Logan’s Run Part II

Some people didn’t like my original “Logan’s Run” post, where I suggested that we could save nearly a Trillion dollars every year by simply euthanizing senior citizens before they put an undue burden on our health care system. They think that I went too far.

Upon further reflection, I now realize that I didn’t go far enough.

Yes, there is no doubt that our citizens in their ‘golden years’ are costing us younger folk a lot of gold. And while offing the oldsters will help the US Government balance their health care ledger, it would bring little relief to our beleaguered health insurance carriers – and that’s just not fair to them.

All across the country, health insurance executives are feeling the economic pinch. I heard a rumor last week that a Senior VP at a well-known non-profit health insurance company was considering buying a used Maybach. USED! I don’t know about you, but I don’t want to live in a country where a highly compensated insurance executive would have to consider parking his keyster in a leather seat already deformed by some other fat cat’s butt.

Thankfully, I later learned that this was just another Urban Legend, told amongst insurance executives at their beach bonfires in Fiji, to scare each other during their semi-annual executive training seminars. The point is, this just might happen in the future if we allow our health insurance industry to continue to decline.

So, what can we do to prevent this from happening? Well, it’s easy to identify the root of the financial drain on our health insurance carriers. Succinctly, the problem is sick people.

When it comes to expenditures by health insurance carriers, by far, the greatest area of loss is dealing with sick people. You may not know it, but your health insurance carrier has an entire staff that they hire JUST TO DEAL WITH SICK PEOPLE. First, they have a whole section of professionals whose entire job is to find reasons to deny requests for ‘pre-authorizations’ whenever sick people want medicine, testing, or to see a specialist. They have an entirely different group of employees people specifically trained to ‘lose’ insurance claims, even when those claims are routed to the carrier electronically. Then, there is another entire department to answer the calls of sick people who call in to find out why their claims are not being paid. Then there is another department whose sole purpose is to find new and creative reasons for rejecting claims once they are actually ‘found’. Then, if the sick person demands that the claim be paid (sick people can get very nasty), they have another department to handle the appeal. And another department to handle the ‘second tier’ appeal. Finally, they have an entire team of ‘Medical Directors’. These brave souls are retired physicians who use their extensive medical training and experience to deny the claims of sick people. So your neurosurgeon thinks that you need brain surgery to remove that nasty tumor? Not so fast - Dr. Patel, (Retired Obstetrician/Medical Director) does not agree.




All of these people have salaries and benefits of their own, plus support staff – secretaries, janitorial staff, etc. Then there are additional costs that most people never take into consideration - I’d bet that there are at least a half dozen people just programming the voice mail system. (Voice Mail Systems are very advanced these days – most corporate systems work extremely well right off the shelf – it takes people with highly developed technical expertise to modify these systems so that don’t recognize simple words like ‘claims’, or that randomly disconnect your call.)


Yes, denying insurance claims is a very expensive business.

The solution to this problem, however, is very simple: Let’s get rid of the sick people. I’m not talking about someone with a cold or flu – I’m talking about people with long term issues like cancer, diabetes, , heart problems. etc. - these are the people who put the greatest burden on the claim-denial process.

When you think about it, this is also a humane approach to the situation. After all, who would want to suffer needlessly for 30 years with diabetes or a bad heart when they could be quickly and painlessly euthanized? Let’s follow the lead of our veterinarians, who know that it’s best to ‘put down’ a sick animal rather then let them go on suffering.

They shoot horse, don’t they?

But let’s not forget that these new rules will not apply to members of Congress or their families. Or to me or my family either. Or my friends, so you’ll want to stay on my good side and tell everyone you meet about my great blog (or else!)


This is a simple thing that we can do to help improve the profitability of our health insurance carriers. Like any solution, their will be downsides, but they will be completely offset by the upsides of tis solution. Perhaps the greatest obstacle that my plan faces is that the drugs that would typically be used to euthanize a human being are generally ‘branded’ formulations, and therefore not covered by most prescription plans.


