The headline in the February 20, 2010, edition of The Los Angeles Times tells a story, "Consumers who buy individual health policies feel trapped. They have few options other than dropping coverage as insurers raise rates and slash benefits. Insurers blame the soaring cost of medical care and the churn of customers in the individual market."

No argument from me; for individual and small group health insurance policies, the rates—and rate increases—are crazy. But, the insurers' complaint about churn is spot on. Until we have universal health care coverage for 95% or more of the population, this ‘shift the risk’ game will continue. There is nothing that consumers or insurers can do about it. Solutions? Only two.


1. The government provides catastrophic health insurance for everyone, and/or


2. Employers are required to provide—and individuals are required to buy—health insurance.


Hopefully, our representatives in Washington will eventually understand these basic health care financing principles.

A few weeks ago, Newt Gingrich with the president/CEO of the National Center for Policy Analysis John C. Goodman jointly responded to President Obama's challenge for Republicans to show him a better idea on health care reform. Their ten ideas, outlined in the Wall Street Journal’s “Ten GOP Health Ideas for Obama” are as follows, with my reactions in red.

1. Make insurance affordable. This could be done by reforming the "arbitrary and unfair" taxation on health insurance. (Read: no more tax exemptions on employee health benefits)
2. Make health insurance portable. Employers should give employees insurance that can be brought from job to job, and people should be able to buy insurance across state lines. (Read: eliminate state-specific regulation of insurance comapnies and move to interstate insurance)
3. Meet the needs of the chronically ill. Help them take charge of their own care with Health Savings Accounts. (Not sure what this means)
4. Allow doctors and patients to control costs. Doctors and patients should be liberated from government-imposed payment rates that reward physicians for treating the sick but not for keeping healthy people healthy. (Not sure what this means)
5. Don't cut Medicare. Medicare's on an unsustainable course, but the $500 billion in cuts the Democrats propose are not the answer. (Interestingly odd for Republicans)
6. Protect early retirees. A bridge to Medicare can and should be built to help the millions who retire before they qualify. (Not sure what this means)
7. Inform consumers. Government data on cost and quality should be made public. (Of course. . .)
8. Eliminate junk lawsuits. "We do not need to study or test medical malpractice any longer," Gingrich and Goodman write, pointing to Texas' liability protection efforts as a model. (As a consumer, I'm skeptical of eliminating legal redress for medical malpractice without more regulation to 'disbar' bad physicians. As a health care analyst, the savings are only in the 1.5% range.)
9. Stop health care fraud. Approaches including third-party liability verification, and electronic payment can help cut the $120 billion lost to fraud every year, (Of course...)
10. Make medical breakthroughs accessible to patients. Red tape should be cut to get new drugs and treatments to patients faster. (Good on paper but full of practical, legal, and scientific problems.)

So what do you think? Can this GOP hit list be married with the existing bills to give us something resembling universal coverage with cost containment? Let me know what you think!

The burden of uncompensated care looms large for most health care organizations—especially with the press pronouncing the "death" of health care reform. For the most part, the term 'health care reform' refers to some package of legislation that has two elements—increasing the number of Americans with some form of health care coverage (particularly catastrophic coverage) and putting in provisions to reduce overall U.S. health care costs. The first is of particular interest to health care provider organizations and the second to small employers like my organization.

Now, you may be like one of my many friends who is celebrating the death of the current set of health care reform proposals. You may say that the free market alone is enough to both reduce costs and provide expanded coverage (one leading to the other)—by having individuals pay for their own health plans and health services. While I'm a fan of many free market elements in health care reform (including consumer vouchers for purchasing plans), I would caution those of you in that camp that the free market alone won't solve the coverage and cost challenges that face us (for many reasons too numerous to list here).

The rumors of the death of any health care reform proposal are going to continue to destabilize any organization in the health service delivery system that is not solely a private pay operation. The rising number of uninsured and inexplicably underinsured Americans will overwhelm the charitable capacity of the delivery system without some paradigm shift. But, I would caution my friends in the health care field to realize that we can't afford universal coverage without cost containment. It's just not a fiscal possibility.

And, as a small employer that provides health coverage to our team, I can state unequivocally that no health care bill will cause increasing stress—both financial and ethical. Over the past two years at OPEN MINDS, we have had two proposed increases in the cost of health care coverage—15% in 2008, and 40% in 2009. So, I wasn't surprised (though the press seemed shocked) at the recent decision by Anthem to raise their premiums by 30-39%.

I hope you'll join me in pushing our representatives of both parties to take action—to move toward a system of universal coverage (even if only for catastrophic coverage) and to come up with rational solutions to reducing health care costs.

“Making College ‘Relevant’”, a piece in the December 29, 2009, edition of The New York Times, was a classic example about how new college graduates are ‘missing the boat’ about being hired. As the CEO of a company that hires both college interns and new college graduates, I want to give some free advice:

1. Learn to write (it doesn't matter what your major is—this is the universally necessary skill for most businesses)
2. Computer skills are a must—and I'm not talking about using Twitter; the basic skills you need are word processing, spreadsheets, and web searches (others are a bonus)
3. Be able to do basic math and understand the meaning of charts and graphs
4. Remember that in the information-based economy workplace, attention to detail matters—your mother isn't there to clean up your work for you
5. Keep in mind that most of your personal preferences are not relevant on the job—if you're not happy with what you're doing, save your comments for after work or find a new job.

For college graduates (of whom there are many) who cannot master the first three items, it is really a systemic fault at the college level. No one should graduate from an academic institution without those basic skills.