US Life Expectancy 42nd! And Getting Worse!

OK, new info merely confirms what I have been screaming about for the last few months in this blog and in other forums for longer: The US is slipping in the health of it's citizens. A new story on MS NBC, http://www.msnbc.msn.com/id/20228552/wid/11915773?GT1=10316 tells of how the US had dropped from 11th to 42nd over the last couple of decades. Countries like Japan and most of Europe, as well as Jordan, Guam and the Cayman Islands are living much longer lives at a MUCH LOWER COST TO THEIR ECONOMIES.

“Something’s wrong here when one of the richest countries in the world, the one that spends the most on health care, is not able to keep up with other countries,” said Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington. That is correct Doctor, there is something wrong and we are spending nearly 17% of our Gross Domestic Product on health care and only to see ourselves getting less and less healthy.

One "major" factor, according to "experts" is the fact 45 million people in the US have no health insurance. That may explain a little of the discrepancy, but more likely it is because the ability of US citizens to choose crappy lifestyle choices! Adults in the US have one of the highest obesity rates in the world. Nearly a third of U.S. adults 20 years and older are obese, while about two-thirds are overweight, according to the National Center for Health Statistics.

Heart disease, hypertension, stroke as well as diabetes area all directly related to weight and lifestyle. So, US citizens are self-prescribing a deadly mixture just because we have the luxury to do so.

What did seem surprising is the high level of infant mortality in the US compared to other nations including Cuba and Taiwan. The level of infant mortality is much higher in Black US families on par with countries like Saudi Arabia which is disturbing and has a significant impact on the nation's infant mortality rate as a whole.

But, the U.S. health care problem is not limited to access to health insurance.

The country MUST find ways to reduce cancer, heart disease and lung disease. We must make it a national drive and effort to reduce tobacco use, control blood pressure, reduce cholesterol and regulate blood sugar.

“The starting point is the recognition that the U.S. does not have the best health care system. There are still an awful lot of people who think it does,” says Dr. Christopher Murray, head of the Institute for Health Metrics and Evaluation at the University of Washington. More government and business leaders have to understand the same thing. Until then, we are just pissing away our money as we whistle in the dark...

Claims Assistance Professionals

I just found another resource to help people with their efforts to get around the US Health Care maze. People called Claims Assistance Professionals are a new group who created a service to help patients address the complexities of their health care insurance claims.

CAPs are usually insurance and/or medical specialists who are better suited to help consumers get around their medical billing and health insurance requirements. For more information, please take a look at the following article:

http://www.goarticles.com/cgi-bin/showa.cgi?C=546291

Americans Just Not Getting It!

I read an editorial from the LA Times Tuesday where the editorialist was so complementary of the US Health Care system because she was able to have her breast cancer diagnosed and treated immediately. Her argument was that only in the US could such immediate treatment occur, therefore, the US had to have the best health care in the world.

US Health Care is fair, but it is not the best in the world for many reasons: US Health Care, is an inefficient institution that needs better oversight and accountability by the marketplace; US Health Care has incorrect pressures to make it what it is, rather than the 'free hand' of the market dictating pricing, outside economic decisions determine pricing and availability; The actual users of medical services are totally ignorant to the pricing, options and availabilities of medical services; Finally, the way we have designed medical insurance coverage and the artificially low price the consumer ultimately pays for almost every cost imaginable, the 'real' cost is never seen, nor understood by the average consumer.

As a result, inefficiencies have run rampant throughout the industry. How can one say that? Look at the amount of GNP US Health Care consumes each year. Notice US Health Care consumes nearly 17% of annual GNP and is rising. The trend for the increase places US Health Care to soon cost every man, woman and child in the US 20% of all generated dollar.

Compare our current 17% to every other country in the world. Choose 5, choose 10, or carefully choose 50 countries and combine their expenditures on health care and see that it is still under what we spend each year! Next, review national health statistics like infant mortality, life expectancy, obesity levels, diabetes, heart disease and other frequency of disease and see that the US is in a pretty low spot on the overall health of its citizens.

Are you getting it yet? We are not getting our money's worth! All of what I say is evident of an inefficient system. I also agree with the LA Time's editorial writer's opinion that nationalizing US Health Care would only make things worse, because that is what has already happened here! The overly cheapened and largely subsidized health care we receive creates an unreasonable expectation of greater supply than actually exists at a price that is 'artificially' lower than the market really demands.

Now, the concept of artificially lower pricing is based upon those who pay little or nothing out of their own pocket for US Health Care. The previous statement and premise is seen in the complete opposite by those without health insurance or who do not have any subsidized manner for their health care pricing.

( Please see http://www.goarticles.com/cgi-bin/showa.cgi?C=545010 for a look at those who are part of the subsidy for the rest of us because they pay 300% to 450% more for the same medical services!).

Check out the facts in comparison to the rest of the world and ask yourself, can we keep paying a fifth of our GNP to be behind almost every other developed nation in the world in our nation's health? Why is it acceptable to pay so much to be so far below average? Open the eyes! It isn't!

