Bruce Lee

Remember the days of playground fights? When someone supposedly said something about someone else, sides are picked, and a rumble of sorts erupts with a lot of pushing and shoving. Nothing too serious – I’m talking about 3rd graders here, long before post-pubescent muscles increased the chance of anyone actually getting hurt.

I’ll admit that I was a bit of a chicken back then – elementary school politics never truly concerned me, at least not enough to risk bodily harm. However, not lending a helping hand was socially disastrous, as no one wanted to be labeled a chicken. So, I developed a simple strategy – when the fight broke out, pick on the little guy. This was the easiest way to save face and come out unscathed.

Today, I look back at that strategy, and I feel a bit embarrassed. Picking on the little guy - what a despicable and cowardly thing to do. Oh well, I was only 8 – what did I know.

What I didn’t realize back then was that this is a very sound and popular business strategy, especially if you are in the health insurance business.

I was pleased when President Obama was critical of Anthem Blue Cross when they recently posted record profits, handed out huge bonuses, and simultaneously raised rates for small and individual plan subscribers by as much as 39%. This new pricing will effect as many as 1 million of their subscribers. I wonder gow many of them will end up losing their health insurance because of this rate change.

It would be another matter entirely if Anthem Blue Cross had to raise rates in order to stay solvent, and did so across the board. This wasn’t the case. I am also sure that many Anthem Blue Cross individual policyholders will threaten to leave them because of this rate change. Which brings to mind one of my favorite Abbott and Costello routines:

Costello: "I'd rather marry a homely girl than a pretty girl anyway,"

Abbott: "Why?"

Costello: "Well, if you marry a pretty girl, she is liable to run away."

Abbott: “Isn't a homely girl liable to run away too?"

Costello: "Yeah, but who cares?"

Yes, I know, not very politically correct, but trust me, it was very funny in the days before Gloria Steinem.

The point is, Anthem Blue Cross doesn’t care if an individual subscriber leaves. Besides, even if they do leave, chances are they won’t be able to get affordable coverage elsewhere, especially if they have a pre-existing condition.

All that Anthem Blue Cross (or any other health insurance carrier for that matter) cares about is losing the large groups, of 50,000 or more subscribers. A loss like that would severely affect their bottom line. “So you want to take your overpriced individual plan elsewhere? Don’t let the door hit you where the good lord split you on the way out.”

But if you were the administrator of a large group, well, that’s a different story. They’ll wine you and dine you, and cut your rates to the bone to keep your business. We’ll just make up the difference by overcharging the little guy. There is no actuarial reason for doing this – you don’t have higher medical expenses if you work for yourself as opposed to working for GE. They charge the little guy a higher rate for a very simple reason – they can.

I know that this is just business, but it doesn’t help the policyholder whose health insurance now costs more then his mortgage.

Fortunately, there are 2 simple solutions to this problem, one that has the government tell the carriers what they can’t do, and one that tells subscribers what they can do.

The first solution is having the federal government pass a law that all health insurance carriers must have the same rates for all subscribers across the board – no loopholes allowed. This involves ‘big government’, and I can see the tongues wagging about this on Fox News for months on end. Besides, I don’t think they would ever get this through Congress. So this is not the best solution.

The second solution is to allow individuals to form groups so that they can purchase their insurance in bulk like the other big groups. New Jersey has a small business group called NJBIA that does just this for auto insurance, and the rate differences are outstanding. The problem is, PAY CLOSE ATTENTION, there is a federal law that prohibits groups doing this for health insurance! I wonder who passed that law? I also wonder what corporations contributed heavily to their campaign funds? Want to take a guess?

As an adjunct to either plan, the federal government should allow people to purchase health insurance from any health insurance carrier they want. So, if I want to purchase a policy from Horizon Blue Cross in NJ or Anthem Blue Cross in California, I can choose the carrier that has the best rates and coverage. The problem now is, PAY CLOSE ATTENTION AGAIN, there is a federal law that prohibits you doing this for health insurance.

It seems to me that the second plan would be easy to pass Congress and implement, especially if there was a grass roots effort to make people aware of how unjust the existing laws are. Oh, to be sure, the Spin Doctors will be hard at work coming up with reasons why we shouldn’t allow these two laws to be changed, but please don’t believe a word they tell you. This plan promotes business and competition, and eliminates a de facto monopoly that many carriers now enjoy on our health insurance dollar. Monopolies are illegal, right?


When little guys gang up, they become a formidable foe. The health insurance carriers would learn that, sometimes when you pick on the little guy, it turns out that his name is Lee…first name Bruce. By making these simple changes, the government can make drastic inroads to making health insurance affordable for everyone.


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The 3 Stooges

Moe, Larry and Curly – some funny guys (if you are a man, at least – it’s a male thing for sure).

How I laughed at their silly antics. How could anyone be so stupid?

One of my favorite routines is when they all went duck hunting. In the 1939 short “A Ducking They Did Go’ the trio is in a rowboat in the middle of a pond. Curly accidentally fires his shotgun into the boat’s bottom, releasing a small geyser of water, and the boat begins to sink. Larry Fine jumps up, shouts “wait a minute, I’ll fix it!” and proceeds to shoot a second hole in the bottom of the boat. He explains “I made another hole for the water to go out!”

(See it for yourself - it's on youtube - search for "3 Stooges" and " a Ducking". Look at Part 2, at about 4:45)



Oh how I laughed as a young boy, watching these shorts on New York’s WPIX (Officer Joe Bolton, where are you?). Even as a elementary schooler, I was able to clearly see how idiotic their approach was to solving this dire problem. What seemed like a ‘logical’ solution to this intellect-challenged character only exasperated the situation.

