It was a Maxwell Smart moment.

Neal Spero politely told us that he had a plan. Dave Clark and I, with equal parts candor and respect, politely disagreed. Mr. Spero is the Senior VP of American Community Mutual, a mid-sized health insurer based in Livonia, Michigan. Dave and I have been two of American Community’s top agents for most of the last twenty years. That is quite an accomplishment since we both work with dozens of insurers. The date was September 6, 2007. We had asked to meet with Mr. Spero to share our concerns.

My perception was that American Community was digging itself into a hole. I saw a problem with their new distribution system (who sells it) and their underwriting (who gets covered and at what price). Mr. Spero saw nothing but blue skies and calm seas.

I stopped writing American Community’s individual policies last October. Their current renewals for their existing business, reflecting their staggering claims experience, came in at 33%. Mr. Spero had a plan. I can hear Steve Carell say “Missed it by that much”.

This past week Senator Ted Kennedy (D-MA) and Senator Christopher Dodd (D-CT) announced that they are now able to project a cost for their committee’s health care reform package – $611 billion dollars over the next ten years. The Health, Education, Labor and Pensions Committee (HELP, really, I can’t make this stuff up) was pleased to get the cost down to $611 billion dollars even though that number doesn’t include Medicaid expansions which put the price tag back over the $1 trillion mark.

I can hear Don Adams say “Missed it by that much”.

Not that Senators Kennedy and Dodd know where six hundred plus billion dollars are coming from, but what if the real price tag is a trillion or so? That is a question nobody wants to answer.

There are ways for American Community to save itself. They will raise their rates, tighten their underwriting, and reassess their marketing and distribution. Or they will fail. I am not being cavalier about this. I want A.C. to succeed, but American Community is a business, not a person, not a government. A company that consistently has higher expenses than income ceases to exist.

What will the U.S. government do? One idea was to tax employer provided health care benefits, a bipartisan compromise that might have brought in a couple hundred billion. Other trial balloons floated have included a tax increase on high earners and a “sin tax” on carbonated beverages and sugary drinks.

How much Coke do we have to drink to make up a $1 trillion shortfall?

What’s missing is a serious discussion of how we are paying for any of this. Discounts from hospitals? Shell games from big Pharma? Would you believe aliens with space ships full of cash? Sorry, it is just that I have been here before.

Let’s all say this together, Tax Increase. It’s OK. The world won’t end and most of Congress will still be reelected. If having the government run health care is a good idea, say so, tell us the real price tag, and tax us appropriately. We’re adults. We’re citizens. Trust us with the truth.

DAVE

www.bogartcunix.com

Quick note: Dave Clark just called. I told him that he was included in this post. His only issue is that the American Community insurance pool isn’t as polluted in Michigan where he lives as our’s is in Ohio. He still loves them and does a lot of business with them. He pointed out that they are still one of the easiest companies to work with, do a great job paying claims, and still have guys like Neal Spero who would meet with agents like us. Duly noted.

FOR PROFIT HEALTH CARE MAKES ME SICK

Those sentiments were on a bumper sticker that graced a neighbor’s Volvo. This was a few years ago when I was living in Shaker Heights. The fun fact? The car’s owner was a physician.

I’m pretty sure this guy didn’t sell suits for a living and only practiced medicine as a volunteer. He certainly didn’t accept chickens and vegetables for his services. He didn’t object to being paid, and judging from his house, paid well, for his services. His objection was to anyone else profiting from the delivery of health care.

Get in line.

Depending upon who you ask
* The doctors are overpaid
* The hospitals are palaces
* The insurance companies are crooks
* The drug companies are gauging us
Heck, the only people universally loved and appreciated are us insurance agents.

Yes, I’m kidding.

My neighbor the doctor was, however, right about one thing. This debate is not about medicine or the delivery of health care. It is about money. Who pays? Whose ox is gored? Who can make a small payment today to protect a major profit center for years? One of my goals is to move our conversation to include the actual delivery of health care.

One of our problems, as a society, is our complete aversion to personal sacrifice. Our state is having a huge problem balancing its budget. Governor Strickland is looking at adding fees and slots for income. To cut expenses he is taking a hatchet to any program that isn’t backed by a strong lobby.

