Selecting a Health Insurance Plan

I recently switched jobs – from one disorganized healthcare organization to another…go figure, but I’m blessed to have a job in this crazy economy!

Even though I work in healthcare, I find selecting an insurance plan painfully onfusing. I wonder if bankers have the same issues with selecting a 401k or if insurance agents have issues with selecting property insurance? Anyways, I have always found picking a plan confusing as hell, and fortunately I am currently only picking a plan for me, myself and I. Out of network, in network, co-pays, PPOs, HMOs, OPP, WKRP, WTF, etc….its all gibberish. I know I could, and should, Google it. I’m smart enough to write out the pros and cons of each but as I read the descriptions in the brochure I find myself daydreaming about shaving blindfolded with a rusty dull blade and then dunking my head in a tub of alcohol eyes wide open. Ouch!

I’m even more of a pessimist about health insurance then I am about healthcare in general. In America, health insurance is a business like stocks and bonds, profit and loss, S&P 500 and Dow Jones. Their only real goal is to make money and to do so they charge you $X based on some actuarial plan that you will use $X - $Y of actual healthcare services.

Insurance companies only make money by (1) insuring as many healthy people as possible so that expenses for them are minimal (me so far) and (2) keeping expenses as low as possible for those with health conditions via negotiating with doctors and hospitals or by limiting or denying service. There is no (3) that says they make money by providing payment for all health services you need no matter the cost.

My attitude is that if I fall outside of the actuarial plan and into category 2, I’m screwed no matter what insurance plan I select. My real insurance plan is to never get sick…which I know as long term strategy is impossible. But, until my body says different, I’ll let all those unopened envelops from my new insurance company keep piling up on my desk.

Crazy Ass Officer Security Guard Man

So my coworker used to work at this hospital and he told me this story about this crazy security guard. The Officer Security Guard Man really, really, really wanted to make some moves on this young lady, let’s call her PYT, who worked in finance or benefits or something. Anyways, she was not acknowledging this dude’s advances; he kept getting shot down. Undaunted, Officer Security Guard Man keeps it up:

• Hello
• How are you today?
• You look nice.
• Hello Beautiful.
• How was your weekend?
• What are you doing for lunch?
• Can I call you sometime, Sweetheart?
• Let me take you out tonight.
• Okay, can I just smell your panties?
  

No, No, No and No continued to be the refrain, but Office Security Guard Man was not taking ‘No’ for an answer. He concluded he needed to create the magic, set the mood. Something needed to happen, a situation, an event, an experience that would open her eyes to see him for more than just Office Security Guard Man, but as Crazy Ass Officer Security Guard Man.

Hot Damn!!! Here it is – Damsel in Distress!!!

This plan is perfect because he is a security guard. If she was in trouble, he could come to the rescue and save her, and THEN she would be his for the taking.

You can see where this is going.

During his actual work day, Officer Security Guard Man gets in disguise and assaults (verbally, roughed her up a bit) PYT in her work area during her lunch. Then he runs out, trashes the disguise, puts on his security uniform and returns as Crazy Ass Security Guard Man to come to her rescue. OFF COURSE PYT recognizes his crazy ass since he has been trying to get with her for who knows how long. So needless to say Crazy Ass Security Man ends up in police custody rather quickly.

He had to know that some or all of this would be caught on film. He had to weigh losing his job, jail, humiliation, picture in the newspaper, story on the news vs. getting the girl. The lack of logic is stunningly incomprehensible. It is at the vortex of my understanding so I won’t attempt to explain it or break it down any further…and this is a True Story, I swear!