Now, all these years later, I watch in disbelief how our leaders look to fix the health care system in this country. Instead of plugging the holes in the very leaky rowboat that is our health care system, they discuss ways of making new, better holes. Few are willing to mention the problems that are causing the leaks in the first place, and then they bring them up only in passing. Creating a ‘new’ government sponsored health insurance carrier is just creating another hole in the boat. Yes, it seems like a good idea for a fleeting second, but it will provide no real long-term relief. If we want to fix the system, we need to start patching holes. – and fast – the water is cold and chest high. Once we patch the holes, we can then start thinking about bailing.

Now I know that our leaders are bright men and woman – some of the brightest this country has to offer. I know that they are much brighter then that elementary school student watching the Stooges in his parent’s living room all those years ago.

Yet, all these years later, as I watch the great health care debate on CSPAN, I stare in mortification……..What did that congressman just say???!!! To me, it sounded like “NYUK! NYUK!!! NYUK!!!”


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Spin Doctors Part 3

When it came to propaganda, Joseph Goebbels was Da Bomb!

For those historically impaired, Goebbels was the ‘Minister of Propaganda’ for Adolph Hitler, that despicable bastard with the funny mustache.

Pre-war Germany was in a sorry state in the 1930’s. Economically, the entire country was in the toilet, and the German people were looking to their government for answers and finding none. Fortunately for the Nazis, they had Joseph Goebbels – and Joseph Goebbels knew all about propaganda techniques. Most importantly, he knew about ‘The Big Lie’.

‘The Big Lie’ is the piece de resistance in the propagandist toolbox. It follows a very simple formula: 1) Tell a Lie 2) Make it Big 3) Repeat it Often and 4) The general public will accept it as the truth. It works every time.

Joseph Goebbels had a brilliant idea for a ‘Big Lie’ – blame the nations’ problems on a small group of people thereby taking the heat and focus off of the government where it belonged. In other words, ‘Blame the Jews for everything’. It worked, and as a result, we faced one of the absolute lowest points in human history.

Today, the major players in the health care game – the insurance carriers, the pharmaceutical companies, and the trial lawyers – are playing the same card with great effectiveness. They tell us that the blame for the system’s financial woes should be placed upon another small group – the physicians and providers – and thereby divert our attention away from where the problems really lie.

Time and time again, like the Jewish shopkeepers in pre-war Berlin, the successful, financially secure physician is targeted as the root of the problem. They gloss over the fact that most physicians dedicated many years of their lives, worked long hours, and lived in abject poverty just to get to where they are today. Even successful, established physicians still work long hours, in and out of the office. They work long shifts covering the ER, often without pay, sacrificing sleep and family time. And let us not forget the emotional toll that many physicians face when dealing with life and death decisions with their close patients and the patients’ family members. In truth, there are easier ways to make money then practicing medicine. This is why most physicians I speak with never want their children to follow in their footsteps.



But the modern day propagandists – the Spin Doctors – never let this dark side of the physicians’ life become known. The dedicated men and women in healthcare - who actually drive the system, and are fundamentally and integrally key to it’s functioning – are reduced to the role of scapegoat.

Herr Goebbels would be proud.

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Spin Doctors Part Two

The term ‘Spin Doctor’ first came into widespread use in the mid 1980’s,. While it is a relatively new term, the profession itself has been around for quite some time. In fact, the term ‘Spin Doctor’ was most likely created by a – you guessed it – a Spin Doctor.

Before they were Spin Doctor’s, they were in the field of ‘Public Relations’ or ‘PR’. However, by the mid 1980’s, PR firms were becoming associated with poorly behaving Hollywood celebrities and other unsavory folk, so they came up with the term Spin Doctor to give a friendlier face to this entire business. Something that politicians and major corporations could use without feeling too closely intertwined with the seamier side of society.

Even the name ‘Public Relations’ is a relatively new term. Before the Second World War, the art of Spin was called Propaganda. Then those darn Nazis went and ruined a perfectly good term.

So let’s put conventional terminology aside and call it what it really is – propaganda.

Propaganda is a well-defined art. It employs many techniques to accomplish it’s magic, including:

- Cherry Picking, or selectively presenting facts and quotes that support one's position (i.e. Dying Grandmothers)

- Non-denial denial (It’s not that we’re not going to cover you with our plan because you wouldn’t be profitable – it’s your ‘pre-existing condition”)

- Phrasing in a way that assumes unproven truths (Used extensively to fight against the use of generic drug substitutions)

- Euphemisms to disguise or promote one's agenda (i.e. “Obamacare”)

- "Burying bad news": announcing one popular thing at the same time as several unpopular things, hoping that the media will focus on the popular one. (i.e The disclaimer at the end of every drug commercial – AFTER we see the couple in the bathtub or the old lady playing with her grandchild)

Yessiree, propaganda is alive and well, and being practiced extensively by the various players vying for our health care dollars.

Here is a fun and educational game to play: whenever a company, politician, or industry tries to justify their misdeeds, inappropriate behavior, or general raping of the American Consumer, just review these ‘Rules of Spin’ and see how they are attempting to manipulate you – you will find it avery enlightening experience!

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The Seinfeld Syndrome.

I, like many people, love Jerry Seinfeld’s observational humor. It's often said that ‘many a truth is said in jest’. Jerry Seinfeld had one memorable stand up routine that, in its’ own way, clarifies one of the root issues with our current health care system.

