Medicaid expansion is needed for NC says this retired benefits professional

As North Carolina continues its stalemate on Medicaid expansion, it might be interesting to heed the words of former Ohio Republican governor John Kasich. When Ohio moved forward with the Medicaid expansion, he called it a “no brainer.”

Now why would he say that? Kasich noted Medicaid expansion would not only help people, it would bring $13 billion to his state over several years. George Washington University did a study that said Medicaid expansion would help a state’s economy, help a state’s rural hospitals and help people. We should also remember NC Republican Mayor Adam O’Neal of Belhaven walking to Washington seeking the expansion of Medicaid after his colleagues in Raleigh turned him down as he tried to save his town’s hospital.

Rather than offer stale arguments, it would be nice if the Senate and House leaders figure out a way to get this done. Let me add the voices of The Commonwealth Fund, RAND Corporation and Economic Policy Institute that echo the results of the GWU study. NC is already in the minority on this. Please let’s find a way to help people.

Let me close with a truism about health coverage to think about. Those with coverage will see doctors earlier and will have access to prescription drugs to avoid future train wrecks. Preventive care and health maintenance are better paths forward for people and healthcare financing.

Note: The author of this post is a retired benefits professional who is a former actuary, former benefits consultant and benefits manager for a Fortune 500 company

The most realistic path to ‘Medicare for All’ says a former Insurance CEO

I said back in 2010 to a healthcare consulting colleague, we will eventually need to consider national health insurance, but it won’t happen. When he asked why, I responded the “Healthcare industrial complex is too powerful.” People forget the reason we have the Affordable Care Act is CFOs were tired of rising healthcare costs to their bottom line.

Healthcare is a complex topic and the ACA added to that complexity. It has since gotten better, but we need to shore it up to stabilize it more, rather continue to allow it to be diminished as its opponents have down for several years.

But, national health care under the banner of “Medicare for All” is worthy of consideration with data and analysis. This retired actuary, benefits consultant and benefits manager supports data driven analysis to improve what we have and consider more substantive changes. JB Silvers, a former health insurance CEO and professor of health care finance at Case Western University, penned an article called “The most realistic path to ‘Medicare for All'” in The New York Times earlier this month. Here are excerpts from the article:

“Much to the dismay of single-payer advocates, our current health insurance system is likely to end with a whimper, not a bang. The average person simply prefers what we know versus the bureaucracy we fear.

But for entirely practical reasons, we might yet end up with a form of Medicare for All. Private health insurance is failing in slow motion, and all signs are that it will continue. It was for similar reasons that we got Medicare in 1965. Private insurance, under the crushing weight of chronic conditions and technologic breakthroughs (especially genetics), will increasingly be a losing proposition.

As a former health insurance company C.E.O., I know how insurance is supposed to work: It has to be reasonably priced, spread risks across a pool of policyholders and pay claims when needed. When companies can’t do those fundamental tasks and make a decent profit is when we will get single payer.

It’s already a tough business to be in. Right now the payment system for health care is just a mess. For every dollar of premium, administrative costs absorb up to 20 percent. That’s just too high, and it’s not the only reason for dissatisfaction.

Patients hate paying for cost-sharing in the form of deductibles and copays. Furthermore, narrow networks with a limited number of doctors and hospitals are good for insurers, because it gives them bargaining power, but patients are often left frustrated and hit with surprise bills.

As bad as these problems are, most people are afraid of losing coverage through their employers in favor of a government-run plan. Thus inertia wins — for now.

But there’s a reason Medicare for All is even a possibility: Most people like Medicare. It works reasonably well. And what could drive changes to our current arrangement is a disruption — like the collapse of private insurance.

There are two things insurers hate to do — take risks and pay claims. Before Affordable Care Act regulations, insurance companies cherry-picked for lower-risk customers and charged excessive rates for some enrollees…”

There is only one solution: pooling and financing many of the risks related to chronic and acute health care issues. A study by my former company noted generally 15% of participants drive 80% of the claims costs in any given year. It may not be the same 15%, but with major chronic issues, some could continue to be in the mix. The principle of insurance is to pool those risks, so that good risks can moderate the higher risks.

The ACA uses the private insurance system, exchanges and expanded Medicaid. Unfortunately, there are about 15 states who still have not expanded Medicaid. Medicare for All would consolidate the risk into one place, eliminating the profit load and reducing the relative administration cost of insurance companies. I have suggested for several years to do a pilot and expanded Medicare eligibility from age 65 to age 62, or even lower. This would let us measure the impact of such a change.

