President Obama: Day 1

Day 1

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President Obama took office today. We wish him only the best. Should America continue the mistake of punishing those Americans in need while rewarding Americans in power, at the expense of her people’s future? We are in very precarious times. I am counting on President Obama to reverse many of the prior administration’s fatal economic blunders. Ignoring the Healthcare Crisis in America will be the next major bankruptcy should Congress and the President not do something during this administration.

Health insurance is cheap in America. Do not attempt to scare me healthy…my mortgage is cheaper and I am in default. Are you in default on your health thru your lifestyle? Is this a crisis or an opportunity? President Obama will make more history by solving the biggest social problem affecting our economy.

Privatize or Socialize?

Where does the money come from? Are taxpayers going to bear the brunt of socialized medicine? Does every taxpaying citizen deserve an unfair shake? Why are taxpayers paying for the uninsured illegal immigrants? If Medicaid decreases its financial criteria to catch the folks in a financial squeeze we should be able to insure the majority of our citizens (universal should only apply to US citizens, right?). Should it be illegal not to carry health-insurance?

Why you don't get it! It's by design? Do you have any responsibility in this? If you are healthy why would you need this now? What about the State versus the Feds? Consumer driven healthcare marks the end of an era, not the beginning of anything truly useful. If you know how to direct your own care, what do we need doctors for? HMOs, PPOs, point of service plans, indemnity plans and even supplemental plans can be used in many effective ways together, but they are not. Most people covered by health insurance don't even understand the plan design that they selected or which has been selected for them in the case of group health insurance. They don't understand what an uncovered benefit is or what contribution levels are.

Contribute before or after taxes?

COBRA rights and continuation of coverage options should be clear to people who are forced to end their health insurance plan. The quality of care is not being addressed well enough by any insurance company. Shouldn’t the quality of care be addressed by the medical profession? Whose grave are they digging anyway? The high utilizers of their benefits plans have many options that have been not been taught to them. It is important in the new era of health-insurance that members learn how to use their plans effectively.

Crisis...

Can we live with a crisis-oriented medical delivery system? Can we still afford it? It is taking over our economy. Where can the biggest savings be realized to fix our current healthcare system and maintain its dignity and integrity as the most sophisticated medical delivery system of health care and possibly insurance in the world? What is a consumer’s part in changing our medical system for the good of all America?

Information means education

Technology can compliment the flow of information. Patients and doctors will benefit together using the flow of information. Many diseases can be completely avoided from lifestyle changes. When you get sick how do you know what you need? What is medically necessary? Well, “I want it done” is what I say. After all, I am the consumer that is directing my care and you are paying for it. I don’t feel that way because my premiums are as much as my mortgage. I am paying for it. Or maybe I am just uninsured? Transparency really uncovers a lot, doesn’t it? Sometimes you get what you pay for. How will the chance of my illness affect my family or my loved ones or my work productivity?

Can I afford to be sick? What is my Employer doing to help me? What kind of protection do we have now? How will the system save me in the event I can't afford it any longer? How can I get health insurance protection when I am sick and unemployed…it’s too late now. Thanks for no protection.

What could we do now to make the U. S. healthcare system better? Now that is a question worth asking. Take some personal responsibility.

Exercise and diet

Make your healthcare a priority. You are what you eat. Your health is your wealth. Why have these expressions won the test of time?

How can technology benefit us? Shouldn't all doctors who practice medicine be online with all health-insurance companies that they do business with or all of the vendors in healthcare? Shouldn't all medical records be available online with a personal password so that when we access urgent or emergency care, the providers who are saving us, are enabled to access critical information instantly?

Shouldn’t any Doctor or provider of medical services be forced to carry malpractice insurance? It seems ancient and perverse to ask these questions of undeniably the most inefficient and expensive health care system in the world.
Eliminate fraud and its nasty attachments. Public programs might help....

Is the government really good at this? Medicare, Medicaid, healthy kids? Do you know that the U.S. government reimburses physicians and hospitals and at a higher rate than health-insurance companies do in America? Where is that extra money going? What message are we giving providers? The watchdog is sleeping and the greedy are getting richer at our expense. Sound familiar?

So what are you doing? What is your part? What is your responsibility? Why don’t you care?

President Obama said that healthcare should be a right. I hope I can help him accomplish just that and I make my living selling health insurance to corporations. Is it truly a right to live an unhealthy lifestyle that leads to being unhealthy, less productive and more costly for those who participate in paying premiums for health insurance of any kind?

Should there be a penalty for those who inflict unhealthy lifestyle choices upon themselves that lead to disease? What about companies? What if it is psychological? Oh, insurance doesn’t reimburse for that. What about those truly in need? What about those American citizens who are born with birth defects, mental illness, diabetes or other critical illnesses? Where is our social responsibility? Is it in oil or war? What about American rights in America?

Does your health insurance disease management program help lower costs? What about a society embracing the concept of evidence-based medicine? How good is evidence-based medicine? The proof is in the pudding.
If it's my responsibility as a patient or member of the health plan who is accessing their benefits to know my plan and to use it effectively, why would I not be doing research to increase the probability of a successful outcome for my particular procedure or interaction with the medical system? Perhaps I don’t have access to that information. Why is a cup of coffee for five dollars more important than your health?

Consumers go to doctors because they do not know how to direct their care

This concept of Consumer Driven Care sold to the government and providers is foundationally irrational. Why do we need to go to doctors if all of us can direct our own care? Transparency which exposes cost is simply based upon supply and demand and not quality. I know because I consult to providers on their reimbursement contracts with health insurance companies. Once again, size matters. Quality is an afterthought.

HEDIS, (health education data information set) is not enough and it is a process that consumers do not understand. Yes, if you work for a health insurer you might have some vague understanding. There are standards that are enforced upon health insurance companies and their providers that do not result in better outcomes and therefore less expensive care, because these standards do not make for better outcomes. They increase cost. The stamp of approval is like the road to hell being paved with good intentions. The cycle of life and the supply and demand curve within health care itself are some of the most challenging issues.

America is the world’s leader in medical advances. We have the best access to care anywhere in the world and better yet, some of the greatest trained practitioners in the world. Why is the system so messed up? Ask for my book, “The War on Medical Terrorism” and find out how you can be part of the solution. I am convinced that President Obama must address healthcare head on.

Has Obama Already Vetoed Single-Payer Health Care?‏

Obama is on record saying...

Obama is on record saying he will have an open mind to changes. During the Presidential debates, President-elect Obama said health care in America should be a right. There is no escaping that. The current U.S. medical system run by health insurance companies will be the next financial disaster Americans have to deal with if our leadership wimps out. This battle must be won so the War on Medical Terrorism, which I discuss in my book with that title, is won by all Americans. There are a lot of promises and hopes for the U.S. health care system and a single payer Medicare-type system for all Americans would be a good sensible start towards making this protection from financial catastrophe to working and unemployed Americans a real possibility. There has never been a better opportunity than now.
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Money is not the problem. Cost is the problem due to 25-50 cents of every premium dollar going to administration. Wasted money and insurance companies as gatekeepers with only profit in mind prevents what is unique and great about the U.S. medical system from becoming a reality. If health insurers win, universal coverage will only benefit them. Health insurance companies should be embarassed at their performance. They have failed to add value to the system. In fact, the health insurance lobby is so rich, selfish and arrogant that the medical industry is bursting at the seams. Demand is much bigger than supply and, with technology and non profit driven motives, maybe our health will not be taken for granted.

Not all CEOs are dishonest...

Good health promotes freedom. Freedom keeps democracy and capitalism alive. Not all capitalism is vested in this Wall Street disaster. Not all CEOs are dishonest. Single payer would create more jobs and allow U.S. business to flourish in this competitive, global economy that has grown very dependent on U.S. financial leadership. However, this should not be viewed as a picnic for our Peter Principled Fortune 500 CEOs. What a fantastic opportunity to add value to the lives of Americans. We have no excuse to not exercise this opportunity especially in light of this terrible recession. Let's make up for lost time!

We must act now President Elect Obama...

United Health Care, the nation’s largest Managed Care Company announced in the NY Times on Dec. 2^nd a new product called Continuity. This product is being sold to protect your right to individual health insurance coverage. Of course if President Bush or President Elect Obama understood what this was, they will immediately level the playing field and make all health insurance sold in America, guaranteed issue from your employer or individually. This garbage is a marketing insult to intelligence and a blow to the lack of action from Congress regarding health reform. 

In my book, “The War on Medical Terrorism”, you can  become educated on the U.S.  health insurance industry and its value proposition. What a farce. This product should never exist because the U.S. government already recognizes the need for every state in America to guarantee issue of individual insurance policies especially in light of the recent high unemployment numbers and our current economic crisis. Americans should always have the right to purchase protection from catastrophic financial disaster due to bad health, if they can afford it. However, as you will find in my book, due to the naivete and lack of responsiveness from the U.S. government, Congress must be convinced that legislation of this type can wait.  I am embarrassed by our inability to act on legislation that would guarantee Americans the right to purchase health insurance protection if they could afford it, instead of adding  profits for a valueless product. 

The fact that this product hasn't any viability is the fault of Congress to enact any useful health insurance reform in the past 50 years. Group insurance, which is usually a guaranteed issue product, will not protect the two million Americans who are now out of work and whose COBRA benefits exhaust after 18 months. If they are not working at a company that makes health insurance benefits available to their employees, this economic crisis will result in many more hardship than is necessary. 

