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Health Care - What if we play the game differently?
Twenty-five years ago I worked for an attorney who said that whatever
didn't require his law degree to do could-and should-be done by
someone else. He trained his staff as paralegals. I started my professional
career learning to think strategically and ask different kinds of
questions-about a lot of things. Today that applies to health care,
health insurance, and the increasing costs to both employers and
consumers.
I'm a business owner, consumer, educator, and human resource professional.
I'm not a medical or health insurance expert. I know that people
behave and act based on motivators and rewards. In general, wherever
the incentives are placed, and or monitoring is done, action will
take place and the monitored results will be achieved. Parents know
this; teachers know this. It's a basic principle of education.
"The answers" will not magically come out of one essay. The subject
is complex and as individualized as consumers. And it's unrealistic
to think one solution will fit all contingencies. My objective here
is to tap the interests, experience, and expertise of everyone,
and get all of us thinking outside the "rules" a bit. Like pieces
of a giant jigsaw puzzle, we all have valuable pieces of information
and experience to contribute. In childhood, didn't we learn the
value of playing outside the rules once in awhile to achieve the
objectives we wanted? I did. Our family version of Monopoly included
IOU sheets-Mom invented them so she and all of my siblings could
stay in the game as long as we wanted to play-her desired objective
at the time.
Asking questions is key. Different questions shine an illuminating
beam on different information that could be useful. Knowledge is
empowering.
Here are some questions I'd start with:
Health Care
What requires a doctor's medical degree? What doesn't? What medical,
health, or wellness practitioner has the expertise needed and is
the most practical (and cost-effective?) resource to address your
'condition?' What is the best utilization of RNs, for example, and
other health and wellness practitioners? Now? In the future?
What is our definition of Health Care? Is it too broad? Or too
limited? What benefits can alternative, integrative, and or experimental
approaches offer to the consumer? To the employer? Consider costs,
including lost time away from work, effectiveness, and incentives
for use-or non-use
Health Insurance
What are the cost / pricing factors? How does health insurance
compare with auto insurance, for example? Is your rate affected
by your claims, or lack thereof? In other words, is there a monetary
incentive for consumers to stay healthy and make healthy life-style
choices? What are the cost drivers? What's "covered" by health insurance
plans? What is excluded? Should health insurance be employer provided?
Or is it time for portable consumer-owned programs/policies? Are
there other options? Now? In the future? What exactly do we want
health insurance to insure us against? "Normal maintenance" expenses?
Or major events and expenses?
Laws - Tax incentives
Who benefits? Are there tax incentives to reduce consumer medical
expenses? To invest in wellness and health? Or are there dis-incentives?
Section 125 - Flexible Spending Accounts Medical Savings Accounts
Health Reimbursement Accounts. What are the allowable expenses?
What expenses are excluded?
The Playing Field has Changed.
The health insurance-health care game and the playing field have
changed. Why?
-
Because employers, small business owners, and solo entrepreneurs
cannot afford to pay as much of the health insurance tab as
they once did.
-
Because we are a much more mobile, connected, and better educated
workforce today.
-
And because the old rules don't fit today's business and lifestyle
environments the way they did when the current systems were
designed.
At present, health insurance is most commonly connected to ones
employer. When you change jobs, your health insurance does not go
with you. Yes, there are COBRA laws for continuation of your health
insurance for a time-at the full premium rate. That leaves one looking
for another employer to provide health insurance benefits, get independent
coverage elsewhere, or go without. In today's economy, many more
are choosing the "going without" option. More people are unemployed.
Some work one or more part-time or contract jobs-generally making
them ineligible for employer-provided benefits.
The workforce and the "company loyalty" standard have changed
as well. Baby Boomers and the generations after have been downsized,
right-sized, and "early retiremented" out of jobs and companies
on a regular basis. The younger generations paid attention. Many
professionals intentionally change jobs and companies more frequently
to build their career experience and increase their salary. Relocation
is often part of the recruitment package. Yes, insurance benefits
are still an important deciding factor in selecting employment-not
always the most important one for this group as it is (was?) for
the Boomer generation. Salary, flexible work schedules, flexible
benefits, and paid time off are prime competitors. The trend toward
flexible staffing options, utilizing temporary and contracted workers
instead of full-time direct employees, continues to grow to accommodate
the fluctuating business marketplace. Both technical and blue-collar
workers are frequently "placed" by staffing agencies. Temp-to-perm
recruiting arrangements for some positions are common, and often
the preferred option. Most temporary staffing agencies do not offer
health insurance.
