The three key stakeholders in the delivery of health care to our citizens are the government, the medical community, and the insurance companies. It has been the goal of this blog to show that none of these players can ever be allowed to operate unchecked.

Yes, I come to this discussion as a thirty plus year veteran of the insurance business. My experience colors my point of view as much, if not more, than my income needs. But, it is fair to ask if I have covered insurance problems and access sufficiently.

Today we tackle an insurance problem.

Joan Rogers (as usual, not her real name) was referred to me by one of my loyal readers. Joan is a self-employed professional in her late fifties. Her divorce was finalized in December 2006. She has been covered under her ex-spouse’s group health insurance policy ever since. Her COBRA ends next month. Joan Rogers is in trouble.

Ms. Rogers has several medical conditions. None are life threatening, but none are cheap to control. Her three medications have a combined cost of $7,700 per year. She does not qualify for a comprehensive individually underwritten medical insurance plan. Since she doesn’t have an employee or business partner, we can’t write a group policy. A group policy would have to take her. She doesn’t want to stop doing what she does just to get a job that provides insurance benefits. Well educated and talented, Joan wants to continue her career.

What are Joan’s options?

First, is it unfair that she doesn’t qualify for a regular policy? Joan’s prescriptions add $650 per month to the cost of her care. Her scheduled office visits and tests are hundreds more. How does Anthem or Medical Mutual build that into her rates? Do we spread her risk to your rates and mine?

United Health Care might take Joan. The policy would exclude treatment for her most expensive conditions and insure her for anything else. The premium is $320 per month. Since the policy would qualify for a Health Savings Account (HSA), Joan could put close to $4,000 in an account, take the tax deduction, and use the money to help pay for her medications. This is not a good option. She has way too much exposure.

I know what some of you are thinking. Since Joan is coming off a group policy, she is guaranteed the right to purchase an individual policy. HIPAA to the rescue.

Federal regulation guarantees that Joan can purchase a policy designed by her state of residence. Ohio has two awful options – The Ohio Basic and Standard Plans. The Standard Plan, the better of the two, has the following benefits:
• $750 deductible
• 70% / 30% coinsurance
• $5,000 maximum out of pocket each year
• $1,000,000 lifetime maximum
• $2,500 maximum benefit each year for outpatient prescription drugs

You get the idea. This is nothing special.

The Anthem premium for this policy is $2,994.95 per month. The Golden Rule premium for this policy is only $1,323.21 per month. These are not typos.

What is the answer? Damned if I know. I agonize over the uninsured and I have spent a ton of time on Joan’s case in the last week or so. And Joan is not the only person in this predicament.

Would the “Public Option” solve Joan’s problem? Hard to say. The Ohio Standard Plan is, in essence, the state’s version of the Public Option. Would the State of Ohio create a better plan the next time around or will the policy be created by the federal government? And who pays for this?

If preexisting conditions were no longer relevant and insurers had to accept all applicants, Joan’s problems are solved at the exact same moment that your problems begin. If everyone is required to have insurance, the burden is less severe.

But today is November 11, 2009 and Joan has run our of good options. There is a real need for health care reform. The question is how to correct what doesn’t work without destroying what does.

DAVE

www.bogartcunix.com

A scene from the future.

Senate cloakroom. An unscheduled meeting of Senators Barbara Boxer (D-CA), Sherrod Brown (D-OH), Byron Dorgan (D-ND), Al Franken (D-WI), John Kerry (D-MA), and John Rockefeller IV (D-WV).

Dorgan: It’s not working.

Kerry: Of course it’s working. Polls show the

Dorgan: John! It’s not working. Polls? Hell John, you’ve got polls that show you won the presidency ten years ago. Barbara, you ran national commercials showing that North Dakotans were mostly covered by one health insurance company. Do you know how many we have now?

Rockefeller: Two? Three?

Dorgan: None! Your public option killed our local Blue Cross. We don’t have that many residents. We couldn’t support three or four major companies. Competition? We want our old coverage back.

Kerry: People across the country love Medicare Part E.

Franken:John, enough with that. It was fun when Olbermann came up with that. But the Republicans successfully dubbed it Medicare Edsel to seniors and Medicare Error to others.

Kerry: Nobody else calls it Medicare Part E?

