Facts? We Don't Need No Stinkin' Facts!

Governor Ted was on a roll. Ted Strickland, our previous governor, is a national co-chairman for President Obama’s reelection campaign. It is his job to tell one side of the story. It is his job to shape the issues to his candidate’s advantage. And, if necessary, it is his job to bypass a fact or two en route to his desired destination. Governor Ted was born for this job. Lucky for him, the reporters were the Plain Dealer’s Sabrina Eaton and Stephen Koff.

The article, Health care law may be big issue for young voters, appeared in last Sunday’s Plain Dealer. The online version linked here is slightly different from the version that appeared in the Plain Dealer. The crux of the article was that young adults are thrilled to be able to stay on their parents’ group health insurance policies. Dumping the Patient Protection and Affordable Care Act (PPACA) could cost the Republicans the votes of everyone under age 28.

This is where Governor Ted comes in.

Without the health care law, this group could lose coverage under their parents’ plans and “it’s impossible to be able to afford an individual policy unless you’re a wealthy or semi-wealthy person,” Strickland says.

It’s impossible? Balderdash!

This act of journalistic sloth, printing that claim by the President’s reelection campaign without question, is inexcusable. The Plain Dealer reporters could have interviewed any health insurance agent. They could have contacted an insurer, like Medical Mutual of Ohio who, unlike the Plain Dealer, is still headquartered in downtown Cleveland. Or, they could have gone online and run a couple of quick quotes.

They chose to do nothing.

And speaking of nothing, covering your children on your employer’s group policy is not nothing. The employer may be paying some or even the entire premium. The parent may be paying all of the cost. Ask your boss how much, if anything, you are paying to cover your children.

Let’s look at some numbers. Medical Mutual of Ohio. Elite policy with an office copay, Rx card, and a $2,500 deductible. Cuyahoga County (most expensive in Ohio). Healthy non-smoker.

......Male..........................Female
....$107.95..........21........$136.50
....$110.56..........26........$150.57

There are less expensive policies. You would never know any of this if your only source of information is the Plain Dealer.

Is $107.95 a month less than your employer’s policy? Most definitely. And if you are paying for this coverage, you may be able to save money by ignoring Governor Ted.

I am not running a campaign, so I will tell you the whole story. Some adult children are benefitting from the PPACA. If your child is unhealthy, if your child has had a major illness or injury, or if your daughter is pregnant, your employer’s group health coverage and the law that allows your child to remain on your policy, is a godsend. That is not dramatic or scary, but it is real.

We need more access to quality health care, not less. We need more facts, not less.

DAVE

www.bcandb.com

I Like My Funds Extra Slushy

Readers of this blog are aware of my fixation on transparency. Readers of my other blog, Again? Really?, know that I am particularly offended by slush funds, large amounts of taxpayer money redirected by government entities to surreptitiously benefit pet causes or personal gain. The slush finds of a local government might be in the thousands or possibly a million dollars or so. It takes the federal government to create a billion dollar boondoggle.

Insured Americans will be paying a new fee as of October 1, 2012. Anthem Blue Cross sent a warning announcement last week to advise us that they will be adding the charge to our bills. “The Affordable Care Act (PPACA) established the Patient-Centered Outcomes Research Institute (PCORI) to explore the effectiveness, risks, and benefits of medical treatments. This study is also known as Comparative Effectiveness Research (CER). PCORI is a nonprofit, nongovernmental organization supported by a trust fund that is financed in part by fees from health plan insurers.”

The fees are $1 per covered person in the first year. $2 per person in the second year. And after two years? The $2 per person per year will be adjusted for medical inflation.

Bureaucracies, in general, like acronyms, but the combination of acronyms and money make for a government love affair.

Comparative Effectiveness Research came into prominence as part of President Obama’s American Recovery and Reinvestment Act of 2009. $1.1 Billion was allocated.

• $300 Million for the Agency for Healthcare Research and Quality.
• $400 Million for the National Institutes of Health.
• $400 Million for the Office of the Secretary of Health and Human Services.

