BOSTON — “I’m not here to set any great records, or to make a spectacle,” Senator Bernard Sanders, independent of Vermont, said Friday, about a minute into his speech on the Senate floor. By the time he stopped talking, nearly nine hours later, Mr. Sanders was an ascendant, if unlikely, Internet star. via www.nytimes.com
That's the power of social media. When you have something to say and are willing to say it then there are tools and folks who will help you say it and share it.
I announced in May, 2010, the 52 - Week Employee Recognition Plan. This is the 22nd week. The lesson this week is:
Invest in their health.
Why wouldn’t you invest in your number one asset?
Why wouldn’t you invest in its upkeep, its maintenance, its repair, its need to reboot, the proper fuel, the adequate security, and operate at a pace consistently below red-line? You do that with your favorite car or your laptop, desktop.
If your business has a car, you buy insurance for it. You take it in for regular maintenance and repairs. You add the proper fuel, the best fuel. You keep the tires inflated. You protect it with alarms and park it inside your garage. You keep its RPMs below that red-line.
If your business has a computer, you buy support packages. You install the updates for operating systems and applications. You install the proper security. You train your other asset how to use this tool. You conduct diagnostic checks and security checks. You run scan disc and defragmenter...(You do these things, right?)
But for some reason...too many companies look at their most important asset, their employees, as a disposable, dispensable asset whose maintenance they choose to ignore, whose repairs they choose to forego and whose redlines are exceeded...all day, every day.
And then when that asset is burnt out and unproductive...well, these same businesses then blame the asset whose care and support they chose to forego.
It’s no wonder that ROA, return on assets, have fallen by over 75% for public companies since the mid-60’s. ( Link at Edge Perspectives. )
And maybe that's why only 11-24% of employees proactively help their organization towards its goals. *
Companies who ignore the health of their number one asset often see that their product quality declines, more customers are less happy, more employees are less motivated, fewer sales conversions are seen, their sales conversion rates decline,, more customer churn, more employee turnover...higher recruiting and training costs. And too often the choice is let’s hire a new marketing director or ad agency. Hurry up, too!
But what have they got to sell? A burned out shell of a company, one created by that same company ignoring the health of its number one asset. That's just like the burned out shell of your hard drive or the burned out engine of your car when you choose to forego their upkeep.
Now. There’s more to our health at work than the terms, accurately stated or not, of the current healthcare legislation.
All of these are omitted from any health insurance or healthcare legislation. They do require the investment of your most precious resource: time. Time to listen. Time to care. Time to learn. Time to wait. Time to fail. Time to change.
But that investment is an investment in your number one asset: your people. Those people are your company, their company.
And that investment can turn that declining ROA into a resurging ROA. And that turns those assets again into people. The ones who create your, all of you’s, success.
You can start with any week of the 52 - Week Employee Recognition Plan and make that your first week.
You can take one of those weeks and turn it into a month or commit to an accelerated pace and complete 6 of the weeks in one month.
You can create your own week of employee recognition. Share that journey here. Share it in your blog or Twitter or Facebook.
But, do something to recognize your employees! They set your brand apart as your ultimate competitive edge. And the more you recognize their achievements, the more achievements you'll see and they'll enjoy, along with your customers and and shareholders, partners and vendors.
One, of the many, strangleholds on our economy from our current healthcare system, has been job-lock. Job-lock describes the inability of of an employee to freely leave a job because doing so will result in the loss of employee benefits.
Employer provided health insurance has grown to become the greatest, most coveted employee benefit as its monthly premium amounts continue to soar annually by 7-9% and as healthcare costs consume 16% of our wallets today and projected to reach 20+% in our near future.Job-lock locks talented, enterprising, passionate, visionary employees in their current jobs. No one is locked in a job where they:
Eric Brody on his blog, Healthy Conversations shared some recent research on employee engagement:
In a recent article on MarketingProfs, Gallup research of 300,000 businesses indicated that 75-80% of employees are achieving much less and feeling far less enthusiastic about their work than they could be.
How many employees would leave their job if their family’s health was not put at risk?How many employees would leave their job if their family’s health was not put at risk AND they were able to find or create an opportunity where they were able to achieve more and generate more enthusiasm for their efforts?
How many companies have seen their growth stifled because they were unable to attract the talent they needed?
How many ideas remain dormant in the minds of employees locked in their jobs with companies uninterested.
How many jobs and opportunities have not been created as a result?We’ll find out. We will all find out.
Judging from mandatory auto insurance laws you’d have to say cars were more important. Otherwise, why would their insurance be mandatory? There’s even pools created for policy owners whose driving records makes their insurance too expensive. These laws and high-risk pools have been around for decades.
Obviously, not so with health insurance. It’s been neither affordable nor mandatory. Until last night’s historic vote, that is.
Yet, some states want to insure that cars remain more important than the people that drive and pay for them. Take Idaho for instance. Idaho Bans Federal Health Care Reform. Their governor signed a measure that mandates their Attorney General sue the federal government against the provision that health insurance be mandatory.
No word on their thoughts about their long-standing laws that auto insurance be mandatory for car owners in Idaho.