All: Just you, John.

Senator Beau Biden (D-De) enters the cloakroom.

Biden: Senators.

All: Senator.

Biden: That never gets old. What’s going on?

Boxer: Byron’s unhappy with the health plan.

Dorgan: I’m unhappy? My constituents are unhappy. And you? How happy are you?

Franken:The numbers are awful. We were told that costs would go down. Happiness would go up.

Biden: Doctors still on strike in San Francisco?

Boxer: Yes, but at least most of them are back to work in Los Angeles and San Diego.

Franken:The claims are through the roof. We undercut the insurers and took their healthiest clients. Since we didn’t ask any questions or exclude any preexisting conditions, we got all of the unhealthy, too. The insurers are making money, hand over fist, selling supplements and we were left holding the bag.

Kerry: I didn’t know so many had cancer.

Boxer: Or heart trouble.

Rockefeller:Or asthma. Half the country must use inhalers.

Brown: Much of this is preventable. If we could only get people to take better care of themselves, quit smoking and drink less, we’d be OK.

Biden: Good luck with that.

Brown: Well, I’ve got an idea. I would like to initiate a trial program in Northeast Ohio. It’s based on a great idea from a few years ago. Toby Cosgrove of the Cleveland Clinic has pointed out that obesity is the root cause of much of our problem.

Boxer: Yes, we all know that obesity related claims are killing us. What’s the idea?

Brown: The Cleveland Clinic would send out three cans of Slim Fast to every household in Great Cleveland. Once people see how easy it is to lose weight, our problems will be over. And of course, since this is such a good idea, they won’t mind paying for the diet shakes.

Rockefeller:How much will it cost them?

Brown: Just $50.

Kerry: Sounds like a steal!

I hope you are reading this under the glow of a low-energy light bulb.

DAVE

www.bogartcunix.com

Forget free lunch. I want dinner.

I briefly touched upon rating differentials in my last blog. To recap, there were women complaining to Congress about paying higher individual health insurance premiums when they are young and, statistically, have more claims than young men. There was, of course, no mention that their rates would be less than their male counterparts when they get older. As Congress decides to invade my business, they will eventually scale back on the grandiose proclamations and actually have to start running their new insurance company.

Yes, insurance company. How will Uncle Sam Mutual operate? Will U.S.M. cover all of the services, tests, and procedures your current plan challenges? Every dread disease will have its teams of lobbyists and victims ready to testify at Congressional hearings. Congress will be the board of directors of Uncle Sam Mutual. Congress, the same group that a few years ago under Doctor Bill Frist’s leadership attempted to diagnose Terri Schiavo, will be asked to make tough decisions. We’re in trouble.

Let’s take something easy – price. How will Uncle Sam Mutual price the product? Let’s assume, to keep this simple, that there is only one policy.

The following determine premiums today:
1. Location
2. Age
3. Gender
4. Health
5. Habits

Residents of Cuyahoga County pay the highest health insurance premiums in Ohio. Our doctors and hospitals charge more, run more tests, and do more procedures. Forget New York or Los Angelas. If we just make all Ohioans pay the same premium, my son Phillip, who lives in Marietta, will have the opportunity to help lower my monthly cost. Theoretically, as my premiums go down, his will go up.

Speaking of Phil, he can really pitch in if age is no longer a factor. I turn 55 next February. Males 55-64 have high utilization. Age 55-59 is expensive. Premiums for men 60-64 can be down right unpleasant. Thirty-one year old males have premiums that reflect their few claims. Remove age as a pricing factor and my premium should plummet. Poor Phillip.

Before we go any further, let’s do a numbers check. Remember, so far we are only talking about location and age IN OHIO. We aren’t stacking the deck with national extremes, smokers with suspended driver’s licenses, or the chronically ill.

We’ll use a “Chevy”. Anthem Blue Cross. $1000 deductible 80/20 policy with office visits and Rx Card.

Marietta – Male age 22 – $101.08 per month
Lakewood – Male age 62 – $506.08 per month

In the interest of fairness, we’ll split the difference. Again, we are only looking at location and age. Gender, habits, and health have yet to be factored into these numbers. The average of these two rates is $303.58. Our mythical 62 year old is thrilled. Our 22 year old is not. Forced to pay way too much, he abandons the system. At 22, he can. What does that do to our price?