This wasn’t a beginning, middle and end. This was seed money.

The Department of Health and Human Services (HHS) explained that CER “compares treatments and strategies to improve health. This information is essential for clinicians and patients to decide on the best treatment. It also enables our nation to improve the health of communities and the performance of the health system.”

Gosh that sounds good.

According to the National Cancer Institute, CER has both its proponents and detractors. One key issue was brought up by Jeffrey Kindler, CEO of Pfizer, who wondered whether the results from Comparative Effectiveness studies would be “automatically linked” to insurance coverage decisions. In other words, will healthcare in the future become one size fits almost all and too bad about the rest.

In his paper “Comparative Effectiveness Research and Kindred Delusions”, Norton Hadler, MD expanded on the difference between efficacy and effectiveness.

I have nothing to add to that debate. My only question is “How Much?” How much money, your money in taxes and your money in fees, are we spending on this and who is getting it?

Billions of dollars funneled through the Department of Health and Human Services became even more of an issue last week when the Government Accountability Office (Yes, that GAO) found that the Obama administration was wasting $8.3 Billion on a questionable Medicare program.

As part of a “Demonstration Project”, HHS has created an experimental program to study the effects of money on the insurance market. This experiment is to award bonuses to high quality managed care Medicare policies known as Medicare Advantage. High quality, like intellectual honesty, was one of the first victims of this scheme. To make a long story short, the money, most paid out in the next three years, covers the cuts that were made in these popular programs by the President’s health care law. The PPACA took money away, but Health and Human Services put the money back in through the back door.

The independent Medicare Payment Advisory Commission panned the misdirection. The Republicans think that this looks suspiciously like a re-election driven decision. The New York Post didn’t bury the lead. They labeled it a political slush fund.

What we are talking about is money. We know where it comes from, US. What we don’t know is where it is going and why. Unlimited funds funneled through Kathleen Sebelius and her politicized Department of Health and Human Services are sure to arouse suspicions. Add to this an $8.3 Billion experiment and you have the potential for a real problem.

DAVE

www.bcandb.com

It Sucks To Be Poor

It sucks to be poor. It is nobody’s goal in life to be poor, to wonder how you are going to feed your family, keep a roof over your head, or to be unable to afford the most basic of needs or wants. I’ve been poor, not homeless or destitute, but close enough to appreciate the fear and uncertainty that comes with an overdrawn back account and a baloney and tater tot dinner.

I’ve never received government assistance, not even unemployment compensation. So I have never had to check in with a government employee, told where I could live, or what groceries I could buy. And when I needed to take my children to the doctor, I’ve always had my choice of all of the pediatricians in town.

The poor have Medicaid.

Medicaid. Fraud ravaged. Doctor hated. Taxpayer resented. Medicaid. And no one likes Medicaid less than the people it was designed to help.

There are 1.7 million Ohioans receiving state funded medical assistance. Ohio is revamping Medicaid, again.

Eleven companies recently participated in a complex bidding process to win a piece of this action. Five won the opportunity to provide coverage. Five lost and are filing appeals. One, Anthem Blue Cross the #1 insurer of Ohioans, shrugged off its loss and walked away.

Medicaid, the State of Ohio’s single payer health care system for the poor, appears to be mired in controversy. As reported in the Columbus Dispatch, there are charges of more than just irregularities, mistakes, and a shocking lack of transparency. There may have been actual fraud and false statements on the applications.

Some of the companies that were shut out contacted London based Barclays to analyze the process. They found “Scoring results indicate considerable inconsistencies among bidders…Scoring processes are always complex, especially in markets this large, but typically not to this degree.”

In a rush to save $1.5 Billion (real or imagined) in the next two years, the state may have selected up to three vendors thanks to applications enhanced with inflated statistics. Though the process was supposed to “improve the coordination of care for 1.7 million recipients and improve health”, it may, instead, have been just one more arbitrarily awarded government contract.