My prediction is that United Healthcare will be the first health insurance company in America who will be begging our government for money based upon their financial collapse, which will prove to have nothing to do with the health risk they bear in selling health insurance policies. It is greed and poor management and lack of leadership that will kill this company and endangers the strength of our entire health care system. They will take many others with them. Is anybody aware of this? Of course not, which is why we are where we are. United Healthcare’s coming inability to pay claims on a timely basis is increasing. Do you know anything about this company and what got them in to this position anyway?

The service provided by American health insurance companies has deteriorated to levels of abomination. If you have health insurance and have been sick, you might understand that the provider side or care suppliers will come through for you regardless of your coverage and the underlying insurance carrier, despite their attempts to keep you from getting the medical services you need by not paying for them. If you provide a service that someone needs and you do it ethically and honestly to the best of your ability, most of the time you deserve to be compensated for it. This United Health Care company invention or product  called Continuity shows the arrogance of the health insurance industry and its strong hold on cherry-picking risk. American citizens should not have to be the insurer of last resort.

 

When the U.S. government, under the directive of President Elect Obama, creates a government alternative to corporate health insurance, Americans should benefit from this competition… not suffer from it. What are we waiting for? There is a tremendous opportunity in this particularly difficult economic crisis to respond with great strength and humanity to our health care crisis. America needs to focus on herself first. It isn't isolationism, just an executable plan for the future. Be bullish on America. The world still depends on us. American capitalism has been the economic machine of prosperity that saved the world numerous times from economic disaster. But when economic woes affect America, the world suffers with us. 

The U.S. dollar will be and deserves to be the strongest currency in the world. Every world leader either knows this or is afraid to admit it. Don’t lose faith in America. We will survive and lead the world back to more stable times but cannot and must not ignore our immediate needs at home. The U.S. health care crisis has the potential to dwarf our current economic crisis. We must act now President Elect Obama. I know you can do it. 

This bail out is not Capitalism. It is Socialism...

This bail out is not Capitalism

Last night on October 1st, 2008, the US Senate voted 75% in favor of the Wall Street Bailout according to the New York Times, CNN, Fox News etc. This bail out is not Capitalism. It is Socialism and borders on Communism. Both presidential candidates voted in favor of the Bill. We will see how the House votes on Friday. If the U.S. government votes to force this outrageous legislation on the middle class and moves Capitalism towards Socialism, what is our excuse for not moving to a single payer health care system that is universal in nature and would identify every single person living in the United States? With single payer, rich and poor United States citizens win together, saving as much as 50% for health care, not to mention the opportunity it will afford us to identify illegal immigrants who are financially stressing out our health care system.

Americans need affordable health care, not to bail out rich executives on Wall Street. Why should a CEO who earned hundreds of millions of dollars on the way to bankrupting their company receive an exit package at all? Careless, fat CEO’s cost Americans hundreds of thousands of jobs if not millions. The CEO’s who caused this mess should proportionately be bailing out this economic mess created by their incompetency and greed.

The U.S. will become a financial fatality…

The cost of a single payer U.S. health care system looks cheap in comparison to this Wall Street bail out. Main Street, or the middle class, will probably be paying for this legislation for many years. As I’ve pointed out in my book (“The War on Medical Terrorism”) the costs of postponing the move to single payer and not fixing the way medicine is practiced, from reimbursement to administering care, will bankrupt our nation. The U.S. will become a financial fatality…a calamity from poor management and a lack of vision. U.S. Gross Domestic Product will be monopolized by the coming health care crisis, should we choose to ignore the problem. Without single payer, the U.S. will not be prepared to compete in this new, highly competitive global economy.

That next U.S. government bankruptcy is rooted in health care…

That next U.S. government bankruptcy is rooted in health care and will dwarf our current economic woes. By the way, no other country will care. U.S. health care is not the same as our global financial markets. If the U.S. does not move to single payer within the next 5 years, the financial corruption in health care will overtake the actual benefits Americans need desperately. More CEO’s get richer and health care in America deteriorates. Keep in mind that a hand-out in America because you have fallen on hard times is acceptable. That is why these social programs exist. The expectation is that every working-age American will at least try and make the effort to work and contribute to our great country. Are all American political policies only reactive or can we become proactive and stand up for the majority of Americans?

On Richard W. Fisher of the Federal Reserve Bank of Dallas

… his recent comments before the Commonwealth Club of California San Francisco

America needs to make significant changes in order to meet and exceed the financial demands that our health care and retirement systems face. In Mr. Fisher’s highly socialistic overtones, his recent comments before the Commonwealth Club of CaliforniaSan Francisco, California regarding the fiscal turmoil we Americans face were depressing when taken literally. Once again, Americans have a supposed financial guru, who is part of the system that created the problems, telling Americans everything that is wrong with our social programs without any proposed solutions. Sounds like the common politician…not the kind of opinion that can make a difference in any of our lives.

Where has the vision in our leadership been? There are numerous ways to fund the shortfalls associated with Social Security, Medicare and Medicaid that Mr. Fisher stressed in his speech. Mr. Fisher’s story implies that fixing the system is impossible with the mounting debts and an unmanageable outlook on America’s financial horizon. However, a smart banker like Mr. Fisher should be suggesting ways to resolve the financial struggles we face in light of some of the critical aspects of our current and future economy.

Here are some ideas:

Our tax system needs to be simplified. Reform it.

The U.S. government needs to re-prioritize where it invests our money. What about the citizens of America? America’s pressing issues include education, infrastructure, health care, retirement and overall global competitiveness. Isn’t that even more important than policing the Middle East by rebuilding schools or fighting terrorism or trying to democratize the world?

What about the medical terrorism within our own economy?

Our problem, Mr. Fisher, is not the scary numbers that you so inaccurately project which intimidates Americans to the point of inertia. Leadership is initiated by people with vision…not to be skewed by unrealistic statistics manipulated to make a point. However, the point Mr. Fisher is making does have some validity to it. What about the medical terrorism within our own economy? America is struggling financially in a global marketplace with some very deep internal problems. The further deterioration of the entire middle class due to greed, selfishness and the lack of leadership continued to allow the privileged few to enjoy a favored tax process that ignores the needs of our democracy. Mr. Fisher should be talking about repealing laws like ERISA that have clearly allowed large employers to escape full responsibility when it comes to health insurance if he favors the current system. If Large Employers did not want to be in the health insurance business, they should have never lobbied to pass ERISA. By the way, Mr. Fisher when we fix the U.S. health care system using some of the suggestions in my book (The War on Medical Terrorism), there will be more than enough money to fund these supposed unfunded liabilities that your statistics support.

The reason we are at this juncture financially is due to poor planning and lack of vision

Mr. Fisher makes some excellent points about life expectancy and medical advances that were not taken seriously into consideration when these programs were enacted. The reason we are at this juncture financially is due to poor planning and lack of vision. We have a chance to make it right. Help us help ourselves. Amend the constitution and make health care a right. Americans will get on with our lives and accomplish the unbelievable. Our tax base will grow immensely due to our thriving economy and once again America’s resilient economy will be the envy of the world. America needs the New Deal of Health Care Reform 2009. It can be a 20 year process that starts to make changes with the next administration in the White House.

Use your vote carefully. It is a matter of life and death.

“Hospitals Now Rate Insurers”

Most of the issues with hospitals and insurance companies surround reimbursement

In the LA Times article on March 7, 2008, “Hospitals Now Rate Insurers”, Hospitals are now rating insurance companies who they get reimbursed from. Is the rating based upon anything that has to do with the care members of health plans actually receive from that particular hospital? Hospitals need to work out their problems with insurance companies and keep consumers out of the fray. Most of the issues with hospitals and insurance companies surround reimbursement. Some issues have tied reimbursement to superficial measurements of quality. Hospitals need to focus on efficiency and flushing out medical errors. They should put more energy into staffing and training. There should be zero tolerance for medical error from all parties involved.

So is there any significance to this new rating that hospitals may be embracing?

When an insurance company receives a favorable rating from a hospital, what does it mean? The fact that a hospital likes to do business with one insurance company over another one means nothing. Hospitals and their respective providers should just do their job of getting us well as efficiently and effectively as possible. Reimbursement will come timely and as per their contract with the insurance company for the appropriate outcome. I know that patients have this viewpoint. So is there any significance to this new rating that hospitals may be embracing? It is just one more cog in the broken health care wheel that needs to be dealt with. Providers and reimbursement issues will always be a hot issue. Profit drives health care and education drives good health.

We need a leader who can…

Our priorities as a nation are challenged by wealthy private interest groups that ruin any chance of timely progress. We need a leader who can make tough decisions and stick with them. America is supposed to be a democracy, not a republic driven purely by capitalistic idealism and overwhelming discrimination. Unfortunately, our elected leaders to the U.S. government are not setting the right example for our children’s future. So, hospitals who rate insurance companies are missing the point. Quality ratings need to be administered by third party vendors that are reimbursed by the U.S. government. There can be no conflicts of interest…especially in the name of profit.

On January 22 in the Boston Globe...

Blue Cross and Blue Shield of Massachusetts…

On January 22 in the Boston Globe, Blue Cross and Blue Shield of Massachusetts, the most dominant carrier in this progressive health insurance state, is trying to slow runaway health care costs and improve the quality of care by changing the reimbursement methodology it uses for paying physicians and other providers. I applaud them for attempting to make useful changes that address the Achilles heal of the U.S. health care system by addressing cost head on.

