We've all heard it. "You're not Christian if you don't forgive me". "You're not Christian if you judge me". Those that abuse others often attempt to twist our faith to suit their own ends, taking things out of context. I remember my niece, being hurt by somebody continually, and the offender simply asking for forgiveness each time. I told her that you can forgive, but you don't have to accept their behavior. Even closer to home, we all deal with people like that. As Christians, we are often faced with living a Christian life and dealing with difficult people. Today’s service served as an illustration on how we can do both. The key is that it’s a two-way street. We can be true Christians without being enabling, which in the long run does not help those difficult people.
There are five steps to determine what to do according to Ephesians.
1) Examine the situation
Ephesians 5:1-5:6 tells of those who do wrong and tells us to have nothing to do with them. Ephesians 5:6 “Let no one deceive you with empty words, for because of these things the wrath of God comes upon the sons of disobedience.”
2) Encounter-
Most humans avoid confrontation. Some from fear, some believing that God will ultimately give them justice. The second part is certainly true. However, NOT saying something simply perpetuates the abuse and in my mind is certainly UN-Christian…who’s to say that God hasn’t presented this as an opportunity for YOU to be the change in someone’s life ? For if this person continues on their path unchallenged, only to reap what they sow as a result, how have we helped them ? Is it not our wish that all stand with us at the end of time ? As the pastor said today, God uses people (Ephes. 5:8). Confrontation is inevitable if you stand for something. It’s not about being critical or judgmental of someone. It is about addressing the hurts and holding the responsible party accountable.
3) Exclude- Ephesians 5:6” Therefore do not be partakers with them.”
4) Expose- Ephesians 5:11 says “And have no fellowship with the unfruitful works of darkness, but rather expose them.”
On the heels of the above, Ephesians 5:12-13 “For it is shameful even to speak of those things which are done by them in secret. But all things that are exposed are made manifest by the light, for whatever makes manifest is light”
Ephesians 5:14—Therefore He says: “Awake, you who sleep, Arise from the dead, and Christ will give you light”. In my mind, we are helping the offenders to awaken. Depending upon how deeply they sleep, more drastic measures are needed to rouse them.
5) Establish- Establish yourselves as standing for something and live in the present, for the days are short. Ephesians 5:15—“See then that you walk circumspectly, not as fools but as wise, redeeming the time, because the days are evil.”
Lastly, we’re supposed to get to this in coming weeks, but in reading ahead, I couldn’t help but notice the appropriateness of the following. Coming full circle with the beginning of this post, people that do us wrong quote passages of scripture that serve their own ends. An example is Ephesians 6:2-6:3 “Honor your father and mother, which is the first commandment with promise, that it may be well with you and you may live long on the earth.” I have always thought that you get what you give—act honorably if you want to be honored. Of course, the answer was in the Bible—actually in the next verse—Ephesians 6:3—“And you, fathers, do not provoke your children to wrath, but bring them up in the training and admonition of the Lord”.
Sunday, September 19, 2010
Friday, June 4, 2010
Everyone loves a H.E.R.O.
Summertime is officially here, but is bittersweet. My stepson is stepping out into the world and will be graduating high school Monday. I’m blessed in that I’ve always been able to relate well to teens. When I came into his life almost seven years ago, he had just turned twelve. I knew the next few years were critical for Josh…middle school is where teasing and bullying really gets mean. I wanted his middle school and high school years to be something pleasant to look back on. We had many long talks on the long, 30+ mile trek to his school and back everyday, where I tried to instill some of my knowledge and experience. Josh tells me that he really appreciated those talks…I can only hope that he means it. I’m happy to say that I’m extremely proud of how Josh turned out and am excited for his future. Now my worries are about my beautiful 11 yr old daughter who just graduated from 6th grade and starts what I call ‘true’ junior high this fall (she looks 14). She’s on the right path, though, in accelerated classes (all A’s with 1 B) and made the National Junior Honor Society. But it’s in 7th grade where many kids lose their way and it’s in 7th grade where the ‘real’ peer pressure starts…and the bullying.
I say this with some conviction because I experienced it. I have friends on Facebook who post these ‘happy’ high school (and junior high) school pictures, looking back, that for them, are happy memories. I’ve spent the last 20-odd years doing everything I could to forget about those years.
Bullying is one of those things that people would rather turn their heads to, teachers included. They think it’s harmless teasing and just part of growing up. But I’m here to tell you…those ‘scars’ don’t go away…ever. Some, like me, go on to successful careers and make a difference (more on that towards the end of this). Others, like the two beautiful teenage girls who hung themselves recently in the news, never make it that far. For me, it started in 4th grade with a miscalculation during a schoolyard fight…I ‘bobbed’ instead of ‘weaved’ and got caught with an uppercut…and lost that fight. But I lost more than a fight that day…I lost my sense of self-worth.
Kids, especially in middle school, are at odds with themselves…their bodies are changing, they are understanding more of the world and that it is not always a ‘nice, rule-abiding’ place, and that some people are treated better than others and that people can be ‘categorized’. That’s where the cliques start—“you belong—you don’t belong”. So, they are trying to ‘fit in’ with everybody else and find their place in a world where they don’t know their place. Some mature faster than others. Some don’t like the status quo and have different interests—which makes them ‘weird’ and ostracized. Some kids look to be the clown; for others they look to put down someone else to take the focus off of themselves and their insecurities. For the kids that ‘belong’, if one of these ‘leaders’ of a clique starts bullying someone or putting down someone else, the others are obliged to go along or risk being kicked out themselves.
This is where I was glad to read that Cartoon Network is putting together a program to reach middle school kids with a campaign to not just stand on the sidelines when someone is being bullied…which makes sense—85% of bullying events are witnessed by someone else. It’s still being put together, but I’m sure that it will be a proactive approach that will have appropriate safeguards to protect a person who stands up to the bully. I’ve seen this work from my own experience and it is one of the reasons that I’m starting my H.E.R.O. Foundation.
The first time I remember Brian Puls coming to my rescue (indirectly) is when I was being chased home by three bullies in the 6th grade. These bullies had me so scared, they said that they had all the routes to my home covered and that they would certainly ‘get’ me. Crying, I ran up to a house—and Brian and his mother answered the door. She could see how upset I was and offered to drive me home, safely around the bullies.
That was when 6th grade was still elementary school. By the time I got to junior high, I was pretty much ok…it was a new ‘start’ for me. But by 9th grade, another bully, Roland, started targeting me. Everyday when I went to school, he would catch me unaware and ‘knee’ me in a sensitive area. I finally got the gumption to tell my mom about it, at which point she urged me to go to the principle’s office. Funny thing; parents ALWAYS tell you to go to the principal (or worse, they go themselves). That is (at least from a kid’s standpoint) worse than enduring the bullying…and it doesn’t make it stop. I told my mom I would take care of it. So, what I did was I stuffed my knit cap (it was winter), in the front of my pants before walking in the school building. Roland, of course was waiting, and again did our morning ritual. Only this time, he didn’t get the reaction he expected and proceeded to grab my hat, which I then grabbed onto. We then started wrestling.
Funny thing is, I’ve been blessed with my father’s physique. At 71, he still runs 5 miles a day, dances 6 hours every Friday night, plays competitive softball on the 1st place team in the league and has a girlfriend 15 years his junior. So, when Roland and I started wrestling, I quickly got the advantage. That’s when I felt another pair of hands on me. I wondered, ‘what the heck ?’ Turns out, Roland’s lieutenant, Tom, decided to give his buddy a hand. I don’t know what would have happened if a teacher hadn’t broken it up right then. As it was, I had embarrassed Roland and in an effort to save face, he proclaimed loudly, “you’re dead. You hear me…dead ! You better meet me at the playground after school”.
As it was, Roland was a bad kid (imagine that) and had to stay after school for detention for an unrelated infraction. So I waited. And waited. And waited. News of the upcoming fight had even gotten to the high school…and Roland was a well-respected ‘tough’ even in high school. My friends had all tried to talk me out of it…but I wouldn’t hear of it. “I’m done. Win or lose, it ends here, today”. Finally Roland shows up. We circle each other and trade some punches. Of course, fights inevitably wind up on the ground…and this one did. I again was able to get Roland in a compromised position. The high school kids stood us up as the fight was going nowhere. It was apparent that Roland’s eye was starting to swell up. What was also apparent was the 3-inch long piece of one-inch steel Roland was holding in his hand.
Being in 9th grade, you’re not sure about a lot of things and believe things you’re not entirely sure are true. All I knew was that that piece of metal looked MEAN and that I could be seriously hurt (I remember paralyzation coming to mind) by that gleaming metal. “Ill fight him, but he needs to put that down”. This is when Tom, Roland’s friend, started tossing pennies at my eyes.
“Leave him alone”.
I looked up. It was Brian Puls. Of course, Tom, who was a little guy, nearly shouted, “leave me alone ! How would you like it someone bigger than you picked on you ?!!!”. Brian, who was a really big kid, looked slowly around and said, “like who’s here ?”. “Vassell !”, Tom pointed, using the kid’s last name. “Ummm, why don’t you put the bar down, Roland,” Tom’s would-be champion exclaimed.
The rest of the story was like a fairy-tale. The fight continued and I was able to get Roland’s back. I then proceeded to rain upper-cuts into his face. What happened next is forever etched upon my mind. As if in slow-motion, my fist connected with Roland’s nose, which gushed a fountain of crimson, at the same time I remember a blonde girl turning (in slow-motion) her face, with her hands flying to her face, in a scream. I planted my hand in the middle of Roland’s back and stood up, simultaneously pushing Roland down on his belly…”Hah!! I beat you !!” I said quietly. And then all the kids ran because the red and blue lights had found us.
In the police station, I kind of got an idea of what Roland was going to face when he got home. His father was more irate that he lost the fight than anything else. I realized something that day…not all kids have the same happy home life that I did. As I walked out of the police station, Roland and I parted ways…I extended my hand, “see you tomorrow at school” I said. Roland shook it.
It’s funny. From that day forward I never got in another fight. But the teasing continued…just at another school. Physically, I’m now only 180 pounds, but I went on to bench-press over 430 pounds. The damage that happens to kids because of bullying isn’t so much physical…it’s mental and emotional. That’s why I am starting the H.E.R.O. Foundation, (Help Everyone Respect Others). One of the best ways I’ve found, (and you’ll be hearing me talk about it in the future), to instill respect, discipline, as well as physical fitness and the ability to defend yourself, is through the martial arts. Perhaps most important is that it instills CONFIDENCE. It’s funny--I had strength and natural grappling skills, but because my confidence was shaken by that uppercut in 4th grade, I allowed myself to be bullied for so long. I have put in a request to the Cartoon Network to try to work with them in any way I can.
In these economically troubled times, everyone deserves a chance to participate. I actually had started martial arts as an 8-year old…but my mom couldn’t afford it. I wonder how my life would have been different if I had continued to go. To that end, the first act I am taking is to write a check to the United Studios of Self Defense to sponsor one kid to attend the karate tournament in California this weekend. I hope to expand it from there. I chose USSD because it is where I currently go, but more importantly, because of the atmosphere…it is truly self-DEFENSE…the best defense is to walk (or run) away, and differs from most of the popular UFC-style MMA schools that have sprung up which only teach you how to hurt people. Also, USSD has individualized instruction but with a common curriculum…by having ‘standardized’ training it allows a structured environment which helps facilitate bonding with other students. My sensei, Mr. Barajas, is one of the best people I know, period. Trust me, a sensei works long hours…and it’s not for the money. He has patience, skill, a love for his craft, and honor. Master Black, the Regional Director, embodies all these characteristics as well. They work with each person’s individual strengths and weaknesses (there was an autistic kid in one of the private lessons I observed). They have a multitude of payment plans, and for a limited time, you can even get your child (or yourself) free lessons. I urge you to call Mr. Barajas at 702-454-6656---they are nationwide if you aren’t in Nevada and can help you connect with a school in your town. I love that when I’m traveling around the country.
In closing, the scars I bear inevitably remain a part of who I am…I still have a bit of shame and haven’t quite learned to wear those experiences as a badge of honor yet—even talking (or writing about it) helps. But I take comfort in the fact that my unfortunate experiences will allow me to help other kids avoid the same (or worse) fate that I endured. I can be their H.E.R.O.; like Brian was to me all those years ago.
