Readers of this blog are aware of my fixation on transparency.  Readers of my other blog, Again? Really?, know that I am particularly offended by slush funds, large amounts of taxpayer money redirected by government entities to surreptitiously benefit pet causes or personal gain.  The slush finds of a local government might be in the thousands or possibly a million dollars or so.  It takes the federal government to create a billion dollar boondoggle. 

Insured Americans will be paying a new fee as of October 1, 2012.  Anthem Blue Cross sent a warning announcement last week to advise us that they will be adding the charge to our bills.  “The Affordable Care Act (PPACA) established the Patient-Centered Outcomes Research Institute (PCORI) to explore the effectiveness, risks, and benefits of medical treatments.  This study is also known as Comparative Effectiveness Research (CER).  PCORI is a nonprofit, nongovernmental organization supported by a trust fund that is financed in part by fees from health plan insurers.”

The fees are $1 per covered person in the first year.  $2 per person in the second year.  And after two years?  The $2 per person per year will be adjusted for medical inflation. 

Bureaucracies, in general, like acronyms, but the combination of acronyms and money make for a government love affair.

Comparative Effectiveness Research came into prominence as part of President Obama’s American Recovery and Reinvestment Act of 2009.  $1.1 Billion was allocated. 

• $300 Million for the Agency for Healthcare Research and Quality.
• $400 Million for the National Institutes of Health.
• $400 Million for the Office of the Secretary of Health and Human Services.

This wasn’t a beginning, middle and end.  This was seed money.

The Department of Health and Human Services (HHS) explained that CER “compares treatments and strategies to improve health.  This information is essential for clinicians and patients to decide on the best treatment.  It also enables our nation to improve the health of communities and the performance of the health system.”

Gosh that sounds good.

According to the National Cancer Institute, CER has both its proponents and detractors.  One key issue was brought up by Jeffrey Kindler, CEO of Pfizer, who wondered whether the results from Comparative Effectiveness studies would be “automatically linked” to insurance coverage decisions.  In other words, will healthcare in the future become one size fits almost all and too bad about the rest.

In his paper “Comparative Effectiveness Research and Kindred Delusions”, Norton Hadler, MD expanded on the difference between efficacy and effectiveness.

I have nothing to add to that debate.  My only question is “How Much?”  How much money, your money in taxes and your money in fees, are we spending on this and who is getting it?

Billions of dollars funneled through the Department of Health and Human Services became even more of an issue last week when the Government Accountability Office (Yes, that GAO) found that the Obama administration was wasting $8.3 Billion on a questionable Medicare program. 

As part of a “Demonstration Project”, HHS has created an experimental program to study the effects of money on the insurance market.  This experiment is to award bonuses to high quality managed care Medicare policies known as Medicare Advantage.  High quality, like intellectual honesty, was one of the first victims of this scheme.  To make a long story short, the money, most paid out in the next three years, covers the cuts that were made in these popular programs by the President’s health care law.  The PPACA took money away, but Health and Human Services put the money back in through the back door.

The independent Medicare Payment Advisory Commission panned the misdirection.  The Republicans think that this looks suspiciously like a re-election driven decision.  The New York Post didn’t bury the lead.  They labeled it a political slush fund.

What we are talking about is money.  We know where it comes from, US.  What we don’t know is where it is going and why.  Unlimited funds funneled through Kathleen Sebelius and her politicized Department of Health and Human Services are sure to arouse suspicions.  Add to this an $8.3 Billion experiment and you have the potential for a real problem.

It sucks to be poor. It is nobody’s goal in life to be poor, to wonder how you are going to feed your family, keep a roof over your head, or to be unable to afford the most basic of needs or wants. I’ve been poor, not homeless or destitute, but close enough to appreciate the fear and uncertainty that comes with an overdrawn back account and a baloney and tater tot dinner.

I’ve never received government assistance, not even unemployment compensation. So I have never had to check in with a government employee, told where I could live, or what groceries I could buy. And when I needed to take my children to the doctor, I’ve always had my choice of all of the pediatricians in town.

The poor have Medicaid.

Medicaid. Fraud ravaged. Doctor hated. Taxpayer resented. Medicaid. And no one likes Medicaid less than the people it was designed to help.

