Thursday, December 31, 2009
Standing in line. I have been standing in line for over twenty minutes at the Beachwood Post Office, waiting for my turn, hoping to learn the fate of my missing mail. It is Monday, December 28th and there are only five of us in line. The women look inpatient, but remain silent. The guy in his late forties is visibly agitated. As more people join our line to see the one, and only, postal worker, Mr. Unhappy tells us that we should “get used to this. This is what life will be like once the government controls health care”.

How many times have we heard that refrain since Mrs. Clinton’s attempt at health care reform? Government Health Care will have the efficiencies of the Post Office with the compassion and customer service of the IRS! I think that statement is terribly unfair to the Internal Revenue Service. I have had to deal with the IRS, for my business, several times and found the agency professional and courteous. Seriously. The Post Office, however, can be a challenge.

The Post Office should serve as a cautionary example of what could happen if the government became too involved with the delivery of health care. How involved is too involved? I will have to leave that up to each of you. My personal opinion is that if we haven’t already crossed the line, we are probably very, very close.

At the top of this post I described the line at the Beachwood Post Office. The Post Office for 44122 is located on Green Road, about a block south of Chagrin Boulevard. Where is the Post Office for 44120? The SHAKER HEIGHTS Post Office is located on Warrensville Center Road, a few hundred yards south of Chagrin Boulevard, less than a mile away. Hell, the 44120 Post Office is located within 44122. The new Post Office was built while Stephanie Tubbs Jones was still alive and serving in Congress. It was placed next to the then Office Max Headquarters in the heart of a very powerful Congressional leader’s district.

You may be wondering whether 44120 really needed a separate Post Office or if one or possibly a few of these separate buildings could have been merged into one larger, more efficient structure. Surely you have guessed that the driving force was payroll taxes to the City of Shaker Heights and not the delivery of letters and catalogues. The more control government has in the actual delivery of health care, the more politicized it becomes. Is your representative powerful enough to make sure that there will be doctors’ offices near you?

“Dave, you’re being silly”, you scoff. “Congressmen and Senators would never exercise power that blatantly.” Ladies and Gentlemen, I give you Ben Nelson.

The Senate Democrats needed 60 votes to get their bill through. Technically, that meant that any one of them could have prevented passage. Technically but not really. Some, like our Senator, Sherrod Brown, were going to vote for this bill no matter what. They had no position to bargain.

Joe Lieberman was one of the first to stand up. He said that he wouldn’t accept a bill that had a Public Option. He wasn’t the only Senator. He was just the one who took the heat. Because he was willing to take a leadership role, he got his deal. Ben Nelson, coming from Nebraska, was willing to take the very public position of opposing any bill that might use taxpayer money to pay for abortions. Again, he wasn’t the only Democratic Senator who would have voted NO. He was the one willing to take the heat. For this he got the promise of millions of dollars. His fellow Senators offered to pick up the tab for Nebraska’s Medicaid bill. Poor people in Omaha may one day owe their free health care to the residents of Parma.

The Republican state attorney generals will eventually threaten to sue the federal government. I suspect that several Republican governors will also make noise. I really don’t think it matters since I doubt that the Nebraska deal clears the conference committee. But this is the start.

My letter carrier was on vacation and I may, or may not, start to receive all of my mail soon. One of the pieces of mail I may have missed was how our Congresswoman and Senator are bringing jobs and programs to our district. I’d sure like to see the report Ben Nelson sent to his.


Imagine My Disappointment

Wednesday, December 23, 2009
My one and only trip to Washington DC was about twenty years ago. This is odd for someone as politically active as me. I was attending a B’nai B’rith national policy conference. What a trip! I had the opportunity to tour the White House and Senate, visit the Lincoln Memorial and Washington Monument, and talked, one on one, with several Senators. But the most inspiring person I met, the guy who made the biggest impression, was one of the featured speakers, the young Ohio Secretary of State, Sherrod Brown.

I have been a Sherrod Brown fan for twenty years. And now I am truly disappointed.

OK, Sherrod Brown and I do not see eye to eye on the health care debate. That’s not news. What is shocking, at least to me, has been the way he has argued his case. I expected more from Sherrod Brown than the factless, emotional presentations of late. This Sherrod Brown plays well to most of Rachel Maddow’s audience. He appears on her show and Keith Olbermann’s Countdown to feed the base. No Problem. Sunday, December 20, 2009, he was on Face The Nation, the venerable CBS show. It was a cringe-worthy presentation.

