Wednesday, September 12, 2012

The Ryan Voucher System and Sleepless Nights


Simply put; Paul Ryan's "Voucher System," for Seniors keeps me up at night.  After spending twenty years in healthcare I consider myself an expert in the insurance game and can state without reservation that the insurance carriers make Bonnie and Clyde look like The Salvation Army.  Insurance companies  represent an extremely powerful lobby whose influence on Capital Hill makes me wonder how much they contributed to the Romney/ Ryan campaign chest, now and prior to his nomination for Vice President ?

One of the biggest frustrations faced by any practice administrator is the constant battle to receive reimbursement for even the most carefully prepared, cleanest transmitted, and authorized up the gazoo claim !  Working on an accounts receivable can drive the most dedicated and experienced billing employee to distraction.  But I digress.  Let's look at the dynamics behind a voucher system for Seniors and discuss the obstacles that make this system such a poor idea.

Alternative health insurers have spent decades wooing seniors in communities throughout the United States and offering them Medicare alternative plans that would free them from the yearly Medicare deductible and provide prescription coverage with either a small or zero co-payment.  Seniors who found the Medicare deductible a financial hardship and whose prescription costs were skyrocketing signed up in droves.

The first problem was that at least 50% of those seniors who adopted the Medicare alternative plans had no idea that they would be giving up their Medicare Part B coverage.  They presented for care in physicians offices with their Medicare card, without realizing that they retained only Medicare Part A.

Secondly, some plans did require a referral from the patients primary care physician and these referrals were also absent at time of visit, especially for those that presented for an emergent visit, where the staff did not have the time to verify their coverage and in many cases were under the impression that the patient was covered by Medicare, where a referral was unnecessary.  

In addition, patients had no real understanding of which tests and procedures were covered under the new plan and many hospitals that these patients had used for years; hospitals in their own community, as well as some of the hospitals who provide specialized care for cancer treatment, etc, did not accept their new primary coverage.

In short, a large portion of the seniors that were treated in facilities that I personally managed had less than a clue about any of the above problems.  

The practices that I spent the majority of my time managing were all located on Long Island, twenty short minutes from Manhattan, one of the most cosmopolitan and sophisticated cities in the world.  If my patients were confused, can you imagine expecting seniors who live in rural areas of the USA to suddenly start shopping around for competitive insurance rates and to outline their health histories and needs for specialized care, before deciding where to use their voucher coverage?  People, this is just ridiculous!  As an Administrator for Cardiology, it was a herculean effort to staff my front office with enough employees to answer the countless questions regarding testing procedures and physician instructions.  Whose practice, or what organization is going to be responsible for assisting seniors in making their insurance choices?

 I guess the insurance companies can sponsor more breakfast and luncheons, but based on my past experience this will not be an adequate salve for the problem.  As far as the Ryan plan forcing the insurance carriers to become rate competitive, I can hardly keep a straight face!  These companies are big, profit driven, monsters, whose bottom line is profit, profit, profit.  Once rates for companies participating in Ryan's plan are established, trust me, there is no where they will go but up.  Is Ryan going to assure us that there will be a cap on voucher costs?  I think not!

Campaign rhetoric is full of the promise that Medicare is no longer a viable system and will collapse in the years ahead.  Those who oppose the Obama Health Care Plan tell us that small businesses will go bankrupt providing health care coverage for their employees.  Perhaps I live in the age of the dodo, but we baby boomers most often chose our jobs based on the benefit package available, including health care coverage, which, by the way, was most often free of employee contributions. Companies who did not offer coverage were often stuck with the lot of substandard employees who had a hard time finding work anywhere.  During the ten years that I worked for Varig Airlines, I was 100% covered by Cigna Insurance after my probationary period was successfully completed.  In addition, Varig matched my pension contributions dollar for dollar up to 6% of my total earnings.   Those were the days, when the CEO of companies based in America collected a fair wage for performance and profits from a hard days work were shared equally, up and down the line.

