“…the only way affordable access can be achieved is for every citizen to have some type of health insurance.”

Barack Obama? Nancy Pelosi? No, that would be too easy. The above sentiments were voiced by the former Republican leader of the Senate, Dr. Bill Frist in September 2009.

And that is the problem. Democrat and Republican leaders know that mandating insurance, whether it is from an employer or individually purchased, is a core requirement to meaningful reform. If you accept that the system we had on March 22, 2010 was unsustainable, then getting everyone to participate is an integral part of any solution.

Is the individual mandate of the Patient Protection and Affordable Care Act (PPACA) constitutional? It depends on who you ask.

On Friday, August 12th, a three judge panel with the 11th Circuit Court of Appeals ruled against the President and the mandate. It was a split decision. Two of the judges, Joel Dubina a Bush appointee and Frank Hull who was brought to the bench by President Clinton, issued a 207 page ruling that clearly stated their opposition. “This economic mandate represents a wholly novel and potentially unbounded assertion of congressional authority: the ability to compel Americans to purchase an expensive health insurance product they have elected not to buy, and to make them re-purchase that insurance product every month for their entire lives.”

Judge Stanley Marcus, also a Clinton appointee, noted that his peers had ignored “the undeniable fact that Congress’ commerce power has grown exponentially over the past two centuries”.

The White House was quick to point out that insurance rates will skyrocket if all of their changes (free stuff) are implemented without the individual mandate. In other words, if insurance is guaranteed issue and preexisting conditions don’t matter, healthy people won’t bother to buy coverage. This would create a pricing death spiral.

This recent decision is just another step towards the inevitable Supreme Court showdown. In an evenly divided Court, Justice Anthony Kennedy becomes the swing vote. What will he decide? Darned if I know. My guess is that he will note that the individual states have the power to impose this mandate, but that the federal government does not. But that is just a guess.

And, if you have been reading this blog for awhile, you know that this ruling has no impact on my prediction of our final destination.

The federal government, the states, the insurers, and businesses have spent millions of dollars to comply with the PPACA. The Republicans may have won the House last November, but as predicted, they have not taken even the smallest of steps to modify this legislation. Their Bill – H.R. 2 Repealing the Job-Killing Health Care Law Act was neither serious nor constructive. This train has left the station.

If the mandate is struck down, but all of the benefits are retained, rates will continue to climb and the federal government will be forced to offer a competing Public Option. The Public Option will be designed like Medicare Part B, an optional benefit that covers doctors, testing, etc… that almost 90% of all Medicare Beneficiaries accept. There is a heavy fee for failing to purchase Medicare Part B when it is initially offered. Seniors aren’t forced (mandated) to take Medicare Part B. They are just screwed if they don’t. That’s constitutional!

The insurers will dump the individual and small group market on the government and concentrate on the far more profitable supplemental products.

So here we are in August 2011, seventeen months into the PPACA. All of the players are following the script. I suggest you get another popcorn. This show has just begun.

It was war.  Ugly.  Bloody.  And there was plenty of collateral damage.  Angela F. Braley, Chair, President, and CEO of Anthem/WellPoint, dug in her heels.  She was, after all, the leader of the largest health insurance company in the country.  Thirty-four million Americans counted on HER company.  Last year’s revenues were $57.8 billion dollars.  Yes billion, with a B.  And yet, she was fighting a board room coup.

Ken Goulet, Executive Vice President and CEO of the Commercial Business Division, had his own ideas of how the company should be run.  His area accounted for twenty-seven million Americans, 80% of the WellPoint’s medical insureds.  He and the Executive Vice President and Chief Financial Officer, Wayne DeVeydt, saw a need for an immediate rate increase to protect long-term financial security.  They wanted more money in the company coffers, and they wanted that now.  Ms. Braley disagreed. 

