“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.

Just saw the CNN report on 13 million uninsured 20-somethings in this country. New to the job force and turning down their health insurance.

What are they thinking?!?! Do they believe that they can just go out and buy what they need in terms of medical goods and services on the free market? Good grief! This is America for goodness sakes.

So what are they doing in lieu of buying insurance?

Radical things like minding their health– watching what they eat, working out, bundling up before they go out in the cold, washing their hands (oh, these kids – they’re like modern day hippies shunning the norms of society).

They go to the doctor only when absolutely necessary instead of for every little ache and pain. They go to retail clinics (like Minute Clinic and The Little Clinic) where they know the costs BEFORE they buy (oh my, what are these kids coming to wanting to know the price before they blindly incur the expense). They look things up on the internet (It may be MY chronic disease but shouldn’t the doctor know more about it than me? He treats it, and I only live with it…every single day of my life).

But why should these 13 million have insurance? In case something happens.

Hellooooo – they’re 20-somethings and invincible.

But seriously, why should they? Because it underwrites the rates of the older portion of the population. If they don’t get healthcare, they don’t offset the risk pool – they don’t underwrite the older segment of the population. And we know what that means – our rates will go up because they aren’t contributing monetarily (and taking less out than they put in) as we expect them to do.

But we can still get them. In New Jersey, children can stay on their parents insurance to age 30! Thirty!!!! In many other states it’s only 24 or so.

So now I’ll set aside the sarcasm.

What we are seeing is the revolution. The new generation is taking a stand. We have a product – health insurance – AND THEY ARE NOT BUYING! The business world should get the message here. These folks are going to opt for surgery overseas, retail clinics and internet consults. They are going to cost shop prescriptions and doctors. They are going to demand affordable access to care and they are going to want to know the price AHEAD of time. And they are going to return health insurance to truly being insurance – a safety net for catastrophic situations instead of the all you can eat buffet for $20 we have bad for soooo long – too long.

Do NOT think that it is the sage old regime of healthcare executives and politicos in D.C. who are going to change healthcare. It is the 20-somethings. They alone are able to break out of the old ways of thinking. It has been that way generation after generation. THEY have the new ideas. THEY are taking a more rational approach. They are getting organized and THEY are not content to go along with the system as it has been.

Yes, they are 13 million without health insurance…and growing. THEY will change healthcare.

Thanks to Elizabeth Cohen for the mention on CNN. As we continue to promote transparency and support consumers, employers and their employees, the recognition is greatly appreciated.

You can view the clip below, which ran on Monday March 2nd.

I have argued the value of transparency in healthcare many times (note: scroll past Robert’s entries to view mine below)! But I have yet to argue the value of transparency in relation to other aspects of healthcare beyond just cost.

Shame on me!!

A recent article in BusinessWeek highlights Health 2.0 – the emergence of “patients as partners.”  Featured is PatientsLikeMe an online social network with communities specifically for patients with neurological, neuroendocrine, mood, and autoimmune conditions such as MS (multiple sclerosis), ALS (amyotrophic lateral sclerosis), and HIV/AIDS. The site provides comprehensive tools which allow patients to track and document everything from their symptoms and lifestyle, to current medications and other recommended treatment.

What is new and revolutionary about this site??  A lot!!  To members of “Health 2.0″ PatientsLikeMe is leading the way in engaging pateints as partners, “experts” of their care.  But to the media, the idea of patients openly discussing their health and leveraging this information to improve their own care is a “new idea.”

Business Week writes, “PatientsLikeMe and a proliferation of similar startups are building a new business predicated on the belief that the wisdom of crowds of patients will bring insights, solace, and most of all, power.

Power because, as it turns out, patients talking among themselves on a global scale with complete transparency produces all kinds of unexpected results. Drug side effects can be reported to regulators by the patients experiencing them, without waiting for the manufacturers to come forward. Pharmaceutical companies can use social networks to recruit subjects quickly for clinical trials, speeding up the pace of research. For that matter, patients can simply band together and run their own clinical trials, leaving drug companies and physicians out of the loop.”

So what is the value of transparency in relation to your healthcare and health conditions?  Wisdom of the crowds.

As it turns out, your health experiences can help someone else find out about a new drug, about the side affects of a drug they have just been prescribed, or possibly a stretching technique that relieves stress.  The possibilities are endless it seems when conceptualized on a global scale.  Our health systems may be set up differently, but the way in which an individual experiences a drug or symptoms of their condition may be beneficial to others across the globe, regardless of whether they have health insurance or not!

Three cheers to PatientsLikeMe for leading the way… And most importantly, thanks to its many members for being transparent, and recognizing the value!

For more information on patientslikeme amd ways in which they are revolutionizing healthcare visit their website at www.patientslikeme.com or watch their featured spot on CBS Evening News.

Just had a great interview with some allies in the battle to bring transparency to the healthcare system. I spoke with Kristy Williams of Alijor and for those not familiar with them, the concept is interesting. On Alijor, patients can connect with providers to address their specific need(s). Simply opening a line of communication between provider and patient is a huge need.Alijor facilitates just that and more.

Right now, there is a lot of effort going into the effort to bring transparency to healthcare, and we’ve met a lot of them in the past two years of doing this. We’re going to meet more in the coming years, but it’s nice to find friends in among the fray who are thinking outside of the box and who share our goals.

We need all of the friends we can get. Thanks guys!

The Nashville Business Journal ran an article Friday about change:healthcare!!

With the book prominently featured, the NBJ says, “Nashville technology start-up change:healthcare has stepped into the national spotlight for its efforts to teach consumers how to shop for health care and decipher the language of  health care providers and insurance companies. The company released “My Healthcare Is Killing Me,” a free e-book for consumers overwhelmed by medical bills or in search of health care choices that benefit them.”

“One of the cornerstones of the consumer-based approach is “transparent” access to pricing from hospitals, doctors, insurance companies and other providers so that individuals can make informed choices about their care.”

Check out the full article by downloading the PDF here.

Christopher talks health care costs, the book, and transparency on Forbes.com!!

Check out the article on the web.

Or download the PDF.