One of the governor’s budget goals includes a change in the open enrollment health insurance program. Under the Federal Health Insurance Portability and Accountability Act (HIPAA), people who have lost their health insurance after eighteen continuous months of coverage, are guaranteed the opportunity to purchase a policy. This is particularly relevant if the individual has significant preexisting conditions. In Ohio, the options are the “Ohio Basic” and the “Ohio Standard”. These are over priced awful policies.

Governor Strickland wants to have these policies, sold to some of our unhealthiest citizens, capped at 1.5 times the base rate. In other words, if we lower the premiums a touch, thousands of unhealthy uninsured individuals would be able to buy insurance. Isn’t this great?

Well, it depends. The Ohio Department of Insurance’s actuary determined that 52,000 additional consumers would purchase coverage through the open enrollment program. The problem is that the rates for policies in the standard individual market would increase by 5.5%.

Are you willing to pay 5 1/2% more so that someone else’s insurance might be cheaper? If your family policy is $500 per month, we are talking about $330 per year. Regular readers know that the equation is always the same. If you increase money out, you gotta bring more money in. So will 52,000 more people be able to afford coverage? Of course not. The rate decrease for the unhealthy people, and the small increase for the rest of us, will be phased in over several years. G-d forbid you or I should have to make a sacrifice.

The debate isn’t about the delivery of health care. It is only about money. That is the real world.

If you really want to know where the money is in health care. watch TV. Not the shows, the commercials. Scooters, lift chairs, and medications that run $8 to $10 a pill dominate prime time. I can track trends just by watching the ads on the evening news.

A new commercial has me a little nervous. It features lots and lots of smiling senior citizens. The reassuring voice over tells us that the reason they are so happy is because of the money they’ve saved due to Medicare Part D, the Rx benefit.

Other than actors, the only senior citizens that happy about Medicare Part D are pharmaceutical company retirees. Designed to enrich and protect the drug companies, insurance companies, and certain well-connected insurance marketers (AARP comes to mind), any benefit a senior citizen gets from Medicare Part D is strictly accidental. None of the rules favor the consumer. And yet, I’ve got senior citizens dancing across the screen and this announcer extolling the virtues of Part D. Of course, the commercial is paid for by the pharmaceutical companies.

Coincidentally, the drug companies recently met with President Obama and have proposed an $80 billion deal. That is $80 billion dollars over ten years. $30 billion will help to pay for brand name drugs for senior citizens who fall in to the coverage gap, the notorious “doughnut hole”. The other $50 billion will be used to help offset expected costs associated with the uninsured.

Are those numbers real? We’ll never really know. But the drug companies think they have a deal. They will make another small, difficult to quantify sacrifice in hopes of a huge payoff. Their goal is to have health care reform to be as profitable as Medicare Part D. The $80 billion deal is strictly voluntary and depends on the enactment of a comprehensive health reform package acceptable to the industry.

Again, here in the real world, we are actually talking about money not the delivery of health care. Well if we are going to talk about money, we should all be forced to use real numbers.

DAVE

Questions or suggestions for future topics?
www.bogartcunix.com

Tenth Hole. Weymouth Country Club. Medina, Ohio. I had hit a surprisingly good drive. It was long, majestic, and in the fairway. My second shot on this par 5 was more than adequate. And now I was standing less than 100 yards from the pin, laying 2, with a sand wedge in my hand. I knew what I wanted to do. I wanted to hit that ball high into the air and have it land, AND STOP, within six feet of the hole.

I knew what I wanted to do.
I knew, theoretically, how to do it.
There was no reason not to birdie this hole. At worst – par.

Bogey – 6.

Back on the cart on my way to the next tee, I realized how much my golf game has in common with the President’s health plan proposals. He knows what he wants to do. He knows, theoretically, how to do it. But we have every indication so far that he is not going to reach his goals.

The consequences of my blown shots are the loss of a couple of bucks and another hit to my fragile ego. Missing the mark on health care is far more significant.

Before we go any further, I should, in the interest of full disclosure, reveal that I voted for President Obama last November. I volunteered and donated to his campaign. I also have no regrets.

As an Obama supporter, I receive daily emails from the ongoing campaign. And yes, health care reform is being run like a campaign. On Saturday I was asked to “Stand with the President”. His three core principles are:

* Reduce costs – Rising health care costs are crushing the budgets of governments, businesses, individuals and families, and they must be brought under control.
* Guarantee choice – Every American must have the freedom to choose their plan and doctor – including the choice of a public insurance option.
* Ensure quality care for all – All Americans must have quality and affordable health care.

