Making an offer employees can't refuse

I never thought I would find a reason to relate to Sarah Palin's phrase "death panels," but a headline in the Boston Globe made me revise that position: "Plans steer patients to lower-cost hospitals" (you can read the full article at http://www.boston.com/business/healthcare/articles/2011/02/10/plans_steer_patients_to_lower_cost_hospitals/). The reporter, Liz Kowalczyk, writes that Blue Cross/Blue Shield (BC/BS) of MA lauched a new "product" purportedly to help small businesses continue to offer health insurance to their employees.

Once again, the health insurance establishment shows itself to know the price of everything but the value of nothing. This cost shifting by BC/BS reflects the belief that patients won't mind going to a community hospital instead of a teaching hospital because doing so will save money for themselves and, wink-wink, their insurers (Three guesses: What will the insurers do with the money saved?). After all, a hospital is a hospital and a specialist is a specialist, right?

Here's the tenor of the deal offered: "The Blue Cross Hospital Choice plan, which went on sale last month, charges members, for example, an extra $1,000 for an inpatient stay or outpatient surgery, and $450 more for an MRI, at 15 higher-cost hospitals, including Massachusetts General and Brigham and Women’s hospitals, Children’s Hospital Boston, and UMass Memorial Medical Center in Worcester. Companies and workers that sign up get a significant break on their health insurance premiums: a 4.5 percent increase for the first quarter of the year instead of a 10 percent increase."

What a deal! You can pay $1,000 more in your choice of ways: Either stay in the hospital following surgery or go home the same day as the surgery. In other words, you will pay $1,000 more no matter which choice you make! And, to sweeten the deal, BC/BS says that, while everyone pays an increase every year, if you choose this new plan, your increase will be less--but only for the first three months of the first year. To seal the deal, the state will pay each employee's three-month share of the premium when the employer enrolls. With choices like these, how could anyone refuse to enroll?

Wait until employees referred for medical treatment to a hospital find out they can't choose the hospital. For "those" people not affected by price--I guess you can call them "price inelastic"--it's no big deal. They will continue to go where they want for the services they need, regardless of cost. But, for the working-class guy or gal and their families, the new plan means they've been "price triaged"--they have less money to spend on their treatment, so the system sends them to the lowest-cost provider. As Stevie Wonder put it: "Livin' just enough for the city." Or, rather, dyin'.

To add insult to injury (pun intended), the reporter quotes the head of an insurance agency on why this plan is such a good idea: "These plans 'really help the employer and the employee start to understand what is driving health care premiums higher', said Paul Pietro, chairman of Mid-State Insurance Agency Inc., an insurance broker in Worcester. 'Simple things, like MRIs and CAT scans, if you’re just able to stay out of those hospital settings, that can save money. It helps everybody'." If you can't believe an insurance broker about what is good for your health, who can you believe?

So, while I don't want to encourage use of Sarah Palin's "death panel" phrase, the BC/BS MA plan comes closer to what Ms. Palin meant than President Obama's initiative.

What do you think?

I read the following today in the New York Times medicine section: "Republicans recalled, however, that they secured approval of two huge changes in domestic social policy that worked much better than Democrats had predicted. They remade welfare programs in 1996 and added a prescription drug benefit to Medicare in 2003. 'The idea that Republicans are just not interested in health care and won't do anything is belied by history', said Stuart M. Butler, director of the Center for Policy Innovation at the conservative Heritage Foundation." My interest lies in the second observation, that adding the prescription drug benefit to Medicare in 2003 demonstrates Republican in health care.

If you recall the phrase "donut hole," you understand why I question the facts behind Mr. Butler's superficially true statement. Here's how Reason magazine wrote about it at the time: "The cost is also likely to rise because of demands to close the drug plan's weird gap in coverage: After a $250 deductible, it will pay 75 percent of prescription drug expenses, up to $2,250 a year; but between $2,250 and $5,100, the point at which the plan starts paying 95 percent of costs, there will be no coverage at all." When one runs the numbers, one realizes that (a) Medicare enrollees are reimbursed up to $2,250 per year and (b) at that point, Medicare enrollees reimburse insurance companies for the same amount, up to $5,100. How did this come about?

