Rauser Health Review

Dismiss The "Negotiators"

noreply@blogger.com (Jon Rauser) — Tue, 01 Mar 2011 08:52:00 +0000

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!

noreply@blogger.com (Jon Rauser) — Tue, 01 Feb 2011 19:00:00 +0000

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.

noreply@blogger.com (Jon Rauser) — Tue, 07 Dec 2010 15:37:00 +0000

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?!

noreply@blogger.com (Jon Rauser) — Wed, 27 Oct 2010 16:31:00 +0000

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'?

noreply@blogger.com (Jon Rauser) — Tue, 12 Oct 2010 06:27:00 +0000

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.

"Wellness" Through Great Customer Service

noreply@blogger.com (Jon Rauser) — Wed, 06 Oct 2010 17:49:00 +0000

This is perhaps a bit of a stretch but I wanted to share how good a simple gesture can make someone feel. The "stretch" would be to accept that beyond exercise, annual physicals and such, a smile contributes to wellness. I'm pretty sure that's true. . . .

So here's what I'm talking about. I discovered "The Soup House" a block away from my office a couple of months ago. Each day they serve several choices. They're all really good. Apparently I'm not the only one that thinks so because every time I go, there is a pretty good line of customers waiting. And if I go too late, they sometimes are sold out!

With each serving of soup, you get a piece of fresh baked bread OR corn bread. On one of my first visits, I told the owner how much I love corn bread. Especially with honey. End of conversation.

I've been in and out of there a dozen or more times since then. Today I was served again by the owner. I brought my soup back to my desk and opened the sack. Guess what? Included with my corn bread was a small plastic container with honey! You think I didn't smile?! You think that didn't make me feel good?!

See what great customer service can do. Practically no effort or cost but what a payback. Thank you Soup House owner. I owe ya'!!

88, UNINSURABLE AND IN THE MARKET FOR NEW HEALTH INSURANCE!

noreply@blogger.com (Jon Rauser) — Sun, 03 Oct 2010 10:10:00 +0000

My mother is the widow of a 3M retiree and as such has been covered by their Retiree Medical Plan for years and years. Just yesterday 'the letter' arrived:

"October 2010

Dear 3M Medicare Eligible Retiree or Surviving Spouse: The recently enacted health care reform law has fundamentally changed the health insurance market. Health care options in the marketplace have improved, and many readily available individual insurance plans in the Medicare marketplace provide benefits more tailored to your personal needs often at lower costs than what you pay for retiree medical coverage through 3M. Our retirees can't afford to ignore these improvements in the Medicare marketplace. On the other hand, health care reform has made it more difficult for employers like 3M to provide a plan that will remain competitive, compliant, and cost effective for both you and 3M.

Today we are announcing that the 3M Retiree Medical Plan for Medicare eligible participants will not be available beyond December 31, 2012."

Go back and read the above carefully. Maybe twice. Look for the nuance in the language. Giving health reform legislation credit for improving the marketplace is - in my opinion - debatable. The individual options my mother must now consider have been out there for years. Until I review them, I'll just guess a Medicare Advantage Plan with a zero (or very low) premium will do nicely. In fact, reform has made providing retiree coverage "more difficult" to be "competitive" and "compliant". Translation: reform has pushed 3M's costs over the edge. Again - in my opinion - they just don't want to come out and say it. (How did McDonald's fare in the press this week?)

So with this Fortune 500 company setting the pace, expect others to follow. Frankly, what employers in the public and private sector pay for retiree health insurance has baffled me for years.

MARCH 23rd + 6 MONTHS = CONFUSION!

noreply@blogger.com (Jon Rauser) — Thu, 23 Sep 2010 23:10:00 +0000

Countless articles have appeared in newspapers today referencing the provisions that go into effect six months after the Patient Protection & Affordable Care Act, which became law March 23rd. A pretty good synopsis can be found at the Health & Human Services reform website.

Politicians on the left have been out in force today reselling the virtues of PPACA. And some on the right have been equally vocal in their criticism. If there wasn't so darn much left unclear by the bill, it might be easier to discern the truth. Beyond that, those assigned to implement PPACA have only started to write the implementation regulations.

