Humbled

December 8, 2010

I hope you don’t have trouble reading this entry. Recently I fell, separated my right shoulder and now I have to write left-handed. 

People who know me say my handwriting is terrible. (I thought you went to Catholic School, didn’t they teach you the Palmer Method)? 

You should see me trying to write and do everything left-handed. 

You never realize just how much we take the everyday things we do for granted until they take your rights (arm) away from you. It might be okay if I was left-handed….. 

But somehow I feel discombobulated. Everything has to be done is slow motion with my left hand. Go ahead try it! 

Try eating with a fork left-handed. 

Comb your hair or brush your teeth. 

I feel like I am going thru rehabilitation. Come on George, I know you can do it. 

How did I hurt my shoulder? Don’t even ask. I wish I could give you a great story. 

You should see what the other guy looked like. 

But no, it was humbling. 

I was actually trying to cross the street at night in front of my office. It is dark and as I was going across the street a car was coming from my right. My first thought was… they seem to be going a little fast. I started to take a couple of quick steps to get to the other side of the street. 

Little did I know that why I am looking to my right at the approaching car and breaking into a jog that a 

“Beware… Pedestrian Crossing” sign was right in front of me. 

What was that? 

Was my first thought, as I was tackled head on… 

glasses flying off my face…. 

I am falling and stumbling to get the first down (across the street and out of the car’s path). 

I throw my right arm out to catch my fall. And as soon as my right hand hit the street….. 

I felt and heard my right shoulder pop out of joint. 

Now I am lying in the middle of the street, (fortunately, the driver stopped and got out of the car) 

The owner of the pizza shop down the street, seeing the whole incident, came running over to help me. 

Are you all right? What happened? Let us help you up? 

I am half in shock…what and the heck hit me?……And in severe pain. 

My first response…… don’t touch me, I just thru out my shoulder

Looking back I can see the sign lying in the middle of the street and my body is locked into crippling position. 

I could not stand up; 

Dragging myself up to my office, (looking like the hunchback of Notre Dame), I yelled to my wife: 

Janet!!!!!! (In extreme pain) 

I threw my shoulder out….. I can’t even stand up…… I need a doctor. 

Seeing me she says, 

What happened?????  Did you get shot?” 

Thinking fast, she ran down the hall. (We happen to have a chiropractor in our building)

Dr Jon comes in, takes one look at me and says: 

Take George to the hospital. 

Did you ever notice that everything takes soooo much longer when you are in pain? 

We headed out to Virtua Hospital in Voorhees and let me tell you they did a great job. 

Kudos to my old classmate, Rich Miller, keep up the good work. 

I have a doctor, a doctor assistant and a nurse all pulling me in 3 different directions. Move a little more to the left, hold still, higher on your end…. but all of a sudden…. 

….Pop….my shoulder went back in. 

How do you feel sir? Are you still in pain? 

Anything has to be better than how I was feeling when I got here. 

What did you give me?  

Am I going to feel more pain later? 

What should I take if it starts to hurt later? 

Are you going to give me anything just in case it starts to hurt? 

So it goes, they put Humpty Dumpty back together again. 

For the next three weeks, I have my right arm in a sling……No Driving.

The doctor says there appears to be no ligament damage and I can start rehab on my right shoulder around the Christmas Holiday. 

Sounds like good news to me…. but how am I suppose to cut down my Christmas tree? 

JANET!!!!!!

March 17, 6:18 PM Political Buzz Examiner Ryan Witt

By now the health care reform bill has become something like Bigfoot in that everyone talks about it but few know what it really looks like if it exists at all.  For clarification there is in fact a “bill” which is set to be voted on by the House of Representatives this weekend.  The current bill was already passed by the Senate and has been analyzed extensively by experts. However in addition to the Senate bill the House also plans to vote on a “fix” to the bill which will then go back to the Senate.  The “fix” is not all together settled and is still being written after going through markup in the House Budget Committee (picture on left).

Still the fixes are relatively small because they must be in order to be passed through the reconciliation process in the Senate.  We therefore know most everything that the bill would do if it is passed this weekend.  Here is a plain language summary of the major provisions of the health care reform bill.

Would I Be Forced to Purchase Insurance?

