As I knew would happen, the first of the year has brought a lot of travel.  Last week I posted about my trip to Philadelphia, which was a great trip, especially since I missed all the cold weather and snow in the Northeast.  

On Friday I returned from a trip to the Northwest, specifically the Seattle area.  As I understand is normal this time of year, it was cloudy and cold, but no snow.  As I always have time to think on long trips, and this was a long one in the air, I turned my attention to medicare and the structure of that program.  This was on my mind due to the client I was visiting.

My understanding is that Presidential candidate Dennis Kucinich is the only candidate that wants a true single payer system for healthcare in America.  The other candidates on the Democrat side want at least a government ran program as an option for the uninsured or for those that might choose it based on certain criteria.  It sure concerns me that any program like those proposed by Hillary Clinton or Obama might turn into a single payer system (meaning the government controls our healthcare).  For all the potential problems with a similar model proposed by Hillary, study the Tenncare mess that occurred in Tennessee.

However, getting back to Medicare, my “air time” brought me to the conclusion that we of course already have a single payer system in Medicare.  It just happens to be for a certain age range.  As I recall, Kucinich would like for Medicare to just be turned into the program for us all, a single payer  healthcare system.  Yet, the more I learn about Medicare and the government regulations via CMS; I know that we must create free enterprise and competition into our healthcare system, not government control.  So, I am studying all the candidates’ healthcare plans before I cast my primary vote on February 5^th.

I had the pleasure this week of being in Philadelphia on a business trip.  I travel a good bit, but for some reason my travels rarely take me to the Northeast.  So, being the history buff that I am, I knew I had to check out Independence Hall and the Liberty Bell while in Philadelphia.  I should also state that I was in search of the perfect Cheese Steak sandwich!

For those of you that might need a reminder, Independence hall is the site where the Declaration of Independence was adopted. It was in the Assembly Room of the building that George Washington was appointed commander in chief of the Continental Army in 1775.  Furthermore, it was also where the US constitution was debated, drafted, and signed.

During the Constitution debate, George Washington presided over the meetings.  He sat in what has become a very famous chair, named the “rising sun”.  This original piece of furniture is still in the building, which I saw this week.  Viewing this chair, made me think about the differences in Americans and the major miracle that occurred in that room to adopt the U.S. Constitution. 

By the way, the Philly Cheese Steak sandwich at Gino’s in South Philly was excellent.  It was recommended by the staff at our hotel.  Anyone know of a better Philly Cheese Steak in Philadelphia for my next trip? 

I hate to keep picking on Joe Paduda’s blog and his thoughts, but here is another example of just how far off Joe can be on www.joepaduda.com. In his recent post, Joe states the following:

“I (and others) have long opined that HSAs are thinly-disguised tax breaks for the well-to-do. Touted as a solution to the growing number of the uninsured and cited as the plan of choice for the newly-insured, HSAs have been the darling of the conservative think-tank set.”

He also writes the following:

“The article notes that the “biggest beneficiaries” of health savings accounts “are proving to be well-to-do investors looking for another way to fund their retirement savings.”

My company offers an HSA plan to all of our Full –Time employees. As I have said on this blog before, a single employee only pays a net of $31 a month in premium, which of course is one of the benefits of the HSA. The trade off for lower premiums is that the policy holder has to pay a high deduction, $2,500 prior to any financial coverage kicking in for the calendar year. For example, every Jan 1 all of my employee’s deduction starts over and they must meet the $2,500 threshold before the plan kicks in paying on medical bills. They do receive PPO discounts on the first $2,500, but these are first dollars out of their pockets.

This is where the actual HSA account comes to play. Each of our employees holds a MasterCard and or checks to be used to pay for the $2,500 deductible. Thus, many of our employees get into a cycle to where they never have to pay out of their normal assets for medical care. Instead, they have saved money in the HSA account, (We, the employer deposit money in their HSA account along with the employee) to pay for their expenses. Once the $2,500 has been met, the insurance plan pays 100% of any medical expenses including pharmacy.