As you might guess, the insurance industry had a lot to do with it. In fact, it was an insurance industry lobbyist who wrote the bill! Only in America.

What everyone forgets but should remember: The bulk of the new health insurance law won't kick in until 2014. No one knows how all those changes will affect care, cost, universality, etc. Of course, that hasn't stopped those who throw slings and arrows about ObamaCare, death panels, and other points on the right-hand side of the Sane<------>Lunacy scale from turning the dark sides of their imaginations loose:

• It will bankrupt the country
• It's a socialist plot
• "I don't want no gummint messin' with my healthcare!" (often heard from those ignorocrats who don't know that Medicare, Medicaid, etc. are government-run programs)

It will be a long time before the populace and those elected to govern them acknowledge that the real solutions--universal, cradle-to-grave, single payer--will take the concerns about who get what and how much and at what cost off the table. Then, we can focus on more important problems:

• Food
• Water
• Education
• Industry & jobs
• Security

Let me know your thoughts.

Laughter is the best medicine!

Healthcare--service delivery, insurance, portability, coverage--is serious business. However, even in the face of life-and-death decisions, occasionally a beam of levity emerges. Often, it seems even funnier because of the extremem alternative. Here are some examples:

1. Check out the Summer 2009 Lahey Clinic magazine (they didn't print a URL in the issue, so you will have to root around on the Internet). In New England, the Lahey Clinic is one of the top medical empires, rivaling even esteemed Mass General Hospital. But, in the article entitled, "New Wing To Open This Summer", white-haired white men in suits are pictured as the drivers behind the project. But, the hilarious--if pathetic--photos attest to the lack of understanding these senior executives have about the needs--and interests--of their patient base.

There are five non-people photos. The first shows the building. This is, of course, an example of the navel-gazing vision of 19th-century New England mill owners; the edifice complex. In a way, they want to show their tomb, as they believe it is something that will outlive them, and that succeeding generations will remember THEM because of the building they caused to be built; a.k.a. paid for.

This pales in comedic comparison to three of the four other shots, depicting (a) The Sophia Gordon Cancer Center, The Pain Center, and Opthalmology's State-of-the-Art (SOTA) Clinic. Well, let me rephrase that description. Pictured are NOT the cancer treatment facility, or pain center treatment rooms, or cutting-edge (no pun intended) eye treatment equipment. What the pictures do show are--wait for it--WAITING ROOMS!!! That's right. They're giving patients--people in pain, fear, and medical need--better, more modern, roomier places in which to WAIT FOR TREATMENT!! The fourth picture, of the new Emergency Room, shows not SOTA treatment rooms, but a pristine, well-lighted carefully constructed sign-in desk and filing cabinet (no doubt for paper files, which are SO 20th century).

You can't make this stuff up! But wait, there is more!

2. Read "The Immortalists", an article in the July 26 Boston Globe Sunday magazine by a freelance writer (and boomer) Jennifer Graham. The lead sentence reads:  "The baby boomers are the first generation that will-let's be honest-actually live too long." While she doesn't mention the word "euthanasia", that is exactly what she means. I won't quote other parts of the article here, but I will mention how she justifies expressing this opinion:  "Meanwhile, maybe they could lighten up on the All Bran and hit the trans fat. Just sayin'. For posterity's sake." Well, when it comes to being made into Soylent Green, Jennifer Graham can have my place in line.

That's the current phrase that's being used by all manner of people to justify their loony, loopy opinions:  "Just sayin'." I think the Globe printed this article because the author does make an attempt to take a tongue-in-cheek tone, but she totally fails. I'm just sayin'.

3. Like The Wall Street Journal? Who doesn't? It's a non-stop source of comedic content. Take, for example, the Friday, August 7th, front-page article headlined, "France Fights Universal Care's High Cost". The lead example provided by the author, David Gauthier-Villars, of the collapse of the French system--widely acknowledged as the finest health care delivery system in the world--is that a woman named Laure Cuccarolo went into early labor and had to call the local fire brigade to take her to hospital 30 miles away! C'est horrible!! In the United States, these things happen all the time. Thousands of moms have given birth in taxi cabs, subways, apartment bathrooms, etc. Mostly, they're just victims of circumstances, traffic jams, and poor planning. Years later, I bet their kids get a kick out of being told their godfather is a Russian taxi driver. 