Perhaps you’ve seen it – I believe it was used to open one of the Seinfeld episodes from the first season. Jerry was talking about ordering in a restaurant, and how, when everyone is hungry and ordering, they give very little thought to the cost of it all. This cavalier attitude reverses the second the bill arrives. ‘I don’t remember ordering this – do you remember ordering this?’ When the magnitude of the bill becomes apparent, suddenly EVERYONE is in shock and denial. I call this ‘The Seinfeld Syndrome’.

‘The Seinfeld Syndrome’doesn’t happen just in restaurants. It can happen wherever money is spent, especially when the money is spent but not paid out until some time in the future. The must-have new car that you bought for no money down loses a lot of its’ shine once you have to start making oppressive monthly payments. Recent college grads are overwhelmed when they gave to start repaying their student loans. You get the picture.

Nowhere is ‘The Seinfeld Syndrome’. more apparent (to me, at least) than in our health care system. Here’s why: Think about those $300.00 prescriptions. At the time you had them filled, all you knew or cared about was your $20.00 co-pay. The true cost of the drugs didn’t even occur to you because A) you never even saw or were blissfully unaware of the price and B) the true price didn’t matter because you had insurance and all it cost you was the $20.00 co-pay. Wrong.

Remember, once again, Star Trek economics. SOMEONE paid the full price for those prescriptions, and that someone was YOU. The money to pay for the difference between what the drug cost and your $20.00 co-pay did not materialize out of thin air. It was paid for by your health insurance carrier. And where did they get the money from? They got it from you, and to make matters worse, they kept a sizeable chunk of it to cover their profits, dividends, overhead, executive bonuses, marketing, and the like.

It just doesn’t happen with prescription drugs – patients with low or zero dollar co-pays tend to overuse their medical benefits as well, or not question a doctor who might be ordering repetitive or redundant tests. I recall one doctor complaining about a patient who insisted that the doctor come in on his day off to look at where he had cut himself shaving that morning. The patient said it wasn’t serious and didn’t require a trip t the ER – he just wanted the doctor to look at it – now. For the patient it was just a $5.00 co-pay.

Have you heard the one about the older couple who went to the sex therapist every week for treatment of the man’s sexual dysfunction? Every week, however, he had no trouble performing in the doctors’ office. When the doctor finally questioned them on this, they admitted that they were both married and this was an extramarital affair. The hotel charged $99.00 for a room, but the Medicare co-pay was only $15.00. A joke, yes, but it has its’ roots in reality – ask any doctor who treats HMO or senior patients.

Okay, so, here we are, down the road a ways, and we are staring in disbelief at our monthly health insurance bill.

I don’t remember ordering this – do you remember ordering this?

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Chemistry for Fun and Obscene Profit

What ever happened to the Alchemists? If you recall your history, alchemists were those medieval scientists who struggled in vain to turn relatively cheap lead into valuable gold.



You would think that with the advances in physics, it now would be theoretically possible to change lead into gold in a nuclear reaction – so why aren’t there any modern day alchemists pursuing this lucrative goal?

This is an easy one to answer. Gold is for suckers.

Oh, I suppose gold is near an all-time high. As I am writing this, gold is at $1,120.00 per troy ounce, which is roughly 31 grams. Some quick math shows that gold is currently selling for $36.00 a gram. While this is an impressive price for a tiny pinch of gold (just under 1/500th of a pound), it’s chump change compared to your favorite pharmaceuticals.

Let’s forget the fillers and binders that make up a modern pill, and focus on the active ingredients – the ones that do the job at hand. If we take the price per pill, and the weight of the active ingredient, it’s easy to figure out what these medicines actually cost per gram:


LIPITOR 40 MG TABLET @ 5.23 Per dose
Which equals $130.75 per gram

NEXIUM 40 MG CAPSULE @ 7.17 Per dose
Which equals $179.25 per gram

LEXAPRO 20 MG TABLET @ 4.00 Per dose
Which equals $200.00 per gram

SINGULAIR 5 MG TABLET CHEW @ 5.73 Per dose
Which equals $1,146.00 per gram

AMBIEN 10 MG TABLET @ 6.20 Per dose
Which equals $620.00per gram

PREVACID 30 MG CAPSULE DR @ 6.43 Per dose
Which equals $214.33 per gram

PLAVIX 75 MG TABLE @ 6.33 Per dose

Which equals $84.40 per gram

LAST BUT NOT LEAST, WE HAVE

LUNESTA 3 MG TABLET @ 7.97 Per dose
Which equals $2,656.67 per gram



That’s why no one is making lead into gold – it’s too much like work for too little money!

So 24K gold is a downright bargain when compared to eszopiclone, the active ingredient in Lunesta. I am sure that eszopiclone is a difficult ancomplex chemical to manufacture, but why should it cost more then 73 times the cost of gold, one of the most valuable elements o the face of the planet?

Or let’s put this another way…you’re paying $74,368.00 – the price of a very nice luxury car – for just one ounce of the active ingredient in Lunesta, or just under 1.3 million dollars for a pound of the stuff. Or let’s imagine taking a flour bag off of your local supermarket shelf and refilling it the eszopiclone – this is an easy way for you to visualize quantity. That flour bag full of eszopiclone would run you around 6 MILLION DOLLARS. This is for a pill that helps you fall asleep. I hope that this insight doesn’t keep you up at night…

So, what did happen to the Alchemists? According to Wikipedia: “An alchemist was a person versed in the art of alchemy, an ancient branch of natural philosophy that eventually evolved into chemistry and pharmacology”.