This much is clear. Health care reform will simply continue to be a political football until after November 5th. After that, the work begins in earnest. For a sneak preview of how real pros intend to adapt to PPACA, I've helped organize a forum on October 5th. We've brought together several prominent business leaders, an insurance company president, a hospital system president and two cabinet level officials from Madison. The number already registered suggests a whole lot of people are confused. More information can be found at the Metropolitan Milwaukee Association of Commerce registration link.

People weren't walking around today in a state of post reform euphoria. Similarly, the world didn't come to an end. For the most part, not much has really changed. (Yet.) And that's too bad!

Where's Everett Dirksen When We Need Him?

noreply@blogger.com (Jon Rauser) — Mon, 20 Sep 2010 19:42:00 +0000

I have signed up for an RSS feed (whatever the heck that is!) from the Department of Health & Human Services. I did so because many of the regulations clarifying provisions of the Patient Protection and Affordable Care Act (PPACA) emanate from HHS. Here is a link where you too can subscribe to these alerts.

This morning there was a notice that Secretary Sebelius had announced $130 million in grants "to strengthen and expand the health professions workforce." You can see how much Wisconsin got here.

It's not clear to me if these are funds allocated as a part of PPACA or unused stimulus dollars. Either way, I wish I had been keeping score. Darn near every day there are similar "grants" announced. Cumulatively, as Everett Dirksen once said - no, I'm not (quite) that old - "a billion here, a billion there, and pretty soon you're talking about real money!"

Want To Feel Really Good? Try This.

noreply@blogger.com (Jon Rauser) — Sat, 28 Aug 2010 14:46:00 +0000

Thursday I took a "mental health day". The forecast was for clear skies, cooler temperatures and low humidity; a perfect day to do some gardening. My wife and I built a home in the country years ago and at least once a year we take on a new project for our yard. This year, we decided to plant 20 new spruce trees. Thursday was the perfect day.

In my own mind, I had figured I could get this done in a couple of hours and be on my patio enjoying a cold beer by about 2:00. Well, thanks to our dry hard clay, it was past noon before I even finished digging the holes. And then, something happens to me once I start planting. For each tree, I worked the soil with bare hands methodically adding root stimulator and manure. It took another four hours to properly get them all in the ground and watered. I was exhausted when I finished. And covered with dirt.

And here's the mental health part. I didn't think about the office or health reform or anything during the whole time. Enjoying that cold beer (albeit later than planned), I could look out over the yard and see my new trees - plus dozens of others planted over the years - and feel a level of satisfaction hard to explain.

Bonus points: I slept like a baby that night. And went to work the next day absolutely refreshed (despite sore muscles and dirt under my nails). If I was a doctor, I'd prescribe this kind of day for each of my patients. I've read we spend over $12 billion a year in this country just on hypertension drugs. 'My' garden therapy would save a ton of money and make all the tree huggers happy to boot!

MAKE UP YOUR MIND

noreply@blogger.com (Jon Rauser) — Fri, 06 Aug 2010 21:44:00 +0000

“Everyone wants to understand how the health reform legislation will affect them. Thus, there have been countless meetings hosted by business groups and government agencies trying to help. I’ve attended about a dozen. I’m sorry to say, I’m pretty sure I’m more confused today than back in March. No doubt that has more to do with my abilities than the presenters!

Now I don’t want to sound like Andy Rooney but I’ve noticed that about half the time at these meetings the speakers refer to the reform bill as “PPACA” (pronounced p-pack-a); the rest of the time they call it “The Affordable Care Act”. I guess you know by now, the full name on the actual legislation is “The Patient Protection and Affordable Care Act”. I wonder if by calling it just “The Affordable Care Act” you somehow infer that 2700 pages wasn’t enough to actually “protect patients”? And since most analysts now agree that the bill does very little to actually reduce health insurance costs, can you use the word “affordable” and be taken seriously?

I like just speaking the acronym PPACA. “P-pack-a” is easy to say. There are no words conferring empty promises. I think we need to decide which it is to be. “PPACA” or “The Affordable Care Act”? Let’s vote. No wait. I already know the results: 219 - 212.”