Probably not.  If you already have employer-provided insurance you can keep it.  If you do not currently have any insurance you may have to purchase a plan by 2014.  Beginning in 2014 most Americans would have to purchase health care insurance or be forced to pay a fine.  If someone already has insurance (including through their employer) they would not need to worry about this provision.  For those who would be affected they could purchase insurance from anywhere but if they do not they would need to pay either $750 or 2% of their income, whichever is greater.  Exemptions would be granted for those in financial hardship which is measured using the poverty line.

Would My Current Insurance Be Affected?

Yes and no.  Yes in that any new plans would be regulated by the federal government.  The regulation would make plans provide a minimum of amount of benefits but not a maximum.  It would also implement consumer protections and an appeals process for consumers who want to dispute the decisions of their insurance companies on individual coverage.  The Congressional Budget Office estimates that premiums would go down under reform compared to the rate premiums would go up without reform.

Having said all that the reform plan “grandfathers” plans already in existence.  Therefore a plan currently in existence would be exempt to any changes at least for a while under the current bill.

What About This Exchange Idea and the Public Option?

There is no public option or new government provided insurance plan under the current bill.  Instead each state would have a health care insurance exchange where any individual can purchase health insurance.  The insurance plans in the exchange would have to meet federal regulation that would ensure they provide minimum benefits, etc.  Individuals who are currently covered by an employer-provided plan could not purchase form the exchange.  Undocumented immigrants could also not purchase from the plan. 

All plans in the exchange would be regulated by the federal government.  These regulations would include requirements that the plans provide a certain minimum level of coverage, that they do not discriminate based on pre-existing exclusions, that they spend a high percentage of their premiums on actual care (around 80%), and that they follow certain consumer protection laws.  In addition plans could no longer limit how much costs they are willing to cover.  In the past insurance companies would be able to limit their liability to $250,000 for example and stop paying once that limit was reached.

What Would Happen to Medicare?

The proposal would set up a board that would research and propose solution to reduce the costs of Medicare.  The board would be specifically prohibited from proposing anything which would amount to rationing care for the elderly.  Instead the proposal would focus on reducing waste and fraud while making Medicare more efficient.

What if I Can Not Afford Health Insurance?

Individuals who make between 100%-400% above the federal poverty level would be eligible to receive credits to assist them in purchasing health care insurance.  The amount of credit would generally go down the more income an individual made.  For the poorest the credit may pay for all of their health care premiums.

Would Employers Be Forced to Provide Insurance?

Maybe.  If a business has over 50 full-time employees they will be forced to offer health care coverage or face a $750 fee per employee.  Businesses with less than 50 employees would be exempted from providing coverage.

What About Medicaid?

Medicaid would be expanded to cover all individuals under the age of 65 who make less than 133% of the federal poverty level.  Currently the poverty level is around $18,000 for a family of three.

Does the Bill Pay for Abortions?

The bill keeps the current federal law on abortion funding in that federal funds could not be used directly to pay for abortion or abortion-related services.  The current bill does not include the abortion language in the House bill which put restriction on funding which were even more strict than the current law.  Essentially the House bill would have prevented individual receiving federal assistance from purchasing any health care plan (private or not) that provided abortion coverage.

What About Small Businesses?

Initially small businesses would receive a tax credit for up to 35% of the money they pay to purchase health insurance for their employees.  By 2014 that percentage would increase to 50%.  The idea is to help small businesses pay for health insurance coverage since they currently do not have the bargaining power of larger businesses.

Small businesses would be allowed to join forces in order to purchase insurance for their employees.  In other words five small businesses could all negotiate with an insurance company together in order to get a lower rate as big businesses currently do.

How is It All Paid For?

First there is a cadillac plan tax.  If an insurance plan costs $8,500 for an individual or $23,000 for family it would be taxed at 40% for any amount above those amounts.  Most health care plans cost much less than those amounts in premiums.

Secondly there are taxes on health insurance companies, pharmaceuticals, and medical supply companies.  Each of these companies would be assessed fees.  Pharmaceuticals would pay $2 billion, medical supply companies would pay $2.3 billion, and health insurance companies would pay $2 billion starting in 2011 and increasing to $10 billion by 2017.

Finally the bill would count on increased efficiency and reduced waste in Medicare to offset some of the other costs.  Overall the bill was projected to save a little over $100 billion in the first ten years of its existence and well over $700 billion after that.  Those projections were done by the non-partisan Congressional Budget Office.