A quick epilogue—I’ve looked for Brian online for some time now; I know he had cancer as a teenager…I lost touch when my family moved to the new high school. I’m hoping beyond hope that he beat it and is alive and well. So I can thank him these many years later.
Dan Heffley
(No, I’m not Greg Heffley’s father of the book “Diary of a Wimpy Kid”—I just have the same name…coincidence ?)
I say this with some conviction because I experienced it. I have friends on Facebook who post these ‘happy’ high school (and junior high) school pictures, looking back, that for them, are happy memories. I’ve spent the last 20-odd years doing everything I could to forget about those years.
Bullying is one of those things that people would rather turn their heads to, teachers included. They think it’s harmless teasing and just part of growing up. But I’m here to tell you…those ‘scars’ don’t go away…ever. Some, like me, go on to successful careers and make a difference (more on that towards the end of this). Others, like the two beautiful teenage girls who hung themselves recently in the news, never make it that far. For me, it started in 4th grade with a miscalculation during a schoolyard fight…I ‘bobbed’ instead of ‘weaved’ and got caught with an uppercut…and lost that fight. But I lost more than a fight that day…I lost my sense of self-worth.
Kids, especially in middle school, are at odds with themselves…their bodies are changing, they are understanding more of the world and that it is not always a ‘nice, rule-abiding’ place, and that some people are treated better than others and that people can be ‘categorized’. That’s where the cliques start—“you belong—you don’t belong”. So, they are trying to ‘fit in’ with everybody else and find their place in a world where they don’t know their place. Some mature faster than others. Some don’t like the status quo and have different interests—which makes them ‘weird’ and ostracized. Some kids look to be the clown; for others they look to put down someone else to take the focus off of themselves and their insecurities. For the kids that ‘belong’, if one of these ‘leaders’ of a clique starts bullying someone or putting down someone else, the others are obliged to go along or risk being kicked out themselves.
This is where I was glad to read that Cartoon Network is putting together a program to reach middle school kids with a campaign to not just stand on the sidelines when someone is being bullied…which makes sense—85% of bullying events are witnessed by someone else. It’s still being put together, but I’m sure that it will be a proactive approach that will have appropriate safeguards to protect a person who stands up to the bully. I’ve seen this work from my own experience and it is one of the reasons that I’m starting my H.E.R.O. Foundation.
The first time I remember Brian Puls coming to my rescue (indirectly) is when I was being chased home by three bullies in the 6th grade. These bullies had me so scared, they said that they had all the routes to my home covered and that they would certainly ‘get’ me. Crying, I ran up to a house—and Brian and his mother answered the door. She could see how upset I was and offered to drive me home, safely around the bullies.
That was when 6th grade was still elementary school. By the time I got to junior high, I was pretty much ok…it was a new ‘start’ for me. But by 9th grade, another bully, Roland, started targeting me. Everyday when I went to school, he would catch me unaware and ‘knee’ me in a sensitive area. I finally got the gumption to tell my mom about it, at which point she urged me to go to the principle’s office. Funny thing; parents ALWAYS tell you to go to the principal (or worse, they go themselves). That is (at least from a kid’s standpoint) worse than enduring the bullying…and it doesn’t make it stop. I told my mom I would take care of it. So, what I did was I stuffed my knit cap (it was winter), in the front of my pants before walking in the school building. Roland, of course was waiting, and again did our morning ritual. Only this time, he didn’t get the reaction he expected and proceeded to grab my hat, which I then grabbed onto. We then started wrestling.
Funny thing is, I’ve been blessed with my father’s physique. At 71, he still runs 5 miles a day, dances 6 hours every Friday night, plays competitive softball on the 1st place team in the league and has a girlfriend 15 years his junior. So, when Roland and I started wrestling, I quickly got the advantage. That’s when I felt another pair of hands on me. I wondered, ‘what the heck ?’ Turns out, Roland’s lieutenant, Tom, decided to give his buddy a hand. I don’t know what would have happened if a teacher hadn’t broken it up right then. As it was, I had embarrassed Roland and in an effort to save face, he proclaimed loudly, “you’re dead. You hear me…dead ! You better meet me at the playground after school”.
As it was, Roland was a bad kid (imagine that) and had to stay after school for detention for an unrelated infraction. So I waited. And waited. And waited. News of the upcoming fight had even gotten to the high school…and Roland was a well-respected ‘tough’ even in high school. My friends had all tried to talk me out of it…but I wouldn’t hear of it. “I’m done. Win or lose, it ends here, today”. Finally Roland shows up. We circle each other and trade some punches. Of course, fights inevitably wind up on the ground…and this one did. I again was able to get Roland in a compromised position. The high school kids stood us up as the fight was going nowhere. It was apparent that Roland’s eye was starting to swell up. What was also apparent was the 3-inch long piece of one-inch steel Roland was holding in his hand.
Being in 9th grade, you’re not sure about a lot of things and believe things you’re not entirely sure are true. All I knew was that that piece of metal looked MEAN and that I could be seriously hurt (I remember paralyzation coming to mind) by that gleaming metal. “Ill fight him, but he needs to put that down”. This is when Tom, Roland’s friend, started tossing pennies at my eyes.
“Leave him alone”.
I looked up. It was Brian Puls. Of course, Tom, who was a little guy, nearly shouted, “leave me alone ! How would you like it someone bigger than you picked on you ?!!!”. Brian, who was a really big kid, looked slowly around and said, “like who’s here ?”. “Vassell !”, Tom pointed, using the kid’s last name. “Ummm, why don’t you put the bar down, Roland,” Tom’s would-be champion exclaimed.
The rest of the story was like a fairy-tale. The fight continued and I was able to get Roland’s back. I then proceeded to rain upper-cuts into his face. What happened next is forever etched upon my mind. As if in slow-motion, my fist connected with Roland’s nose, which gushed a fountain of crimson, at the same time I remember a blonde girl turning (in slow-motion) her face, with her hands flying to her face, in a scream. I planted my hand in the middle of Roland’s back and stood up, simultaneously pushing Roland down on his belly…”Hah!! I beat you !!” I said quietly. And then all the kids ran because the red and blue lights had found us.
In the police station, I kind of got an idea of what Roland was going to face when he got home. His father was more irate that he lost the fight than anything else. I realized something that day…not all kids have the same happy home life that I did. As I walked out of the police station, Roland and I parted ways…I extended my hand, “see you tomorrow at school” I said. Roland shook it.
It’s funny. From that day forward I never got in another fight. But the teasing continued…just at another school. Physically, I’m now only 180 pounds, but I went on to bench-press over 430 pounds. The damage that happens to kids because of bullying isn’t so much physical…it’s mental and emotional. That’s why I am starting the H.E.R.O. Foundation, (Help Everyone Respect Others). One of the best ways I’ve found, (and you’ll be hearing me talk about it in the future), to instill respect, discipline, as well as physical fitness and the ability to defend yourself, is through the martial arts. Perhaps most important is that it instills CONFIDENCE. It’s funny--I had strength and natural grappling skills, but because my confidence was shaken by that uppercut in 4th grade, I allowed myself to be bullied for so long. I have put in a request to the Cartoon Network to try to work with them in any way I can.
In these economically troubled times, everyone deserves a chance to participate. I actually had started martial arts as an 8-year old…but my mom couldn’t afford it. I wonder how my life would have been different if I had continued to go. To that end, the first act I am taking is to write a check to the United Studios of Self Defense to sponsor one kid to attend the karate tournament in California this weekend. I hope to expand it from there. I chose USSD because it is where I currently go, but more importantly, because of the atmosphere…it is truly self-DEFENSE…the best defense is to walk (or run) away, and differs from most of the popular UFC-style MMA schools that have sprung up which only teach you how to hurt people. Also, USSD has individualized instruction but with a common curriculum…by having ‘standardized’ training it allows a structured environment which helps facilitate bonding with other students. My sensei, Mr. Barajas, is one of the best people I know, period. Trust me, a sensei works long hours…and it’s not for the money. He has patience, skill, a love for his craft, and honor. Master Black, the Regional Director, embodies all these characteristics as well. They work with each person’s individual strengths and weaknesses (there was an autistic kid in one of the private lessons I observed). They have a multitude of payment plans, and for a limited time, you can even get your child (or yourself) free lessons. I urge you to call Mr. Barajas at 702-454-6656---they are nationwide if you aren’t in Nevada and can help you connect with a school in your town. I love that when I’m traveling around the country.
In closing, the scars I bear inevitably remain a part of who I am…I still have a bit of shame and haven’t quite learned to wear those experiences as a badge of honor yet—even talking (or writing about it) helps. But I take comfort in the fact that my unfortunate experiences will allow me to help other kids avoid the same (or worse) fate that I endured. I can be their H.E.R.O.; like Brian was to me all those years ago.
A quick epilogue—I’ve looked for Brian online for some time now; I know he had cancer as a teenager…I lost touch when my family moved to the new high school. I’m hoping beyond hope that he beat it and is alive and well. So I can thank him these many years later.
Dan Heffley
(No, I’m not Greg Heffley’s father of the book “Diary of a Wimpy Kid”—I just have the same name…coincidence ?)
Tuesday, June 1, 2010
Make My Day
Make My Day.
What does NAHU and the person that uttered that famous line have in common ? Both have been around for 80 years this year. May 31st was the 80th birthday of Clint Eastwood- actor, director and advocate. I mention this because in addition to giving us acting (and directing) such movie favorites as Million Dollar Baby and Gran Torino, directing Invictus and Flags of our Fathers, he is an avid advocate for businesses, recognized by various organizations for his advocacy.
As this health reform has started to shake out, we’re already seeing the shape of things to come. For those of you unaware, I was informed today that Golden Rule (a United Healthcare Company that sells individual products) is discontinuing insuring children as a standalone policy because of the provision in the law that all children must be taken irregardless of pre-existing conditions. Anyone that understands the insurance industry understands that it can be compared to a balloon…squeeze one area, and another area over-inflates…it’s called cost-shifting. We’ve seen it with insurance mandates and we’ll continue to see it as this defective law’s provisions are implemented.
More than anything, we need a legislator who has a good grasp of business and insurance principles. A background in healthcare is also helpful. Accessibility and active listening are also helpful. In the Senate race, I’ve met with Harry Reid’s office numerous times…but never with the Senator himself. By contrast, I have met with Nevada’s other Senator numerous times and even had the honor of serving on his health care roundtable this past summer. I say this for what follows.
In the race for the Republican nomination for Senator, I attempted to meet with the three (in my estimation) front runners: Sue Lowden, Danny Tarkanian and Sharon Engle. Danny was kind enough to call me back personally; I scheduled a meeting with him and health care reform leadership…it was canceled with a promise to reschedule. I’m still waiting. Sharon Engle couldn’t commit to a face-to-face, but was gracious enough to hold a 45 minute conference call with us where we were very impressed. Sue Lowden, on the other hand actually met with me a couple months back—personally for near-on two hours. Well here it is a week before the primary…and I called Sue’s office and suggested a telephone call with leadership. She wouldn’t do it…instead, she found time to personally drive to Henderson and meet with us face-to-face, where she expounded her pro-business standpoint (she helped with the Worker’s Comp issue in 1995) and her toughness as a litigator.
I know we’re not a political organization. Clint Eastwood stated, “A man needs to know his limitations”. I know my limitations…and I know what I’m good at. Some people say that our state would be better served by having a Senate Majority Leader in power. Whether that’s true or not I cannot comment on…What I CAN comment on is that the Senate Majority Leader believes that the PPACA law is the fix for our system (we know it’s not) and has been parroting rhetoric at the forums he’s held. (We all are familiar with his infamous Chamber of Commerce speech-which he repeated less than a week later !) We are an inherently non-partisan organization; however, we are faced with an imperfect law that threatens our very survival as an industry because it left out cost-containment measures needed to make health reform work. We need leaders in Washington who are willing to listen to us and act upon our input to make the best of this law. We need leaders on a national and state level who are willing to put in place cost measures not in the bill on a state level to help us contain these costs. We need leaders who are ACCESSIBLE. In a perfect world, we all would have health insurance, live in a white house with a picket fence, dog, cat and two-and-a-half kids. However, as Jon Ralston said, “that’s all well and fine on Planet Utopia, but we live in the real world”. In the “real world”, payroll has to be met, the rent has to be paid, business licenses have to be renewed. In a perfect world, I’d be driving a Lamborghini…instead I drive a fuel-efficient convertible…not that I’m complaining.
