Boston Marathon 2013- When Health Care Works

When we’re constantly reminded of all the things wrong with our health care system it’s pretty easy to be critical of it. We hear about all of the unnecessary costs, the inefficiencies, the errors, and the waste and we start to envision a system that can’t seem to do anything right. It’s easy to be negative about health care today.

While the health care system itself may be broken, there are times we need to remember those who are called to work in this broken system and perform their tasks admirably under difficult (or almost impossible) conditions.

We need to remember the medical teams at Massachusetts General, Bringham and Women’s Hospital, , Massachusetts General, Boston Children’s Hospital, and Beth Israel Deaconess Health Center who were called to respond to the tragedy at the Boston Marathon last week. We need to remember their hours of tireless effort as they worked together to save lives, save limbs, and treat the injuries of over 200 Americans. They didn’t care about insurance coverage or the patient’s ability to pay for the care they were receiving. They could have cared less about Obamacare or the fees they would receive for their work- these heroes were focused on doing what they were trained to do, to help save lives.

As we move back into the never-ending debate about how to fix the health care system let’s also take some time to recognize and appreciate when things work well. The Boston health care community responded admirably and continues to care for those recovering from a senseless act of violence (including the one who created it). Their compassion, dedication, and commitment will continue to guide their actions and help the victims heal. The first priority is care for the patient. That is the essence of what our health care system should be all about.

The ACA: More Expensive Than We Think

The Affordable Care Act has turned three and it’s been a rough three years.


The law has plowed through a number of legal challenges (and more will come), survived numerous attempts of repeal, and continues to face a largely unsupportive public. Nobody said changing health care would be easy. It just seems it could have been accomplished in a different way.

To be fair, during the three years since it passed the law has accomplished a few of the things it set out to do. But the real challenges are yet to come- and the challenges are all going to be about the cost.

When this whole effort began in 2010, the CBO estimated that even with the costs associated with it, the ACA would still reduce the debt by $147 billion over 10 years. I always keep in mind when Medicare and Medicaid were enacted in 1965 both program blew through their budget projections within the first two years. Government numbers seem to be optimistic and many times they are wrong. The CBO numbers are likely to be optimistic as well.

The Society of Actuaries released a study estimating that the “cost of claims” (and insurance) as a result of the provisions required in the ACA will increase costs (on average) by 32% in the individual market. The actual results vary by state with Ohio and Wisconsin the “winners” with their costs increasing over 80%. On the other hand, New York and Massachusetts insurance costs in the individual market would decrease by over 10%. On average, however, the costs nationwide will increase 32%.

Now, this 32% increase is only applicable to the individual health insurance market. However, health insurance companies have already indicated the costs on the employer side are likely to increase as well. We’ll know more when they start delivering their 2014 renewals to employers in a few months.

The ACA has focused way too much on getting more people into a costly, inefficient system. It does very little to address the real problem. Unfortunately, unless something dramatic changes we’re going to be paying for it- and it’s going to cost a lot. We’d better be prepared.

State of the Union- The Gridlock Will Continue

The President’s State of the Union address and Marco Rubio’s response underscored the fundamental challenge our country faces today.  We will continue to struggle with finding the right “balance” between free-market and government sponsored solutions to dig us out of the economic mess we find ourselves in. Unfortunately, the two messages couldn’t have been more different.

President Obama’s message was filled with government programs designed to stimulate economic growth. He clearly believes increased government spending can dig us out of hole we’re in. He stated, “Deficit reduction alone is not an economic plan.” This may be true- but the deficit can’t be ignored. The interest payments we’re paying on the debt is becoming a larger component of the federal budget. If interest rates start to rise (and they will eventually) we could find ourselves in a bind that will be tough to get out. His overall package sounded very expensive.

Rubio countered with a smaller government and a deficit-reduction message.  He (and his colleagues) believe the increased spending and increased taxes will actually backfire and hurt the middle class. Unfortunately, he didn’t provide a lot of specifics on the programs he would recommend.

