Archive | December, 2009

Honesty in health care reform-what really has to happen

30 Dec


I am assuming that the pending health care legislation is signed into law by the end of January 2010, not much a risk in that assumption.

Don’t go to the doctor with every distemper, nor to the lawyer with every quarrel, nor to the pot for every thirst.

Along with enactment come a myriad of new regulations, direct and indirect taxes, cost shifting and creative accounting for the federal budget.  In other words, a somewhat less than honest presentation to the American public of what it takes to truly reform health care in the United States, a goal yet to be reached even with this legislation.

So what would it take to reform health care and be honest with all stakeholders?

Here are a few thoughts; you can likely add some of your own.

  1. Look folks, high cost does not equate to high quality health care.
  2. The fee-for-service payment for health care provides the wrong incentives and rewards and has to change.
  3. Health care can never be affordable (or of the highest quality) if you follow the concept that nobody will ever come between you and your doctor when making treatment decisions
    1. Not every procedure or test that is ordered is effective or medically necessary and in some cases they should not be paid for.
  4. Some inconvenience in receiving health care is a fact if we are going to manage costs.  That means you may have to travel longer than five minutes to receive a test or the closet hospital may not have every service possible.
  5. As long a you are not paying for 100% of your own health care, the people who are (that’s all of us) do have some say in how the money is spent.
  6. Health insurance was never intended to pay 100% of every health care expense, it is insurance (or was originally) and thus intended to protect you from unforeseen, unmanaged medical expenses, not pay for routine expenses. You have a personal responsibility to pay many of your expenses and those expenses come before other things you may wish to spend money on.
  7. One of the drivers of health care costs is the fact that most Americans do not have a direct financial stake in their care.
  8. Americans, if you want to help control health care costs, get in shape, change your lifestyle, and maintain your health.  This is your responsibility even if it costs you money to do so.
  9. You do not have a right to not carry health insurance (because it is impossible for your health care expenses not to affect other people in one way or the other).
  10. The favorable tax status of employer based health benefits is unfair to millions of Americans who pay for their own coverage, at a minimum there needs to be some limit on how much of a tax free benefit each person can receive.
  11.  Assuring that all Americans have access to health care and that the cost of providing that care is spread fairly among society requires a great deal of money.  To truly pay for basic health care for all Americans requires that each American pay 8% of his or her income (a rough estimate) toward that goal.
  12.  Health insurance companies are not responsible for controlling health care costs, you are.
    1. The premiums charged by insurance companions are not the problem; the problem is that insurance premiums are high because of the underlying cost of the care provided.
  13.  Affordable health care cannot be sustained while maintaining today’s income levels for physicians, especially for many types of specialists.
  14.  Advertising for prescription drugs and health care services, hospitals, etc. serves no valid purpose other than to generate additional revenue for the advertisers and must stop and be replaced with fact bases resources so patients can evaluate all health care options and services.
  15. There is no valid reason for the best treatment technique of any kind to be an exclusive right of any hospital or organization but rather should be shared across the U.S.
  16. Health care costs will continue to increase at rates above general inflation no matter what is done with legislation as long as we have an aging population, expect the latest in technological advances, indirectly subsidize other countries health care costs, maintain a largely fee for service system, do not change our lifestyles, continue to have unrealistic expectations for the health care we receive and play politics with health care.

A very good opinion piece in the NYT (did I say that?)

29 Dec

Bob Herbert writing in the New York Times December 29 outlines the real impact and assumptions surrounding the 40% tax on so-called Cadillac health plans contained within the Senate version of health care reform.  This tax, the revenue from which is based on absurd assumptions will adversely affect more and more middle class families in the future as employers (none of whom will actually pay the tax) reduce benefits to stay under the arbitrary cap set by this legislation. 

This is just one of the several less than honest ways in which this legislation seeks to change health care and how it is paid for.

Oh calm down, you voted for change didn't you?

