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Tuesday, 22 December 2009

According to a U.S. Geological Survey there is no scientific definition of the volume of a faucet drip, but after measuring a number of kitchen and bathroom sink faucets, the volume seems to be between 1/5th and 1/3rd of a milliliter (mL). Drips from bathroom tubs come in a bit more, though, at about 1/2 mL. So, for our calculations below (numbers are rounded), we are going to use 1/4 mL as the volume of a faucet drip. So, by these drip estimates:One gallon: 15,140 drips, One liter: 4,000 drips.

Looking at it this way, it seems like that drop of water down the drain is pretty insignificant. But, as you can see by the following estimates assuming one home with three dripping faucets leaking at 60 drops a minute, all those drops flowing in "real time" can really add up to a flood.

259,200 drips per day, or 17 gallons per day, or 6,248 gallons per year, or 124 baths per year. And that is just one house. Speaking of houses, in the U.S. House of Representatives there 435 leaks. This number is currently fixed by the Reapportionment Act of 1929. There are an additional 100 dripping leaks in the U.S. Senate. Granted, some are leaking worse than others, but there is very little intention of calling a plumber.

The current march to healthcare reform is a slow, steady drum beat. It is just slow enough to avoid serious attention by the owner of the House, the American public, but persistent enough to cause a flood of Biblical proportions. Yes, there will be reform, of some sort. It really doesn't matter what reform, just something. This is stated in a way that makes it seem harmless. It is being called watered-down, unacceptable to the right and the left. Do you hear the soft music in the background?

WAKE UP AMERICA!!!!

The media reports would have you believe that all they were doing behind closed doors was writing this 2,500 plus page bill. Yes, that was done early in the process. The rest of the time was spent planning how this would be eased through the American bias against actually finding out the truth. The plan, the entire plan, has already been set and is being implemented; right now. There is only one thing that can stop it; YOU, your vote. It doesn't take a doctorate in political science to understand what is going on. A casual understanding of the bill in both the House and the Senate uncovers the real agenda; a socialized healthcare system. Under both the House and the Senate bills, and the Republican bill, healthcare financing cannot survive as we know it. It will become impotent and the only hope will be for the government to step in save the world, while bankrupting our country. We are not only going to have government run healthcare, we are going to have a healthcare system owned and operated by our U.S. Bank - China.

You have to vote these people out of office at your first opportunity and send people to Washington that have no intention of making it a career. We have uncovered an array of ideas on this website that can address the real problems and offer a sound solution. The problem is getting past the need of congress and the media for self-sustaining, self-promotion.

Speak up at every opportunity and keep it short and simple. Something like this:

We cannot afford the current solution. There are not enough primary care doctors to give access to everyone. The government cannot do healthcare cost effectively. The problem ain't financing, it is delivery and utilization. I am doing something about the high cost of healthcare; I am changing my lifestyle and eating habits. Oops, that last one just slipped out.

If simple doesn't seem to work try the ones listed by the National Association of Health Underwriters. Some of the most serious concerns in HB 3590 are:

  • A minimum loss ratio requirement that applies to all fully insured plans, including grandfathered plans, as of January 1, 2011.
  • A completely ineffective individual mandate requirement that will make it more financially advantageous for many healthy Americans to forgo coverage until they are sick and then utilize the guaranteed-issue protections to temporarily obtain coverage and then drop it again.
  • Strict modified community premium rating requirements (including age bands of 3:1) that now apply to all fully insured plans.
  • State-based exchanges that create costly and confusing layers of dual regulation.
  • New employee voucher provisions to allow choice between employer coverage and the exchange, which could actually hurt participation in employer-based health insurance plans.
  • An expansion of the federal Medicaid program to individuals up to 133% of the Federal Poverty Level (FPL).
  • The creation of a huge new federal long-term care program that threatens the private long-term care insurance market and is inadequately financed.
  • Financing mechanisms that would significantly, and negatively, impact the health care industry, consumers, employers and our overall economy.  
  • New annual health insurance premium taxes of over $6 billion per year to be enforced on 2010 contracts that have already been priced and sold prior to the enactment of the bill and taxes.
  • The 40% federal excise tax on high-cost health plans ($8,500 for individuals and $23,000 for families) is not properly indexed for inflation, and this bill does so little to control the medical care costs that are the true drivers of health insurance premiums, eventually all plans may fall under this excise tax umbrella.
  • Massive proposed cuts in funding to Medicare, particularly the Medicare Advantage program.

