NJ 101.5

As much as I love talking about the health care crisis, I am often put in the position of being asked ‘hard questions regarding health care reform. While I don’t mind doing this, it is nice, every once in a while, to be asked an easy question… a so-called ‘softball question’.

Case in point:

When I was speaking on NJ 101.5 a few weeks ago, and indicated that there were things that I favored about National Health Care Reform (i.e. ‘Obamacare’), the host, Dennis Malloy, tossed me a real soft ball – “Who’s going to pay for it?’

This question is a rallying point for those who are opposed to Health Care Reform (along with the ‘dead grandmother’ issue). However, I have a very simple and straightforward answer to this question – in both long and short versions.

The short answer is simple: “We are”.

Yup. A national health care plan will be expensive, and all of America will be forced to pony up their fair share to pay for it.

The long answer is equally simple: “We are. We are paying for it already. In fact, we are paying far too much for it. – much more then we could be paying inder a nationalized system.”

Don’t believe me? See for yourself. Drive by any US Hospital, any time of the day or night. It doesn’t matter where that hospital is, but if you can, drives by a hospital in a lower income area.

Do you know what you’ll see? Me neither.

However, I DO KNOW what you WON’T SEE - poor, uninsured people dying in the street because they were denied treatment. The fact is, hospitals treat a very large percentage of the uninsured. The costs for treating the uninsured are then passed into those of us with insurance, and we end up paying for that care with higher taxes and higher insurance premiums. And that ‘free’ health care is being supplied at the single, costliest place on the face of the planet for getting health care – the U.S. Hospital. Or, as I like to call it, “Home of the $6.00 Tylenol”.



Well, so long as this is on your dime, where would you rather have the uninsured buy their Tylenol – at the Hospital for $6 bucks a pop or at Wal-Mart where you can pay $2.00 for a bottle of 100? Yeah, me too. Now, extrapolate the Tylenol logic to the rest of the health care spectrum and you can see how a National Health Care System can potentially save every American a lot of money.

Yes, we’ll have to pay for it, but we’ll be paying a whole lot less then we are paying right now.

Obamacare is not perfect – far from it. In fact, there are a lot of unanswered questions that I would like to see answered before a National Health Care System is enacted. I especially would like to see freedom of choice in health care preserved, as well as additional safeguards that would keep third parties from abusing that system like they do with our current system.. But it is a step in the right direction.

It’s really that simple.


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Turkey Day

Happy Thanksgiving, everyone.

I wish that I could enjoy the holiday – unfortunately, I’m feeling nauseous.

It’s not from the turkey, the sweet potatoes, or the pumpkin pie. It’s from my constant re-reading of the latest government report regarding health insurance.

Along with the announcement about the Government’s new Health Insurance Carrier regulations came some startling statistics – that some small groups were paying their carrier twice the amount in premiums that they were getting back in the form of medical; benefits.

I always knew that those of us in small groups were getting ripped off – and we now we have some concrete numbers to rally around. I’m a cynic, to be sure, but even in my most cynical moments, I never realized just how bad we were getting butt-raped. We’re talking John Holmes sans lubrication.

But wait – it’s even worse than it appears.

The Government statistics did not factor in other costs that can be attributed to the health insurance industry. Things like greatly increased overhead in medical offices that the patients end up paying for. Then there is all of the unnecessary testing that the carriers require that we also end up paying for. Let’s not forget the general inflation in medical and pharmaceutical costs that can be attributed to the health insurance system.

Don’t know what I’m talking about? Read my blog from the beginning and refresh your memory.

So this translates to AT LEAST a 50% tariff that we are paying for health care that can be attributed, directly and indirectly, to the health insurance industry.

For my family, this translates to around $10,000 a year in hard currency. If you are lucky enough to have your health benefits paid by your employer, your costs are going to be somewhat less, but will probably come out to around $6,000.00 a year , whether you realize it or not. I am not talking about what you are paying for health care – I am talking about what EXTRA you are paying to feed the health insurance industry.

I don’t know about you, but I won’t be able to ride a bicycle for a very long time.



Ten grand a year the sole purpose of feeding corporate greed.

I feel like a real Turkey – don’t you? So I guess that this makes it our special day.

So, to all my fellow turkeys I say “Gobble, gobble”. Which, ironically, also happens to be the motto of your health insurance carrier.



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Victory

Perhaps you’ve noticed a recent news article regarding health insurance. I would have thought that it would have been the lead story on all of the major networks, but, instead, it was relegated to the back pages of most newspapers. Nonetheless, it tells of a major victory in the battle for affordable health care.

The Obama administration has unveiled a new rule regulating the health insurance industry. Health insurers must now spend at least 80% of the premiums they collect to actually pay for medical care. Any excess must be returned to subscribers in the form of credits or rebates. For larger groups, they must spend at least 85%. The new rule will go into effect on January 1, 2011.