Clint Eastwood showed that you had to be a fighter and sometimes take unpopular positions, that on the surface, would could looked at as ludicrous…one that Sue Lowden did in testifying against the mammogram mandate because of the cost-shifting that it would entail; I feel her pain. After all, I testified against the autism mandate last year, which didn’t exactly sit well with my brother and his family (my nephew’s autistic). Doing what’s emotionally right doesn’t mean it’s the ‘right’ thing to do. I mean, who DOESN”T want to help autistic kids or advocate mammography ?
The point of all this is that as an industry, I need to advocate on behalf of our membership and by default, our clients who look to us for guidance. I can’t tell you who to vote for, but I can certainly pass along the information on who has our collective backs and who doesn’t.
Dan Heffley
What does NAHU and the person that uttered that famous line have in common ? Both have been around for 80 years this year. May 31st was the 80th birthday of Clint Eastwood- actor, director and advocate. I mention this because in addition to giving us acting (and directing) such movie favorites as Million Dollar Baby and Gran Torino, directing Invictus and Flags of our Fathers, he is an avid advocate for businesses, recognized by various organizations for his advocacy.
As this health reform has started to shake out, we’re already seeing the shape of things to come. For those of you unaware, I was informed today that Golden Rule (a United Healthcare Company that sells individual products) is discontinuing insuring children as a standalone policy because of the provision in the law that all children must be taken irregardless of pre-existing conditions. Anyone that understands the insurance industry understands that it can be compared to a balloon…squeeze one area, and another area over-inflates…it’s called cost-shifting. We’ve seen it with insurance mandates and we’ll continue to see it as this defective law’s provisions are implemented.
More than anything, we need a legislator who has a good grasp of business and insurance principles. A background in healthcare is also helpful. Accessibility and active listening are also helpful. In the Senate race, I’ve met with Harry Reid’s office numerous times…but never with the Senator himself. By contrast, I have met with Nevada’s other Senator numerous times and even had the honor of serving on his health care roundtable this past summer. I say this for what follows.
In the race for the Republican nomination for Senator, I attempted to meet with the three (in my estimation) front runners: Sue Lowden, Danny Tarkanian and Sharon Engle. Danny was kind enough to call me back personally; I scheduled a meeting with him and health care reform leadership…it was canceled with a promise to reschedule. I’m still waiting. Sharon Engle couldn’t commit to a face-to-face, but was gracious enough to hold a 45 minute conference call with us where we were very impressed. Sue Lowden, on the other hand actually met with me a couple months back—personally for near-on two hours. Well here it is a week before the primary…and I called Sue’s office and suggested a telephone call with leadership. She wouldn’t do it…instead, she found time to personally drive to Henderson and meet with us face-to-face, where she expounded her pro-business standpoint (she helped with the Worker’s Comp issue in 1995) and her toughness as a litigator.
I know we’re not a political organization. Clint Eastwood stated, “A man needs to know his limitations”. I know my limitations…and I know what I’m good at. Some people say that our state would be better served by having a Senate Majority Leader in power. Whether that’s true or not I cannot comment on…What I CAN comment on is that the Senate Majority Leader believes that the PPACA law is the fix for our system (we know it’s not) and has been parroting rhetoric at the forums he’s held. (We all are familiar with his infamous Chamber of Commerce speech-which he repeated less than a week later !) We are an inherently non-partisan organization; however, we are faced with an imperfect law that threatens our very survival as an industry because it left out cost-containment measures needed to make health reform work. We need leaders in Washington who are willing to listen to us and act upon our input to make the best of this law. We need leaders on a national and state level who are willing to put in place cost measures not in the bill on a state level to help us contain these costs. We need leaders who are ACCESSIBLE. In a perfect world, we all would have health insurance, live in a white house with a picket fence, dog, cat and two-and-a-half kids. However, as Jon Ralston said, “that’s all well and fine on Planet Utopia, but we live in the real world”. In the “real world”, payroll has to be met, the rent has to be paid, business licenses have to be renewed. In a perfect world, I’d be driving a Lamborghini…instead I drive a fuel-efficient convertible…not that I’m complaining.
Clint Eastwood showed that you had to be a fighter and sometimes take unpopular positions, that on the surface, would could looked at as ludicrous…one that Sue Lowden did in testifying against the mammogram mandate because of the cost-shifting that it would entail; I feel her pain. After all, I testified against the autism mandate last year, which didn’t exactly sit well with my brother and his family (my nephew’s autistic). Doing what’s emotionally right doesn’t mean it’s the ‘right’ thing to do. I mean, who DOESN”T want to help autistic kids or advocate mammography ?
The point of all this is that as an industry, I need to advocate on behalf of our membership and by default, our clients who look to us for guidance. I can’t tell you who to vote for, but I can certainly pass along the information on who has our collective backs and who doesn’t.
Dan Heffley
Tuesday, May 11, 2010
The $500 Million Outrage
A jury awarded over $500 million to one plaintiff who was infected with hepatitis by a Las Vegas Endoscopy Clinic that was reusing needles in an effort to save money. There was no question that the clinic and it’s lead physician, Dr. Desai, were negligent in causing nearly 40 people to become infected and causing distress to innumerable patients at that clinic, which has been subsequently closed down. Dr. Desai also has had his medical license revoked. This award, and the others that are surely to follow by the other thirty-nine or so infected patients, would be a good thing by punishing healthcare providers who abuse the public trust. Except Dr. Desai, (who has shown no remorse), was subsequently found not able to stand trial due to a medical condition—he had a ‘stroke’ whose severity has been called into question and was found not able to participate in his own defense. He also has filed for bankruptcy protection. So if Dr. Desai doesn’t have to pay the award, who was sued ? His medical malpractice insurance ? No. (Even though the trial lawyers used the scandal when it was first discovered last year to try to repeal Nevada’s $350,000 cap on pain and suffering damages). No, Dr. Desai’s malpractice insurance didn’t pay because what Dr. Desai did was a criminal and illegal act. Malpractice insurance insures doctors for unintentional mistakes that cause harm to patients. Intentionally harming (or intentionally disregarding established medical practices designed to prevent harming someone) are NOT (rightly so) covered by malpractice. How can insurance companies, or ANYONE for that matter, guard against intentional criminal acts ? The answer is they can’t, and shouldn’t be held liable if someone uses a legal product illegally. It’s why the gun industry hasn’t been successfully sued for all the murders in the U.S. (or the knife-manufacturers for all the stabbings, or the film industry for allowing Uwe Boll films to be shown).
Or so we thought. While the infected patients’ situation is an outrage and they are victims in every sense of the word, the defendant who has to pay the $500 million award is also an outrage. Seeing as the doctor and the endoscopy clinic had no assets, the plaintiff’s lawyers looked at whom they COULD sue. Anybody who’s watched a sleazy lawyer on the silver screen knows you look for the money. And in this case it was the pharmaceutical companies that provided drugs to the clinic. It’s a well know fact, that if you buy in bulk, you save money. We only have to look at the success of COSTCO or Sam’s Club to see that. Apparently that’s not a good enough excuse for pharmaceuticals. They produced large bottles of an injectible drug that "allowed" the clinic to reuse the syringes. I guess they thought that if the drug were available in individual doses, then the plaintiffs wouldn’t have been infected. Oh, that and a warning label that stated that a new needle should be used each time. That Implies that the doctor and his staff didn’t know you don't reuse syringes (and would have actually complied with that). I’m sorry, but if you go to school for years and years and have MD or RN at the end of your name, I’m thinking that you already know that you don’t reuse needles. The jury saw it otherwise and cast the blame on the deep pockets. Except those ‘deep’ pockets get their paychecks from insurance companies and those unlucky enough not to have health insurance. Even if this award is appealed successfully (which both drug companies are doing), the damage is done. Drug companies from here on out will ‘idiot-proof’ every drug that heretofore was able to packaged in bulk. Not only will it cost more money for drugs, but also is a waste of our natural resources. Where does the insanity end ?
Or so we thought. While the infected patients’ situation is an outrage and they are victims in every sense of the word, the defendant who has to pay the $500 million award is also an outrage. Seeing as the doctor and the endoscopy clinic had no assets, the plaintiff’s lawyers looked at whom they COULD sue. Anybody who’s watched a sleazy lawyer on the silver screen knows you look for the money. And in this case it was the pharmaceutical companies that provided drugs to the clinic. It’s a well know fact, that if you buy in bulk, you save money. We only have to look at the success of COSTCO or Sam’s Club to see that. Apparently that’s not a good enough excuse for pharmaceuticals. They produced large bottles of an injectible drug that "allowed" the clinic to reuse the syringes. I guess they thought that if the drug were available in individual doses, then the plaintiffs wouldn’t have been infected. Oh, that and a warning label that stated that a new needle should be used each time. That Implies that the doctor and his staff didn’t know you don't reuse syringes (and would have actually complied with that). I’m sorry, but if you go to school for years and years and have MD or RN at the end of your name, I’m thinking that you already know that you don’t reuse needles. The jury saw it otherwise and cast the blame on the deep pockets. Except those ‘deep’ pockets get their paychecks from insurance companies and those unlucky enough not to have health insurance. Even if this award is appealed successfully (which both drug companies are doing), the damage is done. Drug companies from here on out will ‘idiot-proof’ every drug that heretofore was able to packaged in bulk. Not only will it cost more money for drugs, but also is a waste of our natural resources. Where does the insanity end ?
Wednesday, March 17, 2010
Anthem's 39% rate increase explained
Much has been said about the ‘exorbitant’ 39% rate increase that Wellpoint had after declaring high profits. This blog will attempt to address both of these items. First off, why are there rate increases anyway ? To illustrate, sometimes it helps to put things in perspective.
Imagine you have a business. Unless you’re a non-profit company, at the end of the year, you’d like to reward the people that invested money with you (stockholders). That’s how America works…we have companies that people invest in with the expectation that they will make more money than they have put in. One of the favorite targets of Democratic health-reformers is “obscene insurance company profits”. In 2009, as of the third quarter, health insurance company profits ranked #86th, with an average rate of return of 3.3%. Heck, I can get more with a 5-yr CD at the bank-guaranteed ! 4th quarter numbers are in and it dropped further to #88 (which was actually inflated due to a one-time sale of a pharmaceutical arm of an insurance company-without that, they would have ranked #92). “But it still amounts to a boatload of money for the insurance company” is what I usually hear. Again, a bit of perspective is in order. If ALL of the profits could magically be put back into the health care system, what effect would that have ? The answer will surprise you…because health care costs are one-sixth of our total economy, eliminating ALL insurance company profits would fund our nation’s healthcare system for another 36-48 hours . Which brings us to the subject of Wellpoint’s 39% increase.
While insurance companies are a business unto themselves, they are not the drivers of health care costs. On the contrary, they are the financiers of our health care costs. The simplest way to grasp this is by buying a house. If you buy a house, most people can’t afford to pay cash up front-so they go to a mortgage company for the money, and then pay the mortgage company back a little at a time, for a fee (interest rate) and according to their conditions. If you default on the payments, they can take your house. The cost of the house is made up of all the people that worked on it, the materials and so forth. In addition to labor (doctors, nurses, hospital staff, etc.) and materials (drugs, bandages, wheelchairs, medical facilities, etc), there are many cost items specific to health care, but I’ll only outline two. The first is technology and the example I’ll give is straight out of today’s (3/17/10) USA Today—“The cost of cancer treatment is 'skyrocketing'… a new analysis shows. From 1990 to 2008, spending on cancer care soared to more than $90 billion from $27 billion. The increase was driven by the rising costs of sophisticated new drugs, robotic surgeries and radiation techniques, as well as the growing number of patients who are eligible to take them. Many older, frailer patients -- who might not have been considered strong enough to weather traditional surgery -- now have the option to have less invasive operations or more tightly focused radiation treatments, the analysis says". Today’s Seattle Times/Bloomberg reports that "The rising cost of cancer research and care, … helped reduce death rates by 16 percent over 40 years”. Medical advances cost money. Innovation comes from the private sector, not the government. I’ll agree that the reason is selfish- the lure of a big payday. The alternative is just to not try to advance medicine and/or ration it. The second item I’ll address is called “cost-shifting”. Many people have heard of it, but they may not understand it. Let’s say that your company produces a product and you charge $1.00 per item. Every year you see the regular inflation, so you add that in, so next year your price is $1.03 and so on. Now imagine that another inflationary factor is thrown in…in this case medical inflation or the cost of medical research and development…at around 12%. Now in order to continue reaping your 3.3% profit so you can continue to attract investors (and keep the ones you have) you need to raise your price to $1.15, and so on. It doesn’t stop there. Imagine if the government came to you and said, “we like your product, but we are only going to give you 70 cents.” They are the government, so you have no choice. You can’t negotiate with them. So you need to raise your costs for everyone else. That is what Medicare and Medicaid do. It gets worse. In 1986 a law was passed that said if someone doesn’t have the money to purchase your product but needs it, you have to GIVE it to them and try to collect on the costs later. If it’s more than a few thousand dollars, the person usually can declare bankruptcy and you’re still out the money. No house to repossess there. So, you have to raise your price for everyone else to cover for that. It’s gotten so bad that employers and consumers are paying $90 BILLION extra just because of the under-payment from Medicare and Medicaid, not including flat-out uncompensated care.
