Tuesday, November 29, 2011

The Problem With Healthcare

The problem is simple, the healthcare markets are closed markets, at both ends. Think about it …

You are a medical insurance company expanding into a new state. How many customers are you competing for? Millions? No. More like thousands. You could select the 1,000 largest businesses in the state and hire a sales force to schmooze them. You can’t build relationships with millions of customers, but you can with 1,000. You can work to differentiate your product, to make it less of a commodity and to make it less price driven.

Individual consumers should be the true customers of medical insurance companies, but they are not. Medical insurance companies are not trying to keep you happy, they are just trying to keep the businesses happy.

As for the other end …

You are a hospital. In the course of a year how many patients do you treat? Thousands? No. More like 15 to 25. Patients are not the customers, insurance companies are. Healthcare providers model their business to please insurance companies. As a result they collude on pricing. Network pricing is not a discount, it is price collusion.

What to do about it …

Require all healthcare providers to publicly provide a price list of all services and products, from open heart surgery down to a box of tissues. Every patient pays the same price, regardless of medical insurance.

Businesses need to get out of the business of providing health benefits to employees. Tax health benefits as income. Each company is required to show how much it spends per employee on health benefits, and that amount is taxed as income. If a benefit eligible employee opts out, then that employee gets 80% of the per employee health benefit expenditure. If a business decides to no longer provide healthcare benefits then all benefit eligible employees get a one-time pay raise, equivalent to 80% of the per employee health benefit expenditure.

This second part is the key. Once individuals are responsible for finding and paying for medical insurance they will become more invested in how much it costs, thus driving down both insurance pricing and healthcare pricing as both markets compete for the multitude of customers. The healthcare markets need to be open and competitive at both ends. Medical insurance companies need to compete for families and individuals. Healthcare providers need to model their businesses to compete for and please patients.

Friday, November 18, 2011

Big and Fuzzy (a short story)

Callie the Clam was missing. How did the other sea creatures know this to be so? Because Callie the Clam never missed the Full Moon Sing-a-long. Every full moon the sea creatures would gather in the waves, beneath the bright full moon, for dancing and singing. Callie the Clam was a most enthusiastic dancer and a very good singer. She must be found.

A meeting was held and respectable sea creatures were selected to learn the mystery of the missing clam named Callie. There was Otis the Octopus; an eight-legged bespectacled creature of great wisdom. There was Sara the Seahorse; a mind of unbounded imagination and creativity. Finally, there was Teddy the Tuna; a meticulous fish with an eye for details.

The three sea creature friends gathered together to discuss a plan for finding Callie. Otis suggested that facts and evidence must be collected. Each sea creature was given a different task, and the three of them set out, each in a different direction.

Teddy the Tuna visited the home of Callie the Clam. He looked for evidence of when Callie might have last been there, and he looked for clues to where she might have gone. Teddy was indeed pleased and impressed as he swam through Callie's house. Her house was neat and clean, with everything in its proper place. Surely, Teddy thought, if something unexpected had occurred, if some surprise befell Callie, there might be something out of place; there might be something left undone.

There was a comfortable chair just in front of a large window that offered a grand view of the sprawling reef and sea floor. On the sand next to the chair lay some knitting in a heap. Callie seemed to have tossed the knitting aside. Teddy thought this to be out of character for Callie, here was something that was out of place. It was a blanket. Teddy held it up and could see writing across its width. The words stitched into the blanket said "Big and Fuzzy Growing inside a Clam Shell".

What is this, thought Teddy. What could possibly be big and fuzzy that could grow inside the shell of a clam? He must show this clue to his sea creature friends. Teddy left and took the blanket with him.

Otis the Octopus visited the clam beds, for here were a great many of Callie's family and friends. Otis spoke with them to learn what they might know of Callie's whereabouts. There were all worried about Callie for she had been talking nonsense in recent weeks. Callie's closest family and friends recounted how Callie was perplexed and befuddled about a riddle she could not solve. What is this riddle, asked Otis. Something big and fuzzy growing inside a clam shell. “What?”, asked Otis. Something big and fuzzy growing inside a clam shell. Whatever could this mean? Otis must return to his sea creature friends and report this information at once.

Sara the Seahorse roamed far and wide across the reef and the adjoining sea floor. She questioned all manner of under the sea creatures in an attempt to learn if they had seen Callie. Sara had no luck whatsoever. No creature in her under the sea neighborhood recalled anything unusual about Callie the Clam. In her disappointment Sara returned to her sea creature friends.

Otis, Sara, and Teddy reported what they had learned, and the three of them began to consider what might be big and fuzzy and could grow inside a clam shell.  Sara was saddened at the loss of her friend Callie, and began to remember all the times they had danced and sang together under the bright full moon. Sara remembered feelings of joy and happiness when spending time with Callie the Clam.

Sara shouted out, “I know where to find Callie”, and she bolted away. Sara the Seahorse galloped across the ocean, and Otis the Octopus and Teddy the Tuna struggled to keep up with the swift little seahorse. They swam beyond the reef. They swam beyond the nearby sea floor. They swam out into the deep nothing of the ocean. They swam and swam until they come upon another reef; a reef filled with unfamiliar sea creatures. They grew cautious and scared being on a new reef, with strange sea creatures they did not know or recognize.