As I have been saying all along, greed and mismanagement by the health insurance industry has been the single largest contributing factor to the uncontrolled rise in health care costs. For some small business plans, carriers spent as little as 50 cents of every premium dollar collected to actually pay for health care. The other 50 cents went towards administrative costs, marketing, and, of course, executive salaries and bonuses.

The new rules won’t solve all of our problems, but they are a big step in the right direction. Other American industries that manage our money – i.e. banks – are subject to a whole slew of regulations limiting how much money they can make on a transaction. It is only fitting that similar legislation is now being applied to health care insurers.

As a realist, I understand that we will have to wait and see just how effective these new laes are in controlling health care costs. While the insurance carriers are complaining about the new laws, they are not complaining THAT much – and this worries me. We all can be certain that the new laws have loopholes, which will be exploited before the ink is dry on the new legislation.

For instance, I am not aware of anything in the new law that deals with reserve funds. If money dumped into reserve funds can be considered as money being spent on care, then we can expect that all excess profits will simply be dumped into these funds instead of being returned to the subscribers.

We also have to be concerned that the carriers will make drastic cuts in service personnel – the people who actually process our claims – before they consider cutting executive salaries and bonuses. Somehow, I just feel it in my bones that the executives running the carriers will blame these cuts on the new law whilst still taking their multi-million dollar salaries.

Still, this is another step in the right direction – and a major one at that. We can only hope that our government continues to draft similar legislation that addresses the real issues in health care – and works to close loopholes and tighten up the laws that we already have.

Well done, Washington.




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Criminal Minds

A few weeks back, one of my FaceBook friends posted the following query to his status: “Is a recommendation from a friend "tainted" if that friend gets a commission if you buy that product or service? How about if they tell you they are getting paid to recommend it?”

My initial response was, no – as a consultant, I pride myself on my objectivity. I can rise above the temptation to make money and not let financial gain influence my recommendations. However, as the days wore on, I came to a stunning realization – I’m not that good.

Oh, I try to be good. I usually am good. Often, even when I am not being good, I like to think of myself as good – I always believe that I am doing the right thing, even when I am not.

You see, as humans, we are victims of our human nature. Dale Carnegie pointed out that we are incapable of seeing ourselves as ‘bad’ – even when we are doing bad things. He claimed that even Al Capone thought of himself as an honest business man.


This is not a character flaw – it’s just the way we are wired – I am sure that it has something to do with our basic instinct for self preservation.

Being in the medical field, and being from New Jersey, I have known a few Doctor’s named Gandhi in my day. Since they share a surname with one of the greatest human beings ever to walk the earth, can we then assume that they (or any other Doctor for that matter) won’t let the free lunches and honorariums that the drug companies give influence their decision to prescribe that company’s products over another, less generous company’s?

Of course not. First of all, none of these Doctor Gandhis were related to the famous activist (at least not in this lifetime). On a more serious note, they are human beings, and therefore subject to the same falibilities and weaknesses as the rest of us.

Hey, I’d bet that even Mahatma snuck a cookie or 2 during that famous hunger strike.


We have to realize that all Doctors are human beings, just like the rest of us. OK, I know that some Doctors will disagree with this statement – they may feel that they are superior to most of us and able to rise above such temptations – but, like Capone, they are just fooling themselves. Even if there is one doctor out of every hundred who can rise above the influence and remain totally objective when prescribing medications, that still leaves 99 others who are influenced to some degree. How can I be so certain? Do you really think that pharmaceutical companies would spend billions every year on Pill-ola if it wasn’t effective?

OK, so none of us are perfect – even when we try to be. The Doctors who insist that they are not being influenced by what amounts to bribes by pharmaceutical companies are simply delusional. None of us are really THAT good.

This raises the big question – knowing what we know, how can we continue to let pharmaceutical companies bribe our doctors on matters affecting our health and well being?

Beats the Hell out of me.





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Hero Worship

We all need a Hero.

Someone who rescues us from a horrible fate.

Now, a Hero doesn’t have to be someone who runs into a burning building to save an invalid, a small child, or even a kitten. Sometimes a Hero is just someone who restores your faith.

I think I found a new Hero – Senator Charles ‘Chuck’ Grassley. He’s helped restore my faith in the US Government.




Senator Grassley, an Iowa Republican, has been pushing to limit the influence of drugmakers over the practice of medicine.

Unlike a lot of his fellow legislators, Senator Grassley obviously gets it – and he wants to fix it. He realizes that medical decisions should be based upon history, research and experience – and not on the ‘advice’ of a cute blond 20-something bearing a platter of sandwiches and a briefcase full of free drug samples.