In fact, since 1970, the cost of treating a Medicare beneficiary has risen 8.8% a year. In today’s Las Vegas Sun, testimony was given that the $37 rate per 15-minute unit (for medical providers) hasn't been increased since being set in 1980, yet the cost of doing business has risen. And now it is going down to $21" with the proposed Medicare reimbursement cut. Is it any wonder that doctor’s don’t want to treat Medicare patients ? These are just a few of the reasons not to let the government run our health care…they undercut prices with no negotiation, stifle innovation and can’t manage the programs they have now (Medicare will be broke in less than 10 years and Social Security is holding onto $2.5 TRILLION in IOU’s from the government who raided it to pay for other programs).
All of these costs are added to the health care we use, which is financed by the health insurance companies. Is it any wonder we are seeing rate increases ? Speaking of rate increases, that 39% increase ? It was for a demographic (group of people) in a particular age-group only on an obsolete plan. Insurance companies spread the risk over a large group of people, but most don’t spread it over everyone they have insured as that would be a bit unfair to the young healthy people (an example is New York state, where they spread it out over everyone—the premium is in excess of $600 a month). Instead, they group people together by age and gender, usually in 5-year age groups (called ‘bands’). So, there is one rate for males, say 50-54 and another for females, say 25-29. A word about females is in order here. We hear a lot about ‘discrimination’, with women paying more than their similarly aged-male companions. Again, it’s a cost issue-women can get pregnant, which is more expense and which needs to be financed. Even policies without maternity are required by law to cover complications of pregnancy which can be upwards of $1 million or more. Women also have more internal parts that need periodic checking than men. Lastly, they are more health-conscious, which means they go to the doctor more often. All this adds up to more money out than in. So, the insurance company adjusts for that. What happened with Wellpoint’s increase was two-fold. The demographic that accounted for that increase was unhealthier than expected. Also, the benefit plan that they were on was outdated, meaning that the benefits were based upon cost expectations that are no longer valid and the benefits became exceedingly rich compared with other companies’ plans. Now, when you raise rates on insurance companies plans, people typically will choose to go to another less-comprehensive (and less expensive) plan. That is, as long as the premium on the better plan is higher than the anticipated benefits. Those that are facing $100,000+ cancer treatments will gladly pay a higher premium if it means they still get their treatment for $10 instead of going to another plan that requires them to pay the first $1000 and then 20%. This leads to something called ‘adverse selection’, ultimately leading to what is known in the insurance industry as a ‘death spiral’---the amount of money coming in eventually becomes far less than the money that is going out for treatments and it can’t support itself. However, unlike the government, they can’t issue IOU’s.
I would urge our Congressmen to vote for the Senate bill if it addressed the real problems faced by health care- out of control spiraling costs- but it doesn't. All it does is put artificial restrictions and requirements on the financing mechanisms of our health care. And that is a recipe for disaster.
Imagine you have a business. Unless you’re a non-profit company, at the end of the year, you’d like to reward the people that invested money with you (stockholders). That’s how America works…we have companies that people invest in with the expectation that they will make more money than they have put in. One of the favorite targets of Democratic health-reformers is “obscene insurance company profits”. In 2009, as of the third quarter, health insurance company profits ranked #86th, with an average rate of return of 3.3%. Heck, I can get more with a 5-yr CD at the bank-guaranteed ! 4th quarter numbers are in and it dropped further to #88 (which was actually inflated due to a one-time sale of a pharmaceutical arm of an insurance company-without that, they would have ranked #92). “But it still amounts to a boatload of money for the insurance company” is what I usually hear. Again, a bit of perspective is in order. If ALL of the profits could magically be put back into the health care system, what effect would that have ? The answer will surprise you…because health care costs are one-sixth of our total economy, eliminating ALL insurance company profits would fund our nation’s healthcare system for another 36-48 hours . Which brings us to the subject of Wellpoint’s 39% increase.
While insurance companies are a business unto themselves, they are not the drivers of health care costs. On the contrary, they are the financiers of our health care costs. The simplest way to grasp this is by buying a house. If you buy a house, most people can’t afford to pay cash up front-so they go to a mortgage company for the money, and then pay the mortgage company back a little at a time, for a fee (interest rate) and according to their conditions. If you default on the payments, they can take your house. The cost of the house is made up of all the people that worked on it, the materials and so forth. In addition to labor (doctors, nurses, hospital staff, etc.) and materials (drugs, bandages, wheelchairs, medical facilities, etc), there are many cost items specific to health care, but I’ll only outline two. The first is technology and the example I’ll give is straight out of today’s (3/17/10) USA Today—“The cost of cancer treatment is 'skyrocketing'… a new analysis shows. From 1990 to 2008, spending on cancer care soared to more than $90 billion from $27 billion. The increase was driven by the rising costs of sophisticated new drugs, robotic surgeries and radiation techniques, as well as the growing number of patients who are eligible to take them. Many older, frailer patients -- who might not have been considered strong enough to weather traditional surgery -- now have the option to have less invasive operations or more tightly focused radiation treatments, the analysis says". Today’s Seattle Times/Bloomberg reports that "The rising cost of cancer research and care, … helped reduce death rates by 16 percent over 40 years”. Medical advances cost money. Innovation comes from the private sector, not the government. I’ll agree that the reason is selfish- the lure of a big payday. The alternative is just to not try to advance medicine and/or ration it. The second item I’ll address is called “cost-shifting”. Many people have heard of it, but they may not understand it. Let’s say that your company produces a product and you charge $1.00 per item. Every year you see the regular inflation, so you add that in, so next year your price is $1.03 and so on. Now imagine that another inflationary factor is thrown in…in this case medical inflation or the cost of medical research and development…at around 12%. Now in order to continue reaping your 3.3% profit so you can continue to attract investors (and keep the ones you have) you need to raise your price to $1.15, and so on. It doesn’t stop there. Imagine if the government came to you and said, “we like your product, but we are only going to give you 70 cents.” They are the government, so you have no choice. You can’t negotiate with them. So you need to raise your costs for everyone else. That is what Medicare and Medicaid do. It gets worse. In 1986 a law was passed that said if someone doesn’t have the money to purchase your product but needs it, you have to GIVE it to them and try to collect on the costs later. If it’s more than a few thousand dollars, the person usually can declare bankruptcy and you’re still out the money. No house to repossess there. So, you have to raise your price for everyone else to cover for that. It’s gotten so bad that employers and consumers are paying $90 BILLION extra just because of the under-payment from Medicare and Medicaid, not including flat-out uncompensated care.
In fact, since 1970, the cost of treating a Medicare beneficiary has risen 8.8% a year. In today’s Las Vegas Sun, testimony was given that the $37 rate per 15-minute unit (for medical providers) hasn't been increased since being set in 1980, yet the cost of doing business has risen. And now it is going down to $21" with the proposed Medicare reimbursement cut. Is it any wonder that doctor’s don’t want to treat Medicare patients ? These are just a few of the reasons not to let the government run our health care…they undercut prices with no negotiation, stifle innovation and can’t manage the programs they have now (Medicare will be broke in less than 10 years and Social Security is holding onto $2.5 TRILLION in IOU’s from the government who raided it to pay for other programs).
All of these costs are added to the health care we use, which is financed by the health insurance companies. Is it any wonder we are seeing rate increases ? Speaking of rate increases, that 39% increase ? It was for a demographic (group of people) in a particular age-group only on an obsolete plan. Insurance companies spread the risk over a large group of people, but most don’t spread it over everyone they have insured as that would be a bit unfair to the young healthy people (an example is New York state, where they spread it out over everyone—the premium is in excess of $600 a month). Instead, they group people together by age and gender, usually in 5-year age groups (called ‘bands’). So, there is one rate for males, say 50-54 and another for females, say 25-29. A word about females is in order here. We hear a lot about ‘discrimination’, with women paying more than their similarly aged-male companions. Again, it’s a cost issue-women can get pregnant, which is more expense and which needs to be financed. Even policies without maternity are required by law to cover complications of pregnancy which can be upwards of $1 million or more. Women also have more internal parts that need periodic checking than men. Lastly, they are more health-conscious, which means they go to the doctor more often. All this adds up to more money out than in. So, the insurance company adjusts for that. What happened with Wellpoint’s increase was two-fold. The demographic that accounted for that increase was unhealthier than expected. Also, the benefit plan that they were on was outdated, meaning that the benefits were based upon cost expectations that are no longer valid and the benefits became exceedingly rich compared with other companies’ plans. Now, when you raise rates on insurance companies plans, people typically will choose to go to another less-comprehensive (and less expensive) plan. That is, as long as the premium on the better plan is higher than the anticipated benefits. Those that are facing $100,000+ cancer treatments will gladly pay a higher premium if it means they still get their treatment for $10 instead of going to another plan that requires them to pay the first $1000 and then 20%. This leads to something called ‘adverse selection’, ultimately leading to what is known in the insurance industry as a ‘death spiral’---the amount of money coming in eventually becomes far less than the money that is going out for treatments and it can’t support itself. However, unlike the government, they can’t issue IOU’s.
I would urge our Congressmen to vote for the Senate bill if it addressed the real problems faced by health care- out of control spiraling costs- but it doesn't. All it does is put artificial restrictions and requirements on the financing mechanisms of our health care. And that is a recipe for disaster.
Friday, March 12, 2010
A Health Care Travesty
In times of economic downturn, there is a natural tendency to point fingers. Such was the case in Germany during the Great Depression. Among other things, several Jewish citizens held highly visible positions in Germany and Austria…they were wealthy and successful while the rest of the country was suffering. Consequently, they became a scapegoat for their nation’s economic problems, and the subsequent Holocaust is (almost) universally abhorred and has taken its place in history as the ultimate evil. Millions of lives were lost and/or affected.
Certainly nothing can ever compare with the sheer malignancy of the Holocaust and that is why you’ll never see me equate anything else with the term ‘Holocaust’. There is, however a travesty being perpetrated today that has the capacity to affect millions of people’s jobs because of the tendency to project one’s ills onto another entity, real or imagined. That ‘travesty’ is the ‘demonization’ of the insurance industry as the cause of the high cost of our health care system. When health reform first started, it was correctly being called ‘health care reform’. As the real underlying cause of the health care crisis manifested itself-that being the high cost of care in this country—the ‘movement’ was changed to health insurance reform. Ask any politician and they will agree that defensive medicine caused by runaway malpractice lawsuits, a shortage of primary care physicians caused by steadily decreasing Medicare reimbursements, a lack of transparency in the cost of care, billions in uncompensated care at the nation’s hospitals, duplicate and unnecessary testing, coupled with an entitlement mentality of the populace to choose an unhealthy lifestyle but not have to pay for it, are the real causes of the skyrocketing costs. However, it is much more palatable (and politically safe) to throw the blame at an entity that people love to hate…just give them a reason to. Such is the case with insurance companies. What would we do without insurance companies? In a few words, pay for our own dang healthcare. If we paid for it ourselves, we might have an incentive to lay off the bon-bons and get a little exercise. Much has been made about the ‘uninsured’, with some claiming 47 million Americans are ‘uninsured’. After taking out people that could qualify but just don’t want it (wealthy families, people that qualify for government programs but haven’t signed up, people between jobs that are in their waiting periods, college students who would rather buy beer than insurance, or illegal immigrants who want to stay below the radar and who know that hospitals can’t legally report them to INS) the true figure is closer to 12 million people or 4-5% of Americans. If only a fraction of the trillion or so dollars being bandied about were put to insuring those people and were coupled with common-sense reforms such as tort reform and wellness programs, we could solve our healthcare crisis.