The real reason, of course, that the Journal printed this story is not because it has any real news or even feature story value, but because propaganda theory demands such an approach. After all, if you can't attack the best example from the opposition of why its approach makes sense, then you try to tear that example down. Some people will believe it to be true. And, for the propagandist, that's the key:  Not whether something is true or false, but whether it is believable.

I am sure you can add to the list of examples I've provided--and, I wish you would. There is a tinge of gallows humor about all these citations, because we realize instinctively the insidious intent of the authors. Still, it is good to step back and laugh in the face of so much seriousness.

I'm just sayin'.

Let me know your thoughts.

No One Is Willing To Say, "Yes!"

Lots of people say, "No!" to President Obama's proposed healthcare reform package; mostly Republicans, whose entire legislative strategy for this session of Congress can be summed up in that one word. Unfortunately, even some Democrats are saying, "No!", too. Why they are doing this is a mystery, because if Obama's plan fails to be enacted, the Democrats will have handed the next election to the Republicans. 

Even in the contorted realm of political logic, this one defies description. Here's the situation:  the Democrats control both houses of Congress and the White House. Celebrating this outcome the day after the elections, any Democrat--be he yellow dog, blue dog (why do politicians have to have colors for everything?)--would be justified in thinking, "Now we're gonna turn things around and get this country back on its feet!"

But, hey--these are politicians we're talking about. They've got no spine or moral compass. All they care about, regardless of which party they're in, is getting re-elected. Want an example? If you were a U.S. Senator in 2002, knowing then what you know now, would you elect Harry Reid to be your leader? He's a textbook definition of gutless wonder. And Nancy Pelosi in the House? All I'll say is that she's even worse than Reid.

However, they're what we've got to unite the legislative troops behind President Obama's many initiatives, healthcare reform being the most pressing and immediate. We need people who can stand up and say, "Hell, YES! I'm gonna support my President and his programs!" Obama must feel like he's being nibbled to death by ducks. Here he's the head of a party that has all the pieces in place to go out and make real change in this country, to turn it around from the descent into Hell the previous administration engineered over eight years of rule by the foulest, most despicable, inbred, power-mad, war-hungry criminals this country has ever seen.

Even my wife, who is one of the smartest people I know, complains that she doesn't want a plan that takes her tax dollars to subsidize the healthcare of people who are obese and unexercised because they brought on their own health problems, like diabetes and heart failure. She's drunk the Republicans propaganda Kool-Aid, leading her to link this societal problem to Obama's healthcare reform package. THEY'RE MUTUALLY EXCLUSIVE! TWO SEPARATE PROBLEMS! YOU CAN WORK TO FIX THEM BOTH AT THE SAME TIME WITHOUT ANY CROSSOVER!

What do I mean? Obama's plan addresses the three key aspects of healthcare:  coverage, services, delivery. When his plan is enacted--never mind getting true universal coverage, like the rest of the civilized world--yes, fat people and their problems will be covered. BUT, THEY'RE NOT FAT BECAUSE THEY'RE COVERED. THEY'RE COVERED BECAUSE THEY'RE AMERICANS. Two separate problems. Get it?

Let me know your thoughts.

You can't make these names up!

Here's a quote from today's New York Times: "Richard Kronick, a professor at the School of Medicine at the University of California, San Diego, cautiously concludes from his own study that there is little evidence to suggest that extending health insurance to all Americans would have a large effect on the number of deaths in the United States. That doesn’t mean that it wouldn’t; we simply don’t know if it would." A doctor named Kronick--what are the odds?--especially with the topic he researched.

It would be interesting to see his research protocol for this study. After all, beyond the superficial data points that can be known--age, sex, marital status (but, how many times married? I bet not), homeowner or renter, etc.--the information one gathers is squishy at best.

For example, of what illness(es) did each person in the study die? As an example, I'll use my mother. She had kidney failure and was on dialysis three times a week for about six years. She also developed Alzheimer's, gradually and insidiously, over many years. She had pulmonary problems, due at least in part to smoking for about 40 years (she quit for the last 18 years of her life). The list continues: Macular degeneration, cataracts, migraine. But, the cause of death listed on her death certificate is acute aortic stenosis. Yes, she had health insurance, which covered just about every treatment and prescription. The question is: If you put her into your research categories of "Had Insurance" and "Lived to Age . . .", what have you learned? Very little, in my opinion.