Today, most companies expect their employees to pay a portion of their coverage and the Obama plan is not asking employers to fully fund health care.  There are inexpensive plans on the market that provide basic coverage, with slightly higher deductibles, that most small businesses should be able to afford, providing that the small business owner does not expect to walk away each week with the lion's share of the profits representing far more than a fair and equitable wage.  The Republican Party is vehement in their opposition of the Obama Plan and threaten to repeal it the moment they take office. Or keep some of it.  That seems to be the latest in the Romney/Ryan plan.  Politicians have been working to come up with an idea for health care for its citizens for the past fifty years, but when a plan is proposed, it is met with a resounding NO.  Eventually NO leads to NOTHING, and this seems to be the hallmark of American politics for the past decade.

When Medicare was born, we had no assurances that it would be a success or fail miserably.  This is true for Social Security, the Head Start Program, and programs that put Americans to work during the depression.  If the Obama plan turns out to be a loser, we can kiss it goodbye.  But to simply deny its existence, or scrap it, in favor of NOTHING?  Is this counter-productive or am I living in the land of the  hopelessly optimistic?   Instead, as the Republicans desire, we should scrap Medicare, and replace it with tickets for coverage.  Tickets?  Just because most seniors remember the early days of Disneyland, where E-tickets gave you the best ride, doesn't mean that we want to take that ride, or save it for ten years for our fellow cronies to use !

Of course, if we made or produced anything in this country anymore, we could offer more opportunities for business to grow and thrive and the question of a business covering their employees would not suddenly seem as if it was a new and nightmarish idea.  All at once, we are proclaiming that the idea of an employer providing his workers with coverage is as horrific as Hiroshima.  When did we develop this sense of memory loss regarding the connection between employment and insurance coverage?  I would have to speculate that we disregarded the fact that it ever existed in the light of our new desire to covet more profits.

Some would proclaim that our jobs are too slim and our population too large to provide benefits that existed for decades in the past.  Well people, if we stopped sending American jobs overseas.  If China paid a fair import tax.  If we did a better job of patrolling our borders, then perhaps American business could put Americans to work, and protect them in times of sickness and health.

Having owned a start up medical practice, it was my job to provide the employees with coverage. I did the research, I paid the premiums, I investigated new plans each year, and was still able to draw a fair salary for the efforts of my labors.  This is not an anti-success idea, nor does it represent a desire to keep small businesses small.  Over the past few decades, Wall Street and the banking institutions have flaunted the fact that their bigwigs brought home billions, while those who made those profits possible; well - who cares!

We have become a society that applauds greed and bulldozes over anyone who dares stand in the way while we plunder our corporations, lay off workers, export our jobs, and do it all with a shrug of apathy.  If we see it often enough, we become immune to the disgrace of it and literally become the fairy tale of '"The Emperors New Clothes."  We keep saying that the king is clothed, while our failures are nakedly apparent.  We might start to solve some of our problems, if just one of our politicians decided to finally tell the truth!

Let us also realize that citizens without adequate health care coverage often present in our hospital emergency rooms, where patients cannot be pre-screened and treatment cannot be denied.  Overwhelming costs for treating the uninsured have allowed thousands of smaller hospitals to be gobbled up by larger health care systems where treatment becomes standardized, and may be inferior.  Forget about bankrupting small businesses; should we ever face the day where our healthcare system is bankrupt, our problems will be far greater than a lack of profitability.  

Those who wish to ignore the poor and disenfranchised fail to realize that they may not ignore us.  As poverty and unemployment increase; when those without jobs or those who are homeless are ignored, it is not speculative to remind ourselves that crime increases.  Desperate people perform desperate acts.  Eventually, there is no ivory tower, or apathy to protect us.