But let’s not dwell on the negative aspects of my plan. Instead, let’s revel in the glorious upside. Health insurance carriers would be able to lay off thousands of workers and maintain, or even increase, executive compensation. The entire health insurance industry will be revitalized and simplified – under my plan, the only pre-existing condition would be ‘life’ The economy will be stimulated as companies like Aston-Martin, Rolex and Chris-Craft will see sales returning to per-recession levels. There will be a real estate boon in places like Palm Beach and Cabo.

The only thing that stands between us and this glorious re-birth of our health insurance industry is a bunch of whining sick people. A plan this good has got to catch on. So, let’s all start dumping our under performing stocks and re-invest our savings in crematoriums and cemeteries. Mark my words - they’re going to be the new Amazon.com.

(Yet Another Sarcasm Alert: That previous blog was entirely sarcastic - well, at least the part about killing off sick people was - the rest of the post was pretty spot on. Anyhow, if you're going to be reading this blog your going to have to understand the word 'sarcastic'. Don’t know what “sarcastic” means? Blame your High School English Teacher and look it up – Funk&Wagnals makes a very nice dictionary, complete with pictures.)




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Logan’s Run

Misery loves company. That’s why I was so happy to see a news story last week about a Delaware County (Pennsylvania) grandmother who had to enlist the intervention of a local news reporter, ‘3 on your side’ in order to get a $600 dental claim paid by her insurance carrier. You can read all about it here”



http://philadelphia.cbslocal.com/2010/12/09/health-dental-dispute/



After my recent battles with my own carrier, I felt kind of relieved to learn that I wasn’t alone in this boat. But then, as I re-read the article, I wasn’t so sure that I wanted to be associated with 75 year old Marie Ettorre. Apparently, this old biddy doesn’t like to play by the rules.

According to her insurance carrier, United Concordia, Ms. Ettorre’s claim issue could have been resolved amicably if only she followed her carrier’s appeal process. Instead, frustrated by her carrier’s inaction, she went and blabbed to some nosey newshound, who then proceeded to slander the carrier’s good name all over the local news. For shame! I can envision the poor CEO of Concordia complaining “….and we would have gotten away with it, too, if it weren’t for you meddling kids!”

It occurs to me that senior citizens can be a real pain in the ass. After all, what gives them a right to break the rules of a mighty insurance company? Besides, it is a well established fact that seniors use a disproportionate share of our health insurance dollars. Perhaps we would be well served to consider the consider the approach depicted in the classic Sci-Fi novel/movie ‘Logan’s Run’ . To wit, maybe everyone should have a crystal implanted into the palm of their hands. When that crystal changes color, long before owner reaches that persnickety age, they would be forced to turn themselves in for that long dirt nap.

Actually, this is a great idea on many levels. I know that the government is concerned about how they are going to fund Medicare and Social Security in the upcoming years. The “Logan’s Run” approach would solve those problems as well. Since the majority of money that we spend on health care is spent during the last year of our life, this would allow us to nip that problem in the bud as well. The end result would be annual savings in the hundred of billions of dollars. The current 2010 Medicare budget is now 326 billion dollars. Add to that another 667 billion in savings in Social Security. That’s almost a Trillion dollars in savings annually. It could prove to be just the boost that our economy needs.

Oh sure, there would be some downside to my plan. South Florida and Phoenix would become empty wastelands. . Restaurants would lose their profitable 4:00 PM dinner seating. No one would be there to greet you at your local Walmart. But the tradeoff would be well worthwhile.



Unlike many ‘band-aid- solutions proposed for solving the national health care crisis, this solution could very well prove to be the last one we’ll ever need,,,, a final solution, if you will.

Of course, there would have to be some exceptions to this legislation. Members of Congress, as well as their families, would be exempt. After all, we all know that they can’t be expected to abide by the same restrictions as the proletariat when it comes to health care. Along this same line of thinking, my family, friends, and, of course. Yours truly, would also be exempt – after all, it was my idea.