It was interesting to note that both Obama and Rubio agree on the primary issues facing the country- the economy, jobs, health care, and education. Their methods for addressing them are polar opposite and (as has been said many times before) the real answer is somewhere between the two.

Unfortunately, with the political picture we face today we are unlikely to come to some common-ground; and the gridlock concerning the economy (and health care) will continue while the debt and deficit will continue to grow. The State of the Union messages only reinforced this fact.

The Health Care Fiscal Cliff is Next

No matter where your political views lie- most will agree that President Obama is a really good communicator. He’s easy to listen to, what he says seems to sound logical, and he just comes across as a “nice guy.” But, like everything else on the political scene anymore, I just don’t know if I trust him.


Obama gave another “photo op” speech yesterday to try to get the general public more engaged in the fiscal cliff debate in Congress. In front on an obviously staged audience, and standing in front of 14 “average Americans,” the President encouraged those watching to keep the pressure on Congress to get a deal done to avert the economic collision they created. Once again, his comments sounded logical, he was easy to listen to, and he seemed like a nice guy.

But he made a comment during his remarks that took me by surprise- and it was about Medicare.

Ever since March, 2010 I’ve been trying to get behind the health care model that was created by the Affordable Care Act. I don’t like the law, I don’t agree with many aspects of the law, but it is the law. Something has to be done to fix the crisis we’re going to experience with health care costs and the Affordable Care Act is what we have to work with. There are some provisions in the law that makes sense and a lot of things that don’t. But I thought it was all supposed to be based on changing the trajectory of health care costs (including Medicare) and contribute to a reduction in our deficit over time.

Yesterday, to highlight his willingness to compromise on a fiscal cliff deal, President Obama said, “For example, I’m willing to reduce our government’s Medicare bills by finding new ways to reduce the cost of health care in this country. . . We want to make sure that Medicare is there for future generations. But the current trajectory of health care costs has gone up so high, we’ve got to find ways to make sure that it’s sustainable.”

Silly me, I thought that was the whole idea behind the Affordable Care Act.

With the exception of enrolling more people into a high-cost, inefficient, health care system- I’m not sure what the Affordable Care Act is about any more. All I know is that it’s going to be expensive and it’s going to get even more complicated; not what I thought I was signing-up for.

Happy New Year

Asking the Wrong Questions

For the first time since 2000, Gallup has found a majority of Americans now feel it is not the federal government’s responsibility to make sure all Americans have healthcare coverage. According to a recent poll, 54% now feel it is not the government’s responsibility as opposed to 44% who say it is. 

Gallup also found most of those interviewed still think health care system has some major problems, don’t like the costs, but are generally satisfied with the care received when needed.

Whether or not it is the federal government’s responsibility to make sure American’s have health insurance isn’t the real question. If the question was changed to, “Is it the responsibility of the federal government to make sure American’s have access to affordable health care?” the answer results might be different. Considering the fact that health care costs are now impacting the entire economy, I know I’d say it is.

It’s pretty amazing that after all that has happened we’re still having separate discussions around these topics and haven’t put them together. Health insurance financing of health care and an affordable health care system are related.

The Health Care system is moving in the right direction but is resisting the change any way it can. It’s going slow. Until we bring the general public on-board, making the changes that are going to be required is going to be much more difficult. If we used Gallup’s numbers and assume over half the country may be resist the changes that are coming because they don’t understand them, the challenge may be overwhelming.

That is why educating the public about what is going on and getting them engaged critical. They are going to need to be more engaged than they are today to make the change happen.

Now Fix the Affordable Care Act

The election is over. It was close, but not as close as some thought it might be. At least we now have an idea of the direction we’re heading as we try to fix health care. The Affordable Care Act (ACA) is certainly not perfect and not too many folks actually like it (it’s expensive and very few understand how the pieces of the law are all supposed to fit together). But it’s what we have to work with.


The House of Representatives continues to be controlled by the Republicans and the Senate by the Democrats. And we have a Democratic President. No change from where we were before. The respective numbers changed slightly in both the House and Senate, but the overall picture looks the same. Hopefully, the two sides will start working better together more than they have been the last four years.

