Dismiss The "Negotiators"

Guy Boulton - the Journal Sentinel health care reporter - wrote yesterday about the "generous" benefits enjoyed by state employees. Here's a link to the story.

The article provides hard data to support this summary: "The state pays more to provide health benefits than private employers not because it isn't a shrewd buyer, but because it provides more generous benefits."

Would you expect any other result when the negotiators on one side of the bargaining table work for - and are accountable to - those on the other side. And, they are "bargaining" with OPM, i.e., Other People's Money.

Deciding on the Constitutionality of PPACA: Timing Is Everything!

We're reading today of another judicial opinion on certain provisions of the Patient Protection & Affordable Care Act (PPACA). We all know these early round decisions are just a precursor to a Supreme Court ruling.

There was one of many quotes in reaction to the Florida ruling that caught my eye: "Senator Richard J. Durbin, Democrat of Illinois, said he would convene a Judiciary Committee hearing on Wednesday to examine the constitutionality of the law."

So, let me see if I have this right. Those that were 'smart' enough to craft this legislation are only now thinking about a Committee Hearing to consider its constitutionality. Shame!

Health Premiums in SE Wisconsin Compared to Washington D.C.

I'm often asked if health premiums in SE Wisconsin are really higher than elsewhere and if so, why. Since most of my business is local, my answers are usually anecdotal but just this week, I experienced a more concrete - and shocking - example.

I'm helping a new business in Washington D.C. set up their first small group health plan. The employer and census details are of course confidential. And, I'll not name any one insurer (but we are quoting the usual national 'players'). There's nothing irregular about the suggested plan design(s) being quoted either; a standard $1000 deductible with office visit and drug co-pays or a "Qualified (i.e, HSA eligible) High Deductible Health Plan. For both plans - identical benefits and identical census - the premiums in D.C. are dramatically below the rates from the same insurer for SE Wisconsin.

Two quick examples: a 46 year old male with a spouse and three children - the monthly premium for the $1000 deductible/co-pay plan would be $1,489 here but only $815 in D.C. Or how about a 33 year old male with a spouse and one child - the HSA HDHP here would cost $707 but in D.C. only $394. (No, that is NOT a typo - family coverage for under $400 !!!!)

One small group is hardly a fair test. In this case however, the premiums average 45% less for a business located in Washington D.C. than for the same business if located in Milwaukee. Stunning!

I'm going to have to ask some of my agent/broker peers in other cities help me gather additional data. This is just too curious.Stay tuned.

Can This Be Just A Coincidence?!

This post has nothing to do with health care, except writing it will make me feel better. Consider:

1.) Yesterday of course started the final week of campaigning for the November 2nd mid-term elections. You wouldn't think it possible after the past several months, but in the "home stretch", the politicians have escalated their campaigning. More candidate appearances. More speeches. More TV and radio ads.

2.) For the last 24 hours Milwaukee has been experiencing near gale force winds. Very unusual. And they are expected to continue throughout the day.

Can this be just a coincidence? The weather forecasters say the winds will subside sometime tomorrow. I'm not a meteorologist but I'd guess next Tuesday would be a better guess.

WHAT IS OPTIMUM HOSPITAL OPERATING 'CAPACITY'?

A list of the "Largest Milwaukee-area acute-care hospitals" appears in Friday's edition of The Business Journal (p.A21). Although the focus is on the ranking by revenues, another column of numbers caught my eye.

For each hospital, the number of "licensed" beds is listed along side the number of "staffed" beds. Cumulatively, in our area there are 7,091 "licensed" beds; only 4,664 are "staffed". In the unlikely event all of the "staffed" beds are actually occupied, could it be our health systems are over built by a third? And, compiled from 2009 information, this particular list doesn't even include the new hospitals in Summit or Grafton.

Coincidentally, on pages A14-15 of this same issue, there is a listing of the 50 "Largest Milwaukee-area private companies". Again, the ranking is by revenues but the number of "local" employees also appears. Noting that six of the top eleven companies are health systems, I found myself doing a little math. All tolled, the 50 companies combined employ 70,123; of that, 51,223 are employed by just the 6 health systems. (Is this where a texter would add OMG!?)

Someone a lot smarter than me might suggest how you squeeze what seems to be significant over capacity out of our area health delivery system. I do read about shortages of nurses and primary care physicians. Maybe if an entire health system shut down, that manpower could be reallocated without imploding the local economy. It's something to think about anyway. I might add, we'll be forced to think about it when the insurance reforms of PPACA fail to lower health care costs.