U realize that this may sound like an extreme approach to solving the health care reform issue, but drastic times do call for drastic measures. We can’t afford to continue to allow disgruntled senior citizens to drag the good name of our health insurance carriers through the mud now, can we?

(Sarcasm Alert: That previous blog was entirely sarcastic – from start to finish. Other than Ms. Ettorre’s story, I didn’t really mean a word of it. I said all of those nasty thing to illustrate a point. However, as my wife pointed out, some people don’t actually ‘get’ sarcasm and might be offended by such remarks. What a shame. Sarcasm is such an effective tool. Perhaps people who were born without the sarcasm gene should be forced to vacation in New Jersey until their sarcasm neural pathways are established)

–
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The Springsteen State

same old story same old act
One step up and two steps back

Bruce Springsteen, One Step Up

Ah, the Boss – unofficial poet laureate of my generation.

Bruce certainly knows a lot about life’s ups and downs. This is in no doubt due to his experiences living in the great Garden State.

Witness, if you will, the latest debacle surrounding Medical Marijuana in New Jersey.

The prior governor, John Corzine, was certainly no Cracker Jack prize. His free-spending attitudes nearly bankrupted the state. But, giving proper respect where it’s due, Corzine did do at least one thing right: Shortly before leaving office, he made New Jersey the 14th State to approve the use of Medical Marijuana.




Now the new governor, Chris Christie, is doing a lot of good things to help the state get back on its’ feet financially. Many are talking about him being a front runner for being the Republican presidential candidate in the next election. However, he is doing one thing very wrong here – he is doing whatever he can to sabotage legal Medical Marijuana in the state.



OK, I get it – Medical Marijuana wasn’t his idea – it was dumped upon him by his predecessor as a parting shot. But, Mr. Governor, that’s not any reason to try to sabotage a good idea.

At first, Governor Christie did whatever he could to drag the state’s collective feet on Medical Marijuana. He claimed that a production system had to be established. A distribution systems had to be in place. The entire matter required a great deal of study and evaluation. But, to anyone with half a brain, it was easy to see that this was just stalling tactics on the Governor’s part.

Hey, General Eisenhower didn’t ‘study’ and ‘evaluate’ this much before invading Europe in 1944. Besides, if he ever bothered to tour any college dormitory in the state, he would have seen that many production and distribution systems are already in place….

Finally, after a year of delay, the Governor is now talking about ‘compromises’ in order to get Medical Marijuana off the ground in NJ. Chief among these ‘compromises’ is his declaration that Medical Marijuana can only be prescribed as a ‘last resort’ medication when all other medications have failed. In other words, if you are lying on your death bed, suffering through the final stages of terminal cancer, maxed out on morphine, Christie will give you a reluctant green light to light up.

Give me a fricken break.

Another compromise will limit the potency of Medical Marijuana. Yet another great idea. Patients who are dealing with extreme health issues will be forced into inhaling greater quantities of smoke in order to receive the needed dose. After all, conventional wisdom in the 1940’s was that smoking was good for you – none of this new-fangled anti-smoking rhetoric from Trenton, thank goodness. Maybe they should pass a law taking that pesky surgeon general’s warning of the side of the cigarette pack – that stupid warning makes it so much harder for teenagers to look cool these days.

No other prescription drug is limited by such provisos, including popular pain killers like Morphine, Codeine, Hydrocodone, Oxycodone, Methadone, Fentanyl and Meperidine. These drugs are all opiates, closely related to heroin. And they all carry the terrible potential side effects of addiction, overdose and death. (Of all the potential bad side effects of modern pharmaceuticals, death, for me, is one of the biggies). But the good Governor obviously doesn’t have a problem with these popular medications, even though they carry with them the very real risks? No siree – pop ‘em if you got ‘em – it’s OK with Governor Christie!


After reading about the latest developments with Medical Marijuana in NJ, I had to stop and check a calendar, and yup, it turns ot that it actually IS the year 2010. So why are we still treating Medical Marijuana like the good people of Salem Massachusetts treated their single womenfolk back in the 1600’s? The governor doesn’t appear to be stupid or naive – so why the witch hunt on Medical Marijuana?