The disagreement erupted at the Board meeting.  Angry words were exchanged.  Ms. Braley demanded spending cuts and changes in benefits.  Goulet and DeVeydt tried to force across the board premium increases.  Claims were suspended as the company attempted to sort out its finances and determine a prudent path to take.  Insured’s were advised that their policies would be reactivated once a decision was reached, passed by the Board, and signed by the CEO.  Until then, the best one could hope for was good health, a quick resolution, and a reasonable rate increase once the bill arrived.

The above is, of course, total fiction.  Those are the names and titles of WellPoint’s leaders.  The revenue and membership numbers are accurate, too.  But the idea that an insurance company would hold up benefits while sorting out an internal conflict is just me being silly.  Real businesses are too responsible to behave that way.  No, the only place people’s lives are put in jeopardy like this is with the government.

Today is July 29, 2011.  The Republicans just passed John Boehner’s bill.  The Speaker of the House, the leader of the Republican majority, needed over 24 hours to get an almost meaningless piece of legislation approved by his own troops.  In the end, the only thing he accomplished was the final destruction of his own reputation and position.  This bill is Dead On Arrival at the Senate.  Boehner knows that.  His Republican members know that.  And the Senate is incredibly clear about the bill’s status.  There was only one reason to pass this legislation – political theater.  If Boehner could have passed the bill with little effort, with all of the Republicans and a smattering of Blue Dog Democrats, he would have been in position to consolidate power and force a deal more to his members’ liking.  Now?  Who knows?

I don’t think we are going to default.  I certainly hope we don’t.  I keep thinking that the adults are going to step in at the last moment and resolve this.  At the very least, I keep thinking that this will be kicked down the curb till next March. 

Until this is resolved, seniors dependent on Medicare and countless others wait and wonder.  Will they be paid next week?  Will they be insured next week?  Will the government shut down?  We have states that have or are close to shut down.  Why not Washington?  With so many people campaigning against the federal government, what would happen if enough people got elected who wanted to dismantle the great social safety net?

And thus we return to my question – is your health care too important to be entrusted to politicians?   This isn’t an unqualified endorsement of insurance companies, just a simple question.  John Boehner?  Harry Reid?  Nancy Pelosi?  John McCain?  Which of these people would you like to have managing the nation’s health care industry?  Which do you want in charge the next time you need a kidney?

Let me be clear, the insurance industry is only as good as the regulations that control it.  Ask my friend John about his claims from Hurricane Katrina. Health insurance claims are far less aggravating then car or home insurance claims, but rules and regs play a large part in that.  Financial stability comes, in part, from the laws the companies are forced to abide.

So, on Friday the 29^th, the idea of Anthem not paying my clients claims is ridiculous.  The idea that my friends and neighbors are being threatened by a government default that may or may not cover their claims isn’t ridiculous.  It is shameful.

“Unintended pregnancies carry health consequences for the mother – psychological, emotional and physical – and also consequences for the newborn”, said Dr. Linda Rosenstock, panel chairwoman and dean of public health at the University of California, Los Angeles. “The overwhelming evidence was strongly supportive of the health benefit” of contraception.

The above paragraph was part of an Associated Press story that appeared Tuesday at Cleveland.com. The headline was Panel urges no co-pay insurance coverage for women’s birth control.

Last year’s Patient Protection and Affordable Care Act (PPACA) included a provision for preventive care. Most health insurance plans are now required to cover a list of preventive care exams and tests without any co-payments. FREE! The costs for these services are simply shifted to the insurance company who eventually shifts them back to you or your employer in the form of higher premiums. Knowing that recommendations over and above mammograms and Pap tests would be controversial, the issue was shipped over to the 16 person panel at the Institute of Medicine.