There are 1.7 million Ohioans receiving state funded medical assistance. Ohio is revamping Medicaid, again.

Eleven companies recently participated in a complex bidding process to win a piece of this action. Five won the opportunity to provide coverage. Five lost and are filing appeals. One, Anthem Blue Cross the #1 insurer of Ohioans, shrugged off its loss and walked away.

Medicaid, the State of Ohio’s single payer health care system for the poor, appears to be mired in controversy. As reported in the Columbus Dispatch, there are charges of more than just irregularities, mistakes, and a shocking lack of transparency. There may have been actual fraud and false statements on the applications.

Some of the companies that were shut out contacted London based Barclays to analyze the process. They found “Scoring results indicate considerable inconsistencies among bidders…Scoring processes are always complex, especially in markets this large, but typically not to this degree.”

In a rush to save $1.5 Billion (real or imagined) in the next two years, the state may have selected up to three vendors thanks to applications enhanced with inflated statistics. Though the process was supposed to “improve the coordination of care for 1.7 million recipients and improve health“, it may, instead, have been just one more arbitrarily awarded government contract.

It is one thing to entrust your children’s health to the lowest bidder. It is even worse to be herded into a facility or provider that lacks the integrity to compete fairly. But when you are a football, when you are tossed between players, you don’t have much say in the process.

But then again, it sucks to be poor.

Her Nationwide guy suggested that she call me. And though I appreciate Mike’s confidence, I also know that his referrals are often people who have somehow fallen through the cracks of our system. This woman epitomized the permanent flaws in this and any system of health care. And more to my frustration than hers, I could not fix her problem.

Much like Eddie Vedder’s The Fixer, I have always been obsessed with making things right, of solving everyone’s problems. That empathy works well in what I do for a living. But I am deeply frustrated when I encounter a situation that can’t be fixed. Here is hers:

The woman, we’ll call her Maria, has group insurance through her employer. The cost of the policy has increased over the years, but the employer is still paying the vast majority of the premium. This year the employer changed the coverage to a High Deductible Healthcare Plan, in other words, a policy that qualifies for an HSA. Maria no longer has an office visit copay. Maria no longer has an Rx card. All of these expenses are applied towards her $4,000 deductible. In theory, this might save her money. In reality, she is screwed. She is on two very expensive medications. One is $885 for a three month supply. The other is $1,400!

Where does she come up with the money for these prescriptions? She makes just enough per month that she won’t qualify for any help from the drug companies. She makes too little to be able to afford the medications she needs to be able to work.

Got an answer? Neither do I?

No system could possibly sustain the cost of paying for everyone’s doctors’ visits, prescriptions, and hospital stays. We must contribute. We must either pay for insurance or be taxed by the government (or both) to fund the system that pays most of the bills. The balance, whether that structure includes copays or deductibles, must be paid by the person receiving treatment. Should we all be responsible for the same amount? Will there be a sliding scale based on income, location, or family size?

No matter the final outcome, most people will be offended when it is their turn to pay. Worse, many people will be forced to pay more than they feel that they can afford. And some will be buried in debt. The other choice is to simply limit the most expensive care based on survivability and efficacy. And that opens another set of worries.

In a recent Forbes article, Richard Grant argues that what we need is less regulation, not more. “Government’s main role has been to serve as the enforcer of a cartel that limits the supply of doctors, of hospitals, of drugs, and of innovative alternatives.” There is truth to all of that. And if we reversed our course and somehow made it to a completely open market, the well-off and educated, like Mr. Grant, might receive better care for less. Unfortunately, the Maria’s of our world would be collateral damage. I’m not sure which regulations Mr. Grant would like to eliminate. Do we want to trust the marketplace to license doctors and approve prescriptions?

The HSA policy is a half-hearted attempt at empowering the patient and controlling costs. It succeeds at neither. Does Maria need to be on these expensive medications? Would more common, less expensive drugs, be almost as good? Since at least one of these drugs is for a mental condition, would she have the needed faith in a new prescription that was purchased not because her doctor thought it was better for her, but because she can’t afford the good one? The experiment is doomed to failure.

And I can’t help her. And there is no moment worse for a Fixer than when he realizes that there is nothing that he can do.