It is one thing to entrust your children’s health to the lowest bidder. It is even worse to be herded to a facility or provider that lacks the integrity to compete fairly. But when you are a football, when you are tossed from one player to another, you don’t have much say in the process.

But then again, it sucks to be poor.

DAVE

www.bcandb.com

The Fixer

Her Nationwide guy suggested that she call me. And though I appreciate Mike’s confidence, I also know that his referrals are often people who have somehow fallen through the cracks of our system. This woman epitomized the permanent flaws in this and any system of health care. And more to my frustration than hers, I could not fix her problem.

Much like Eddie Vedder’s The Fixer, I have always been obsessed with making things right, of solving everyone’s problems. That empathy works well in what I do for a living. But I am deeply frustrated when I encounter a situation that can’t be fixed. Here is hers:

The woman, we’ll call her Maria, has group insurance through her employer. The cost of the policy has increased over the years, but the employer is still paying the vast majority of the premium. This year the employer changed the coverage to a High Deductible Healthcare Plan, in other words, a policy that qualifies for an HSA. Maria no longer has an office visit copay. Maria no longer has an Rx card. All of these expenses are applied towards her $4,000 deductible. In theory, this might save her money. In reality, she is screwed. She is on two very expensive medications. One is $885 for a three month supply. The other is $1,400!

Where does she come up with the money for these prescriptions? She makes just enough per month that she won’t qualify for any help from the drug companies. She makes too little to be able to afford the medications she needs to be able to work.

Got an answer? Neither do I?

No system could possibly sustain the cost of paying for everyone’s doctors’ visits, prescriptions, and hospital stays. We must contribute. We must either pay for insurance or be taxed by the government (or both) to fund the system that pays most of the bills. The balance, whether that structure includes copays or deductibles, must be paid by the person receiving treatment. Should we all be responsible for the same amount? Will there be a sliding scale based on income, location, or family size?

No matter the final outcome, most people will be offended when it is their turn to pay. Worse, many people will be forced to pay more than they feel that they can afford. And some will be buried in debt. The other choice is to simply limit the most expensive care based on survivability and efficacy. And that opens another set of worries.

In a recent Forbes article, Richard Grant argues that what we need is less regulation, not more. “Government’s main role has been to serve as the enforcer of a cartel that limits the supply of doctors, of hospitals, of drugs, and of innovative alternatives.” There is truth to all of that. And if we reversed our course and somehow made it to a completely open market, the well-off and educated, like Mr. Grant, might receive better care for less. Unfortunately, the Maria’s of our world would be collateral damage. I’m not sure which regulations Mr. Grant would like to eliminate. Do we want to trust the marketplace to license doctors and approve prescriptions?

The HSA policy is a half-hearted attempt at empowering the patient and controlling costs. It succeeds at neither. Does Maria need to be on these expensive medications? Would more common, less expensive drugs, be almost as good? Since at least one of these drugs is for a mental condition, would she have the needed faith in a new prescription that was purchased not because her doctor thought it was better for her, but because she can’t afford the good one? The experiment is doomed to failure.

And I can’t help her. And there is no moment worse for a Fixer than when he realizes that there is nothing that he can do.

One Ballot, Two Votes

Dave Cunix – surrogate. I was asked to represent Al Gore during the 2000 presidential campaign. I presented his positions at candidate forums and spoke to citizens’ groups. Based on Mr. Gore’s success, I was recruited four years later to serve on the John Kerry campaign. We know how well that went.

The candidate forums were very inclusive. Surrogates were invited from all of the major campaigns. The Bush representative and I were often joined by men and women prepared to advance the agendas of Pat Buchanan (Reform), Ralph Nader (Green), and Harry Browne (Libertarian). At the end of these forums I would say something that though incredibly true was sure to agitate the Libertarians and the Greens. “A vote for Ralph Nader is a vote for George Bush. A vote for Harry Browne is a vote for no one”.