The panel recommended that the following female-specific items be included under the free preventive care benefit:

• All forms of contraception – Birth Control Pills, IUD, and emergency contraception (the morning-after pill)
• At least one “well woman” preventive care visit annually
• Annual HIV counseling and screening for sexually active women
• Annual counseling on sexually transmitted infections for sexually active women
• Screening for and counseling about domestic violence
• Screening every 3 years starting at age 30 for the virus that causes cervical cancer
• Screening for diabetes during pregnancy
• Support for breast feeding mothers, including the cost of renting pumps

The recommendations didn’t have a 16-0 endorsement. Anthony LoSasso, a senior research professor at the University of Illinois School of Public Health, objected. He noted the absence of a cost-benefit analysis. But since money wasn’t relevant, the Rosenstock led panel pushed through their wish list.

There is a very good chance that Kathleen Sebelius, the Secretary of Health and Human Services, will incorporate these recommendations into public policy in the next few weeks. There is an even better chance that Kathleen Sebelius, the Secretary of Health and Human Services, will be attacking the insurance companies next year when your rates go up.

I am not suggesting that giving women information and access is bad. Far from it. The lack of concern over cost bothers me. And, this decision to explore personal habits opens us, as a society, to countless issues.

Dispensing free contraceptives as part of preventive care means, in essence, that any woman physically capable of getting pregnant, but not utilizing some form of contraception, is not following accepted medical care. Should your eleven year old daughter be on the pill or have the patch? IUD at fifteen? I believe that this is a family discussion.

Is sex a choice? Is sex too desirable to avoid?

What about gun ownership? I’ve never owned a gun. I have never fired a real gun. But I know people who feel even more strongly about their guns than I do about the wooden pen I’m using to write this post. We know that children find guns in their homes and accidentally kill themselves, siblings, or playmates. What is to keep Secretary Sebelius from incorporating a gun ownership prevention/education/safety program into every child’s preventive care visit?

It doesn’t stop there. I was a healthy kid, but I had numerous basketball injuries. Should my teenage preventive care exams have come with elbow and knee pads, or should the doctor have just given up and prescribed a 30 minute video on the horrors of knee injuries?

Football is a choice. So is riding a bike. We now require children to wear bicycle helmets. Shouldn’t the doctor just periodically dispense them as the child outgrows them? This is preventive care. The science supports the need.

And Money Is No Object.

We live in a fantasy world where there is an abundance of free stuff. The U.S. is currently fighting two or three (depending on who you talk to) unfunded wars. The party, Democrat or Republican, out of power is always more obsessed with budgets and deficits than whichever is in charge. And wherever there is a microphone you will find a politician promising something for nothing.

We’re adults. We know better. But we still want more free stuff.

I couldn’t write. I was too agitated to write. Now for someone like me who seems to write principally to vent, agitation is a useful state. Sometimes it is the starting point. But I have been handcuffed for over a week.

“If Congress really wanted to balance the budget,” I heard an elderly man say. “They could stop spending our money on things like…” an elderly woman continued. Turning my attention to the television, I found a parade of senior citizens complaining about the federal government having the nerve to allocate funds for anything other than their health, welfare, and happiness. Some of the claims were bogus, some merely exaggerations. The total of all of the alleged expenditures wasn’t enough to change anything. The commercial, sponsored by AARP, was simply one more salvo in the ongoing budget debate.

We are all in agreement that sacrifices need to be made. We are waiting for YOU to make them.

The nursing homes in Ohio feel that they are entitled to a larger and larger share of the State of Ohio’s budget. Deliver Medicaid care at home? Unthinkable. Thus we are treated to aged, decrepit seniors crying into the camera. “Please don’t take my dignity,” said the 200 year old guy wearing the Veterans of Foreign War hat. Too late. That ship has already sailed.

I heard the familiar strains of You Only Hurt The One You Love. The television screen was filled with sick people. The American Hospital Association wants you to know that cuts in federal funding will have an immediate impact on the elderly, children and the disabled. And just in case you have the sound off, their ad concludes with the camera focusing on the unhappy child in a wheelchair.

We in Greater Cleveland know how the hospitals have been suffering. It has been almost a week since a new facility opened!