As I have said many times on these pages, the “savings” generated in all of this have little to do with the millions of Americans who have health insurance, especially those with coverage through an employer.  Rather, at least for the next ten years, the combination of changes including those affecting Medicare and Medicaid, the cost shifting, new mandates and more combine to increase costs for already covered Americans.  In addition, the increased obligations for the states through expanded Medicaid benefits will translate into higher local taxes for residents in those states (except Nebraska of course).

As Herbert notes, a little honesty would be nice.

Repeal, Repeal you say

29 Dec


The legislation has not been signed into law, and yet to be finalized and some Republicans are talking about repealing the Democratic crafted health care “reform” legislation.

I have one word for that, fageddaboutit.

Surely you jest, you guys can't even follow your own laws

Despite all the protest and kill grandma nonsense (I hope, speaking as a seasoned citizen), what politician of any persuasion is going to support repeal of any legislation that appears to be a large dose of apple pie and motherhood, in this case taking the form of providing subsidized health insurance to millions of Americans.  Nobody wants to hear about the costs or long-term implications. Republicans should have thought about doing something positive a year ago and presented their ideas continuously side by side with the Democrats.

It’s too late baby, just like Social Security, Medicare and Medicaid this legislation will be ingrained in the American culture with endless modification to satisfy ongoing demands for more.

The fundamental problems of health care in American start when you enter a doctors office

28 Dec


The obvious absurdity of what we are doing with health care in America is most evident in the statements of the supporters of the current legislation.  Simply put, they miss the boat and focus not on the problems, but on the symptoms.  A good example of that is the position of the AMA (an organization as bogus as the AARP in terms of representing its supposed constituency).  Consider this excerpt from a letter to the editor of the Wall Street Journal by the President of the American Medical Association. 


Our current health system is fragmented, and it’s not working for far too many patients and the physicians who dedicate their lives to patient care. Reform of our health system is needed, and the Senate bill includes key benefits that will increase choice and access while eliminating insurance company tactics like denying coverage for pre-existing conditions. 

What we fail to understand is that the fundamental problems of health care in American start when you enter a doctors office, not when you file a claim.  Forty- eight years of managing health benefits and of hearing claim appeals from employees tells me very clearly that people don’t get it, they want it all, they do not want to pay for anything, they think every test and procedure ordered by a doctor is warranted, and they never ask why something cost so much, but they always ask why the health benefits did not pay more.   That is what is wrong with health care in America.

An amazing Christmas on the Garden State Parkway

28 Dec


First, Merry Christmas even though Christmas is past.  I felt it important to say those words since in public they seem to be a politically incorrect thing of the past. Even my Word ® software tried to correct me when I typed those words.

For more years than I can remember, Christmas dinner was at our house with all of our children or as they had families of their own over the years, when it was our turn as the alternative to the in-laws.  This year we achieved an amazing goal of all of our children and grandchildren at our house for Thanksgiving but at the cost of no one coming for Christmas.  That left us two seasoned citizens on our own.  However, the kindness of our soon to be daughter in law saved us from staring at each other over Christmas leftovers; she invited us to her family’s Christmas celebration.  It is now 10:30 AM the day after Christmas and we still haven’t made it to her house.

Instead, we decided to spend Christmas day sitting on the side of the road on the Garden State Parkway our Christmas carols replaced with the whining of cars speeding by us at 75 MPH as we sat three inches from the main road with our hazard lights flashing in lieu of flickering candles.  Ah such merriment and to make it more exciting I had to pee.

I did learn new phrases such as “gear box fault” and “engine system failure” but they appeared on my dashboard, and did not measure up to Deck the Halls.  My wife’s low mileage, less than four-year-old, Jag had let us down.  I mention the maker of the car only on the chance that someone associated with that thing reads this and knows that many other people are as well.

