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.


The World's Worst Lobbyist

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.