So vague. So general. No detail on how this gets done or how much it will cost. I sent an email asking for more information. I’m not holding my breath while I wait for a detailed reply.

Joe Biden was on Meet The Press yesterday (June 14th). When asked by David Gregory how President Obama was going to pay for health care reform, Mr. Biden quickly mentioned a few cost savings measures. His second option was, “Get rid of Medicare Advantage“.

Millions of senior citizens currently enjoy the benefits and convenience of Medicare Advantage policies. As we learned two weeks ago from my interview with the Cleveland Clinic manager, private health insurance pays the most to a hospital or other medical provider. Medicare Advantage plans do not cover all of the costs but are still much better than regular Medicare. Costs are SHIFTED to the people with private insurance. If the government eliminates Medicare Advantage plans, senior citizens would be forced to choose a Medicare Supplement and hospitals would get less for their services. This pushes an even larger burden on those people with private insurance.

This is not hard to understand. There is nothing counter intuitive. Money goes in. Money goes out. Checks are sent to doctors, labs and hospitals. Where is the money coming from? If those doctors, labs and hospitals are shortchanged, who picks up the balance?

The President has been talking about a public plan to compete with the insurance companies. This sounds a lot like me competing with Tiger Woods. Here are a couple of quick questions:

1. Health insurance companies are real businesses. Their books have to balance. Premiums are determined, in part, by claims and risk. What would determine our new competitor’s rates?
2. Will the government continue to under-pay the medical providers? If so, will the doctors, labs and hospitals be allowed to shift the costs to those covered by private insurance? That, alone, would seal our fate.

My golf game, with a little luck and a lot more practice, will one day achieve an acceptable level of mediocrity. Health care reform is different. There will be no Mulligans. There is very little margin for error. We are racing towards an August deadline. What’s the rush? Regardless of your personal position or goal, you must have questions that have yet to be addressed.

Stand up and demand answers.

DAVE

I ran into Corky and Lenny’s to grab a quick lunch to take back to my office. I ordered a pint of chicken soup, broth only, and .20 of pickled tongue, no bread. A waitress overheard my order and whispered to the deli man “He must be a doctor”. So he asked me “.20? Are you a doctor?” “No”, I replied. “I’m an insurance agent, but somewhere in California my mother is smiling.”

OK, I’m not a doctor, but I recently had the opportunity to spend a half an hour with a high ranking manager at the Cleveland Clinic. The gentleman was familiar with Medicare reimbursements. He asked not to be identified and I will, of course, comply. Our interest is to collect information.

My first question centered on patient demographics. I was told that the Cleveland Clinic’s patients were approximately:
* Private Insurance – 50%
* Medicare – 40%
* Medicaid, self-pay, and charity – 10%

Those numbers are important. Even though the government paid care accounted for less than half of all patients, I was advised that the Cleveland Clinic spent 215 million dollars last year in charity care, Medicare and Medicaid subsidies.

The Wall Street Journal reported on May 1, 2009 that the federal government planned “to keep Medicare payments to hospitals essentially flat”. There is even talk that doctor’s payments may be reduced. Those were two topics my new friend wouldn’t touch. Even an unidentified Cleveland Clinic employee wouldn’t want to appear too negative. We could discuss the general concepts of Medicare payments.

I wanted to know how the Centers of Medicare and Medicaid Services (CMS) decided how much a particular service or procedure was worth. More importantly, why wasn’t it enough?

What he explained is that CMS determines a cost for a region. Though a teaching hospital is paid slightly higher, but not nearly enough to cover the extra expenses, CMS doesn’t recognize the “difference between Bedford Community Hospital and the Cleveland Clinic”. And there is a difference. Doctors, training, technology – someone has to pay for all of that. Those costs are shifted to the patients with private insurance.

There is a hierarchy of payments:
* Private Insurance pays more than
* Medicare Advantage pays more than
* Medicare pays more than
* Medicaid.

Medicare Advantage, which provides better care,is reimbursed at a higher rate. Medicare pays less than 50 cents on the dollar. Again, where does the money come from?

My last question, as his secretary was dragging him to his next meeting, was “Who pays if there isn’t private insurance to cover the balance?”

We’re meeting at P F Chang’s this week to discuss this further.

DAVE
www.bogartcunix.com

I used to smoke two packs of cigarettes a day. Some days I also indulged in a cigar or one of my pipes. I enjoyed smoking. This was at a time when smoking was permissible everywhere- work, restaurants, even while shopping. I found it calming. I would inhale deeply, especially from my beautiful natural burl pipes, and use those moments to center myself. Smoking was therapeutic. Smoking was a hobby. And, smoking was unhealthy.