Did they say pharmacology? Mystery solved!

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The Panini Parade

Want to see your health care dollars at work? It’s easy – just go see the ‘Panini Parade’





On almost any given weekday, go to your local trendy bistro around 11:30 in the mooring – right before lunch. For best results, choose a restaurant near a major hospital or medical center. Then watch for the cute blonde 20-something women in a business suits picking up large lunch orders. In a particularly busy restaurant, there may be enough of them to start a small parade.

Now, most of these lithe cuties look like they haven’t eaten a full meal in years, but they will be picking up lunch orders that cost hundreds of dollars and pay for them with their corporate credit cards.

Who are these women? Why, they are drug company representatives, buying lunch for an entire medical office just so they can get the doctor’s ear for a few minutes, and convince them to prescribe their company’s medications. Their hot bods, bubbly, flirtatious nature and trays of delectable goodies are a time-proven way to get the doctor’s ear. Amazingly, these free spending sweetie pies may represent only one particular drug!

Their generosity does not stop at lunch – they gleefully dispense tickets to the play or ballgame, or other tantalizing goodies.

How can they afford to do this? Economics! Let’s look at some of the most widely prescribed drugs and the modal cost per pill:

LIPITOR 40 MG TABLET ...$5.23
NEXIUM 40 MG CAPSULE ..$7.17
LEXAPRO 20 MG TABLET ..$4.00
SINGULAIR 5 MG TABLET CHEW ..$5.73
AMBIEN 10 MG TABLET ..$6.20
PREVACID 30 MG CAPSULE DR ..$6.43
PLAVIX 75 MG TABLE ..$6.33
VALTREX 1 GM CAPLET ..$15.20
LUNESTA 3 MG TABLET ..$7.97


(Source: NJ Attorney Generals Office)

https://www6.state.nj.us/LPSCA_DRUG/search.jsp

This is the MODAL RETAIL PRICE PAID (or in simpler terms, the price most commonly paid) per PILL (ONE PILL) by consumers in my area. Some pharmacies charge significantly more per pill.

When you realize that the average 30 day prescription is for 30 to 60 pills – wow – those lunches are paid for when the doctor writes just one lousy prescription. Factor in that a busy doctor might treat (and prescribe for) 30-40 patients per shift, each patient might get 2 or 3 different prescriptions, and these prescriptions may have 3 or 4 renewals, and wow – the money piles up faster then smoked turkey on cibada bread.

Hurray! Hand tossed salads and Broccoli Cheddar soup for everyone!



Oh, some of you will say ‘pharmaceutical companies don’t do that anymore – they are really cracking down on this practice’. SSSHHH! I won’t tell if you won’t – it still goes on, albeit a bit more quietly then before. Don’t believe me? Just visit that trendy bistro right before lunch and enjoy the parade!


Just be sure to take your prescription antacid before you go – the sight of these parades really can get your stomach juices churning! And the next time you visit your doctor, make sure that he or she thanks you for lunch. After all, recalling Star Trek Economics, you paid for a little bite of that panini sandwich.

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Punch Druggie – No Punch Backs!

Here is a fun and exciting game the entire family can play – and it’s free.

As you are watching your favorite television programs, wait for a prescription drug commercial to come on. The first person to recognize the commercial as being for a prescription drug yells “punch druggie – no punch backs!” and punches everyone else playing playfully in the upper arm. Then, they go to the NJ Attorney General’s website at:

https://www6.state.nj.us/LPSCA_DRUG/search.jsp

and look up how expensive that drug is per dose in your area (or, if you are not from NJ, use the Zip Code 07012 – my old home town.) The person who calls out the most expensive list of drugs that night is the winner!


Strategy Hints: Be on the lookout for adverts for ‘Daddy's Little Helper’ drugs. Shouting PUNCH-DRUGGIE ! for a Viagra commercial (at $18.25 per dose) is like putting down ‘Quartzy’ in Scrabble on a double word score.

By the way, this is what over a thousand dollars worth of Viagra looks like. I bet it isn't Viagra users happily singing in that commercial - it's Pfizer executives !

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Spin Doctors

Said if you want to call me baby,
Just go ahead now
And if you like to tell me maybe
Just go ahead now….

…..Two Princes – The Spin Doctors







Wow, remember the Spin Doctors – that one hit wonders band of the early1990’s (OK 2 hits).

Well, I’m pleased to announce that the Spin Doctors are alive and well. Maybe not the band (I don’t know what happened to them) but Spin Doctors are alive and well, and working in our healthcare system.

Many might say that they are the MOST IMPORTANT doctors in our health care system. Think of them as ‘Think Doctors’.

Now, Psychiatrists and Psychologists may tell you how to think, and Neurosurgeons treat disease and injury so that you are able to think, but Spin Doctors serve a much more important function – they tell the general public WHAT to think.

Oh, these crafty professionals play us like Emerson played the keyboards, whirling and spinning like a dervish, expertly directing and misdirecting John Q. Public. Like military sappers, they quickly de-fuse every potentially explosive situation. Magicians at heart, they mis-direct us like David Copperfield, and make us believe in the impossible (we all KNOW that that bus could not have vanished in thin air, but hey, it’s gone!),

They live in the shadows, and command huge sums of money for their services, and they are worth every penny. With hundreds of billions of dollars at stake every year, there is no limit to what their keepers will pay them for their smoke and mirrors.

When they are on their game, you never even realize how hard and well they work – but work they do!

