“Have you heard of tiny Melinda Mae,
Who ate a monstrous whale?
She thought she could,
She said she would,
So she started in right at the tail…”

- Excerpt from Melinda Mae by Shel Silverstein

Healthcare reform is a “monstrous whale.” The federal government could learn a little something from the childrens’ tale about Melinda Mae. Instead of trying to cram ALL of healthcare reform into one big bill and get everyone to swallow it all at once, smaller bites would be more manageable.

Smaller bites might actually pass.

What Do Small Bites Look Like?

Let’s start with some easy small bites that most Americans are eager to agree on. How about a bill with just these points in it to garner support and get something/anything passed.

1. No more pre-existing conditions
2. No more pulling of policies for large claims
3. Same premium rates for all with premium adjustments only on the basis of tobacco use, age, family size and geographic location
4. Banish all attorneys to…erm…I mean…malpractice suit limitations

Those are things most all of us can get behind. Once we get that, let’s go for the next bite. Eventually we will finish the whole whale, or at least we’ll eat what we’re able to stomach.

That’s how Melinda Mae would do it.

Let us know your thoughts on healthcare reform in the comments! Your voice matters.

Image from Mike Moreu

As long as we’re herding cats on healthcare reform, let’s ask a critical question…What is the timing for the changes being made for healthcare reform? Not “when will it get passed” but rather “when will the changes, whatever they end up being, go into effect”?

Logistically, it’s a nightmare.

Healthcare Reform Will NOT be here by January 2010

Employee populations have already been underwritten for 2010. Rates have already been set. Policies are already in place. Open enrollment has already begun. Surely no one would jump in front of that rolling momentum even though the government has the authority to do so. It takes a full year to do all that needs to be done for a health plan when it is business as usual.

[cats like big balls of yarn, and this is a BIG one]

Imagine the implications of just two details…

1. Insurers Have to Cover Pre-existing Conditions
2. Insurers Cannot Drop Clients with Extreme Expenses.

In short, the very business practices on which insurers, doctors, hospitals and every company that provides health insurance have built their business are undermined. Wow!

[think two wild feral cats left to their own devices in the barnyard]

Insurance companies would be SCRAMBLING…

• to change rates.
• to underwrite to new standards.
• to negotiate new provider agreements
• to develop new policies.
• to train people on the changes.
• to print new materials.
• to engage countless attorneys to understand and interpret changes.

[think of the crazy old cat lady with 72 cats in her one-bedroom 650 square foot apartment]

At the same time, employers would be scrambling to understand and reevaluate their business model as their health plan costs changed. They would be looking to alter their plan in an effort to control their rates and protect their business. They would be struggling to educate their employees. And struggling to meet a bottom line with new rules on one of their single largest line item expenses – health insurance.

[think of the animal shelter stuck with the crazy cat lady's 72 cats - what the hell do we do with these?]

Docs and hospitals and other care providers are little better off. They would have new rules on what is or is not covered. They would be left to figure out how much they could expect in income on those “Good Samaritan” services they had been providing for “free”. They would have new systems and rules to evaluate. Their very business model would shift.

[think of the vet trying to provide services out of the goodness of their heart, but faced with the financial implications of having to spay ALL 72 cats]

Cats would be living with dogs. And January 2010 would be here.

A Similar but Not Related Video that Conveys my Thoughts on This…

Image Courtesy aflcio2008 on flickr

Senator Jim Cooper (D) of Tennessee has been one of the most prominent politicians traversing the country on the idea of healthcare reform. In his early presentations on the subject, the approach was a hard line push to get universal coverage (covering the uninsured) with NO FOCUS ON CUTTING wasted expense that could have paid for the program. Cooper is clearly the most articulate and knowledgeable politician I have run across with an in-depth perspective of healthcare AND business. I am convinced that he has a hand in the movement of the healthcare reform to something that will be more beneficial to Americans that earlier plans.

The modifications that have been made in the past few weeks are significant. Socialized healthcare (a wholly government run program) is giving way to government incentives for consumerism coupled with universal healthcare (getting the uninsured covered), and more ethical treatment of members by health plans (no pre-existing conditions and protection from being kicked off of a plan for large claims).

It is encouraging to see that questioning of Senator Cooper and other prominent members of congress have started to take root in D.C., either as a result of that meeting or others. I hope the plan is not finished evolving. Private business needs to get behind the idea of making healthcare more efficient and some are fighting for the opportunity to do that through organizations like SIIA.

For far too long, companies have been passive about healthcare as an outsourced expense and did not get involved preferring to push the burden of understanding this to the insurance companies. The insurance companies obliged and took the power that came with that responsibility.

The government is pushing employers to get involved. Getting employers MORE involved and not less involved is what we help us drive the cost down while improving quality. If employers continue to wholly outsource their healthcare without actively addressing it, look for us to wind up back at the sort of option that Senator Cooper had originally presented.

Lots of interesting bits and pieces in the Presidential Speech last night. Lots of things people wanted to hear like no more pre-existing conditions and no getting dropped from insurance plans if you have a serious medical condition.

I LIKE these statements.

But what do they mean?

Follow the logic…

No more pre-existing conditions and no getting dropped = more costs covered by your private insurance = higher premiums = more employer cost control by raising deductibles to keep their part of the premium down = more costs passed to the consumer.

It’s the way to legislate into a more consumer-directed solution.It’s an assbackward way of doing it, but it should work. Whether all of the parts of government healthcare reform work according to plan or not remains to be seen, but this is one piece that no doubt will DRIVE UP THE COST TO THE CONSUMER and force the issue of consumerism in the private healthcare market.

