Theory: Chances are that if I write about Health Care Reform…I’m going to piss off somebody.

I’m really sick of hearing about Health Care Reform. I probably speak for a lot of folks when I say that. I’m so sick of the topic that I just have, and I mean HAVE TO, write about the subject. So here we go….

“Obamacare”, in its grandest form, is a novel concept in its entirety. It’s meant to appeal and fight for a demographic that is normally without a voice and without a strong arm to push back with. Not just the overly sick, but people who are living at or below the poverty the level. People who are newly arrived immigrants (legal and illegal) that don’t hold degrees and must work two jobs to help pay for their cost of living. And finally, Obamacare fight for people who may have been dealt a bad hand in life and now are stuck with medical bills out the wazoo.

But there is one more group of folks that don’t normally get mentioned in this grand plan: the economically insane. These guys live well beyond their means, racking up debt and credit, desperately trying to lead a life that’s not really possible on the type of income they live under. Why do they do this you ask? Well, the answer to that is simple: it’s the American way. Spend more, live more, pay it back later.

And with Health Care Reform, we will most assuredly be “paying it back” later.

So now you probably know where I stand on the issue of “pro vs. against” for this whole matter. Don’t get me wrong, I think the new laws have some great provisions. Eliminating pre-existing condition clauses is a really great thing. Basically, an insurance company can’t look at you and go “wow, you’ve had two strokes in your life. There ain’t no way we’re giving you medical insurance.” So hey, tha’ts a nice thing. Plus, everyone (regardless of who you are) must be covered with health insurance. This will help hospitals and doctors who are constantly dealing with billing and payments issues when patients walk in without an insurance card. That’s a great thing too so way to go, guys. You’re really doing some good….

But that’s where it really ends for me. You see, I actually work in the health care field (ta-da, the plot thickens!) so I see this stuff day-in and day-out. No, I’m not a doctor and no, I’m not a nurse. However, I do work on the consulting end of employee benefits so I work with all those nasty, cutthroat insurance companies that so many people hate yet really don’t understand. Yes, it’s my job to help advise YOU as to what your best avenue for coverage should be. On a side note, I think we do a pretty good job, especially for being in an industry that can be loathed and is sometimes viewed as thankless to those who work within it.

So anyway, I work in the capacity that I interface with employers who have group health insurance plans for their employees. And yeah, about 99% of the employers complain about the increases they receive from ‘x’ carrier year over year. And yes again, there’s not much they (the employer) can do about it except for an increase in employee contributions and maybe a change in their plan design.

Major bummer, right?

Well, that’s what I see and I understand the plight of an employer. When you’re trying to make ends meet and grow your business, the last thing you want to concern yourself with is an influx of seriously high health care premiums. You do, however, want your employees in tip-top shape so they can perform at their highest level, thus giving you the optimum amount of output to further advance your company (lots of big words in there to digest). So you face a serious paradox. You want your employees healthy (in theory) but you also don’t want to necessarily pay for the best health plan the market has to offer (in theory) which will give your employees peace of mind when they walk into a doctor’s office.

Therein lies the biggest struggle for you, the employer. In the past, competitive health plan offerings were the key to getting employees to jump ship and join your company. Now, it’s more about “ok, how much do I pay? Ok, great. I’ll come on with you because that’s way less than what I pay for here.” It’s not so much about the richness that the insurance plan provides, it’s more about how much you plan to take out of my paycheck every two weeks.

Here’s the kicker though – regardless of what I pay for my health insurance, I’m still going to behave in the way that I feel is best for my own health and the health of my family. Case in point, my kid gets a stomach ache. A really bad stomach ache. The kind that has your child screaming bloody murder like he could pass a record-sized kidney stone at any moment. So being the responsible and above average parent that you are, you promptly take your kid to the Emergency Room to rule any kind of potential life-threatening situation. And by the time you’re done with all your tests, a doctor comes out to tell you that your kid had “gastrointestinal blockage” which has since been dealt.

In lamen’s terms, your kid just needed to fart and it would be advisable if no one enter room A for at least another hour. Crisis averted, but going forward, your kid probably needs to watch his intake of cheese.

Breathing a heavy sigh of relief, you return home with your child. After a kiss goodnight, you dream about your own battles with intolerable flatulence (or maybe not) as you drift off into a deep slumber. Flash forward a couple weeks and your bill arrives. Through utter shock and horror, you discover that items like stethoscopes and the price of going “out of network” costs more than some television sets. Naturally, your first reaction is to get angry. And when you get angry, you break things. And when you break things, you want to get rid of cable…. (ok, sorry for that tangent, I just like those commercials).

But seriously, you begin to wonder who is to blame for such a messed up health system. How can a single visit to the ER, which yielded nothing terrible, warrant such a charge? The simple answer is this: I don’t know, but you’ve made your bed and now you must lay in it. Maybe it’s your employer’s fault? If only that guy would’ve ponied up the dough last year, you could have gotten that premier plan that would have covered you 100%. What a jerk, right? Or maybe it’s the hospital’s fault? I mean, come on, who charges $1,000 for running a few tests? That’s just ludicrous. But hey, the real problem are those nasty insurance companies. They’re the ones who make us pay all those premiums just so I can go to the doctor and still have to pay out of my own pocket for services that should only cost me a few bucks.