About This Blog

noreply@blogger.com (Jon Rauser) — Fri, 06 Aug 2010 21:26:00 +0000

I first got my insurance license in 1981. Even back then, though I had a full quiver of insurance product arrows, folks only wanted to talk about their health coverage. All those years the headlines have spoken to the same “Skyrocketing Premiums” and “Uninsured Americans”. So now, with the March 23rd 2010 enactment of historic health reform legislation, what will change? In this blog I hope to write about just that.

The law itself – The Patient Protection & Affordable Care Act (PPACA) – is massive. Even so, it is only a start. The Department of Health & Human Services (HHS) is empowered to draft the rules and regulations that will be used to implement PPACA. And HHS will look to other regulators and state governments for additional guidance. All this will be challenging to follow.

Consumers will most certainly have to adapt to the post reform world of health care. Now that they are required to buy insurance, how they do so will dramatically change. As it has been for nearly 30 years, through insights gained from working with employers (the payers) and conducting countless employee enrollment meetings (the ultimate “focus group”), my peers and I will continue to serve as the agents of change; i.e., those who help control costs while facilitating appropriate access to the delivery of quality health care. Writing more about “What I Do” will be a part of this blog.

Finally, it seems to me there is a great irony to health reform as it stands today. Before, we all loved to complain about the insurers who stood between us and our doctors. Now, thanks to PPACA, we’ve added layers and layers of government! So ultimately, the best way to avoid all of that is, don’t get sick! Wellness and Preventive Care are natural subjects for this blog.

I hope you enjoy the RauserHealthReview. Subscribe, if you do. And thanks for any feedback you might offer.

Jon Rauser
More about the author here

TIME TO ReformAT THIS BLOG

noreply@blogger.com (Jon Rauser) — Fri, 28 May 2010 21:05:00 +0000

It has been way too long since my last posting. As I try and digest all that is being written about the PPACA, it is clear it will be a long time before we come to any real understanding of this massive piece of legislation. One case in point.

HR 3590 calls for health plans to cover dependents to age 26 later this year. Seems simple enought, right? Well, since March 23rd many questions have been raised about just who is a dependent, among other things. So, HHS Secretary Sebelius was left to clarify the matter. Two weeks ago 71 pages of regulations on just this one topic were released. 'Experts' now predict there will be 20 to 30 pages of regs for every page of the original bill. Imagine! So, now I've signed up for a link to the Department of Health & Human Services. As the regs are released, they'll show up on my desktop. Oh joy! Since "misery loves company", you may do the same here.

I'm going to sit down with my IT partner and retool this blog so that it may serve readers hoping to be savvy consumers of health care and be a source of information on the reform legislation as it is set into place.

Retooling won't take too long . . . . . . back at you very soon.

"Time In" (and Pass the Advil)

noreply@blogger.com (Jon Rauser) — Tue, 06 Apr 2010 22:19:00 +0000

I took a little "time out" since my last posting, which was on the eve of the health care vote. They did it! HR 3590, The Patient Protection and Affordable Care Act AND HR 4872, The Health Care & Education Affordability Reconciliation Act of 2010 have both been passed and signed into law. Copies of each are due to arrive via UPS tomorrow. The first is "just" 2,076 pages long; to "repair" the first, the second is 2,309 pages. Imagine. If I read about 100 pages a day - allowing for a couple of days off for good behavior and a related appearance in divorce court - I should finish late in June.

Not surprisingly, many of the summaries of the legislation differ in key areas vital to our business interests so I really have no choice but to get the facts for myself. Beyond that, I think I owe it to myself and my clients to read the darn things.

So when I'm asked "how has the new law effected you?" I can only answer: "I'm wearing out my reading glasses. I have a constant pounding headache. And I'm going cross-eyed."

It can only get better, right?!