The acknowledgement that medical costs are the most significant problem facing the U.S. health care system and that reimbursement incentives to providers have to be changed, is a major step forward, especially for an insurance company. In light of that, empowering the medical system to work together to provide the right care sounds great in theory. Performance measures carry the message of accountability. That is a good start. There is so much work for America to do and, as a country, we are running out of time. The facts are Americans are letting insurance companies once again determine what they think is right. Americans need to wake up and face the music. Americans need to elect politicians who have a vision of what the future will bring. We are in the midst of a serious provider shortage. Many doctors are leaving the field especially at teaching hospitals where we develop the most competent doctors. Nurses are extremely hard to come by. That is a recipe for disaster and increased medical error rates. At the same time, we are talking about overhauling the U.S. health care system. What a tremendous challenge.

There are numerous tax laws and other disincentives…

There are numerous tax laws and other disincentives through out the system that have to be changed. Americans and providers are obviously concerned but understand that the US Health Care System has to change. Massachusetts’s Health Care System has been an excellent model for other states to attempt to duplicate. The problem is that very few states actually are like Massachusetts. Sophistication, population, access and other issues affect the potential for standardized change. However, all States must do something to resurrect the entire U.S. medical system.

Health insurance companies are trying to make a difference…too little and too late. The problem is no one trusts that their heart is in the right place. We already know that CMS operates at 3% and insurance companies operate at 12% to 24 %. That means a single payer system would save money or leave more money on the table for necessary care instead of top level executives getting rich at the expense of the American people’s health. Keep that in mind when you elect the next President.

Can any of the candidates get the U.S. health care system back on track?

The Clinton/Obama Health Care Reform Rhetoric

It seems as though the most popular reform ideas…

There are numerous ways to address health care reform. It seems as though the most popular reform ideas stem from supposed Universal Health Care crusades and acknowledgement of the uninsured issue. Senator Clinton feels that health care reform is achievable by mandating universal coverage with no recognizable enforcement of that theme. Senator Obama feels that by mandating child coverage only, the uninsured issue is resolved more effectively. There would be fewer uninsured Americans according to his statistics. I love how these candidates use statistics to manipulate public opinion with out telling the whole story.

Insurance has some basic and simple principles. The law of large numbers creates opportunities to spread risk over a broader spectrum of both the healthy and the sick. Hence, when more Americans have health insurance coverage, there will be a better chance of spreading risk and keeping premiums affordable. Although there is truth in that statement, the real problem is being sidestepped. That problem is cost and we will talk about that more.

At least both Senators recognize that health care costs are out of control

At least both Senators recognize that health care costs are out of control. They want to make health insurance accessible to more Americans. I congratulate both of them for that. What about the problems that insured Americans have? These are issues that affect the majority of Americans who, by the way, are covered by health insurance? Overall, Americans may enjoy a better standard of living when the stress created by this health care crisis is resolved.

Both Senators state that the inefficiencies and error rates in the U.S. Health Care System are extremely high for the World’s most sophisticated economy. Several suggestions from both candidates will have a positive impact. However, significant change will come slowly unless a more constructive Congress is willing to approve necessary regulation and, in some cases, de-regulation in order to bring private markets back on track so useful reform can be accomplished.

…the overall impact of more insured Americans on the U.S. health care system is not yet known

Insurance companies will benefit from insuring more Americans. However, the overall impact of more insured Americans on the U.S. health care system is not yet known. It costs a lot more money to insure Americans in need whether they are children or not. If Americans can not afford health insurance and the next President mandates it, what is the penalty for not having it? What are the new income levels to qualify for this mandated coverage? Although Senator Obama criticized Senator Clinton for this lack of oversight, Obama doesn’t have an answer, either. Americans understand conceptually that if you eliminate medical error and have electronic medical records and create more efficiency with in the health care system, costs can come down. What happens then?

None of the 2008 Presidential candidates talk about the fact that demand for medical services is at an all time high and increasing at an alarming rate, while supply is somewhat limited for many reasons. Costs well exceed the current rate of inflation. For how many years will these proposed changes provide relief, should we accomplish them? America needs to have a long term purpose for reform.

Consumption taxes on goods and services on which we are trying to become less dependent…

Consumption taxes on goods and services on which we are trying to become less dependent, present an excellent opportunity to fund positive change. Gasoline, cigarettes and fast food are excellent places to start. The cost of medical services versus the demand issue for those services will be around for a long time. Contrary to what the pessimists are asserting, when Americans have their health, America will experience resurgence in world leadership. Unfortunately, Americans have taken their health for granted and the stress it has created in our lives is overwhelming.

Americans need a 21st century President, who is a leader with vision and ethics. Take this advice from America’s Voice on Health Care Reform. There has never been a better time in America’s history to revitalize our image in the World. Our long term competitiveness in the scope of the world’s economies depends on it. Will either of these candidates get the job done?

Can you believe that this family had the best health insurance money could buy?

Yes, even though you may be one of the lucky Americans…

When it comes to health insurance, if you don’t know what your rights are, you have no rights. Health insurance companies don’t always make it easy for claimants. Yes, even though you may be one of the lucky Americans with health insurance protection, there are numerous instances when the insurance company refuses to pay a claim.

One of my clients, the President and CEO of accompany with 150 employees had a wonderful spouse who unfortunately was diagnosed with advanced stage ovarian cancer five years ago. She was a fighter, though, and hung on for 5 years of chemo, seeking out every possible treatment to fight her disease. She is now deceased.

How was she covered by her Blue Cross and Blue Shield PPO plan?

What transpired during those five years of her fighting ovarian cancer with Blue Cross was difficult to comprehend. This woman and her family received no support from this Blue Cross insurance company when it came to managing her illness and seeking the best possible path toward recovery. With all of their medical directors and disease and case management programs, this woman and family were left to seek treatments on their own.

One would expect, if you advertise a service, that you actually perform it…

When Americans pay for a health insurance policy, they expect to be financially protected from catastrophic loss. This Blue Cross plan advertised its disease management and other care management programs as superior to that of the competition. One would expect, if you advertise a service, that you actually perform it. This Blue Cross plan’s medical director and nursing staff never reached out to help my client. Too many Americans live close to the edge financially and any change in the delicate balancing act of their budgets has potentially crippling effects. This wonderful woman, mother and spouse went through numerous medical treatments for her ovarian cancer. I negotiated on her behalf with Blue Cross, their medical directors, a pharmaceutical company and a hospital, to get experimental treatments approved for coverage. The Blue Cross Plan covered it, despite the high expense. My client’s family was so thankful.
When she was close to dying, she exceeded her policy limits for hospice care. She had 5 million dollars in medical insurance protection, but her hospice benefit was limited to $7,500. Her Blue Cross policy was a very rich, older PPO benefits plan and it was very expensive, too. But, her policy had this limit on hospice care.

The family, focused on her terminal cancer, never paid attention to this limited hospice benefit…

This sick woman had gone in and out of hospice and back to the hospital at the recommendation of her oncologist numerous times. The family, focused on her terminal cancer, never paid attention to this limited hospice benefit and only shared the situation with me after they had exceeded the plan limits by twelve thousand dollars. Imagine that after paying for hundreds of thousands of dollars in claims, now the insurance company would not pay this last bill. My client, the President of this large company, gave me power of attorney to negotiate on his family’s financial behalf regarding the outstanding bill for $12,000 thousand dollars. This Blue Cross’s incompetence exposed my client to substantial out of pocket expenses. Blue Cross never coached my client or their family even after they paid huge claims to try and help this woman. In the end, no pun intended, it took grievances and appeals and rejection after rejection to finally pursue the matter with this Blue Cross legal department. What an incredible hassle!

After I threatened to go public with the story…

Do insurance companies do this purposely? I negotiated with both the general council at Blue Cross and the hospice center. After I threatened to go public with the story, Blue Cross legal department responded by offering my client $2,500 dollars, though they made it clear that they felt they did not have to. I further negotiated with both the hospice center and Blue Cross. The hospice center lowered the bill to $4,000 dollars and Blue Cross increased their offer to $3000 dollars. Now, my client would only owe one thousand dollars to the hospice center instead of the original twelve thousand dollars. After the hospice center received the three thousand from Blue Cross, they closed the account and my client did not have to have any out of pocket exposure. By the way, this Blue Cross has since filed all of its new plans with an unlimited hospice benefit.
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Do your employee benefits consultant negotiate on your behalf? Would they work this hard for you? Do you have the time and understanding of health insurance, to try to make this happen on your own? Is your health really important to you? What are you getting for all of that money you spend on your health insurance premium, anyway

Hillary Care

Now Hillary is scaling back her fight…

On Monday in Iowa, Senator Hillary Clinton unleashed her newest health care reform proposal. Hillary Care? How absurd. Whether you like this woman or not has nothing to do with her position on health care. Senator Clinton use to believe in Universal Health Care…some bureaucratic system that would guarantee a socialized health care system for all Americans. Now Hillary is scaling back her fight on health care reform, favoring a more achievable outcome. Baby steps, perhaps.

Senator Clinton unveiled her latest proposal and it happens to be the most sensible of all of the 2008 Presidential candidates. I am not saying that her vision is perfect. Hillary claims that nothing will be taken away from any of us who are currently insured and happy with our plan. She simply wants to increase competition by creating another alternative in the market when she mandates health insurance for everyone. Those Americans that qualify for tax credits are then to be empowered by those credits and by mandate will have to purchase health insurance.