Yet, what we don’t need is this to become political. What people do not realize is the ACA has been sabotaged on several occasions by my former party which drove some insurers out of the market and increased premiums for everyone else more so than they otherwise would have been.

So, let’s cut to the chase and study options. And, politicians should let people who know what they are doing do the analysis. The ACA was made too complex and the exchange roll out was botched. On the flip side, what the GOP did in 2017 was sloppy and poorly staffed, so what was voted on woulf have been harmful to many.

Five easy memory tricks

With two of our four parents succumbing to complications due to Alzheimer’s, memory maintenance is of interest to my wife and me. Readers’ Digest ran an article by Andrea Au Levitt called “5 Easy Memory Tricks.” Her intro paragraph follows:

“You know that eating healthy, staying active, and solving a few brain games can help keep you sharp. But these lesser known habits work wonders, too.”

1. Sit tall – when slouching it follows or promotes defeated, anxious and depressive thoughts, which hinder memory.

2. Exercise – once – gains in memory after one exercise are similar to gains after regular exercise (note still do the regular stuff).

3. Limit TV – including online versions of TV, too much screen time can harm cognitive development and maintenance.

4. Doodle – people can remember things better if they doodle or draw a picture of what they are thinking of. Writing the words of the thing is not as memorable as drawing a picture.

5. Walk backward – real, imagined or watched walking backward or even forward, can help remember something. So, in keeping with #2 above, take a walk (and walk backwards on occasion).

Let me take one of the above and break it down more. One of the examples from Malcom Gladwell’s book, “Talking to strangers,” notes that torture is a horrible way to gain information. Why? Under trauma, people remember less than they would normally. The comment about sitting tall in #1 above, notes if we slouch we increase anxiety or depressive thoughts, a mild form of trauma.

Outside of the walking backward, I do the above things. The sitting tall actually helps this tall person with his back. As for doodling, for some reason when I work the various puzzles in the newspaper, I blacken in the circular letters (O’s, D’s, P’s etc.) in the title of the advice section (sorry Dear Abby). Maybe it helps me with the puzzles (or advice).

As I leave you, think of Barbra Streisand walking backward singing “Memories light the corners of my mind, Misty water-colored memories of the way we were.”

Our children deserve better

Two time Pulitzer Prize winner Nicholas Kristof wrote an editorial earlier this week in The New York Times called “Our children deserve better.” It is a clarion call to our nation showing the plight of kids in America.

Here are a few quotes to frame the issue:

“UNICEF says America ranks No. 37 among countries in well-being of children, and Save the Children puts the United States at No. 36. European countries dominate the top places.

American infants at last count were 76 percent more likely to die in their first year than children in other advanced countries, according to an article last year in the journal Health Affairs. We would save the lives of 20,000 American children each year if we could just achieve the same child mortality rates as the rest of the rich world.”

“Half a million American kids also suffer lead poisoning each year, and the youth suicide rate is at its highest level on record….The Census Bureau reported this week that the number of uninsured children increased by 425,000 last year.”

These are different views and sources of the threats to US children that note we have a problem. Another source I read a couple of years ago noted America has a much higher maternal mortality rate at child birth than other civilized countries, which further endangers children as well as the mothers.

Yet, these issues are not being discussed in the halls of government. We have a poverty problem in our country with too many living in or just above poverty levels. We have not expanded Medicaid in fifteen states whose numbers are worse than these national numbers per capita. We have not addressed our national water crisis which has a Flint, MI like exposure to lead in too many cities and a volume of available fresh water issue in other places. We have not invested as we should to diminish crime and provide more opportunities for jobs in disenfranchised areas. There are several pockets of success that can be emulated in more cities.

We also need to address better gun governance, especially with the number one gun death cause by far being suicide and a non-inconsequential accidental gun death rate. And, we have not dealt with the continuing and rising exposure to technology and artificial intelligence which have taken and will take even more jobs in the future. Finally, there is that climate change thing we need to deal with.

These are real problems. And, they will get worse. Data driven analysis of causes and solutions are needed. They are both multi-faceted. Investing more now, will save huge amounts later. This is not just an urban issue, it is rural one as well. The opioid crisis is rampant in these impoverished rural areas, for example.

None of the solutions will fit on a bumper sticker. And, political attempts to oversimplify issues should be questioned. Here is an easy contradiction to spot – if people believe gun deaths are a mental health issue, then why the effort to eliminate or not expand mental health benefits?

Please make your legislators aware of these issues and ask pointed questions. These questions deserve answers, not bumper sticker slogans. These concerns deserve to be talked about, studied and acted upon.