All of these factors, in addition to the surge of small business
entrepreneurial endeavors, have led to a ready market for affordable
health insurance through independent providers. Health insurance
companies are now directly targeting consumers in their advertising.
Online providers like www.eHealthInsurance.com and www.insure.com
make it easy for consumers to do comparison-shopping and purchase
health insurance directly through their site and offer live customer
service reps to assist. Consumers now have more options and choices
than anytime before this.
So what if your health insurance was more like your auto insurance,
for example? You own the policy, and you work with an insurance
agent or an online brokerage? And what if the provider networks
were national-or international. When you switch jobs, you keep the
same policy-even if you move across state lines. What if employers
go out of the health insurance business and provide other related
benefits instead? For example, what if employers could provide tax-free
flat amount contributions to individual medical savings accounts
of their employees? What if employers would provide an annual 'wellness
allowance,' and incentives for employees to actively engage in healthy
lifestyle choices? What if there were significant monetary incentives
from your insurance company for personal wellness habits and claim-free
years, such as significant rebates on your premiums, for example?
What outcomes do you want? Where do you need to put the action incentives?
If we want to reduce consumer health care and hospital costs,
maybe health maintenance and wellness activities need to be significantly
monetarily rewarded somehow. We all know smoking and other addictions
translate into expensive medical costs; that super sizing our meals
without increasing exercise levels adds to our waistlines and expensive
medical costs; that irresponsible sexual choices and practices have
expensive consequences; and that our stressed-out lifestyles have
costly consequences. These are all areas of individual responsibility
and opportunities for healthier lifestyle-and cost reducing-actions.
There are still the majority of consumers who would rather have
"somebody else" take care of all the health insurance stuff for
them. And who can blame them? The mountains of insurance forms,
billing statements, coded charges, and terminology can be daunting
to common consumers. Then again, here are some more questions:
One significant challenge to consumer education and consumer-drive
health care is that consumers don't see a NEED to learn more. The
incentives, motivators, aren't in the right place-yet. Many workers
are still in the "somebody else takes care of this for me" and "I
really don't have much choice anyway" mindset. For some, that may
be true. Then again, little actions-doing something differently,
like spending our money in different places-can have a ripple of
effect of consequences. By knowing the cost drivers and our options,
one can make informed choices and start the ripple effects in the
direction we want them to go. If we do nothing, inaction also has
consequences: the old game stays the way it is. And there are some
players with a vested interest in keeping it that way.
First, let's get past the fear factors. Just because insurance
and health care issues are complex and can be confusing, doesn't
mean we can't learn to be smart shoppers. We have learned to become
smart shoppers and savvy consumers in a lot of other important areas
of our lives-buying a car or a home, finding a mate, running a household,
raising children, or starting a business, to mention a few. Just
as we tapped the experience and expertise of others in those areas,
we can in this one too.
Who has the knowledge and information you need? Which of these
are education and consumer-focused?
The Internet is a phenomenal resource for consumer information,
education, and participation. So are many knowledgeable health and
wellness practitioners, and common folk, in our neighborhoods. Watch
for consumer education classes and health and wellness events on
topics of interest. Ask questions. You are the customer. You know
you want to learn more, and you want it in plain terms you can understand,
including pricing and background information on services and providers.
Like your homework process in any other buying decision, make your
list of what you want to know and prioritize what's important to
you. Then use your brain and your voice, and keep your ears and
eyes open to information sources. You've made good and informed
decisions and choices before. You can here too.
Start where you are, your health and your family's health. Start
becoming an educated consumer. Pay attention to the cost drivers.
Ask for cost information from providers-in understandable terms.
Seek out information you're interested in. Be open to learning.
Existing systems are not likely to change overnight. You can use
new knowledge to start making healthier, and more strategic, choices
though. And you can start 'playing the game differently' as a result.
Maybe together we'll find some new solutions, and consider approaches
we never took seriously before. I invite you to add your knowledge
and creativity and questions to mine. We're in this together. The
objective-at least for me-is aligning consumer and employer behavior
incentives with cost reduction, health maintenance, and better utilization
of practitioners. So let's start with the questions.
About the Author:
© Anne Wondra (2004) Anne Wondra is a writer, educator, and
life, spirit, and career empowerment coach. Visit her site to find
out how you can get a free consultation http://www.wonderspirit.com
or mailto:annew@wonderspirit.com
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