Nationalized Health Care - How Consumers Act

The abrupt and direct response to US Nationalized Health Care is that it will become a floundering mess of inefficiency and waste. One can argue, will nationalized health care in the US become more inefficient than what we have today and will it consume 20% or more of our nation's resources like what we experience today? My opinion is that if it doesn't consume 20% or more of our nation's resources, it soon will be designed to do so!

Two main problems exist with nationalized health care in the US: The supply side and the demand side. More clearly, in an environment where everyone is allowed and encouraged to seek medical attention as often as they want, the demand goes skyward. And since everyone is supposed to have equal access to health care considerations and resources, there certainly will never be enough to go around.

We get back to the major premise of socialism and why it distorts the reality of the free hand of an open market. With everyone wanting a service and theoretically enabled to have that resource, demand will always outstrip supply. (Insert image here of an old Soviet-ere Babuska slugging it out with another, similar woman over a package of toilet paper in a bare-shelved Moscow store).

One can argue all day about how successful Britain's or Canada's semi-socialist medical system is and they would be absolutely correct! Let's see if we could transfer that model to the US. Hmmm! I don't think so!

Why? Because US citizens are used to having the access of total availability of health care resources but at the already subsidized rate. If one thinks the present market has placed any restrictions upon consumer demand for health care resources, then please let's look at the reality of the marketplace.

There is no real "open-market" considerations where the actual payer makes decisions based upon price, availability and local resources. Most consumers are insulated from knowing the "true" cost of a procedure because insurance programs almost always pay the bill. The consumer only has to find a medical provider and the cost be damned! He or she really doesn't pay the bill anyway, so there is no understanding of the overall economic cost of specific services, resources or facilities.

So, what exists now is a "seemingly subsidized" consumer health care system in the US. Consumers buy the insurance program options when their employer's benefits renewal program presents repriced options, but nowhere does the consumer take direct responsibility of their own health care dollars as if no insurance existed.

As a nation, we are seeing more and more people without insurance for health care. The US Census Bureau has calculated that amount to be near 45 million up to 50 million people per year. The realities of a true consumer market for US health care actually only exists for a little less than one sixth the present population. These 45 to 50 million people have to make decisions as to how to spend their limited monetary resources on health care without the benefit of an insurance policy to smooth the way. WOULD A CONSUMER WITHOUT INSURANCE MAKE DIFFERENT DECISIONS ABOUT HEALTH CARE THAN ONE WITH?

The answer would have to be a resounding YES! Certain tests would have to be weighed with extreme scrutiny for cost-effectiveness. "Iffy" procedures and operations with low response and success rates would be immediately removed from the decision-tree. Greater importance would be placed upon how an individual makes choices for him or herself.

Specifically, individuals would have to take greater responsibility for diet, physical exercise, alcohol and tobacco consumption in order to preemptively remove the excessive and extremely high cost of obesity, diabetes, heart failure, arterial sclerosis, emphysema, various and sundry cancers and other life-style diseases.

Why is it then, when spending time with most Western Europeans or Canadians, they continue to exhibit such consumerism in health care even when there is socialized medicine in some form or another in their native countries? While US citizens are bellying up to the buffet table/trough on cruise ships, our German, Icelandic, Italian, French and Danish counterparts have modest portions. Why is smoking so unpopular in Europe, but still nearly 40% of Southern US adults still smoke? What is different where in countries health care is readily available the citizens show individual responsibility for its use? My premise is that such responsibility would not be exhibited by US citizens who would fight and claw for each very last piece of good or service to claim as their own, regardless if they needed it or not. Possibly, after years and years of being told they have to take on their own health care concerns, especially regarding life-style issues, Europeans have been conditioned to do so. And since post-WWII was the beginning time for such education, the remaining population really had to believe the government's statements of limited resources!

Yet, if we were to try that very same thing today to instantly limit the access medical resources, with the current level of over-abundance of medical resources just waiting to be called upon at our slightest whim, consumers would revolt.

And that is what we are going to see. As resources tighten-up further and further and people who had previously had access to too much in terms of medical resources suddenly have little or no options, there will be problems. What needs to happen is more "medical consumerism" where the vast population understands and realizes the true value of each and every medical procedure. From there, individuals can decide on how and on what to spend their 20% per annum charge. Additionally, everyone will have to acknowledge the fact that those with more income and wealth have more options.

At least, that is, until US citizens understand how to responsibly use nationalized health care.

California Health Care & Big Business

Yesterday's LA Times published and article about how big business is jumping into the discussion about US Health Care and how Gov. Arnie is trying to get more people in the state of California covered under health insurance plans. This is another example that politics make strange bed-fellows. The article, in its entirety is at http://www.latimes.com/news/local/la-me-health7may07,0,4141456.story?coll=la-home-headlines
I applaud the 30 or so companies trying to make improvements to their employees lives by getting better insurance coverage, however, it also appears to be a little disingenuous considering how management typically and "normally" acts regarding overhead expenses, the largest being personnel and affiliated personnel expenses like benefits (insurance being the largest of that component).