Obama Health Care

March 5, 2010

WASHINGTON — The end game at hand, President Barack Obama took command Wednesday of one final attempt by Democrats to enact bitterly contested health care legislation, calling for an “up or down vote” within weeks under rules denying Republicans the ability to kill the bill with mere talk. Appearing before a White House audience of invited guests, many of them wearing white medical coats, Obama firmly rejected calls from Republicans to draft new legislation from scratch. “I don’t see how another year of negotiations would help. Moreover, the insurance companies aren’t starting over,” the president said, referring to a recent round of announced premium increases affecting millions who purchase individual coverage.

While Obama said he wanted action within a few weeks, Senate Majority Leader Harry Reid, D-Nev., seemed to hint a final outcome could take far longer. “We remain committed to this effort and we’ll use every option available to deliver meaningful reform this year,” he said.

 The results will affect nearly every American, mandating major changes in the ways they receive and pay for health care or leaving in place current systems that leave tens of millions with no coverage and many others dissatisfied with what they do get.

With Republicans united in opposition, there is no certainty about the outcome in Congress – or even that Democrats will go along with changes Obama urged on Wednesday in what he described as a bipartisan gesture. With polls showing voters unhappy and Democrats worried about this fall’s elections, Obama also sought to cast the coming showdown in terms larger than health care, which is an enormously ambitious undertaking in its own right. “At stake right now is not just our ability to solve this problem, but our ability to solve any problem,” he said.

Republicans dug in for another struggle on an issue that they agreed would echo into the fall campaign. The Senate GOP leader, Mitch McConnell of Kentucky, said a decision by Democrats to invoke rules that bar filibusters would be “met with outrage” by the public. “This is really not an argument between Democrats and Republicans. It’s an argument between Democrats and the American people,” he said. At its core, the legislation under discussion still is largely along the lines Obama has long sought and GOP critics attack as a government takeover of health care. It would extend coverage care to tens of millions of uninsured Americans while cracking down on insurance company practices such as denying policies on the basis of a pre-existing medical conditions. A new “insurance exchange” would be created in which private companies could sell policies to consumers under terms fixed by the federal government.

Much of the cost of the legislation, nearly $1 trillion over a decade, would be financed by cuts in future Medicare payments to hospitals and other providers and higher payroll taxes on individuals earning more than $200,000 and couples over $250,000.

 Story continues below The president’s appearance marked a presumably final pivot point in a long, uphill effort by Obama and other Democrats to enact far-reaching changes to the health care system – and with his own administration at an important crossroads. Eager to turn attention to efforts to stimulate the economy and create jobs, the president is seeking a victory on health care that can also give him a boost on other priority legislation. At the same time, a defeat could damage Obama’s ability to help fellow Democrats heading into the fall campaign. Failure on health care could well lead to a shake-up of the president’s White House team, which has received criticism recently from Democratic lawmakers.

After nearly a year of struggle, the House and Senate passed separate bills late last year, and appeared on course for approving a final compromise version early in 2010. But those efforts were abruptly abandoned when Republicans unexpectedly won a special election in Massachusetts. Sen. Scott Brown’s victory gave the GOP an ability they had lacked, the strength to sustain a filibuster, a form of opposition that requires supporters of a bill to post 60 Senate votes in order to cut off debate and force a final decision.

 Democrats went into something of a political fetal position, and have begun to stir in recent days only as Obama asserted his determination with a bipartisan summit followed by a revised set of proposals.

Obama said the use of rules that deny the minority the right to a filibuster had been used numerous times in recent years, including on passage of welfare reform legislation in the 1990s and twice when President George W. Bush pushed tax cuts to passage. Health care “deserves the same kind of up or down vote” as those earlier measures, he said.

 Under the rather complicated approach under discussion, the House would be asked to approve the bill that passed the Senate late last year, despite objections by many members of the rank and file to several provisions. Simultaneously, both houses would also vote for a companion measure whose purpose would be to make changes in the first bill sought by either House Democrats or the White House.

Obama said he was exploring GOP proposals for cracking down on fraudulent medical charges, revamping ways to resolve malpractice disputes, boosting doctors’ Medicaid reimbursements and offering tax incentives to curb unnecessary patient visits to doctors. The ideas include an experiment that would establish special courts in which judges with medical expertise would decide malpractice allegations. The idea has been criticized by the Center for Justice & Democracy, a consumer group that prefers the current system of awarding damages. It said health courts would be “anti-patient.”