In reality the HSA plans are better than a traditional 80/20 plan. As a single employee, you know in our company that the most you will spend out of pocket in a year is $2,500. Under an 80/20 plan like so many have, a $30,000 hospital and related expenses bill will mean the employee would pay $6,000 out of pocket. The HSA is a better deal.

So, how can HSAs be a disguised tax break for the well to do? I have no idea. Our employees with health insurance range from employees that make below 20K a year to ones that do very well. I don’t know of any employee of our company that believes HSAs are for their retirement. Come on Joe, the HSA money is for medical expenses, not retirement. Real companies that have HSAs know they are a good deal for all.

As many of you know, I often disagree with Joe Paduda regarding his healthcare views. I don’t have to look far to find good examples of where I disagree with him. Below is a post from Joe on 01.03.2007 the day of the Iowa Caucus at, www.joepaduda.com

“Hillary’s strength - health care

Among Democrats polled in Iowa who are most concerned about health care, Hillary Clinton has a substantial lead (38% v 21% for Edwards and 18% for Obama). While health care is not the top issue (the economy is), it is for 24% of Iowa Democrats.

And it remains a big issue for the rest of America - a gut issue, one that keeps voters up at night, worried about coverage for their moms, dads, and kids. It bleeds over to the economy and jobs - with health insurance tied to employment, many middle-class voters are keenly aware that losing a job means losing health insurance. This is not an esoteric, remote intellectual issue - it is the neighbor who just lost her job, the “pennies for a cancer victim” tin can at the convenience store, the parent too young for Medicare and too wealthy for Medicaid.

With the Iowa race wide open, the gut issue of health care could be a deciding factor.

The caucus environment is one where neighbors talk to neighbors about issues that concern them, and about which candidate is best suited to fix that problem. Yes, Hillary Clinton has her share of detractors, but many are undecided and Hillary owns health care. And that may just make the difference for her in Iowa.”

The results of the Iowa Caucus are in, and Hillary came in THIRD. If healthcare is owned by Hillary, as Joe states, then democrat voters in Iowa must not be as interested in the topic as Joe believes. Yes, polls indicate it is an important issue. Yet, they also have indicated for some time that the economy is very important as Joe states, despite what is still a great economy in the US. Voters will ultimately decide who our next President will be, but don’t be so sure that Hillary owns healthcare. She nearly socialized our system in 1993/1994 and I don’t know that voters have forgotten.

What does global warming and healthcare have in common? It would seem not much on the surface. Yet, when it is examined more closely there are many connections. Let’s examine one of the most important to me, which is the political outlook of both the global warming enthusiast and the person that wants universal healthcare. Now, to set the stage further, I am not talking about your average guy on the street that thinks we need universal healthcare and also believes we should take care of the environment. No, I am talking about the Al Gore types that are extreme alarmist (Healthcare and Global Warming) who assume mankind is bad, heartless, and uncaring toward our planet and fellow man. Oh yea, let’s not forget they tend to be political types that believe they know better than the rest of us, which is the ultimate connection between them and global warming/healthcare.

I am a conservative, not Republican or Democrat. But, something funny happens in the debate on healthcare and global warming, extremist on both topics seem to be Democrat party supporters and liberal, not Republican. These extremist are convinced that Global Warming must be caused by people. Why, well because it can’t be a natural cycle of the earth they reason, it must instead be caused by people. Reagan optimism in people is not something they posses. They also believe that we as American’s are heartless because we don’t’ provide healthcare to all of our citizens. The problem I have is that liberals, and some democrats, have high jacked these two topics for political gain. As I said above, these people simply believe they know better than the rest of us. Unfortunately, they gain political power from both of these topics, Global Warming and Universal Healthcare, and thus have a stage to influence us all.