Well, there you have it. Now, start making plans to call the plumber. Better yet, become one.

Posted on 12/22/2009 3:08 PM by Bob G. Shupe

Tuesday, 15 December 2009

Lost, or maybe assumed, in this current debate about healthcare costs is that the key reason to defeat the democratic proposal-healthcare reform du jour-is to allow the republican proposal to come to the front of the pack. There is one small problem with that strategy; the republican bill is no better and is based on the same mis-information as the democratic nightmare on Pennsylvania Avenue.

The Patient's Choice Act would assure essential health coverage and health care to every U.S. citizen, without increased federal spending and taxes, and without the federal government taking over health care. The key to the bill is that it shifts the tax benefits for employer provided health insurance from corporations to all workers. As a result, every citizen not retired on Medicare will get a refundable tax credit of $2,300 per year for individual health insurance or $5,700 per year for family coverage. For workers who don't have insurance now or who pay for their own insurance, that is thousands of dollars a year they don't have today to help pay for health insurance. Workers with employer-provided coverage can keep that or use these credits to purchase their own preferred insurance instead.

Under the bill, each state would set up their own Health Insurance Exchange, where insurers could compete to offer coverage to everyone in the state. All insurance offered on the Exchange would have to provide coverage meeting the same standards as the insurance offered to federal employees and members of Congress under the Federal Employee Health Benefits System. The bill would also enable employers to devote a specified amount toward health coverage for each worker each month, with the worker to then use those funds to buy the health plan of his choice on the state Exchange, or outside the Exchange. States could join with others to form regional Health Insurance Exchanges that would expand insurance options. Consumers in each state in a regional Exchange would be free to purchase health insurance from any other state in the Exchange.

Do you understand what you just read? Are you shaking your head, as you should be, and asking what is so different about this approach when laid along-side the democratic version? The republican approach makes some fatal catastrophic assumptions; bigger is cheaper, buying insurance across state lines will not make the cheaper insurance become more expensive, individuals know better what to buy than their employers, and that a Health Insurance Exchange is somehow not "insurance." Remember, insurance companies are cheats and greedy corporate robbers of helpless American citizens. Let's look at each of these assumptions.

Bigger is cheaper. No, bigger, to a point, offers more choices for administration and flexibility of plan design and for the formation of a self-funded model (preferred.) There is no, did catch that, no empirical data that proves bigger is cheaper. Buying insurance across state lines will not make the cheaper insurance become more expensive. Why, you should be asking, is insurance in Tennessee cheaper than in New Jersey? Why is anything cheaper? It cost less to make. Insurance costs in Tennessee are based on the regional costs for medical care; e.g. hospitals, doctors, and what drug stores can get by with in pricing. If someone in New Jersey buys a policy based on Tennessee rates, those rates will eventually go up. Why? Because the person in New Jersey is going to use New Jersey healthcare...which is...more expensive. Get it? 

Individuals know better what to buy than their employers. Really? Why do over half of the people who have insurance depend entirely on their employers to offer benefit plans designed for their group? The same reason why individual sales of health insurance have lagged behind for years, people don't understand insurance. They don't want to understand insurance. If it is left to an individual they will buy based on cost alone. This is not in conflict with the earlier statement that bigger is not cheaper. Remember I said there were limits. Finally, that a Health Insurance Exchange is somehow not "insurance."  Several years ago this was offered and defeated as "Association Health Plans." It was the same concept. It wouldn't work then because it was so restrictive. It will only work if it is set up correctly, self insured, reinsured and restraints are placed on members who wish to withdraw for the wrong reasons. Again, an exchange will work, not because it will be cheaper, but because it will offer choices not available otherwise.

In the end, this republican alternative still has at it's core the destruction of the current financing system. Why is that important? Simple, there is nothing wrong with the financing side that a few tweaks within the industry will not cure. The problem is delivery, and over utilization by a society that prides itself in finishing everything on their plate; so starving children in India won't be mad at them. The only hope we have to fix this problem is to take a step back - politicians please take a hundred steps back and stay there - take a deep breath, and then look around for some folks who know what they are doing. Those folks need to fix this one step at a time, not reinvent the things that do work. The current approaches on both sides resemble touching up a Rembrandt with a four inch paint brush that has be dipped all the way to the bottom of the can. One would hope that many in the current Congress would take their retirement and stay home after the next election. Any statesmen, I'm sorry, statesperson out there that would like to run for office. Send me your credentials.