The biggest way to improve health care in the US, is for each and every individual to take responsibility for their health. From being a wise and informed consumer of health care options to wise and aware consumer of food and lifestyles which keep one healthy and not endangered due to "fast living" or poor life decision-making. As a country, we have to teach our citizens such practices. (One can always tell the US citizens on international cruise ships -- they are the ones who habitually pig-out at the open buffet lines of food. Europeans show much greater restraint and moderate eating behavior).

The other part, is to make sure the medical/health care market place really is open. If we are allowed to make informed decisions based upon our wallets, I think we will do fine. Unfortunately, we as a nation don't see health care that way and think it is someone else's responsibility to pay. Wrong answer. I am healthy and don't want to pay for the hypochondriac. Let that person use most of their disposable income to chase phantom boo-boos. I don't want to pay for someone who enjoys their vacation time in medical waiting rooms. Not me!

But there is plenty of blame to go around for making the US a bunch of pill-popping wimps. Medical light-weights who are abdicating our ability to make our own decisions. Force it back to my wallet and I will be as cheap as I can be. Wait. I already do that with insurance! Then, I challenge the rest of my citizen cohort to do the same. Be brave. You can do it!

Patient Experiences - Mini Monopolies

I write this a day after I had a minor outpatient procedure. The procedure was conducted at the local hospital, which is the only facility within a 3o mile radius for such procedures. The intake process was demeaning and impersonal. The intake clerk expected me to provide all information without question or hesitation.

When I was to sign the contract between me and the hospital, she refused to comply to my request for my copy of the contract. I would be able to ask for a copy from medical records some other time. I was not allowed to get a copy of what I had just signed.

Wait! This is the sort of contempt back-office and billing areas of hospitals seem to normally exemplify to patients. I only requested a copy of a legal contract I was entering into with the hospital. I do believe that is part and parcel for US business; all parties are provided with the agreements to which they enter.

A secret agreement or one in which is hidden certainly is one that is not made in good faith. And that is what I postulate here - that the contempt and one-sidedness of US hospitalization (the back-office, admissions side) makes the validity of the contract questionable.

Please understand, I had absolutely wonderful care from the floor nurses. They were attentive and concerned about my feelings, concerns and desires. My biggest problem with the floor nurses was that they were a little hurried trying to do as many procedures as scheduled, so much so that they were not always aware of my little jokes or comments. They were being extremely professional, moving fast, but efficiently and always aware of how I, the patient, was feeling.

Wow! the situation was exactly the opposite of the intake/admissions person. She would have rather me drop dead than actually dig out the "Patient Rights" booklet when I asked where it was after I was to sign I had already received it. The booklet was in a bottom of a cabinet on the opposite side of her office area and she had to move her chair and rearrange locations of a few items just to be able to get to a copy. But, I was required to sign a formal document saying I had already received it, but there was no intention of having me get it. I forced her into complying with her own laws which I doubt had been done for a long. All this in regard to documentation stating she had provided mythical information.

Contempt doesn't appeal to me as a way to continue doing business with a company or entity. And yet, what choice do we have? My physician is in a town 11 miles away and the hospital is the only facility in a 30 mile radius. Do I or the people who live in my community really have an option? NO. We are in a localize monopoly. And the hospital knows it too. Every week they spend local advertising dollars to tell the community how wonderful they are. The hospital has several half-page newspaper ads touting their contribution to the good of the community. Why would or is that necessary if it were really the case? Truthfully, because it isn't. The emperor is all to aware he (or she, as is the CEO) has no clothes. The hospital is not all that great. It overcharges by a factor of 400% on procedures and more on pharmacy and oncology. The hospital is stated to be a "Christian-based and not-for-profit", but has employed about every technique available to make it a huge "reserve" generator. Recently, the hospital added more new construction, new heli-pad and business relations with other, larger hospitals to feed patients. And above all, nastier, meaner and more contempt-filled back-office workers.

If other hospitals were available, I would certainly like to check them out. And basic consumerism is denied. At great expense to the consumer.

Skewing the Medical Supply/Demand Curve

As of yet, I have not addressed the issue of US Universal Health Care. I can only assume readers will be asking themselves as to my position of such a national offering.

Universal, or more accurately, nationalized health care will not work in the US. If you are a fairly cognizant person, emergency rooms now are overrun with people who have no need being there. For the most part, visitors of ER's are there because they have no regular physician for themselves or more likely their children. ER visits happen when the parent is not at work, which often is after 6 pm and before 7 am. As a result, ER's become overwhelmed with sore throats, minor viral infections and little boo-boos.

Now, consider the scenario of health care where the individual feels it their right to take as much of the resources as possible in order to get their 'fair share'. Consumers will see health care with the same concern as cheap gasoline which spawned the overly huge SUV's that get terrible gas mileage. At today's gas prices of $3.++ a gallon, SUV's are dying horrible dinosaur deaths.

