The Medical Insurance Industry and The Health Care Industry

        On March 8, 2012 I posted a blog titled “ The Greatest Marketing Job Ever.”  This blog points out how the medical insurance industry sold the public on the idea of medical insurance with first dollar coverage. 

They also sold the public on the convenience of having the health provider handle the claim.  They sold the health care provider that this was a needed service for their clients.  They also sold the health care provider that this system would help them get paid for their services. 

This sounds great, but all this service costs.  Thousands of people are employed in medical billing and claims for both the insurance company and the health care provider.  Every health care service provided is submitted to the insurance company, even if pays nothing on the claim.  The cost of the claims process is enormous and is driving up the cost of heath care. 

Another problem in my option is the practice of discounting the cost of health care services to the insurance company.  The insurance company obviously encourages this practice.  It also means the health care provider must raise their prices to cover the discounts. 

Health care providers discount their services by as much as 70% to the insurance providers.  This means an insurance company would only pay $300 for a $1,000 service. 

Which figure do you think is used for your deductible or co-pay requirement.  If you think the $300 figure is used for those computations, you are just being naive.

It also means that if you want to buy a true major medical policy and pay for your normal predictable and routine health care personally, you will be paying $1,000 for a $300 service.  Some politicians like U.S. Senator Charles Grassley of Iowa has been trying to stop the discounting practice for years with little success.

Since many people do not ask about costs for health care services, there is little competition.  People have the attitude, “It is covered by insurance anyway so who cares.” 

There was a study of heath care costs in our area.  One health care service studied varied in price from $1,000 to $6,000.  Were there differences in quality?  Yes, but quality had little correlation to the price.  This seems to be the same as with most businesses.

How much has this first dollar coverage medical billing raised the cost of heath care?  A very conservative estimate is 100%.  Personally, I think the real cost is closer to 500%. 

How do we fix the problem?  It is a problem that has been caused over the last sixty years and can’t be totally fixed over night, but some change could be done over night.

Specifics next week.

Affordable Health Care and Medical Insurance

        Much to my surprise the Supreme Court has said “Obama Care” is constitutional.  There are a lot of different opinions on the specifics of the decision and what it means.  My concern is with providing affordable health care.   

        I don’t think “Obama Care” can do that even under the best possible scenario.  The reason is we are attempting to fix a problem caused by “First Dollar Coverage” medical insurance with “First Dollar Coverage” medical insurance.  It makes no sense.  It cannot achieve the objective of affordable health care. 

        One of the major problems in providing affordable health care is differentiating between “health care” and “medical insurance”.  These are two separate things and the terms are not interchangeable. 

        It seems most politicians and even at least one Supreme Court Justice does not understand the difference.  They keep interchanging the terms.  How can we deal with a problem if we don’t identify and define the problem?

        Many people think they are guaranteed the best health care because they have good medical insurance.  They may be wrong and will never now the difference until it is too late. 

        Many people don’t even know what coverage they have.  I hear statements like. “I have the best” or “I have full coverage.”  This often means people don’t know what coverage they do have. 

       

The leading cause of bankruptcy in this country is medical expenses.  Over 40% of all bankruptcies are because of medical expenses.  

        The really reveling part of these bankruptcies is the majority of these people had medical insurance.  They thought they were covered.  Not true. 

        There are several problems with medical insurance including; annual deductibles, co-pay requirements, excluded coverage, maximum limits for coverage, and continuing monthly premium payments.  If you are sick and cannot work, you have no salary or income.  Who pays the premiums, deductibles, and co-pay requirements? 

       

        If you are independently wealthy or part of the political elite there is no problem, but there is a problem for the rest of us.  Medical insurance premiums may have been offered as a benefit of our job, or we may have paid them personally.  We have paid these premiums for years with little benefit in most cases, but when we really need it for a catastrophic illness or injury, we end up with no medical insurance coverage. 

        Next week I will take a closer look at the working of the medical insurance industry and the health care industry and how it is hurting our health care and costing this country. 

       

Muslim Brotherhood President in Egypt

        Egypt elected a new President last week.  The new President is from the Muslim Brotherhood.  I was not surprised by this event. 

What did surprise me was a news commentator making the statement that Las Vegas would have given a million to one odds that this would not happen two years ago.   I could not believe the stupidity of this statement.  I would have taken some of that action at a million to one.  How naive are people?

Egypt had financial problems.  There were riots and protests in the streets.  The Muslim Brotherhood was a major force in those demonstrations.  Who in their right mind did not think the Muslim Brotherhood gaining control was a possibility.

At lot of people like Glenn Beck made the prediction over two years ago.  Oh, that’s right Beck is a “Conspiracist” so his predictions don’t count.  Not even when he is right.  Sorry I mentioned it.

Are we so concerned with making a statement about Muslims that might be considered politically incorrect, that we ignore the facts?  Not all Muslims are bad, but some Islamic extremists are bad and we cannot ignore that fact. 