Florida has mandatory car insurance, too. Florida's Attorney General thinks their cars are more important than their people, too: Florida AG McCollum threatens over mandatory health insurance.
35 other states are planning the same step. mandatory insurance for cars? YES! Mandatory health insurance for people...NO!
Cars or people: Which is important enough to insure? You insure what’s important...if you can afford it.
The positive side of this is that...well, at least residents know what's important, cars, and what's not, their healthcare. That's a start to making informed decisions.
Congress called WellPoint’s President to testify before their august body last week. She testified to her company’s record-breaking profits in 2009. According to the LA Times, WellPoint posted an eightfold increase in profit for the fourth quarter and projected solid earnings for this year despite a recent softening in enrollments and revenue from premiums.
And this was during the Great Recession, too.
It makes sense that Congress would be interested in business model that generates a 8 fold increase in profit while customers and revenues decline.
But, Congress was not interested in her success. They were interested in her company's audacity to create value for their shareholders. That’s right. A company based in the US generated record profits during The Great Recession. And Congress wanted her to testify now how they were able to do that, but...how they do that. How dare her company achieve these record profits!!
This is where our healthcare system has problems.WellPoint is in the business of making money. WellPoint is a for-profit company. And hat’s off to them for having a record year for revenues and profits while much of the country was having a record year for revenues and losses.
WellPoint’s business is caring for their shareholders. It is not caring for American’s health, in general, nor even in providing for healthcare either for its members or our country. Their success is measured by how well they can minimize the expense required to deliver any service for the healthcare of their members, aka customers. Their service could be any service. It just happens to be what some call health insurance or healthcare provider.
Interestingly, WellPoint’s record year in profits was achieved by a record year in customer cancellations. That’s right. During the recession WellPoint member numbers declined. As their jobs were eliminated, and along with it their group membership, WellPoint members, aka customers, were no longer either members or customers. And those whose WellPoint membership came as individual policy-holders and whose jobs were eliminated found themselve unable to afford membership with WellPoint.
As they served fewer members, they made more money.
As they served fewer customers, not only did they make more money, but they and their industry colleagues acquired a greater share of our pocketbooks, ie, our economy.
That’s an odd business model. You see more paying customers walk away and you make more money. You see more sources of recurring monthly revenues disappear... And you make more money. You lose paying customers but gain a bigger share of everyone else’s pocketbook and collectively our economy.
I see why she should testify. We all could benefit from those skills.
That’s our healthcare system in a nutshell. The gatekeepers, the money handlers, are the insurance companies. They determine not only the costs of our healthcare system but also what care is delivered. And we relinquish our control and our money and our health and our economy to them. And they make more money as they deliver fewer and fewer solutions for more and more Americans. And as they do this, they consumer a great portion of our wallets and our economy.
What can we learn from the business model of WellPoint, etal, in the health insurance industry?
How do you serve fewer customers and make more money?
How do you make more money when you have fewer sources of monthly recurring revenues?
How do you find more ways to discourage more existing customers...and make more money?
How do you grab a growing share of our pocketbooks and our national economy while adding less and less value for your customers and our economy?
But these health insurance companies are not in the healthcare business. Their business is to maximize shareholder value. And the way they do that is to minimize the value they deliver to fewer and fewer customers.
Can you imagine another industry where adding shareholder value depends on finding more and more ways to send more and more customers away? The Big Three tried that approach. Failed miserably. The home mortgage industry tried to lure customers who shouldn’t be customers. That failed.
But the health insurance industry not only turns away customers who should and could be customers (they can afford it), who need their solutions (pre-existing conditions, eventually most of us) but they find ways to turn away customers who have paid for the services promised and never asked for them to be delivered. And in doing so, they make more money and take a greater share of our pockets and our economy.
An industry that generates such negative word-of-mouth is usually not long for this world. Where do you see customer evangelists for the health insurance industry. Stealth bloggers, expensive lobbyists and members of Congress do not count. And yet, this industry continues to absorb more and more of our economy, our potential creativity with job-lock keeping people in unproductive positions because they cannot afford be without their health insurance, our time as we are forced to constantly manage our health insurance expenses....
And this my dear readers is our healthcare system. For-profit companies masquerading as healthcare providers when their shareholders demand they deliver less and less. Congress complaining that for-profit companies are too profitable. And we, who should be their masters as we’re the source of their income and influence stand idly by and quibble over economic ideologies.
Meanwhile, 45,000 Americans die each year because health insurance is too expensive and that makes their healthcare too expensive to afford.
The proposed cuts to Medicare spending, scheduled to start March 21 (Happy Spring!) with 21% cut in rates paid to doctors who treat Medicare patients is nothing more than healthcare rationing by elected officials.
The term elected officials is technically correct, but functionally generous. It implies being a leader, one who was elected to represent your community.
However, in this initiative led by Rep. Paul Ryan R- WI and the GOP, the function of this initiative is to serve merely as a bureaucrat and ration the amounts paid for healthcare. Rationing the amounts paid for healthcare rations the amount of healthcare delivered.