Perhaps the governor is concerned that, if Medical Marijuana was given the acceptance that it deserves, millions of dollars of the NJ economy would flow out of the state and across the river into Philadelphia. Philadelphia is, after all, the home of the Tastycake factory. Come to think of it, the Governor is a known Twinkie aficionado – perhaps he is fearful of a shortage of his favorite sweet snack?

Applying Ockham’s Razor, it’s most likely some other influence that is affecting his decision making regarding Medical Marijuana – but what, pray tell, can it be?



Let’s take a moment to ponder this query – and whilst we ponder, here is an interesting, totally unrelated, factoid.

Did you know that 10 out of the top 12 pharmaceutical companies in the world have ties to New Jersey? Here’s a list:

1. Johnson & Johnson - 5 NJ Locations including US and World Headquarters

2. Pfizer - 7 NJ Locations

3 – Roche - 2 NJ Locations

4 – GlaxoSmithKline - 2 NJ Locations

5 - Novartis - 3 NJ Locations including US Headquarters

6 - Sanofi-Aventis - 2 NJ locations, including their US Headquarters

7 - AstraZeneca - No NJ connections (Boo! Hiss!)

8 - Abbott Laboratories – 2 NJ Locations

9 - Merck & Co. - 4 NJ Locations including Global Headquarters

10 - Bayer HealthCare - 2 NJ locations

11 – Eli Lilly – No NJ locations

12 - Bristol-Myers 2 NJ locations including Corporate HQ

Those ten top companies with ties to NJ had combined revenues in 2009 of around 389 billion dollars.

That’s not a typo – that’s Billion with a ‘B’

Isn’t that interesting?

OK, enough pondering – let’s get back to our main topic.

.Rats. Ponder as I may, I still can’t figure out why so many of our elected leaders are so against Medical Marijuana.

I guess we’ll never know why our politicians are so freaked out by an ugly little weed that has proven medical benefits with very few harmful side effects? This is not some illicit substance that outlaw bikers are cooking up in an abandoned trailer out in the woods – it’s a silly little plant that anyone could grow in their backyard. And that, my friends, is the problem.

Big Pharm doesn’t want the competition. In fact, they have none of the formulations that they produce can compete with Medical Marijuana when it comes to the ratio of benefits/harmful side effects. In addition, no one needs Big Pharm to produce Medical Marijuana – almost anyone could produce their own. Big Pharm hates competition. They spend billions on lobbyists and spin doctors to help ensure that no one rains on their 400 billion dollar cash parade. In the meanwhile, millions of Americans are suffering needlessly because they are being denied medicinal use of this ugly little weed – and it’s just not fair. In fact, from my standpoint, it’s downright criminal.

So what are we going to do?

Well, regular readers of my blog should know that I have already published the solution last Spring. If anyone had the foresight to follow my lead, the entire Medical Marijuana controversy would already be over. In case you missed it, here’s a link to my brilliant idea:



http://healthcarehullabalo.blogspot.com/2010/03/medical-marijuana.html



Barring that, I would ask a special favor of all our lawmakers who continue to roadblock Medical Marijuana– something we all should demand them to do before they consider any further legislation against Medical Marijuana. It wouldn’t take them very much time, but I’ll warn them up front, it may be the most difficult thing that they will ever have to do.

First, I would ask them to visit a few people in their constituency. People wasting away in cancer hospices. Other people who are in the midst of battling cancer, and who are devastated by the horrible side effects of chemotherapy. Other courageous souls who are trying to live with Multiple sclerosis. Or with the insidious creeping blindness of Glaucoma. Or living with chronic pain. Or who are dealing with a host of other debilitating diseases and conditions. People whos suffering might just be eased, even a little bit, by a silly, ugly little green plant.

Then, after visiting these people – people who they’ve sworn a sacred oath to represent – after seeing and experiencing the hell that is their daily lives – I would ask them to go back to their homes, walk into their bathrooms, and take a long good hard look at themselves in the bathroom mirror.