Flowcharts

My boss just called me about developing a new flowchart for some other random dysfunctional department where the right hand doesn’t know what the left hand is doing so now I have to flow-it-the-fuck-out for Manager Becky who doesn’t have an updated job description for Tom and doesn’t know what Matt does everyday even though Becky hired both Tom and Matt and she has been their manager for over 5 years and Damn Becky is an imbecile so it is no wonder people are all confused about what they do even though everyone in the damn department sits in same office corridor she still needs a workflow or flowchart or process chart or a bunch of damn boxes with lines so she can visually see where shit is going bad and why am I doing work for this woman and why does she make so much more money than me this is so frustrating and demoralizing and Oh Fuck! Who knew shit was THAT bad so now Becky sends out a meeting request to more smart dumb people so that we can meet every Wednesday morning over Starbucks or Dunkin Donuts coffee and make me listen to pointless ramblings from people with no accountability and minimal levels of responsibility and absolutely ZERO common sense and now I have to make the damn flowchart 18 pages long and 100 times more complex than your relationship with your college ex and why am I here and why did I study 5 months for the GRE to get into that top rated grad school so that now I can draw mother fucking flow charts for dumbass Becky?

Holy Crap Batman! Where’s the Plan?!?

About 3 months ago President Obama took office and activated the Bat Signal for healthcare reform, alerting legislators and the healthcare industry that the system is in dire need of drastic reform. Actually…none of this is new; Obama just opened the window blinds so that we all could see the Bat Signal that has been flashing for about 20 years already. Half a dozen or so healthcare organizations saw the signal, grabbed their Utility Belts and developed the “Healthcare Reform Plan for President Obama,” committing to $2 Trillion dollars of savings over the next 10 years.

That’s Trillion with a ‘T.’

Happy now Bey-ot-ches?!? The Healthcare crisis is solved! Meltdown averted!! Put away the launch codes!!! I should get off of my high horse and shut this whiny blog down NOW!

But wait in the shadows…can you see it?

HOLY CRAP BATMAN!!!

It's the Joker! That diabolical Joker must have hidden the actual “Healthcare Reform Plan for President Obama” and replaced it with this “Letter to President Obama!” Only the Joker would think it funny to offer a letter full of shell promises and recycled rhetoric in absence of a true plan that would outline Who, What, When, Where and How. Yes, the cunning Joker – stripping out accountability, strategy, direction, statistics, measures, goals, structure – the very elements healthcare requires for true reform. Truly Devious.

The Joker aside, this is why healthcare reform has been a joke and why the healthcare system is a catastrophe. Even at this, the highest levels of the industry the best that these educated, intelligent and distinguished leaders could present was a well-crafted letter. A letter that is light on specifics, absent of accountability, lacking in data and devoid of actual details. Perhaps even more obscene, the letter presents no new ideas, just rehashes the same old solutions that we are still waiting on to be implemented. Simply, it is a letter, not a plan. This is like buying a beautiful woman a drink and then realizing that she is dumb as bricks, has a small moustache, suffers from an acute case of halitosis and worst of all she is your 19 year old first cousin who you haven’t seen since 1996. You just wasted time, energy and effort on a fruitless endeavor. And you’re both are creeped out. And you facilitated underage drinking.

Most of the cynics that have already commented on this letter have concluded that this is mostly political. This effort ensures that these entities get a seat at the table during the crafting of healthcare reform legislation, and therefore a way for them to protect their organization’s interests. If you want to look at the glass half full, at least the industry understands that like Al Green - a change is going to come – and it is best to work for it than against it.

Stay tuned.

Priceless

So the hospital’s senior leaders, also known as the “Executives MBAs” decided that the “Very Important Clinic” needed a few more exam rooms to accommodate an increase in patients. This was based on rumblings from the “Administrator MPH” and “Dr. Chief” (Very Important Clinic’s seasoned administrator and most influential doctor, respectively). They declare that they are busting at the seams and have been forced to turn away patients to the Lowly Competitors. But, before we move on to the solution, first let’s understand The Politics:

• Dr. Chief must be pleased in order to get some guarantee he won’t defect. He makes us all look good, gets the hospital’s name in the press, a great speaker, nationally respected and most importantly makes us all a lot of money.
• Administrator MPH is there to please Dr. Chief. Her career trajectory has a proportional relationship with Dr. Chief’s satisfaction. It is best to agree as much as possible in order to keep her star rising so that one day she can become an Executive MBA.
• The Executive MBAs trust in the opinions of Dr. Chief and Administrator MPH. No need to doubt or question their wise decisions, they are Executives and they have MBAs.
  