But the those pushing for health insurance reform would have you believe that the insurance companies are the root of all our health care woes. “Greedy insurance companies” has become the new mantra to rail against. Consider this- insurance companies have a 3% profit margin on average. People don’t see that; if they do, they inevitably exclaim that 3% of the total premiums taken in is a huge number. Here’s a thought experiment: Let’s take out ALL of the insurance companies’ profits and throw it back into the cost of health care. The result would be that the American system of health care would survive another 36 hours. That’s right. ALL of the health insurance companies’ profits combined would fund the health care monstrosity for another 36 hours.
But it’s such an easy target.
Certainly nothing can ever compare with the sheer malignancy of the Holocaust and that is why you’ll never see me equate anything else with the term ‘Holocaust’. There is, however a travesty being perpetrated today that has the capacity to affect millions of people’s jobs because of the tendency to project one’s ills onto another entity, real or imagined. That ‘travesty’ is the ‘demonization’ of the insurance industry as the cause of the high cost of our health care system. When health reform first started, it was correctly being called ‘health care reform’. As the real underlying cause of the health care crisis manifested itself-that being the high cost of care in this country—the ‘movement’ was changed to health insurance reform. Ask any politician and they will agree that defensive medicine caused by runaway malpractice lawsuits, a shortage of primary care physicians caused by steadily decreasing Medicare reimbursements, a lack of transparency in the cost of care, billions in uncompensated care at the nation’s hospitals, duplicate and unnecessary testing, coupled with an entitlement mentality of the populace to choose an unhealthy lifestyle but not have to pay for it, are the real causes of the skyrocketing costs. However, it is much more palatable (and politically safe) to throw the blame at an entity that people love to hate…just give them a reason to. Such is the case with insurance companies. What would we do without insurance companies? In a few words, pay for our own dang healthcare. If we paid for it ourselves, we might have an incentive to lay off the bon-bons and get a little exercise. Much has been made about the ‘uninsured’, with some claiming 47 million Americans are ‘uninsured’. After taking out people that could qualify but just don’t want it (wealthy families, people that qualify for government programs but haven’t signed up, people between jobs that are in their waiting periods, college students who would rather buy beer than insurance, or illegal immigrants who want to stay below the radar and who know that hospitals can’t legally report them to INS) the true figure is closer to 12 million people or 4-5% of Americans. If only a fraction of the trillion or so dollars being bandied about were put to insuring those people and were coupled with common-sense reforms such as tort reform and wellness programs, we could solve our healthcare crisis.
But the those pushing for health insurance reform would have you believe that the insurance companies are the root of all our health care woes. “Greedy insurance companies” has become the new mantra to rail against. Consider this- insurance companies have a 3% profit margin on average. People don’t see that; if they do, they inevitably exclaim that 3% of the total premiums taken in is a huge number. Here’s a thought experiment: Let’s take out ALL of the insurance companies’ profits and throw it back into the cost of health care. The result would be that the American system of health care would survive another 36 hours. That’s right. ALL of the health insurance companies’ profits combined would fund the health care monstrosity for another 36 hours.
But it’s such an easy target.
Wednesday, March 3, 2010
Healthcare reform column
(Originally published online at HealthNews.com August 26th 2009)
Healthcare Reform. Just say the words lately and everyone seems to have an opinion. Town Hall meetings are getting a lot of hits on YouTube lately but it’s not because of the educational content. One common thread that I see in all this is hoopla is the amount of misinformation. So this week, I want to take a look at what I see as the Top 10 Health Insurance Reform Myths:
1. Comparative Analysis will dictate what procedures doctors will be able to use with their patients. Chances are, with health reform changing daily, you’ve forgotten about this provision that was provided for in the Stimulus Package that was passed wa-a-y back in March. What this does is to investigate which treatment procedures have the best chance for success in the general public. It is investigational only and is specifically prohibited by the same law to let government force the procedures to be used.
2. Individual Responsibility Mandate infringes on individual freedoms. This law says that everyone has to pay to be in the system whether they want to or not. While technically true, since everyone would have access to healthcare by law without preexisting conditions, without this law, nobody would sign up and pay until they needed medical care. Without money, the system would go broke.
3. Public Plan can coexist with the private market plans with no disruption. This is false. As one Economy Professor at Harvard said, “it’s simple economics.” As of the date of this writing, President Obama may have taken it off the table for that very reason.
4. Health Insurance is the reason health care costs so much. Actually, the opposite is true. Health insurance is nothing but healthcare financing. Americans have among the best healthcare in the world. That, plus innovation and new drugs, costs money. Health insurance pays for that, hence the cost goes up.
5. Formation of Death Panels is unequivocally false. What the provision provided for was to have Medicare pay for end-of-life wishes that seniors discuss with their doctors now at their own expense. As of the date of this writing, such provisions have been stripped from the two bills because of this hysteria.
6. The number of uninsured was originally touted as 46 or 47 million (depending upon who you asked). Most media rounded up the figure to an even 50 million. In reality, the number is closer to 16 million that are truly “uninsured” and can’t get insurance. The other roughly 30 million is made up of (1) people that qualify for some sort of government program, but for whatever reason don’t sign up, (2) families that make over $75,000 a year that choose to self-insure, (3) college kids who have come off their parents policies and are awaiting coverage, as well as (4) other people who are in the waiting period at their employers. Lastly, the millions of undocumented workers are counted in this category as well.
7. Socialized medicine is “bad,” when in fact it is neither bad nor good…it simply is. Most medical and pharmaceutical advances come from America due to the profit motive and the risk/reward of the free market. Socialized medicine would curb and/or eliminate that. The current system also employs millions of workers from doctors to claims representatives to (yes, even insurance brokers). A socialized system at this point would cause a catastrophic economic shakeup greater than the auto, financial and banking industries combined.
8. Insurance companies are floating in money but in reality 87% of money insurance companies take in is spent on claims. 10% is for administrative expenses. Only 3% is profit.
9. The high cost of prescription medicine is because the U.S. doesn’t have price caps. In fact, one factor of high prices is that other countries DO have caps. Drug companies make up their huge R&D costs, advertising costs, lost income from generics and failed drugs by charging higher prices in America because other countries have these caps.
10. Voting against the President’s plan is voting against reform. This is the biggest fallacy I see. Virtually everyone (that understands it) wants reform, insurance companies included. Something as complex as our system needs careful thought to fix, not rushed judgments that we may wind up regretting.
Next week we’ll look at the top 10 reasons why reform is necessary.
Until next time, stay healthy!
Healthcare Reform. Just say the words lately and everyone seems to have an opinion. Town Hall meetings are getting a lot of hits on YouTube lately but it’s not because of the educational content. One common thread that I see in all this is hoopla is the amount of misinformation. So this week, I want to take a look at what I see as the Top 10 Health Insurance Reform Myths:
1. Comparative Analysis will dictate what procedures doctors will be able to use with their patients. Chances are, with health reform changing daily, you’ve forgotten about this provision that was provided for in the Stimulus Package that was passed wa-a-y back in March. What this does is to investigate which treatment procedures have the best chance for success in the general public. It is investigational only and is specifically prohibited by the same law to let government force the procedures to be used.
2. Individual Responsibility Mandate infringes on individual freedoms. This law says that everyone has to pay to be in the system whether they want to or not. While technically true, since everyone would have access to healthcare by law without preexisting conditions, without this law, nobody would sign up and pay until they needed medical care. Without money, the system would go broke.
3. Public Plan can coexist with the private market plans with no disruption. This is false. As one Economy Professor at Harvard said, “it’s simple economics.” As of the date of this writing, President Obama may have taken it off the table for that very reason.
4. Health Insurance is the reason health care costs so much. Actually, the opposite is true. Health insurance is nothing but healthcare financing. Americans have among the best healthcare in the world. That, plus innovation and new drugs, costs money. Health insurance pays for that, hence the cost goes up.
5. Formation of Death Panels is unequivocally false. What the provision provided for was to have Medicare pay for end-of-life wishes that seniors discuss with their doctors now at their own expense. As of the date of this writing, such provisions have been stripped from the two bills because of this hysteria.
6. The number of uninsured was originally touted as 46 or 47 million (depending upon who you asked). Most media rounded up the figure to an even 50 million. In reality, the number is closer to 16 million that are truly “uninsured” and can’t get insurance. The other roughly 30 million is made up of (1) people that qualify for some sort of government program, but for whatever reason don’t sign up, (2) families that make over $75,000 a year that choose to self-insure, (3) college kids who have come off their parents policies and are awaiting coverage, as well as (4) other people who are in the waiting period at their employers. Lastly, the millions of undocumented workers are counted in this category as well.
7. Socialized medicine is “bad,” when in fact it is neither bad nor good…it simply is. Most medical and pharmaceutical advances come from America due to the profit motive and the risk/reward of the free market. Socialized medicine would curb and/or eliminate that. The current system also employs millions of workers from doctors to claims representatives to (yes, even insurance brokers). A socialized system at this point would cause a catastrophic economic shakeup greater than the auto, financial and banking industries combined.
8. Insurance companies are floating in money but in reality 87% of money insurance companies take in is spent on claims. 10% is for administrative expenses. Only 3% is profit.
9. The high cost of prescription medicine is because the U.S. doesn’t have price caps. In fact, one factor of high prices is that other countries DO have caps. Drug companies make up their huge R&D costs, advertising costs, lost income from generics and failed drugs by charging higher prices in America because other countries have these caps.
10. Voting against the President’s plan is voting against reform. This is the biggest fallacy I see. Virtually everyone (that understands it) wants reform, insurance companies included. Something as complex as our system needs careful thought to fix, not rushed judgments that we may wind up regretting.
Next week we’ll look at the top 10 reasons why reform is necessary.
Until next time, stay healthy!
A better healthcare system (??) Part Deux
France's system has been called the best in the world. My previous blog described how France is attempting to meet the challenges of an aging population, and increasing medical costs the same way that all health care systems do...raising taxes and limiting services. The argument has been made that while flawed, France's system does work, and with vastly better outcomes. Furthermore, I illustrated the demographic and cultural differences that exist between the two countries, leading to an inherently unhealthier U.S. population, to which the argument was made that if people had access to healthcare in the U.S. that our general health would be improved. I intend to mitigate the first argument, and to expose the other arguments as being incorrect.
The statement was made that the income tax rate in France is less than what that person is paying in the U.S. in response to my assertion that France has had numerous health care tax increases since 1986. Income taxes are but one form of taxing the populace. Since 1985, when France first ran a deficit on it's healthcare program (which continues to this day), the following taxes have been implemented.
1986 -- Increase in health-care payroll taxes.
1988 -- Creation of a special tax on medication advertising to help fund health care.
1990 -- Introduction of the CSG, a new tax levied on all types of income to help fund health care.
1991 -- Increase in health-care taxes levied on payroll.
1993 -- Increase in CSG rate. Coverage of doctor consultation is reduced.
1996 -- Increase in health-care taxes. A new health-care tax is levied on private health-care plans
1999 -- New tax levied on drug makers when their revenue exceeds a pre-defined level.
These are just the tax increases. Increased out-of-pocket costs, reduced doctor reimbursements, increased bureaucracy (there are 43 various government agencies overseeing the French system) and facility closures are occurring at a faster and faster rate. So, while the French system may 'work' at this point in time, it's future viability is seriously in question (so much so that the prime minister stated in 2007 that the system is 'bankrupt'). Just how long can a 'bankrupt' system survive ? Not exactly a model to emulate going forward.
As far as having better outcomes, let's take a look at a few examples. SARS, a childhood respiratory disease,is a serious illness that can cause death. A full 14% of French babies that contract SARS die. The figure in the the U.S. is 0% statistically. Furthermore, 5.3 people in France vs 3.4 people in the U.S. per 100,000 people die of a particularly hard-to-treat cancer, stomach cancer. As far as cancer deaths overall, another "working" socialized medicine program that was held up as an example has the HIGHEST cancer death rate (the Netherlands). Better outcomes indeed. As far as prevention goes, (as an example), 91% of Americans are immunized by age one for measles as opposed to only 85% of French citizens. There are many more examples; space and time limits their inclusion.