As thousands of young men in their early 20’s abandon Uncle Sam Mutual’s policy, the average age of the participants increases. The price, assuming any semblance of rational accounting, increases. Every time the price increases, it forces more young, healthy people off the policy. Our 22 year old’s biggest problem is the high percentage of older people who vote.

According to President Obama, we need the public option “to keep the insurance companies honest”. How? Will the government really begin to pay medical providers the higher insurance rates? Will the policy be as self-sufficient as the Post Office? Will all the promises to the pharmaceutical companies, the seniors, the sick, etc… be kept? Or is this just one more campaign to pass a piece of legislation?

We have only touched upon two of the rating factors. Gender, habits, and health can actually be bigger contributors to the cost to pay for someone’s health care. That is what we are discussing, Morbidity. What does it cost to pay for YOUR care?

I’m looking forward to a great dinner. And by the way, it’s your turn to pick up the check.

DAVE

www.bogartcunix.com

I know I’ve asked this before, but at the risk of appearing repetitive, What is our Goal? Is it too much to ask that before we completely restructure our health care delivery system and a major portion of our economy, we take a moment and delineate our goals?

There are a few, very few, activists and members of Congress who have the goal of eliminating all private insurance. They view the current legislation as the first step towards a Canadian-style single payer system. It is easy to lump everyone suggesting proposals that might have a negative impact on my business as proponents of “Socialized Medicine”. Easy, but very wrong. It is also wrong to assume that anyone not lining up behind a significant overhaul or the “Public Option” is a right-wing nut job probably on the take from the insurance industry.

So let’s look for some other goals. One I keep hearing about is that we want to cover the uninsured. Sounds great to me, but before you can cover the uninsured, you have to ask who they are and why they don’t have insurance.

We know that a large number of the supposed 47 million are undocumented Americans. The President’s big speech put the number somewhere between 12 and 17 million. We also know that a large number are not permanently uninsured, just simply between jobs. Some high earners choose to be uninsured. My favorite was a well known doctor at Hillcrest Hospital. For all I know, he and his family may still be without insurance coverage.

Some of the uninsured have major illnesses. Some are children, eligible for Medicaid, but their parents don’t know or haven’t bothered to complete the process of enrollment. And many of the uninsured are the working poor. Earning less than 200 percent of the poverty level, often working one or two low wage part time jobs. These people have fallen through the cracks. It is our responsibility to help them get covered.

But there is another group. And this is the group that concerns many of us. There are people of limited means who chose not to be insured, or at least, not today. When they need coverage, due to illness, accident, or pregnancy, they expect to be welcomed like long lost friends by the insurers, doctors and hospitals.

Let me give you an example. Pamela (not her real name) works full-time for a large specialty retailer in a Greater Cleveland mall. She is a healthy single mother in her early 40’s. She stopped smoking years ago. Aside from her two pregnancies and her breast implants, she has not had any hospital stays or surgeries. Her older child is on her own. Pamela’s teenager is covered by her father. Pam is uninsured by choice.

Pamela’s employer has an excellent group health insurance policy. The plan includes an office visit copay, Rx card, and preventive care. Why isn’t Pam covered? Why won’t they take her? Neither the insurer nor the employer is to blame. The employer pays the vast majority of the premium. The employee portion for this policy is $41 per paycheck, $82 per month. Pam refuses to participate. She would rather spend the money elsewhere, preferably on e-bay.

Who pays if Pamela gets sick or injured? We do. What would it take to get her to participate in the system before she is being wheeled in on a gurney? Should she be forced by implementing a tax (We are supposed to say fees. The President and Senator Baucus love fees.) on people who refuse to buy insurance? Should her employer be required to pay 100% of the premium? Should the government, which is us, just give her free insurance? Obviously the moral imperative of being personally responsible hasn’t been a motivator so far.

What happens when premiums increase? There is every indication that premiums will rise with the implementation of the Baucus bill. Will Pam’s coworkers drop off the coverage as their disposable income is attacked? There are a lot of Pamela’s. Each of these people has a reason why his/her lifestyle is more important than insurance right up until the moment care is needed.