And the band played on

“And the band played on” comes from a powerful protest song called “Ball of Confusion” sung by The Temptations in the late 1960s and written by Norman Whitfield and Barrett Strong. It was also the movie title for a 1993 movie about the slow action to address AIDs during the 1980s..

“And the band played on” is a metaphor pulled from the band continuing to play as the Titanic sank. It is used unflatteringly to address inaction by leadership to address major problems. The Temptations pleaded for action to address inequality, maltreatment of Blacks, the Vietnam War and so on. The movie noted how little the White House cared until they realized that heterosexual people could get AIDs as well.

As of this writing, a sixteen year old girl named Greta Thunberg is stepping onto our shores to address climate change. This young hero began her quest for action last year and became a catalyst for student strikes pleading for action. When her critics encouraged her to be a kid, she said she would love to, but the adults are not addressing this issue, so she said she had to do so, since, her generation will be left with the unsolved problems.

Yet, while she is here to address these issues to the United Nations and those in Washington, the US president is rolling back restrictions on methane and carbon release, which was announced yesterday. Further, the president blew off a G7 meeting to discuss climate change and the burning forests in the Amazon.

This type of action from the US president is what I feared most from his winning the 2016 election. I feared reversal of action on climate change from the federal level and the environment becoming second fiddle. Yet, I must confess the environmental degradation caused by this president and the EPA under the watch of fossil fuel lobbyists Scott Pruitt and Andrew Wheeler has been worse than I expected.

Inaction by this White House would actually be an improvement. On top of announcing the US’ departure from the Paris Climate Change Accord, the rolling back of Obama’s climate plan requirements, deletion  of climate change data from the EPA websites and the forcing out or redeployment of climate change scientists is harmful to our planet and country. We are behind on acting because of similar actions when the second Bush White House was filled with fossil fuel people like Vice President Dick Cheney, including Cheney making sure fracking companies were not exposed to the requirements of the Clean Air Act and Safe Drinking Water Acts (please Google the 2005 Energy Act and Dick Cheney or the Halliburton Loophole).

Fortunately, there are some good things happening in America in spite of this president. Five automakers are ignoring the rollback of increasing MPG requirements under Trump and siding with California’s new requirements. Their thesis is we want younger people to buy our cars, so we better care about the environment because they do. It should be noted that it was announced today that 67% off Republicans between the ages of 18 – 34 believe we must act on climate change. Their leadership can no longer hide on this issue due to fossil fuel funding of their campaigns.

And, other states, cities and companies are addressing climate change with efforts to remove carbon from the air and put less of it there. Wind and solar energy have taken off as costs have declined and other measures like tidal energy, battery storage,  are under way. I wrote recently about these efforts based on the documentary “Ice on Fire.”

The younger generation gets this. And, to be frank, if the Republican Party does not change its paradigm, they may become obsolete. The band can no longer play on. The Titanic is sinking and we must act. I hear criticism about AOC and the Green New Deal. I recognize it is imperfect, but as I tell people, at least it is a plan. We must come together and figure it out. This is far more urgent than politicians are letting on. Please ask them what they plan to do and if they do not answer satisfactorily, do not vote for them. And, please join voices with the young Ms.Thunberg. She should be heeded.

The hook brings you back

The group Blues Traveler had a huge hit with a song called “Hook,” which intentionally says nothing of substance. The chorus is as follows:

“Because the hook brings you back
I ain’t tellin’ you no lie
The hook brings you back
On that you can rely”

The song is about their frustration with MTV or popular music which relies on a “hook” to grab your attention. A hook is a catchy riff, phrase or gimmick used by songwriters. The Blues Traveler song is a tongue-in-cheek criticism of the use of a “hook” while using one.

To me, this song is a metaphor for companies selling products harmful to people’s health. The “hook” is an addiction, that brings people back to buy more.

The vaping industry is repeating the successful sales model of selling smoking to kids and young adults to get them hooked. The tobacco industry knew dating back to 1964 that nicotine was addictive. So, they hid this fact as they added more nicotine. The subterfuge lasted until the mid-1990s when an insider blew the whistle. This was after eight tobacco CEOs sitting at a table in front of a Congressional Committee lied saying nicotine was not addictive. What is troubling about the vaping industry is they are selling these vapes as candy in all kinds of flavors.

An even more dramatic and traumatic sales job relates to the opioid pain killer business. These companies were not forthcoming about how addictive their product is. People have died and families have been ruined by this subterfuge. And, once again we have a heroin and worse drug addiction problem in America, as it is cheaper than the opioid product. Please strongly consider non-opioid painkillers if you have surgery or an injury, if permissible by doctor.