We are in year two of the President’s health care reform. The Patient Protection and Affordable Care Act has succeeded in keeping a smattering of adult children on their parents’ policies. It has eliminated policies that covered only children. It has cost millions of dollars for compliance. But, the PPACA has not reformed health care.

You may not like insurance companies. Hell, I’m an insurance agent. There are lots of days that I don’t like insurance companies. But, you can’t reform health care without addressing the cost of medical care and how it is delivered. And no one is more change resistant than the medical industry when the subject is money.

Every time the government proposes a cut in the funding or even the growth of funding of medical care, we see more costs shifted to those who are covered by private insurance and the television commercials reappear. My goal is to eventually be one of those elderly actors. I bet AARP pays well.

We have yet to have a serious discussion. And it is hard to blame the doctors. Do you want to take a pay cut? Would you want to work more, see more patients, for the same money, or G-d forbid, less? Everyone involved, from the lab techs to the hospital administrators, has the same argument. And until anything happens, all of the participants are staking out their territory.

We are all in agreement that sacrifices need to be made. We are waiting for YOU to make them.

Somewhere there is someone reading this who is pounding the table and yelling, “Take the profit out of healthcare!” Balderdash. There is profit at every step. The doctors aren’t volunteers. The labs, the pharmacies, the drug companies, the equipment manufacturers, the company that cleans the linens, they all expect to be paid for their efforts and rewarded for their risks.

Of course, we could bring all of this under government control. Wouldn’t that solve everything? A recent Wall Street Journal article detailed the incredible cost (waste) when people are covered by both Medicare and Medicaid. Medicare is a federal program. Medicaid is controlled by the individual states with a partial reimbursement from Washington. There are 9.7 million patients covered by both systems. “Dual Eligibles” have disproportionately higher claims as they expose the inefficiencies of the two programs and their inability to effectively coordinate care. The examples in this article will give you pause.

The answer won’t be found in a scary commercial. Old veterans and disabled children are just stage props. We understand that there aren’t any 2011 Cadillacs waiting for us at the corner used car lot. At some point we have to decide what health care we really want and how much we can and will spend. Those tasks are still waiting for Congress, Republicans and Democrats, to tackle with the President. The business models will work themselves out, once those questions are answered.

And will someone please get the child actor in that wheelchair a teddy bear?

Before we begin – The Tony Award Show is serving as background noise as I write this. The Dallas / Miami game may be on, but not in my home. I want the Mavs to win, or more importantly, I want the Heat to lose. I don’t want to invest two hours of my life cheering for someone to fail. That negativity isn’t healthy. For that matter, investing all of your energy praying for the other political party to fail is not only unhealthy for you, it can be devastating for the country.

It is only fair to warn you, dear reader, that this is another post about Medicare. Click. I just lost half of my readers. Medicare is boring and about old people. Since most of my readers are under 65, most don’t care about a program designed to provide health care to senior citizens and the permanently disabled. The average American has a notoriously short attention span. We need good guys and bad guys, winners and losers. There is little interest in nuance and detail.

The path to a true solution is built with patience, compromise, and lots and lots of detail.

Medicare was created in 1965. The business of health care has changed significantly in the last forty-six years. We are living longer, getting lots more treatments, many of which didn’t even exist in the mid-60’s, and we are taking an incredible amount of medications.

Senior citizens, in 1965, were thankful that the U.S. Government was coming to their rescue. Medicare filled a need. That need was very real. Today we take Medicare for granted and whine about copays and deductibles. Medicare is the ultimate entitlement program. Ask everyone on Medicare. They will tell you that they are entitled to all the medical care they could possibly need or want.

How do we pay for this? How do we control costs? Can we limit care without being accused of creating death panels? How much should the U.S. Government pay a doctor, a lab, a hospital? Does a doctor in Akron, Ohio really get paid the same amount as a doctor in Manhattan? Can a government really make all of these decisions, and thousands of others, efficiently?