We knew. I may have been in my late twenties, but I knew that smoking was a health risk. My father was smoking unfiltered Pell Mell cigarettes. He was addicted. There was no joy, no peace. He had a habit, a cough, and eventually a cancer that would cause great pain and death. I knew that I could end up just like him if I wasn’t careful.

I also knew my triggers, the times or circumstances that caused me to reach for my cigs and a lighter. One of my most consistent triggers, something that would always force me to reflexively light a cigarette, was any commercial from the American Cancer Society. Their anti-smoking commercials drove my smoking.

I haven’t determined whether it was the tone, the content, or simply the point of view, but to this day the American Cancer Society has this hugely negative impact on me. I stopped smoking cigarettes on January 1, 1985. I still avoid their commercials.

We are knee deep in the national health care discussion. As a life long Democrat who has served on numerous campaigns, I am well aware of one side of the debate. As a thirty year plus veteran of the insurance industry, I live the other side. The American public, addicted to open unfettered access to medical care largely paid for by someone else, is interested in the discussion, but not the commercials.

The strident, polarizing messages issued from both camps, parked conveniently on the extremes, do nothing to illuminate the issues. Chrysler didn’t fail because of our health care system. Conversely, Canadians are generally pleased with their access to health care. There is a grain of truth buried within the ads from both the unions and the insurance agents. Will the American public patiently sift through the propaganda to find that truth.

There are people of good will on all sides of the health care debate. There are doctors desperately trying to balance patient and business needs. Insurance agents are intimately aware of our clients’ desire for affordable comprehensive insurance and the competing challenge to finance the care. There are thoughtful government employees and elected officials whose only goal is to help the American public. And there are labor leaders and business owners convinced that one option or the another would be the best for their members or employees.

Where are these people of good will? You won’t find them on the talk shows. Reasoned debate is not good TV. In fact, if television is your primary source for news and information, the only thing you know for sure is that there is a huge conflict and that eventually one side will win and one side will lose. And that’s just not true. We can all lose. That would be easy. We can do nothing and let cost and access spin out of control. Or we can over-reach and ignore our strengths.
Can we all win? That should be our goal and it won’t be easy.

This blog is an invitation to participate in the discussion. When those commercials come on your set, when the talking heads work harder to drown out the opposition than to advance understanding, when you feel like I did when I watched the anti-smoking ads on my television so long ago, don’t shut down. Participate.

Our goals should be common ground and mutual success. What is in the best interest on the American people? How do we get there?

DAVE
www.bogartcunix.com

Quick addendum: I got stuck for two hours at a presentation by Stuart Browning, the Michael Moore wanna be from the other side. Full disclosure – I walked out before it was over. Still, I want to expose my readers to as much info as possible. Michael Moore’s website is www.michaelmoore.com Stuart Browning can be found at www.stuartbrowning.net He is known for his 6 minute movie A Short Course On Brain Surgery

Avenue or Street? Name or Number? Four quick details and you can find your way around in Phoenix in minutes. Numbered roads run north and south. If that numbered road is also a street, such as 24th Street, then it is on the east side of town. 19th Avenue is on the west side. Indian School Road runs east and west. A perfect grid, Phoenix is easy to navigate.

Have you ever tried to explain how to get from Westlake to University Heights?

The Phoenix grid was designed first. The city of Phoenix was built within that framework. Greater Cleveland is very different. Our communities are linked by our roads. Our street system, with its twists and turns, traffic circles, and five point intersections, is organic, reactive, and responsive. New Brainard Road quickly comes to mind.

I think about our lack of north – south streets and the joy of an efficient grid every time I am stuck in traffic on Richmond Road. We have all dreamed of a better way to get around town. We just have to decide which neighborhoods to bulldoze.

Creating a health care delivery system where none existed is a lot like planning a city’s grid. With limited expectations and little to disrupt, the new program would face little opposition.

Think about the delivery and payment of health care in the US. Our system is organic and ever changing. Part action, part reaction, we have evolved from a system of community hospitals and doctor/entrepreneurs to regional medical centers who employ entire teams of professionals.