Posted on 12/15/2009 5:10 PM by Bob G. Shupe

Wednesday, 09 December 2009

I have only watched HBO Poker for a few minutes but it was clear to me that the folks playing had each developed their own unique style of not letting their opponents see them sweat. I have both C-Span channels running on two TV's in the background. Legislators on both sides of the isle have told their story so many times that you can almost mouth the words with them. And, they do it with a straight face. The difference between the HBO players and congress is money; ours. Here is what is being said with a straight face.

The Associated Press reported that negotiators scrapped a public plan in favor of an insurance program run by private companies, but supervised by the federal agency that oversees health insurance for federal employees – the Office of Personnel Management. That was after a ten member closed door meeting to hammer out a compromise Tuesday night December 8th. Then Senate Majority Leader Harry Reid, D-Nev., said the emerging compromise "includes a public option and will help ensure the American people win in two ways: one, insurance companies will face more competition, and two, the American people will have more choices." Reid declined, in this impromptu news conference, to provide any additional details about the agreement. He said it with a straight face. He really believes this stuff. So did people who swore that the earth was flat. Like Reid, they had only the details they wanted to have. Even if the ten member group and Reid are both right, they are wrong. Why? If the government oversees a non-profit, sets the rates, and dictates the eligibility, the fact that the program is administered by a private entity doesn't make it a private plan.  It is still a public plan. 

The basis of a public plan is that it creates competition and thereby lowers cost. Kind of like Wal-Mart. I said that with a happy face. I couldn't keep a straight face. The government is going to lower what they pay doctors, hospitals, states, pharmaceuticals, and others and that is going to make "insurance" cheaper. First it is not insurance, insurance is simply a transfer of risk. Congress confuses sound risk principles with their own terminology. Like what is usually said about poking a balloon and it pokes out the other side, they are flat wrong. But they say it in such a way that the public believes it. After all they elected them, surely they know what they are talking about. Let's consider sound science. If you poke your finger in a balloon it doesn't form a bump on the other side, the entire balloon gets bigger. The space doesn't go away it just rearranges. Same with mandating lower costs for goods and services. If the government is paying less for something, one of two things happens. One, somebody else pays the difference, or two, the one providing the service or product goes away. That is enough railing on poker face politicians. Instead, let's again spend some quality time discussing, with a straight face, what will work; how you actually make the balloon smaller.

In other sections of this website I have clearly and with documentation explained who the contributors are to this problem. Let's review the major players; insurance companies, doctors, hospitals, lawyers, politicians, employers, pharmaceutical companies, and consumers. If these are truly the players in the problem then there is absolutely no way to fix the problem without offending all of those on this list. It is also prudent to assume that the only way to fix the problem is to do just that; offend them - with a straight face. Insurance companies enjoy cash flow, agents have to have something to sell, doctors, while running preventive tests to make sure they have evidence if they get sued also enjoy the profits coming from the extra testing, hospitals complain about treating patients with no insurance but enjoy the DSH payments they receive from the government that offsets a significant portion of that loss, trial attorneys suck blood from all sectors of the industry with a very straight face, politicians enjoy a rich, permanent retirement benefit, not because they do something right or worthwhile, but because they were elected, employers have enjoyed ignoring a problem that should have been recognizable a decade ago, pharmaceutical companies enjoy a very bright future since medicine will inevitably move in their direction with the discovery of tailor made drugs based on genetics, and consumers still don't have any significant skin in this game, they can still abuse their bodies and expect someone else to pay the bulk of the cost. Any viable solution must impose on everyone of these enjoyed abuses. Every piece of current legislation is designed to have as little impact on those enjoyed benefits as possible. If that can be done with an agreement from both sides of the isle, with a straight face, America will be saved from economic implosion.

Here is the answer. Click here and enjoy the abuse. 
 