I don’t live in Iowa, and I don’t plan on moving there, so, unless he decides to run for a higher office, I don’t think that I will ever get the privilege of voting for Senator Grassley. I would, however, love, one day, to get the opportunity to shake his hand and tell him: “Well done, Senator Grassley – the nation needs 99 more Senators just like you”.


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Back to School

Reminiscing about my school days, I now realize that I really did learn something useful in High School.

I remember being forced to take a ‘music appreciation’ class. The teacher was this red-faced, overweight man who always looked to be on the verge of having a massive heart attack. I forget his surname – everyone just called him Dwight.

Now, I know of only 3 people named Dwight. There was the 34th President of the United States, my High School music teacher, and that guy from The Office. But his unique first name was not the reason why he was so memorable. It turned out that he was actually a pretty good teacher.

Back then, Beethoven, Jazz and Gregorian chants weren’t on my musical radar. For me, the only ‘historical’ music I was interested in was that Live Cream Volume II 8-Track that my older brother gave me. Even though I wasn’t very keen on taking the class, Dwight soon won me over with his insights on different musical genres and musical history. He was particularly interested in the Payola scandal, and spent a great deal of time covering this subject in class.

Now, Payola was before my time. If you never heard of it, Payola was a practice in the record industry to pay radio stations to play their records over others. The theory was that, the more times a record was played, the greater it’s perceived popularity, and this would result in higher record sales.

In practice, the Payola system worked very well-perhaps too well. Lesser known record companies who lacked the deep pockets of the major labels were finding their records more and more difficult to get on the air. They raised such an uproar about the Payola system that Congress got into the act, amending the FCC Act to exclude Payola practices. The resulting backlash hurt the careers of many DJ’s, including Alan Freed and Dick Clark (I saw him last New Year’s Eve –as if the man didn’t have enough problems).

All of this hullabaloo over the sales of 49 cent plastic discs.

Fast foreard to 2010.

Personally, I don’t see a lot of difference between the Payola scandals of the 1950’s and the gifts and payments that pharmaceutical companies use to entice doctors to write prescriptions for their particular drugs. In fact, I think that the practices of the pharmaceutical companies are much, much worse.

With Payola, it was radio stations and disc jockeys that were being paid to play music. The music itself – as broadcast by the radio station – was free. You were not paying the radio station to listen to their broadcast. You were not paying the disc jockeys for their musical opinion. Plus, if you didn’t like the music they were playing, it was very simple to change to another station.

With the pharmaceutical industry, they are influencing physicians to push their products – and these products cost a lot of money – on average, close to $1,000.00 per year for every American. In addition, they are influencing people who we are paying for their supposedly unbiased professional opinion. If we are unhappy with their opinion, it takes a whole lot more effort to change physicians than it does to change a radio stations. Plus, as important as music is to many of us, it can in no way be deemed nearly as important to anyone as their life and well being.

So, why is no one making a bug fuss over this practice? Have we changed, as a nation, so much in the last 50 years so that what was scandalous back then is merely mundane today?

I think I know what part of the problem, and I want to start fixing it right now.

The radio station scandals would probably be a forgotten footnote in history except they had a catchy, memorable name – Payola. Perhaps the pharmaceutical company practices need an equally catchy name in order to be given the proper attention and respect by the American public.

So, I’ve come up with a good one: Pill-ola.





Remember, folks – you heard it here first.

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Clash of the Titans

Finally, the 2010 elections are behind us. Once again, our televisions will be free of the mud-slinging commercials, at least for the next 18 months or so.

With the Republicans re-taking control of the House and making major gains in the Senate, many people are wondering how this will affect much of the legislation that was passed during the last two years. Health care reform is definitely one thing in the crosshairs of the new Congress.

The National Health care initiatives passed during the first half of Obama’s presidency are an interesting example of how our government really works. While many Americans believe that public opinion is what drives legislation, it is really something much simpler. Want to know what it is? Here’s a hint. It’s paper-thin, 2.61 inches wide, 6.14 inches long, and grayish green in color. I’m referring, of course, to the once-great American dollar.

Like it or not, money is what drives our government. Bills are introduced and passed almost solely on how much money is spent by those favoring the bills versus those opposing them. Usually, the side spending the most money wins.

This dynamic is especially interesting when it comes to health care reform. You see, two of the biggest spending lobbies are standing on opposite sides of the health care reform fence. On the side opposing National health care, we have the insurance industry. To them, National health care would kill the fattest cash cow that they have ever seen – health insurance. Without health insurance policies to sell, they would be forced to make money the old fashioned way – selling boring, low-margin policies for property and casualty as well as life insurance. Yuk. Selling these type of policies are too much like work – that’s why many large insurance companies, like Aetna and Cigna, abandoned them years ago and now strictly sell health insurance.

