Health care: Empty arguments

Last week at a birthday dinner, I was talking health care reform with a newly licensed Physician's Assistant who works at a clinic where most of the patients are on Medi-Cal or Medicare. She has some stories to tell, mostly of client abuse of the system. We were having a nice talk...



Unfortunately for me, there were others at the table. I don't mind a good discussion, but I dislike empty arguments. I especially dislike arguments that are not well researched.

To make matters worse, the dissenter was militant and offensive.

I don't know whether he listened to me or not, but I suspect not.

I, on the other hand, mulled a bit over his comments. Here's the gist of them:

1) My premiums go up every year.
2) What is covered is less every year.
3) Insurance companies add no value.
4) Insurance companies are profiteers, gouging the populace.

As I mentioned in my last post... I research things. I even research the militant spoutings of those who don't listen.



Here's what I found:

1) Premiums are generally going up for health insurance: costs are rising.
2) In order to keep costs from rising even faster, insurance companies look for ways to reduce risk. One way is not insure it. The insurance companies work with their clients, especially the large ones, like the California teachers program (CalPers) to achieve an affordable trade-off. CalPers understands risk management.
3) This argument is just silly. It demonstrates a lack of understanding about the nature of what insurance is: pooled risk. My health insurance company negotiates with doctors and other health care providers over price per procedure. My wife recently had some routine work done that was billed at $500. The insurance company disallowed $185 in charges. My wife had a $20 co-pay. That's something.



Once upon-a-time, I was charged about $200,000 for a month-long stay in the hospital for a family member. The charges with the three surgeries pushed the figure up to $250,000ish. Because I was in a risk pool: I had insurance... the out-of-pocket limit was $3,500. Whew. (One of the reasons I had insurance was because I didn't change jobs for seven years. Why? Because I knew that insurance companies generally don't cover pre-exisiting conditions. I knew what the rules were, and I stayed in the pool.

I've discovered that insurance companies do things: they negotiate prices, they screen practitioners, and they provide a cushion against catastrophic expense.

4) Are insurance companies gouging consumers? I didn't know, so I did some research. I googled things. I found out that insurance companies profit margins are ranked 87th. (See the link to CNN Money.)One of California's largest insurance companies is Kaiser: a non-profit corporation.

I don't pretend to know-it-all, but at least I've done some digging. I've looked at what various experts say, and I've looked at their biases.

Is there a problem: yes, health care costs are rising.



But I'm not convinced that more government involvement is the solution. I think the government has a role, and they are playing it. However, most decisions about wellness, quality of life, fitness, nutrition, and health risks are personal.

Life is risky. There are financial risks, health risks, emotional risks, and even spiritual risks. What's a person to do?

Me? I'm doing the best I can by actively participating in life. I ponder the problems. I muse. Then, I do the best I can. I readjust as necessary as I navigate through life towards the goals I've set. I enjoy the journey and weather the storms.

And I try not to offer empty arguments.

Healthcare: Reasonable Solutions

I research things. That's how I roll. My friend's sometimes smile and say, "I'll bet you did some research..." (I've got a reputation.)



My dad taught be to have a healthy disregard for authority. The 60's influenced me as well. So when a debate arises that I care about, I check things out. I dig a bit.

Doing research in the arena of health care, I've found well-reasoned opinions of people I respect. Once such opinion and person is John Mackey. I've been a subscriber to his weekly newsletter for six months or so. He's a thinker and a writer who consistently makes sense. He lives in the real world: He's the CEO of Whole Foods Market, Inc. He writes about life, often based on life in the work-a-day world, but with wider application.

Recently he authored a op-ed piece on healthcare that ran in the Wall Street journal. His article obviously touched some nerves, as it generated quite a lot of press and even a bit of a boycott. Why? He questioned the authorities and shared some ideas based on his own research and experience.



Here's an excerpt of five key improvements needed in the arena of health care that he sees:

• Repeal government mandates regarding what insurance companies must cover. These mandates have increased the cost of health insurance by billions of dollars. What is insured and what is not insured should be determined by individual customer preferences and not through special-interest lobbying.

• Enact tort reform to end the ruinous lawsuits that force doctors to pay insurance costs of hundreds of thousands of dollars per year. These costs are passed back to us through much higher prices for health care.

• Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor's visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost us?