This is a point I've mentioned before, but it bears repeating; in fact, this blog is in large part dedicated to hammering on this point until at least a majority of people in this country (and, elsewhere) accept it as valid: The people who make the decisions about your, and my, healthcare options, insurance, and eligibility are people who know the price of everything but the value of nothing. As a society, we have not evolved to the point where the fruits of innovation, discovery, initiative, and concern for the well-being of others are valued much less than the ability to show a profit. Until we do, healthcare--and education, childcare, work opportunities, etc.--will generally go to the people most able to afford them. This is a kind of rationing, which is the topic of the article from which the quote at the outset is taken.

As Damon Runyon once wrote, “The race is not always to the swift, nor the battle to the strong, but that's the way to bet.”

Let me know your thoughts.

We're in trouble . . .

. . . now that Professor Michael Porter published his new book about how to cut health care costs. To his credit, Professor Porter espouses a solution based on the principles that he lives and dies by and teaches to students at the Harvard Business School. But, as soon became clear during an interview on WBUR (an NPR affiliate at Boston University), Professor Porter's solution is a classic ivory tower confabulation having no relationship with the realities of health insurance and delivery of health care services.

His solution? Let's change the way we pay health care providers for their services. Instead of paying a fee for service, which we do now, Professor Porter proposes to pay physicians and others based on health care service outcomes. On the surface, this might seem to be reasonable. After all, when you take your car in to be repaired, you get a warranty on the work performed. Bring it back within the warranty period if anything specific to the repair goes wrong, and they'll fix it for free. Closer to the topic, a patient, or whoever is responsible for issuing payment, might determine that it took little Johnny three weeks to get over his cold rather than the "normal" recovery time of seven days. As a result, Johnny's pediatrician would be paid less. If little Johnny has a relapse (how do we know it's the same cold?), the doctor might receive no payment because of the unsatisfactory result of his treatments.

This is about as logical as Broadway Danny Rose saying to his paramour, when she tells him bad guys shot her ex-boyfriend through the eyes, "Oh, my god, he's blind!" "No, you idiot," she retorts, "he's dead!!"

A medical example might make this more apparent. Say you have a hernia repaired. How long does the doctor have to wait before h/she is paid? Well, if it's done laparoscopically, you walk out of the hospital the same day--the so-called outpatient procedure--and recuperate at home for 10 days-two weeks before resuming normal activities. If it's done with an incision, there's a two-day hospital stay, followed by six weeks of recuperation, during which you can't lift anything. Regardless of which kind of repair is done, any surgeon, if you ask (most patients do not), will tell you that the real test of a surgical repair comes 10 years after the repair. If it's still solid after all that time, you can think of yourself as "cured". Does the doctor have to wait 10 years to get paid?

Or, suppose you break a leg. Dr. Porter and a fair number of other folks with, as my father used to say, "more nerve than brains," will tell you that market forces will determine the path to the most cost-efficient solution to the problem. In other words, much as if you were buying a refrigerator or a computer, you will compare prices, brands, customer experiences, and other things that will lead to a wise purchase.

But, wait a minute! YOU HAVE A BROKEN LEG! YOU ARE IN PAIN! PERHAPS YOU CAN SEE THE BONE COMING THROUGH THE SKIN--A COMPOUND FRACTURE!! You are not going to shop around for the best price for treatment. You are about to go into shock. You must get to the nearest hospital STAT! "I don't care! Just end the pain", you tell the emergency room people as they track down the orthopaedic surgeon on call.

In that scenario, who will evaluate the doctor? On what basis will the evaluation be performed? Did you remember to ask the doctor about his warranty policy? It should be clear by now that Professor Porter and that tribe of business-oriented, cookie-cutter solution-loving people he represents--those who know the price of everything but the value of nothing--offer loopy approaches to problems that can't be measured or contained. They are squishy and fluid, not solid and of fixed shape.

So, avoid the trouble this kind of approach brings. Everybody knows the real solutions to the problem: single-payer, universal coverage, cradle-to-grave coverage. Demonstrating that they will do the job and contain the costs is the next real challenge.

Let me know your thoughts.