The 'cheapening' of valuation of US Health Care would only drive the hypochondriacs out of the woodwork and choke the limited resources we have now. In a way, cheap health care insurance up until now, has cheapened US Health Care too. The process of cheapening a resource also drives up demand (refer to Econ. 101 for supply/demand curves). Artificially cheapening a good or service really screws up the demand curve!

The reality is that US Health Care is to be more expensive in order to allow the market to keep it scarce. But, why is the thought to raise the cost to the middle class and the working poor? And is making such an important service like health care scarce what this country really wants or needs? What makes it very hard to accept as an institution, is to see the very poor who are taking a disproportionate amount of the total resources because THERE IS VERY LITTLE OR NO COST TO THEM!

Really! Oh, some states have a small co-payment for their programs for children's health care, like $15 - $25 per child for total care coverage. California, I believe has a very generous plan which has people opt for a state run program that is totally inclusive rather than use a commercially available plan with co-payments of 10 - 15%. What happens? People will find ways to cheat the system by excluding specific information in order to qualify for cheaper, but more inclusive state programs and by-pass the higher costing, but more legally accurate market available health care insurance program.

US Census data can tell us that there is a huge number of uninsured individuals and it even may tell us of how many citizens qualify for extremely low cost or no cost health care coverage. And with that data, one will begin to see the amount of waste directly attributed to undeserving individuals. Indirect waste is the viewpoint that the service is worth less than it really is in the market, and the demand for service for boo-boos and runny noses is totally unnecessary, artificially taxing our US Health Care resources. (Thanks to intelligent triage nurses, most of the people who don't need to be in an ER have to have a very long wait).

No, we need to bring the concept of higher value (best administered by cost) to the ones paying the least illegally and artificially. We must attack the hit to US GDP at 16 - 18% for US Health Care by attacking waste in all areas. The waste Southwest Medical Bill Review & Recovery challenges is the $51 Billion in fraud conducted at the medical provider level and the over $220 Billion at the error and clerical aspect of hospitalizations. Hitting the problem from several ways will increase the efficiency of US Health Care to make it more market realistic.

What Underlies the US Health Care Disaster?

'Tis Sunday of the Memorial Day weekend and not likely to have any real meat in any blog, especially one relating to something as serious as US Health Care and its broken state. However, consider what is happening across the nation in hospitals - nursing staffs pull a full shift with enough people present. Doctors have made arrangements to cover ER, OR and whatever area needs attention. Sufficient staffing has to be made at all testing labs and everyone affiliated with the ability to get the data to and fro despite the time, holiday or situation.

Is the 'round the clock' manner of US Health Care part of the failure of it? I can hardly think so. Almost any sort of industry has not had a negative impact due to working swing and night shifts. Certainly, only some people can really thrive on a different clock than daylight work, but most in the medical field - those who are in direct contact with patients - know that is all part and parcel of their jobs.

What about the other part of the medical industry - the personnel who are not in direct contact with patients or the needs of patients, but who make up the other half of hospital employees? I speak of the back-office workers, the paper pushers, the coders, the day workers...

The day workers in the accounting and records departments are not mandatory during shifts other than daytime. And the managers of those departments are not around except a little less time than the day workers. It is my contention that the 'other half' of the hospital has employees who are likely much less motivated than the actual floor workers who have patient interaction. Floor workers see the positive impact they have on the well-being of their 'customers'.

The 'back office' workers are not seeing any real positive benefit of their work, I propose their level of job dissatisfaction would equal or possibly be higher than office workers throughout all industry. And that is where we have a rub...Health care is life and death, extremely important to everyone directly involved. Yet, we have the 'other half' of the hospital who may have a great deal of contempt for the patient, the employers and the job itself because they are not directly involved. The level of connection and compassion can never be forged because the office area is not tuned into the feelings, emotions or history a floor nurse or other care-taker would have.

Consider this, part of the major problem in US Health Care being broken is that well over half of those involved really don't give a shit! It's a job and I count widgets or manage beans or whatever in this setting or in about any other interchangeably here or anywhere else...AND I STILL HATE MY JOB!

With a high level of job dissatisfaction the US worker has, how can we have a 'well' economy when it comes to health care? The contempt for the job is barely contained and bubbles over into the general population, the hospital operation and specifically, patients.

I have to contend that a major part of the inefficiencies we see in US Health Care is due to the high level of dissatisfaction of employees. Such dissatisfaction impacts the level of productivity, the degree of mistakes made and spitefully made, albeit, erroneous entries.

Then, is the epidemic of inefficiencies of US Health Care really isolated to that industry? My contention and postulation it is not. In fact, I feel very strongly that the feeling of disassociation the US worker feels, the high level of anxiety and fear of job instability and insecurity of their perceived actual contribution makes them emotional wrecks with direct impact upon domestic problems, alcoholism, drug abuse, depression and obesity.

While I am not stating source materials here, and that I am sitting out of my office on a holiday weekend, I am certain I am a lot more correct than wrong. Others may dispute my claims and opinions, however, the proof is in the pudding. The reality of what we experience surely shows what I have said is true. The other issue to consider is what impact will the worker feelings have on our overall economy in the future? The cost will be discovered to be devastating!