Gosh that would torque them off. Worse, as we now know, I was totally correct. Here are the results of a few of the states:

..........Browne...Buchanan..........Bush.........Gore........Nader
Fl........16,414.....17,484.......2, 912,790....2,912,253....97,488
IA.........3,209......5,731..........634,373......638,517....29,374
NH.........2,757......2,625..........273,559......266,348....22,198


Emotion plays a huge roll in politics. The politicians, our leaders, use our emotions to push us in one direction or another. Our first task must be to remove all emotion from political discussions. Once we get down to facts, to cause and effect, we can determine what we really want to do and how to create a logical course of action.

My issue with government in 2012 is the inherent laziness of our politicians. Speaking in snippets and sound bites and relying on emotion laden advertisements, candidates and elected officials don’t debate solutions, just fears. They exploit our fear of spending money. Our fear of the “Other”. Our fear of losing what little peace or privacy we have left.

The President’s health care program, the Patient Protection and Affordable Care Act (PPACA), was initially sold as a way to insure the uninsured, all 50 million of them. The American public was told that not only wouldn’t it cost more to do this, but that premiums would go down. And we were going to get better coverage (free stuff!) at no additional cost.

The Republicans were asking for a birth certificate from the tooth fairy.

And what were the Republicans doing during all of this? They defended the status quo and promised to respect the doctor/patient relationship. They assured us that they would protect the world’s best health care system. And we do have a great system. And we do have great doctors and hospitals. But G-d help you if get really sick and are stuck with inadequate insurance coverage.

So here, again, is the truth. We aren’t going to return to 2007. No one in power wants to replace the PPACA. No one wants to fix it. The Republicans took control of the House of Representatives over a year ago. Repeal Obamacare? How? To what end? If the Republicans had a constructive option they would have advanced it by now. As in any successful negotiation, common ground and saving face are keys to victory. Mr. Boehner, Mr. Cantor, Mr. Romney, and even Mr. Gingrich, a legislator who has promoted the individual mandate for most of the last twenty years, have not offered a path to modify the PPACA to make it work. They have no solutions, just campaign issues.

The Democrats have a program that won’t work as a privately insured system, but could lead to single payer. The Republicans have a fundraising gold mine. You? You have debates about birth control pills and a lifetime supply of smoke and mirrors.

The numbers are real, everything else is, as Rick Santorum would say, “BS”. The PPACA had to have gimmicks built in to it to cover the exorbitant costs. One by one these income generators are disappearing. The 1099 silliness is gone. The Long Term Care program (CLASS) is gone. The tax on Cadillac Health Plans will disappear, too. The Supreme Court is hearing arguments TODAY about the constitutionality of the individual mandate. We will get the verdict in a couple of months. Regardless of the outcome, the Patient Protection and Affordable Care Act will move forward.

So which party deserves your support? Who is going to get our health care system on to firm financial ground? Will a vote for one guy really be a vote for someone else?

I need a ballot that offers “None of the Above”.

DAVE

www.bcandb.com

Let's Pretend

Let’s pretend that you own a business, any business. Since we are talking about your imagination, this enterprise could be as small as just you and one employee or it could be as large as G.M. Your pretend business might be a service provider, a manufacturer, or a retail store. You may establish this business in any of the fifty states. It doesn’t matter. The only rule is that your imaginary company must be in a field that is totally foreign to you. So for me, someone who can’t even play an instrument, my fantasy will have me as the leader of a private orchestra. Got it?

I want you to think about your pretend business for a moment. Think about your time, your effort, your sacrifice as I announce that one of your company’s largest expenses is being eliminated. Excited? Did you feel that you are about to be rewarded for your hard work? Have you begun to spend the money?

But this is all an exercise. None of it is real. You can’t know, really know, what you might do in such a situation. Just as I will never be in a band, much less lead an orchestra, the members of the Congressional Budget Office (CBO) have no idea how real businesses function.

In a recently released report, the CBO attempted to predict the possible effects of the Patient Protection and Affordable Care Act (PPACA) on the deficit and the uninsured. It has been widely predicted that employers will dump their company sponsored insurance plans due to the ever-rising costs to comply with the new legislation. That is not new. This COB report unveils a Bad News / Good News scenario that we haven’t seen before.