Suddenly, the strange sea creatures parted and there was Callie the Clam! Callie was dancing and singing. The three friends approached and called to Callie. Callie greeted them with a smile and hugs. Teddy asked Callie what she was doing here. Callie replied that she was teaching these sea creatures to dance and sing, for they did not know the joy of dancing and singing under the bright full moon. Otis asked Callie why she was doing this. Why did Callie leave her family and friends? And what possibly could be big and fuzzy and grow inside a clam shell?

Callie replied that she would soon enough return to home; return to her family and friends. Callie the Clam then turned to Sara the Seahorse and asked if she knew the answer. Sara said she did know the answer, “love”. “Yes”, said Callie, “love”. Not just love for a child. Not just love for a parent. Not just love for a husband or wife or partner. Love for all sea creatures, everywhere. The big and fuzzy something is love, and that love was growing inside Callie the Clam. She had to share that love. And so she travelled the ocean so she could meet new sea creatures and teach them the joy and happiness of song and dance; the joy and happiness of love.

Otis the Octopus, Teddy the Tuna, Sara the Seahorse, and Callie the Clam stayed with their new found sea creature friends. And under the bright full moon, in the waves of the sea, they danced and sang.

Tuesday, November 15, 2011

Pick a Lane!

“Dad, you talk to cars more than anyone else I know.” So says my son. Granted, he isn’t riding around with too many different people, not at his age, but I do talk to cars. Sometimes I yell. Although I am never really angry, just being expressive and dramatic.

The first thing I ever said to a car was, “Pick a lane!” You have been there before, driving behind someone who is straddling the white line or at least veering over to the side, hugging that line. “Pick a lane!”

I commonly throw in a name, too. It could be the make or model, or something based on a bumper or window sticker, or if the plate is out of state. If I know the gender of the driver I might add a prefix. “Pick a lane, Mr. New Mexico!”

“Make the turn. Make the turn! MAKE THE TURN!” Dontcha hate when you are behind someone making a right turn and they slow to a near stop and then crawl through the turn for no obvious reason? “Make the turn, Toyota!”
“Don’t do it! Don’t do it!” This you can say under a variety of circumstances, but most often I say it when someone looks like they are thinking of turning into the traffic flow in front of me when clearly there is not enough space. “Don’t do it, Mustang!”

Most of the time it is more conversational. “Watcha gonna do, Ms. Minivan?” Or, “I see what you are doing there, Ford Truck.” Or when someone wants to move into my lane but is hesitating, “Come on over, red rover.” (game reference, not a Land Rover reference)

One of my favs, never combined with a name and when said with the proper sarcasm will usually get laughs from any passengers, is “The accelerator is the pedal on the right!”

Thursday, November 10, 2011

The Value of Losing

“You lost today, kid, but that doesn’t mean you have to like it.”

In the opening sequence of the third Indiana Jones movie River Phoenix plays a young Indy attempting to keep profiteers from getting their hands on the Cross of Coronado. Young Indy fails. The leader of the profiteers tells Indy, “You lost today, kid, but that doesn’t mean you have to like it.”

Everyone loses, and more than just contests. Anytime you don’t get what you want then you lose. You don’t get that job. You don’t win that contract. You lose a friend. You lose your partner. You can’t have the one you love. You lose your job. You lose money. Our lives are replete with losing.

How does a person deal with losing? Does it make them angry? Does that anger bleed into other areas of their lives? Do they take it out on someone, or something, else? Do they throw a tantrum?  Does it paralyze them? Do they resort to cheating or breaking the law in order to win?

The value of losing is learned (or not learned) as we grow up. As a child and teenager how we are taught to deal with losing is how we will deal with losing as adults. At the front line are parents, followed closely by coaches, teachers, and other adult leaders who serve as a mentor. When children lose those who lead them should be setting the example and providing a guide on how to learn from failure.

Whenever disappointment is encountered a person can choose to externalize or internalize. To externalize is to look outside of yourself, to blame others, for why you failed, or lost. To internalize is to recognize your contribution to why you lost and to work on growing and improving yourself. Little league sports is a good example.

Little league sports are about learning the game, improving skills, acquiring discipline and determination, building character and respect, and learning how to win and how to lose. (Actually, any endeavor can be said to embody the same characteristics; school, hobbies, extra-curricular activities, even inter-personal relationships.) One very important aspect is to have fun in whatever you do. Winning is certainly more fun than losing, but winning is the by-product of your actions and attitude. Winning in a team sport is the by-product of all the player’s and coach’s actions and attitudes. You don’t win because you want to win. You win because you want to be the best in your actions and with your attitude. And when you lose you see that as an opportunity to improve yourself, to improve your skills, and to improve mentally.

If losing makes you angry and spiteful, and you look outside yourself for the answers, then you have lost at life. Learning and growing from losing, from your failures, is how you win at anything you do.

“You lost today, kid, but that doesn’t mean you have to like it.” Indy didn’t like losing, but he learned and he grew. Twenty-five years later he had another opportunity to retrieve the Cross of Coronado, and this time Indiana Jones won.