• Enact Medicare reform. We need to face up to the actuarial fact that Medicare is heading towards bankruptcy and enact reforms that create greater patient empowerment, choice and responsibility.

• Finally, revise tax forms to make it easier for individuals to make a voluntary, tax-deductible donation to help the millions of people who have no insurance and aren't covered by Medicare, Medicaid or the State Children's Health Insurance Program.



I've seen these ideas echoed elsewhere, but Mackey lays them out clearly and succinctly.

His arguments make sense... unlike many I've heard, in part because Mackey has done his homework, walked the talk, and taken the time to form an intelligent opinion.

He's my kind of guy. I learn stuff from him.

A Balm for healing...

Life is full of disappointments and discouragements: some small, some large.

Despite my general positive outlook, some times I get "bummed out."



I'm not an avid fan of any particular team, but I like to watch sports: especially football. A week or so ago, I watched two games, and the teams I wanted to win, lost. In the final minutes. It was disheartening. It was discouraging. It was only football, but I found myself feeling a bit blue. Woe is me.

(You may be laughing. That's okay. It is a bit pitiful and shallow that such trivialities should effect my mood. But perhaps you're laughing at yourself too?)

Too often, we let the little stuff get to us. Unexpected bumps trip us up.



Being a proactive problem solver, a day or so later, I retreated to my newly fenced-in enclave with my Bible. I discovered a few decades ago, that "God is the lifter up of my head." Just like a parent who puts their over-sized hand under a child's chin to make the look up, so the Parent-God does the same for me. If I let Him.

I've been reading through the New Testament. I'm in Luke. As I was reading, in my slight funk, I came across some words of Jesus that struck home: "I came not to destroy men's lives, but to save them."



Those words were the balm my soul needed. The smoldering feelings of disappointment, loss, and helplessness that had been ignited by observing a couple of football games suddenly ceased.

God wasn't out to fill my life with destruction: small or large.

The logical conclusion of my mild despair was that God wasn't good. Though I didn't speak the words, the emotional conclusion I had reached was that disappointments, hurts, and heartache awaited me. (And it wasn't just about football.)

I had lost sight of who God is: Good.



"If God be for us, who can be against us?" God is for us, not against us.

A simple phrase from an old story lifted my heart, restored my faith, and improved my mood. In the week or so since encountering the words, "I came not to destroy men's lives, but to save them," I have reapplied the balm repeatedly, and I have benefited.

Life is full of disappointments and discouragements. But as one poet wrote hundreds of years ago: "There is a Balm in Gilead."



That Balm still reaches out to wounded hearts, discouraged souls, and downcast sports fans. Even me. Even you.

There is a Balm in Gilead.

Reducing risk: Your family's health

I wrote in my last post about Risk Management and health reform. Since that post I've been thinking... I wrote this:

So how can you deal with risk?



1) You can assume the risk.
2) You can get rid of the risk.
3) You can transfer (insure) the risk.

When I wrote that, I was at a loss at how to use #2 to eliminate risk as regards to health. If you're alive, you are at risk. Certainly I don't want to stop living just to "get rid of the risk."

But as I pondered, I realized that "getting rid of the risk" does not have to be an "all or nothing," it can happen in degrees.

A better questions for addressing #2 is: How can I reduce the risk?

How can I reduce the monetary risks of poor health? (Not that's a good question.)

Several years ago, my wife's dentist referred her to an periodontist to address some receding gum issues. Some surgery took place and more loomed on the horizon, but... instead of dealing with the results of poor gum health, we found a way to improve the health. In doing so we reduced the monetary risks of additional surgeries.

The improvement in monetary risk was a by-product, not the goal. In fact, our solution cost us and extra $75 a year. That's the cost of one more trip to the dental hygienist for a non-covered cleaning. Our dental insurance covers two cleanings a year, we assumed the cost of the third, and gum health has improved.

My point is we reduced risks by improving health (wellness) and lessening illness.



What illnesses cost us the most? (A mathematician named Parelli discovered that a principle called the 80/20 rule, or the Parelli principle.)

If I wrote down and ranked 10 of the main factors that put my health at risk, and I fixed the top two, my health risk could be reduced by 80%. (Thanks Parelli!)

Can I eliminate my health risk? No.
Can I significantly reduce it? Yes.