As reported by Sarah Kliff in The Washington Post, “If employers drop 14 million, currently-insured workers into the exchange, the CBO projects that the federal deficit would actually decrease by $13 billion since those workers could no longer use the current tax deduction for employer-sponsored insurance.” Ms. Kliff’s article quotes the CBO’s numbers and explanation.

The staffers at the Congressional Budget Office imagined a scenario where the owners of businesses would drop the cost of insurance, ignore the government penalty (currently set to be $2,000 per employee per year), and give every employee a raise equivalent to the previous cost of health insurance! If that happened, if all of the employers in the country magnanimously dispersed 100% of the insurance premiums, ignoring personal wants and needs, Social Security tax, unemployment tax, Workman’s Compensation costs, etc…then, and only then, could there be significant deficit reduction from moving millions off employer sponsored group insurance and into the exchanges.

Does this make sense? Sure, if we pretend.

DAVE

www.bcandb.com

The Entertainer

I was on a cruise, over a thousand miles south of the Florida coast, when Rush Limbaugh chose to waddle into the fray. Watching CNN as we were dressing for dinner, we thought that we were going to get a break from the stories of the horrific shooting rampage in Chardon when the anchors moved on to other topics. First it was the announcement of the death of Davey Jones. Then it was the death of reason in the ongoing health care debate. El-Rushbo had spoken.

The delivery and payment of health care in this country is already over politicized. We have more than enough emotion and not nearly enough facts. Logic and intellectual honesty are notably absent in most of the discussions. The Republican presidential candidates have studiously avoided anything that even approached a solution. They have all vowed to repeal Obamacare as if that wouldn’t create more problems than it solved. And into this we add Rush.

Where do we begin? Let’s start with a clear statement. Calling Sandra Kay Fluke, a law student four days older than my daughter, a “slut” and a “prostitute” because she vocally supports the President’s health care legislation is abominable. She is a civilian, a private citizen. She isn’t a public figure, someone who willingly subjected herself to this kind of derision or scrutiny. And no, it may not be right to say such things about public figures, but we do. Ms. Fluke should have been off-limits, like the nameless group of men that had testified about women’s birth control the week before.

So the predictable occurred. We put an important national debate on hold while we discussed the relative merits of a radio talk show host. The people that hate him, and Gosh there are plenty who do, got riled up and went after his sponsors. His defenders, a little more reserved than usual, assured us that Rush was just being Rush. There was a certain amount of merit on both sides. There is nothing the political right hates more than to be defeated by the use of the free market. And in all fairness, Limbaugh, ignored in the Republican presidential primary and uninvolved in the national discussion, desperately needed attention. Any attention. Everyone won, even Ms. Fluke. Her brand, her name recognition, is huge. She is assured of a much brighter future thanks to Rush Limbaugh.

What didn’t happen, what was stopped completely, was an intelligent, honest discussion of the issues. So let’s try to kick start the process.

Here are a couple of the stories you might have missed:

• We have discussed the Pre-Existing Condition Insurance Plans that the Patient Protection and Affordable Care Act (PPACA) created for the unhealthy uninsureds. The federal government’s actuaries predicted the average cost per enrollee at $13,026. They weren’t even close. The average cost now predicted for each enrollee in 2012 is $28,994! It is that kind of predicting that gives most of us pause as we contemplate the President’s health care program and future liabilities.


• Senator Mitch McConnell (R-KY) has decided that he sees no reason to vote on the repeal of the PPACA until after the November election. It is important to remember that he has never seen a reason to offer an alternative to the President’s plan or a workable way to modify the legislation.

Add to this the date March 26, 2012, when the Supreme Court will begin to hear arguments about the Patient Protection and Affordable Care Act, and we have more than enough to keep us busy. In fact, we are much too busy to waste time on an entertainer.

DAVE

www.bcandb.com