The answer – Maybe.

The citizens of most of the developed world depend on their governments to make those decisions. We, emphatically, do not. We want choices. We want to feel like we are in control. We just want someone else to pick up the tab.

If Medicare is to survive, the government will need to get control of the cost of care. The insurance companies have had some success in this area. Medicare has not. The government will have to get control of fraud and abuse. The insurance companies have had some success in this area. Medicare has not. As long as the doctors have lobbyists, the hospitals have lobbyists, the labs have lobbyists, and the pharmaceutical companies have Congressmen, meaningful change will not happen easily.

There are almost 50 million Americans on Medicare. The influx of baby boomers with our growing life expectancy means that more and more people will be dependent upon a government that is unprepared and unwilling to change until forced.

Representative Paul Ryan’s plan is to pass the buck. Instead of controlling medical costs or even working with the medical providers and insurers, Representative Ryan would send you a check and tell you that you are on your own. If you view his plan as simply a starting point to a long discussion, then it has some (small) merit. If you view this as the ultimate answer, you might need new glasses. Dumping all of the decisions and problems on to the backs of our senior citizens is not the answer.

So how do we move forward? It will take a Presidential Commission comprised of serious, well-known and well-respected Democrats and Republicans. We desperately need to remove the politics from this if we are to have any chance of success. Some of the questions are:
* Medicare begins at what age?
* How much does it cost?
* Will the price be adjusted by age or assets (means testing)?
* How do we control medical expenses?
* Is every test a doctor orders necessary?

This is a partial list. It will take a fair amount of courage to answer those questions. It will take a historic effort to implement the final recommendations.

And when that time comes, when a bi-partisan group has created a workable framework to save and preserve Medicare, it will be our job to cheer for their success. Because their success will be our success. And their failure would be devastating.

I just snuck a peek. Five minutes are left and Dallas is up by 7!

DAVE

The patient was being prepped to be transferred to Hillcrest Hospital. It was at this point that the attorney, a senior citizen covered by a Medicare Advantage policy (Medicare Part C) objected. In pain, he had been rushed to Hillcrest. After some initial testing, he was packed up and delivered to Ahuja Medical Center, the new University Hospital facility. And now the administrators wanted to send him back to Hillcrest, part of the Cleveland Clinic system.

What medical condition would cause two of the most advanced hospital systems in the country to treat the patient like a hot potato? He had a tummy ache. Seriously. It wasn’t the medical condition. It was the insurance.

The attorney and his wife had purchased a Brand X Medicare Advantage contract. The company has a well-defined network of providers in its home market several counties from here. There was nothing wrong with the product. The Federal government certified and approved it. Our hospitals were unsure of the network, which meant that both hospitals were unable to determine that they would be properly paid.

Let’s stop and review this:
* Educated consumers evaluated their insurance choices.
* All of the products were government approved.
* Two of the largest, most successful, hospitals in the country reviewed the coverage.
* The insurer’s “Home” territory is less than 100 miles away.

The patient could have been treated by either hospital. There was no reason to transfer him. None.

Representative Paul Ryan would like to reform Medicare. The Democrats claim that he is trying to kill Medicare. Pictures of little old ladies being pushed off cliffs will be on your TV by this weekend. This is, of course, a gross exaggeration. Mr. Ryan would never push elderly people off a cliff. He would, however, lecture tsunami victims for their inability to out swim the wave.

Mr. Ryan introduced his Roadmap for America’s Future in 2008. he has had three years to refine it. He has had three years to learn how to explain it. He has failed on both counts. His Medicare plan does not involve vouchers. In truth, Representative Ryan appears to have borrowed the worst parts of the Medicare Advantage program, Medicare Part D (Rx), and the Charter School Voucher initiative, thrown all of these ingredients into a malfunctioning blender, and poured his concoction into a couple of broken martini glasses. Delicious.