The White House and Democratic leaders said they hoped that Obama’s maneuvering would at least win the votes of wavering conservative and moderates in their own party, even if it didn’t entice Republicans. But there was no guarantee of success, despite Obama’s vow to do everything in his power to succeed – and a White House announcement that he would travel to Pennsylvania and Missouri next week to campaign for the legislation.

 ___ Associated Press writers Jennifer Loven, Ben Feller, Alan Fram and Erica Werner contributed to this story.

As reported in Courier Post Feb 10, 2010

Obama and Congress need a focused reform bill that brings changes most Americans want.

Improving and reforming health care in the United States, at one time, must have seemed like a simple and clear idea to President Barack Obama. After all, once he began hard-selling the idea in the summer, his administration seemed to believe that legislation could be ready to go by Labor Day.

That was six months ago — six long months filled with heated rhetoric, back-and-forth debate, writing and rewriting of the legislation, major changes and a steady erosion of public support among Americans.

It was all done wrong.

The legislation approved a few weeks back by the Senate (the version more likely to be approved than the one passed by the House of Representatives in December) is so muddled, so convoluted and confusing that it has left supporters of health care reform scratching their heads, trying to make sense of exactly what it is. It doesn’t have a public health insurance option for the most needy Americans. It won’t manage to get everyone who isn’t insured onto some kind of health insurance plan. It will lead to hefty fines for people who don’t get health insurance. And it will cost hundreds of billions.

Bottom line, few average Americans understand very much about this monstrous, thousand-page-plus bill. What parts they do understand, they don’t like, including the cost. That’s why opposition to it has steadily mounted and support has weakened.

That’s also why the current version of the health care reform legislation now looks destined to die. The election Jan. 19 of a Republican U.S. senator in Massachusetts who opposes the bill hit Washington like a bomb. The shockwave of that bomb: Many Democrats worried about getting re-elected are reconsidering their support for the bill. And the president is now calling for a televised, bipartisan health care summit in which Democrats and Republicans offer ideas for health care reform.

Obama is changing his game and trying to get Republicans involved because he did it wrong. The Democrats controlling Congress did it wrong, also. They tried to write a bill without a defined set of goals. They just went about fixing every problem, large and small, that they identified. There became no central point of what this legislation would do, aside from create a public health insurance option. Then that got compromised out of the bill.

Health care reform, if it happens at all now in a charged election year, needs to be clear of focus. It needs to prioritize a handful of important goals that most Americans want to see addressed such as lowering the cost of temporary individual (COBRA) health plans and stopping health insurers from rejecting people for coverage due to “pre-existing conditions.” Those and a few others are points we think most people and lawmakers — Republican or Democrat — can agree on.

Stick to those things that have broad support; get Republicans involved in the process; and, above all, make the cost bearable and clearly explain how it will be paid for without cutting Medicare or Medicaid, and you’d have health care reform legislation that more Americans would understand and feel good about.

Our Perspective:

What seemed like a good idea has been corrupted by politics. The fact that in 2010, the United States can not offer access to basic medical care or coverage to all it citizens is shameful. 

Those who are covered by private and group plans  are already paying  a  fee in their premiums for uninsured coverages. As usual pork and politics take front stage and the American people are left holding the bag.

President Obama has to take charge and bring both parties together. Define what they all can agree on and strip everything else out. Maybe it cannot be done all at one time! Think of the people who put you in the office first.

A bipartisan commission can be set up to present an overview of the implementation and define issues they find that should be addressed at a later date.

By NICHOLAS D. KRISTOF
Published: August 26, 2009
Opponents suggest that a “government takeover” of health care will be a milestone on the road to “socialized medicine,” and when he hears those terms, Wendell Potter cringes. He’s embarrassed that opponents are using a playbook that he helped devise.

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Fred R. Conrad/The New York Times

Nicholas D. Kristof

“Over the years I helped craft this messaging and deliver it,” he noted.

Mr. Potter was an executive in the health insurance industry for nearly 20 years before his conscience got the better of him. He served as head of corporate communications for Humana and then for Cigna.

He flew in corporate jets to industry meetings to plan how to block health reform, he says. He rode in limousines to confabs to concoct messaging to scare the public about reform. But in his heart, he began to have doubts as the business model for insurance evolved in recent years from spreading risk to dumping the risky.