We never made it to our Christmas dinner, which by now you have figured out.  Rather, we limped off the Parkway to our son’s house (he was at his fiancés) in New York.  Amazingly (don’t you just love that word), the car actually does have a “limp home mode,” you have to give credit to the Brits for thinking of that. When we arrived, I turned off the engine, but few minutes later decided to move the car to better place it in the parking space and amazingly no warning lights, no limping mode the car was fixed, it seemed fine.  I quickly concluded that it must have been the fault of the cruise control, my conclusion mind you with zero knowledge of automotive mechanics or electronics…big mistake.  So, with things seemingly all in order we took off for Christmas Joy…big mistake.

As we drove down the Parkway again, my failing engine and faulty gear box friends returned only this time shutting off the engine and restarting got us about 200 feet at each try, just let me make it to the next exit I think I still have to pee. No such luck our final moving destination for Christmas Day was on the side of the Parkway only this time there was barely any shoulder and we were precariously sitting very close to the traffic racing by with no regard for our holiday hazard lights flashing.  In fact, we were so close to the guardrail there was no way to get out of the car on the passenger side. My lovely wife reminded me of the fact it may have been better to stay at our son’s parking space.  I know, I sheepishly said in recognition of my poor but desperate choice to save the day.  

I dialed 911 and quickly told the operator all I wanted was the number for roadside assistance; he connected me to the State Police who connected me to the road service who with amazing efficiency arrived in about 15 minutes.  Despite the flat beds flashing lights the passing cars still whizzed by at amazing speeds and only inches from the side of our car…happy holidays to you too bud which is not what I said to the driver who insisted on blasting his horn at me as I limped off the highway the first time. After a short period of strategic planning, I eased out of the car as the driver of the tow with his orange vest tried to get cars to move a bit to the left.  My seasoned citizen wife then climbed over the console and got out on the driver’s side followed by both of us inching along the flatbed to get to the other side of the cab.  That required her to climb over the guardrail and then climb on top of the guardrail into the cab.  No need to go to the gym this morning.

Can you take us to the nearest Jag dealer I asked the driver?  I can only take you off the Parkway; you have to call AAA to pick you up there.  “Can I bribe you a vast sum to break these absurd rules?” I asked. “Sorry, I don’t want to get into trouble, was his friendly reply.”  Ok, can you at least drop us off at a diner so we don’t freeze, starve, or have to pee?  Sure, that’s no problem and he dropped us at a Burger King.  As the car was unloaded from the flatbed I told my wife I would call AAA and she could wait in the Burger King and get a cup of coffee…the Burger King was closed.

Before he left, we gave him the bottles of wine we were bringing to the Christmas dinner, Merry Christmas, sorry for getting you out today.  That turned out to be a fortuitous gift because when I learned from AAA that it would be one and half to three hours before we were picked up I mentioned that fact to the tow driver.  Let me see what I can do he said.  The flatbed for the next leg of our Christmas travels arrived in only twenty minutes.  Good thing, I really had to pee by this time and my wife alluded to a similar dilemma.   I guess some other poor traveler was waiting a bit longer, but to be honest, I had two bottles of wine and he did not. 

The second driver turned out to be friendlier than the first especially after leaving his Christmas meal to save us.  He spirited us home (after we climbed three feet up into the cab of the flatbed), dropped off the car at our local garage and even dropped us at our front door a few blocks away.  We willingly gave him a nice tip as well, cash this time we were all out of liquor.

Now that we were warm and cozy (and peed) and pondering the cost of fixing this British bomb my wife and I settled down to Christmas dinner of goldfish crackers and wine, but our culinary dilemma was vastly improved when our son in law brought us some leftovers from their Christmas dinner.

This morning I walked to the garage where I left the car to see what could be done.  They were closed for the weekend. 

We are going back to splitting up the holidays so there is always somebody home for Christmas because I am never leaving the house again on a holiday…even for an amazing day on the road.

Elequent Speech

24 Dec

I just listened to the President speak on the success of the health care reform legislation and then take a slap once again at insurance companies. He was full of promises from lowering costs to bending the increase curve to improving quality. Shortly after the speach I read an article in the Wall Street Journal about how employers will be cutting back on retiree benefits as a direct result of new taxation contained in the legislation.