Remember when ‘Obama Care’ was in danger of being passed, threatening the inflated livelihood of every overpaid executive at every health care carrier? Oh, the Spin Doctors revved up like the turbines of a 747 on takeoff. And what did they give us? Dying Grandmothers! Every town hall meeting, every discussion on TV, everywhere where ‘Obama Care’ was being discussed, at least somebody brought up Dying Grandmothers! Spontaneously (or so it seemed) the issue of Dying Grandmothers materialized out on thin air simultaneously all across the nation. Brilliant! Who could be in favor of Dying Grandmothers being denied life-saving or life-extending care by the government – no one! Case closed!

Of course, no one is up in arms about Dying Grandmothers being denied care by their Medicare HMO’s – that is an entirely different kettle of fish. I’m sure that some Spin Doctors de-fused that issue right away, and we never even noticed them doing it.

As the great Oz once said: ‘Pay no attention to the man behind the curtain!’

So, before we can start solving this mess, we’re going to need Toto to pull the curtain away and expose these shadowy charlatans.

Toto? Oh, they were an 80’s band!

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How to Cut the Cost of Health Care by 10%

OK, enough complaining. It's time for action. Here is a surefire way to cut health care costs by 10% immediately. This is an easy one – why hasn’t anyone thought of this before? All we need to do is to stop paying those overpriced doctors. Let’s decree that, from this point forward, all doctors will work for free!

Oh, we may get some resistance from the medical profession, but the heck with them. We can use our military to hold these over-priced prima donnas at gunpoint and force them to provide their services gratis.

It seems to me that we could implement this plan nationwide within 30 days time, and start realizing that 10% savings right away.

Oh, there may be some repercussions down the road. It might be tough to get new doctors to dedicate 8+ years of their lives and invest hundreds of thousands of dollars in higher education, but we can deal with that when the time comes. After all, the current healthcare crisis is all about short-sightedness.

By implementing this plan, and saving 10% on our healthcare costs, we can stave off healthcare inflation for at least 2 years. Unfortunately, at two years from now, we will be right back where we are right now.

I bet you thought that this drastic plan would have saved a lot more money then 10%. Good for you! That is exactly the way you are supposed to think! You know that the greedy doctors are to blame for the current healthcare crisis! You don’t know WHY you know that – you just do! It just kind of makes sense.

Of course, if we want real, significant change in controlling the cost of healthcare, without tremendous negative effects in the near future, we will have to start looking elsewhere for solutions. But that sounds like hard work. Blaming the greedy doctors for the problem is easy, so why don’t we all just ride that train together for a while.

All Aboard!

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Dr. House

WOW! I was watching House tonight – a great medical drama. (BTW, did you know that Hugh Laurie, the actor who portrays House, speaks with a heavy British accent? He sounds like he’s from Jersey to me! Great actor!)

Two big surprises in tonights’ show !

First, they broke the formula that I’ve come to expect from House (i.e. Patient gets weird illness, no one can figure out what it is, they finally figure out what it is and start treating them for it, the patient has a bad reaction to the treatment and almost dies, House figures out what is REALLY wrong with the patient at the last minute and saves their life…). No, tonights show was more about the administrative and financial issues involved in running a small hospital.

Secondly, a sub-plot tonight was the battle that the hospital administrator was having with a major health insurance carrier in negotiating the hospitals’ new contract. They even went so far as to show how the people running the carrier were hugely overpaid and cared little about patient/subscriber welfare and truly only cared about their personal fortunes.

I was heartened to see mainstream media actually promoting healthcare insurance carriers in less than a flattering light. Perhaps there is hope after all!

WOW! Hollywood is listening to me! Shouldn’t you?

(PLEASE NOTE: For the benefit if the clueless, please be advised that that last statement was said strictly tongue in cheek – Thank You

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Tithing

You might have gathered from my previous post that I place a lot of the blame on the health insurance industry – and you’d be correct.

You might even infer that I think that if we were to eliminate health insurance, we would save up to 10% of our health care dollar – and you’d be wrong. The actual savings would be significantly higher. How is that, you might ask?

As I mentioned before, health insurance carriers are huge bureaucracies. If you want proof of this, just call your carrier sometime and try to collect money on an overdue claim (don’t tell them you’re the subscriber – tell them you’re calling from a provider’s office). Dealing with a health insurance carrier, their voice mail systems, and their multitude of minions is one of the most frustrating tasks you can ever envision. Yet, this is what health care providers must do on a daily basis just to get paid properly for their services. It takes manpower to do this – a lot of manpower. Did you ever notice all those people working in your doctor’s office who have nothing to do with your care? Chances are, 80% of those extra people work in some capacity dealing with insurance billing and collection. Guess what? In larger offices, there may be an entirely different group of employees (the billing department) that you never see whose sole purpose is to deal with the insurance bureaucracy. These people all cost money – they need salaries, health insurance, retirement funds, computers, software, office furniture to work on and office space to work in. They need telephones and fax machines. They need to have their office space heated in the winter and cooled in the summer. All things that Good ‘Ole Doc Rusen never had to worry about or pay for.

It’s not just collecting on claims. There is a myriad of other ways that the insurance industry strains the modern medical office. Your doctor determines that you need to see a specialist? - Not so fast! Your specialist is not going to get paid unless he gets a Pre-certification from your carrier. Your carrier has decided that they won’t pre-certify you unless you have these additional tests (which your doctor – the one who went to school for this stuff) doesn’t think you need. More forms to fill out for your doctor. More time and expense. More running around and time lost from work for you. More money burned at the altar of the health insurance carriers.


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Pointing Fingers

Someone once told me never to point fingers – whenever you point, one finger points at your subject but three point back at you.