 

Posted on 12/09/2009 3:15 PM by Bob G. Shupe

Wednesday, 25 November 2009

There are several frustrations in my life but one of the most profound is sitting in a meeting where some one is explaining why something is not working because "they" said...  It is always they, them, those people, the other party, them and us, on-and-on infinitum. We have developed a problem over the past 233 years; a party system. No, I did not say a two-party system, a party system. Two has nothing to do with it. We have had two or so parties since before the bell cracked in Philly. What has evolved over the past six or seven decades is a "them and us" mentality. To overcome that we now hear everything prefaced with, "it is a bi-partisan effort," as if that makes it pure and holy. It makes it impure and sacrosanct from those who would like to actually just...work together for the good of the people. Nothing can be accomplished today unless it is bi-partisan. What the hell happened to "by the people?"

This also bleeds over into the other class of intellectual curiosity, Hollywood. CSI Miami used to be a great show to watch. I can't anymore. Every episode has dialog that accuses the immoral insurance companies of being the sole villain in the healthcare crisis. Oh, and rich CEO's who will not provide a policy for their employees that will cover a $200 knee brace! A recent episode revealed that an undesirable rich, greedy, CEO was taking out life insurance policies on his employees and then knocking them off one at a time to collect the life insurance proceeds. They must have had their understanding of insurance a little out of phase. That is exactly what could happen under a federal, government run program that cannot stop billions of dollars in fraudulent claims. The facts are that if such a thing were to happen the private insurance company would have been all over the second claim, not Horacio Cain.

Here is the sad news. Many Americans believe what they hear from politicians and actors, and other famous people, most of which also now have a book to sell. If you have not sold your soul to politics, Hollywood, any cable news network, or accomplished daring-do in a sports arena your opinion and facts are pretty much toast. Not because the networks and others don't want to share you with the world, but because the public don't want to hear it. Why? It is not believable or repeated enough to be a redundant fact (otherwise known as a sound-bite.)

How do we fix it? Depends on who is reading this blog. If you are already out front, which I doubt you are or you wouldn't have time to read this, you will do nothing because it is not in your best interest. What is important to you is what is happening right now, being the first to report it as though that makes it relevant. If you are one of the majority of people in this country who would like to change your perception, the choice is yours. To the first group I would say get all the gusto you can get. You're going to need the memories. To the second, it's your move. Actually you were raised better. Demand the truth, not opinion. Demand facts and details, not outlines and promises. Ask questions like...who are they anyway?

Posted on 11/25/2009 10:58 AM by Bob G. Shupe

Wednesday, 18 November 2009

Recently my wife and I took a cruise to Norway to celebrate our 40th wedding anniversary. Norway is the home of her grandparents and she wanted to see were they came from. A trip like that requires that you stay on a very large boat for several days, eventually agreeing to attend some of the entertainment venues offered on-board. One of those opportunities was to see a magician. He didn't have any rabbits and he didn't wear a top hat, but he did do something with a couple of attractive ladies heads. As intently as I tried not to be distracted and allow myself the opportunity to tell my wife how he "did it", I was tricked into believing that he actually swapped the ladies heads. The guy was good. So are politicians.

Did you see it? There it goes again. The healthcare bill and its debate just disappeared! It is no longer a healthcare bill, it is an abortion bill. No, now it is a stimulus bill, no,no, what it is is an opportunity to work together and pass something we can all agree on. You know, when the rabbit disappears into the top hat you know in your heart of hearts that the animal is somewhere eating a carrot in a cage. You know it didn't disappear, but you were entertained. Well, congratulations, the greatest show on earth just marched up Pennsylvania Ave.

Aren't you wondering what else can be added to this already massively overstated, mistaken solution to the wrong problem? Don't be fooled by the current distractions, the best move was at the beginning of the show when we were told that the problem was all within healthcare financing. You know, the evil, immoral insurance companies. Then it was Medicare Advantage and all those greedy seniors who were taking advantage by paying extra premium for an Advantage program. Then it was an endless list of things highlighted by every special interest group that could afford a bus ticket to Washington.

In reality we are so very far astray from our target because the initial definition of the problem was so far off course at the beginning that our final destination will be light-years away from a true solution. Everything that has happened since is noting more than a distraction to keep us from waking up and realizing that we were fooled during the opening monologue. It is like a good card trick, the card was exchanged at the very beginning of the trick. Everything else is just show to help us forget what happened at the beginning. The only way to get back to stage one is to burn the current proposals, on both sides of the isle. This solution must be based on the original, real problem, and it must be designed from the ground up by those who are at ground zero, not in the flight tower.