I suppose the President is no different from any other politician but given more than half of Americans are not comfortable with these changes a little honesty would be refreshing.

A good assesment

24 Dec

I can’t take credit, but here is a good assessment of health care reform I read. Take a look.

Health Policy News

Don’t tax my fruitcake

23 Dec


My wife says that I am cheap and in as much as I can easily fall asleep behind the rubber plant in the corner of any room during a raging party, I must be dull as well. In fact, at a house party the first friendly contact I make is generally with the family pet, preferably a dog.  I am allergic to cats and have little use for them in any case.  There, now I have offended yet another group of people.  

Here is my fruitcake from 1958, we are still working on it

I have one other major flaw (among many minor ones).  I like fruitcake.  The more fruit the better, especially candied cherries.  Fruitcake gets a bad rap, mostly from people who have never tried it.  What’s not to like?  You have a moist dark cake, loaded with nuts and pieces of candied fruit and with any luck lots of whiskey or other suitable spirit.  Moreover, how many other cakes do you know of that are used in a weightlifting regimen? There is no doubt many fruitcake lovers are still in the closet.  After all, they don’t make fruitcake just to take up shelf space during the holidays…or do they. Perhaps that is a concept for further reflection. Why there is even a Miss Fruitcake, in 2005, it was Courtney Sheffield and her mission is to “stop fruitcake abuse wherever it occurs”.  Somebody besides me must buy fruitcake but I am still on a quest to find the person who will admit it.  

My wife whips up a mean fruitcake (still some in the freezer from last Christmas) by creatively using a date nut bread mix with a personal touch, including extra candied cherries. I don’t even have to go out in public to get my fruitcake fix; yet eating a piece in front of my family has been traumatic at times.  “Would you like a piece,” I always ask. “No thanks” or simply “Are you kidding,” is a typical reaction.  That is not quite true; the typical reaction is “yuck.” 

Let me make it clear, if you like your fruitcake, you can keep it. It just may cost a little more.

I must admit that there appears to be a considerable amount of fruitcake leftover after Christmas and if my memory serves me well, most of it is in the A&P stores, or at least it used to be before the Great Atlantic and Pacific Tea Company went the way of AIG. Given that one can buy imported fruitcake (the German variety weighing about five pounds per square inch is a favorite) there would appear to be an international demand as well.  That is, unless everyone ships their fruitcakes to be consumed by ten or twelve Americans.  Like many other holiday treats fruitcake goes on sale after Christmas, so there appears no reason to pay full price.  I suspect that fruitcake purchased at 50% off in February or March can be preserved with little effort until the following December.  That is a theory mind you; I have not tested it yet.  I pushed my luck once seeking a 75% discount in April, but by then the bloom was off the fruitcake and it was no where to be found. It’s like looking for a pumpkin around Easter. 

Just because I like fruitcake, I do not want you to think I am a health food nut.  However, with cholesterol twice as high as my IQ (no it is not under 200), I do watch what I eat.  The other day I was looking at a vending machine.  I bet you thought there was nothing but junk food in those things. Not true at all.  As I gazed into the machine, I saw words like apple, honey, strawberry, peaches, corn and whole wheat, there was even a product that began with Mothers.  How bad can that stuff be?  When I take a shower those same words confront me.  The shampoo women use contains everything except steamed Chinese vegetables.  My latest discovery is a bottle of shampoo containing Oak Bark and Kiwi…but no fruitcake….yet. 

By the way, if you soak the fruitcake in rum it will last longer than the Democratic Congress, or at least until next year.  We are going to have a health tax on tanning salons, my word what are they going to do to fruitcake?

Health care reform may be delayed

23 Dec is reporting that the White House expects health care reform talks to go into February and not be finalized until after the State of the Union address.

There appears to be growing discontent in the House over what is or is not part of the Senate bill.