Finally, as a representative of the generation who have or will approach the age where we can avail ourselves of the benefits of senior status, I am far from fooled by the constant blather of those who point out that the reserves for our time will not be available.   Certainly, Obama, Romney, and Ryan can pay the costs for their health care with the spare change that lines their pockets.  Unfortunately, most of my generation cannot do the same.  There is enough blame for both sides of the aisle.  If the politicians are so concerned with the issue of health care coverage for the uninsured, why don't they just give all of us the same Federal Plan, which covers their every ache and pain so effortlessly.

Perhaps the government should rename the baby boomer generation, AIG, or Morgan Stanley.  They might suddenly find a trillion dollars or so to keep the Medicare system intact.






Thursday, September 6, 2012

Stimulating The Economy



The 2012 Presidential race is reaching fever pitch.   Both the Republican and Democratic candidates agree that our economy is in the toilet, but neither Romney or Obama seem to be able to communicate exactly what plans they have for economic recovery.  More government, less government, and the grey area in between don't leave any of us in the middle class tremendously optimistic about the future.

The fact is, that despite all of their experience in business or politics, most citizens are fearful that any great idea for economic growth will die on the vine or become the victim of bi-partisan immovability.

Perhaps it might be a good idea to first take a look at the state of the economy, admit some hard to swallow truths and then take action to move forward.  Many of us struggling to maintain our status in the middle class discuss these issues with our family, friends, and neighbors in our community.  It's difficult to understand why the ideas that spring from our conversations have never been previously considered or implemented.  

In this blog post, I will attempt to lay out some of the ideas that spring from the work place and the dining room tables across America.  Agree or disagree with them, but admit that at least our thinking caps are in place.

1.  In order to spend money to stimulate the economy, middle class pockets need to contain more than laundry lint.  It's impossible to buy goods or purchase services if you are barely able to pay the bills or put food on the table.  American banks received billions of dollars in bail out cash, but not one dollar was spent to bail out the millions of Americans who lost their homes, their jobs, and many of their hopes for the future.  One good idea may be the initiation of a state lottery program, administrated by the Federal Government and named,"Free Mortgage Money."

Instead of picking a series of numbers, Lottery players would purchase a $2.00 ticket that would be fed into a computer.  The paid ticket would entitle its holder to enter their names, address and amount of mortgage debt into the "Free Mortgage" computer.  At the end of each week, for every two million dollars played, one million would be paid to the state coffers and one million dollars would be used to pay off up to two hundred and fifty thousand dollars of the winners mortgage debt.  The computers would be set to randomly pick the names of the winners and calculate how many winners would benefit each week, depending on the money owed by the winner and the amount of money collected in lottery play.

The technology would be simple to implement and winners names and addresses could be posted on a web-site each week.  The winners would report to their local lottery office where administrators could assist them in transferring funds directly to the institution holding their mortgage debt.  Perhaps we could use some of the thousands of brilliant law graduates who have passed the bar and remain unable to find a job in their field to administrate this process.    

All parties benefit from such a program:  states get a weekly infusion of funds, the mortgage winner now has the funds to purchase more goods and services, and even the banks who seem to require your first born child before they give you anything, could use the cash infusions to create new mortgage money or to offer low interest loans.  Law school graduates could finally move out of their parents basement, gain work force experience, and have a salary to pay back some of their enormous school loans.


2.   In most of the Northeastern states, property and school taxes are beyond belief.  My own taxes are close to ten thousand dollars a year and most of my neighbors question just what we are getting for our money.  Certainly in other parts of our country there is garbage collection and snow removal for less than ten grand a year.  Our roads in New York are filled with potholes and many of our public and parochial schools are using desks from the 1950's.  For the most part, our homes are modest and many of us have a lot that measures 40 by 100, so its not like we are paying for an estate that holds our collection of Arabian ponies.  If you have ever traveled to other parts of our country and looked at the sizes of homes and lots, you have no doubt shaken your head in disbelief when you become aware that you are paying double or triple the taxes of your fellow citizens.