I’ll take my lumps on this one.

First up on the block, let me make an example of American Express.

American Express, you say? What do they have to do with healthcare problem?

Actually, nothing that I can think of – I have nothing against Amex – but they make a great way to illustrate my point.

Now, unless you live under a rock, you are very familiar with American Express – one of the most successful companies in American History. Most of us carry one of their cards in our wallets. Don’t leave home….

As a young man, I did some IT consulting for Amex. Twice a month, I would travel to New York’s financial district and set to work in some very impressive offices in Battery Park City, 50 floors or so above the Hudson, looking down towards Liberty State Park and Ellis Island. The most impressive offices I have ever seen. I would roll in about 10, have a nice catered lunch on Amex around noon, and take off around 4:30. For this, I was paid a daily wage that I still have trouble making again 25+ years later. God, I miss the eighties.

Yes, Amex was, and still is, a company that oozes wealth. But did you ever stop and think how they make their money? (HINT: It’s not on the $50 annual fee they charge for one of their cards).

No Amex makes their money by charging the merchant (store, gas station, etc.) a small percentage of the amount put on the card. This amount may vary depending on a number of factors, but usually is in the range of 2% to 3.5% of the purchase.

Doesn’t sound like much, does it? What’s 2% of my breakfast tab – hardly enough to get excited about. The key to their success is VOLUME. 2% of a $5 breakfast tab comes out to a thin dime - chump change. But if you consider the billions of dollars put on Amex cards every year, that 2% cut suddenly becomes significant. Very Significant. Enough money to buy them fancy offices in lower Manhattan.

What does this have to do with the healthcare crisis? Well, there is one very large player in the healthcare game that makes their money in much the same way that Amex does – the healthcare insurance providers. This isn’t an exact correlation. First of all, the insurance carriers make a much larger percentage of of your dollar than Amex does. How much? I can’t really say with certainty, because many carriers are not publicly held and play their financial cards very close to their chest. Even those who publish financial data don’t really give the whole story. Net profits really mean nothing here. Net profits are what’s left over after they pay all those salaries and bonuses, build those huge office parks, and shove huge sums of money down various ratholes that John Q. Public will never see. (We’ll talk about more of these ratholes later) In the days before big healthcare, all of these dollars that used to stay in the pocket of the patient or end up in the pocket of the doctor. Don’t be mislead - every penny spent by the huge insurance carriers has come out of the pockets of their subscribers – you and me. Every one of those dollars used to pay for healthcare – now they pay for bureaucracy, bloated bonuses, and blimps.

The second way in which these carriers are not like Amex is in the shear volume of money involved. According to Wikipedia (so it’s gotta be true!) health care expenditures account for 16% of the GDP, or over 2.2 TRILLION (with a T) dollars this year. If the healthcare carriers keep just 10% of that, they are pocketing 220 billion dollars a year as middlemen. Remember, these carriers don’t vaccinate, they don’t diagnose, they don’t treat the sick and elderly. They sponsor baseball stadiums, fly blimps, and produce ridiculously expensive TV commercials that try to convince us of how benevolent they are. They also pay their top executives ludicrous sums of money. And, perhaps most importantly, they pad the pockets of our elected leaders whose job it is to decide the future of healthcare.



Well, if you weren’t sick before reading this, I am sure you’re feeling just a little queasy right now.

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Star Trek Economics

There are a lot of varied healthcare topics I will discuss on this blog, but several topics will form the foundation of many of my arguments.

There is one principle in particular that bears definition right away, as I plan to refer back to it often.
I’m not an economist, and I don’t know the academic term for this phenomena, so I just came up with my own catchy phrase - I call it “STAR TREK ECONOMICS”.

You see, many of the players in the healthcare game would have you believe in Star Trek Economics on one level or another. This is not done overtly – Star Trek Economics is something that they want you to accept on some deep subconscious level. They never want to actually give any thought to Star Trek Economics – because Star Trek Economics is, by my definition, pure fantasy. Anyone with half a brain would agree that it’s pure fantasy if they thought about it for more than a few seconds. This exactly why the major healthcare players don’t want you to think about it. Hopefully, if I’ve done my job, I’ve let this genie out of the bottle, and you will all reject Star Trek Economics from this point forward.

But I will remind you of it whenever I get the opportunity…I’m annoying like that….

Remember Star Trek? Of course you do. For most people, the coolest thing about the original Star Trek was the Transporter. People could beam down to a planet and materialize out of thin air. So cool.

Many players want you to think (actually, not think, rather just accept on a subliminal level) that their money works the same way – it just materializes out of thin air, like Captain Kirk on a planet full of green women. This, of course, is pure nonsense. Money, in the healthcare system, comes from somewhere, and that somewhere is ultimately your wallet. It comes from there directly, via your co-pays and premiums, or indirectly, via your tax dollars. But from your wallet it comes.

Your hard-earned dollars are at work everywhere. All of those commercials on television that implore you to 'ask your doctor about..'. Those billboards at the baseball park. that blimp flying overhead. That sprawling office campus. Whenever you see these things, you have a right to feel proud. After all, your health care dollars have paid for a little piece of each one of them.

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My Family Doctor

OK, back to problem solving 101:

I am at that awkward age where my wife calls me ‘middle aged’ and my children ask me what it was like to live before electricity. The truth lies somewhere in the middle.

