Choosing Sides

Sunday, July 26, 2009
Mr. Cunix? My name is xxxx and I'm calling from Shaker Hts. Your client, Mrs. xxxx, suggested that I call you.

How can I help you?

I need to know if you could connect me with some people who are employed and suffering because of their high insurance premiums.

You need me to tell you about working people who can't afford their insurance? I don't think I can.

I've got unemployed people who will complain about insurance cost, but I can't find any employed people.

Let me guess. You're trying to stock the pond?

Well, yeah, but I'm not suppose to tell anyone. If we can find the right person to tell his story, he may even get to introduce the President.

Sorry I can't help. Good Luck.

The President and his team are in full campaign mode. After the scheduled photo-op at the Cleveland Clinic, Mr. Obama was taken to the friendly confines of Shaker Hts. high school. I had already declined two invitations to Thursday's event before the above call. I had been pretty sure it was going to be more style than substance even before I was asked to help stage it.

It's a campaign and I don't want to choose sides.

Really, I don't want to choose sides. Mr. Steele and the Republicans can't find it within themselves to work for a solution. Senator DeMint (R-SC) is more interested in breaking the President than the breaks in our system. Caught, he attempted on the July 22, 2009 Today Show to say that he wants to "put the brakes" on Mr. Obama's plan. He went from Senator DeMint to Senator Disingenuous.

It's a campaign and I don't want to choose sides.

I think it is safe to say that most of us believe that change is needed. The status quo is not acceptable. Costs are spiraling out of control. Our specific goals and how we will set about achieving them should be the subjects of serious debates. But we aren't having those debates. We are having campaigns.

The President's press conference started at 8 PM Wednesday evening. I got home in time to watch him. Gosh it was so frustrating, so unsuccessful that even MSNBC had difficulty cheer leading for him in the subsequent two hours of discussion. Dr. Nancy Snyderman and Chris Matthews talked more about the questions the President ducked than the ones he answered.

Candidate, I mean President, Obama promised Wednesday:
* No preexisting condition clauses
* No additional charges if you already have a medical condition
* No mandate, no requirement for participation
* Excellent patient-centric coverage when you need it right down to a dietician preparing individualized plans for every diabetic
* No interference from some administrator sitting at a computer

The first couple of points are interesting because they may, by themselves, doom the whole process to failure. Insurance is about shared risk and responsibility. Regular readers of this blog know that I was hit by an uninsured motorist in January. We can't enforce something as basic as our mandatory car insurance regulation. If we don't even try, if we don't require health insurance coverage, many of the same uninsured now will be uninsured later. Why would they bother purchasing health insurance until after they are really sick?

Dr. Snyderman and many of us were surprised by the President's insights into the practice of medicine in the U.S. "If a blue pill and a red pill do the same thing, but the red pill costs half as much, why wouldn't you take the red pill?" He also suggested that some doctors perform tonsillectomies on children for the money.

The idea that some administrator sitting at a computer won't be involved in your health care decisions under a new public plan was debunked right there. Who makes the determination that the red pill and the blue pill are equivalent? When is one better than the other or are we to believe that the only difference is the dye? And surgeries? Who will decide which surgeries are needed and which are simply for doctor and hospital cash flow? Will all of these inspectors work for free? Our cost savings depend on their volunteer effort.

We have had one goal up to now. Our goal as Americans has been to have great access to top doctors and hospitals paid for by someone else. That's the old goal. It is time for a new goal: Great access to top doctors and hospitals that we can afford.

We don't need a campaign. We shouldn't be forced to choose sides. We need details. And we need them now.


Missed It By That Much

Monday, July 13, 2009
It was a Maxwell Smart moment.

Neal Spero politely told us that he had a plan. Dave Clark and I, with equal parts candor and respect, politely disagreed. Mr. Spero is the Senior VP of American Community Mutual, a mid-sized health insurer based in Livonia, Michigan. Dave and I have been two of American Community's top agents for most of the last twenty years. That is quite an accomplishment since we both work with dozens of insurers. The date was September 6, 2007. We had asked to meet with Mr. Spero to share our concerns.

My perception was that American Community was digging itself into a hole. I saw a problem with their new distribution system (who sells it) and their underwriting (who gets covered and at what price). Mr. Spero saw nothing but blue skies and calm seas.

I stopped writing American Community's individual policies last October. Their current renewals for their existing business, reflecting their staggering claims experience, came in at 33%. Mr. Spero had a plan. I can hear Steve Carell say "Missed it by that much".

This past week Senator Ted Kennedy (D-MA) and Senator Christopher Dodd (D-CT) announced that they are now able to project a cost for their committee's health care reform package - $611 billion dollars over the next ten years. The Health, Education, Labor and Pensions Committee (HELP, really, I can't make this stuff up) was pleased to get the cost down to $611 billion dollars even though that number doesn't include Medicaid expansions which put the price tag back over the $1 trillion mark.

I can hear Don Adams say "Missed it by that much".

Not that Senators Kennedy and Dodd know where six hundred plus billion dollars are coming from, but what if the real price tag is a trillion or so? That is a question nobody wants to answer.

There are ways for American Community to save itself. They will raise their rates, tighten their underwriting, and reassess their marketing and distribution. Or they will fail. I am not being cavalier about this. I want A.C. to succeed, but American Community is a business, not a person, not a government. A company that consistently has higher expenses than income ceases to exist.

What will the U.S. government do? One idea was to tax employer provided health care benefits, a bipartisan compromise that might have brought in a couple hundred billion. Other trial balloons floated have included a tax increase on high earners and a "sin tax" on carbonated beverages and sugary drinks.

How much Coke do we have to drink to make up a $1 trillion shortfall?

What's missing is a serious discussion of how we are paying for any of this. Discounts from hospitals? Shell games from big Pharma? Would you believe aliens with space ships full of cash? Sorry, it is just that I have been here before.

Let's all say this together, Tax Increase. It's OK. The world won't end and most of Congress will still be reelected. If having the government run health care is a good idea, say so, tell us the real price tag, and tax us appropriately. We're adults. We're citizens. Trust us with the truth.


Quick note: Dave Clark just called. I told him that he was included in this post. His only issue is that the American Community insurance pool isn't as polluted in Michigan where he lives as our's is in Ohio. He still loves them and does a lot of business with them. He pointed out that they are still one of the easiest companies to work with, do a great job paying claims, and still have guys like Neal Spero who would meet with agents like us. Duly noted.