Fine print, details, real motives, take your pick

22 Dec

The devil is in the details they say, so here is a detail that should draw the attention of large employers.  This is from a section of the Managers Amendments recently issued by the Senate.  On its surface it appears rather bland because all it requires is for the Secretary of HHS to cull data from existing Form 5550 filed by self-funded employer plans.  


‘‘Not later than 1 year after the date of enactment of this Act, and annually thereafter, the Secretary of Labor shall prepare an aggregate annual report, using data collected from the Annual Return/Report of Employee Benefit Plan (Department of Labor Form 5500), that shall include general information on self-insured group health plans (including plan type, number of participants, benefits offered, funding arrangements, and benefit arrangements) as well as data from the financial filings of self-insured employers (including information on assets, liabilities, contributions, investments, and expenses). The Secretary shall submit such reports to the appropriate committees of Congress. 

The question is why and why such reports will go to committees of Congress? 

Okay, so we all know why and that is because Congress will be looking for more changes to make in health care benefits.  Two words jump out at me, “funding arrangements.”   Many employers do not have funding arrangements, especially for a non-union workforce.  It is pay as you go. 

Hey, it's for informational purposes only...right Congressmen

Will Congress be looking to tighten up on this, to avoid any risk for plan participants, it is actually a problem?  Who knows, but you can be certain that some member of Congress will find a way to get into your knickers sooner or later because you all know where the devil lies.

No free lunch, really

22 Dec

Regardless of your views on government involvement in health care, perhaps we can all agree that once politicians get into the act anything is possible including the wartering down of key provisions of pending legislation. Consider the all important 40% excise tax on high cost health plans. Already, the groups exempt from the tax are growing the latest union to be exempt is the longshoreman. Miners, some fisherman, electrical lineman and even the 17 states with the highest health costs get a deal on this one.

So, you have to ask yourself if this provision is so important in controling health care costs, how can we have all these exceptions and still reach the revenue and cost control goals?

Of course, the answer is you can’t but then again this tax achieving it’s stated goal was never a reality any more that the assumption that lowering the value of health benefits by employers to avoid the tax would translate to higher wages.

For those of us who shall we say have reservations about the ability of Congress to keep it’s hands off the final legislation for more than a month, this deal and others contained in the legislation give a good indication of what is to come and it is not higher quality, affordable health care.

State legislatures have been adding to the health care cost problem for decades with special interest benefit mandates and other restrictions and rules. Is there any reason to believe Congress will be different (although perhaps more stealth)?

Americans should be concerned what is lurking behing secret doors number 1,2 or 3.

You have to give Congress credit though, nobody will ever know what this all costs or how much they are truly paying for “reform.”

The most significant legislation in decades and who likes it?

21 Dec

As we get closer to health care reform as defined by the Democratic administration, we have legislation that everyone loves to hate, but we have it nevertheless. 

Liberals hate it, Republicans hate it, Conservatives hate it, the majority of Americans do not want it in the current form, and scores of interest groups do not like it for reasons that range from abortion to taxation, to Medicare cuts, to new administrative burdens on employers and insurers. Noted health experts make it clear that this legislation does not either address the real quality or cost issues.  The legislation supposedly saves money for the federal government by shifting costs to those Americans who already have health insurance, to the states, to many Medicare beneficiaries, to insurers, to employers and health care providers and according to the CBO by 2019, there will still be 23 million uninsured Americans. 

The legislation lacks any bi-partisan support; the House of Representatives passed its version by a small majority and the Senate by the minimum 60 votes.  To gain support from Senators individual deals were made left and right.

The stated objective of health care reform is to make quality health care affordable to all Americans.  There is little to improve the quality of health care in the general population, affordable remains defined as adequate subsides to buy health insurance the cost of which will remain out of control.

What happened, in a word, politics? What a way to run a country.

On to the House and Senate Conference.