On The Eve Of "The Vote": A Prediction

noreply@blogger.com (Jon Rauser) — Sat, 20 Mar 2010 13:13:00 +0000

We are told tomorrow the House will vote on HR 3590 - the 2600 + page Health Reform Bill passed by the Senate on Christmas Eve. Whether or not the measure passes, we'll be no closer to controlling the underlying drivers of health care costs. In fact, the Bill and the many 'fixes' contemplated through reconciliation - deals largely with insurance market practices and not the delivery of health care. A good summary of the legislation is on the Kaiser Family Foundation website which you can find here.

So regardless of how things go tomorrow, I predict the 'children' who have been wrangling over reform for a year will now take a back seat to the 'adults' who will be faced with the real work of finding a way to pay for health care - reformed" or not.

Health Care Reform: "The Sky Is Falling! The Sky Is Falling!"

noreply@blogger.com (Jon Rauser) — Wed, 17 Mar 2010 18:24:00 +0000

The final stages of the health care reform debate remind me of the old story about "Chicken Little". Now don't get me wrong, I think there are elements of HR 3590 that are terrible and the real reform that needs to take place - lowering the cost of care - is largely unaddressed in this legislation.

Unfortunately however the endgame has devolved into a giant excuse for raising money and not an honest debate of the issues. Case in point is an email I received from John McCain last Thursday entitled "Time is running out on health care reform". I am implored to "send a message to President Obama, Harry Reid and their friends on the left that the opposition to this plan is strong . . . . . we have very little time, and every dollar counts." Then, a couple of hours ago I received an email from the MoveOn.org crowd entitled "Wow!" In it I'm invited to donate money to help support as yet unknown candidates to challenge any House Members who vote against the Reform Bill. They've raised $1 million this week alone (thus the "Wow!") but want to raise another million by Friday.

And in between just these two recent examples, I'll bet I've had more than a dozen other similar solicitations. All of them claim "the sky is falling" and only by sending more money can 'we' win the day.

Dragging this battle on from Labor Day to Thanksgiving to Christmas to the State of the Union Address to now . . . . . . . and maybe on to Easter and then beyond . . . . . . may not be an accident. A cynic in the crowd might conclude delay is good for business! I just hope I have some change left in my pockets after it all ends!

"Carl From Duluth": Just Another Happy Customer

noreply@blogger.com (Jon Rauser) — Fri, 12 Mar 2010 09:18:00 +0000

Tuesday morning (March 9th) I was a guest on Wisconsin Public Radio's Joy Cardin Show. I was invited to do so by the show's producers who had read my February 24th blog "defending health insurers profits". Ironically, the blog was actually about exposing a public servant's bias so by interpreting the blog as a defense of insurers, didn't the WPN producer reveal a similar bias?

Anyway, I thought the callers were actually pretty balanced and fair. A friend observed he thought I was unusually composed in the face of at least one hostile caller. I could only reply in this way: for 29 years I have been visiting with groups of employees delivering the (always) good news of rising premiums usually accompanied by reduced benefits in the form of higher deductibles and co-pays. I've pretty much heard it all. "Carl from Duluth" could easily have been a client!

Here's a link to the archived spot. (Scroll down to Tuesday March 9th, 6:00 AM.) I'd welcome your critique.

What Do Scott Brown, Ben Nelson & Mike Pence Have In Commmon?

noreply@blogger.com (Jon Rauser) — Tue, 09 Mar 2010 17:32:00 +0000

I am in Washington D.C. at the National Association of Health Underwriters annual "Capitol Conference". With the President making his final (?) push for passage of the Senate reform bill - calling for a House vote March 18th - it is timely to be at 'ground zero'.

Newly elected Senator Scott Brown (R-MA) was one of our first speakers. He was followed by the somewhat infamous (as in "Corn husker Kickback") Senator Ben Nelson (D-NE). Congressman Mike Pence (R-IN) rounded out the morning session. Besides all three speaking at our NAHU event, I was struck by how different they seemed from their media portrayals. Frankly, Senator Brown wasn't all that gifted or charismatic as a speaker. (Although the ladies in the room obvioulsy found him to be pretty hot!) No, his message was just straight talk about being sick of politics as usual. It was I think that message that got him elected not some slick style.