Yeah, that’s gotta be it, right?

Well, the bottomline in this scenario is behavior. Your screaming child overrode any rational decision to a) check what hospitals were in your network and b) what knowledge you had on overly flatulent children. But hey, I’m no dummy – if that were my kid, I would have acted quickly and promptly to handle the situation as best i could. And that would mean going to the one place to get me my fastest answer to solve the problem. The only part is that the quick answer is not your most financially sound decision and now, you’re paying for it. Metaphorically and literally.

In my experience while on this side of health care fence, I’ve heard my fair share of sob stories and mistakes made by honest, intelligent people just trying to take care of their own. My heart goes out to them, each and every one of them. When faced with a situation that is beyond your immediate understanding, you gotta call in the pros. But oftentimes (and it’s very often) people don’t know just how to handle a situation that could have been averted. And what’s worse, is that if you have a really great health plan that your employer is willing to help you out with, you may run right back to that hospital at the drop of a pin, regardless of your last experience. Because let’s face it, when it comes to our own well-being, we make that priority numero uno. It just sucks that our well-being comes at such a high price to keep it in check.

On the flip side, there are people who absolutely need to be at the ER or get their much needed meds on a consistent basis. And those don’t come cheap, my friends. Unfortunately, many people are born with or experience actual life-threatening diseases that need speical attention. As easy as it could be to go sleep off a headache for some, it’s not so easy for those who suffer from chronic migraines. And as easy it could be for one person to sit and discipline their child, we’d rather order a good dose of anti-anxiety meds so they calm down for a little while (parents included). The fast road isn’t necessarily the best one, it’s just the path of least resistance for that moment. That way we can get back to our lives doing other things…like…well, not having to worry about our health, or something.

And your employer hates the fact that you are an abuser of the system. Well, “hates” is a strong word. More like “disapproves of your reaction to the circumstances”. Yeah, I think that sounds a little more PC. Don’t get me wrong, not every emploiyer wants to screw their employees by raising health contributions, no, plenty are far from that. It’s just one of those elephant-in-the-room conversations when you’re trying to explain to someone that the reason for their health increases are due to a handful of people that have either chronic conditions or just love, love, love going to the doctor. Yeah, it’s not the easiest conversation to have.

Ultimately, you have to realize that outside of the things you can’t change (such as a car accident, random heart attacks, and the like) you can clearly focus on the things you can control. And sure, there are only a few that you can. One of those is enforcing better behavior, which means educating your employees to act like more responsible consumers; which also means actively engaging with your employees to make them feel like their employer cares not just about their input/output, but also about their well-being outside of the workplace. Once again, not the easiest thing to do and most employers would rather take the much easier route; bite the bullet again this year and raise those premiums for their employees.

Tough, tough, and more tough. It really is true that you “get what you put in”; so why not try and put into your workforce a solid program that teaches them to become better health consumers? A tough gig if you really prescribe to the concept. And no, you’re not going to stop every person from overusing their pills and you’re not going to stop people from going to the doctor every time the news releases some story about how there could be anthrax in your toilet (yes, I’ve seen the newscasts before on that one. Ridiculous….). But hey, you may be able to make your employees more educated on the topic. Make them understand why it really is important to use in-network doctors; why medical costs increase every year; and why a claim isn’t always paid on time. Tackling issues up front are much better than bandaging them up at the end.

Yes, these are the things that should be about Health Care Reform. Mandating health insurance is not the answer; it’s just the eaiser way out since it’s less resistent to create more taxes than it is to invest time and energy into human captial. And by human capital, I’m referring to you, the individual, of course. What we’re doing is trying to solve the end result of a much more complicated system than what is presented. The root of health care issues need to be tackled if there is ever going to be some true “change” in America.

And it starts with behavior and ends with education. People are always going to want things cheaper, better, faster…but when it comes to your health, that’s much more of a need than a want. I’ll always need health care from a doctor or specialist, but what I want is for that health care to be affordable and easily accessible. And oh yeah, I don’t want to be held accountable for the person standing next to me so make sure you give me justified health premiums while the other guy gets his own. Secondly, I want to cover my kids. Thirdly, I don’t want these huge increases year over year, and oh while you’re at it, don’t make it necessary that I pay for health insurance if I don’t want to – I shouldn’t have to pay for something if I don’t use it consistently. And come on government, just stay out of this whole process. Let the free market decide what it wants to do. I don’t mind paying taxes, I just don’t want to pay any more if I can avoid it.

So yeah, that all seems rather fair, right?

Of course it does. But can it be done? That’s a harder question to answer than most. Can a system be fixed that’s already broken? Will Health Care Reform really solve the stance on health care in America? And will children ever understand the difference between passing a kidney stone and just having really bad gas? These are life’s eternal questions, my friends. Mull it over and decide for yourself. But most of all, become as informed as you can on the issue.

On another note, I promise my next thought/post to be a little more light-hearted. Really, I do.

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