Maybe, that is why the US economy has been moving away from personnel expenses and that of technology and capital. Cutting out people seems to be the answer in our economy...with obvious clarity!

Figures Don't Lie!

It's no secret that people manipulate statistics and figures on spreadsheets in order to make it appear the way they want it. Books are cooked, data is mixed and rearranged in order to tell a specific story. The only time that is not the case is when an audit takes place to verify and validate numbers according to accounting standards.

Yet, there are no set of standards for almost all internal operations of a company. Only at the end of the line are standard GAAP (generally accepted accounting practices) adhered to. And on top of that, rarely are firm's books audited (I know, I know. Books are audited frequently, but give me a bone, here!).

I had a very smart product manager in finance who had elaborate spreadsheets showing margin, profitability, rate and all the other important ingredients he needed to use in order to give us rates. He had explanations, figures, facts and all the supporting information to choke a horse. As a result, my office always had to accept his decisions because there was no use in trying to dissuade him from figures he had decided upon.

I would groan or frown when he gave us our pricing changes and maybe even make a weak protest about how far out of whack his pricing was considering the competition. Nevertheless, Gary would stick to his guns. He was one tough character.

About 10 years later, I had cause to talk to Gary at his new position in a bank in Pittsburgh and I was in profitability consulting. The discussion turned to old times and then...he confessed! Gary said that when he made new pricing decisions, he just made it up! He pressed us to get the highest rate he thought he could get us to swallow and manipulated his spreadsheets to "validate" his opinion.

Oh, his figures didn't lie. Gary just did. The numbers on the spreadsheet were real, and they computed correctly and there were actual relationships built in. But, in the real analysis, he pulled a number out of his ass and ran with it, sometimes just to see how we would react.

Because of Gary's "Silly Wild-Assed Guess" (or SWAG) method of pricing, he put a lot more undue stress on my sales' team and me, but, got very high yields on the portfolio. During his and my time at that particular operation, we made a boat load of money for the bank!

That still doesn't excuse Gary for lying to me. It does show a great example that figures don't lie, but, liers use figures. Even if proof is made, is it worth believing? Who do you trust? I guess, the audited books.

US MBA Programs - Grenades in Tents

MBA - Someone with a Masters degree in Business Administration. (Remember, you can't spell MBA without BMW!).

Are we, as a country, getting our money's worth out of MBA's? Really! Consider what an MBA does in our current economy, then counter it against their self-centered justification for their income, lifestyle and arrogant nature in corporate America. My thesis is that business schools are not, repeat, NOT producing the value to US business that the schools, the students and corporate America believe.

As a nation, we should discount some things, like if one has an MBA degree. I have seen the result in how a smart, quick-thinking person has been reduced to an arrogant, self-grandiose buffoon once he or she is handed that dreaded degree.

It appears that once a person can affix "MBA" behind their name, they become like a low-middle belt in karate -- very dangerous but without any of the understanding or respect for their lethal abilities. And just like karate, as one ascends the belt ranking, an MBA who studies further develops the level of respect of their lethal knowledge as not to hurt people inadvertently.

I have seen many, many companies listen to the MBA's they have recently hired to make some very stupid decisions. Rarely have I seen companies take the advice of long-term, yet lower level, employees which made more sense. Consider the analogy of the military using the advice of a newly minted second lieutenant to that of a seasoned Master Sergeant. If memory serves me, the last time that was attempted in a real battle situation, the term "frag" came into our language with a specific military meaning in the Oxford English Dictionary.

The US Army soon realized its mistake in taking the advice of "wet-behind-the-ears" newbie to that of a seasoned warrior. The US corporate world is not that far advanced to think their methodology is much different from the US military, circa 1970.

I propose changing curriculum of the business administration programs throughout the US to be more realistic and not so theoretic. I realize, European MBA programs are advanced in terms of the theoretic aspects of business management, particularly with the the methods of financial analytics, however, the US market is not showing itself ready for the objectivity the Europeans, the Asians and the Middle Eastern students are learning in their respective universities of higher learning.

One could then assume that US business schools are retarded. Hmmm. I cannot argue with that assumption. Not when my personal experience as a manager is to see much more intellect coming from workers who are well versed in their jobs, but without the income or titles that accompany the kids from MBA school. At least not the US students.

In my dealings in business, I was fortunate to run into some very smart young people. Not one of the smartest of the smartest young people were US educated. If memory serves me correctly, I was very impressed with those educated for business in the UK, France, Netherlands, India, and Singapore. And what of the students educated in the US obtaining MBA degrees? What do I remember most about them? I remember them being loud, obnoxious, arrogant and not very intellectually stimulating. I recall them being more in love with their newly acquired BMW, trophy girl friend and their polished image in the mirror, than with the concept they were still learning how to be a contribution to society. As a result, they didn't, haven't and won't...

Next time..."figures don't lie but liers use figures".

Emotion in US Business - Good or Bad?

This story is about the channel marketing approach to a new business. We have been successful in attracting the attention of a couple of established entities from which to propose marketing relationships. Vimo responded with a "let's talk further" and my contacts in insurance said they are ready to proceed. All that has happened is within my levels of expectations.