Bob Schieffer, the moderator of Face The Nation, tries to give his guests enough time to talk in complete sentences. Used to speaking snippets and catch phrases on television, many politicians falter when given the extra time. Senator Brown must have misplaced his index cards. He kept on talking about the evil insurance companies charging women more than men. He also briefly mentioned that age is also a pricing factor, but quickly retreated back to gender.

I touched on this very subject in my October 19th post. In the past I would have wished that Mr. Brown had seen my blog. Now I’m not so sure that it would matter. Will Sherrod Brown let the facts get in the way of a good argument?

I had a client contact me today. She was worried that her health insurance policy was all screwed up. After watching TV, she couldn’t understand why her premium was substantially less than her husband’s even though he is four years her junior. Her policy is fine, it is our politicians that are screwed up. So I ask for your patience while we discuss a real issue with real numbers.

Case Study #1
Bob and Jane are healthy 21 year olds living in Cuyahoga County. They are both single, non-smokers, and have clean driving records. They need to purchase liability auto insurance from their neighborhood Erie Insurance agent. I wasted a half hour of Brian Ritzenberg’s time. They also need a basic health policy from Anthem Blue Cross with a $1000 deductible, office visit copays and an Rx card. And while they are at it, they are each going to purchase a twenty year term policy for $250,000 from North American. Auto, Health, and Life Insurance. Nothing out of the ordinary.

Auto - $731 per year
Health - $123.45 per month
Life - $217.50 per year

Auto - $630 per year
Health - $157.54 per month
Life - $205 per year

The price of insurance reflects the risk. Young men have more accidents. They pay more for auto insurance. Young women have more medical claims. They pay more for health insurance. Some young women may need to purchase their own health insurance. Almost all young women, at least here in Northeast Ohio, drive.

Case Study #2
Joseph and Pamela are healthy 61 year olds living in Cuyahoga County. Everything, including the amount of time I wasted of Brian’s, is the same as above except for their ages.

Auto - $358 per year
Health - $539.64 per month
Life - $1960 per year

Auto - $358 per year
Health - $515.66 per month
Life - $1550 per year

Life insurance is less expensive for adult women, young and old. Auto insurance is the same price or less for women at every age. Health insurance is sometimes less, sometimes more. With all of the online rating services, anyone can recreate this little test from the comfort of their home or office. In other words, you know that Senator Brown’s argument is specious at best.

We have almost a year invested in this process. That means that I have been sitting here for twelve months waiting for the Sherrod Brown I met in Washington twenty years ago to show up. The current Sherrod Brown is no longer inspiring. Imagine my disappointment.


Built By Committee - Designed to Fail

Tuesday, December 15, 2009
Senator Harry Reid is fighting a deadline. The President may have wanted a bill before Labor Day, but they want ice water in Hell, too. Reid, the pragmatist, knows the real target, December 31st. The last thing he wants is to be holding a hot potato of a health care bill in January, or worse, February.

Senator Reid has a problem.

Regular readers of this blog know that I have been asking one question from the start, What is our Goal? It is unfortunate that even though our political leaders may not have had well defined, easily explained goals, they all had solutions. Creating questions to given answers is the basis of the television show Jeopardy! Creating legislation to preconceived answers puts all in jeopardy.

It is hard to describe the pending legislation as health care reform. In fact, it is not even insurance reform. The current bills appear to reposition the government’s role in the payment of health services. Based on the numbers coming from the Congressional Budget Office, some critics think that this is just Washington once again proving that it can turn wine into water.

Let’s take a quick look at a few of the issues:

PUBLIC OPTION – Previous blogs have dealt with this particular issue. If nothing else, the Senate does not have 60 votes to pass a bill containing a Public Option.

MEDICARE OPENED TO PEOPLE AGE 55 TO 64 – This idea had a two minute life span. Nancy-Ann DeParle, the director of the White House Office of Health Reform, is quoted in the December 12th Plain Dealer. “Let me be clear, it’s not adding 55 year olds to Medicare.” If this is only Medicare-like coverage, it is really the Public Option. Please see the above.

ABORTION - Once you get the government involved, really involved, in the delivery or payment of health care, abortion is almost always the first serious question. Conservatives, Democrats and Republicans, won’t allow federal money to pay for this procedure. Liberals want to pretend that they won’t back down. Again. Couples suffering from infertility issues want to insert coverage for in-vitro into this discussion.