Tax credits do not help Americans who…

Tax credits do not help Americans who enjoy the lowest tax rates in history. For Americans whose income exceeds the standards to qualify for a public assistance program but falls short of having money in their family budget to afford adequate protection from catastrophic loss, health insurance premiums will continue to remain a problem. Having the choice to purchase insurance through the Federal Employee Health Benefits Program (FEHBP) is an excellent idea. FEHBP has a stable history with numerous choices and levels of protection.

Under Hillary’s newest proposal, Americans will still have a choice of who they want to be insured with. Health insurance remains a privilege… although some say that it should be a right. Well, that doesn’t sound so bad if you are insured and healthy or currently participating in a government run program. It would be a painful transition to a Single Payer Universal Care System, for all of us that are currently insured. But, isn’t it time to invest in the future of our citizens and our country? Should all Americans have mandated health insurance?

The money we will need for National Security will be used up…

The money we will need for National Security will be used up by health care if we don’t make the necessary changes to our Health Care System during the next 20 years. Remember, if we are not a healthy America then we may be unable to continue our fight for freedom, of which the rest of the world is envious. Imagine that. Our health is our greatest asset. Tell that to the fat guy on the corner stuffing a bacon cheeseburger and French fries from McD’s down his throat. What is coming? The provider system, Dr.’s Hospitals, Labs, Drugs Co.s, Insurance Co.s and those that supply it, could experience the wrath of government control that not even George Orwell portrayed in his book “1984”. Americans will be forced to carry and pay for medical insurance protection by the government. The question remains… will it be better for us? Will “what” be better for us?

Maybe, a different kind of health care system that emphasizes quality preventive care, wellness and evidence based medical practice that doesn’t make us feel like we are getting ripped off every time we need medical attention. Plus, I don’t know about you, but if health insurance premiums double in the next 5-10 years again, there will probably be 150 million or more uninsured Americans. Why mandate what Americans can’t afford? Tax reform is also part of the problem. Even fewer Americans will realize the dream. Hey…no kidding. What kind of candidates are you supporting? Middle Class America is in trouble. Trickle down economic theory has lost a lot of ground to greed and short term vision. At least Senator Clinton has a position on health care that calls for significant changes and appears to have an executable plan to make those changes.

Even with the full support of Congress and the American people…

Even with the full support of Congress and the American people, there will always be a slew of pessimists. America can do this, if we choose to deal with it. How much more money and time do Americans want to waste thinking about health care reform? The price tag of reform keeps growing. We can have the “New Real Deal Health Care System” without waiting times and other problems associated with some of the existing socialized systems of care. In fact, our patience, not patients, may have served us extremely well. Change is imminent either way according to the latest polls. Where change will take us is why we need leadership, now. A combination of private enterprise and the U.S. government seems to be the only fair and pragmatic short term solution. But is it the right solution?

The far more radical approach to a Single Payer system would be too hard for Americans to endure. Right? After all, haven’t we been led to believe that America’s current health care system is the best in the world? No other country wants America’s health care system because they know it is unaffordable and its outcomes are mediocre when compared with the rest of the world. Are Americans getting what we pay for from our Medical System? Is the value of the current system worth fighting for? Why does everything having to do with health care cost substantially more in America?

If elected, Hillary will take Americans…

If elected, Hillary will take Americans on a health care ride. Hopefully, the promise that health information technology advances hold and the acknowledgement that the U.S. health care system is broken, will lead to a huge step forward towards the creation of effective alternatives. These alternatives must change the face of protection to include all Americans, eliminate discriminating underwriting practices and lower overall healthcare costs. Everyone is so concerned about the $110 billion a year that Hillary says her proposal would cost. Why don’t we start addressing health care costs directly associated with medical treatments and plan for the future? There is a lot at stake. The wealthiest private interest groups will fight change.

Congress has a history of achieving useless outcomes and spending American taxpayer money, frivolously. The analogy is that running in place has cardio-vascular value. Yes it does, but couldn’t you do something else that is far more effective for your heart? Yes we can. But, will we? America is at a crossroad with healthcare. We know that the current system is going to crash and burn. Do we need to hit bottom in order to evolve for the good of all Americans? No.
Will these proposed changes lead to a competitive health care system that works for all Americans? I doubt it. How would a Universal Single Payer Health Care System improve the lives of Americans and big business, too? Is that where Hillary actually wants to take us? Stay tuned and find out.

2008 Presidential Candidate Health Care Reform Proposal Wrap Up 9/1/07

Democrats and Republicans are scrambling to come up with a promising way to overhaul America’s Health Care System. Almost all of the candidates recognize that something has to change. Unfortunately, the road to hell is paved with good intentions. Let’s start with the Republicans.

Governor Mitt Romney thinks individuals should be more responsible for their own care. He insists that States should remain in control of health care and the Feds should not mandate to the States. But the current system with States in control to a large extent is failing miserably. He supports a Free Market System…you know, like the one that got us into this mess to begin with. Massachusetts has made little progress towards lowering health care costs. Mitt recognizes that preventive care and education are important. He even suggests that Europe’s economic slowdown is somehow directly correlated to their practice of Socialized Medicine. Reality is that Americans are not that naïve. There is no substance here…only disaster.

Senator John McCain has not spent as much time on the health care issue as many of the other candidates. I don’t know why. Maybe he doesn’t think we have a problem. He certainly has not offered any solutions. He has addressed Veteran’s needs and would ensure that they receive the funding and care that they need. However, that goes without saying for any candidate. Lost on this issue.

Senator Sam Brownback wants to put consumers back in the driver’s seat by offering more choice thru a market based system. He wants to encourage the use of more high deductible plans combined with price transparency. Price and cost are the problem. Showing what each provider charges is not a direct reflection on quality and solves nothing. HDHP’s are responsible for the highest increase in consumer medical debt in history. Thanks for nothing.

Senator Mike Huckabee says the private sector should drive cost relief. Demand for medical services is at an all time high with an unsustainable growth rate. Mike, what will the private sector do provide relief? Take the money and run? That has been the pattern. Mike, you do not have a clue.

Mr. Rudy Giuliani says no to a single payer system. Improve the current system with some significant changes. He proposes a major tax deduction of up to fifteen thousand dollars and the promotion of health savings accounts. Rudy, we already know that HSA’s are creating other problems like medical debt. A tax deduction for low to middle income Americans who already have a low tax rate and can’t afford insurance to begin with, does little to help. Rudy suggests that insurance policies are Government dominated and when permitted to offer low cost options without Government mandates that require minimum amounts of coverage in many areas, premiums will be less expensive. So what? Insignificant amounts of health insurance protection will only lead to more consumer medical debt. Rudy wants to cover wellness and encourage healthy lifestyles. He is for investing in Health Information Technology and for reforming Medical Liability, which is promising. He is the only Republican that recognizes the urgent need for change in the U.S. Health Care System besides Senator Romney. Mr. Giuliani has proposed the most innovative Republican position on health care reform.

The Democratic candidates follow:

Senator Joe Biden wants to insure all children under 18, modernize medical records and provide catastrophic coverage to the 46 million who can’t afford it. What about the currently insured population who can’t afford rising contributions to escalating premiums? Or what about the astronomical out of pocket costs due to high deductibles prescription costs or other cutbacks in benefit plan designs? Not a clue.

Senator Chris Dodd is suggesting a health insurance marketplace much like the FEHBP which is the Federal Employees Health Benefits Plan. FEHBP is an excellent program. He believes contributions should be based upon your ability to pay. Spreading risk, investing in technology and preventive care are other concepts that he endorses. Chris feels health care is the most important issue for the 2008 Presidential Candidates. We are looking forward to more specifics from the Dodd campaign on this issue.

Senator Barack Obama preaches Universal Health Care by 2012 implementing a new National Health Care Program for individuals and small business with no preexisting conditions and subsidies for all of those in need. He wants to reform the private insurance market, expand Medicaid and SCHIP. Barack believes that Employers should be paying their fair share. He endorses Health Information Technology, access to preventive care and chronic disease management programs. Senator Obama wants to regulate hospitals to report all data and to reform the market structure to increase competition. His understanding and intelligence of the health care issue are evident. His command of the subject matter is a different issue completely. Senator Obama has a plethora of well intentioned changes to suggest, but with no glue to join them together. Except for the National Health Care Program--a precursor, I suppose, to socialized medicine--Barack has taken a position on many of the issues, but is not very convincing about how changes would get done.

Senator Hillary Clinton knows that America is ready for change. Hillary claims that Americans will have Universal Health Care by the end of her second term which is very optimistic on all fronts. The Clintons are masters of artfully dodging how anything specifically will be achieved. However, Hillary says it will take a collaborative effort from Government, Business, Labor and the Private Sector. Hillary has put her neck on the line with the health care issue and understands the challenges facing our nation to create a more effective health care system. Although a single payer system is not the only answer, it is the most obvious solution. Senator Clinton has endorsed Electronic Medical Records, creating large insurance pools and improving the quality of care through the Best Practices Institute. She wants to remove barriers to genetic drugs and reform malpractice insurance. Although she faces considerable opposition, her persistence and the political climate suggest that Americans could endorse evolving the U.S. Health Care System towards something that looks like the best socialized medicine has to offer with our own American spin on it. If elected, Hillary has the drive, perseverance and vision of a leader who can reform health care in America.