Senator Nelson displayed a workable understanding of the complexities of health care reform; I particularly liked his comments about preserving the role of the agent/broker in a revitalized system. (Of course, he was preaching to the choir.) Representative Pence was terrific. I think I'd most enjoy having a beer with him. It seemed interesting that with Congress' approval ratings so low, all three came across as honest sincere guys.

Also, all three shared this assessment of "reconciliation"; don't hold your breath! Here's what they said. The Senate has passed a Bill. The House will be asked to pass the same Bill next week. If they do so - and that is a BIG if - HR 3590 (The Patient Protection and Affordable Care Act) becomes law when the President signs it. And he surely will.

Those that expect HR 3590 to be changed/fixed after passage are drinking the Kool Aid. Once it is law, it's done.

Just thought you ought to know what the insiders think.

Brother, Can You Spare An Hour?

noreply@blogger.com (Jon Rauser) — Fri, 05 Mar 2010 23:03:00 +0000

For all the frustration over double digit premium increases, at least some employers are controlling health care costs. At this link, you can watch a health care panel discussion that was a part of the WMC Business Day in Madison February 23rd. John Torinus from Serigraph is the last of three speakers and the entire discussion is a little over an hour. It's all good stuff but make sure you listen to John. Take notes. I did.

Let me know what you think.

Exposing One Public Servant's Bias

noreply@blogger.com (Jon Rauser) — Wed, 24 Feb 2010 16:41:00 +0000

Yesterday I attended the WMC Business Day in Madison. The afternoon session included a panel discussion on health care which was recorded (about 65 minutes). It will be archived on Wisconsin Eye in a few days. John Torinus talked about how he is controlling health care costs at his company and how those same principals can be applied to other businesses and the public sector. It was a compelling presentation; one everyone should watch.

Also on the panel was the Secretary of the Department of Health Services, Karen Timberlake. She talked about steps the state is taking to control costs. Again, I hope you will seek out this presentation and listen to her remarks as there are some very positive steps being taken. Regrettably, she had a few comments on health insurers that showed her great bias against 'my' industry.

A power point slide focused on how in 2009 health insurers profits increased by 56% while over the same period they were "dropping" 2 million people. I don't have access to the industry wide P & L results for 2008 and 2009 but I happen to know 2008 was a terrible year for health insurers. In addition to the usual underwriting losses, their investment portfolios (like everyone's) were hammered by the stock market crash. (Investment returns often offset unexpected claims.) So if insurers collectively had earnings in 2008 of about 1.8% of revenues but in 2009 earnings recovered to about 2.8% (these are estimates but pretty darn close, I'd wager), that would be a 56% increase. By reporting only the % increase, it sounds pretty bad doesn't it? (Now I ask you, what business owner in his/her right mind would be content with earnings of only 3% of revenues?)

As for "dropping" 2 million members, do you suppose the economy had something to do with that? H-m-m-m, haven't I been reading something about unemployment over recent months and don't the majority of Americans get their health insurance through their employer?

At least in this case, Secretary Timberlake - like so many politicians on both sides of the aisle - seems to be distorting the facts to her end; i.e., if you portray health insurers as scheming to drop 2 million (just the sick, of course) customers to pad profits, does a gullible public conclude government might do better?

Well, we're not as gullible as 'they' think. And by distorting the truth so badly, 'their' overall credibility is even lower than the insurers they vilify.

And while I'm thinking of insurers, I'm sure you're hearing a lot from the same political class about recent premium increases. While I'm hardly a lackey for those insurers I represent - and clearly some of their increases seem unnecessarily high - regulators have a lot to do with premiums. Insurers are required to remain solvent. If we applied the same rules to Medicare, the tax increases would make premium hikes seem small! My suggestion is that Medicare's 'Board of Directors' (that would be Congress) get their own house in order before they presume to second guess insurers!

Why Premiums Are So High: Chapter 287

noreply@blogger.com (Jon Rauser) — Fri, 19 Feb 2010 10:02:00 +0000

Clients invariably tell me of their own encounters with health care. Here's another anecdote from just the other day.