 

 

 

 

Posted on 11/18/2009 2:25 PM by Bob G. Shupe

Wednesday, 11 November 2009

Very little, if any, discussion about the healthcare crisis has highlighted the self funded market. Why? Very few understand it and politicians have never heard of it. Why is it important? Because it is the perfect laboratory for dissecting the frog and looking inside to see how it works.

Simply diagramed, a self funded plan consists of two things; fixed costs and claims. Fixed costs are about 15% to 20% of the total expenditure and the rest is pure claims. Yes, pure, transparent claims. Or, as transparent as providers want them to be. The other reason to look at a self funded plan, other than the fact that over half or the people insured today are in these arrangements, is that it takes the evil insurance companies out of the discussion. On second thought, maybe that is why politicians don't want to discuss self-funded; it removes their only target and turns the discussion back to where it should be - delivery.

It is not unusual for a self funded group to get a 20% to 40% increase in expected costs for the coming year. Here is where that is different when compared to a fully insured group (see defining stuff for an explanation.) If a fully insured group gets a 40% increase, that is 40% on the entire premium. If that original premium was $1,000,000 it would go to $1,400,000. The insurance company's cash flow for investment income would also increase and the agent's commission. If there is a 40% increase on a self funded plan that would be a 40% increase on 15% to 20% of the total cost or $1,000,000 X .20 = $200,000 X .40 = $80,000 increase, not $400,000. That is because the increase on the self funded plan is only on the fixed cost and not the claims portion. Does that mean that the claims will not also increase? Certainly they will, and that is the point. The claims will increase, not the insurance premium. The claims went up because the group is spending money at providers and drug stores, not because the evil insurance company is charging immoral prices for their coverage. In reality, that is also why the fully insured premium went up - claims. You just don't see it on a fully insured group.  That is why self funded is transparent and why we should be focusing on these groups to clearly see the problem. The problem is us, you and me. I won't go into that here because there are plenty of other pieces on this site that address the issue.

We are not in Kansas any more and there is no yellow brick road. There is however a very large tornado and it is sitting right over Washington DC. It will stay there and continue to destroy our ability to fix this problem unless someone seeds the clouds or changes the pressure in the atmosphere to allow it to move along. You my friend have the ability to do this. Step one, get this message out. Step two, let your elected official know that if they don't start listening to reason that you will not vote for them and will in fact campaign for the opponent in the next election. Step three, lose weight and begin a rational exercise program. Step four, get a check up with blood work and take proactive action once you get the results. Yes, it is that simple.

 

 

 

 

Posted on 11/11/2009 11:46 AM by Bob Shupe

Monday, 09 November 2009

I have thought a lot about what I could do to get the attention of a practical person in Washington, DC. Someone who has the resources and the desire to fix this healthcare cost mess. Someone who was not absorbed by their own popularity, selling their book, and commercials to support their TV programing. Someone who would be willing to shut out every thing that was going on just long enough to consider something different, something fresh, something that required everyone giving up something. Well, it doesn't seem like such a person exists.

Having come to that conclusion most would just say, oh well, and fade away. Not a chance. I will keep writing on this site until someone finds something of value and starts to move forward with a new banner, a real solution.

Aren't you tired of hearing what is wrong with the current proposals? Do you really have any desire to fix the proposals instead of fixing the problem? Here is the deal. A bunch of politicians got together, with the help of their aides and lobbyists and those who have influence and financial means, and drafted a set of legislative band aides. Those were put forward over an acceptable period of time, changed, amended, debated, and eventually passed by the House, without the first thought that it was totally wrong. That it was more important to fix the legislation than the problem. That it was more important to get bipartisan agreement than pass something meaningful.

Well, back to me and few others like myself who have to stand in the crowd and scream because we do not have a voice in the debate, other than our persistence and self-supported websites. We are the frozen-few who do have answers. Getting those to an uninformed and sometimes uncaring public is a problem.

So, if you are out there and have an audience and the financial backing to make something different a reality, we'll be right here. Just in case no one responds, we will keep on writing and talking to whoever will listen. That would be you, if you read this blog. Thanks.

Posted on 11/09/2009 12:32 PM by Bob G. Shupe

Thursday, 05 November 2009

Nancy Pelosi has stated that insurance company's are making "immoral profits" on the backs of people who are being denied coverage.  Click HERE to hear a pod cast.