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When it comes down to it, either a Free Market Driven System or a more drastic move towards a Socialized System of Health Care can improve the current U.S. Health Care crisis. Which system is best for America’s long term future will be decided by the voters in the 2008 President Elections. Keep your children’s future and the future of America in mind when you think about health care. Vote with your emotions in tact. Changes to the health care system are going to be costly and painful, whatever side you take. Be well.

According to the Los Angeles Times...

Americans have a responsibility to work towards bettering their own health status

In the Los Angeles Times article “Medical Illiteracy Can Be Fatal” a sad truth is told. People with chronic illnesses and those who simply get sick often do not understand or adhere to the necessary medical instructions they are given to manage their condition. The issue is: When you do not follow your Doctor’s advice, are you exacerbating your condition?
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People undergoing medical treatment, insured and uninsured, need to be educated on the risks of not following instructions. The medical field and insurance companies are simply doing a bad job of educating. Americans with chronic conditions have to be monitored and given incentives to improve their health. For the most part, older Americans are not internet savvy and often can not tap in to the world wide web of medical information at our fingertips. Americans have a responsibility to work towards bettering their own health status. Otherwise, their health will continue to be compromised due to their medical illiteracy or lack of knowledge. When Americans “buy in” to getting educated and becoming a conscious partner in managing their health status, demand for medical services will decrease.

What was the question?

The YouTube debate turned out to be a huge disappointment

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Why is the Press apprehensive about pushing the limits on health care reform? Where is their passion for change? Americans are obviously distrustful about health insurance companies and the Universal Health Care puzzle. The YouTube debate turned out to be a huge disappointment. Our Presidential candidates are weak on accountability and details about health care reform. Their ambiguity is meant to confuse as opposed to enlighten. Employers and their employees have been feeling the burden of growing health insurance premiums and out of pocket expenses for over a decade. Americans cannot afford cost shifting in its most abusive form called Health Savings Account’s. What will bring down health care costs, now?

Americans are unable to afford out of pocket expenses associated with medically necessary health care. Does keeping Americans from accessing the healthcare that they need impacts demand for the right reasons? I can’t think of a more important topic other than defending the freedom of United States citizens from rogue governments and extremists. Can America afford to ignore the current problems within the health care and insurance industry? Can we fix them?

Job satisfaction and productivity are directly correlated to benefits

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Most Americans are covered by group health plans offered by their employer. As health plan benefits continue to deteriorate and health care costs climb, U.S. corporations should prepare for significant drops in productivity. Not a good move in the light of global competition. Job satisfaction and productivity are directly correlated to benefits. Many Americans are trapped in a job that they don’t like or would prefer to retire from, but need the job for the health insurance benefits. While increasing health care costs outpace the rate of inflation and salaries increases, the squeeze on the entire middle class becomes even more striking. Fortune 500 CEO’s whose companies provide health insurance policies to their employees know that a 1965 Mustang does not drive like a 2007 Mustang.

The climate for change is upon us. The same old ideas and rhetoric are not working. The evidence presented to us in Michael Moore’s “Sicko” may be inconclusive, but there is little doubt that America is ready for a transition plan to a government run U.S. health care system. My estimate is that it will take 20 years to accomplish, if we start making changes during the next administration. The press cannot let the 2008 Presidential candidates off the hook. During the 1973 oil embargo, almost 35 years ago, it was said that we should not be dependent on foreign oil. Look at the situation we are in now. Isn’t anyone listening? We already know that Health Savings Accounts do not work. We are running out of band-aids.

Where are the 2008 Presidential candidates on health care reform?

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The “problem” behavior created by low co pays is over-utilization of medical services. However, it is still cost that is the real problem. If we abandon the importance of health care reform now, when will we address it? Where are the 2008 Presidential candidates on health care reform? Far away from reality…another recipe for failure is just cooking. The media has a responsibility to the American people to expose the weaknesses of the 2008 Presidential candidates’ health care proposals. The U.S. health care system is an albatross around our necks. Based upon our current savings rate as a nation, health care continues to be an obstacle to financial stability in the lives of Americans.

The transition to a government run health care system will provide tremendous relief to the majority of Americans. I agree with Michael Moore who stated that we don’t have to inherit the negatives of current socialized medical programs. America can adopt the best practices of those systems and eliminate their weaknesses. A gridlocked Congress is a waste of American taxpayer dollars and time. Achieve and we will believe. With the ability to influence public opinion so easily, there is no excuse for the American media to overlook the urgency of health care reform during the Presidential debates.

The Congress that could?

Silence is the best policy when you have little ammunition…

How will the Insurance Companies possibly defend themselves from the facts with which Mr. Moore confronts them in his film “Sicko”? Insurance Companies could lie and say that these atrocities are not happening or accuse Mr. Moore of lying. We are talking about health…the very essence of human life and existence. Silence is the best policy when you have little ammunition to defend yourself with.

Health Insurance is a sinking ship in very rough seas. When there is such high demand for medical services, why not profit from the sick? Because it is immoral…that is why. Whether or not the United States of America accomplishes a Universal Health Care System, free for all Americans, remains to be seen. Now the question is what can be done to stabilize the U.S. health care system and keep the coming financial storm from wiping it out completely? We have to do something. This fragmented system needs a change agent and the people of the US, insured or not, can and will be the change agent.

Is it too much too late?

Insurers are scrambling to finally try to do the right thing. A touch of preventive care and a ton of ephemeral profit-driven marketing propaganda can not redeem the damage that is done. Is it too much too late? What we Americans realize is that we have been taken advantage of. It is a rare moment in the life of a business that presents itself now to the health insurance industry. Sweeping regulation is around the corner just to keep the floodgates of their horrific failures from being lethal. It is not about lobbying. It is about being American. Americans are about to step up and show the rest of the world why they have always respected us. We take care of our own business at home with dignity. America needs to refocus itself on our own issues.

…where is the Congress that could?

Defense of freedom comes at a very high cost, but so does not being healthy enough to fight for our rights. Every American deserves health insurance as a public service. Let’s regroup and defend our own people’s needs first. Then, we can redefine our role as a world leader. Reality is we have to increase taxes, anyway. That is where the money will come from. We are living on borrowed time. We need fiscal responsibility in the midst of this health insurance crisis. We need these programs to realize our potential as the giving, generous people of America that we are. Stop electing politicians who can’t get the job done. Immigration, health care, social security and defense…where is the Congress that could?

Michael Moore has done it again

Is this news to anyone out there?

Mr. Michael Moore’s movie “Sicko” is a one-sided story written, directed and produced by a creative and intelligent man trying to make the point that the U.S. Health Care System is badly broken and needs to be fixed. Moore states an excellent case for a broad based Universal Health Care System for all U.S. citizens. Is this news to anyone out there? Aren’t the problems associated with the U.S. Health Care system in the news on a daily basis? Well, here the movie “Sicko” is bashing of the American freedoms that our health care system and citizens have enjoyed for decades. Once revered as the most sophisticated medical delivery system in the world, the current state of affairs with the U.S. Health Care System is akin to levees about to break from the perfect storms of over utilization, greed and dozens of other factors. There are many wonderful stories to tell about the U.S. Health Care System, too. Mr. Moore did not include the wonderful attributes of the U.S. Health Care System…only the atrocities. Well, reality is that there are many atrocities associated with Socialized Medicine, too.

The metamorphosis of our U.S. Health Care System will effect tens of thousands maybe hundreds of thousands of employees that work in the health insurance industry

Maybe the time has come. The U.S. Government, acting on behalf of all Americans, could flip the switch on public programs like the Federal Employee Health Benefits Plan or Medicare or Medicaid. Cover everyone the way our current socialized programs cover members. Apply all of the same rules, cutting out huge administrative costs. Now all Americans will be covered. However, we are still ignoring the huge medical delivery cost problem, the “Sicko” claim notwithstanding, which seems to be that Universal Care is the right thing to do for American citizens and our country. I agree! Let’s do it! Universal Care may not a bad move for this country. Universal Care needs to be phased in over a timeline that must be strictly adhered to. Tens of millions of Americans could benefit. Maybe we all will benefit. The metamorphosis of our U.S. Health Care System will effect tens of thousands maybe hundreds of thousands of employees that work in the health insurance industry. Most will start over again in hopefully some other productive career or have to be retrained. Employees of the industry are victims of insurance company greed just like those depicted in Mr. Moore’s film. Perhaps Americans are ready for such a change.

There will be private insurance gap plans in a Universal Health Care environment that permit citizens to purchase extra protection should they feel that they can afford and need it. Now the rest of the story is not so easy. Many laws need to be repealed. Our medical services reimbursement system needs to be overhauled. Technology needs to be embraced and “incentivized”. Preventive Care needs to be emphasized. Confidentiality needs to be protected. A whole host of other extremely important issues need to be addressed. We have to start somewhere and there is no better time than the present.

Not only do I embrace the concept of Universal Care, but I fully endorse it

I am an employee benefits broker and consultant. Not only do I embrace the concept of Universal Care, but I fully endorse it. I have worked as a broker, executive and consultant in the health care industry for twenty years. In 1999, I founded Longevity Benefits, Inc., an insurance agency specializing in health insurance. My other company is called the Pro Active Health Care Association. We use our expertise to help and defend insured Americans who are getting ripped off by their health insurance carrier. Please email us your story to les@longevitybenefits.com and we will be happy to help you. We understand your rights and responsibilities under your insurance policy guidelines and provisions and can help you navigate when you are in need. Let the “Pro Active Health Care Association” help you fight for your rights with regard to any denials that you may be encountering with your insurance company. Please email any miracles that you or your family have experienced as a result of the U.S. Health Care system, too.