NEW TAXES AND FEES #1 – The pharmaceutical industry thought that it had a deal with President Obama at a very fudgeable $80 billion. The House of Representatives passed a bill that would hit the drug makers for $140 billion. The Senate’s version has yet to be released.

NEW TAXES AND FEES #2 – The Senate has proposed a new, non-deductible, tax of $6.7 billion a year on the health insurers. The easiest way to make health insurance more affordable is to add huge new costs to the health insurance companies. Makes perfect sense. To Congress. You and I might also wonder if, as the President suggested, the purpose of a Public Option was to give the insurers real competition. The best way to compete? Give the insurers huge new taxes.

NEW TAXES AND FEES #3 – The Senate has proposed a new tax on cosmetic surgical procedures. The bill currently includes a 5% tax on tummy tucks, facelifts, etc… This is a tax on medical procedures that are not usually covered by insurance. The doctors are howling. Their first line of defense is to note that the majority of these procedures are performed on middle class women with an average income of $30,000 to $50,000 per year. The second line of defense will be to add that other elective procedure, abortion, which should end the conversation.

NEW REDUCTIONS IN MEDICARE PAYMENTS - The Senate bill anticipates significant cost cutting at hospitals and nursing homes. They are so sure of this happening that they are lowering Medicare payments now. We already have Medicare’s underpayments shifted to those of us with private insurance. Reductions in Medicare reimbursements simply mean more costs shifted to us which just means higher insurance premiums. The Government’s Centers for Medicare and Medicaid Services (CMS), according to that same Plain Dealer article, states that the other option from these cuts will be the forced closing of about 20% of these institutions.

Today is December 15th, nine days till Christmas Eve. Can Reid deliver a bill for Christmas? If the President and the Democrats, and at this point it is a one party bill, enact legislation, the Republicans will have a winning campaign next fall. If legislation is blocked by the Republicans, the President and his party can paint the opposition as obstructionists who were too busy saying “NO” to help solve the problems of average Americans.

Considering how awful this legislation is, will Senator Reid win now and lose next November or has he already realized that the reverse, losing now and winning later, is much better? Is this program designed to fail?


Laying In The Gutter? It's My Fault!

Thursday, December 3, 2009
“It’s the insurance company’s fault that there are drug addicts walking the street.”

I did not know that. I needed the twenty year old junkie to explain this to me. After alienating her parents and step-parents, dropping off their coverage even though she is a full-time student, and suddenly getting married, she was surprised that insurance companies weren’t standing in line to welcome her in their warm embrace.

Of course, she was in my office for over a half an hour before she finally told me the truth. Thirty one years in this business has to be worth something. I could tell, I could feel that there was more than what she was disclosing. Bit by bit she released more information to me. It wasn’t until I had begun a pre-screen application that she dropped the bomb, her fourth on-going medication was an opiate blocker that costs $900 per month!

Forget everything but the math for a second. She wants to be allowed to pay $100 per month to Anthem Blue Cross so that the insurer can buy her $900 drug and three other medications. Shockingly, Anthem, Medical Mutual, et al… said “No Thanks”.

It was at this time that she informed me that her addiction is “genetic, like cancer”. Her mother is an alcoholic, so it is natural for her to have been hooked on heroin and methadone. “It is a disease. That’s what you learn at Alcoholic’s Anonymous.”

She spent an hour and a half in my office alternatively complaining about her parents who don’t want to have anything to do with her and the insurers who don’t want to have anything to do with her. She has options. Unwilling or unable to make the calls, I grabbed my phone and contacted her previous insurer, her mother’s employer, and went online to research the local university's student policy. She can be covered, but it will take some time and effort on her part.

She will not be covered.

Which part is more frustrating, the self destructiveness of the drug addiction of a teenager or the delusion that someone else is to blame for one’s behavior; the refusal to take the necessary steps to solve one’s problems or the anger that there are lifelong consequences for one’s actions? She sat there whimpering while I tried to solve her most immediate problems.

Will any of the proposed changes in Washington solve her problems? NO! Even if we have a policy that would take everyone and provide any known pharmaceutical remedy, there is no guarantee that she would even sign up. More importantly, Congress is incapable of passing a law that would force Americans to take responsibility for their actions.


By the way, Jeff Bogart,my business partner, and Michael Saltzman, my attorney, went ballistic when they read the original post of this blog. So I have made a couple of key changes to completely hide the identity of the man/woman subject of this story. I guess you can't be too careful.