Then in 2007 Mr. Potter attended a premiere of “Sicko,” Michael Moore’s excoriating film about the American health care system. Mr. Potter was taking notes so that he could prepare a propaganda counterblast — but he found himself agreeing with a great deal of the film.

A month later, Mr. Potter was back home in Tennessee, visiting his parents, and dropped in on a three-day charity program at a county fairgrounds to provide medical care for patients who could not afford doctors. Long lines of people were waiting in the rain, and patients were being examined and treated in public in stalls intended for livestock.

“It was a life-changing event to witness that,” he remembered. Increasingly, he found himself despising himself for helping block health reforms. “It sounds hokey, but I would look in the mirror and think, how did I get into this?”

Mr. Potter loved his office, his executive salary, his bonus, his stock options. “How can I walk away from a job that pays me so well?” he wondered. But at the age of 56, he announced his retirement and left Cigna last year.

This year, he went public with his concerns, testifying before a Senate committee investigating the insurance industry.

“I knew that once I did that my life would be different,” he said. “I wouldn’t be getting any more calls from recruiters for the health industry. It was the scariest thing I have done in my life. But it was the right thing to do.”

Mr. Potter says he liked his colleagues and bosses in the insurance industry, and respected them. They are not evil. But he adds that they are removed from the consequences of their decisions, as he was, and are obsessed with sustaining the company’s stock price — which means paying fewer medical bills.

One way to do that is to deny requests for expensive procedures. A second is “rescission” — seizing upon a technicality to cancel the policy of someone who has been paying premiums and finally gets cancer or some other expensive disease. A Congressional investigation into rescission found that three insurers, including Blue Cross of California, used this technique to cancel more than 20,000 policies over five years, saving the companies $300 million in claims.

As The Los Angeles Times has reported, insurers encourage this approach through performance evaluations. One Blue Cross employee earned a perfect evaluation score after dropping thousands of policyholders who faced nearly $10 million in medical expenses.

Mr. Potter notes that a third tactic is for insurers to raise premiums for a small business astronomically after an employee is found to have an illness that will be very expensive to treat. That forces the business to drop coverage for all its employees or go elsewhere.

All this is monstrous, and it negates the entire point of insurance, which is to spread risk.

The insurers are open to one kind of reform — universal coverage through mandates and subsidies, so as to give them more customers and more profits. But they don’t want the reforms that will most help patients, such as a public insurance option, enforced competition and tighter regulation.

Mr. Potter argues that much tougher regulation is essential. He also believes that a robust public option is an essential part of any health reform, to compete with for-profit insurers and keep them honest.

As a nation, we’re at a turning point. Universal health coverage has been proposed for nearly a century in the United States. It was in an early draft of Social Security.

Yet each time, it has been defeated in part by fear-mongering industry lobbyists. That may happen this time as well — unless the Obama administration and Congress defeat these manipulative special interests. What’s un-American isn’t a greater government role in health care but an existing system in which Americans without insurance get health care, if at all, in livestock pens.

Our Perspective:

The topic of Health care is once again at the forefront. It is sad to think, that in 2009, America is still unable to provide basic medical care to all its’ citizens.

Believe it or not, we pay for it already. Those who actually have insurance, pay a fee to help offset the cost of the uninsured.

Our emergency rooms were becoming a haven for the uninsured until the hospitals started charging $75 to $100 upfront to provide services.

What do we do? Let’s drop the partisan bickering. All of Congress agree on at least 80% of the provisions that should be in a healtyh care reform bill.  Let’s begin there. This does not have to be done all at one time. Most major initiative are done over time anyway.

Let us start with providing the basic care and catastophic coverages that should be made available to all our citizens and then look to define it further over time.

Here’s an idea! Why not look at setting up clinics and using our med students to work from there. Many of these students graduate with huge loan balances that must be paid off over time. Why not provide an incentive to help them pay down a portion of these loans in exchange for the services provided,  while also paying them a small stipend for their service.

We must address this issue now. I have the the insurance come back each year raising their rates so that their clients must drop down to a lesser coverage. Raise the co pays, increase the out of pocket. It is all a game.

I am all for making money but I am also for doing what is right. Health Care reform is the right thing to do. Let’s hope Congress doesn’t screw this up!

Let us know tyour thoughts. You may leave a comment or email george@hbsadvantage.com