watchwords, Responsibility and Consumerism. We (yes, I am an unashamed insurance agent) want you to take Responsibility for yourself. We have the data. You eat too much. You smoke. You drink. And you are too sedentary. Your unhealthy behavior is driving up the need for health care and the cost to provide it.

And while we are talking about YOU and your bad habits, let's discuss your laziness. Did you shop for the best doctor? Did you compare the prices at different clinics, pharmacies, or hospitals? Do we have to always take care of you?

I have a shocking statistic. 100% of all of the people alive today will eventually die. 100% We are not machines. Even the most responsible amongst us will, one day, succumb to the inevitable.

Now this is not to say that we couldn't all use a check up. Lot's of our behaviors lead to illness or injuries. We just learned last week how dangerous the bunny hill can be. I don't ski, but I try to go snorkeling in the ocean each year. Where is the line between recklessness and acceptable risk?

Lecturing Americans on the evils of their diet, lack of exercise, or habits may be correct, technically, but is it useful? Are the insurers credible? I went low carb six years ago. Finding healthy food at an insurance company meeting is like searching for moderation at AIG. Insurers seem to be self-serving on this issue, blaming the victim for the problem. There may be a certain amount of truth in their pronouncements, but a different messenger must be found.

The insurance companies, with their incredible data banks of health costs and outcomes, have a place at the table. Real change, however, is cultural and starts in the home. Only a campaign of doctors, hospitals, schools and the government, unified in a common goal of healthier Americans, has a chance to succeed.

I touched earlier on Consumerism. Insurance companies want you to ask more questions, challenge the quick answer and to shop for the best value for your health care dollar. There is, of course, one exception. The insurers aren't too anxious for you to shop for the best insurance premiums, but I digress.

Much of this Consumerism is just silly. Our system has little transparency. Try to get the price of an office visit, x-ray, or a colonoscopy in advance. Worse, how do shop for quotes for an emergency quadruple by-pass? Do you want the low bid?

The same insurance industry that is demanding that you accept our data unquestioningly and to immediately change your habits is also trying to get you to challenge your physician. We want you to ask the doctor if that test is really necessary. We want you to be your best advocate with the rest of the health care delivery industry.

Of course, we're right, but only to a point. You probably could take better care of yourself. You probably should ask more questions of your health care providers. Don't stop with the doctors and hospitals. Question all of us, big pharma, the government, and the insurance companies.

Start today.

Dave
http://www.bogartcunix.com