        I am not even saying a President from the Muslim Brotherhood is a bad thing for Egypt.  I remember when John F.  Kennedy was elected President.  Some people thought the Pope would be running the country.  It did not happen. 

        If Egypt’s new President tries to rule under Sharia law, there is a problem.  People would lose their freedom and in some cases, their lives.  That would concern me and I hope it is not the case.  We just have to stay alert and not ignore the facts. 

Chief Executive, Executive Order, and Executive Privilege.

        We have executives in business and government.  I once heard that “Executive” was derived from a European word meaning “Tester of the law.”  That decription seems to fit today for executives in both business and government. 

        We have many Chief Executive Officers (CEOs) that test the laws with business decisions.  Maybe it is good to test, define, and maybe change laws or regulations.   If these executive decisions are intended to improve the economy, employment, and the country, I am all for them.  I have a big problem with decisions made totally for short-term gain and executive bonuses. 

       

The Chief Executive of our government is our President.  The Constitution clearly defines the duties of the President.  The President is the Commander and Chief of our military.  The President is also responsible for enforcing the laws of the land.  That is all. 

        The President is not allowed to choose which laws to enforce.  A great example of this abuse of power is immigration.  Not one President in at least forty years has enforced the immigration laws. 

        The President has the power to veto a bill, or sign it into law.  The President does not have the authority to modify or change a bill with a “Signing Statement” which several Presidents have done.  This is “making law” in my opinion and beyond the President’s authority. 

The President is not allowed to create laws with “Executive orders”.  This practice has increased over the years and has increased at an ever-increasing rate since John F. Kennedy.  This practice should not be allowed and may be illegal under the Constitution in my opinion. 

Presidential expansion of government must be stopped.  New government positions are created at the sole discretion of the President.  Some of these new “Czars” create laws and regulations without the approval or support of Congress.  This practice is also illegal under the constitution in my opinion. 

“Executive Privilege” is another practice that should not be allowed in my opinion.  The President is responsible to Congress.  What happened to the “Transparency in Government” every Presidential candidate promises?  It never happens and the clandestine practices seem to get worse with every President. 

There has to be a check and balance in our government.  That is why there are three branches of government.  The President is responsible to Congress.   I think Presidential powers have gotten out of control.  The President is not an “All Powerful Supreme Leader” with no responsibility to Congress or the people. 

Government Spending and The Nation’s Debt

        As of this morning our national debt was $15,796,333,964,878.  Each citizen’s share is $50,440.  Each taxpayer’s share is $138,799.  The national debt has continued to increase an average of $3.93 billion per day since September 28,2007.

        When President Obama took office on January 20, 2009 the national debt was $10,626,877,048,913.  That is an increase of  over four trillion dollars since he took office.  This is a 49% increase in just over 40 months.  I am not totally blaming President Obama.  Congress is just as much at fault.  The fact that Congress has not passed a budget in over three years is appalling.

        Here is what our founding fathers thought of government spending and debt.

“Government spending?  I don’t know what it is all about.  I don’t know any more about this thing than an economist does, and, God knows, he doesn’t know much.” - Will Rogers            

Will Rogers is not a founding father, but I like him.  He obviously is talking about a Keynesian economist.

“I think we have more machinery of government than is necessary, too many parasites living on the labor of the industrious.” – Thomas Jefferson

       

        What would Jefferson think of today’s behemoth federal government? 

“If Congress can employ money indefinitely to the general welfare…The powers of Congress would subvert the very foundation, the very nature of the limited government established by the people of America.” – James Madison

“When the people find that they can vote themselves money, that will herald the end of the republic.” – Benjamin Franklin

“There are two ways to conquer and enslave a nation.  One is by the sword.  The other is by debt.” - John Adams

 “I, however, place economy among the first and most important virtues, and public debt as the greatest of dangers to be feared.  To preserve our independence, we must not let our rulers load us with perpetual debt.  If we run into such debts, we must be taxed in our meat and drink, in our necessities and in our comforts, in our labors and in our amusements.  If we can prevent the government from wasting the labor of the people, under the pretense of caring for them, they will be happy.” - Thomas Jefferson

        Thomas Jefferson has to be one of my favorite Presidents and one of our greatest founding fathers.  The intelligence and foresight they showed is amazing.  They had it all covered. 

        Too bad we keep trying to reinvent the wheel and show them wrong.  We keep proving them right and don’t seem to have the intelligence to learn from history. 

“The fact that we are here today to debate raising America’s debt limit is a sign of leadership failure.  It is a sign that the US government cannot pay it’s own bills. It is a sign that we now depend on ongoing financial assistance from foreign countries to finance our government’s reckless fiscal policies. Increasing America’s debt weakens us domestically and internationally.  Leadership means the buck stops here.  Instead, Washington is shifting the burden of bad choices today onto the backs of our children and grandchildren. America has a debt problem and a failure of leadership.  Americans deserve better.” – Senator Barack Obama, March 2006   

Certainly not a founding father, but I agree with the statement.  What happened? 