Yes, wages may be higher in the Northeast and job opportunities more plentiful, but the disparity between salaries and the prices of homes in our neighborhoods are not what they used to be when our parents moved from the cities to suburbia.  For those of us whose kids are grown and gone from the nest, enormous school taxes are especially hard to swallow.

Perhaps it might be more equitable to offer a tax rebate or reduction to homeowners whose children are no longer enrolled in the school system.  A 50% reduction in school taxes for these families seems fair and solves an even larger problem.  Currently those who rent in a community are exempt from payment of school taxes.  This includes those who are not yet citizens, or are in the country illegally, as well as those who are not home owners.  If your children are registered to attend schools in the community, you should be responsible to shoulder some of the costs of their education, despite the fact that you do not own property.  

3.   Those currently unemployed for more than six months should be required to perform some form of community service in order to receive a weekly check.  This should also be true for those who collect welfare and are not caring for young children or a sick family member.   Teachers can offer tutoring or mentoring services for schools in their community.  Those in the legal field, who have lost their jobs, or who cannot find a job, can provide free assistance for a certain number of hours each week for those citizens who require and may not be able to afford such services privately.

We have seen the large number of individuals who turn out each winter to clear snow from stadiums or streets.  Thousands have shown up for these jobs to earn $12.00 an hour.  With our employment rate holding steady at 8%, why can't we create jobs for individuals to shovel snow for seniors who register in advance for these services at their local town halls.  In spring and summer, these same individuals can be trained to make street repairs or to clean and refurbish our parks, many of which are unfit for use by the community.   This is certainly a solution to work for welfare and does not cost the Federal or local governments additional funds.

Construction companies who have suffered from a lack of projects due to the economy could receive a government grant to rebuild and refurbish the large number of abandoned buildings that are found in and around the New York area and other parts of the country. Thousands of new jobs would be created  and these buildings could be turned into low cost housing so that none of our citizens are forced to live in the cars or on the streets of our nation.

All such buildings should be manned by adequate security forces such as those that are utilized by the tonier apartments in our cities.  This would avoid the influx of drugs or destruction of property that caused the abandonment of these buildings in the first place.

Adequate security forces for such projects would provide jobs for returning veterans or for those who have received security training and continue to seek elusive employment.

Small businesses would spring up to serve the needs of these communities and the community would continue to develop and grow.

4.  Years ago, I purchased clothes made in the United States that I was able to wear for years.  Today, our country makes absolutely nothing.  Even Calvin or Anne Klein can't seem to make their apparel lines outside of Malaysia or China!  The goods we now purchase are often substandard and you are lucky to make it through one season with the clothes produced overseas.  Perhaps, we are not purchasing consumer items because our stores are stocked with inferior goods.

Many of the communities in our country have hundreds of empty storefronts representing the efforts of small business to compete with the foreign countries that now produce everything from our underwear to our toaster ovens, electronics and automobiles.

Our Federal government needs to sponsor a new program called: "Made in the USA."  The abandoned storefronts in our neighborhoods could be turned into shops where we start producing at least our own clothing again.  As a child, I watched my grandmother proudly work for the ILGWU and produce some of the most well made and affordable clothing offered for consumers in the United States.  Even if we started with a small storefront and some knitting machines, subsidized by state or Federal dollars,  certainly we could produce sweaters that American consumers would be proud to purchase and wear.  Let's utilize the same expertise that made the ILGWU such a great organization.  With so many unemployed, I can predict that thousands would show up for the opportunity to either practice their skills or be trained to produce quality goods.  Wages could start off on the lower end with the chance for those employed in these businesses to eventually own the business or at least share in the profits.  Stores that agree to display American made sweaters would receive an tax break for showing these items in their stores and keeping their prices competitive.

In order for us to succeed as a country, we need to stop the massive import of foreign made goods.