Why am I so positive, or better yet, so cocky, that I assumed or felt the responses would be as such? The product is very, very sound. The pricing model and the deal offered associated business is very favorable. There are a lot of dollars left on the table as it stands, and the proposal we have shot to various entities makes a lot of sense. For the amount of effort we ask, the profit is pretty darn nice!

I did get an email from a friend in the insurance business asking if we were ready to play in the realm of big business. I feel we are. None of us at Southwest Medical Bill Review & Recovery are newbies to life, business or the way the world works. The only real concern I have is being in the same room with the person who "owns" the sacred cow I slaughter.

Here is what I mean. Anytime in business, when decisions are made, someone has to champion and sell a specific process or method to their internal operation. That person is the one who has the most "ownership". The way things have been done, which are proving to be more and more inefficient, means that he or she has the most (emotional or mental) ownership of that decision. When an outsider comes in to prove, give examples and downgrade that method or decision, the one with ownership gets defensive.

The attack on the process becomes personal. No longer does this person retain objectivity in evaluating business procedures, rather, the old "owner" stiffens, closes his or her ears to rational discussion and retreats to their old position of power with which to fend off attacks.

While it would be reasonable for that person to realize things change over time, and that their pet decision, while the best at the moment, has run its effective course and now needs replacement. Unfortunately, just like a nurturing parent, their child has no problem and if anyone thinks there is, then the real problem lies with the outsider who is trying to harm my (child, idea, process, business decision, etc.).

I have seen it so many times before. For example, a very bright CFO who understands Excel spreadsheets inside out and had a lot of personal time to devote to it can write a pretty good model for cost of money/asset allocation for a financial operation. Will it do a pretty good job? That depends. Maybe. What really matters is the level of sales that person can do internally to convince upper management that a 'home-grown' spreadsheet can address all the concerns the Financial Accounting Standards Board requires. (Whether or not it can will be determined in the next audit by the Feds, OCC or whatever regulatory agency reviews them). Regardless, if after it has been approved by internal power positions, the seller will hold on to that model like a parent in a tornado!

Emotion, anger, rationalization, deceit, any and everything is warranted in order to keep ownership where it is. This is the reason why changes are so very hard to make in business. (KEY POINT). Status quo is not controversial. Change is. A procedure which is proving to be ineffective is still safer to maintain than switching to a new method or process of doing business. As a result, US business is mired in the muck and fear of change only to try to ride a dead horse, beating it needlessly.

Example: US car makers are sucking badly now. Why? They are guilty of the same thing they have been for the last 35 years, arrogance and fear. They arrogantly hold on to the concept that the US market wants a huge SUV in order to maintain our active lifestyles and fear to suggest anything but what was seen as the case. But, are Americans really that active? No, they just like a lot of leg room in their vehicles so they can stretch out and watch DVD's while moving. In reality, SUV's, with their ability to go off-road, run in the forests, deserts and back country, never get off pavement ore even out of the suburbs. The size and room of a vehicle is just bragging rights like a 4,000 square foot house with home theater for two people to get lost in so they don't have to see one another during their marriage.

The success stories are the same thirty-five years ago; Honda, Toyota, Nissan (then Datsun) and their luxury lines, Acura, Lexus and Infinity respectively. Does anyone see a trend here? What enabled the same companies to be at the lead again? Likely, the reason is these companies have been doing research as to what the US marketplace wants in an automobile. The fact Toyota of North America has a design center in Long Beach, CA is no coincidence. These companies research, ask, review, test market and seek input...NO MATTER IF IT CONTRADICTS THE CURRENT THINKING OF DESIGN OR NOT!

American car makers, as well as other US industries, are afraid to ask questions because it has the impact of change. Change is dangerous and risky. People get fired over change. And with the general fear employees have in financial stability, no one wants to put their neck out just to get the head chopped off. Raise a new idea? Challenge the status quo? Beg to have attention brought to oneself only to be seen as unnecessary and "allowed to spend more time with the family". And the reward for those who are forward thinking in a corporate environment? The opportunity to spend more time with family.

Small and start-up businesses have to be aware and fast-thinking. Fortunately, that is one of the best features of the US economy -- when slow-moving and slow-thinking corporations impede the natural efficiency of the market, new companies spring up to fill the void. Eventually, old business adopts the new processes, but without the "fear and loathing" that accompanies the changes if they were to be internally produced. The new businesses may even eclipse the old and squeeze them out, becoming the new leaders.

HSA and Reality of Open Market System

I found a new blog about health care, titled, Healthcare Blog. http://www.healthcare-blog.com/2007/hsas-enrollees-predicted-to-rise-to-30-million-by-2009/
The particular item I read (and subsequently responded) was about the increase of Healthcare Savings Accounts (HSA's) to increase dramatically by 2009. I doubt HSA's will increase very much at all in 24 months. I cite the savings rate the US has entertained in the past 40 years, the short-term mind-set our business encourages and the fact we all want to play now with our money. As a result, I would be very surprised to see an abrupt change in consumer savings habits in such a short period of time like 24 months.