This is one of the reasons health insurance companies sponsor weight control programs and smoking cessation programs.

Some years ago I was 300% more likely to have a heart attack than the average. After trying unsuccessfully for two years to control blood pressure and cholesterol on my own, I bowed to the wishes of my doctor and went on prescription drugs. (A health care cost that was the result of my obesity.)



Two years later, I successfully lost 30 pounds, reduced my risk, and eliminated the need for prescription drugs. Now I'm less likely than average to suffer a heart attack, and the resulting losses.

I took ownership of my health issues, persisted, and lessened my risks.

Health.com reports, "Almost 10 Percent of U.S. Medical Costs Tied to Obesity."

What's the #1 cause of premature death (more than 400,000 per year)?

Smoking.

The hidden costs of smoking are shared by individuals, families, and society. Who pays?

"These are costs we all pay in higher taxes to fund government health care programs, like Medicare, and in higher health insurance premiums," said John R. Seffrin, PhD, Chief Executive Officer of the American Cancer Society.

What's my point?

Risk management on health issues isn't just about the cost of transferring the risk via insurance. It's also about reducing risks by investing in your family's wellness.



Nutrition, exercise, sleep, hydration, clean air...

Improving health and reducing health costs are like a teeter-totter. You reduce health risks, and you add healthy habits.

You can tip the balance in your favor and thus manage your risk.

You haven't eliminated the risks, but the actuaries will tell you, you've improved your chances of living a long and healthy life.

Whatever route the government takes on health care, I can chart my own. So can you.

Dealing with risk: health insurance? health care reform?

My profile on this blog says I've had lots of jobs "growing up," two of them were in the insurance industry. I worked for several years for Kemper Insurance in a claims office. I also worked in the Risk Management Department of Santa Fe International, an energy company. Besides the on-the-job training, I also took company offered classes, especially at Kemper. (Currently I serve as a member on my school district's Health Benefits Committee.)

So what? (So health-care reform.)

Today, there is a lot of debate about improving health care in the US. I'm surprised how much of that talk surrounds health insurance, as if insurance is going to solve our health crisis. (We need a large dose of wellness: diet and exercise. But I digress.)

Insurance is one way of dealing with risk. It is one of three ways to manage risk. Risk is inevitable, but we have choices in how to manage it. (Life is risky, whether we are talking cars, appliances, life, or health.)

So how can you deal with risk?

1) You can assume the risk.
2) You can get rid of the risk.
3) You can transfer (insure) the risk.

Option 1) After my first wife died, I took a severance package and "retired" for several years. I became a Mr. Mom in order to give stability to my kids. I was offered a COBRA but declined it. It was too expensive. (I could have had more money if I'd filed for unemployment. But I didn't file because I wasn't looking for a job. I was insured, but I wasn't going to lie to get the money.) I assumed the risk of family health problems for about two years. (And nothing big happened.)I also assumed the risks (and consequences) of not having an income for two years. (We survived; however, my retirement (401K) took a major hit.)

In the "old" days, people assumed a lot of risks. And they survived. So did I.

Option 2) You can get rid of the risk. This works better on a car or house than it does on medical expense insurance. You can sell your car or house. Then you don't need insurance. My youngest daughter sold her car to lower her monthly expenses. I don't have renter's insurance; I have home owner's insurance. I got rid of my apartment. (When I lived in an apartment, I assumed the risk. I didn't have much to lose.)

Option 3) You can transfer (insure) the risk. My cars are insured: that's required in California. My house is insured. My life is insured. My appliances are not: they break, I suffer the loss. I just replaced my dishwasher. It died and I didn't have appliance insurance. I went without a dishwasher for a year. Then I bought a new one.



My dad and mom used to warn me about families that were insurance poor. They used too much month-to-month income transferring risks and paying a premium. (I read last week that of the $6,000 dollars that a doctor charges these days for pre-natal care and the birth procedure, $2,000 is to pay his malpractice premium. (Tort reform anyone?)

In my opinion, too many people want to transfer the risks of life without paying the premiums. They want Cadillac coverage at rock bottom prices. It doesn't work that way. Some really good mathematicians (called actuaries) calculate the projected costs to be shared by a pool of premium payers to cover projected losses.