Health care reform one step closer, get ready for the historic moment

19 Dec

Well, it is one step closer to a done deal as they say.  Health care reform that will save the government money and by 2019 still have 23 million Americans without health insurance (although 1/3 of that number would be illegal immigrants).  Of course, the money saved comes from reduced payments under Medicare, cuts in Part C of Medicare, a new 10% sales tax on tanning salons (who cares), the 40% excise tax on high cost plans (expected to generate $35 billion in revenue in 2019) good luck with that and penalties paid by people who do not obtain coverage plus an increase of .9% in the Medicare tax for individuals who earn more than $200,000 a year.

Sen Ben Nelson cut a deal (despite the fact his office staff told me there was no way he was voting for the bill for many reasons) part of which is that Nebraska will have the entire additional cost of the Medicaid expansion under the legislation picked up by the federal government while other states will see an added expense for Medicaid in 2017.  There is a national view of doing the right thing.  I suspect Nebraska has a huge Medicaid population compared with New York, New Jersey and California.


The CBO estimates a lowering of the deficit by $132 billion over ten years as a result of this legislation (but an increase in insurance premiums for many people who already have coverage). That includes $72 billion in revenue for the new long term care insurance that will automatically enroll workers unless they opt out.

If there is anyone who believe that the federal government can estimate anything accurately over a ten year period or that future Congresses will not tinker with all this starting in  2010, make sure you leave some cookies and milk for Santa.

Bring back risk

18 Dec

I was delighted to hear on the radio that the head of the FDIC wants banks to stop lending only to the best risks, but to take more prudent risk and expand their lending to small business.

Needless to say that in order to make this workable we need the FDIC to issue extensive regulations defining prudent.

It may also help if there were a new prudent risk bankers bonus pay plan.


What the housing “crisis” and health care reform have in common

18 Dec


Boy this is a stretch you are thinking tying mortgages with health care.  In fact, there is one common thread in all this…personal responsibility or rather the lack of it.  A few weeks ago, the Wall Street Journal ran a story about a town where people were simply walking away from their homes and their mortgages.  I reported on it in Quinnscommentary.

On December 17, 2009 the Wall Street Journal has another story on the same topic, that is homeowners deciding that given their mortgage is larger than the value of the house they are better off stopping monthly payments, let the bank foreclose and walk away to a rental and in the process clear several hundred perhaps thousands of dollars a month.  Sounds like a plan…if you have low ethical standards.  However, maybe not, in today’s society apparently there are few standards.  Consider this quote the WSJ article:

Brent White, an associate law professor at the University of Arizona who has written about this issue, says homeowners should make the decision on whether to keep paying based on their own interests, “unclouded by unnecessary guilt or shame.” He says borrowers can take a cue from lenders that “ruthlessly seek to maximize profits or minimize losses irrespective of concerns of morality or social responsibility.”

Frankly, this is not a person I want to lend money to and for that matter not someone I would want teaching my children either.  He seems to worry about banks ruthlessly seeking to maximize profits (he is a lawyer remember) and yet ignores the fact that these people were no doubt out to maximize their profits as well expecting the price of house to keep climbing.  They obviously have little attachment to the house as a home.  These are people who can afford the mortgage; they just want out to maximize their financial situation at the expense of the bank and all who are affected by these losses. 

So, how do you equate this with health care reform, I bet you have been waiting for this one.

In the case of health care, the insurance companies, the drug makers, and the hospitals are the banks.  The ruthless profit seekers who are at the root cause of health care costs.  Weeeeeel, not so much.

You see the root cause of health care costs is us (the homeowner).  Much of what we spend on health care is the result of our own actions and lifestyles, the demands we place on the system to fix what we screwed up cause the system to respond with more and more expensive treatment, more drugs, more specialists, more of everything.  We want good health with no down payment (and no monthly payment).

   What a way to look for a new home

In both the case of the house and our health, we seek and the politicians are more than willing to provide scapegoats be it the banks and Wall Street or the health insurance companies.  At the same time, we seek a quick fix that does not get in the way of our right to do anything we want.  Apparently, in 2009 that quick fix means more government intervention and control, as long as that control is on someone else.

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