I love irony. It's a bittersweet tease for the emotions or the intellect. Irony asks: Can you imagine...that?
And in this case there's a lot of irony and more bitter than sweet. You see, one of the great arguments offered by opponents of healthcare reform was the threat, ok, the fear that nameless/faceless government bureaucrats would ration healthcare based on an esoteric financial formula known only to them.
And yet here are the opponents of healthcare reform proudly and publicly offering cuts to Medicare payments as a solution for healthcare reform.
Doctors have already said they would stop seeing Medicare patients when that cut in Medicare payments goes into effect in a few weeks. That would result in only those patients who can afford private health insurance or supplementary Medicare insurance being able to afford doctor's visits. Given the high percentage of Medicare recipients who are senior citizens, on fixed incomes, fixed incomes to limited to allow for private health insurance, then the cuts would most cruelly be applied to those least able to afford the private free-market healthcare solutions offered by Mr. Ryan, Mr. Gingrich and their ilk.
And if further proposed cuts are offered in Medicare payments then the solution is that we just buy more insurance or pay more out of pocket expenses. Obviously, if we could, we would. Otherwise we would not turn to government run programs that are less efficient, right, gentlemen?
(See. There's another irony. These same opponents of healthcare reform say government run programs are so less efficient. Yet, Medicare needs only 3% of its budget to administer the program; private health insurance companies require 16 - 18% of our premiums to administer, or not, our benefits.)
But ,if doctors refuse to see Medicare patients because of their lower payments and private citizens who most need Medicare benefits are unable to afford the costs of private care then Mr. Ryan and his supporters have effectively rationed health care to be affordable only to themselves and their lobbyists and the wealthiest percentage of Americans.
Now, that's irony.
And they will become in the future the nameless, faceless government bureaucrats who rationed healthcare...to be affordable only to their financial supporters.
ABC News reports States Seeking to Ban Mandatory Health Insurance.
...[C]onservative lawmakers in about half the states are forging ahead with constitutional amendments to ban government health insurance mandates. The proposals would assert a state-based right for people to pay medical bills from their own pocketbooks.
Ah. No one loves a PR-spin better than I and a constitutional amendment to...assert a state-based right for people to pay medical bills from their own pocketbooks...well, it's a beauty.
By granting this right for people to pay medical bills from their own pocketbooks...that amendment would grant the right for people to reach into their own pocketbooks and find they do not have the money to pay for...their medical bills from their own pocketbooks.
See, 45 million Americans reach into their pocketbooks, each year, and find they cannot afford health insurance. And in the future, if they live in a state that passes an amendment granting them the right to pay medical bills out of their own pocket...then their empty pocketbooks for healthcare will be protected, constitutionally.
A recent study conducted by Harvard's Medical School reported that 45,000 Americans die each year from lack of access to healthcare that would be affordable if they could but first afford health insurance.
See the ratio? 45 million without health insurance: 45,000 deaths as a result from the lack of affordable healthcare possible with health insurance. Consider that ratio when the number of those who cannot afford health insurance grows to 60 million? If 60 million cannot afford health insurance and the access to affordable healthcare it provides...then...we can expect the number of deaths to grow from the lack of affordable health insurance and then healthcare to grow to...60,000 of our friends and neighbors per year.
So that constitutional amendment to assert a state-based right for people to pay medical bills from their own pocketbooks...becomes a constitutional amendment to allow people to continue to die for lack of access to first health insurance and then the affordable health care it provides.
* Links to deaths from lack of health insurance
PR-Spin? Nah. George Orwell would be so proud.
This is a video that was submitted in a contest by a 20-year old. The contest was titled “u @ 50″ by AARP. This video won second place. When they showed it, everyone in the room was awe-struck and broke into spontaneous applause. So simple and yet so brilliant. Take a minute and watch it. Then apply the concept to healthcare reform? Enjoy! Reverse Your Outlook on Healthcare.
Talk about transparency. No more thousand page documents with hidden deals. It's all there nice and clear. You agree or disagree then vote to decide, send it over to the appropriate agency to implement if it passes, and move on to the next item.This elegant, achievable solution comes from my friend, Joan-Koerber Walker. She published it at her blog, Core Purpose: Celebrating the Entrepreneur...in all of us. The post is titled: Health Care Legislation on the Brink. Maybe it's time for ... Innovation and Change We Can Agree On
It’s beautiful. It’s beautiful in its elegance, or scientific precision, neatness.
Scientific precision and neatness are two of the qualities of elegance. And they are two of the qualities missing from our healthcare reform debate. And Joan’s solution, to itemize each issue, one piece at a time, and then debate it, then vote on it, could with... willing participants...bring greater precision to the debate.
And by debating each item, then voting on it, would allow for open and rational participation by all of us, not just lobbyists and industry representatives.
And, that’s not all her solution would do. It would create...progress. It may appear akin to baby-steps of progress to itemize each of the issues in the 1000-page bill first and then vote on each of them separately. However, progress has been lacking in trying to reform in one-year a system that’s been built over decades.