Has this country become so self-centered that we are willing to jeopardize the future of our children and grandchildren with current government spending and growing government debt?  I hope and pray we are waking up to the problem, recognizing the problem, and dealing with the problem.

The Cost of Recall Elections 

        Wisconsin just had a recall election last week.  I am not a proponent of recall elections for many reasons including the monetary cost.  The recall process also creates civil strife and uncertainty, which hurts the economy and employment. 

        An attempt was made to recall Governor Scott Walker.  Governor Walker was first elected in 2010.  The recall election drew record voter turnout.  Walker is not only the first Governor to survive a recall election, but Walker won the recall by a larger margin than he was originally elected in 2010.  His victory was so decisive that most news networks called the election within one hour of the polls closing.  This was a great vote of confidence.

        The recall was started by WEAC (Wisconsin Education Association Council) after Walker changed the state’s public union bargaining rights.  Many of Wisconsin’s schools, the

state and most municipalities were facing huge budget deficits and layoffs.  One of Walker’s solutions was to limit the state’s public union’s bargaining rights. 

        The biggest change was to make public employees contribute to their medical insurance and pension funds.  This contribution was less than the private sector, but was very objectionable to public employees, as they had previously contributed nothing.  This was objectionable for both financial and emotional reasons.

        School districts were also no longer required to use WEAC’s medical insurance company and were allowed to ask for bids from other insurance companies.  This option produced large budget savings.

        Schools were also now allowed to reward and retain teachers based on merit and not just seniority.  This is obviously very objectionable to poorer quality teachers protected by seniority.

        The reforms were obviously very unpopular, but worked.  Layoffs were prevented, and budgets were balanced without increasing taxes.     

        I found it interesting that very little mention was made of the change in public sector union bargaining rights in the later stages of the campaign.  Obviously, the Democrats did not feel this was a winning campaign issue. 

        I thought recall elections were rare, but they are not as rare as I thought.  I think most states have provisions for recall elections.  The conditions of the recall vary from state to state. 

        A recall of a Governor is rare.  There have only been three.  North Dakota successfully recalled Lynn Frazier in 1921.  California successfully recalled Gray Davis in 2003.  Scott Walker survived Wisconsin’s recall in 2012.

        I think recall elections, if allowed at all, should only be for gross misconduct in office.  Recalls because of policy should defiantly not be allowed. 

        Allowing recalls for policy is totally counter productive.  This threatens elected officials who make hard decisions that might offend special interest groups.  The result is nothing gets done.  Problems facing the state get pushed down the road and only become more serious until they reach a crisis.  We see this now in several states and our federal government.

        Governor Walker was recalled because of his fiscal policy and the fact that he made hard decisions.  Walker stated clearly what he would do when he campaigned in 2010.  He said he would balance the budget without raising taxes.  He clearly stated specific changes that he would recommend.  He also said he would improve employment and the State’s economy. 

        After elected, Walker did just exactly what he said he would do. Think about this.  A politician that does exactly what he said he would do.  Does that even meet the definition of a politician?  

        What good came of the recall?  The recall cost the taxpayers $16,000,000 in election costs.  Over  $75,000,000 was spent on the campaigns.  Volunteers spent thousands of hours on the campaigns.  Do you think we could have found a better use for this ninety million dollars?

        Wisconsin was divided in a civil war.  I have heard people say Walker created a civil war.  I would disagree.  I think the people starting the recall created a civil war. 

        Wisconsin’s economy and employment were hurt by the recall.  Think about it.  Any business decision for expansion that can be postponed will be postponed until after the recall election.  This only makes good business sense.

        Basically nothing good came of this recall election except for a vote of confidence for Governor Walker.  The public said they are ready for politicians with sound fiscal policies that are willing to make tough decisions for the good of the state, the country and future generations. 

        I hope and pray this attitude extends to the federal government and the rest of our country. 

All Men Are Created Equal 

        One of the often-quoted lines from the Declaration of Independence is “All men are created equal.”  What did this mean to our founding fathers?  The complete sentence is; “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.”

        This seems pretty simple to me.  People have a “Right” to life and liberty as long as they don’t break the law or harm other people.  They also have a “Right” to the “Pursuit of Happiness”.   I never saw anything about people having a “Right” to any “Things”.  

        If people have the right to some minimal standard of living without working for it, we are talking socialism, not a free republic.  The political bureaucrats of the government are now making decisions for us.  Is that a free republic? 

        “The proper role of government is to protect equal rights, not provide equal things.”  This is a quote from The 5000 Year Leap.  I can’t say it any better. 

        I would recommend this book for anyone wanting a better understanding of how our country’s government was formed.  I am continually amazed at the intelligence and foresight of our founding fathers.  I wish we taught more of it in our schools.

       

        Most immigrants came to this country because they wanted the right to work, succeed, and make a better life.  They did not come because they were guaranteed “Things”, or some minimum standard of living. 

        We must not take away people’s ambition and work ethic.  We must take a closer look at our current welfare and entitlement policies.