I want to be very clear. I am not talking about people who have lost their group coverage, can’t find another job, and have a serious preexisting condition. This year’s COBRA extension was only a bandage. Our system has failed too many of these people. The working poor, wage earners struggling to survive, are also not the point of this. At one point the Republicans wanted to give the working poor tax credits to buy insurance. That isn’t an answer. Immediate access to Medicaid, a state run program, and an increase in funding (taxes) is the only way I know to help them.

I refuse to believe that people choose to be poor, sick, or disabled. Just as it is our responsibility to help those who can not help themselves, it is our duty to provide for ourselves and our families when we can.

So what are our goals and how are we going to achieve them?

DAVE

By the way: Now that we are getting closer, it is time to assert YOUR Divine right to special consideration. On the October 15, 2009 ABC World News Tonight, Charlie Gibson reported about women testifying on Capitol Hill. The issue was that insurance companies were charging them more for health coverage than males the same age. The injustice! Of course, there was no mention that these same women would pay less than men for health insurance later in life or that their car insurance was less since the day they received their driver’s licenses. And life insurance? Women’s rates are always less than men’s. Poor Charlie. He just didn’t have the time to mention any of that.

www.bogartcunix.com

OK, Dave. What do you think is going to happen with health care?
Have you read my blog?
When I get a chance, probably not for the last couple of weeks. Just give me the two minute version.

The two minute version? Health Care. Life and Death. 15% – 20% of our economy. And he wants this condensed to two minutes so that he can move on to more important things like Shaquille O’Neal’s debut in a Cav’s uniform.

Details. There are no details in the two minute version. But then again, there have been almost no details in the barrage of commercials (for or against anything), speeches, or news programs. We’ve got hype. We’ve got fear-mongering. We’ve got lobbyists. But details? Who has time for details?

There is a great commercial on television that stresses that the PLAN:
* Let’s you choose your own doctor
* Won’t penalize you for any preexisting conditions
* Keeps bureaucrats out of your health care
* Incorporates the best ideas from Democrats and Republicans
“That’s reform we can all feel good about.”

Sign me up!

Of course, this plan doesn’t exist. Senator Baucus recently unveiled his version of health care reform. Over 500 amendments have been offered so far. Let’s pretend that two thirds of those amendments are nothing more than intentional roadblocks, that still leaves over 150 substantive changes. How many of these will be adopted and how will they affect the final legislation? What you like about the bill today, may disappear tomorrow. Or vice-versa.

Details. Ask a dentist how the proposals pay for dental care. Obviously the dental community needs better lobbyists. Even Medicare Advantage policies only cover routine exams and cleanings. Medicare doesn’t cover fillings, crowns, or major services now. Will the so-called public option provide this in the future? Who knows?

These same questions apply to care for mental, nervous, and emotional disorders, eye care, or even chronic conditions. Turn on the television and you’ve got Former Governor, Former DNC Chair Howard Dean begging for a public option. What would the public option cover? Don’t ask him for details. That’s not his job.

So I have an answer for the next person who wants the quick answer for What’s going to happen? I am going to quote that famous philosopher, L.O. Annie who said, “The sun will come up tomorrow.”

DAVE

www.bogartcunix.com

Before we get started – Sunday, September 13, 2009. Fourth Quarter. Brady Quinn completed a 26 yard pass to Robert Royal for a touchdown. You may be wondering what this has to do with health insurance. The Browns offense hadn’t scored a regular season touchdown since last November which was driving Cleveland fans nuts. Since the President and his team have yet to discuss mental health, I want to help out where I can.

Anthony Weiner is a Congressman for New York City. He is a survivor, the kind of guy who seized the opportunities given to him and made the most of them. His story is the success side of any and all government programs designed to help people help themselves. Though I personally can’t relate to his upbringing or how it continues to impact his views on the issues, I respect his accomplishments.

Anthony Weiner hates me.

Well, not exactly. We’ve never met and probably never will. Congressman Weiner does, however, advocate for the elimination of all health insurance companies. As the health care debate heats up, you will find Mr. Weiner on such television programs as The Rachel Maddow Show, Countdown with Keith Olbermann, and even, occasionally, on a mainstream Sunday morning program. His article Giving Single-Payer a Second Look appeared September 7, 2009 on the Huffington Post.