So, lets start by looking at STEP ONE:



For this, I am hopping into Peabody’s ‘Wayback Machine’ (if you know what this is, you are at least as ‘chronologically impaired’ as I am), and I travel back to when I was a boy where I met one of the best Doctors I have ever known – Good ‘Ole Dr. Rusen. When I was sick, Good ‘Ole Dr. Rusen would come by the house in his Grey Ford sedan, examine me, and then give my Mom some sage nursing advice. In bad cases, he would telephone the pharmacy, who would soon deliver some vile elixir in a brown bottle the taste of which was worse then the illness itself. (Yeah, the pharmacy made housecalls too back then). Through Good ‘Ole Dr. Rusen medical expertise, I was usually on my way back to health in a day or two. If my disease was particularly stubborn, he might swab my throat and culture the result (back then, Doctors had microscopes in their offices that they actually used themselves to diagnose patients). And what did Good ‘Ole Dr. Rusen get for his trouble and expert advice? I think it was something like $10 or $15. My parents did not have ‘health insurance’ so they paid out of pocket. Now, they did have ‘hospitalization’ which covered the real big medical expenses, but few people back then had ‘health insurance’, as we know it today. Those who did have insurance still paid out of pocket – it was up to them to fill out the forms and submit them to their carrier for reimbursement.

Funny thing was, back then, nobody complained about ‘the cost of healthcare’. My parents could easily afford the 10 or 15 dollars they laid out when someone got sick because they weren’t spending a couple of hundred dollars (over a thousand in today’s money) for health insurance premiums every month. The Doctor made a real nice living, too. His only overhead was the office in the first floor of his house, a receptionist, and gas for his gray Ford, so he kept proportionally more of the money he was paid. He didn’t need a small army of employees to fill out and collect on insurance claims. Malpractice Premiums? He never heard of them. Even the local pharmacist was happy – he could make a couple of bucks on that elixir that he most likely mixed up himself. (At that time, no marketing genius had yet thought to give elixirs vaguely scientific, yet familiar sounding names and advertise them on television).

Yes, Virginia, things have certainly changed since then. Today, doctor’s are scrambling to keep their income somewhat in line to what they were making ten years ago. Their overhead continues to rise. House calls are as much of an anachronism as blood letting. Patients struggle to pay for their insurance premiums, prescriptions and co-pays. The local pharmacist sold out to a major chain a few years back when he couldn’t cover his overhead anymore. And that magical (but foul tasting) elixir has been made obsolete by the introduction of Sensocorium (which is basically the same drug, modified just enough to patent, mass produced and marketed by Pharmaglomorate Labs). By the eay, Sensocorium sells for $500 a bottle ($150 in Canada). It now tastes vaguely like cherries – science does march forward.

Now, I’m not so naive that I don’t realize that medicine is much better then it was when I was a kid. And that these advances in medicine, pharmaceuticals, and diagnostics don’t cost more money – they do. But the sad fact remains that we spend a heck of a lot more – proportionate to our incomes - for our healthcare then we did just 30 or 40 years ago even when we factor in the added costs of healthcare advances. And in spite of all the noise and fury, our healthcare dollars continue to be sucked into an ever-widening black hole. We better start fixing things – fast—because our entire economy is approaching the event horizon. (Don’t know what an ‘event horizon’ is? Google it and see how clever I am with healthcare and theoretical physics).

Dr. Kildare meets Dr. Kaku




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Problem Solving 101

Pssst! Want some FREE EXPERT ADVICE on how to solve a problem? Not just this problem – almost any problem you might come across in business or life. Three simple steps to solving it – works almost every time. Trust me on this – my infomercial is coming out shortly, and it’s going to cost you Tony Robbins type money to get ‘the solution’ once I’m on TV, so you might as well grab it now when the gettings good (and FREE!)

Here it is:

STEP ONE: Identify when the problem didn’t exist

STEP TWO: Identify what has changed between the time when the problem didn’t exist and the time that the problem reared it’s ugly head

STEP THREE: Address the thing (or things) that changed and caused the problem in the first place!

Sound simple? Yup. Overly simple? Perhaps. But is it effective? ABSOLUTELY! You would be shocked how much time, effort and money people expend trying to solve problems without knowing or fully understanding what the problem truly is. And without that knowledge, they will only solve a problem by chance. If it is truly a complex problem, they will most likely never solve it, and probably make matters even worse by trying to solve it blindly.

For some reason, the larger the organization is that has the problem, the harder it is for them to identify the root cause and solve the problem. The more people involved in ‘the solution’, the more off the mark the perceived solution tends to be. This is quite prevalent in corporate America, and gets even worse in government. Will Rogers supposedly said “A camel is a horse designed by a government committee’ It rings as true today as it did back in the 1930’s. This is not a fault of ‘the government’ per se – it’s just a simple fact that the more people you have working on ‘a solution’, the more time is spent on bureaucracy. Most of us have been there and witnessed this for ourselves: people speaking just to hear themselves speak, meetings to discuss the agenda of upcoming meetings, Blackberries click-clacking away with endless memos and responses, and an overall shuffle where everybody tries (usually without success) not to step on anyone else’s toes (especially if that person makes more money than they do!) It’s a miracle when any work gets done at all…

Have you heard the story about that tractor-trailer that went off route and got wedged under an overpass with lower than normal clearance? While no one was hurt, the trailer was so firmly wedged in place that not even the stoutest tow truck could budge it. With traffic backing up for miles, the city and state sent in every expert they could muster to figure out how to remove the trailer from its spot under the overpass. Firemen with their rescue equipment, Local and State police, and Emergency Management agencies buzzed around the accident site, each one trying (and failing) to remove the trailer. These highly trained men and women had the very best in state-of-the art rescue equipment yet they all ultimately failed.