The lack of progress has only contributed to a polarizing conversation in our country that is similar to constantly picking at a scab. It never heals. And continually debating healthcare reform with no real means to bring reform only serves to allow us, as a nation, remain polarized, in conflict....divided. And we can never heal these divisions. And a house divided, much less a nation divide cannot stand.
However, by creating a system where we can bring sunshine to all the terms and issues, deals and compromises, in the healthcare reform bill, we all can participate in the real discussion, in an open and transparent manner and not only bring change we can all agree on, but bring change that begins to unite us.
“It’s an example of the insurance company getting between you and your doctor,” Dr. Rubin said.
Doctor Rubin is an economics professor at Rutgers University. He's talking about the efforts of United Healthcare to demand that the hospitals [included in Continuum Health Partners consortium of 5 ] notify the insurance company within 24 hours after a patient’s admission. If a hospital failed to do so, UnitedHealthcare would cut its reimbursements for the patient by half. - NY Times
United Healthcare has been mailing tens of thousands of patients over the last few weeks, warning that they could be cut off from coverage at Continuum hospitals and affiliated doctors.
Yes. I'd agree with Dr. Rubin. This is an example of the insurance company getting between you and your doctor. If doctors protect our health and thus our life, then any example of an insurance company getting between me and my doctor would be an example of what's called healthcare rationing or...death-panels.
Odd. I hear nothing from any opponents of healthcare reform, opponents who have maliciously accused reform plans of including healthcare rationing or death panels, in response to this effort by a health insurance company to do just that: get in between us and our doctors and ration healthcare based on their bureaucratic needs.
We have met the enemy and he is us.
Each time I read what passes for debate on healthcare reform (and anything, really) in our venerable houses of congress I’m reminded of that line and its truth. We have met the enemy and he is us.
Our system of vested and selfishly conflicting interests are supported by those who benefit and allowed by those now disinterested. A well-funded rear-guard action of no compromises, ever...EVER along with skillful betrayals of commitments to constituents, personal integrity, our nation as a whole and even economic data, along with a shrill call to xenophobia and a willful turn of the eye to inconvenient inconsistencies in ideology that lacked supporting data and in some cases logic of the obvious and linear kind...has delayed, diluted, diminished, denigrated any and all efforts and parties involved with even attempting to reform even a portion of the current healthcare system...the health insurance system...whose prices have grown so bloated from skillful avoidance of competition that the companies in this industry gleefully leave 45 million customers and their monthly premiums...on the floor. Literally it seems.
What kind of competitive industry leaves a market of 45 million on the floor for its steadfast refusal to reconsider its pricing structure? Clearly not one designated as competitive operating in a truly free-market arena.But the real question for this industry is the result of leaving 45 million potential customers on the floor. What happens to them?
Nothing good, really. Of those 45 million Americans who cannot afford health insurance, .1% (1/10th of 1 percent) or 45,000 die each year from the result: They cannot afford healthcare. They cannot afford doctor’s visits nor treatments nor prescriptions. And the healthcare needs that could be met with regular visits to the doctors and prompt access to prescriptions...is denied. Not for a year, or two. But year after until those simple needs become unmanageable.
And yet, this system is allowed by us, the voters and us the consumers. We allow lobbyists and non-profit shells funded by the health insurance industry to tell us what to think or how to react. And we allow them to dictate terms and conditions not only of votes but of entire bills before members of Congress. We allow this as the news of their influence, an influence that overrides ours, is clear and obvious and reported regularly by ‘radical’ media sources like the USAToday and CNN and MSNBC.
Whatever happens or doesn’t, whatever leadership springs to action or more likely doesn’t, we get what we have settled for. The enemy is not them. It is us. We’ve met ‘em. And they are us.
Here's Walt Kelly's Pogo strip for Earth Day.
Then consider some of the numbers in our health insurance, healthcare system, that need reforming:
45 million uninsured Americans. 45 million Americans now cannot afford health insurance. Consider the story of this one individual. Then multiply it by 45 million.
Hyperbolic? perhaps. But would it feel better if you multiplied by...1 million?
Another 6.9 million to be uninsured in 2010. Health Affairs predicts another 6.9 million Americans will lose their health insurance during this recession. The loss will arise from either unemployment or the rising costs of health insurance plans. Or both.
45,000 unnecessary deaths. A recent study conducted by Harvard Medical School reports that Nearly 45,000 annual deaths are associated with lack of health insurance.
45,000. Per year.
45,000 of our friends and neighbors die each year because health insurance is too expensive for them. Without health insurance preventative healthcare, including checkups and prescriptions and treatments remain out of reach until the demand is undeniable.
45,000. Per year. Die. As a result.
Said Dr. Andre Wilper, one of the authors of the study: We doctors have many new ways to prevent deaths from hypertension, diabetes, and heart disease — but only if patients can get into our offices and afford their medications. 45,000 Americans per year die because they can’t.
The .1% effect. If 45 million Americans are without health insurance, and 45,000 Americans die from health insurance bineg unaffordable. Then .1% of the uninsured will die each year from health insurance being unaffordable.