His message, even if slightly exaggerated, is consistent. According to Mr. Weiner, the “United States already uses single-payer systems to cover over 47% of all medical bills through Medicare, Medicaid, the Veteran’s Administration, the Department of Defense, and the Bureau of Indian Affairs.” He often takes time to tell us how happy everyone is under these various programs and usually includes the canard that Medicare has only 4% overhead compared to up to 30% the insurance industry has in profits and overhead.

Where do we begin? Let’s start with the 47% of us on a government run single payer system that proves that insurance is unnecessary. I won’t dwell on the easy stuff – the regular television expose’s of underfunding, waste, and despair that describes almost anything having to do with the Bureau of Indian Affairs and the Veteran’s Administration. I used to volunteer at the V.A. in University Circle, easily one of the most depressing places I’ve ever encountered.

To get to 47%, Congressman Weiner includes Medicaid, a collection of State run programs for the indigent that varies in quality from the almost acceptable to the down-right shameful. Underfunded even in a State like Ohio, Medicaid’s beneficiaries are treated to health care reserved for those on the lowest rung of society’s ladder. Women come to my office to purchase insurance in the hope of getting better care for their children even when they still qualify for Medicaid. Is that right? No! But the States, which means our elected representatives, which means us, have not shown the willingness to tax us sufficiently to provide top of the line health care for our poorest citizens. It is either a priority, or it is not.

Let’s talk about Medicare. I love my children, but I know what Jennifer and Phillip can do and what they can not. I also love Medicare. Congressman Weiner is well aware that much of Medicare’s overhead falls within other parts of the government’s budget. He is also well aware that even though Medicare underpays medical providers, there are real funding issues and that long-term viability is in question if changes aren’t made.

But there is still one issue that Congressman Weiner completely ignores. People are satisfied with Medicare because of private insurance. Senior citizens see Medicare as the combination of the government’s program and their Medicare Supplement policies. Eliminate the supplements and they would be faced with the deductibles, unpaid hospital days, 20% coinsurance, and total exposure to the high cost of prescription medication. Senior citizens are very satisfied with Medicare Advantage policies, the private insurance option Mr. Weiner and the President hope to terminate. Medicare, without the supplements, without the prescription drug benefit, would have very few fans.

Anthony Weiner may hate private insurance, but his constituents still need us.

DAVE

www.bogartcunix.com

September 2012

Welcome. Welcome. Please take a seat. My name is Bill Shnorer. Thank you again for attending this pre-rally briefing. There is a sign-in sheet in the back next to the coffee and cookies.

We have plenty of signs thanks to our friends in the U.A.W. Guys, please raise your hands. Thank you U.A.W. The signs say “It is a RIGHT not a PRIVILEGE, Equal Access For All, and Our Tax Dollars Built This System”. We will make sure that each of you gets a sign as you leave this room.

Friends, we are here because we care. We are here because we have been victimized by the current system. We have seen our loved ones lose jobs and go bankrupt. We have seen factories close and jobs go overseas.

And yet, does Washington care? Is Washington listening? Our concerns have been brushed aside by the industry shills and the talking heads on TV. It is time for action. It is time for you and I and our neighbors to have the same options as our Congressmen and Senators.

There are some who would say that what we are discussing is Socialism. But I am reminded of that great American, Senator Edward Kennedy, who fought tirelessly to better the lives of all Americans. He understood that the corporate CEO is no greater than the single mother in the eyes of liberty. He understood that in a democracy, we are all equal, all are free, and all are entitled to respect.

Yes, if Teddy Kennedy was alive and here, I am sure he would tell you that all Americans have a right to high quality, affordable Transportation.

It is an outrage that even today, in this country, there are still Americans without cars. Cars take Americans to work. Cars take Americans to the doctor for needed health care. Cars take Americans to the grocery store to buy food for their children. Here we are in the richest country in the world, and yet millions of us do not have access to adequate Transportation.

How can this be? Who has forced their way in between you and your auto manufacturer of choice? Who is denying you unfettered access? We look no further than the A.D.A., the Automobile Dealers Association.

Thousands of small towns across this great nation are held hostage by one or maybe two dealers who control the market. Even here in Beachwood, Ohio, you might want to buy a Ford, but we only have a Cadillac dealership.