On a more widespread basis, food companies have asked their chemists to make their products more addictive. How? By adding more sugar to their products. The sweeter taste is more alluring and gets people to eat more and buy more. What is the harm in a little more sugar? The US is the most obese country in the world and kids are now getting adult diabetes, not just juvenile diabetes.

So, like catchy songs, these hooks are designed to sell lots of products to unsuspectingly addicted consumers. Please be mindful of when you buy to make sure you are not being reeled in.

Helping people climb a ladder – a perspective

The following is an edited version of a comment on Hugh Curtler’s (a retired college professor of philosophy) post regarding whether we should help people in need or let them fend for themselves. I provide a link below to his post. I am going to cite the work a charity I used to be a part of that builds off the book “Toxic Charity,” written by a minister who lived with the disenfranchised people he sought to help. His name is Robert Lupton.

Lupton’s thesis is simple: true charity should focus on emergency or short term needs. What he argued for to help others long term and we did (and still do) is help people climb a ladder back to self-sufficiency. That should be the goal. An easy example is he would advocate for food and clothing co-ops rather than giving the food and clothes away. People love a bargain, so let them maintain their dignity while they get discounted help. This dignity thing is crucial – people would rather not have to ask for help.

Note, we cannot push people up the ladder. They must climb it.  A social worker I have advocated with used to say “we walk side by side with our clients.” The folks we helped are homeless working families. We had two keys – they received a subsidy for rent based on their ability to pay, but they had to plan, budget, get financially educated working with a social worker and attending required training programs. Our homeless clients had to be responsible for rent and utilities up to 30% of their income, which is threshold for housing risk. Another key is we measured success. Success to us is being housed on their own without help after two  years.

As a community and country, we need to better identify what we mean by success in our help for people in need. Also, are things like healthcare a right? Is food on the table a right? Is a roof over the head a right? What we need is better measurement of what we spend and how it helps. It actually is cheaper to provide housing to chronic homeless and partially-subsidized housing to those who are more acutely homeless (due to loss of job, reduction in hours,  loss of healthcare, problems with car, predatory lending on a car, etc.) than let them go to the ER or commit petty crimes and be jailed. People should know all homeless are not alike, so the remedies to help need to vary.

My former party likes to argue off the extreme anecdotes – the significant majority of people do not cheat the system, but the perceived thinking of such is much higher in Republican ranks. When I have spoken to church groups, chamber groups, rotary clubs, United Way campaigns, etc., I come across this bias which is firmly believed. Just last month, the US president announced curtailing a rule on food stamps which will put 3 million people at risk, as one man was able to purposefully game the system. Yes, there is a small percentage of folks that do that, but the significant majority do not.

What people like David Brooks, a conservative pundit, tout is a dialogue on what kind of country do we wish to be? Our economy is a fettered capitalist model, with socialist underpinnings to help people in need and keep people out of poverty. What is the right balance? Is it better to pay a much higher minimum wage or have a higher earned income tax credit, e.g. Is it better to have a Medicare for All system, subsidize those in need or have a free market system only? A factor in this decision is many employers now employ a larger part-time or contractual workforce (the gig economy) to forego having to provide benefits. This is especially true in retail and restaurant industries.

At the end of the day, Gandhi said it best – a community’s greatness is measured in how it takes care of its less fortunate. With so great a disparity in the haves/ have nots in our country, I can tell you we are out of whack as our middle class has declined and far more of them fell into a paycheck-to-paycheck existence. Ironically, even in the age of Trump promises, we have many people who do not realize they are voting against their economic interests. Doing away with the ACA and not expanding Medicaid are very harmful to rural areas, e.g.

So, I agree with Gandhi, Lupton, and Brooks that we need to help people, but decide what is the best way. We should measure things and adjust them when they get out of whack. It is hard to fix what you do not measure. The group I was involved with would alter its model, if the numbers showed less success than hoped. What I do know is over 80% of the people we helped are still housed on their own after two years of leaving the program. In other words, they live without a subsidy.

Finally, what we need most is for politicians to check their tribal egos at the door when they enter the room. Having been a member of both parties, each party has some good ideas, but both have some bad ones, too. I do not care what a person’s party preference is or if he or she is more conservative or liberal than me  (I am fiscally conservative and socially progressive), we need to use facts and data to make informed choices. And, continue to measure the results making modifications, if needed.

Dilemma