For example, Al Gore has been an advocate of Global warming caused by man. Yet, his personal life has contributed more to carbon emissions than most of us will ever contribute. He also says the debate is over, attempting to make everyone who disagrees seem unknowing and ignorant. Yet, good ole Al is the ignorant one on top of being a hypocrite. In his movie An Inconvenient Truth, he fails to tell everyone that Carbon emissions over history only go up AFTER the temperature has risen (usually by several hundred years). For me, that simply blows every explanation this crowd has of global warming. Instead, it is a natural cycle of the earth. Is it getting warmer, sure, it seems that is true. But, it is not caused by human activity, in my opinion. Most of the warming in the twentieth century occurred in the early part, prior to the 1940s. Check out the 10 biggest myths of global warming.

What about a healthcare example? Well, look no further than Michael Moore. In Sicko he tries to tell us how wonderful the Cuban healthcare system is for their people. Do you want to go to Cuba for healthcare? I kind of doubt it. Yet, Mr. Moore has political clout and would rather trust his fellow American’s healthcare, in my opinion, to the government instead of to people’s choices. Again, healthcare high jacked as a topic to advance his liberal extreme political beliefs. So, let’s debate both topics in our society, Universal Healthcare and Global Warming. However, let’s not let the extremist highjack these topics for political gain. Americans as a whole are very smart when they have the facts, not when the media presents biased one sided arguments to the public such as Gore’s Inconvenient Truth. At least in Great Briton a high judge had the sense to point out the inaccuracies in the documentary. I wish we had public officials with the same guts in America. If you have kids, ask them if they saw An Inconvenient Truth in school, mine had no choice but to watch it.

I watched Hillary Clinton’s Christmas ad yesterday. In the TV ad, she is seen sitting by a Christmas tree with wrapped packages each tagged with her wishes for us all. These items include: Alternative Energy, Universal Pre-K, Bring Home the Troops, Middle Class Tax Breaks, and of course Universal Healthcare.I am struck by several items from this ad as Hillary shows her true colors as she is trying to get the Democrat nomination. All of her “gifts” to us includes redistribution of wealth. How else could one explain Universal Healthcare and Universal Pre-K? Someone has to pay for these “gifts” and she would make sure it came from the “rich” as Democrats define that particular class of Americans. The problem of course is that Democrats define the “rich” as a much larger percentage of Americans than most people realize. Her Robin Hood mentality is counter to all things American.

Next, Hillary’s ad feels a little degrading. She is playing Santa and supposedly giving gifts to us all as if we are little children. Does Hillary really think she is smarter than the rest of us?

It seems clear to me from this ad that Hillary is trying to win by giving out money for votes. Both Democrats and Republicans use this method, and ultimately it is bad for the country. I think it was Ben Franklin that said we are basically doomed as a Republic when we start voting ourselves money. For me, I think that is Hillary’s plan.

Finally, Bill Clinton always scared me a little, but for the most part he was held in check by a Republican congress in the 1990s. Hillary is a different story. I truly believe she is a socialist (she wants to redistribute wealth). This Christmas ad just reinforces my thoughts on her. What are your thoughts about Hillary?

Well, the headline today on www.foxnews.com  read as below:

Study: Uninsured Cancer Patients Twice as Likely to Die

I had to read this story based on the above shocking headline.  Yet, it raised more questions than I expected after reading it.  Here is an excerpt from the story:

“People without health insurance are less likely to get recommended cancer screening tests, the study also found, confirming earlier research. And when these patients finally do get diagnosed, their cancer is likely to have spread.The research by scientists with the American Cancer Society offers important context for the national discussion about health care reform, experts say — even though the uninsured are believed to account for just a fraction of U.S. cancer deaths. An Associated Press analysis suggests it is around 4 percent.”

This article goes on to imply that the reason uninsured cancer victims are dying is due to our heartless healthcare system, which is letting these people down and essentially killing them.  This is an article, at its heart, that is as biased as they come regarding the uninsured.  First, as the article states, uninsured cancer deaths are thought to be 4%.  Now, I understand if you are unfortunate enough to be one of the 4% that you don’t care the number is that low.  Yet in the context of national politics, it is a rather low number.  So, 96% of cancer deaths are from the insured.  In that case, I don’t think having insurance has much to do with the outcome of treatment. However, reading the rest of the article sure sounds like our healthcare system is in total failure for this population.