Some of our opponents have pointed to public transportation as a reasonable alternative. Have they been on a bus? Have they waited in the rain for the Rapid? Would our Senators ride the RTA? We want no more, and no less, than what our representatives are given in Washington. And I’m told that they have great Transportation.

We built the roads, the freeways, and the turnpikes. Our tax dollars funded the very avenues we have been prevented from enjoying.

We need CARS. And we need them NOW.

This will not cost money. It will save money. Providing automobiles to every American eliminates the need for public transportation, an incredible waste of taxpayer money. We will also save the millions of dollars blown on Dealer salaries and perks. Our friends on the West Coast dream of a day when there won’t be anymore Cal Worthington ads on TV.

But this is not a money issue. This is a moral imperative. We will prevail. Americans value our rights. We value our families. And most of all, we Americans value our CARS. When we see our neighbor without a car, we know that there, but for the grace of G-d,walks us.

Grab a sign. The camera crew from Channel 8 is already outside.

DAVE

www.bogartcunix.com

I was standing, two Mondays ago, on the 16th fairway of Fowler’s Mill Golf Course. I was attending the annual American Jewish Committee / N.A.A.C.P. golf outing and had just had my best drive. As if G-d, Himself, had finally seen enough bad golf, an impressive lightning bolt lit the sky. We jumped into our carts and were among the first to arrive at the clubhouse. Torrential rain and heavy winds ended any chance for further athletic embarrassment.

It was too early for dinner, so the nearly one hundred golfers and staff simply hung around and kibitzed. We probably talked more at this outing than at all of the previous ones combined. With the Indians tanking, the Cavs on vacation, and the Browns a few weeks away, health care reform was a major topic of discussion in every group of golfers.

My friend Leo asked how I would solve the problem. “What is the Cunix plan?” Oddly enough, I hadn’t actually thought of one prior to his question. This is what I came up with that afternoon.

1. Health Insurance would be mandatory.
2. All preexisting conditions would be covered for anyone enrolling in the next year.
3. Medicaid is opened up to everyone earning up to 3 times the poverty rate, paid at a sliding scale.
4. The federal government would reinsure all shock claims in excess of $250,000.
5. All group and individual health policies would be revamped to reflect ten uniform options. All plans would include basic preventive care as well as dental and eye exams.
6. All medical providers would be required to update their record keeping in an effort to eliminate duplicate and wasteful testing and procedures.
7. Billing fraud would be aggressively prosecuted.
8. Hospital, doctor, and even prescription ratings would be independent and the results would be easily accessed by the public.

As I said, it was raining, we were stuck inside, and we had lots of time to kill.

I won’t claim that this is a solution to all of America’s health care woes. That would be impossible since we haven’t, as a country, defined the issues. My eight points are my off-the-cuff conversation starters. I am not qualified to advise doctors on cost containment, so you won’t see that here.

My suggestions only work as a whole, no picking and choosing. The insurers, the federal government, the states, and the providers all take a hit. Shared responsibility. Shared pain. Shared solution.

Warning: the following explains, with some detail, the above eight points. If you’re really not interested, it’s OK. Skip ahead to the last paragraph and we’ll see you again in two weeks.

There are supposedly 45 – 50 million uninsured in America. There will always be uninsured. It has been estimated that between 10 and 12 million are illegal aliens. Millions more, like the uninsured motorist who hit me in January, simply choose to not waste their money on insurance. Health insurance must be mandatory for the system to work. We won’t get everybody, but we’ll get most.

The insurers would be put at risk proportionate to their market share with the elimination of both underwriting and any exclusion for preexisting conditions. Of course, there has to be a window when any currently uninsured could acquire coverage regardless of health. After that open enrollment opportunity of six to twelve months ends, uninsureds seeking coverage would be subject to a preexisting condition exclusion.

Affordability would be addressed in several ways. Medicaid, the state run program, would be made available to the working poor – men, women and children. Premiums would be on a sliding scale. The federal government would serve as a universal reinsurer. All claims in excess of $250,000 would be shifted to Washington. Private insurance would be less expensive since the risk would be more manageable.