That’s all I would ask of them.

I bet they can’t do it.



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Combat

Watching the news these days, it’s almost impossible not to hear something about war. We have the war in Afghanistan and the war in Iraq. Now, for a change in pace, the two Koreas are lobbing stones at one another. And let’s not forget about the war on terror.

The same thing happens when you load your home page, turn on the radio, or pick up a newspaper (Remember newspapers?)

War permeates even my non-news television watching. The Discovery Channel, the History Channel, and, of course, The Military Channel all are heavy on programming about war or it’s machinery.


Hey, when you think about it, even good old All-American Football is just a thinly-disguised war game. (Need proof? My poodle becomes very aggressive whenever he sees Michael Vick on TV).


Yes, like Elvis, war is everywhere.



Last week, I had my own little war with my insurance carrier as well as my eye surgeon’s office. Not a little border skirmish, mind you. While the opposition may not have realized it, I was preparing for M.A.D., and I’m not talking about the magazine. The blast doors were off the silos, launch keys were inserted, the ‘football’ was powered up, SAC was in the air over the North Pole, and an ELF signal was sent out to the Boomers.

I’m talking Defcon 1 here.

Regular readers of my blog may recall my past conflicts with these two warring parties. It all started last summer, when my insurance carrier and my eye surgeon failed to reach an agreement on contracted fees. The end result was that the eye surgeon ceased being an in-network participating provider for my health plan, and things got really nasty between them and my carrier. The situation soon turned into the out take reel from the classic movie ‘The War of the Roses’. I played the role of the Morgan Roadster. (Never saw the movie or need to refresh your memory? Check it out here:

http://www.youtube.com/watch?v=dXskW2VvfC0

Unfortunately for me, I was in the middle of a staged (2 part) surgery at the time. I was left blind in one eye with no one willing to fix it (while there were other, in network doctors who could finish the operation, no one wanted the responsibility of finishing another surgeon’s work, at least while that surgeon was still alive).

So, last month, I spent a great deal of time working with both my surgeon as well as my insurance carrier in order to get these two warring factions to agree to work together, at least until my surgery was completed. Against the odds, I managed to broker a deal between these two pissy children, and everything was set for my surgery, which was then scheduled in a about one month's time. I forwarded the carrier’s authorization number to the eye surgeon, and I was good to go – or so I thought. Then, 3 days before my date with the knife, I got a call from the surgeon’s business office

It seems that my Camp David accord of the previous month had fallen apart, and they now wanted me to pay for the entire surgery up front or else they were going to cancel it.

My first thought, as they say in Old Paree, was “Merde”.

Not willing to pay up front (I have very expensive insurance – why should I?) or wait any longer, I launched a vicious counter attack. I’m talking ‘Shock and Awe’ here. I made ‘Operation Desert Storm’ look like a backyard fireworks display.

I spent the next 72 hours attacking both sides, pleading, screaming, threatening, manipulating and cajoling both parties until, at exactly 4:58 PM Thursday evening, I got another tenuous agreement cobbled together between the 2 parties.

Henry Kissinger has got nothing on me.

People who don’t know me very well might think me a bit of a pussycat - I’m generally a pretty easy-going guy. However, underneath my calm surface lies a pit bull with ‘roid rage. I’m not a physical person - I don’t ever get violent - but I cannot stand dealing with mindless bureaucracy - especially when a bureaucrat tries to tell me I have to remain blind in one eye because these two brats can’t play nice with each other. Yeah, I reverted back into total North-Jersey guido mode.

“Oh yeah, tough guy? Where you from?”



You also should understand that this was not my first rodeo - when it comes to dealing with physicians and insurance carriers, I’m what you would call a professional. I am intimately familiar with medical ethics, malpractice, and insurance law. I know where every loophole is, as well as how to close it. As a consultant, I have used my knowledge and skills to personally collect millions of dollars from uncooperative insurance companies. I have over 25 years of medical practice management experience.