The best that can be said is that France's system is beset by the same problems that affect all healthcare systems--cost. The difference is that the French people lead a healthier lifestyle (reflected in the fact that over 30% of Americans are obese, compared to less than 10% of French citizens). The argument was made that if the American people had access to health care that perhaps they would change their lifestyle to a healthier one. This argument falls flat on it's face for two reasons: #1 is EVERYONE in America has access to health care...just not access to the major financing mechanism for health care--insurance. A regular office visit in Nevada is around $85. Additionally, there are low-cost clinics, FREE clinics, Planned Parenthood and Quick Care centers for those that can't afford $85. #2-- the main cause of the health disparity between France and the U.S. is the obesity rate. From grade school (remember the food pyramid ?), television advertising (Healthy Choice meals, "get your 5 servings of vegetables in a V-8", yogurt, fiber, ad nauseum), support groups (weight watchers, jenny craig), gym and gym equipment advertising, food labels, laws against trans fats--we have been inundated with the perils of being obese. We don't need to go to the doctor to be told we're fat and need to quit smoking. It's all around us. Again, it is people's CHOICE to engage in these behaviors; a trip to the doctor won't magically change that. Additionally, disease management: hypertension, cholesterol, diabetes, etc. (all caused by obesity), requires the patient to take responsibility...a majority of hospital admittance is due to the failure of PATIENTS to manage their own diseases to the point where they have to go to the hospital. Where a trip to the doctor WILL help is in uncovering an unknown and non-apparent condition such as cancer. The U.S. already has among the best cancer survival rate in the industrialized world. Even then, a regular self breast exam in the shower will uncover more cases of breast cancer than mammograms and is free. Yet, the majority of women don't even do that...While doctor visits may be affordable (or free), what of catastrophic diseases (such as kidney failure for example) for people without an ability to finance it (i.e.through insurance)? The fact is, ANYONE can get dialysis if they need it...just ask UMC hospital in Nevada, which treats numerous ILLEGAL ALIENS to the tune of MILLIONS of dollars per year for free. The EMTALA act made that possible...passed in 1986, it made it illegal to deny care to someone based upon their ability to pay (or even citizenship).
As I said in my previous blog, it's always easier to point the finger of blame outward rather than in the mirror. However I think I'll close with a sentiment expressed by those in the know regarding health reform--You think health care is expensive now ? Just wait until it's free.
The statement was made that the income tax rate in France is less than what that person is paying in the U.S. in response to my assertion that France has had numerous health care tax increases since 1986. Income taxes are but one form of taxing the populace. Since 1985, when France first ran a deficit on it's healthcare program (which continues to this day), the following taxes have been implemented.
1986 -- Increase in health-care payroll taxes.
1988 -- Creation of a special tax on medication advertising to help fund health care.
1990 -- Introduction of the CSG, a new tax levied on all types of income to help fund health care.
1991 -- Increase in health-care taxes levied on payroll.
1993 -- Increase in CSG rate. Coverage of doctor consultation is reduced.
1996 -- Increase in health-care taxes. A new health-care tax is levied on private health-care plans
1999 -- New tax levied on drug makers when their revenue exceeds a pre-defined level.
These are just the tax increases. Increased out-of-pocket costs, reduced doctor reimbursements, increased bureaucracy (there are 43 various government agencies overseeing the French system) and facility closures are occurring at a faster and faster rate. So, while the French system may 'work' at this point in time, it's future viability is seriously in question (so much so that the prime minister stated in 2007 that the system is 'bankrupt'). Just how long can a 'bankrupt' system survive ? Not exactly a model to emulate going forward.
As far as having better outcomes, let's take a look at a few examples. SARS, a childhood respiratory disease,is a serious illness that can cause death. A full 14% of French babies that contract SARS die. The figure in the the U.S. is 0% statistically. Furthermore, 5.3 people in France vs 3.4 people in the U.S. per 100,000 people die of a particularly hard-to-treat cancer, stomach cancer. As far as cancer deaths overall, another "working" socialized medicine program that was held up as an example has the HIGHEST cancer death rate (the Netherlands). Better outcomes indeed. As far as prevention goes, (as an example), 91% of Americans are immunized by age one for measles as opposed to only 85% of French citizens. There are many more examples; space and time limits their inclusion.
The best that can be said is that France's system is beset by the same problems that affect all healthcare systems--cost. The difference is that the French people lead a healthier lifestyle (reflected in the fact that over 30% of Americans are obese, compared to less than 10% of French citizens). The argument was made that if the American people had access to health care that perhaps they would change their lifestyle to a healthier one. This argument falls flat on it's face for two reasons: #1 is EVERYONE in America has access to health care...just not access to the major financing mechanism for health care--insurance. A regular office visit in Nevada is around $85. Additionally, there are low-cost clinics, FREE clinics, Planned Parenthood and Quick Care centers for those that can't afford $85. #2-- the main cause of the health disparity between France and the U.S. is the obesity rate. From grade school (remember the food pyramid ?), television advertising (Healthy Choice meals, "get your 5 servings of vegetables in a V-8", yogurt, fiber, ad nauseum), support groups (weight watchers, jenny craig), gym and gym equipment advertising, food labels, laws against trans fats--we have been inundated with the perils of being obese. We don't need to go to the doctor to be told we're fat and need to quit smoking. It's all around us. Again, it is people's CHOICE to engage in these behaviors; a trip to the doctor won't magically change that. Additionally, disease management: hypertension, cholesterol, diabetes, etc. (all caused by obesity), requires the patient to take responsibility...a majority of hospital admittance is due to the failure of PATIENTS to manage their own diseases to the point where they have to go to the hospital. Where a trip to the doctor WILL help is in uncovering an unknown and non-apparent condition such as cancer. The U.S. already has among the best cancer survival rate in the industrialized world. Even then, a regular self breast exam in the shower will uncover more cases of breast cancer than mammograms and is free. Yet, the majority of women don't even do that...While doctor visits may be affordable (or free), what of catastrophic diseases (such as kidney failure for example) for people without an ability to finance it (i.e.through insurance)? The fact is, ANYONE can get dialysis if they need it...just ask UMC hospital in Nevada, which treats numerous ILLEGAL ALIENS to the tune of MILLIONS of dollars per year for free. The EMTALA act made that possible...passed in 1986, it made it illegal to deny care to someone based upon their ability to pay (or even citizenship).
As I said in my previous blog, it's always easier to point the finger of blame outward rather than in the mirror. However I think I'll close with a sentiment expressed by those in the know regarding health reform--You think health care is expensive now ? Just wait until it's free.
Tuesday, March 2, 2010
A Health Care Success Story (??)
Whenever we talk of ‘socialized’ medicine systems, opponents of those systems refer to Canada and the UK’s system to illustrate the shortcomings of a governmental health care program. However, Canada and the UK’s system are but two examples. Proponents of government health care inevitably point to the ‘successes’ of various socialized systems as their basis for having a socialized system that works. In the interest of fairness, let’s take a look at the gold standard of government-run health plans as determined by the World Health Organization. In 2000, the WHO recognized France’s system as the number one health care system in the world.
The truth is that France has had continual challenges in balancing their health care budget and has made incremental changes for the last three decades, including SIX tax increases specifically for health care while reducing benefits and increasing out-of-pocket costs. In 1990, general revenue taxes supplied 7% of French health-care expenditures. By 2003, the general revenue figure had ballooned to 40%, with no end in sight. The French national insurance system has been running constant deficits since 1985. Since the WHO report, some of the changes implemented to help contain costs have been steadily increasing fees, reducing reimbursements to both health care providers and patients and facility closures. Ironically, France is borrowing ‘Western’ health care ideas to contain costs. In 2004, France had a number of far-reaching reforms, including coordination of care through one ‘primary’ physician who must be consulted first before going to a specialist. Failure to do so results in reducing the reimbursement to the patient by almost 57% ! France currently spends the most of any European country as a percentage of its GDP (11%) compared to the U.S.’s 17% and it continues to grow. Without drastic action to contain costs, France’s system could face bankruptcy as evidenced by France’s Prime Minister Francois Fillon, who stated “The truth is that I am the head of a state that is in a state of bankruptcy due to its financing plan.”
While cost continues to be the biggest challenge affecting every country’s health care, perhaps the most telling is the general health of the underlying population. Opponents of free market health care routinely state that the U.S. spends the most on health care but has poorer outcomes, living on average two years less than our French counterparts. Is this a result of our health care system or Americans’ choices ? The answer may surprise you. Seventy-four percent of health care spending in the U.S. is directly related to preventable conditions such as heart disease, diabetes and cancer. Obesity is the main cause of the first two, smoking and other lifestyle choices account for a large part of the third. Why does U.S. health care cost so much more than France’s with lesser outcomes ? Consider that the U.S. leads the world in obesity with over 30% of its population considered clinically obese. It is generally accepted that two thirds of Americans are either overweight or obese. Compare that to less than 10% of France’s citizens being clinically obese. So, is it that difficult to understand that treating 90 million sick Americans costs more than treating 7 million French citizens ? Another factor is America’s lawsuit-happy culture. While malpractice claims themselves account for a negligible percentage of health care spending, the fear of malpractice leads to wasteful and redundant practices that are estimated to be as much as $60 billion a year (or 3% of overall medical spending). Malpractice cases in France are brought before their regions' government-appointed review board that determines how much compensation (if any) should be paid out of a national compensation fund
Simply because something works in another country is no basis for implementing the same program in America. Demographics and cultural differences account for the majority of America’s health care problems. It’s not the failure of the U.S. style of health care that is responsible for our system’s high cost and lower outcomes. It may not be popular, but the real blame lies with the American people’s lifestyle choices. While American’s certainly have the ‘freedom’ to choose their own lifestyle, they should understand that with freedom comes responsibility for the choices they make. It is not the fault of corporate America or American’s health care providers for American’s health care woes. It’s always easier to point the finger of blame outward than it is to look in the mirror.
The truth is that France has had continual challenges in balancing their health care budget and has made incremental changes for the last three decades, including SIX tax increases specifically for health care while reducing benefits and increasing out-of-pocket costs. In 1990, general revenue taxes supplied 7% of French health-care expenditures. By 2003, the general revenue figure had ballooned to 40%, with no end in sight. The French national insurance system has been running constant deficits since 1985. Since the WHO report, some of the changes implemented to help contain costs have been steadily increasing fees, reducing reimbursements to both health care providers and patients and facility closures. Ironically, France is borrowing ‘Western’ health care ideas to contain costs. In 2004, France had a number of far-reaching reforms, including coordination of care through one ‘primary’ physician who must be consulted first before going to a specialist. Failure to do so results in reducing the reimbursement to the patient by almost 57% ! France currently spends the most of any European country as a percentage of its GDP (11%) compared to the U.S.’s 17% and it continues to grow. Without drastic action to contain costs, France’s system could face bankruptcy as evidenced by France’s Prime Minister Francois Fillon, who stated “The truth is that I am the head of a state that is in a state of bankruptcy due to its financing plan.”
While cost continues to be the biggest challenge affecting every country’s health care, perhaps the most telling is the general health of the underlying population. Opponents of free market health care routinely state that the U.S. spends the most on health care but has poorer outcomes, living on average two years less than our French counterparts. Is this a result of our health care system or Americans’ choices ? The answer may surprise you. Seventy-four percent of health care spending in the U.S. is directly related to preventable conditions such as heart disease, diabetes and cancer. Obesity is the main cause of the first two, smoking and other lifestyle choices account for a large part of the third. Why does U.S. health care cost so much more than France’s with lesser outcomes ? Consider that the U.S. leads the world in obesity with over 30% of its population considered clinically obese. It is generally accepted that two thirds of Americans are either overweight or obese. Compare that to less than 10% of France’s citizens being clinically obese. So, is it that difficult to understand that treating 90 million sick Americans costs more than treating 7 million French citizens ? Another factor is America’s lawsuit-happy culture. While malpractice claims themselves account for a negligible percentage of health care spending, the fear of malpractice leads to wasteful and redundant practices that are estimated to be as much as $60 billion a year (or 3% of overall medical spending). Malpractice cases in France are brought before their regions' government-appointed review board that determines how much compensation (if any) should be paid out of a national compensation fund
Simply because something works in another country is no basis for implementing the same program in America. Demographics and cultural differences account for the majority of America’s health care problems. It’s not the failure of the U.S. style of health care that is responsible for our system’s high cost and lower outcomes. It may not be popular, but the real blame lies with the American people’s lifestyle choices. While American’s certainly have the ‘freedom’ to choose their own lifestyle, they should understand that with freedom comes responsibility for the choices they make. It is not the fault of corporate America or American’s health care providers for American’s health care woes. It’s always easier to point the finger of blame outward than it is to look in the mirror.