Furthermore, I really wonder why people without insurance don’t get cancer screening tests.  Some of these tests like a colonoscopy are expensive, but others are not.   I think Americans need to be willing to take on the responsibility of their own healthcare, including screenings.  Sure, they can be expensive, but this is a person’s health at stake.  Wouldn’t the cost of a healthcare screen be more important than taking a vacation?  Also, I don’t know the stats, but I doubt most people with insurance get preventive health screenings for cancer.

I have always thought that all Americans should have catastrophic insurance coverage, especially to cover cancer.  The real question, as always, is who should pay for it?  Right now, we all pay for the uninsured through higher premiums.  Thus, I still like the idea proposed by Romney, require all Americans to purchase at least catastrophic insurance coverage.  Many of my conservative friends don’t agree with this, but I still believe it to be a reasonable solution. 

A week ago, Joe Paduda on his blog examined the current state of bill review and several of the major players in the market. See an excerpt from a recent post of his:

“King hired former Medata exec Don Theis to head up sales and marketing; Theis’ task, and it is a formidable one, is to bring a market- and customer-orientation to the company. With no ownership of networks, Medata is looking to be neutral and customer-driven regarding network access, building links to the major network vendors and assessing customers a transaction fee for access. Word from Medata is the transaction fees will be transparent and modest.Medata’s new leadership could not have come along at a better time, and the tight focus on WC and ‘Switzerland’ approach to networks may help King and Theis reverse the company’s course.”

Regarding all the various bill review organizations that Joe examined, I think he nailed it just right in discussing the need for bill review companies to be “Switzerland”. It seems to me that in the long run it will be hard for them to be successful, if they don’t take a netural approach regarding PPOs, TPA functions, etc… Over the years, the partnership between independent bill review company and PPO has served the industry well.

Everyone that has operated a Workers’ Compensation PPO in Louisiana knows what a nightmare this state has been recently. I talked to one PPO back in the summer that indicated they had close to 1 billion dollars in exposure for penalties associated with PPO discounts taken where ID cards had not been used. Of course, using an ID card for workers’ compensation is just almost impossible. Most workers’ compensation PPOs simply chose to quit doing business in the state. Now, with new Republican Gov. Bobby Jindal, the thought is that workers compensation can be revisited in the state. In a recent article from Louisiana Medical News (see quote below), there is new hope for LA.

“Sharma says that LWCR, which represents 250 large employers and hospitals and close to 1 million workers, is taking a comprehensive approach to changing the workers’ comp system. Sharma said he is confident that changes will be made by the legislature.

The group has recommended lowering compensation costs, changing the dispute resolution process to promote consistency and efficiency, and creating quality medical provider networks to treat injured workers.”

Thus, any changes to allow PPOs to operate effectively in the state again will help to lower medical costs. This just might solve some of LAs problems such as Louisiana employers have the longest temporary disability duration rate, 40 percent higher than the median, and pay more than the national average in workers’ compensation costs, with higher premiums.

Letters are now going out from PPOs to their payor clients requesting their help to comply with the new workers’ compensation Colorado law (Senate Bill 79). In these letters work comp PPOs are requesting the following information from their payor clients: (1) where should doctors send the bills (2) where to call for inquiries. The real difficulty in the law is that the injured worker has to present the above information to the medical provider at the first visit.

It is somewhat easy for the PPO to comply with these requirements for direct clients. Yet, it is much more difficult when a reseller such as a medical bill review company is the client of the PPO. For PPOs to follow this law, it is going to take the help of the medical bill review companies and their clients.

This state law, as in so many, once again shows the limited understanding legislatures have of the various layers of workers’ compensation cost containment.