Dave Cunix – surrogate. I was asked to represent Al Gore during the 2000 presidential campaign. I presented his positions at candidate forums and spoke to citizens’ groups. Based on Mr. Gore’s success, I was recruited four years later to serve on the John Kerry campaign. We know how well that went.

The candidate forums were very inclusive. Surrogates were invited from all of the major campaigns. The Bush representative and I were often joined by men and women prepared to advance the agendas of Pat Buchanan (Reform), Ralph Nader (Green), and Harry Browne (Libertarian). At the end of these forums I would say something that though incredibly true was sure to agitate the Libertarians and the Greens. “A vote for Ralph Nader is a vote for George Bush. A vote for Harry Browne is a vote for no one”.

Gosh that would torque them off. Worse, as we now know, I was totally correct. Here are the results of a few of the states:

        Browne   Buchanan      Bush             Gore         Nader
Fl      16,414     17,484      2, 912,790   2,912,253   97,488
IA       3,209       5,731          634,373      638,517    29,374
NH      2,757       2,625          273,559     266,348    22,198

Emotion plays a huge roll in politics. The politicians, our leaders, use our emotions to push us in one direction or another. Our first task must be to remove all emotion from political discussions. Once we get down to facts, to cause and effect, we can determine what we really want to do and how to create a logical course of action.

My issue with government in 2012 is the inherent laziness of our politicians. Speaking in snippets and sound bites and relying on emotion laden advertisements, candidates and elected officials don’t debate solutions, just fears. They exploit our fear of spending money. Our fear of the “Other”. Our fear of losing what little peace or privacy we have left.

The President’s health care program, the Patient Protection and Affordable Care Act (PPACA), was initially sold as a way to insure the uninsured, all 50 million of them. The American public was told that not only wouldn’t it cost more to do this, but that premiums would go down. And we were going to get better coverage (free stuff!) at no additional cost.

The Republicans were asking for a birth certificate from the tooth fairy.

And what were the Republicans doing during all of this? They defended the status quo and promised to respect the doctor/patient relationship. They assured us that they would protect the world’s best health care system. And we do have a great system. And we do have great doctors and hospitals. But G-d help you if get really sick and are stuck with inadequate insurance coverage.

So here, again, is the truth. We aren’t going to return to 2007. No one in power wants to replace the PPACA. No one wants to fix it. The Republicans took control of the House of Representatives over a year ago. Repeal Obamacare? How? To what end? If the Republicans had a constructive option they would have advanced it by now. As in any successful negotiation, common ground and saving face are keys to victory. Mr. Boehner, Mr. Cantor, Mr. Romney, and even Mr. Gingrich, a legislator who has promoted the individual mandate for most of the last twenty years, have not offered a path to modify the PPACA to make it work. They have no solutions, just campaign issues.

The Democrats have a program that won’t work as a privately insured system, but could lead to single payer. The Republicans have a fundraising gold mine. You? You have debates about birth control pills and a lifetime supply of smoke and mirrors.

The numbers are real, everything else is, as Rick Santorum would say, “BS”. The PPACA had to have gimmicks built in to it to cover the exorbitant costs. One by one these income generators are disappearing. The 1099 silliness is gone. The Long Term Care program (CLASS) is gone. The tax on Cadillac Health Plans will disappear, too. The Supreme Court is hearing arguments TODAY about the constitutionality of the individual mandate. We will get the verdict in a couple of months. Regardless of the outcome, the Patient Protection and Affordable Care Act will move forward.

So which party deserves your support? Who is going to get our health care system on to firm financial ground? Will a vote for one guy really be a vote for someone else?

I need a ballot that offers “None of the Above”.

Let’s pretend that you own a business, any business. Since we are talking about your imagination, this enterprise could be as small as just you and one employee or it could be as large as G.M. Your pretend business might be a service provider, a manufacturer, or a retail store. You may establish this business in any of the fifty states. It doesn’t matter. The only rule is that your imaginary company must be in a field that is totally foreign to you. So for me, someone who can’t even play an instrument, my fantasy will have me as the leader of a private orchestra. Got it?

I want you to think about your pretend business for a moment. Think about your time, your effort, your sacrifice as I announce that one of your company’s largest expenses is being eliminated. Excited? Did you feel that you are about to be rewarded for your hard work? Have you begun to spend the money?