5.  Instead of tolerating the insane costs of heating oil or electricity, lets provide our citizens with the tools to convert part or all of their homes to solar efficient dwellings.  Today, it costs about thirty thousand dollars to install the equipment needed to harness solar energy, a cost too prohibitive for most citizens in these trying economic times.  If we want our citizens to spend money to stimulate the economy, why don't we provide them with the tools to save on the high cost of monthly energy use.  It cannot be that difficult to train employees to install such systems, creating not only new jobs in the industry but significant savings to American consumers.  Perhaps our leaders need to start with a program that is possible, instead of the loftier plans proposed each year and yet here we are, still dependent on foreign energy sources.

Solar energy would also allow us to utilize cars that are not dependent on gasoline.  Right now the cost of plugging in your car every evening would force most of us to work three jobs just to pay our electric bills.  Buying an electric car is just not an option that we could afford to adopt without solar energy to defray the cost.  Let's keep it simple people and create jobs that would allow citizens of the United States to profit from their creation.

If we calling our citizens to action and making promises that we will give them access to the American dream, we need to have the kind of leadership that spends money on programs that will allow us to grow and prosper.  If we can afford to bail out the banks, the automobile industry, and finance wars that cost us billions of dollars and thousands of American lives, perhaps we can provide our citizens with some simple solutions.











Wednesday, September 5, 2012

Tom Cruise, Scientology, and the Crazy Women in his life


Once again, the media is chock full of stories about the trials and tribulations of the women who have come and gone in the life of Tom Cruise.  Countless photos of Katie Holmes clutching little Suri protectively in her arms on the streets of Manhattan, as if the child could suddenly be in harms way from the wacky reach of Scientology, in the midst of hundreds of paparazzi!

Now we find out that Vanity Fair's October issue will feature a story about Scientology's auditions for a suitable spouse for Tom.  Supposedly, prior to the "Katie days," Tom's church conducted a massive search for the perfect woman who would not only worship Tom but also show the proper reverence to the hierarchy of L. Ron's disciples.   The woman in question was supposedly required to dye her hair, and shave her incisors in order to become the perfect woman for Tom and members of the Celebrity Center of the church.
When the romance went south, the poor dear was forced to scrub toilets with a toothbrush and censured  for her failure to make Tom dance across a couch in the Oprah Winfrey studios.

Obviously, the trod upon women who dated or married Cruise had only the purest of intentions and had spent much of the time before meeting him probing the surface of an obscure planet, making them totally unaware that Tom was even remotely affiliated with Scientology, let alone that they might be expected to become affiliated as well.

I don't know much about the principles of Scientology, nor would I assume to judge any form of worship, other than those who advocated doing harm to others.  I do like to think, however, that before I agreed to date or marry someone, I would have a complete understanding of my partners commitments and obligations.  Tom Cruise doesn't do much for me; I mean he is no "Baldwin," as far as I am concerned, but there is no doubt he is a man with money, power and charisma.  Perhaps, these were the charms that convinced his former partners to overlook his dedication to a religion that appears to be a major part of his philosophy of life.

When she married Cruise, Holmes had a Scientology ceremony.  His best man was a major honcho in the Scientology community, and his children, from his marriage to Nicole Kidman, practiced his faith.   Perhaps that should have given Holmes the slightest of clues to Cruise's intentions regarding their own lives and future offspring.  It not as if Cruise suddenly jumped on this particular bandwagon and experienced an instantaneous conversion and demanded her conversion as well.  Had Holmes considered his religion some crazy cultish dogma, it should have been her obligation to assign those characteristics to her future husband as well.

Maybe Vanity Fair should consider writing an article titled,"Women Who Deny."  They could interview a wide variety of women who swear to having no prior inkling that their husbands were gay, abusive, gamblers, drunks, or drug users, until well after they dressed in white and marched down the aisle.  It might be hard to swallow, since the magazine seems to cater to women who aspire to independence, ambition, and shopping for just the right shoes and handbags, but still, with the right slant, some readers might just buy it.