"Keeping the status quo may be what the insurance industry wants, their premiums have more than doubled in the last decade and their profits have skyrocketed." Maryland Rep. Chris Van Hollen, member of the Democratic leadership.

"Health insurance companies are willing to let the bodies pile up as long as their profits are safe." A MoveOn.org ad.

MY WAY, WASHINGTON (AP), By CALVIN WOODWARD, Oct 25, 8:37 AM (ET)
"Quick quiz: What do these enterprises have in common? Farm and construction machinery, Tupperware, the railroads, Hershey sweets, Yum food brands and Yahoo? Answer: They're all more profitable than the health insurance industry...Ledgers tell a different reality. Health insurance profit margins typically run about 6 percent, give or take a point or two. That's anemic compared with other forms of insurance and a broad array of industries, even some beleaguered ones. Profits barely exceeded 2 percent of revenues in the latest annual measure. This partly explains why the credit ratings of some of the largest insurers were downgraded to negative from stable heading into this year, as investors were warned of a stagnant if not shrinking market for private plans."

Why do politicians do this? The answer is simple but my response may surprise some. The answer is that it is easy, and most politicians are either lazy, or smart, or both. Using terrorist jargon, insurance companies are soft targets. They are low hanging fruit, and all of the other clichés you can think of regarding easy money. Insurance companies actions are often questionable in the eyes of the ordinary citizen who goes to work every day and earns an honest living. Why not shoot at the fat cat? The American public gives politicians the right to make these accusations.

My response however is that the insurance industry, in particular the largest carriers are to blame. Not for their profits, but because they are so damn arrogant. That statement comes from a life in this industry that has been frustrated on countless occasions listening to endless chatter from various insurance company department heads about their cost control procedures. Here is what they say, "We have the tools to lower your cost Mr. and Ms. Customer." "We have wellness programs, disease management programs, lifestyle programs, smoking cessation programs," and my all time favorite, "health risk assessment programs." Oh, and they also have "predictive modeling" programs. All of this is designed, and the cost included in your premium - sometimes, to lower your health care cost or at a minimum stabilize them. So where is the rub? They don't work. And there is no body of data or evidence that they do.

These programs are ineffective for one reason, there is no incentive or motivation to get the majority of people to take ownership of the programs. I said there was one reason, well, there are actually a couple of more. An insurance program is only good, if it even works, as long as you are with that company. Once you change companies you have to start over - assuming the new company has one - because everything will be different. In addition, these programs only work on people who have actually had a claim. It is proven that early detection saves lives and dollars. It is also true that lab work is 80% of detecting early prevention and management of disease. As an example it is more likely that a diabetic will find out that they have the disease after collapsing and being rushed to an emergency room than through a simple blood test. The same is true with high blood pressure and cholesterol, and a score of other diseases. HRA's or health risk assessments taken on-line with an insurance company do very little to identify detection and even less to motivate the patient to take action.

There are powerful on-site clinic models available that have proven time and again that they overcome all of these negative problems. They are owned by the client so it doesn't matter if they change carriers, they are revenue neutral for self-funded employers, they are personal and convenient so they are used and manage an illness after a serious diagnosis is discovered. The best way to make this work is to get the "big" carrier to furnish data and cooperate with the client, including giving proper credit for costs that they do not incur because the patient never files a claim. When confronted with this solution the carrier, more times than not, says, "The data is proprietary and confidential." Or they say their systems will not communicate. Or, "We are the ones who should be providing this service so you can't leave us." Arrogance. How did they get this way?

It isn't their profits, it is their size. And, the unholy union with providers through a thing called managed care, discounts, networks, CPT codes, and a host of other mechanisms that allow them to dominate the scene, continue to consolidate, and drive competition away. How do you get arrogance to go away? Through a humbling experience. How do you create more competition in the insurance industry? Not through a Public Option or any government run health care, but by replacing managed care with total transparency and restricting growth of these mega beasts. Big may work for Wal-Mart but the health care industry isn't selling clothes and greeting cards. Big has the opposite effect on cost in the health care arena. No, Ms. Pelosi, the problem is not immoral profits, it is pious arrogance.

