Exposing One Public Servant's Bias

Yesterday I attended the WMC Business Day in Madison. The afternoon session included a panel discussion on health care which was recorded (about 65 minutes). It will be archived on Wisconsin Eye in a few days. John Torinus talked about how he is controlling health care costs at his company and how those same principals can be applied to other businesses and the public sector. It was a compelling presentation; one everyone should watch.

Also on the panel was the Secretary of the Department of Health Services, Karen Timberlake. She talked about steps the state is taking to control costs. Again, I hope you will seek out this presentation and listen to her remarks as there are some very positive steps being taken. Regrettably, she had a few comments on health insurers that showed her great bias against 'my' industry.

A power point slide focused on how in 2009 health insurers profits increased by 56% while over the same period they were "dropping" 2 million people. I don't have access to the industry wide P & L results for 2008 and 2009 but I happen to know 2008 was a terrible year for health insurers. In addition to the usual underwriting losses, their investment portfolios (like everyone's) were hammered by the stock market crash. (Investment returns often offset unexpected claims.) So if insurers collectively had earnings in 2008 of about 1.8% of revenues but in 2009 earnings recovered to about 2.8% (these are estimates but pretty darn close, I'd wager), that would be a 56% increase. By reporting only the % increase, it sounds pretty bad doesn't it? (Now I ask you, what business owner in his/her right mind would be content with earnings of only 3% of revenues?)

As for "dropping" 2 million members, do you suppose the economy had something to do with that? H-m-m-m, haven't I been reading something about unemployment over recent months and don't the majority of Americans get their health insurance through their employer?

At least in this case, Secretary Timberlake - like so many politicians on both sides of the aisle - seems to be distorting the facts to her end; i.e., if you portray health insurers as scheming to drop 2 million (just the sick, of course) customers to pad profits, does a gullible public conclude government might do better?

Well, we're not as gullible as 'they' think. And by distorting the truth so badly, 'their' overall credibility is even lower than the insurers they vilify.

And while I'm thinking of insurers, I'm sure you're hearing a lot from the same political class about recent premium increases. While I'm hardly a lackey for those insurers I represent - and clearly some of their increases seem unnecessarily high - regulators have a lot to do with premiums. Insurers are required to remain solvent. If we applied the same rules to Medicare, the tax increases would make premium hikes seem small! My suggestion is that Medicare's 'Board of Directors' (that would be Congress) get their own house in order before they presume to second guess insurers!

Why Premiums Are So High: Chapter 287

Clients invariably tell me of their own encounters with health care. Here's another anecdote from just the other day.

"I took my wife to the doctor for a varicose vein procedure. We arrived for her appointment at 9:00 in the morning. By 11:30 we were at Panera Bread having lunch. There was no surgeon; no anesthesiologist. Not sure what exactly was done but for the short time she was there, I never expected to see a bill for $13,000!"

Stories like this drive me nuts. Is this a fair price? (Maybe it is.) I imagine a doc doing about a dozen or so procedures a day at $13,000 a pop. Wow. Isn't it just a matter of time until the opening of a "Veins R Us" where you can have sclerotherapy for $1000?

I hope so . . . . .

Sanity Check: Why Don't 'They' Just NOT Answer?

I just made a business call to a vendor's cell phone number. As I usually do, when he answered I asked if I was interrupting. His reply: "Yes! I was in a meeting but stepped out to answer your call. I should probably go back in (to the meeting)."

Now tell me please, why the heck didn't he just turn off his damn phone? I could have left a voice mail message. That would have been far more efficient than the exchange we had. Now he has to call me again just to find out what I want.

We live in goofy times . . . . .

Paying My Respects To A True Gentleman

Today is the funeral of a good friend; an unassuming man of character, dignity and common sense. He was a great leader. There will no doubt be an overflow crowd paying their respects at the church today. I'm pretty sure this little 'eulogy' posted on line would make him uncomfortable so I'll not share his name. And what, you might say, would one man's death have to do with health care?

Well you see, my friend served on the Board of Directors of a health insurer for years. Many of the most strident health care 'reformers' routinely vilify insurers for having the audacity to underwrite risk and other 'evil' practices. They often paint a picture of greedy executives scheming in board rooms for ways to deny claims to enhance profits. To know my friend, such portrayals are ludicrous and downright insulting. (And I know many executives at many health insurance companies who endure these insults with barely a peep of objection.)

People run health insurance companies. Mostly good people. We just lost one and I will miss him a lot.

Medical Tourism; Maybe Your PPO Network IS Too Small Afterall

Suppose you are a business owner with 220 employees. Like the majority of medium sized to larger businesses, you partially self-fund your health plan. By that I mean, you have 'stop loss' insurance but only after - let's say - the first $75,000 of claims per covered life come out of your pocket. Despite your best efforts at promoting wellness, every year one or two people in your group have a very expensive episode of care. Wouldn't you jump at the chance to reduce the cost of those 'shock loss' claims by 50 to 75% or more?!

I've been reading about "medical tourism" for a couple of years now. What is that? Well, check out this link for a prime example. Take the Bumrungrad International Hospital 'virtual' tour that can be easily accessed on their Home page (upper right). After just three minutes, I wonder if - like me - you'll be thinking what I'm thinking; why isn't this facility in my PPO Network?

Perhaps it's (past) time to demand that your insurer or self funded TPA (Third Party Administrator) credential and add facilities like these to our networks of providers.