It would be safe to say that, unlike John Q. Public, I know my merde.


The amazing thing is, in spite of my knowledge and experience, it still took me 3 solid days to get this mess straightened out, and then only in the 11th hour.

Which makes me wonder - How would the average person, without my experience, fare if they were put into the same situation? How many people have to do without the healthcare that they need and are entitled to because they were unable to bully their way through the system?

I'm not trying to toot my own horn here -I'm just trying to illustrate just how limiting and frustrating our current health care system is today. People opposed to any form of National Health care like to say that they don’t want a government bureaucrat making decisions regarding their health.

For my money, I would have an American Bureaucrat, with a command of the English language, make those decisions, instead of some fumble-mouthed lacky working for $1.40 an hour in an off-shore call center. At least we would be able to reason with each other in something that resembled the Queen’s language.

What did you say? – you never had a problem dealing with your health insurance carrier? Don’t worry – you will – mark my words. All you need to do is require an expensive procedure, or a medication that isn’t on your carriers ‘approved’ list. As Hemmingway said, ‘Ask not for whom the bell tolls….”

Fortunately for the insurance carriers, only a small percentage of their subscribers will be in a similar situation to mine at any given time. The number of frustrated health care consumers never seems to get large enough to cause a united front to rise up against this type of mistreatment.

On the bright side, I made it through the mine field. I kind of feel like Andy Dupree emerging from that sewer pipe – covered in feces, but glad to be out of there relatively unscathed. So far, the only ill effects I am suffering from this ordeal is a slightly elevated blood pressure, a lingering aroma of cordite in my nostrils, and an occasional urge to get up in a bell tower with a rifle. (Just kidding about the rifle folks- chill).

Here’s hoping that you fare as well as I did when it’s your turn over the barrel. Just promise me that, when your day comes, you'll drop me a line before you pick up that Mannlicher-Carcano.



I just may be able to give you some pointers.


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Geico-nomics

Who doesn’t love Flo - the quirky spokeswoman for Progressive insurance?

Well, probably a lot of people can’t stand the weirdo, who encourages consumers to customize their auto insurance coverage with Progressive. But, love her or hate her, she is now a part of the American culture, thanks to Madison Avenue.

Flo is well known for hawking of Progressive's 'name your own price' program - which is a pretty neat innovation.

Traditionally,auto insurance consists of several well established components: Liability, Collision, Comprehensive, Fire, Theft, Glass breakage, etc. These are the areas that companies like Geico let you mix and match in order to customize your policy. This was pretty innovative thinking by Progressive, and helps explain why Progressive is so successful. (As annoying as Flo is, she;s much less annoying than those stupid cave men commercials that Geico uses). It occurs to me that Geico could be more successful if they ditched the cave men and talking lizard and followed the example of the health insurance industry. Here's what I have in mind.


First and foremost, we would introduce an entirely new type of Auto insurance - something that I would call a ‘VMO’, or Vehicle Maintenance Organization. For only a $10 deductible (or "co-pay"), it would would cover everything on your vehicle - not just catastrophic loss like traditional insurance. It would even cover expenses that you never even thought of as being insurable, including maintenance items like oil changes, car washes - even filling your gas tank. Of course, drivers would have to go to a particular service Station to receive these services - ones who had agreed to be in our network of participating stations (Preferred Petroleum Operators, or PPO's).

The VMO model would be very attractive to consumers, who would be drawn in by the perceived cost savings. This attraction would be enhanced by a catchy name - something like 'US Vehicare'.




Unfortunately, the independent service station owners would soon find that they were losing money on their VMO clients. Out of desperation, they would compensate by raising their rates for service and gasoline to their non-VMO clients. Soon, once the VMO system reached critical mass, no one would be able to afford to drive a car unless they belonged to a VMO or a similar insurance program.