Product design must be improved. We currently have too many choices. The consumers are confused. The providers claim it is too complicated. And the insurers waste too much money on administration. We need to simplify the product offerings. The Medicare Supplement model is worth duplicating. With input from the state insurance commissioners and the major insurers, health insurance options could be pared down to a far more manageable ten individual plans and ten group plans. The plans would be numbered 1-10 thus eliminating the confusion caused by product names. Plan 5, for example, would offer the exact same benefits whether you purchased it from Anthem, Aetna, or even, G-d forbid, the U.S. government.

By the way, all ten plans would cover basic preventive care including annual eye and dental exams. If we’re going to do this, let’s make sure we do it right.

I covered the importance of modernizing our record keeping and information transmission back in February. This cost would be borne by the providers. Better information will save both money and lives.

Medicare and Medicaid fraud are rampant. The president may want to stop unnecessary tonsillectomies, but over-coding and ghost patients are far more serious issues. We can no longer afford to ignore white coat crime.

We can be better consumers if we have more information. Which hospitals are better for heart surgeries? When will the generic medication be perfectly fine? Independent, accessible studies should be available for all Americans. We need the opportunity to make informed decisions about doctors, hospitals, and therapies.

Our health care conversation came to a merciful end with the arrival of a fabulous dinner catered by Blue Canyon Restaurant. Lucky for me, my invitation to this charity event is not contingent on my golf game or my conversation skills, just my willingness to write a check for a good cause. With any luck, next year will have more golfing and less health care.

DAVE

www.bogartcunix.com

Man, that’s the second time you’ve mentioned that guy. He must really piss you off for you to talk about him at dinner.

Alec, my girlfriend’s son, was correct. I must have been a touch agitated. I place a very high value on honesty, loyalty, and competence. Over the last couple of years I have had to deal with a number of people deficient in one or more of those qualities. One, in particular, may have pushed me a bit too far.

Lately, honesty, loyalty and competence have been in short supply in American politics. Yes, these blogs have taken issue with some of the goals of the proposals coming from the Democrats. I have certainly expressed my disdain for the President’s content-free campaign. I disagree with many of Mr. Obama’s assertions and proposals, but I don’t, for a moment, question his motives or sincerity.

It is also possible to respectfully disagree with some of the Republican proposals and goals. There are people of good will on both sides of the issue.

Good will is not a given and civil discourse has been hard to find. It started with the so-called “Birthers”, the fringe element who refuse to believe that a guy named Barack Hussein Obama could have been born in the United States. Nothing short of a time machine whisking each of them back to the Hawaiian hospital room will convince them. Easily manipulated, the Birthers were led by the usual suspects – Rush Limbaugh, Lou Dobbs, and a half dozen Republicans in Congress unashamedly pandering to the base.

The whole Birther conspiracy theory / paranoia was just an amusing side-show until a Republican Congressman lost control of a town meeting. Tapes of the event looked more like a Saturday Night Live skit than real life. The encounter quickly devolved from amusing, to pathetic, to scary. I was worried that the woman, or one of her friends, was armed.

And the Deathers may be worse. Intentionally twisting the availability of living wills and counseling for end-of life issues into a government plot to kill grandma is neither honest nor useful. Organizing mob-like assaults of public forums is a direct attack on our values.

On July 28th Virginia Foxx (R-NC) said on the House floor that the Republican plan “is pro-life because it will not put seniors in a position of being put to death by their government”. Is it possible to be more counter-productive?

The tone of these town hall confrontations is discouraging. The men and women of Congress use the August recess to meet with their constituents, to learn our issues, to hear our concerns. Organized teams, schooled in the art of disrupting a meeting, prevent the honest exchange of information.

Insurance agents certainly have a stake in the outcome of this debate. Our organization, The National Association of Health Underwriters, expressed its concern in an August 7th email:

While we understand that these issues are very sensitive and it can oftentimes be frustrating to hear legislators disagree with your views, NAHU strongly discourages our members from disrupting these proceedings in anyway. It is perfectly acceptable to express your opinions politely and respectfully disagree with your legislators, if warranted. However, we don’t want you to mob the town hall meetings and participate in some of the scenes we all have seen on You Tube.