"I took my wife to the doctor for a varicose vein procedure. We arrived for her appointment at 9:00 in the morning. By 11:30 we were at Panera Bread having lunch. There was no surgeon; no anesthesiologist. Not sure what exactly was done but for the short time she was there, I never expected to see a bill for $13,000!"

Stories like this drive me nuts. Is this a fair price? (Maybe it is.) I imagine a doc doing about a dozen or so procedures a day at $13,000 a pop. Wow. Isn't it just a matter of time until the opening of a "Veins R Us" where you can have sclerotherapy for $1000?

I hope so . . . . .

Sanity Check: Why Don't 'They' Just NOT Answer?

noreply@blogger.com (Jon Rauser) — Thu, 18 Feb 2010 18:35:00 +0000

I just made a business call to a vendor's cell phone number. As I usually do, when he answered I asked if I was interrupting. His reply: "Yes! I was in a meeting but stepped out to answer your call. I should probably go back in (to the meeting)."

Now tell me please, why the heck didn't he just turn off his damn phone? I could have left a voice mail message. That would have been far more efficient than the exchange we had. Now he has to call me again just to find out what I want.

We live in goofy times . . . . .

Paying My Respects To A True Gentleman

noreply@blogger.com (Jon Rauser) — Tue, 16 Feb 2010 14:34:00 +0000

Today is the funeral of a good friend; an unassuming man of character, dignity and common sense. He was a great leader. There will no doubt be an overflow crowd paying their respects at the church today. I'm pretty sure this little 'eulogy' posted on line would make him uncomfortable so I'll not share his name. And what, you might say, would one man's death have to do with health care?

Well you see, my friend served on the Board of Directors of a health insurer for years. Many of the most strident health care 'reformers' routinely vilify insurers for having the audacity to underwrite risk and other 'evil' practices. They often paint a picture of greedy executives scheming in board rooms for ways to deny claims to enhance profits. To know my friend, such portrayals are ludicrous and downright insulting. (And I know many executives at many health insurance companies who endure these insults with barely a peep of objection.)

People run health insurance companies. Mostly good people. We just lost one and I will miss him a lot.

Medical Tourism; Maybe Your PPO Network IS Too Small Afterall

noreply@blogger.com (Jon Rauser) — Sun, 14 Feb 2010 09:10:00 +0000

Suppose you are a business owner with 220 employees. Like the majority of medium sized to larger businesses, you partially self-fund your health plan. By that I mean, you have 'stop loss' insurance but only after - let's say - the first $75,000 of claims per covered life come out of your pocket. Despite your best efforts at promoting wellness, every year one or two people in your group have a very expensive episode of care. Wouldn't you jump at the chance to reduce the cost of those 'shock loss' claims by 50 to 75% or more?!

I've been reading about "medical tourism" for a couple of years now. What is that? Well, check out this link for a prime example. Take the Bumrungrad International Hospital 'virtual' tour that can be easily accessed on their Home page (upper right). After just three minutes, I wonder if - like me - you'll be thinking what I'm thinking; why isn't this facility in my PPO Network?

Perhaps it's (past) time to demand that your insurer or self funded TPA (Third Party Administrator) credential and add facilities like these to our networks of providers.

When Will Obama Deliver His State of the Union Address?

noreply@blogger.com (Jon Rauser) — Tue, 05 Jan 2010 14:55:00 +0000

There was a short article in this morning's paper describing the process by which the Senate and House Health Care Reform Bills will be reconciled. What I found interesting is that the time line for the process suggested a completion date sometime in February. Previous reports had suggested a Reform Bill had to be on President Obama's desk before January 19th so he could sign it in time for his State of the Union Address. I had the date circled on my calendar!

Apparently there is no requirement that the SOTUA must occur in January; in fact, in the first year of a new President's term, it usually doesn't happen until February. Nevertheless, previous reports had indicated a January 19th target date for Health Reform legislation to be done. This followed earlier reports that it would be done by Christmas. Or Thanksgiving. Or, Labor Day.

It's actually pretty sad. About 75% of what is in both the House and Senate Bills is acceptable to liberals and conservatives alike. A Bill could have been passed months ago.