Posted on 11/05/2009 6:46 PM by Bob Shupe

Thursday, 05 November 2009

For a long time there have been ads running on TV and in publications offering a Medicare Supplement policy to their membership. From those ads many would assume that this is a special deal just for AARP members. Well, there is the fine print. That sounds strange when you are offering something to a generation, myself included, that already have a hard time reading the large print edition of the family menu at Red Lobster. Yes, there is fine print. Some ads may even say it out loud. Here's the kicker - "You do not have to be a member of AARP to purchase this product." This offering is what many associations call "affinity programs" or "sponsorship programs." See this article published by L A L Association Membership Services out of Ontario, Canada.

These programs have been popular for years because they offset association administrative costs and are an additional source of revenue to membership dues. In itself there is nothing wrong with this arrangement, except, occasionally members are left to form their own opinions about what the product is, it's value to them, and why the association offers the benefit. All associations should be required to make a full disclosure regarding these issues.

In AARP's case the plot thickens. (See related article HERE) If you do a little research you will note that AARP, not necessarily all their members, support the current health insurance reform coming out of the house and the senate. The main element of that proposals funding comes from a significant cut in the Medicare Advantage program. This is a different benefit than that used for regular Medicare. Medicare Advantage has co-pays for most procedures instead of large deductibles and it includes drug coverage without the "dough-nut hole." But you say, the United Health Care Medicare Supplement does not offer a Medicare Advantage product. You would be correct...enter SecureHorizons.

Here is a copy of their offer on one of the AARP web links.

"AARP® MedicareComplete® plans are SecureHorizons® Medicare Advantage plans insured or covered by an affiliate of United Healthcare, Medicare Advantage Organizations with a Medicare contract. These health plans may provide all of the benefits covered under Original Medicare and more. Our plans have no limitations for pre-existing conditions for enrollment, and they do not require a physical exam."

Okay, why is this such a big deal? AARP supports a bill that cuts a new program they are just unveiling. Is it bad timing? Is it calculated? Oh, and here is another piece of information from the above mentioned site.

"The AARP® MedicareComplete® plans are SecureHorizons® Medicare Advantage plans insured or covered by an affiliate of United Healthcare, an MA organization with a Medicare contract. AARP is not an insurer. United Healthcare pays a fee to AARP and its affiliate for use of the AARP trademark and other services. Amounts paid are used for the general purposes of AARP and its members. The AARP MedicareComplete plans are available to all eligible Medicare beneficiaries, including both members and nonmembers of AARP. AARP and the AARP logo are trademarks or registered trademarks of AARP. The SecureHorizons and MedicareComplete marks are trademarks or registered trademarks of United Healthcare Alliance, LLC and its affiliates.

AARP does not make health plan recommendations for individuals. You are strongly encouraged to evaluate your needs before choosing a health plan."

Note the last statement fellow senior, you are to "evaluate" your needs before making the plunge. Your Association is not permitted to help you with that - they are not licensed agents.

Here is the summary. Very few things we see on TV, read in the paper, see on a billboard, or hear on the radio are what they seem. That would also be true of noise coming out of Washington DC. If AARP really wanted to endorse the current health care reform efforts by the majority shouldn't they get out of the Medicare Advantage business?

Posted on 11/05/2009 5:27 PM by Bob Shupe

Tuesday, 13 October 2009

10-13-09 5:10 PM CST

Well, it is official. No one knows what they are talking about. I have been watching interview after interview on both the left and the right leaning cable networks and the overwhelming result is pure ignorance. If it wasn't clear that those in Washington making a living out of lifetime politics didn't have a clue before, it will soon be evident that they don't have the slightest chance of understanding the problem...much less crafting a solution.

Now it is about molding all of the committee bills into a lean, mean cost saving machine. The only thing more important is that both sides agree and that there is a solid bill that will announce to everyone that their local elected official did the right thing. Why is that important? There is an election next year.  A very big election. They will be able to stand in front of a camera and say that they did something, but, when pressed about what they did, they will all say the same thing..."we provided health INSURANCE to half of the 50 thousand/30 thousand/25 thousand, what ever the number that is popular at the time. In reality what they did is...nothing.  And for that, everyone of them, of both stripes, should be sent home.