The VMO system would have other long term effects. The service station owners would have to hire a small army of clerical people in order to handle the mountains of paperwork associated with processing VMO claims. Gasoline companies, now with their prices masked by the VMO system, would be able to raise their prices well past what they are in Europe or Canada. All of this increased expense would be passed on to the consumer in the form of higher premiums - and would lead the way to landmark profits for the VMO insurance companies.

If Geico decides to pass on the VMO idea, perhaps I'll start one myself. If history repeats itself, I'll be able to make hundreds of millions squeezing the vehicle owners on one side and the service providers on the other, leaving more for me in the middle. After a few years, I could sell the company to a big auto insurance company for a billion or 2, and then retire to a golf course.



Sounds like a plan.

But, on further thought, it probably would never work. After all, the American public would never be stupid enough to fall for such an obvious rip-off scheme, would they?



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I Dream of Jeannie

As a young, red-blooded American male, “I Dream of Jeannie” was one of my favorite sitcoms of the 1960’S. It had everything a young man wanted in a TV show: Astronauts, beautiful girls in suggestive costumes, outrageous situational comedy – everything but exposed navels.

As stupid of a show as it was (yes, I can now realize how vapid that show was) it did once throw in some heavy duty philosophy that has stuck with me to this day. I cannot find the clip on line, so forgive me if I paraphrase: Tony Nelson asked Jeannie why she didn’t use her magical powers to end bad things like war, world hunger, etc. The normally bubbly Jeannie got all serious and responded by saying something like “because sometimes when you bring water to a desert you drain an ocean”.

Okay – Jean-Paul Sartre she wasn’t, but it was a very deep statement to the 7 year old me. As I said, to this day, I use that statement as an illustration how sometimes very good intentions have an opposite effect to what we were hoping for.

The reason why I bring this up is that we have seen this very principle happen in the health insurance industry, and I am fearful that we will soon see it happen again.

The first time a good intention turned around and bite us in the ass was when Obamacare was beginning to be enacted. The heakth insurance industry realized that the end was near for their financially lucrative group health policy business. However, instead of repenting and mending their ways, they instead cut domestic staff, outsourced other operations overseas, and skyrocketed premiums by as much as 40%. I guess that when the end of the world is near, some of us will go to church and some of us will go to Plato’s Retreat. The Health Insurance industry figured that they will squeeze every drop they could out of the lemon and make hay while the sun was still shining. While many people are ignorant of the fact, this last minute gouging by the health insurance industry has contributed mightily to our current economic woes. The health insurance industry has acted like an alcoholic at last call – instead of quietly finishing their drink and going home, they order 3 shots and down them in rapid succession.

While I was initially thrilled by the new ruling that health insurance carriers must pay out at least 80% of premiums collected on medical care, I am troubled by the lack of reaction from the health insurance industry. Either they have been humbled by the new ruling and will now start behaving more like responsible businesses OR they have something up their sleeves……my money is on the second scenario.

It now occurs to me that this recent ruling may lead to unbridled inflation in the cost of health care coupled with runaway spending. The reason is simple. If they can only keep 20% of your health insurance premium, the only way for them to make more money is to enable you to spend more money on health care. In simple terms, your health insurance carrier can keep $200 a month if your monthly premium is $1,000.00 or $400 if your premium is $2,000.00. It now behooves them to encourage spending even more money on medical benefits. It’s simple actuarial economics – something that they are quite adept at.

So what may be in store for us? How about more unnecessary testing, more overpriced prescription drugs, and more inflated fees?

Health insurance carriers once pretended to help control the cost of health care. I think that those days are now gone.

I can only hope that there will be some guidelines associated with the new ruling that will put a cap on what health insurance carriers spend on medical benefits – perhaps tying fees to a percentage of Medicare or 2010 levels. In other words, if they paid $1,000 for an MRI in 2010 they should not be allowed to pay $6,000 for the same procedure in 2011. Any increase to fees must be based on what they paid for the procedures in 2010 plus an adjustment for inflation. While I realize that this will put even more government control on health care – something that many of us are not in favor of – but it will keep our health insurance carriers from going on a spending binge when they hear ‘last call’.




Once again, you heard it here first.



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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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