Thursday, February 25, 2010
1:36am
1:36 am
Not many people get to meet an angel on earth. I married one. Ever since she was a little girl all she ever wanted to do was to be a nurse-and the type of nurse she is- a “burn nurse” shows the compassion and caring she has. I’ve never heard my wife complain, swear, nor heard her talk poorly about anyone…even when they deserved it. Sometimes people are just ‘good’. Animals flock to people like that.
Such was the case with a cockatiel named Romeo. Birds are known for picking their owners-a chance trip to a friend’s house 11 years ago that had just purchased Romeo sealed the deal. Romeo immediately went crazy over Laurie and the friend gave her to Laurie.
Romeo died last night on Laurie’s neck while snuggling her hair. We tried to put her on a heating pad, but she weakly climbed off and up to Laurie. Now some people may say Romeo was just a bird. But if people are the food by which we fortify our lives, then the pets we love certainly are the spice. I cry for my wife’s loss.
Not many people get to meet an angel on earth. I married one. Ever since she was a little girl all she ever wanted to do was to be a nurse-and the type of nurse she is- a “burn nurse” shows the compassion and caring she has. I’ve never heard my wife complain, swear, nor heard her talk poorly about anyone…even when they deserved it. Sometimes people are just ‘good’. Animals flock to people like that.
Such was the case with a cockatiel named Romeo. Birds are known for picking their owners-a chance trip to a friend’s house 11 years ago that had just purchased Romeo sealed the deal. Romeo immediately went crazy over Laurie and the friend gave her to Laurie.
Romeo died last night on Laurie’s neck while snuggling her hair. We tried to put her on a heating pad, but she weakly climbed off and up to Laurie. Now some people may say Romeo was just a bird. But if people are the food by which we fortify our lives, then the pets we love certainly are the spice. I cry for my wife’s loss.
Sunday, January 24, 2010
On Healthcare and Capitalism
(I started this to respond to a series of posts between extended family members I care about to give them some ‘inside’ information on the true aspects of reforming our health system. I wanted to dedicate maybe an hour to this…alas, there is so much to it that I could write for a week. So, I apologize for barely scratching the surface of this important topic. I can and will take the time to answer specific questions regarding the various aspects of reform. To do so here would result in a book).
To all concerned: I’m sure that my forthcoming comments will serve to irritate both sides of the fence. However, I feel I’m qualified in this area (health care financing, not irritating people). Most of what follows is based upon 20 years experience in the health care financing arena-with a smattering of opinion thrown it. I actually wrote a column regarding socialized medicine that stated it (socialized medicine) is ‘not inherently good or bad’—it just is. It doesn’t mean that the people who took part in this debate are right or wrong. Rarely is either extreme 100% correct. The answer oftentimes is in the middle between the two.
For people familiar with socialized medicine that like it, changing America's system is (thankfully) not as easy as saying, “well it (socialized medicine) works over in other countries”. Which is good, because as with anything, sometimes the grass is not always greener. As an example, while France's system is rated as having the best health care in the world by the WHO, a full 70% of people that live in other socialized medicine countries say their system needs to be overhauled. The argument that we spend more on health care than other countries and have less healthy people has more to do with lifestyle than anything else. The #1 disease in America is heart disease and related illnesses. Obesity accounts for the majority of this rather than any genetic predisposition. Same with diabetes and any number of illnesses in America- it's what we choose to do that's killing us, not the lack of health care. Freedom cuts both ways.
Any health care, whether it's in France or America, has to be paid for somehow. In France there is a mandatory tax on all people to pay for their healthcare--even on their pensions, capital gains and gambling winnings. French doctors also make about a third what American doctors make-in fact, they make roughly the amount it takes to pay for malpractice insurance in the United States, around $55,000. The bright spot is that France pays for it's doctors to go to medical school. A point of commonality between the two countries is the overprescribing of tests and procedures, usually associated with defensive medicine (see below) in the US, but France's docs utilize it (as many US doctors do as well) to pad their income. I'm getting ahead of myself here; let's take a look at why the US system, while not perfect and in need of some common sense reforms, cannot be summarily dismissed and replaced with socialized medicine.
Freedom...Just the word itself is burned into the American psyche. And nothing defines freedom to those Americans that were born here than Capitalism. Those naturalized US citizens who weren't born or brought up here may think otherwise, but "Socialism" for all intensive purposes, is equated with less freedom and more government involvement. Indeed, America was founded on a 'freedom' from the 'tyranny' of a monarchy--to this day Americans celebrate 'Independence Day'. While no on alive today has first hand knowledge of those days, a majority of people can remember World War II, either firsthand or via their parents, where patriotism, the American way, and freedom, went hand in hand and the enemy was anything that infringed upon that. Capitalism is as much entrenched in American's minds as apple pie. The capitalistic nature of America is designed to reward the best and the brightest. At the turn of the 20th century, immigrants arrived in droves because of the opportunities in America that weren’t available anywhere else. While ‘the streets are paved with gold’ may have been a bit exaggerated, immigrants still flock to the US in record numbers (although there has been a slight decrease of late of Hispanic workers due to the economy and an increased scrutiny on undocumented workers). Healthcare is no exception. How does that help with health care ? There are more reasons than space, but the biggest one is: INNOVATION. Since the mid-1970's, all but 5 Nobel Prizes in Medicine were won in whole or in part by Americans. The top 5 hospitals in the United States perform more clinical studies than all hospitals in any single country combined ! Health care in the US is among the best in the world--if you can afford it (or you have someone else pay for your care-i.e. an insurance company). Such is the nature of a system that rewards the "able" that actually "do".
Now there ARE political systems out there that seek to have all citizenry be egalitarian. However, real life is different than ideological principles and most of those systems have collapsed or are rife with corruption and human rights violations (Communism). Even in countries where that seems to work, the profit motive is recently being recognized for what it is…an incentive. Cuba relies on expensive imports to feed their people, which is ludicrous considering that Cuba’s fertile soil is among the richest in the world. Cuba’s government agrees and is experimenting with a system that gives partial ownership of farms to farmers and rewards them for successful harvests. As one farmer put it, “if you work hard you will be rewarded”. Just don't call it 'capitalism'. And so it is with America…the only barriers to success is largely due to personal determination, ingenuity and genetics. However, opportunity for success is not the same as ‘guaranteed’success.
Generally speaking, those without health insurance want changes in the law; those that have health insurance don’t. In fact, 87% of people that have health care insurance are happy with it…they are just not happy with what they pay for it. When reform was first started, the goal was to “reduce the cost curve of health care” and get the uninsured covered. Examining the 46 million uninsured (representing 15% of the population), it was found to be closer to 11 million (representing 8%) when you took out the illegal immigrants, people that could buy insurance but choose not to, (wealthy families that self-insure and young ‘invincible’ males aged 18 to 29 who think they don’t need it) and people eligible for public programs but for whatever reason don’t sign up. Somewhere along the way, health ‘care’ became health ‘insurance’—the two are quite different. Regulating health insurance (which is the financing mechanism for our health care) will do nothing to bend the cost curve of care. It is precisely the cost of health care that affects the cost of health insurance-not the other way around. Contrary to general belief-everyone has access to care in the US-the EMTALA act passed in 1986 requires health care providers to treat, without regard to citizenship or ability to pay, anyone needing emergency care. For non-emergency care, treatment is available—like any other service, however, someone has to pay for it. Because of EMTALA, roughly half of all hospital care is now done for free. Well, it’s not really free; the costs are shifted to everyone else either through increased taxes or increased insurance premiums. The threat of lawsuits has led to doctors practicing ‘defensive medicine’. Basically it means that unnecessary tests and procedures are performed so that ‘no stone is left unturned’. Just one of the many ‘true’ costs that can be affected by correct reform.
I recently spoke with someone who was born in Europe regarding reform. She stated very plainly that she understood that her socialized healthcare wasn’t ‘free’ and she paid extra taxes to finance it, which she was fine with. Therein lies the rub; people in the US generally don’t want any more taxes.
What of those people that aren’t successful ? Should we just let them waste away ? No. That’s why reform is needed. However, focusing on the wrong things to reform is worse than no reform at all. The health care industry is being unfairly maligned. Whenever you give something to someone it has to be taken from someone else. A doctor puts in years of time, and effort in pursuit of their chosen field, only to be saddled with large debts and soaring malpractice insurance costs. One doctor in a socialized medicine country when asked what our ‘problem’ was replied like this…”here doctors are content with one nice home and one nice car”—the imposition being that American doctors have numerous cars and homes. A pharmaceutical company spends billions developing new drugs to treat the myriad conditions that we find ourselves beset by, only to have those same drugs be recreated by other companies after 7 to 10 years. Not a long time to recoup your money. Many drugs fail and the threat of class action suits abound thanks to our litigious society-not a word about tort reform however- in other countries, citizens laugh about our lottery-style lawsuits. How about price caps on drugs ? The rest of the world has them. And that’s the problem-because the rest of the world has price caps, the drug companies look to America to make up the difference.
It’s easy to blame the insurance companies and the drug companies. What people miss is that we all are, indeed, people. Behind the corporations, there is a face—the people that are employed by them, the people that run them, the investors who finance them. I’ve heard said, “how much profit is too much profit ?” That question was asked of Senator Ensign at a recent health care roundtable I was part of. His response ? There’s no such thing as too much profit. Which I agree with. How do you limit creativity ? Talent ? Effort ? …that’s the beauty of a capitalistic system…in theory, the sky’s the limit. It’s why I got into sales…you’re limited only by your own personal dynamic. There used to be a time when being a doctor meant you were automatically ‘rich’. The reality is that successful salespeople routinely make more than doctors-without the requisite education required of doctors. It’s exactly because of government interference (and insurance company’s in response to that interference) that suddenly it’s no longer lucrative to become a primary care physician. Is it any wonder that only 17% of medical school grads choose primary care ? We are facing an unprecedented shortage of primary care physicians. Proof that, doctors (or CEO's, or any number of people) will go into other fields or industries as the opportunity to live the American dream is stifled by regulation. Since we mentioned CEO's and insurance companies, did you know that on average, insurance companies make 2% profit (the largest, United Health Care, made a little over 6%--not much better than a long-term CD). Speaking of profit, what if all of the insurance companies’ profits were somehow able to be put back into the system or CEO’s ‘exhorbitant” multi-million dollar salaries and bonuses were given back as charity to the needy ? It wouldn’t make a difference—the $13 billion in profit that insurance companies made in 2007 (before the recession hit) represents .6% of total healthcare spending. CEO’s total compensation represents even less- .005% of total spending. People hate that which they don’t understand.
Lest you think I agree wholeheartedly with the Republican side of things, know that I questioned Senator Ensign regarding his opposition to a ‘personal responsibility’ mandate during a conference call. Or as most people know it-“being forced to buy health insurance”. The auto insurance analogy is correct, but not for the reasons you think. True, you ‘choose’ to drive and you don’t choose to get sick or have an accident. However, the concept of why you have auto insurance is the same. If you’re in an auto accident, and it’s your fault that you injure the other party, the other party is entitled to have you pay for their damages or healthcare bills. Since many (most) people don’t just have the funds lying around to pay for this, insurance (that grand old financing mechanism for things we can’t afford) steps in. It’s to ‘protect the other guy’. Same thing with health insurance…if you’re a young 25 year old guy and you blow out your knee for example—an emergency room visit can cost you thousands. How many 25 year old guys do you know that have thousands laying around to pay for the care ? Taking it one step further, a heart attack in Nevada runs around $200,000. Can you predict 100% that you won’t have a heart attack ? Kind of hard when you consider an American has a heart attack every 29 seconds. How about any of the millions of other health emergencies ? Mandated health insurance protects the ‘taxpayers’-who ultimately pay for uncompensated care. It also serves to reduce premiums. It also could help save a life…Consider the following.