But this is all an exercise. None of it is real. You can’t know, really know, what you might do in such a situation. Just as I will never be in a band, much less lead an orchestra, the members of the Congressional Budget Office (CBO) have no idea how real businesses function.

In a recently released report, the CBO attempted to predict the possible effects of the Patient Protection and Affordable Care Act (PPACA) on the deficit and the uninsured. It has been widely predicted that employers will dump their company sponsored insurance plans due to the ever-rising costs to comply with the new legislation. That is not new. This COB report unveils a Bad News / Good News scenario that we haven’t seen before.

As reported by Sarah Kliff in The Washington Post, “If employers drop 14 million, currently-insured workers into the exchange, the CBO projects that the federal deficit would actually decrease by $13 billion since those workers could no longer use the current tax deduction for employer-sponsored insurance.” Ms. Kliff’s article quotes the CBO’s numbers and explanation.

The staffers at the Congressional Budget Office imagined a scenario where the owners of businesses would drop the cost of insurance, ignore the government penalty (currently set to be $2,000 per employee per year), and give every employee a raise equivalent to the previous cost of health insurance! If that happened, if all of the employers in the country magnanimously dispersed 100% of the insurance premiums, ignoring personal wants and needs, Social Security tax, unemployment tax, Workman’s Compensation costs, etc…then, and only then, could there be significant deficit reduction from moving millions off employer sponsored group insurance and into the exchanges.

Does this make sense? Sure, if we pretend.

I was on a cruise, over a thousand miles south of the Florida coast, when Rush Limbaugh chose to waddle into the fray. Watching CNN as we were dressing for dinner, we thought that we were going to get a break from the stories of the horrific shooting rampage in Chardon when the anchors moved on to other topics. First it was the announcement of the death of Davey Jones. Then it was the death of reason in the ongoing health care debate. El-Rushbo had spoken.

The delivery and payment of health care in this country is already over politicized. We have more than enough emotion and not nearly enough facts. Logic and intellectual honesty are notably absent in most of the discussions. The Republican presidential candidates have studiously avoided anything that even approached a solution. They have all vowed to repeal Obamacare as if that wouldn’t create more problems than it solved. And into this we add Rush.

Where do we begin? Let’s start with a clear statement. Calling Sandra Kay Fluke, a law student four days older than my daughter, a “slut” and a “prostitute” because she vocally supports the President’s health care legislation is abominable. She is a civilian, a private citizen. She isn’t a public figure, someone who willingly subjected herself to this kind of derision or scrutiny. And no, it may not be right to say such things about public figures, but we do. Ms. Fluke should have been off-limits, like the nameless group of men that had testified about women’s birth control the week before.

So the predictable occurred. We put an important national debate on hold while we discussed the relative merits of a radio talk show host. The people that hate him, and Gosh there are plenty who do, got riled up and went after his sponsors. His defenders, a little more reserved than usual, assured us that Rush was just being Rush. There was a certain amount of merit on both sides. There is nothing the political right hates more than to be defeated by the use of the free market. And in all fairness, Limbaugh, ignored in the Republican presidential primary and uninvolved in the national discussion, desperately needed attention. Any attention. Everyone won, even Ms. Fluke. Her brand, her name recognition, is huge. She is assured of a much brighter future thanks to Rush Limbaugh.

What didn’t happen, what was stopped completely, was an intelligent, honest discussion of the issues. So let’s try to kick start the process.

Here are a couple of the stories you might have missed:

• We have discussed the Pre-Existing Condition Insurance Plans that the Patient Protection and Affordable Care Act (PPACA) created for the unhealthy uninsureds. The federal government’s actuaries predicted the average cost per enrollee at $13,026. They weren’t even close. The average cost now predicted for each enrollee in 2012 is $28,994! It is that kind of predicting that gives most of us pause as we contemplate the President’s health care program and future liabilities.
• Senator Mitch McConnell (R-KY) has decided that he sees no reason to vote on the repeal of the PPACA until after the November election. It is important to remember that he has never seen a reason to offer an alternative to the President’s plan or a workable way to modify the legislation.

Add to this the date March 26, 2012, when the Supreme Court will begin to hear arguments about the Patient Protection and Affordable Care Act, and we have more than enough to keep us busy. In fact, we are much too busy to waste time on an entertainer.