If another 6.9 million Americans will lose their health insurance in 2010, then we can project another 6,900 Americans will lose their life because health insurance remains unaffordable.
Now, it's 51,900 (45,000 + 6,900) of our friends and neighbors will lose their lives without affordable health insurance.Health insurance reform does matter.
Rush Limbaugh announced that our healthcare system is just fine the way it is. Fantastic.
Unfortunately, there remain those who can't afford the care El Rusho received, or vacation in Hawaii where its healthcare system is considered among the most progressive, or whose health insurance policies have been rescinded before they could receive it, or whose treatments were denied by nameless faceless administrators at health insurance companies.
Fortunately, there remain those who are not threatened by this reality, nor have vested interests in denying it. And they remain committed to making Rush's reality affordable for everyone who makes just a wee bit less than Rush ($28 million, annually?).
Will it change our lives? Yes.
When and how? Details for both questions remain...uncertain.
But, let's use the metaphor of learning to walk. When and how did we learn to walk as a baby? First come...baby-steps, then some toddling with knee scrapes and finally, we’re up and running confidently by around year 4 or 5. There are moments of delight and celebration as well as scraped knees, bonged heads and some tears shed a long the way. Well, it was for me anyway, from what I’ve been told and remember.Baby-steps: Coordination: Left-foot, right-foot...Balance. Repeat.
The current baby-step in healthcare reform is coordinating the terms in both versions, the House and the Senate, of healthcare reform bills. That’s akin to coordinating the right and left legs in walking. (Read no significance into right and left leg other than their positions on the body. )One step: Take our medicines.
Drug-coverage donut gets bigger; donut-hole grows smaller.People on Medicare might well see the "doughnut hole" in drug coverage shrink by $500 this year from what it would otherwise be. Jim Gallagher, St. Louis Dispatch.
Kids are alright.
Both versions of the current healthcare reform bills extend coverage for children to 26 and 27, respectively for House and Senate versions.
Cadillac Plans Tax. The Senate version includes a provision for a 40% (!) tax on so-called Cadillac Plans. These are plans whose costs exceed $8,500 for individuals and $23,000 for families, for the cost of combining health savings accounts, medical, prescription drugs, dental, vision, etc.. The tax is charged to insurance companies, but it is widely assumed they would passed it on to employers. - Megan McCardle, The AtlanticToddling, soon:
Coverage is guaranteed, even for pre-existing conditions. Those with pre-existing conditions would have to either pay a premium, not to exceed 25% over those without it, and this would be made possible by a federally supported high risk pool.
Unfortunately, this will not be implemented until 2013 or 2014, if approved.Stumbles and Scrapes ahead:
Rising Healthcare Costs and The Cadillac Tax Plan. The majority of Americans with health insurance have this benefit provided through their employer. That means the potential tax on these cadillac plansfirst assessed health insurance companies will then be passed on by the health insurance companies to the employer as part of the costs of their group plan that provides this employee benefit. (My prediction: This tax would be itemized so clearly, prominently, with attached documentation in striking contrast to all other items listed on our health insurance invoices.)
Companies will then have three choices:
1. pass the cost on to their employees,
2. absorb it
3. lower the benefits and costs included in their group insurance plan.
Individuals would face two choices:
1. pay it
2. lower the benefits and costs of their health insurance plan.
There will be a lot of stubbed knees in the future as we see the impact of annual premium increases of 10 - 15%. Oh and these increases are compounded...annually.
So, the minority of Americans facing this tax today...will become the majority of Americans facing either a tax on their health insurance plans or reduced health insurance benefits or both.
If you’re current health insurance premiums increase by oh, say 15%, annually by 2013...will you be subject to that tax? Do the math.
Could you afford the tax along with these higher premiums to maintain the coverage you receive today?
OR, will you reduce your health insurance benefits to avoid both affordable healthcare and this tax and sustain your ability to pay for food, rent, gas in your car to get to work, college for your kids, care for your parents....?
This question, with its unpleasant answers, applies to the cost of healthcare. We are an aging population. We are an unhealthy population. Annual rate increases for our healthcare will continue. Their amounts will increase.
What can we afford? This leads us to our next stumble and scrape:
Rationed Healthcare. We'll ration our healthcare and that of our families, ourselves. Health insurance plan administrators will be right-sized. There will be no need. We will ration our healthcare needs. When the slaves control themselves...life is good and profitable for their master.Public Option. This one makes me laugh. Well, not its intent, but its opponents. Their reactions are one of two or both of the following:
#1 Unfair competition. The health insurance companies would not be able to compete with...the federal government. There’s some reason to agree. Medicare benefits are administered with up to 3-4% administrative costs. While our very efficient, free-enterprise, competitive industry needs 15% or more to administer their plans.
#2. The federal government is inept. They would be unable to respond to the needs of the consumers. Bureaucrats would dither in approving procedures. (That is somehow different than health insurance administrators niggling over costs or coverage in their approval of procedures...) In other words, the feds cannot compete with the competitive marketplace. There’s some reason to agree.
On the other hand, wouldn’t that be a competitive edge FOR the health insurance industry?