I have read the Congressman’s website several times. I wanted to ask him a couple of questions, but his site only accepts emails from residents of his district. If he wants to be a national leader, he should be nationally accessible.

The current Medicare Advantage program allows senior citizens to acquire coverage online, by phone, by mail, or through a specially trained and licensed agent. There is no difference in price. The attorney went it alone. He was never in any real danger. He was always covered, but there had been better options. Representative Ryan’s plan is far more complicated and it doesn’t carry any guarantee of success. It is important to note that the attorney and his wife CHOSE the Medicare Advantage route. They could have stayed with traditional Medicare and purchased supplements. Mr. Ryan eliminates that choice.

The good news is that there are no cliffs involved. But Paul Ryan thinks that you better learn how to swim.

DAVE

The second most frequently asked question of an insurance agent is, “Why did my policy lapse?” The answer is because you didn’t pay the bill. The absolute winner, the question that I am asked at least once a day is, “Why did my rates go up?” There isn’t a simple answer to that question.

Some of the factors that may contribute to a premium increase for an employer are:
* Increased Utilization
* Aging Population
* More Mandated Benefits
* Medical Inflation
* New Insurance Taxes

That is not a complete list. There are more. But today’s post isn’t about price increases. It is about one of the ways to impact costs.

The May 2011 edition of Employee Benefit Adviser, which is not nearly as boring as it sounds, included an article about two employers enjoying 0% renewals this year. We are going to look, briefly, at J. J. Keller & Associates, Inc. of Neenah, Wisconsin.

J. J. Keller & Associates, Inc. is a privately held company with about 1,100 employees. Keller helps companies navigate through the minefields of government regulations. The company enjoys a stable workplace environment. 60% of the employees are over age 40 and the majority have worked for the company for five years or more.

Keller’s commitment to Wellness includes:
* Company sponsored Weight Watchers at Work
* Smoking Cessation programs
* Fitness Challenges
* A Walking Trail available during breaks
* In-house Food Service
* Workout Facility
* In-house Wellness Center staffed by a Nurse Practitioner

You get the idea. They have made the complete and total commitment. J. J. Keller has everything in place for a successful program. Even the fact that it isn’t a publicly traded company helps. Does this mean that the health insurance rates are going to decrease? Are they saving money?

The article doesn’t answer either of those questions. My guess is NO on both counts.

Medical inflation, alone, is going to impact costs at close to 10% per year. Maybe more. The Patient Protection and Affordable Care Act is taking a toll, too. But the most important issue is that we are not discussing machine maintenance. We are talking about human employees, flesh and blood. We are going to get sick or injured. We are going to have claims.

A properly designed Wellness Program can mitigate the type and amount of claims by controlling behavior. Ongoing claims for diabetes, heart disease, stroke and cancer are budget killers. Many of these conditions are controllable through education, medication, and behavioral modification. The Keller program is designed to improve morale and awareness. From here, today, it appears to be working.

There are some local stars in the wellness universe. Kaiser Permanente is returning to its HMO roots. After a bit of soul-searching, the company realized that it was attempting to be all things to all people. Kaiser has recently declared that it will return to its core competency – an integrated medical practice whose mission is to keep people healthy. With a focus on Prevention, Kaiser hopes to reestablish itself as a unique option in the marketplace.

I recently met with Jamie Field of University Hospitals. Ms. Field has created an incredible wellness program for Northeast Ohio employers. She and her team will conduct Health Fairs, Wellness profiles, and Health Screenings at the worksite. The pricing tells the story. U.H. has made the decision to perform community outreach. For example, $20 per employee includes on-site health screenings for:
1. Blood Pressure
2. Blood Sugar
3. Cholesterol
4. BMI
5. Bone Density

Employees who fall outside of the normal range on any of the tests are given useful information designed to answer immediate questions and to spur productive steps towards help or control.

Will this lower the employer’s group health insurance rates? No, at least not anytime soon. But if the goal is to help someone before they have a stroke, heart attack, or other major claim, then a wellness program could be very useful. And yes, it could improve employee morale.

