Enabling Healthy Decisions

I completely agree that we need to find a health care solution for the country that doesn’t deny coverage for people based on pre-existing conditions. There are obviously issues of how to do this fairly without driving companies out of business. BUT, I completely disagree with one concept that I read about which would require coverage but allow people to enroll in a plan after they get sick. This is why a mandate for coverage has to be required.

• I can’t wait until I get in a car accident to buy car insurance.
• I can’t wait until my house floods to buy flood insurance.

There is no sustainable business model where the only people paying into insurance are those that are drawing out of the insurance. That makes no sense.

Do you believe that uninsured people will buy health insurance if there is no mandate to require this?

Why would they? Don’t you think most people would like to have coverage today if they could either (a) afford it or (b) be convinced they need it (i.e., young invincible) or (c) get coverage at a reasonable cost due to pre-existing conditions?

In my opinion, it is naïve to believe we can achieve universal coverage in this country in the president’s first term (as he stated last year) or that it can be achieved without some mandate.

I think it’s a shame that our kids won’t have the same experience of sitting back with a newspaper and reading it. It seems like such a classic icon of Americana. That being said, I am a big user of technology and clearly understand why they are in trouble.

But, what I wonder is if they aren’t in bigger trouble than we believe. The only time I read papers is at the airport or when I am in a hotel. What if you eliminated all the papers sold through those two sources? I can’t believe that individual (home or business) subscriptions could support many (any) of the newspapers in the US.

I am borrowing this phrase from a friend of mine, but it is how he described their organizational culture and made me think of several things.

• Why do people become so myopic on one type of savings that they don’t realize the entire cost of the process?
  • E.g., Driving miles to save pennies on gasoline.
  • E.g., Paying less for clothes that don’t last as long as a slightly higher priced item.
  • E.g., Buying things “on sales” even though they don’t like them as much and won’t get much use out of them.
  • E.g., Paying a consultant to help them drive down costs in an RFP when the cost savings are less than the consultant’s fees.
  • E.g., Focusing on one “square” in an RFP when the effectiveness of the solution is much higher with the slightly higher vendor such that the cost per conversion is less.
  • E.g., Buying one solution that requires them to make other organizational changes that cost money and aren’t factored in.
• Why do companies charge more when they think they have “power” only to limit their lifetime value of the customer?
  • E.g., Sprint recently told me that to synch my e-mail on my Blackberry with an Enterprise Server would require another $20 per month (never mind that they have been doing it for two years for free). After 14 years as a customer, I was annoyed. A one-time charge – maybe. A recurring charge for them to do basically nothing is ridiculous.

I remember that I once wrote a business case on limiting e-mail size which I think gets to this point. At that company, we had a limit of 20MB of e-mail storage. After being there more than a year, even if you were diligent at cleaning e-mails, you would likely begin to have problems. I got to the point where I was spending 4 hours per week cleaning my e-mail box so that I could send e-mails. I didn’t know the exact cost of storage, but if I multiplied 4 hours times thousands of corporate employees times their average salaries, it was a lot of money being wasted.

I know many of you that follow the blog and work with me will say I am preaching to the choir, but the intricacies of language are so important around healthcare.

And, how do you know what works…TEST, TEST, and RETEST. Do you think credit card companies have stopped trying new strategies? Of course not.

So, what’s the latest example…

“Do Not Resuscitate” vs. “Natural Death”

USA Today has an article today about these two phrases. It has real life examples from several hospitals that have changed their language when talking to families. It also talks about a study last year that was published in the Journal of Medical Ethics that showed nurses, student nurses, and people with no health care backgrounds reporting a greater likelihood to forgo resuscitation if “allow natural death” was the phrase used.

“Our greatest responsibility is to listen to the person and find the language that is best understood by them.” Samira Beckwith, CEO, Hope Hospice in Fort Myers, FL.

Although I want to, I will try not to get engaged in a bunch of politics. Let’s focus on the disastrous effect that the economy is having on healthcare in the country.

According to a recent study by the Kaiser Family Foundation:

• 1 in 4 Americans put off needed health care in the past year because of cost including 16% who postponed surgery of a doctor’s visit for a chronic condition.
• 53% said they cut back on health care in some way.
  • Over the counter medications
  • Self-diagnosis
  • Skipped the dentist
  • Postponed a test
  • Didn’t fill a prescription
• 15% split their pills or skipped doses of medication.

This is scary. Maybe this is what the $600B is for over the next 10 years in the budget since I thought reforming healthcare was going to save money.

In another report, it talks about people sleeping less due to stress over their financial situation.

Another report I saw talked about how cheap foods like McDonalds were seeing huge growth while fresh vegetables and fruits were more expensive.

With all the layoffs these days, this is a real issue that many people are facing. According to the Kaiser Family Foundation, the average premiums for 2008 were:

COBRA allows laid workers to continue their former health insurance for up to 18 months at the full cost plus a 2% administrative fee. That’s approximately $400 for an individual per month or over $1,000 for a family per month. For many people, these amounts eat up a large amount of their monthly income from unemployment or severance or savings so it becomes a tough decision.

I guess a ray of good news is that in the “stimulus package” people will have 65% of their COBRA premiums subsidized if they were laid off between 9/1/08 and 12/31/09. (Remember that you have 60 days to sign up for COBRA after you receive a notice from your employer about eligibility…which should happen shortly after you lose your job.)

Your other option is to go to your health insurer or someplace like eHealthInsurance.com to buy an individual policy. Most health plans now offer an individual plan although they don’t do a good job of selling it to people leaving the plan. The subsidy may change the economics a little, but my understanding is that it is generally less expensive to get the individual insurance than COBRA. BUT, I have two caveats:

• Several company have announced large increases in their premiums for their individual plans (as much as 30%+). These will be tough for a lot of people to swallow.

• If you have a pre-existing condition, don’t drop your COBRA until you have found another plan.

As long as you are continuously covered, insurers can’t deny you coverage under the Health Insurance Portability and Accountability Act (my understanding and stated in a USA Today article on this topic).

What I do think is unreasonable is that when you lose your job, you have to stay with the same plan under COBRA. You can’t switch to a lower cost plan that your employer might have offered. Why shouldn’t you be able to? Now, USA Today says that if you’re eligible for the subsidy then your employer might let you switch – why now…is the employer paying for the subsidy?