A more convincing reason as to why HSA's are unlikely to increase greatly is that the US Health Care scenario is becoming more illuminated as being "broken". It is my contention that, as individuals become more responsible for their health care dollars, the choices one makes will show greater insight into value and the efficient use of the consumer dollars. HSA's have a very small part of showing consumers the true value of expenditures, when they still have the large insurance policy backing the BIG expenditures...and that is where our health care system is running at its least efficiency.

Oh, please understand, the fact we will remove a few people from the ER for their child's flu-like cough and sore throat will do a lot to improve the way health care dollars are spent, however, those who recognize and actually change behavior because of it will be slim to none (and as the old joke goes, Slim left town two weeks ago).

The place we will achieve better efficiencies will be when procedures are charged based upon a relative standard pricing scenario, exactly which takes place in the open market and consumers have options and choices as to where their value is best located. The old line from Econ. 255 of "voting with our dollars" is the basis of our economy. Unfortunately, the way US Health Care is configured, dollars seem to be sent to very undeserving locations which are far, far from the most efficient. As we migrate toward a more open market environment for spending our health care dollars, people, places and organizations will find consumers are less and less willing to spend true, open market dollars with them, which will upset more than a few...

Be prepared for changes. It must happen and is on the beginning edge of happening. Make sure YOU are fully aware and congnizant of how you spend your dollars.

Starting Channel Marketing

We are at the start of setting up channel market relations. Vimo.com has responded to my inquiry and requested additional business model information. Those who know me have requested of me not to be too conspiratorial! OK, there won't be another hospital charging you from the grassy knoll.

I have put together a good draft and is likely to be approved. I hope to get it out tomorrow AM. If we are successful in getting more positive feed-back, the whole process may take a long time. I hope it will be effective and efficient.

The other channel I hope to open soon is with insurance companies. The window has opened for me to enter there too. I will also pursue that direction.

Trust and fiduciary offices are another avenue. After direct calls, though, I find that the situations of end-of-life hospitalizations do not occur that often in the world of trust services. I don't know how to accept that. Maybe I just got offices where their clientele is younger and not likely to die. Either way, I will pursue, persist and continue...

The idea of channel marketing is to have other sources of business rather than what oneself can generate alone. In the firms I have worked in the past, the idea of channel marketing was embraced more by the firm with less to offer, but had more contacts. In Southwest Medical Bill Review & Recovery, we have a lot to offer, but need to get a fast and large footprint on the market. At this point, the pricing structure is workable and would enable us to grow with very little expense. Hopefully, we can get some links to other sites and contracts with some large number organizations. Our business model puts work, but not cost up-front to us. We can do it and make it very, very profitable.

Blog Name Concerns

Here is the second installment on US Health Care 2.0. I was severely disappointed when I tried to Google my own blog to see if ANYONE could find it. As I typed in the title of the blog and searched available entities, I came up with a PAGE of stuff titled US Health Care 2.0! The one that incensed me the most was the use of the term and Steve Case.

Now, I have always had a very low opinion of AOL. The company seemed to be successful IN SPITE of themselves, not because of good management (Case) or business model. AOL just happened to be very lucky and have had very good "friends". Worst of all, I feel that Time-Warner is too good of a company to be connected to AOL, and I loathe the fact AOL owns one of my favorite franchises, Bugs Bunny. They don't deserve him!

Never the less, here in black and white of my screen was a suck-up article by someone who feels the world is now realigned correctly due to the fact Steve Case is on the job. (The article can be found at: http://www.entrepreneur.com/blog.html?id=177420 ).

I am unimpressed. Not that such a site as Case's is needed, but as to the messenger. "I believe health care in this country is screwed up," Case said during a webcast. "People generally don't trust it." That is true for many parts of the US Health Care system. What Case fails to recognize is that his "Q" rating or trust factor isn't all that great itself.

Part of the problem is the fact that what was is not what should be. Case really doesn't represent anything I can grasp and say with conviction a resounding, "YES" he has any ability to be "what should be"! To the contrary. His time at the helm of AOL forces me to feel just the opposite and not trust him, at all. So, what do we have...another old member of the established process putting some fancy web pages on line and buying some people to do the work. All well and good, but, what's in it for Case. Remember, there ain't no such thing as a free lunch (in other word(s) TANSTAAFL - with many many thanks to Kurt Vonnegut). So Case's motivation is just like anyone or any other company's. Actually, it is the same as mine and I don't particularly want to share it with Case. He had his hit, now it's my turn because I can do it better, faster and much cheaper.

Spoken like a true entrepreneur.

Initial Post - Welcome

Welcome to US Health Care 2.0. I named the blog this because we are on the edge of a huge change in the way health care is addressed, and more importantly how we as a nation allocate resources toward our citizen's health care.

According to the American Hospital Association, US Health Care is in crisis. They use the word "broken". As a nation, we spend over $1.6 Trillion a year on our health and are the least healthy nation of the developed nations. That dollar amount equals about 18% of our Gross Domestic Product, and by all estimates, will only increase to much higher levels.