Just as the medical providers have changed, so too have the payers. Blue Cross and Blue Shield associations were originally created by doctors and hospitals as a means for the patients to prepay for medical services. Health insurance quickly followed. Over the last seventy years we’ve moved from indemnity policies to Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), and even the occasional Point of Service Plan (POS). Insurers now research everything from the most efficient ways to deliver health care to drug interaction and disease management.

Medicare brought the federal government into our system. Almost overnight, Washington went from uninvolved to a key player. Medicare pays the majority of the cost for the care of our elderly and infirm. The government decides how much it will pay for a doctor’s exam,test, or hospital stay. Less than the insurance companies, less than the self-pay, government payments are accept or reject. The medical provider either accepts Medicare and its rules, its limitations, and its millions of beneficiaries, or he/she doesn’t. Most providers accept Medicare.

Providers, insurers, and governmental changes have significantly impacted the way health care is practiced in this country. In many ways we have lost sight of who pays for medical services.

There are commercials on TV for diabetic testing devices, lift chairs. and scooters that are FREE if you are on Medicare. They aren’t free. We are paying, probably over-paying, for all of this.

Like a drive down Van Aken Boulevard, Congress is discovering that our health care delivery system isn’t a simple north-south or east-west. The New York Times reported on April 26, 2009 http://www.nytimes.com/2009/04/27/health/policy/27care.html?_r=1&th&emc=th that the shortage of primary care physicians is just one more unanticipated obstacle on the path of change. Our current system rewards specialists. A revenue neutral option would lower the reimbursements for specialists, freeing up money for the general practitioners. Needless to say, the orthopedic surgeons are not happy.

Action and reaction. Raise compensation? Add more doctors? The one thing most of us know for sure is that we can’t tear down our existing system and start over from scratch. So as we debate change and what the final results will be, we must be certain that we don’t neglect to map the road from where we are to that final goal.

DAVE

Questions or suggestions for future topics? http://www.bogartcunix.com/

“I want to know what President Obama is going to do about this!”

The client was in full rant. I was seated in front of his cluttered desk. He was too agitated to sit. His Anthem Blue Cross policy, scheduled to renew in May, had taken a significant premium increase. Bill Jones (name changed to keep the attorneys impoverished) wanted me to know how unhappy he was with me, Anthem, and the entire system.

I’ve been doing this for thirty years. This isn’t the first time I have been used for target practice. There are times you just have to let the clients vent.

What made this unusual is that Bill Jones is a licensed insurance agent! He has twenty-five successful years in the business. Even though he specializes in life insurance and investments, Bill still sells five to ten health policies each year. He knows the rules. He understands the concepts. He is a true believer, just as long as we are talking about your money and not his.

Fairness is the key issue of the health care debate. The question is always the same. Is this solution fair to me? We don’t want to pay for someone else’s claims, but we demand to be part of a pool, hopefully a really big pool, if we have problems.

Health policies, especially small group policies, are underwritten during the application process. The renewals reflect, in part, the group’s claims experience. In part, but no where near in total. Still, unhealthy groups pay more than healthy ones. I’ve had clients tell me that the insurance company shouldn’t penalize them just because they have had a triple by-pass, or cancer, or a three month stay at Hazelton, 0r… You get the idea. They are nice people. Money spent on their health care by the insurance companies isn’t like money spent on someone else’s care.

Let’s look at Mr. Jones’ company. Officially, the business consists of Bill and one employee. In truth, we are insuring Bill, his wife, and two kids. They take 15 prescription medications. That number increases during allergy season. Some of these prescriptions may be inexpensive generics, but even if all of the medications were cheap, think about the medical conditions these four people must have. Plus, there are a large number of office visits, lab tests and x-rays to diagnose and treat these maladies.

Given the opportunity to insure Mr. Jones and his business, Medical Mutual of Ohio, Aetna, and other companies were hundreds of dollars per month higher than the current carrier. So he will stay with Anthem.

But is it Fair? Depends. Once he cools down, and before he reads this, Mr. Jones may decide that he is getting a fair price. He is getting more in benefit than he is paying in premium. If you are a fellow Anthem policyholder, you might think that it is unfair that you are being forced to subsidize his family’s coverage.

Rate increases are proof that insurance companies are doing their job. If costs increase, and they are, then premiums must also increase. That is a tad simplistic, but you get the point. If, or when, the government controls health care, will premiums increase uniformly as cost increase? If not, then the system will spiral towards bankruptcy until someone has the courage to raise premiums (TAXES) to cover escalating costs.