The purpose of group health insurance is to attract and retain good people. A wellness program, one designed to help and educate, could complement your efforts.

The results may be happier employees. You may have healthier employees. But the insurance will still lapse if you don’t pay and the rates may still go up. I’m hoping just a little.

DAVE

One of the new benefits of the Patient Protection and Affordable Care Act (PPACA) is that dependent children, even if they are married, can be covered on their parents’ policies until they reach the tender age of 26. Ohio upped the ante and made it 28. Employers are rejoicing.

A provision was built into the law that prevents an employer from passing any of the extra cost of insuring an adult child onto the parental employee. If the employer pays 75% of the cost of insuring a five year old girl, the employer must pay 75% of the cost of insuring a twenty-five year old woman. There is a huge difference in these risks. Neither the State of Ohio nor the US government is concerned.

The insurers are passing the additional cost to cover these adults, much like the other new benefits, to the policyholders. Individual (non-group) contracts are rising. Group policy premiums are climbing. Some employers are absorbing the difference. The recent hike in gas prices will quickly end such largesse.

I am seeing employers tackle this problem by raising their deductibles and co-payments in an effort to retain reasonable premiums. Other clients are asking their employees to pay a larger portion of their premiums. This would appear to be inevitable.

As the costs continue to mount, there are still those who want more. Can we include the spouses of the married children? Shouldn’t we include grandchildren? I’m reminded of my friend Jack who didn’t quit smoking. He simply quit buying!

There are no FREE benefits. There are no Free physicals. No Free colonoscopies. No Free coverage for dependent children. We are all paying for this, directly or indirectly. If this, any of this, makes sense as part of some greater public good, say so. It is time for our political leaders to publicly state their values. We need to be asked to support their choices with out money.

We’ve had subterfuge and deception. Let’s try something entirely different – honesty and transparency. I’m paying. Let me feel like I’m getting my money’s worth.

DAVE

10:05. Not Bad. I was right on time for my 10 AM appointment. It had taken me years to do this, to break my habit of arriving early, or at worse, exactly at the scheduled moment for certain clients who are always late. There is a certain comfort in predictability. If we have a chance to prepare, we can deal with almost anything.

Security – Consistency – Predictability

One place Americans beg for a measure of predictability is in the delivery of health care, especially for senior citizens. Sadly, the only consistency of late has been the unrelenting fear mongering delivered by both political parties. And my prediction is that there is no end in sight.

This blog has tackled Medicare numerous times over the last two years. The February 5, 2010 post includes a complete break-down of Medicare Part A and Part B. The Doc-Fix, Medicare Fraud, the need for private coverage, Medicare Advantage policies, and even hospital reimbursements have been addressed. There is no need to rehash any of that today.

Both the Democrats and the Republicans agree that Medicare needs help. Their only other area of agreement is the political value of Medicare. Seniors vote. Each side is willing to manipulate Medicare’s funding, physician reimbursements, and even plan design to garner those votes.

The Democrats have spent much of the last two years demonizing insurance companies. One of their favorite targets is the Medicare Advantage program. Instead of having traditional Medicare, plus a Medicare Supplement that may cost $150 a month or more, and a Medicare Part D (Rx) plan for another $50 + per month, a senior may choose a Medicare Advantage policy that might not cost him a penny. The federal government pays the insurer a set amount to handle all of the senior’s health bills. Medicare Advantage policies may include office and hospital co-payments.

The low monthly premium, or in many cases the total absence of premium, is very attractive to some seniors. In exchange, there may be a network of preferred providers and the possibility of lots of copayments should the senior require multiple hospital stays and doctor visits.

Medicare Advantage policies are not for everyone. Approximately eleven million seniors have chosen this option.

This administration has bemoaned the very existence of Medicare Advantage policies since they took office. Part of the President’s plan has been to cut funding for this program. This week the administration reversed itself and plowed an additional $6.7 Billion into Medicare Advantage.