Finally, stay tuned, listen and learn how the U.S. Health Care System can migrate to Universal Care within our unique economy and absorb the challenges facing our medical costs and system. For achievable solutions to the growing U.S. Health Care Crisis, stayed tuned in to this Blog or email us directly at les@longevitybenefits.com.

“Edwards to Press Insurers on Health Care Premiums”

Mr. Edwards states that he would force insurers…

In the June 14, 2007 NY Times article, “Edwards to Press Insurers on Health Care Premiums”, Mr. Edwards states that he would force insurers to spend at least 85% of their premiums directly on patient care. He also wants to limit the amount of time on patent protection that pharmaceutical companies currently enjoy. Mr. Edwards understands that regulation is the key to changing behaviors of abusive monopolies. Will efficiencies be realized with the Edwards Plan for Health Care Reform? Maybe.

There are many ways to impact the way insurers conduct business from a regulatory standpoint. What about mandating preventive benefits coverage? How about fixing the entire medical reimbursement system? Cost is what needs to be addressed. Insurance company profits can be limited too, but the true cost of medical services needs to be fixed. Chronic illnesses, like diabetes, are predicted to cost more than 10 times what they cost now in just 5 years. Americans want the best possible choices at all times when they access the medical system. Edwards, like many other candidates is manipulating statistics to influence public opinion. He does have the right idea.

The reality is that our U.S. health care costs more than other industrialized nations…

Intervention is obviously necessary to control the escalating cost issue within our U.S. Health Care System. One of the nation’s largest consulting firm’s most recent annual survey stated that more than 85% of Americans who have health insurance actually do like our system. They don’t like the cost shifting. The reality is that our U.S. health care costs more than other industrialized nations but is far from unsatisfactory for those who have insurance or utilize medical services in our country. Every American has care. Close to 50 million Americans do not pay for it through health insurance. Taxpayers bear the expense. Does anybody remember that the U.S. Government does not operate without the tax money that working American citizens contribute?

Most doctors and hospitals do provide excellent, necessary and fairly efficient care. Our highest paid Senators in Congress can’t even get bills passed for years sometimes. These are the same people that are going to force efficiencies upon our medical system. Not the most encouraging thought. As the Government gets more involved in regulation and creating alternatives to Employer Sponsored Healthcare, for instance expanding Medicaid income requirements, the administrative costs will skyrocket. If the US Government spent time actively pursuing every citizen that qualifies for an expanded Medicaid program, we would make a huge dent in the number of Americans without health insurance coverage.

So, Mr. Edwards, the road to Hell is paved with good intentions. We need a systematic, methodical and detailed approach to revamping the U.S. Health Care System and at least you have put your cards face up on the table. A lot more candidates should be doing the same. Then we can flush out the bad ideas and embrace the good ones.

David Leonhardt

David makes an excellent point…

In the NY Times article, “Health Care As If Its Costs Didn’t Matter” written by David Leonhardt on June 6, 2007, David makes an excellent point. Cost is the primary driver behind desired changes. There is a lot of unnecessary procedures and unproven technology that we pay for. Receiving the best possible care for the best outcome means embracing proven technologies in place of thinking that if it is the latest invention, it must be the right thing to do. I have been saying all along that the “cost factor” is not being addressed directly.

Information and data must be compiled and disseminated in a user friendly way over the internet. Transparency or cost data means little until we see whether it is tied directly to quality or not. Where is that data? We still must protect confidentiality and yet understand that legislation often serves special interests and gets in the way of progress. HIPAA is a cumbersome piece of legislation that needs to be amended for proposed changes to the US Medical System to take place. ERISA legislation is also outdated.

The reality is there is almost no chance of accomplishing Universal Health Care…

We have been led to believe by our presidential candidates that a few simple suggestions like electronic medical records and Universal Care will fix the ills of the U.S. Medical System. The reality is there is almost no chance of accomplishing Universal Health Care in the U.S. until politicians are honest with US citizens about what it will take to implement it. The U.S. Government is not going to flip a switch and all of a sudden we have Universal Care…whatever that means. It is a partnership with U.S. citizens, the U.S. Government and, of course, the private medical and insurance industry. Wasteful spending runs rampant in many areas of medical practice.

There are several good suggestions being proposed. However, Congress and our next President have a tremendous challenge on their hands. They have to figure out how Americans can continue to benefit from what is good about the U.S. Medical System while they work on changes to the system that will eliminate costly inefficiencies. That concept is not Universal Care. Showing Americans how to achieve Universal Care over a timetable of very specific achievements is a separate and important step to overcoming continued medical inflation. What is our part? What is the Government going to do? How much will it cost? When will it be done? Is Universal Care rationing of health care?

Where are the innovative programs that utilize these statistics for improving care more efficiently?

We have medical outcomes data locked up in the Federal Government (Medicare and Medicaid) and at all of the major Health Insurance Carriers in America to uncover the best practices for cost efficiencies. We don’t publish it, break it down for the entire population or do much about it. The large consulting houses crunch numbers and statistics of the claims experience data for their specific clients to shape new plan designs that may save the Employer some money. Health plan actuaries use experience claims data to apply for increases every year. What about the entire U.S. population that uses medical services whether they have insurance or not…private insurance or public programs? Where are the innovative programs that utilize these statistics for improving care more efficiently?

If a new and improved U.S. Health Care System is ever going to work, American citizens must fully participate. American citizens must feel that we own it. Health is our greatest asset. Unhealthy people can not protect their freedom or their families. Most people take their health for granted until a health crisis puts them in a precarious position. All of a sudden, whether you have insurance or not, when you are sick, it becomes clear that the U.S. Health Care System performs well, but at a higher cost than other countries. What about the difference in our economy versus that of other countries that have socialized medicine? Statistics can be manipulated to make almost any point. Preventive care, access, awareness, incentives for difficult healthy lifestyle changes, education and consequences for not embracing change, are necessary for cost efficiencies to be realized.

There is no doubt that some type of reform is necessary

Legislative changes, teamwork with the private sector and innovative ways of sharing information will help informed consumers and their providers make better decisions regarding their health care. There is no doubt that some type of reform is necessary. Presidential hopefuls need to show Americans a detailed plan for health care reform that includes a timetable to achieve each dynamic proposed change within the U.S. Medical System and how each change will lead to the next progression towards whatever they as candidates are proposing. Then, you will have believers rather than polarized potential voters. If Americans, the U.S. Government and private industry are all truly working together toward change, is will be hard, but cost efficiencies without sacrificing quality of care can be accomplished and the U.S. Medical System will be improved for decades to come.

Barack Obama

Mr. Obama wants to limit profits of private industry…

In the NY Times article on May 30, 2007, “Mr. Obama calls for wider and less costly health care coverage”. Mr. Obama wants to limit profits of private industry because he believes it is the right thing to do. Using money from previous tax cuts made by the Bush Administration and regulating Insurance Company profits will not do anything to resolve escalating health care costs. It is an encroachment on private industry that sounds like too much Government to me. However, it may free up some money to pay for things in the current system that are unavailable to low income families. Let innovation and creativity be the motivating factor. Mr. Obama is correct about the fact that private industry and the US Government have to work together to resolve the cost issue.

More affordable coverage comes at the price of less desirable plan designs…

Unfortunately, Mr. Obama has not expressed any innovative ideas for improving our costly health care system. It is the same old rhetoric. The US Government and private industry can make significant changes that will make health care more accessible. What Mr. Obama is suggesting is a mix of employer based and government funded programs, which is what we have now in the US Health Care System to improve access to health care. He is not suggesting a Universal Plan or requiring all Americans to carry health insurance. So, just what is he proposing…very little. He has no real position because Mr. Obama, like most of the other candidates, does not comprehend the undertaking ahead of them. It is not the powerful lobbies that keep Americans from accessing affordable health coverage. More affordable coverage comes at the price of less desirable plan designs that will continue to encourage cost shifting to consumers who utilize health care services.

Providing health coverage to the masses does nothing to curtail health care inflation

That cost shifting becomes unaffordable for working Americans who have employer sponsored coverage, as well. Every candidate has expressed an interest in covering all children. That is the right thing to do. All it takes is money. Providing health coverage to the masses does nothing to curtail health care inflation. Whether the US Government, or actually tax paying citizens of the United States, are asked to pay more to fund these programs still does not address the issues of cost. More money for the uninsured will get more Americans covered with health insurance. Ultimately, US health care costs will probably decline when Insurance Companies are forced through Government mandates to cover more preventive care and provide incentives for other healthy changes in behavior. Subsidizing health care still does not resolve the cost issue either.

Over time, broader preventive care coverage and incentives that lead to healthy lifestyle changes could bring down the current health care inflation rate.

Surgery With A Warranty

A flat fee will be charged up front for this “guarantee”

In the NY Times article, “In Bid For Better Care, Surgery With A Warranty”,Geisinger Health Systems has implemented a new program available for more reimbursement dollars up front. The article infers that if there are any complications regarding a surgery, they will not charge any additional money if the patient is re-admitted due to medical error or other re-admission reasons that relate to that surgery and hospitalization. A flat fee will be charged up front for this “guarantee”.