The pundits are analyzing the results. Some think President Obama has a “mandate” from the general population. I don’t think so. He was simply given more time to deliver results. This wasn’t a mandate, it was a message. Most of the general public is exhausted from the process and simply wants Washington to start fixing what needs to be fixed and quit the political warfare that has already cost us our debt rating has brought us close to the “fiscal cliff” that will occur on January 1 if some pretty bold actions aren’t taken, and the debt and costs continue to grow and the average citizen continues to feel the results. We won’t fix our problems if the two sides don’t start working better together. President Obama needs to lead by example.

Now would be a good time for both sides to sit down and re-evaluate the intent and status of the Affordable Care Act implementation. They should get rid of the costs and unnecessary bureaucracy that may not make sense considering our current economic picture. Some of the ideas that might have seemed logical in 2009-2010 may not be all that logical today.

The Affordable Care Act has some good ideas but in many ways misses the point on the fundamental problem we need to address. The ACA focusses on access (getting everyone into the health insurance pool; mandating health insurance) and doesn’t really deal with the costs until we’re further down the road. Cost is the issue. Including more people in a system that doesn’t immediately address the costs of health care is going to make the Affordable Care Act much more expensive than anticipated- ultimately losing any support from the general public it might have had.

Consumers/individuals will need to get on board at some point if the Affordable Care Act is going to work. Those in Washington can set the tone by doing what is right and doing what makes sense for us today.

Both sides need to have open minds. Instead of barreling “full steam ahead” regardless of the costs just to meet deadlines, DHHS (Department of Health and Human Services) should step back and (as a good Top Gun quote goes) “evaluate what has happened so you can apply what you’ve learned.”

Washington needs to work together to fix what needs fixing.

That’s what we elected them to do.

Election 2012- We've Only Just Begun

The election is Tuesday. Most are going to be glad when it’s finally over. But it’s really not going to be over- no matter who wins. It’s only the beginning.


We have some serious issues to address in this country. We can continue to kick the can down the road like we’ve been doing but we’re running out of road. And the stakes just keep getting bigger. We’re sitting here like the proverbial frog in the slowly boiling pot. We feel things getting hot, but we are not able to ask for a helping hand to get us out. Our politics won’t allow it.

It’s very likely that deciding the Presidential election on Tuesday may be a drawn-out affair. It is going to be close and could result in a president who has won the electoral college not the popular vote. That is not necessarily unusual. George W. Bush, Harry Truman, Woodrow Wilson (both times), Grover Cleveland (both times), Rutherford Hayes, Thomas Jefferson, and others have experienced the same thing. But this one may be different. Boatloads of lawyers are standing at the ready to challenge any and all aspects of the results. It could pull the country further apart rather than pulling us together.

At this point, it looks like the House will continue to be controlled by the Republicans and the Senate controlled by the Democrats. This hasn’t worked out all that well over the past four years. The emotions, the events, and the politics have created the most partisan Congress we’ve ever experienced in this country.

While the political process becomes more polarized we look ahead to “fiscal cliff” and the suffocating costs of health care we still have to address. Addressing them the right way will require real teamwork and collaboration between the parties and their constituents to reach some consensus on how to move forward. That’s the way a democracy is supposed to work. If we decide to keep growing further apart, every American is going to feel the consequences in some way or another.

So, no matter who ultimately “wins” the presidency on Tuesday (or whenever it is finally decided) this is only the beginning for the rest of us. Just because the election is settled doesn’t mean we can all shut-off our minds and move on to other things. There is too much at stake. We have a role we need to play to continue to hold those we have elected accountable and setting a direction that is good for the country and not based solely on a single political ideology. Believe it or not, both sides have some good ideas to share. Neither one has a lock on being right. While the elections may set a direction, we (the citizens) can do a lot to set the tone and demand the results.

We have a choice- not only about who is leading our country but about how it is going to be led. Now more than ever we need to stay involved and stay engaged and remain an integral part of the political process. If we continue to let individual party-ideology reign as the key determinant of how we're going to work in America- we're all going to lose. The choice is ours.