The types of losses covered are predefined. The caps (the most they'll pay) are predefined. Who can get into the premium paying pool is predefined. If losses are to be shared, then these definitions must be in place.



If you change what losses are covered (like pre-existing conditions), or if you remove the caps that must be paid out of the collected premiums, or you change who can get into the pool... then the math requires that more premiums be collected.

You can't have more for less. The math precludes it.

It's all about managing risk and making choices.

Once I chose to change jobs, not lie about my wife's pregnancy (she'd been to the doctor once), and I assumed the risk of my son's birth: cost? $3,000. Sense of well-being from being honest? Priceless.

Later I chose not to change jobs after my first wife was diagnosed with cancer. The medical cost risk was too great. I wanted to keep that risk transferred. (My insurance didn't cover some of the experimental aspects of one therapy. I made a choice, assumed that risk, and paid for the treatment: for over four years.)

Life is full of risks, including health risks. Sometimes you assume the risk, sometimes you get rid of the risk, and sometimes you transfer the risk by purchasing insurance.

Being grown-up means that I take responsibility for making the choices. Being grown-up means I need to educate myself to know what my options are.



If we, the American people, want to transfer all our health risks to a government run plan, it will come at a cost. (And just like some of the families my parents warned me about, we might become insurance poor. As a nation, we could use too much month-to-month income transferring risks and paying a premium.)

Personally, I'd rather manage my own health risks. It's part of growing up. (Besides, I'm pretty good at math, and I know a bit about Risk Management.)

A Mental Map for Teacher Success

"As a man thinks, so is he..."

So what kind of a teacher do I want to be this year? What are my personal goals, my guiding principles, the mental targets I want automatically steer towards?

I have eight:

I choose to find it easy to greet staff members and students by name.
I choose to invent schedules, curriculum, and routines to support Special Education.
I choose to successfully utilize my aide to assist the learning of students.
I choose to find it easy to get ready for IEPs ahead of time.
I choose to feel as if parents and staff like me and appreciate what I do.
I choose to cleverly incorporate memory improvement lessons into my curriculum.
I choose to have fun doing my own memory improvement projects.
I choose to find satisfying ways to balance work and home.

It's hard to hit a target if you don't know what you're aiming for. But if you consistently remind yourself who you are, then you become that image.



I have some pretty good ideas of who I am and who I want to become.

Have your created your own mental map for personal success? Can you bring that map into focus?



If you can't picture the target... chances are...
If you can picture the tartet... chance are...

What are your chances?

Why I blog? People like Chase!

Today I went to a Welcome Home party. One of the blogs I follow is the Taiwan Drift. Chase has authored this blog while he was a teacher on temporary assignment on the island nation of Taiwan. Chase is from Southern California. He came home last night after spending a year in Taiwan.

His family had a Welcome Home Party and I was invited.



As much as I love people, I was a bit hesitant to go. It was not the 30 mile journey south to his parents home that made me hesitate. I thought I might be out of place. But I went.

Why?

Because I was invited.

Generally people invite you to things because they'd like you to come. It's really not that complex. Most of the time, people say what they mean and mean what they say. No need to over think things.



Although Chase was the only one I knew, and I "only" knew him from his blog. It turns out that I was warmly welcomed by his family. I felt that I knew some of them from "listening" to Chase's blog. They also felt like they knew me from my comments on Chase's blog. (Some have visited my blog too.)

It was a fun time, in fact it was memorable.



The party was an open house, and I stayed for an hour or so. I met his mom, dad, sisters, and brother. (Plus his grandma, aunt, and family dog.)

The Girl Scout song has it right: "Make new friends, but keep the old: one is silver and the other is gold."

As I was leaving, Chase's mom stopped me. Her plan was to capture the attendees on "film." I had taken my camera, so I also had them take a picture of Chase and me together. Chase's mom said, "I'll look for it on your blog!" (So here it is.)



I keep blogging because of the friends I've made online. Once in a blue moon, you might get a chance to meet in "real life." Today was one of those times.

"When you get the chance to sit it out or dance: I hope you dance."

Today I danced. Why?



Because I ignored my doubts, trusted my heart, and I responded to an invitation. I've spent a year making a new friend. I wanted to add my face and voice among his family and friends as we all joined hearts to say, "Welcome home Chase."

Because, ultimately, it's not about us... it's about others.