#3. Both arguments. I have seen and heard opponents of healthcare reform share both arguments in the same conversation.
What about the uninsured? Of the 45 million uninsured Americans...only 20 million or so will be able to afford health insurance if these reforms end up being approved and enacted...in 3 years.Can we wait? Can we wait another 3-4 years for all of us to enjoy the same healthcare that Rush enjoyed this past week? Should you, or your family, need to wait that long?
Additional links:Baltimore Sun
A Less Than Honest Policy, Bob Herbert, NY Times
* iStockphoto from freehelski
The distribution of the tamiflu vaccine seems to capture, at a glance (maybe a lengthy glance), the current state of our healthcare system. Two articles last week told this story.
The first article was Researchers: Tamiflu may not benefit otherwise healthy people.
British researchers say there is little evidence Tamiflu stops complications in healthy people who catch the flu...The researchers said the benefits of Tamiflu were small and that authorities should consider its side effects before using the drug in healthy people.
Fiona Godlee, BMJ*'s editor, said the papers cast doubt not only on how safe and effective Tamiflu is, but on the drug regulatory system that approved it. "Governments around the world have spent billions of pounds (dollars) on a drug that the scientific community now finds itself unable to judge," she said in a statement.
The second article was Corporate employers got scarce flu vaccine first.
When the swine flu vaccine was most scarce, health officials gave thousands of doses to corporate clinics at Walt Disney World, Toyota, defense contractors, oil companies and cruise lines.
USA TODAY examined how state health departments distributed H1N1 vaccine after public outcry last month over Wall Street firms such as Goldman Sachs receiving doses while doctors and hospitals encountered shortages.
So...billions have been spent on a vaccine drug which researchers cannot say definitively and with supporting data offers benefits in healthy people. And isn’t that the demographic of vaccines: healthy people? And isn’t that the point of vaccines to sustain and protect healthy users?
And...this drug was then made available on a priority-basis first to large corporations, not healthcare providers, and to the able-bodied employees of these corporations and not those high-risk members of our communities which were children under 6 years of age, elderly, pregnant women and those with underlying health issues.
Our current healthcare system and its benefits is made affordable to those who can afford it and least likely to need it: the able-bodied employees of large corporations with health insurance and health care as an employee benefit.
Children, those with underlying issues, increasingly the elderly and pregnant women....and those unable to afford health insurance and its benefit of timely healthcare....are left with clinics unstocked with the treatments they need.
As a result, some call our healthcare system The 150,000 - Life Healthcare Plan
The Institute of Medicine developed a detailed methodology for projecting the lives lost due to lack of insurance. The original paper estimated that 18,000 lives were lost in 2000, and the Urban Institute updated that analysis with data for 2006, yielding an estimate of 22,000 lives. As for 150,000, well, that's almost certainly too low. That's just the 2006 number across 10 years...
Maybe we should call it Our Current 150,000+ Lives Lost Healthcare Plan.
The McCarran-Ferguson Act of 1945 exempted insurers from federal anti-trust laws provided that states and their insurance commissions policed any anti-competitive conduct.
Now, in 2009 we see the results in the health insurance industry of these decades of anti-trust exemptions.
* UNSUPPORTED FEAR. Fear that the federal government may prove to nimble as a competitor.
The irony of the opponents of healthcare reform say out one side of their mouth that the federal government will have an unfair competitive advantage.
And, then tomorrow, they will say out the other side of their mouth that the federal government cannot provide a viable service because of its bloated inefficiencies.
* DRAIN ON OUR ECONOMY
As much as 18% of our GDP is devoted to healthcare. This compares to these bastions of socialist, government-run, healthcare:
Socialist, government-run, healthcare systems operating more efficiently than an industry enjoying anti-trust exemptions?
INCREASED SAVINGS for THEM, DECLINING SERVICE DELIVERY FOR US
Health insurance companies devoted more than 95 cents of each of our premium dollars to providing healthcare for our needs.
Devoted. Past tense. This rate of 95% medical loss ratio was in the early 1990’s.
Now, health insurance companies only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits, grotesque executive salaries, huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most. Wendell Potter, The insurance industry’s lethal bottom line.
This represents a savings of $110 billion a year. And a loss of $110 billion a year in healthcare for us.
* UNAFFORDABLE PRODUCTS. Health insurance is becoming increasingly unaffordable.
* HUGE MARKET of CUSTOMERS UNSERVED.
This is a huge market of customers and revenues that for some reason has failed to inspire affordable innovations for these potential consumers of the health insurance industry.
How huge?45 million Americans x $100 a month in premium costs =
Anti-trust exemptions for the health insurance industry has created a market equal to $54 billion annually. And the health insurance gives out a collective yawn. And why shouldn't they? They are exempt from anti-trust provisions. And in their world, that means they are exempt from competition.
Why would an industry ignore a market of such magnitude unless they were not only exempt from anti-trust provisions, but exempt from competition itself?
For that matter, why would an industry create this market?Why would this industry spend 40% more on lobbying this year to maintain these anti-trust exemptions that leaves $54 billion on the table, $54 billion out of their pocket, each year?