Why guarantee something that is should be done right the first time?

All hospitals should be forced to publish this information…

Medical information should be made available to the public in a compiled user friendly format. It would be useful to have the re-admission rates and other standards to evaluate your Hospital System and Practitioners, prior to having the surgery. What good is it after the fact? All hospitals should be forced to publish this information and patients will use it with Transparency data to evaluate the best choice for them. Patients want to make decisions regarding any care they might receive, armed with this new information that is taking its sweet time reaching us. I am more concerned with the end user, the patient, than I am about reimbursement on this matter. After all, we expect to get well when we pay the best educated, highest paid profession to keep us well when we do need their services.

You, the patient, will not get any better after your surgery because you received a guarantee...

Americans need to get interested in their health care when having a procedure in order to guarantee better outcomes for themselves. There are so many ways to get more for our medical reimbursements than is being done today. But, a guarantee is simply better than nothing at all. Expectations and generous reimbursements for reputed high quality care are not enough. This “warranty” is simply a new way of contracting for the Hospital System with Health Plans for reimbursement. You, the patient, will not get any better after your surgery because you received a guarantee, unless the system performs like they should be doing, in the first place.

AIDS drugs and the Clinton Foundation

In response to the NY Times article about the Clinton Foundation…

Why don’t Americans come first? In response to the NY Times article about the Clinton Foundation using it’s influence to help developing countries negotiate prices for much needed AIDS drugs and other crucial life prolonging medicines with US Pharmaceutical Manufacturers, I know their hearts are in the right place. Doing the right thing means making difficult choices. The US is still the World’s leader for producing innovative life saving drugs. Our pharmaceutical companies are extremely profit oriented and everything they do to sell their products to any buyer, are well calculated strategies that ultimately drive profits higher in their respective target markets. Every human being that is faced with a life threatening or debilitating disease wants access at an affordable price to care and the wonderful discoveries that lead to a potential cure. However, services and products do come at a price.

Our much maligned strategy to help every other country…

Innovative drug therapies are not free and were never meant to be. Our much maligned strategy to help every other country but ourselves leaves me perplexed. The Clinton Foundation should be working with the US Government to come up with a sound strategy where American consumers and our peaceful world counterparts come together to make access at an affordable price, a reality for these life saving drug therapies, first to Americans and then the rest of the world. If your Country is not a friend of the US, then our research should not find its way to your citizens. Medicine is an even more important resource than defense. We need to be healthy in order to defend our freedom and way of life. The Clinton Foundation’s partisan approach that follows all of the Clinton strategies will always be flawed. A divided Congress and Big Business need to come together with an open mind to listen to all opinions that may have value in resolving this growing crisis. By the way, the only reason there is any solution to AIDS is because of committed, unselfish scientists using their gift of extreme intelligence and well funded research to create potential solutions to a horrible diseases.

The conflict is when someone has to deal with the reality of paying for it

If your son or daughter was working at one of these large pharmaceutical manufacturers, making a modest living and discovered a cure for AIDS, don’t they deserve an overabundance of compensation along with recognition? Of course they do. The conflict is when someone has to deal with the reality of paying for it. Everybody wants something for nothing. Drug companies are greedy and market demand is extremely strong. The challenge is how to make access a reality to the needy at an affordable price. Killing the entrepreneurial zest for greatness that Capitalism and private enterprise have always encouraged is not the answer. What is the Clinton Foundation doing to bring the US Congress, the President and Pharmaceutical Manufacturers together to help Americans first? In the event that the Clinton Foundation actually accomplishes something real, then other world populations in need may benefit as well. If healthcare is the most important issue facing Americans, then why don’t Americans come first?

In response to President Bush

I am extremely disappointed

In response to President Bush’s health care initiatives and his position on Health Savings Accounts (HSA’s) and tax code changes, I am extremely disappointed. HSA’s are high deductible health plans that shift more of the financial burden of medical costs to the consumer in exchange for a slightly lower premium for the employer or individual. President Bush has no idea how to strengthen health care. Think about the statement “to strengthen health care”. Just look at what he has done so far. President Bush has accomplished nothing that addresses the most challenging issues of cost and quality. Instead of encouraging Plan Designs by Health Insurance Companies to be more innovative, they are simply being allowed to use an old and aging trick called cost shifting. Health Savings Account plan designs are not the answer. High deductible plans were always available. Health Insurance plan designs always should have discouraged the over-utilization of emergency rooms. Blame the Insurance Companies for that actuarial plan design flaw. The problems within our system that are getting all of the attention have to do with the uninsured and actual incurred medical costs for treatment. When we triple the current income limitations to help our less fortunate citizens qualify for Medicaid, we will have more children and their parents insured.

When Mr. Bush creates incentives for Americans…

When Mr. Bush creates incentives for Americans that give perceived value to changing unhealthy behaviors, we will be getting somewhere. Where are the tax incentives to push all providers to use the most advanced available technology for all medical records and communication? When America and its leadership embrace the effective use of available technology with tax incentives, the modernization of the US Health Care System can make real progress in lowering overall costs. Give Americans a tax incentive to buy healthy foods or join a gym. Give a tax break to Americans who get a physical every year. According to the most accepted medical research, these types of incentives would keep Americans healthier. How does giving an insignificant tax break for electing a Health Savings Account plan design for health insurance coverage address the lowering of medical costs in our Country?

Random notes

Abolish discriminatory health insurance underwriting

Abolish discriminatory health insurance underwriting. A Federal Mandate should be passed that prohibits the insurance industry from the practice of medical underwriting of health insurance. All health insurance should be guaranteed issue.

Employer Sponsored Health Insurance must co-exist with the foundation of State Run Health Insurance alternatives in all 50 States. What many States are setting up for children needs to be set up for Adults living in those States, as well.

Employers with 5 or more full time employees must be mandated to provide health insurance to their employees.

Health Insurance should be mandated upon anyone living in the USA.

Medicaid income qualifications need to be expanded to 3 times their current rate.

I advocate EMR or electronic medical records, but not controlled by the government…

I advocate EMR or electronic medical records, but not controlled by the government. We already have the systems in the private sector. Just look at your prescription benefits. Private industry does a fine job of handling this data. Walgreens and other large pharmacy chains have all of your valuable health care information at their fingertips. Although this information needs to be protected, it should be available where appropriate--for example to triage Docs in emergency rooms.

Doctors who practice medicine in this country should be mandated to have their office online with all of the insurance companies who offer health insurance in their respective State. Hospitals should also have the same requirements.

Transparency is only the tip of the iceberg. When Insurance Companies, Providers and their respective Vendors all want more money for their services or products and the demands because of technology and access to better care are stressing the spine of the US Medical System’s back, something has got to give. What is likely to come out of any attempt at Universal Health Insurance is a good thing. The industry will still remain private. However, to play the game, Insurance Companies, Providers, Vendors and all Americans need to play by different rules. Yes, Americans want to know what medical procedures cost. The secrets of how to disseminate this information in an effective, useful way need to be unveiled. It is difficult to interpolate the data and verify its source, how it is collected and how to evaluate it in a logical way.

What about Outcomes Data? We should be asking what value we get for our premium money, cost shifted out of pocket exposure and our insurance company protection when we use a particular provider. What is the value of the dollar here? Why is one provider better than another? Is cost the most important factor? Or is the outcome the most important factor?

Medicare and Medicaid are doing fine. They have low administrative costs and yet higher reimbursement levels than the Nation’s largest health insurance companies. We are all paying good money for medical services being provided. So what else is new? Do Medical Providers and their respective Attachments deserve what they are getting?

The beginning of a Universal Health Care System starts with Health Insurance that is guaranteed issue or with no medical underwriting. Following that, all humans living in this country should be mandated to carry medical insurance. If people should be on public assistance, than we ought to pursue them and improve their lives. Medicaid must do a better job of getting people trained, educated and back to work.

The war in Iraq illustrates the senseless prioritizing of financial resources in the US…

Where are the American People’s priorities? The war in Iraq illustrates the senseless prioritizing of financial resources in the US and a useless, unnecessary arrogance that the rest of the world scorns us for. That arrogance flows down to all Americans. Just look at our savings rate, which is now at an all time low. We would rather spend $20 per week on Starbucks coffee than spend it on a health insurance plan that protects us from financial catastrophe. Imagine what we could have done to advance the US Health Care System with the money we spent on the war in Iraq. Did the war advance our freedom ideology? Are we safer from Rogue nations? Did we ever really get back at Osama Bin Laden? We have so many fundamental issues to address as a country. The USA is still the greatest country in the world. We must adapt to the global changes taking place more thoughtfully. We have many growing financial issues as Americans that will affect the entire middle class at all levels. The upper class does not have financial woes although they still face health issues like the rest of us. The lower class will hopefully be given the support to improve their lives and evolve to realize the American Dream.
Strong defense is good. What about strong defense against disease?

I’ll leave you with this…Can you guess what Proactive Health Planning means to your future?

AARP

I am happy to see an Association Health Plan available to a working age block of Americans...

In the NY Times article, “AARP Says It Will Become A Major Medicare Insurer While Remaining A Consumer Lobby” Mr. Novelli, CEO of AARP states that AARP’s mission is to create a healthier America. AARP is a lobby for retired people, a voting block with very strong political representation. Aetna and United Health Care are two of the nation’s largest health insurers. Will it be better in some way for Americans? All of these entities are out to make money. I am happy to see an Association Health Plan available to a working age block of Americans being launched despite Insurance Companies lobbying against them.