If you have picked up a newspaper or turned on any news station during recent weeks, I am sure you have heard a lot about President Obama and health care reform. I am also sure that much of what you have heard about has been the lack of any resolve between Democrats and Republicans. Divided as to what the appropriate step towards improving the US health care system should be, the disagreement has made it difficult for policy makers to develop a bipartisan plan. At this point, President Obama has started directing more of his energy towards engaging the states and individuals in this national issue. Following the health care debate can definitely become confusing and overwhelming. So, we’ll briefly outline the status of health care reform as it stands now.

Currently, the main push by the White House and most Democrats is to provide a public option for the uninsured that will compete with private insurance companies. Essentially, those without an employer-provided option would be able to choose either a different private health care insurance option or the public plan. President Obama has argued that if the insurance companies are telling the truth and doing the best they can for their customers, then the implementation of the public plan should not affect their business.

Last Thursday, Democrats released a revised plan that estimated $611 billion over the next decade would be required to overhaul the healthcare system and provide coverage for 97% of Americans. This proposal calls for most employers to provide health coverage for their employees and the development of a public option. In addition to the funds outlined in the proposal, the expansion of Medicaid (which would be the expected first step in the process) could add several hundred billion dollars more in legislation costs. President Obama and Democrats want to cap initial costs in healthcare reform to $1 trillion over the coming decade. This limit, however, is not set in stone.

Clearly, there are two big issues surrounding reform: how much this change will cost and how involved the government will become in the healthcare market. Surveys by NBC and the Wall Street Journal, CNN and the Opinion Research Corporation, and Quinnipiac all indicated a nearly 50/50 split in terms of people who are willing to pay and not willing to pay to provide coverage for the uninsured. Two surveys by the Kaiser Family Foundation and CBS and the NY Times produced contrasting results that Americans are not and are willing to pay for reform respectively. The prospect of increased income taxes and/or taxes on employer-based health coverage makes many Americans hesitant to support the spending the government proposals would require. Moreover, various interest groups oppose the implementation of a government plan that could interfere with the healthcare market. For example, insurers and drug companies, along with Republicans, fear that the public, government option would drive private insurers from the market and would eventually lead to a single-payer system. While Republicans have been quick to criticize proposals, they have been slow to provide suggestions of their own. Without support from both parties, moving healthcare legislation through Congress will be difficult. Luckily, there has been growing optimism from both sides that an agreement will be met by the end of August.

So, that was pretty much the simplest rundown on reform imaginable, but hopefully it got any newcomers up to speed.  Keep in mind that you as a consumer and voter have the power to influence what happens in Washington.  If you support or oppose any proposed legislation or you want your elected officials to know your opinion, call their office or write them a letter.  You may not realize it, but it does make a difference.  They are in office to make their constituents voices heard.  So, tell them what you think.  Trust me, they want your votes and know they have to respect their voters to get them.  Want to contact your congressman? your senator? your governor?  Find out who they are (in case you don’t know) and how to contact their office here.

While we would love to help keep you up to date on the changes and news with health care reform, that topic deserves an entire blog of its own. Plus, while I like to think of myself as well-informed when it comes to health care, I’m thinking the experts might have one up on me when it comes to the complexities associated with the reform process.  There are lots of good sources out there that tackle the many issues wrapped up in changing our healthcare system. A good place to start is Jane Sarasohn-Kahn’s blog, http://www.healthpopuli.com/, which provides daily updates on health care reform.  Happy reading.

I can only imagine how many differing opinions there are about how to solve our healthcare crisis.  But how many opinions are out there about what is wrong with our healthcare system?  Dare I start a list…

Anyhow, in doing some recreational reading and email sorting this morning, I came across a link to an article (sent from a colleague) “Government Contemplates Financial Bailout While Taxpayers File Bankruptcy for Medical Bills – When Will Congress Intervene in Skyrocketing Healthcare Costs?”  Great title, right? As I read through the article I couldn’t help but wonder how many people think that our healthcare problem should be “solved” by our government. Yes, yes, please let the government solve our healthcare crisis (read: tax payers pay for it).

I do not have beef with the article, or with the government “solving” problems for that matter.  The piece is very well written and highlights the problems and costs Americans are facing in relation to their health expenses.

I guess my question lies in this last paragraph, “The unacceptable result of all this is that an increasing number of Americans are foregoing expensive but much-needed drugs and treatments, including those for serious conditions such as diabetes and high blood pressure, which if left untreated can result in worsening conditions, hospitalizations, or even death. The problems in our health care system need to be addressed by Congress now.”

Hmmmm, so what does Congress do… implement a mandatory exercise hour across America?

Our solution has to be a JOINT EFFORT.  This is not solely the government’s problem!!

Yes, a lot of this is their fault. However, I would argue that there are five major players in this mess, one of which is the government. (See my previous posts for the four contributors – since then I have added one). The other four: doctors, pharma (newly added), individuals, and insurance companies. Unfortunately, I have yet to appoint percentages of blame.

The majority of Americans know our system is failing, but are unwilling to make any sacrifices or changes. We have had a third party paying for our care for far to long, with ever increasing bottom lines and stricter rules for coverage. On top of that, the government cannot bail us out of our obesity (or sub other unhealthy behaviors) and sense of entitlement. Insurance companies sure aren’t going to help either.

There are three things that are going to help fix this system, and individual accountability is one of them.  We have to stop running to the doctor every time we have the sniffles. We must make health and wellness a priority – and start exercising.  Second, is transparency.  No one really knows what the true cost of healthcare is.  Guess what folks; an office visit does not cost $20.  To be accountable, cost and quality information must be available to consumers.  Last, is competition.  By being accountable for our decisions, and knowing the true cost and quality of healthcare, providers can begin to compete for our care. Until doctors/hospitals have to be accountable for the quality of care they provide and the amount they charge, nothing is going to change.  Every other market has competition, why should healthcare be any different.