Some studies say US Health Care will double by the end of the decade, others give it a little more time to double, but the result will be much more cost and expense in the future.

I was recruited to help market a start-up business that directly relates to the current inefficiencies in US Health Care, which has brought me into a world I had no idea existed. In the past, I used to have employer provided medical insurance benefits that had low visible costs. My premiums were deducted from my paycheck along with all the other things like stock purchase and retirement contributions. I had no real idea as to the cost of the overall policy, I only could relate to the relative pricing options at enrollment time, usually in mid-October, and forget about it until another year.

And that is exactly what we have now. The consumer is still not the entity seen as the purchaser of health care. The entity which provides the check to the hospital, doctor, lab, is seen as the customer. Unfortunately, the cost of insurance premiums are starting to become so high, many US workers are unable to afford insurance, proper insurance, or insurance with the ability to cover high deductibles.

The individual now has to step up to the plate to shoulder some of the economic decisions as to how to choose health care among the different options available. With that comes the need for clear, concise and accurate information about the true cost of medical procedures.

But, there is the problem we as a nation have about medical pricing information. It is almost impossible for the individual consumer to obtain it. Without honest information, no legitimate decisions can be made. In effect, the current environment of US Health Care shows itself to be controlled marketplace. My thesis is that the unnatural and unrealistic traits of US Health Care is a major contributing factor to its broken status.

The second part of this blog is to track the progress of a start-up company as we move it from just out of the gate to, hopefully, a major player in Health Care Audit and Accounting.

The parent company to which I refer is Southwest Medical Bill Review & Recovery. Southwest Medical Bill Review & Recovery is about 6 months old and launched our initial marketing efforts about a month ago. Part of the blog will relate to the overall situation of how the broken US Health Care system migrates toward something else while the other part will refer to the migration of Southwest Medical Bill Review & Recovery as a viable operation.

The most fortunate thing the company has is no payroll. All of us who are working to make this run are doing this on the side of some other ventures or work. It is being run out of different houses with only real expenses are for communication, web site hosting, printing and mail. With no overhead expenses, we can address our strategy toward the primary objective of getting contracts.

Would a venture capitalist like to invest in us? I doubt it, and I don't think there is any need or desire for funds. We are trying to get to that point of being real first.

When I say "real", I don't mean we are faking this project. I mean "real" in the terms that our name will inspire some emotion to our clients, the companies we audit and marketplace in general. We are real in terms of having already conducted hospitalization audits for patients and have discovered unbelievable overcharges!

According to a study by Equifax, over 90% of all US hospital bills are in error. Subsequent studies have found that errors range from 15 - 25%. When one does the math for all charges across the US for hospitalization and the amount of errors, we find that consumers are being overcharged, at minimum, $200 Billion! TWO HUNDRED BILLION DOLLARS A YEAR! Now, does that sound like an efficiently operating industry?

One hospitalization Southwest Medical Bill Review & Recovery audited was a 4 day stay by a close family member. I was shocked about every step of the way. First, I was shocked how difficult the hospital made it to obtain full and complete medical records. The hospital refused in the beginning. After being reminded the records were the patient's property, they contested anyone would need to have it. Going round and round on that issue was frustrating until they realized we weren't about to back down in our request. Eventually, the hospital did send out the records, but they were incomplete, edited and almost worthless.

The second attempt almost had security remove us from the office because the clerk behind the glass was so upset from our request, we thought she was about to get violent. Still, she tried to keep specific articles necessary for a thorough audit out of our hands. Eventually, she gave in when we cited specific passages from HIPPA law code of 1996. At the end of our meeting, the hospital clerk was nervous, shaking with what appeared to be rage, and very flushed.

The billing showed some very unusual things, like a single IV application that cost $70,000. A little lower on the bill, the same IV drip was charged $47,000. As we reviewed the audit, the actual medicine was shown to cost about $15,700 in the amount administered in the first application. Even allowing reasonable profit of 25% for the medicine, why was it overcharged by 446%?

And the list goes on and on and on with examples of outrageous overcharges. In the end, our insurance covered the bill. But, who is our insurance company? In this case, the coverage is from a large company that self-funds its health insurance plan. In other words, medical expenses for the employees are paid by a fund set-up and established by the company itself and that every dollar paid out for health care benefits comes out of capital. Corporate capital is funded by profits. If wasted dollars are being spent for 446% overcharges of medicine, it come out of the company's own profit structure.

Now, is it easier to understand how overcharging and medical inefficiencies impact a lot more than just the consumer? Medical expense waste is a huge toilet where we throw even larger amounts of money. As a result, I am learning to be very upset and afraid the issue is not looming larger on the minds of US citizens.

I will post more on the inefficiencies of US Health Care as we go along. I named the blog with a 2.0 designation in hopes we get to the next release voluntarily and based upon what we as a nation desires in health care. If we fail to change directions now, the future of this nation will be in pretty sad shape. Remember that!