If more lenient or less stringent underwriting guidelines to attain health insurance are available thru AARP membership for people between the ages of 50-64 and come with competitive premiums, more people in that age group should be able to access catastrophic protection. That would be wonderful as Representative Pete Starks from California suggests. What a great opportunity for AARP and Aetna. It is a little perplexing that Aetna will ease its underwriting principles for the prospective members of AARP in this age group. For AARP, this marketing alliance with Aetna and United Health Care allows AARP to accelerate membership growth in a new target market and gives those respective carriers credibility and access to their new block of prospective members aged 50-64. This partnership is likely to lead to significant profits for all entities.

Sick Americans are still left in the dust, uninsurable...

Because these new plans from AARP are not guaranteed issue, this is not a significant announcement for anyone but AARP, Aetna and United Health Care. Sick Americans are still left in the dust, uninsurable. AARP’s premiums will eventually reflect the experience of this new group after a couple of years of new membership growth. So what is really new is a strategic marketing alliance that strives to increase membership in both an Association and a health plan. Not a healthier America. But possibly lower premiums, at first, for Americans seeking individual health insurance coverage in the 50-64 year old age group. If the underwriting is more lenient, the premiums will not be as competitive as some of the alternatives that may be available in each respective state. Let’s see if this marketing opportunity for AARP and Aetna leads to doing the right thing and more Americans become insured at a lower premium. Wouldn’t that suggest that AHP’s are a good thing?

Michael O. Leavitt

Transparency is not all it is made out to be….

In an open letter to CEOs, Secretary of the U.S. Department of Health Human Services Michael O. Leavitt wrote:

“I am writing to invite you to play a leadership role in the
movement toward transparency…”
(See:www.hhs.gov/transparency/employers/ceo.html)

The article infers that this information will be available in some useful way, soon. Unfortunately, not soon enough. Transparency is not all it is made up to be. The basis behind transparency is paved with good intentions. Americans need to know the prices for the services that we access. But, if Americans really understand how provider contracting is often negotiated, we would easily see the holes that lead to erroneous information designed to protect the best negotiators, not the sick who are in need.

Size matters. We all know that. However, size is not necessarily a fair reflection on quality. Price doesn’t always determine quality, especially in medical care. What happens when the price for a service among several doctor’s hospitals or providers is the same? Who is the best choice? How are we to judge, then? What criteria will lead Americans to make a better health care decision? Cost is still the largest stumbling block to access US healthcare. Will this information change that? Americans want more value for their money. Excuse me for emphasizing that Transparency is more useful to the insured population because the idea is designed for payers. Whether healthcare is accessed through employer sponsored or individual health insurance or is accessed inefficiently by the uninsured, tax paying citizens ought to be concerned about price. Americans who contribute to the tax system are paying for the uninsured already.

They just woke up to the fact that they have been paying more for medical services…

What is Uncle Sam doing to make sure that, as the largest payer of health insurance claims, they are protecting tax payers and securing the best deal? They are not doing much. They just woke up to the fact that they have been paying more for medical services than the privately insured sector for our socialized programs like Medicare and Medicaid. Private health insurers consistently negotiate the most cost effective reimbursement levels for medical delivery services. There will always be some consumers who will find that they can live with the values tied to the retail discount “Wal-Mart’s” of medicine. Others will find that the highly specialized providers, akin to the overpriced “Neiman Marcus’s” of medicine, are worth the difference in cost.

Is there truly a quality difference? There may be…but differentiating and understanding how to use the data that is being shared with us to make that decision, is a mystery to most Americans in need of medical services.

Is Transparency going to change or influence behavior?

Professionals are having a hard time perusing through the data to determine if publishing certain facts will be confusing or helpful. The concept of pay for performance is truly an embraceable one. Although it is unlikely that this incentive can create better healthcare outcomes alone, it is a start. This information is likely to be especially useful in our times of need when it is easily accessible and the codes to determine appropriateness are clearly delineated. Once Americans understand how to use the distribution of this new data, they can be armed to make more appropriate decisions for protecting the health of themselves or loved ones. It will certainly be an improvement on just word of mouth decision making. Americans want to be empowered by information. Will it cost less? Maybe. Is Transparency going to change or influence behavior? Yes. Consumers crave more information. Can this information help bring down the price of medical services? It is one small cog in the wheel that turns the fragmented US Health Care System. We don’t need socialized medicine. It will create more of a mess. We need to fix what we have, first.

United Health Group

Where Does the US Government Draw the Line on Corporate Greed…

Where Does the US Government Draw the Line on Corporate Greed, when it comes to America’s most talked about social problem…Health Insurance?

United Health Group, the largest US health insurance company continues to reward shareholders at the expense of its commercial and Medicare customers. This earnings report demonstrates the US Government’s level of tolerance for letting corporate giants in Health Insurance get away with unethical standards that seem to apply only to them. A 35% profit margin in health insurance is obscene by most standards. No wonder there are so many without health insurance. Where is all of that money going?

It is certainly not going in to medical care for members of their health plans. Many of UHC’s members are burdened by the accelerated cost shifting in the consumer driven plans that they are a market leaders in, while UHC continues to reap huge profits. This is doing nothing to resolve problems within the US Health Care System.

Consumer driven plans have impacted utilization patterns of members…

Instead of doing the right thing, as the largest player in the field, UHC’s greed to squeeze profits is placing an enormous financial burden on members of their plans. Consumer driven plans have impacted utilization patterns of members. Perhaps members are not accessing unnecessary medical care. However, what if members are avoiding care because of high deductibles? We already know that avoiding care leads to more significant costs later on. Is this really helping anyone? Do consumer driven plans do anything more than increase insurance company profits? In the long run, maybe yes.
Health insurance companies want to change their insured’s behavior towards accessing medical care. Why aren’t health insurance companies lowering premiums significantly for those that are more risk tolerant by electing consumer driven plans, when there is so much profit to be made? Is it greed? If UHC and its competitors are trying to change the medical utilization patterns of members, where is the reward for the premium paying members?

Will Healthcare and Health Insurance be the deciding factor in our upcoming Presidential elections?

Socializing the whole system does not deal directly with…

There are an overwhelming number of issues to address. The key is to embrace change and to execute potential solutions. Talk is cheap. We must resolve issues now, in order to avoid a future crisis. How is that going to happen?

Socializing the whole system does not deal directly with all of the moving pieces that make up the best and most sophisticated medical delivery system in the world.

Presidential candidates ought to be thinking about several immediate and long term solutions to the current “crisis” within the US Healthcare system.

What is wrong with our US Healthcare System?

What is wrong with our US Healthcare System? Escalating costs, cost shifting, the growing number of the uninsured, inefficiencies in medical delivery, avoidable medical errors, frivolous lawsuits, confusion about benefits and utilization, just to name a few.

Typically in any industry, better technology comes at a higher cost that can lead to lower costs over time. Escalating costs are no one’s fault, but can be addressed.

What role do doctors, hospitals, pharmaceutical companies and other providers of medical services play in the evolving of a more cost efficient system?

What can the US Government do to incentive private industry?

Health insurance is not a right

Immediate gratification to those who favor socialized medicine is much sexier than innovation to correct the issues within our current medical delivery system. Healthcare is a right that all humans are born with. Health insurance is not a right. It is simply the transfer of financial risk to an insurance company for protection against catastrophic financial loss due to sickness. It comes at a price whether it is a subsidized by the US Government or accessed through our current system. When the US Government becomes the health insurer of last resort, are we really addressing the issues?

Lifestyle choices probably have a larger impact on the medical services we access throughout our lives than we care to admit. Many studies support this idea. Education can lead us to making the right choices; choices that have positive consequences.

Questions for all Presidential candidates:

What incentives can the US Government provide to help Americans make healthier lifestyle choices?

How can the US Government help more Americans access the current US Healthcare system?

If Medicaid’s income allowance were to double, how many more uninsured children would be covered?

Besides money, what could the US Government do to help low income families automatically be covered through our current socialized programs? (Medicaid and Medicare)

Where will the money come from? All potential solutions have a cost associated with them. Will these solutions ultimately lead to lower costs in the future?

How can the US Government stop the runaway costs associated with health care? Are technology and innovation driving the majority of those costs?

What about access to preventive care instead of crisis oriented care? What role can the US Government play in addressing this issue?

What role or responsibilities must the American people have in order to preserve the best aspects of our current medical delivery system and to stay healthy?

If good healthcare is the most important gift that we are born with, why is staying healthy not our first priority? Why do we take our health for granted and expect someone else to take care of it for free, when we get sick? It is never free. Someone is always paying for it.

What can be done to eliminate medical errors within the system?

What future does the internet play in reducing overall costs?

What role can technology play in fixing the inefficiencies within the system?

What types of incentives will change behaviors and impact daily living choices towards healthier lifestyles?

What incentives can the Federal Government impose upon private enterprise to act in the best interests of all Americans?

Why would a socialized US medical system, taking Medicare and Medicaid as an example (our current socialized system) be a less expensive alternative to Employer sponsored private health insurance?

Are our socialized systems working well enough to extend that model of coverage to all Americans?

So, Presidential candidates ask yourself these questions and tell us what you would do if you were elected President of the United States?