So, the only viable solution is to build the expansion and give Very Important Clinic and Dr. Chief more space.

Fast forward 6 months, I complete an analysis of space usage for Very Important Clinic as a part of a larger space project. Turns out that patient volume did not increase drastically and the expansion is only sparingly used. It appears that the entire expansion was primarily based on anecdotes from Dr. Chief that Administrator MPH supported and Executives MBAs never questioned. No one completed any type of thorough analysis of the daily patient schedule, capacity and the current use of space to measure Dr. Chief’s claims against the reality.

How can I be sure? Only because Very Important Clinic’s scheduling was still done on paper. Yes it was 2008, yes you would think it would be done on a computer…but I digress – that’s a story for another day. In order for me to do any analysis I had to manually collect a month’s worth of paper schedules, copy into Excel and then calculate the utilization over time based on the average visit length. Okay…that’s kind of complicated. Let’s break it down for the Executive and Administrator types:

Larry, Moe and Curly each have 2 hour appointments. Very Important Clinic has 3 rooms available and is open from 9am to 5pm (8 hours). You have one room for Larry, one room for Moe and the last room for Curly. Thus, 2 hours/room divided by 8 hours/room equals 25% utilized. Or if the word “utilized” is too cumbersome, you can say they “used 25% of their available space.”

Obviously this type of analysis was not completed prior to the decision making. Executives and Administrators don't due manual analysis. They most likely developed a business plan based on annual patient volume and observing that it was trending up – absent analysis to measure if the actual trend volume exceeded available space (capacity). Hey, I’m only speculating…there might not have even been a business plan to start with.

So, in conclusion:

• Building of expansion…say $100,000
• Physician influence over good business practices…say $50,000
• Poor space planning…say another $50,000
• Wasting of talent, time, energy and effort…why not another $50,000
• Dr. Chief’s happiness…Priceless

What's in a Name?

Ap/a/thy: Lack of interest and concern, especially regarding matters of general importance or appeal, indifference

Ca/tas/tro/phe: A complete failure, fiasco

Put it together, lack of interest in a complete failure, even though it is a matter great importance to everyone. Yep, that seems like an accurate description of the sad state of the US healthcare system. So, welcome to ApathyCatastrophe.

You disagree? Utter disaster, catastrophe, fiasco….those are some strong words just to put out there. Where's the proof? The evidence? Well, let’s get cookin’:

• 47 million uninsured Americans, that’s almost 1 in 6 people…catastrophe
• Healthcare spending represents 17% of GDP…fiscal catastrophe
• African Americans account for 12% of the US population, but account for 50% of all AIDS case diagnosis…epidemic catastrophe
• Hospital medical errors cause between 44,000 and 98,000 deaths/year, the 8th leading cause of death in the US…human error catastrophe
• Close to 500 ERs have closed over the last decade…emergency catastrophe
  31% of Americans are obese, childhood obesity has tripled over the past 2 decades…one fat catastrophe
• By 2025, there could be a nursing shortage as high as 500,000…looming catastrophe
• 250,000 physicians will retire by 2020…another looming catastrophe
• In 2004, Medicare benefit expenses exceeded the program’s income, Medicare faces insolvency by 2020…one more looming catastrophe
  

Okay, you have to agree that’s a recipe for catastrophe. No? Not enough flavor?!? Okay, let’s mix in some medical malpractice, rising drug costs and lack of access for the urban poor and rural communities. Not quite there? Lets baste it with racial disparities in outcomes, HMOs, shrinking number of hospitals, lack of primary & preventative care and some good old-fashioned Medicaid funding shortages.

Does that do the trick? A bit more spice you say?

I forgot to add the ingredients for the professional types: the administrators, the managers, the MBAs, the accountants, the human resource reps, the lawyers, etc. Let’s bake in some mismanagement of resources, sprinkle some lack of accountability, garnish with a side of inefficiency, frost with some operational ineptitude and whip up some quick sides of lack of foresight and shortage of understanding of basic business principles.

Let it cool for a couple of decades.

Tastes catastrophic to me.