You may have heard that there is an election next year.

The Republicans have dabbled in Medicare politics, too. Medicare Part D (Rx) was created, in large part, to insure the reelection of George W. Bush in 2004. Their new found interest on deficit reduction arrived long after they created this program.

Representative Paul Ryan is now talking about eventually moving all seniors into a voucher program. I have yet to see the details, but is sounds a whole lot like Medicare Advantage. The Democrats have already begun the campaign against this. They paint a picture of frail, elderly Americans forced to return to work to pay for their insurance. The Republicans are claiming that this is a necessary major step to controlling costs and reducing the deficit.

It is all great theater, but there is precious little truth in any of it. And, there is no security, consistency, or predictability. The cost of care, unaddressed in any of this, continues to rise. Our seniors, our medical providers, and even the insurers suffer from the uncertainty of this process.

If I could monetize frustration, I would be rich.

Instead, I just learned that my client forgot about our appointment. I only predicted that she would be late, not a total no show at her own business. Her employee and I just negotiated an appointment in my office at 2 PM.

I’m positive that she will arrive before 3.

She was making a joke. It was her second joke/witticism in the last twenty minutes. And like the first time, I didn’t laugh. I’m not a good fake laugher. At least I smiled. Busted! She again noticed that I wasn’t laughing. Her protests may also have been attempts at humor. Oh well. I had no trouble convincing her that I was not an experienced lobbyist.

About seventy-five members of the Ohio Association of Health Underwriters were at the State House to voice our concerns about pending legislation. The Lieutenant Governor, Mary Taylor, who is also in charge of Ohio’s Department of Insurance, came to talk with us. Even Democrats like me appreciated what we heard as long as she didn’t stray from our particular area of concern.

Like any health insurance agent program, the day began with coffee, juice, and platters upon platters of cakes and pastries. The morning program consisted of several speakers who detailed Ohio’s attempt to deal with the Patient Protection and Affordable Care Act (PPACA), the new exchanges, and where we, professional insurance agents, fit into this evolving system. Next was lunch and another couple of speakers. By three o’clock we were more than eager to meet with legislators for our pre-set appointments.

There were heavy hors d’oeuvres and cocktails waiting for us at the five o’clock finish line. Being a health insurance agent isn’t necessarily healthy, but it can be fun. I met with two Democratic State Senators and a Republican member of the Ohio House. While waiting for my appointments I bumped into representatives of the credit unions, service unions, YMCA’s, and other interest groups. I found our elected officials to be incredibly generous with their time. They were sincerely interested in talking with me, not at me. They appeared to be committed to doing the people’s business. I’m not sure that I was up to the task. I was supposed to talk insurance. The states can not wait to see if the PPACA will be defunded or struck down by the Supreme Court. All 50 states are attempting to create a mechanism to comply with the law that will best serve their particular population. 50 plans. All different. All based on a law and a set of assumptions that could change at any moment. Ohio’s options and my clients’ needs were my topics. All three legislators veered into other areas.

The Republican and the Democrats wanted to talk about S.B. 5, the bill that was pushed through last week. The Republican appeared to be shaken by the vitriolic push-back. The Democrats were shocked by the over-reach of the newly elected, and incredibly partisan, Republican Governor. The similarities between S.B. 5 and the PPACA are striking. In each case the party in power passed a highly partisan, one sided piece of legislation that is opposed by close to 50% of the population. The victory is short-lived. The Democrats paid dearly at the polls last November. The Republicans in states like Wisconsin and Ohio will probably pay for their impudence this November and next.

My message was that whether you love or hate the PPACA, it is our job to make this legislation work for our clients and all Ohioans. The best use of our time and efforts will be programs that will provide greater access and information. That was the message. I don’t know if I was successful in delivering it. I might have been more effective had I been able to laugh at those jokes.