Some day in the future, when the cost of your health insurance increases, will you complain to your agent, your congressional representative, or the President? Which one will come to your office to listen to you vent?

DAVE

http://www.bogartcunix.com/

Two elderly ladies were sitting by the pool on a cruise ship.

My son paid for my cruise.
My son paid for my cruise, too.
My son is a doctor.
What a coincidence. My son is also a doctor.
My son is a cardiologist.
Wasn’t the fish dry last night?

So it goes for those parents whose children attended Tootsie Tech. Podiatrists may provide needed medical care, but they will never receive the respect other physicians take for granted. Today’s blog is not going to help.

The exchange that begins this piece is fictitious. The rest of this is not. My attorney, Michael Saltzman, forbids me to use the real names of the patient or doctor involved in this episode. In fact, he won’t even let me mention the actual suburb where this took place.

The patient is a nineteen year old college student. He had an ingrown nail on each of his big toes. This is not terribly unusual. He went to the doctor’s office, located on a side street in a small building in a Cleveland suburb, the first Tuesday of last September. He returned to the same nondescript office the next day for the procedure.

How much does it cost to have two ingrown toenails fixed?

Nope. You’re wrong. Did you include the following charges:

• Office visits
• Surgery
• Anesthesiologist
• Free standing surgery center

The actual charge for two “Partial or Total Maxtrixectomy”(sic) was $8,225. Let that sink in for a second. $8,225.

No, the nineteen year old was not given gas, but the charge for the anesthesiologist was $1,100. The podiatrist charged $6,120 for the Surgery Center. I wouldn’t have believed it had I not seen the bill. The doctor’s fees for seeing the potential patient and performing the surgery were totaled $1,005.

My client, the patient’s father, was billed $8,225, but he didn’t owe nearly that much. His son is insured. Insurance companies do not practice medicine. What they do, and actually do very well, is transfer money and weed out waste, corruption and fraud.

The doctor and his facility have a contract with the insurance company, Medical Mutual of Ohio. I don’t know if MMO suspects that there may be some bogus charges here or if they are reviewing their contract with this podiatrist, but even the existing contract protected my client, and by extension, you.

There was a separate $3,060 facility charge for each toe! By contract, agreed upon by the podiatrist and the insurer in advance, the total allowed was $2,142. This may still be excessive, but it is 65% less than the original bill.

The anesthesiologist’s fees were reduced by 40% to $437. The podiatrist’s $1,005 bill became a more realistic $631. The total contractual bill for the two ingrown nails was $3,210. Some of that was paid by Medical Mutual of Ohio. Some was applied towards the family’s deductible.

What was the real cost of these two visits to the doctor and the repair of two ingrown toenails? Depends. had the family not had insurance, they would have been obligated to pay $8,225. Since they had MMO, the real cost to my client was $3,210. If he had had a different insurer, the price might have been a little more or a little less depending on the contract.

When I had the same procedure performed in a doctor’s office twenty years ago the total cost was $500.

Your health insurance premiums reflect the escalating costs of procedures, testing, and surgery centers. How medical providers are paid and what they can charge for the use of their offices is a major concern as we contemplate a change in payers. Will you, as the taxpayer, be billed $8,225 or $3,210 for some future nineteen year old’s visit?

Picking on the ridiculous billing practices of a podiatrist is easy. Do you want a real challenge? See if you can even get a complete breakdown for the charges of a triple by-pass.

DAVE

http://www.bogartcunix.com/

The insurance industry has two watchwords, Responsibility and Consumerism. We (yes, I am an unashamed insurance agent) want you to take Responsibility for yourself. We have the data. You eat too much. You smoke. You drink. And you are too sedentary. Your unhealthy behavior is driving up the need for health care and the cost to provide it.

And while we are talking about YOU and your bad habits, let’s discuss your laziness. Did you shop for the best doctor? Did you compare the prices at different clinics, pharmacies, or hospitals? Do we have to always take care of you?

I have a shocking statistic. 100% of all of the people alive today will eventually die. 100% We are not machines. Even the most responsible amongst us will, one day, succumb to the inevitable.

Now this is not to say that we couldn’t all use a check up. Lot’s of our behaviors lead to illness or injuries. We just learned last week how dangerous the bunny hill can be. I don’t ski, but I try to go snorkeling in the ocean each year. Where is the line between recklessness and acceptable risk?