A statement from the drugmaker explains: We believe that the private health care marketplace fosters competition, innovation and consumer choice.But, clearly that’s not true, now is it?
What kind of competitive industry makes no effort to innovate products to meet the unmet demand in a market worth $54 billion?
One that's exempt from anti-trust and competition, that's who.
There was a time, in the early 1990s, when health insurance companies devoted more than 95 cents out of every premium dollar to paying doctors and hospitals for taking care of their members.
Today, insurers only pay about 81 cents of each premium dollar on actual medical care. The rest is consumed by rising profits,... huge administrative expenses, the cost of weeding out people with pre-existing conditions and claims review designed to wear out patients with denials and disapprovals of the care they need the most. - Wendell Potter, former Vice President of Corporate Communications for the CIGNA corporation, The Insurance Industry’s Lethal Bottomline...
That sounds kind of harsh.
On the other hand, if you have ever been forced to deal with coding errors, or just a standard claim, with an insurance company, either directly or through your healthcare provider then you’ll know it is not only...kind, it's also rational.
That’s the best term you can use for the practice of creating layers of bureaucracy (yes, it exists in private health insurance companies...sheesh) for the sole purpose of defeating us, the customers of health insurance companies, customers from using your services. These services being the services we pay for each month with our monthly premiums. Those of us fortunate enough to be able to afford health insurance.Stepping away from the issue of providing for our healthcare, or the issue of providing the services for which we pay each month...what kind of commercial, for-profit industry can intentionally create layers of bureaucracy for the sole purpose of not providing their services to their customers. Sure, some companies do this as a result of the standard disconnect between companies and their customers. But how many industries do this as part of a profit-making strategy?
Health insurance executive: Hey, guys. I have an idea. Let’s create layers of bureaucracy....no wait a minute, hear me out...staffed with titles like plan administrators and claims adjustors or customer service reps. Except their role is not to administer the plans and benefits our customers have paid for, but to prevent this from happening!!!
Board member who’s executive at real for-profit company: Wait a minute. Won’t that frustrate and anger your customers? And won’t they leave you for your competitors?
Health insurance executive: (Nodding to his colleagues and then pointing at the Board member) He doesn’t get it. You see, our customers have nowhere to go. See. You have to compete for your customers. That's so yesterday. We don't have to compete!
In most states we have an "exemption from competition". It’s a complicated and very legal term (wink) that our PR agencies provided each state's insurance commission to use as they announced they had blocked all competition for us.
Here's the kicker, you'll love this: the rational for blocking competition in each was so we could "provide better service unencumbered by competition!
And in those states where we have to ‘compete’ (as he uses his hands to make the quotation mark), well, we’re all going to do this, so our customers will all find out there's no point in leaving one for another!
I think cooperation is so much more beneficial than competition.And, see, we have the actuaries and their skills to create a table that shows how many layers of bureaucracy we need to implement before the customer gives up on their claims! It’s so cool!
Board member who’s executive at real for-profit company: Huh. Yeah. Now I see. I wish our industry was competitive like yours. (And they all laugh together.)
And that’s how they work together: MLRs, profits and our [declining] healthcare system. As a result of lower MLRs and higher profits, our healthcare system is now the most expensive to administer. And what is administered declines in quality each year as compared to our counterparts in other countries.
And the great thing, the thing I really admire (darkly) of the health insurance industry, is how they used their profits from our rising premiums and their declining level of service delivery to turn literally on the hands that pay them and with expensive lobbyists convince us:
* they are not a monopolistic industry,
* that they are not already subsidized with terms and conditions designed to prevent competition from entering,
* that competition from the federal government (the federal government) is unfair,
* that their layers of bureaucracy are not intended to ration care,
* that they haven’t already created their own death panels from these macabre plans with unaffordable premiums and unattainable benefits and they are far better than the 16-17 other countries whose healthcare systems run far more efficiently, deliver better care to more citizens and claim a lower percentage of their GDP.
Elsewhere in the world, healthcare systems are much less reliant on private sector support--and much less expensive. For example, the U.S. system costs 83 percent more per capita than the Canadian system, where public funds collected through taxes pay for up to 70 percent of healthcare coverage. A number of East Asian systems also enjoy high quality of care for a much lower cost.
Health policy expert Gregory Conko warned that removing antitrust exemptions, which date back to the 1940s, will actually drive up prices and harm consumers.
“Federal enforcement isn’t necessary to ensuring fair competition in the health insurance industry, but could actually drive smaller companies to the brink of insolvency,” said Conko.
The McCarran-Ferguson Act of 1945 exempts insurers from federal antitrust laws as long as the states police anticompetitive conduct.
The chart below shows the results of 40 years of anti-trust exemptions.
* US Health Spending Breaks from the Pack, Economix - NY Times
Instead of forthrightly dealing with the fundamental problems, discussion is dominated by rival factions struggling to enact or defeat President Barack Obama's agenda. The rhetoric on both sides is exaggerated and often deceptive. Those of us for whom the central issue is health—not politics—have been left in the lurch. - Jeffrey S. Flier, Dean of Harvard Medical School in WSJ op-ed,
Garbage in, garbage out.