On the other side of the fence, we have the pharmaceutical giants who are salivating over the prospect of National health care. A National health care system would certainly include prescription coverage, which would mean at least another 30 million Americans buying their over-priced chemicals. That’s why they reportedly spent 80 Billion dollars lobbying for National health care the last time around.

Of course, we all know who won that first battle – 80 billion dollars is a huge sum for any opponent to overcome. To put things in perspective, when corrected for inflation, this is close to the amount NASA spent on the entire Apollo/Saturn program. While big pharmacy may have won the first battle, they did not win the war. Battle lines are being re-drawn, and it looks like we’re in for a real doozy of a rematch.

The dynamics have certainly changed for the rematch. The insurance companies, who were preparing to lose a major portion of their business, have been raising rates and cutting staff for the past few years. They’ve managed to stockpile quite a war chest in the interim. Having lost the first battle, they are probably ready to do whatever they have to in order to take advantage of this rematch. On the other hand, the pharmaceutical companies have already exhausted a huge sum of money winning round one. With some of the major players such as Pfizer and Merck facing expiring patents on some of their superstar drugs, one must wonder just how much fight is left in them.

It’s Ali-Frasier all over again.



The fireworks won’t be restricted to just CSPAN and the Nightly News – they are sure to spill over to television commercials that were carefully designed to win the hearts and minds of the American public. In fact, I’ll wager that the number of mud-slinging commercials will approach that of the last election. Sadly, the one person that could have provided a decisive victory for either side has departed this planet some 18 months ago. Rest in Peace, Billy Mays.
No one could sell the American public a load of crap like Billy. Instead, we’ll just have to be resolved to sit back and watch the two giants spend billions of dollars assaulting our senses. Thank God for the DVR.

So, my fellow Americans, sit back, relax, and enjoy the show. After all – be it through ridiculously high health care premiums, or $6.00 prescription pills, you’ve financed this shooting match.




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In the Toilet

You may ask yourself, well, how did I get here?

- Once in a Lifetime, The Talking Heads



That’s the $100,000 question. How did our health care system, so promising in the 1960’s, de-evolve into the mess we have today? We know who is to blame – the question is – how did we let this happen?

Well, the simple answer is that corporate greed is sneaky….and patient. Minute changes, made at a snail’s pace, are not noticed by the consumer until it is too late, and the new reality has become the norm. Consider, if you will, the curious case of Mr. Whipple.


Most of you will remember Mr. Whipple – the fictitious spokesperson for Charmin toilet paper. His character graced our TV sets in over 300 commercials from 1964 through 1985. Because of his lasting image, Mr. Whipple can help me illustrate my point.

Remember toilet paper back in the 1960’s and 70’s? There was only one size roll back then. And, oh, what a roll it was! I remember that when you first put a new roll on the toilet paper holder, it was so large that it dragged against the back wall for the first couple of uses (my kids don’t remember this because they never actually installed a roll of TP on a holder) Today, my Mom’s house still has that same toilet paper holder that it did back in the 70’s, , but no new roll comes close to that back wall when it’s first installed. Look at the photo of Mr. Whipple and check out that Charmin he’s packing – those rolls are more voluptuous than a 1960’s Italian starlet – no wonder everybody wanted to squeeze them.


But then the paper companies started to get greedy and started selling us rolls with much less paper on them. First they started by wrapping the rolls looser and calling them ‘quilted’. Apparently, ‘quilted’ is to ‘toilet paper’ as ‘managed’ is to ‘healthcare’ – I think this one should be on next year’s SATs. Then to rolls them selves started to slowly shrink. Then they had the audacity to offer a ‘single’ roll and a ‘double roll’. These too continued to shrink until they started to offer a ‘mega roll’. The funny thing is, none of these rolls even come close to the old Mr. Whipple sized rolls. The other day I noticed that one company started advertising that their rolls were guaranteed to fit your dispenser – duh! They might as well have guaranteed that it will rain sometime next year.

The newest trend is that the rolls are now becoming shorter. from left to right. They now rattle around on my dispenser. Pretty soon, we’ll all be wiping our butts with toilet paper that looks like it came off of an adding machine.



This slow attrition in consumer value is not limited to toilet paper or health care – it’s all around us. Try to buy a 1 pound can of coffee the next time you go to the supermarket. It’s just that this shrinkage in size or value happens so gradually until it’s too late for us to notice, and we’re left with an 11 ounce can of coffee and a roll of TP that’s good for dealing with the aftermath of just one Taco Bell dinner. Not to mention an overpriced, under-performing health care system.





And the unwitting, uninformed American consumer will shrug their shoulders and say to themselves “same as it ever was, same as it ever was, same as it ever was, ….”

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