Supposedly, after several hours of watching this exciting scene, a little boy wandered up to a policeman and asked “Why don’t they just let the air out of the tires?”

So, what I am saying is, we don’t need a government committee to solve the healthcare crisis, we need a little boy with fresh eyes.

Has anyone seen my wed wagon?


Problem Solving 101

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Good Question

So, your next logical question might be “Who are YOU to host this discussion?”

Good Question!

(I wish I had a good answer)

Actually, I do. I have been involved in healthcare administration for over 20 years. I am not a doctor (but I do play one on TV…) I do work with doctors (lots of doctors) in the administrative end of their practices. I have seen a lot of changes over the past 20+ years, and most of them have not been for the better.

I have worked as an independent consultant in the field of health insurance collections (i.e. trying to get insurance carriers to pay their claims) and I have also worked as a patient and physician advocate. As a self-employed person, I have paid for and administrated my company’s own healthcare plan, and I’ve watched my coverage decrease and my premiums increase. In other words, I have been in the belly of the beast, and I am slick with it’s putrid slime (my 11th grade English teacher would have loved that phrasing!).

OK, full disclosure here: My perspective on this issue is going to be slanted towards that of the “healthcare consumer” (we used to be called patients) and the “healthcare providers” (they used to be called Doctors). I have markedly less affinity towards the rest of the healthcare system (these players will be named later). My opponents in this discussion have the aforementioned lobbyists and Madison Avenue on their sides, not to mention a bevy of Spin Doctors that make James Carville look like a ran amateur. So lets call it an even match….

So, first question to all of you: Who do you blame for the ‘healthcare crisis? Greedy Doctors? Overly Needy Patients? (HINT: If you answered YES to either of these questions, you have fallen hook, line and sinker for the hype – but hey, don’t feel too bad about it – you have LOTS of company)

More on this later…

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Joaquin Rivera hearings in Philadelphia.

A little out of sequence, but I heard a great quote on the news tonight during the Joaquin Rivera hearings in Philadelphia. For those of you unfamiliar with this case, Joaquin Rivera was an elderly man who was tragically robbed and then passed away while waiting to see a doctor in a Philadelphia ER.

The attorney for the Rivera family said “We need to put the Emergency back in Emergency Room”.

I couldn’t agree more. However, I don’t think that the Rivera family attorney is speaking about the same thing that I am.

The way I interpreted his sound byte is that we need to use Emergency Rooms for their intended purpose – treating patients with Emergent Conditions. Until we can find a place where non-emergent, sub-acute patients can be safely and legally triaged to outside of the ER, we’re likely to see more sad stories like this one coming out of overloaded Emergency Rooms all across the nation.

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Let's Get Things Started...

Wanna start a fight for the fun of it? EASY!

Just start talking about Nationalized Healthcare (Obama Care) or related topics at your next gathering of family or friends. Just make a few, well placed comments on the subject – pro or con – then sit back and watch the sparks fly! Just be sure to keep the room clear or pointy objects or anything else that can be used as a weapon – we don’t want to get anybody seriously hurt now, do we? Not when a trip to the ER costs $800 or more, and wastes three or four hours of your time…

Let’s all try to agree on two premises here - 1) the current system is screwed up and 2) it isn’t getting better on it’s own. OK, agreed? Now let’s discuss how we’re going to go about fixing it. Wait, that’s putting the cart before the horse. Let’s begin by looking out what is actually wrong with the current system from an objective standpoint and then, perhaps, we can begin to talk about fixing it.

This is too important of a topic to let it’s fate reside with our leaders in Washington (or, realistically, the highly paid lobbyists who really make these decisions). Will Rogers said “if pro is the opposite of con, what’s the opposite of progress?” Smart guy, that Will Rogers.

Watching from the sidelines, it seems to me that this entire healthcare debate is like the story of a group of hunters moving through the woods in search of some game. After a while, they come across some tracks in a clearing.




“AH HAH!” exclaims the first hunter. “These are obviously deer tracks. I’ll wait up this tree for the deer to come by again and then I will shoot it with my bow”.

“NONSENSE” shouts the second hunter “If you knew anything about tracking, you would realize that these are moose tracks. A moose is too large and strong to kill with a bow. I will wait up the tree and shoot it with my shotgun!”

“ARE YOU CRAZY” screams the third hunter “Any idiot can see that these are mountain lion tracks. A mountain lion is too swift and cagey to kill with a shotgun. I will wait for it up on yonder ridge and then shoot it with my rifle!”

“YOU’RE THE IDIOT” yelled the last hunter “These are grizzly bear tracks. A grizzly is the most dangerous animal in these woods. I will simply set and bait my bear trap, and then we can all wait in safety back at the campsite.”

These four hunters stood and screamed at each other for hours, each one convinced that they alone understood the problem and that the solution that they held was the only possible solution to consider. They would still be there today, screaming and arguing with each other about the true nature of the tracks in the woods if the Amtrak express train hadn’t run them all over….

My point is simply this: If we want to ‘solve’ the healthcare crisis, we must first figure out what the problems are (Emphesis on the plurality) and the discuss possible solutions to these problems as objectively as possible.

No small task, but it sure sounds like fun. But first, let me make sure that my healthcare premium is paid up, and that the local hospital ER hasn’t closed down. After that , we can begin our little discussion in earnest.

The only thing I ask is that you put your own 2 cents in from time to time. I promise to remove all pointy objects from around my workstation so you should be able to leave your comments in relative safety.

‘til then….

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