Many provisions in this bill are landmark. The one we’re talking about today is the provision that mandates all employees, with any and every business, receive health insurance benefits.
According to the Bureau of Labor Statistics, employee healthcare benefits comprised 10.9% of employee compensation costs per hour. This percentage is compiled as an aggregated percentage from all employers, regardless if they offer healthcare benefits or not.
The bill passed this weekend would mandate employers either provide coverage or pay a tax of 8% of these same employee compensation costs.
Maybe, my math is off. But 8% of employee labor costs sounds less expensive than 10.9% of labor costs.
Now, those companies who do not offer health insurance benefits will now face an increase in employee compensation costs. They will be required to either offer healthcare benefits themselves (for on average a 10.9% increase in employee compensation costs) or pay 8% of their employee compensation costs to a government run pool to provide insurance.
What percentage of a company’s revenues is comprised of the combined wages and benefits paid to their employees? It depends on the industry, according to BizStats. Let’s benchmark employee compensation costs (wages and benefits) at 20% of a company’ revenues.
Healthcare benefits increase total employee compensation costs (wages and benefits) by 10.9%.
So, what percentage of total revenues would these possible mandated benefits equal?Let’s look:
Mandated costs: 8% (mandated health insurance pool contribution) of employee compensation costs
Employee compensation costs as percentage of revenues: 20% (average employee compensation costs as percentage of total revenues)
Mandated healthcare costs as percentage of revenues: = 1.6% of total revenues.( .08 x .20 = .016)For 1.6% of total revenues for those employers who now do not provide healthcare benefits for their employees, we will receive:
Job-lock elimination. Job-lock is that phenomena where talented employees remain at large companies, underutilitized and unmotivated, because healthcare benefits are not available at small businesses.
Now small business can compete on a more level playing-field against large companies for the number one asset it needs to grow: human asset.
50% of personal bankruptcies eliminated. Over 50% of personal bankruptcies are attributable to catastrophic healthcare costs. The majority of these costs arise from the lack of health insurance. By providing health insurance to all employees we eliminate the source of 50% or more of personal bankruptcies and the costs passed on to business and their customers.
Lower health insurance premiums. As much as 10% of our current health insurance premiums are due to the healthcare costs incurred from those not insured.
Lower healthcare costs. Costs for standard hospital treatments for the uninsured are often as much as three times higher as compared to the cost of the same treatments for those with health insurance. Why? Because the uninsured have a three times greater rate of non-payment. It is reasonable to assume, though I doubt it will ever be discussed in polite company, that the standard costs for hospital treatments even for those with insurance reflect the debt incurred by the hospital from non-payment.
Greater productivity. Fewer days lost from employee illness. Now, with health insurance they can receive the care they need, when they need it and before it blossoms into a major healthcare crisis.
Imagine their greater focus when they’re not worrying about their child’s healthcare needs because those healthcare needs are affordable?
Added revenues. Remember those personal bankruptcy costs? You know those are the costs passed on to your business from the debts to you left unpaid in your customers’ personal bankruptcy. 50% of those costs would disappear. That would be reflected on your P&L statements as either increased revenues and cash-flows.Employees. Remember that cool startup or small business? That’s the one you met with 5-6 times. They had a great culture. You believe in their purpose. They have so few meetings you could accomplish more and have more time for your family. Well, now they would have the healthcare benefits you can afford. Maybe, there would be some out-of-pocket expense for you. But the return on that would be a meaningful career again, a company where you love the people, and more time for your family. Think you’ll be more productive? Yeah, so do I.
Granted, there are nuances. Some are favorable, some are not. If a company's total employee compensation expense is lower than 20% of total revenue then the costs from mandated health insurance will be less than 1.6%.
Granted, the benefits of some of these health insurance plans may not equal the benefits of the gold-plated plans of years past. But, those benefits are not affordable to the majority of those who can enjoy private or employee-sponsored health insurance. And for those previously without health insurance, any health insurance is a step in the right direction.
But the biggest benefit I can see is that first one: elimination of job-lock. Health insurance not tied to your employer frees each of us to pursue the opportunities where we can contribute the most. And it frees smaller companies to compete for the talent they need to grow their business.
That is critical. Why? Small business is the driver for job creation. We have a jobless recovery right now. Job-lock plays a large role in the inability of small business to create the jobs we need to grow our economy out of this recession. Eliminate it (and make credit available to small business) and we have a job-generating small business segment, again.
So, for 1.6% of total revenues...on average for small business I see positive ROI from a variety of sources. Here's a few more.
And for no increase or even a savings for businesses now able to offer health insurance, I see I see mandated health insurance as a cost-saver.
That's a pretty good days work for Congress.
Granted, it is not a perfect bill. The NFIB or National Federation of Independent Business, has some very good points about how to improve this bill. But, we didn't create our healthcare system in a day or even in 10 months. And like any journey out of swamp, it begins with the first step and the same amount of time is required to get out.
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