This past summer Senator Reid was canvassing the country with a former CNN correspondent whose twenty-something brother died due to his inability to have a heart transplant. She stated that “because the insurance company denied him, he died”. Listening to more of her story, she related how she applied for Social Security disability which would give her brother Medicare—and that he was denied twice. She then had success in getting her brother on Medicaid-the state’s care for people who make less than $12,000 a year. However, Medicaid wouldn’t pay for the transplant. Why not ? Because he was older than 19, the maximum age that Medicaid would pay for a transplant. Now why would Medicaid have an age limit ? Reason: cost. Now what is sad is that both Medicare and Medicaid are GOVERNMENT (read Public) plans. This is the reality with government health care…it’s still not free care and when revenue is less than expenditures something has to give (rationing, bureaucracy and poor service). The really sad thing is that if this young man had purchased health insurance before he got sick, in all likelihood he would be alive today. At his age, his premiums could have been had for less than $30 a month.
For those that can afford it, US health care represents the pinnacle of excellence. As costs have risen, insurance premiums have risen to keep pace. The US system has been around for 80 years, employs hundreds of thousands of people, and represents one-sixth of our GDP--this cannot summarily be dismissed without cataclysmic-ally affecting our economy. As President Obama stated sometime in July, (paraphrased)The best time to have started socialized medicine was at the beginning. It's too convoluted and entrenched to start now.
To all concerned: I’m sure that my forthcoming comments will serve to irritate both sides of the fence. However, I feel I’m qualified in this area (health care financing, not irritating people). Most of what follows is based upon 20 years experience in the health care financing arena-with a smattering of opinion thrown it. I actually wrote a column regarding socialized medicine that stated it (socialized medicine) is ‘not inherently good or bad’—it just is. It doesn’t mean that the people who took part in this debate are right or wrong. Rarely is either extreme 100% correct. The answer oftentimes is in the middle between the two.
For people familiar with socialized medicine that like it, changing America's system is (thankfully) not as easy as saying, “well it (socialized medicine) works over in other countries”. Which is good, because as with anything, sometimes the grass is not always greener. As an example, while France's system is rated as having the best health care in the world by the WHO, a full 70% of people that live in other socialized medicine countries say their system needs to be overhauled. The argument that we spend more on health care than other countries and have less healthy people has more to do with lifestyle than anything else. The #1 disease in America is heart disease and related illnesses. Obesity accounts for the majority of this rather than any genetic predisposition. Same with diabetes and any number of illnesses in America- it's what we choose to do that's killing us, not the lack of health care. Freedom cuts both ways.
Any health care, whether it's in France or America, has to be paid for somehow. In France there is a mandatory tax on all people to pay for their healthcare--even on their pensions, capital gains and gambling winnings. French doctors also make about a third what American doctors make-in fact, they make roughly the amount it takes to pay for malpractice insurance in the United States, around $55,000. The bright spot is that France pays for it's doctors to go to medical school. A point of commonality between the two countries is the overprescribing of tests and procedures, usually associated with defensive medicine (see below) in the US, but France's docs utilize it (as many US doctors do as well) to pad their income. I'm getting ahead of myself here; let's take a look at why the US system, while not perfect and in need of some common sense reforms, cannot be summarily dismissed and replaced with socialized medicine.
Freedom...Just the word itself is burned into the American psyche. And nothing defines freedom to those Americans that were born here than Capitalism. Those naturalized US citizens who weren't born or brought up here may think otherwise, but "Socialism" for all intensive purposes, is equated with less freedom and more government involvement. Indeed, America was founded on a 'freedom' from the 'tyranny' of a monarchy--to this day Americans celebrate 'Independence Day'. While no on alive today has first hand knowledge of those days, a majority of people can remember World War II, either firsthand or via their parents, where patriotism, the American way, and freedom, went hand in hand and the enemy was anything that infringed upon that. Capitalism is as much entrenched in American's minds as apple pie. The capitalistic nature of America is designed to reward the best and the brightest. At the turn of the 20th century, immigrants arrived in droves because of the opportunities in America that weren’t available anywhere else. While ‘the streets are paved with gold’ may have been a bit exaggerated, immigrants still flock to the US in record numbers (although there has been a slight decrease of late of Hispanic workers due to the economy and an increased scrutiny on undocumented workers). Healthcare is no exception. How does that help with health care ? There are more reasons than space, but the biggest one is: INNOVATION. Since the mid-1970's, all but 5 Nobel Prizes in Medicine were won in whole or in part by Americans. The top 5 hospitals in the United States perform more clinical studies than all hospitals in any single country combined ! Health care in the US is among the best in the world--if you can afford it (or you have someone else pay for your care-i.e. an insurance company). Such is the nature of a system that rewards the "able" that actually "do".
Now there ARE political systems out there that seek to have all citizenry be egalitarian. However, real life is different than ideological principles and most of those systems have collapsed or are rife with corruption and human rights violations (Communism). Even in countries where that seems to work, the profit motive is recently being recognized for what it is…an incentive. Cuba relies on expensive imports to feed their people, which is ludicrous considering that Cuba’s fertile soil is among the richest in the world. Cuba’s government agrees and is experimenting with a system that gives partial ownership of farms to farmers and rewards them for successful harvests. As one farmer put it, “if you work hard you will be rewarded”. Just don't call it 'capitalism'. And so it is with America…the only barriers to success is largely due to personal determination, ingenuity and genetics. However, opportunity for success is not the same as ‘guaranteed’success.
Generally speaking, those without health insurance want changes in the law; those that have health insurance don’t. In fact, 87% of people that have health care insurance are happy with it…they are just not happy with what they pay for it. When reform was first started, the goal was to “reduce the cost curve of health care” and get the uninsured covered. Examining the 46 million uninsured (representing 15% of the population), it was found to be closer to 11 million (representing 8%) when you took out the illegal immigrants, people that could buy insurance but choose not to, (wealthy families that self-insure and young ‘invincible’ males aged 18 to 29 who think they don’t need it) and people eligible for public programs but for whatever reason don’t sign up. Somewhere along the way, health ‘care’ became health ‘insurance’—the two are quite different. Regulating health insurance (which is the financing mechanism for our health care) will do nothing to bend the cost curve of care. It is precisely the cost of health care that affects the cost of health insurance-not the other way around. Contrary to general belief-everyone has access to care in the US-the EMTALA act passed in 1986 requires health care providers to treat, without regard to citizenship or ability to pay, anyone needing emergency care. For non-emergency care, treatment is available—like any other service, however, someone has to pay for it. Because of EMTALA, roughly half of all hospital care is now done for free. Well, it’s not really free; the costs are shifted to everyone else either through increased taxes or increased insurance premiums. The threat of lawsuits has led to doctors practicing ‘defensive medicine’. Basically it means that unnecessary tests and procedures are performed so that ‘no stone is left unturned’. Just one of the many ‘true’ costs that can be affected by correct reform.
I recently spoke with someone who was born in Europe regarding reform. She stated very plainly that she understood that her socialized healthcare wasn’t ‘free’ and she paid extra taxes to finance it, which she was fine with. Therein lies the rub; people in the US generally don’t want any more taxes.
What of those people that aren’t successful ? Should we just let them waste away ? No. That’s why reform is needed. However, focusing on the wrong things to reform is worse than no reform at all. The health care industry is being unfairly maligned. Whenever you give something to someone it has to be taken from someone else. A doctor puts in years of time, and effort in pursuit of their chosen field, only to be saddled with large debts and soaring malpractice insurance costs. One doctor in a socialized medicine country when asked what our ‘problem’ was replied like this…”here doctors are content with one nice home and one nice car”—the imposition being that American doctors have numerous cars and homes. A pharmaceutical company spends billions developing new drugs to treat the myriad conditions that we find ourselves beset by, only to have those same drugs be recreated by other companies after 7 to 10 years. Not a long time to recoup your money. Many drugs fail and the threat of class action suits abound thanks to our litigious society-not a word about tort reform however- in other countries, citizens laugh about our lottery-style lawsuits. How about price caps on drugs ? The rest of the world has them. And that’s the problem-because the rest of the world has price caps, the drug companies look to America to make up the difference.
It’s easy to blame the insurance companies and the drug companies. What people miss is that we all are, indeed, people. Behind the corporations, there is a face—the people that are employed by them, the people that run them, the investors who finance them. I’ve heard said, “how much profit is too much profit ?” That question was asked of Senator Ensign at a recent health care roundtable I was part of. His response ? There’s no such thing as too much profit. Which I agree with. How do you limit creativity ? Talent ? Effort ? …that’s the beauty of a capitalistic system…in theory, the sky’s the limit. It’s why I got into sales…you’re limited only by your own personal dynamic. There used to be a time when being a doctor meant you were automatically ‘rich’. The reality is that successful salespeople routinely make more than doctors-without the requisite education required of doctors. It’s exactly because of government interference (and insurance company’s in response to that interference) that suddenly it’s no longer lucrative to become a primary care physician. Is it any wonder that only 17% of medical school grads choose primary care ? We are facing an unprecedented shortage of primary care physicians. Proof that, doctors (or CEO's, or any number of people) will go into other fields or industries as the opportunity to live the American dream is stifled by regulation. Since we mentioned CEO's and insurance companies, did you know that on average, insurance companies make 2% profit (the largest, United Health Care, made a little over 6%--not much better than a long-term CD). Speaking of profit, what if all of the insurance companies’ profits were somehow able to be put back into the system or CEO’s ‘exhorbitant” multi-million dollar salaries and bonuses were given back as charity to the needy ? It wouldn’t make a difference—the $13 billion in profit that insurance companies made in 2007 (before the recession hit) represents .6% of total healthcare spending. CEO’s total compensation represents even less- .005% of total spending. People hate that which they don’t understand.
Lest you think I agree wholeheartedly with the Republican side of things, know that I questioned Senator Ensign regarding his opposition to a ‘personal responsibility’ mandate during a conference call. Or as most people know it-“being forced to buy health insurance”. The auto insurance analogy is correct, but not for the reasons you think. True, you ‘choose’ to drive and you don’t choose to get sick or have an accident. However, the concept of why you have auto insurance is the same. If you’re in an auto accident, and it’s your fault that you injure the other party, the other party is entitled to have you pay for their damages or healthcare bills. Since many (most) people don’t just have the funds lying around to pay for this, insurance (that grand old financing mechanism for things we can’t afford) steps in. It’s to ‘protect the other guy’. Same thing with health insurance…if you’re a young 25 year old guy and you blow out your knee for example—an emergency room visit can cost you thousands. How many 25 year old guys do you know that have thousands laying around to pay for the care ? Taking it one step further, a heart attack in Nevada runs around $200,000. Can you predict 100% that you won’t have a heart attack ? Kind of hard when you consider an American has a heart attack every 29 seconds. How about any of the millions of other health emergencies ? Mandated health insurance protects the ‘taxpayers’-who ultimately pay for uncompensated care. It also serves to reduce premiums. It also could help save a life…Consider the following.
This past summer Senator Reid was canvassing the country with a former CNN correspondent whose twenty-something brother died due to his inability to have a heart transplant. She stated that “because the insurance company denied him, he died”. Listening to more of her story, she related how she applied for Social Security disability which would give her brother Medicare—and that he was denied twice. She then had success in getting her brother on Medicaid-the state’s care for people who make less than $12,000 a year. However, Medicaid wouldn’t pay for the transplant. Why not ? Because he was older than 19, the maximum age that Medicaid would pay for a transplant. Now why would Medicaid have an age limit ? Reason: cost. Now what is sad is that both Medicare and Medicaid are GOVERNMENT (read Public) plans. This is the reality with government health care…it’s still not free care and when revenue is less than expenditures something has to give (rationing, bureaucracy and poor service). The really sad thing is that if this young man had purchased health insurance before he got sick, in all likelihood he would be alive today. At his age, his premiums could have been had for less than $30 a month.
For those that can afford it, US health care represents the pinnacle of excellence. As costs have risen, insurance premiums have risen to keep pace. The US system has been around for 80 years, employs hundreds of thousands of people, and represents one-sixth of our GDP--this cannot summarily be dismissed without cataclysmic-ally affecting our economy. As President Obama stated sometime in July, (paraphrased)The best time to have started socialized medicine was at the beginning. It's too convoluted and entrenched to start now.
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