Washington is not the brain trust of fresh, new, entrepreneurial ideas. Be honest, congressmen, I mean, congresspersons, are trained by their staff. You need to actually go to Washington - if you have not shame on you - and meet some of these folks. You will be impressed by their manners, their intense enthusiasm, and their total misunderstanding of this issue. They believe what they are told. By whom? Which ever group has an appointment that day. And, by every lobby group in town. That would be four to one if you are keeping score.

So, where are we on October 13, 2009? Legislatively congress is at their best. They have flushed a fox out of the bush and they are all on their horses riding in what ever direction the dog is barking. For the news media it is ratings time. This will sell soap or whatever an attorney is selling at the moment, protecting you because you haven't paid taxes in years, you worked with asbestos 20 years ago and now have mesothelioma, you've been in a car wreck...you know the ads. Insurance companies? Well they got pretty beat up. Probably justified. This was their problem to fix ten years ago and they turned away. Hospitals and doctors? Depends on which ones you ask. Employers? The smart ones are freezing employment and studying their benefit plans. Joe the plumber? There are two camps, one that still believes in Santa Claus and that the federal government can fix everything, the other, the ones with common sense are looking into different ways of cutting back on everything they have to buy so they can pay for what is coming. The first group is about to find out what the rest of the country already knows. War is hell and the ones who can't see past their desire to have the wealth shared is about to go even deeper into despair. The second group, I hope, is gearing up to send home as many politicians next year as possible.

What I heard today from most every congressperson is that they don't think the American public will recoil at their decisions. They really believe they are untouchable. They believe that special interest groups will keep them in office and that they can continue to borrow this country into failure. I really, really, hope it has not come to that. I hope that America will raise their silent voices at the voting booth next year. I really hope this country has had enough. 

Posted on 10/13/2009 4:57 PM by Bob G. Shupe

Sunday, 04 October 2009

Every media sound bite will contain several references to the fact that certain parts of bills and amendments are "bipartisan", meaning that both parties agree on that aspect. There seems to be much joy and excitement when this occurs. Actually, nothing is ever said about whether the aspect of the bill or amendment has any validity, just that both sides agree. It is as though the mere fact that both sides agree, makes it valid. Being bipartisan has become more important than being for the right thing.

Is that to say that both sides have never agreed on something that could help with the current healthcare cost crisis? No, in fact there are a few things that both agree on that should be put into play immediately. What neither side agrees on is who gets credit for those items.

Here's the problem. The things on which both sides agree are so common sense that neither should take credit for their passage. Both sides want to pass a large, all encompassing bill with their name on it so they can point to it and say, "We did that! Re-elect us because we care for the folks who cannot get insurance." How? "We came up with more money". How? "We borrowed it." How will you repay it? "We will print more money. We will increase taxes. We will make those who are not currently paying into the system wish they did." Did that fix it? "Well, no." Why? "Because we financed a solution that we thought would get us re-elected. We knew better, but it was worth the shot."

It is possible that the federal legislature is so broken that it cannot be fixed. It may be true that the only fix will come from the common person who understands how things really work, or don't work. At the end of this debate maybe the best outcome would be for the word bipartisan to drop out of the English language and be replaced with, bythepeople.

Bob G. Shupe - Director, SCHCR

Posted on 10/04/2009 2:45 PM by Bob G. Shupe

Monday, 14 September 2009

In listening to the endless bantering of politicians it is obvious that they are sure that the way to stop the increased cost of healthcare is to create more ways to pay for a broken system. The bills they (both sides) are proposing all point fingers at the financing side of the equation - insurance companies - agent commissions - lack of competition among insurance companies - tax credits - subsidies - means tested premiums - expansion of entitlements - and on and on. What is rarely, if ever, addressed are the things that actually create the cost - the use of the healthcare system. Worse is the casual mention of wellness and disease management of chronic care. This item should be the centerpiece of any reform proposal, not a small amendment to the bill.

Speaking of bills, why do we even need the government involved in this fix? Because the insurance industry has refused to fix it themselves. All of the finger pointing however must stop. All of the parties to this disaster must gather around a common table and do the right thing, the other thing, as President John F. Kennedy said about going to the moon in the early 1960s. We have to do the hard thing, change our behavior. Yes, this is personal.

Join me in making this forum the heart of a grassroots solution.

Thanks

Bob Shupe - SCHCR

Posted on 09/14/2009 6:00 PM by Bob G. Shupe, Director of SCHCR

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