I had to read that paragraph twice. At first I thought it was ridiculous that responsible adults would have to be told to behave like adults. It looked like the sign reminding restaurant employees to wash their hands. Then I realized that like those silly restroom signs, this paragraph was necessary. It was important. We, as an organization, as a profession, had to state in English, clearly, that we are participants in the discussion, not members of a mob.

Honesty. Loyalty. Competence. My frustrations as president of the Beachwood Chamber of Commerce end April 1, 2010. And the truth is that part of my problem is that I keep expecting more out of some people than they will ever want to deliver. But Honesty, Loyalty, and Competence are the least we should expect from our elected officials. Feeding conspiracy theories and playing on the darkest fears of the easily scared is not how to fix our health care system.

DAVE
www.bogartcunix.com

Mr. Cunix? My name is xxxx and I’m calling from Shaker Hts. Your client, Mrs. xxxx, suggested that I call you.

How can I help you?

I need to know if you could connect me with some people who are employed and suffering because of their high insurance premiums.

You need me to tell you about working people who can’t afford their insurance? I don’t think I can.

I’ve got unemployed people who will complain about insurance cost, but I can’t find any employed people.

Let me guess. You’re trying to stock the pond?

Well, yeah, but I’m not suppose to tell anyone. If we can find the right person to tell his story, he may even get to introduce the President.

Sorry I can’t help. Good Luck.

The President and his team are in full campaign mode. After the scheduled photo-op at the Cleveland Clinic, Mr. Obama was taken to the friendly confines of Shaker Hts. high school. I had already declined two invitations to Thursday’s event before the above call. I had been pretty sure it was going to be more style than substance even before I was asked to help stage it.

It’s a campaign and I don’t want to choose sides.

Really, I don’t want to choose sides. Mr. Steele and the Republicans can’t find it within themselves to work for a solution. Senator DeMint (R-SC) is more interested in breaking the President than the breaks in our system. Caught, he attempted on the July 22, 2009 Today Show to say that he wants to “put the brakes” on Mr. Obama’s plan. He went from Senator DeMint to Senator Disingenuous.

It’s a campaign and I don’t want to choose sides.

I think it is safe to say that most of us believe that change is needed. The status quo is not acceptable. Costs are spiraling out of control. Our specific goals and how we will set about achieving them should be the subjects of serious debates. But we aren’t having those debates. We are having campaigns.

The President’s press conference started at 8 PM Wednesday evening. I got home in time to watch him. Gosh it was so frustrating, so unsuccessful that even MSNBC had difficulty cheer leading for him in the subsequent two hours of discussion. Dr. Nancy Snyderman and Chris Matthews talked more about the questions the President ducked than the ones he answered.

Candidate, I mean President, Obama promised Wednesday:
* No preexisting condition clauses
* No additional charges if you already have a medical condition
* No mandate, no requirement for participation
* Excellent patient-centric coverage when you need it right down to a dietician preparing individualized plans for every diabetic
* No interference from some administrator sitting at a computer

The first couple of points are interesting because they may, by themselves, doom the whole process to failure. Insurance is about shared risk and responsibility. Regular readers of this blog know that I was hit by an uninsured motorist in January. We can’t enforce something as basic as our mandatory car insurance regulation. If we don’t even try, if we don’t require health insurance coverage, many of the same uninsured now will be uninsured later. Why would they bother purchasing health insurance until after they are really sick?

Dr. Snyderman and many of us were surprised by the President’s insights into the practice of medicine in the U.S. “If a blue pill and a red pill do the same thing, but the red pill costs half as much, why wouldn’t you take the red pill?” He also suggested that some doctors perform tonsillectomies on children for the money.

The idea that some administrator sitting at a computer won’t be involved in your health care decisions under a new public plan was debunked right there. Who makes the determination that the red pill and the blue pill are equivalent? When is one better than the other or are we to believe that the only difference is the dye? And surgeries? Who will decide which surgeries are needed and which are simply for doctor and hospital cash flow? Will all of these inspectors work for free? Our cost savings depend on their volunteer effort.

We have had one goal up to now. Our goal as Americans has been to have great access to top doctors and hospitals paid for by someone else. That’s the old goal. It is time for a new goal: Great access to top doctors and hospitals that we can afford.

We don’t need a campaign. We shouldn’t be forced to choose sides. We need details. And we need them now.

DAVE
www.bogartcunix.com