me Me ME

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?

DAVE

www.bcandb.com

Team U.S.A.

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

www.bcandb.com