Lecturing Americans on the evils of their diet, lack of exercise, or habits may be correct, technically, but is it useful? Are the insurers credible? I went low carb six years ago. Finding healthy food at an insurance company meeting is like searching for moderation at AIG. Insurers seem to be self-serving on this issue, blaming the victim for the problem. There may be a certain amount of truth in their pronouncements, but a different messenger must be found.

The insurance companies, with their incredible data banks of health costs and outcomes, have a place at the table. Real change, however, is cultural and starts in the home. Only a campaign of doctors, hospitals, schools and the government, unified in a common goal of healthier Americans, has a chance to succeed.

I touched earlier on Consumerism. Insurance companies want you to ask more questions, challenge the quick answer and to shop for the best value for your health care dollar. There is, of course, one exception. The insurers aren’t too anxious for you to shop for the best insurance premiums, but I digress.

Much of this Consumerism is just silly. Our system has little transparency. Try to get the price of an office visit, x-ray, or a colonoscopy in advance. Worse, how do shop for quotes for an emergency quadruple by-pass? Do you want the low bid?

The same insurance industry that is demanding that you accept our data unquestioningly and to immediately change your habits is also trying to get you to challenge your physician. We want you to ask the doctor if that test is really necessary. We want you to be your best advocate with the rest of the health care delivery industry.

Of course, we’re right, but only to a point. You probably could take better care of yourself. You probably should ask more questions of your health care providers. Don’t stop with the doctors and hospitals. Question all of us, big pharma, the government, and the insurance companies.

Start today.

Dave
http://www.bogartcunix.com

On January 19th I became the most popular guy in Beachwood. At the very least I was the recipient of lots of unwanted attention.

At 8 AM that morning I was hit by an uninsured motorist. She was speeding through the curve on George Zeiger Boulevard when she slid on some ice, lost control, and broadsided my car. Her 1999 Subaru spun to a stop, her bumper no longer on speaking terms with the rest of the car. Slammed just behind the driver’s door, my Honda and I did a complete 180. Out of control and air bags deployed, I finally stopped moving a couple of hundred feet later. I called 911, climbed out of the car, and went to check on the other driver.

My car had over $6000 of damage. State Farm and Page’s Body Shop took care of everything after I paid my $500 deductible. I was not hurt. I was freezing. Standing outside with the police waiting for the tow truck to take my car away, I was very cold and disoriented. I kept asking for hot coffee. To their credit, the Beachwood police realized that I wasn’t making a donut and coffee joke at their expense. Again, I was not hurt.

I mentioned the accident to two attorneys that week. Their immediate question, after some possible concern for my well-being, was whether I had been “checked out”. Instead of being a nuisance, this accident could be an opportunity. Much to their dismay, I refused to see either my doctor or one of their suggested specialists.

Then the mail and phone calls started. In an effort to prevent me from being the target of a lawsuit, you’ll pardon me if I don’t name names. No longer forced to chase ambulances, these attorneys, chiropractors, and physical therapists troll the public records. All of their solicitations had a few things in common:

• Don’t talk to the insurance company.
• Even if you aren’t injured, you might be.
• I would need to talk to them to get the money I DESERVE.
• Don’t talk to the insurance company.

One of the law firms, familiar from their TV ads, even sent a special DVD. I got Apollo 13 a few years ago and I haven’t made time to view that. I’m going to sit through an attorney’s spiel? Some of these direct mail ads were amusing. Misspelled words. Offices that are really just mail drops. Claims bordering on the absurd. And then there were the chiropractors, physical therapists and massage therapist.

What do all of these people have in common? They create unnecessary demand for health care services. Over utilization, which is by definition every test run for the enrichment of the provider with little regard for the patient, inflates cost and creates the need for more equipment. You are paying for all of this.

Please do not regard this as an indictment of all personal injury attorneys. There is some important work being done by honest attorneys who even the playing field by giving the victims of negligence and incompetence their opportunity for justice. Guys like Mark Obral quickly come to mind. My back pain from old basketball injuries is relieved by a great massage therapist, Wayne Dustman, a couple of times a year. I was happy to see that their offices weren’t chasing accident victims. Just as there are good and bad insurance agents, there are honorable and responsible attorneys and health care professionals, and there are plenty who are not.

As we contemplate the changes in our health care system, we must again remember that everyone has a stake in the outcome. Creating unnecessary need for one’s services is a human failing. Multiply that times thousands of providers and it could be a financial disaster.

DAVE

http://www.bogartcunix.com/