Frank O. had been an agent for over twenty years the day I started with Prudential in October of 1979. My desk was next to his. Fifteen months later I was his manager and my desk was in a private office. I asked to spend a day in the field with Frank, not because he needed me, not even because he wanted me. At best, Frank tolerated me. No, I needed to learn what he was doing and how he had survived for so long as an agent.

The first stop was a longtime client of Frank’s. Climbing up the front steps, I noticed that my employee was walking to the side door. The side door? Frank reminded me that we were not related to the client. We weren’t family. We weren’t their friends. We were service providers and service providers enter via the side door.

It was at that moment that I realized how little I knew about the insurance business.

I was reminded of that humbling experience as I watched President Obama and Health and Human Services Secretary Kathleen Sebelius stumble, again, as they attempted to control the delivery and payment of health care. The biggest difference was that I, at age 26, realized how much I had to learn. Our President and his staff seem surprised that their frequent missteps are so apparent and so unacceptable.

My last post, The Ongoing Religious Battle, addressed the Obama administration’s decision to classify Birth Control Pills, IUD’s, the Morning After Pill, and some forms of Sterilization as preventive Care. The Patient Protection and Affordable Care Act (PPACA) includes a provision that preventive care is FREE. That is the government’s definition of affordable, FREE.

The predicted firestorm erupted. The Vice-President and other committed Catholics in the administration had warned of problems. The White House Chief of Staff resigned. Last Friday the President announced his solution. As long as you don’t care about the moral implications, the money, how insurance works, or intellectual honesty – it was the perfect compromise.

Everything is still free. The insurance company will pay for it.

(Before we go any further, let me assert that I am totally in favor of most forms of birth control and voluntary sterilization. Let me also remind you that this has nothing to do with me, personally. This is about us, all of us.)

It only took a few hours for the double talk of the compromise to become apparent. Senator Roy Blount (R-MO) quickly released a statement via email. It stated, in part:

It’s clear that President Obama does not understand that it isn’t about the cost – it’s about who controls the religious views of faith-based institutions. President Obama believes that he should have that control. Our Constitution states otherwise.
Just because you can come up with an accounting gimmick and pretend like religious institutions do not have to pay for the mandate, does not mean that you’ve satisfied the fundamental constitutional freedoms all Americans are guaranteed.

A little dramatic? Perhaps. I suspect that the Supreme Court will be the final arbiter as to whether this crosses the line. But, Senator Blount was absolutely right when he called out the President for his sleight of hand.

The insurance companies are just going to pay for Birth Control Pills, IUD’s, the Morning After Pill, and certain forms of sterilization? Really? How do they show that on their books? These are claims that are eventually paid by the employer. And of course, large employers, such as hospitals and universities, are often self-insured. The insurance company simply processes the claims and organizes the market.

President Obama decided that insulting observant Catholics and other people of faith wasn’t enough. He decided to insult our intelligence, too. The President declared that insurance companies should pay for Birth Control Pills, IUD’s, the Morning After Pill, and even sterilizations from company coffers because it will save them money. By eating these costs, the insurers won’t be paying for unwanted, unplanned pregnancies. Ignoring the fact that it isn’t the insurer’s money or responsibility, perhaps we should take this to its illogical extreme. If we want to save money and eliminate unwanted and unplanned pregnancies, why don’t we have the insurers hand out chastity belts? Of course that’s silly, but it is no less honest nor illogical as the President’s suggestion.

It is time to remind you that none of this is about contraception, women’s rights, or even preventive care. It is about creating an environment where private insurance becomes unaffordable and only a government solution will work. Whether that is by accident or on purpose is for you to decide. But if you have someone restructuring the delivery and payment of health care in this country who doesn’t understand the basics of the market and insurance, you might as well have your attorney remove your appendix.

Can you force your employees to live YOUR creed? More importantly, can you make it unpleasant and expensive for your employees to break your personal religion’s rules? The answer, as it is so often, is Yes and No.

Preventive Care is a key benefit of the Patient Protection and Affordable Care Act (PPACA). Katherine Sebelius, Secretary of Health and Human Services, recently decided that Birth Control Pills, IUD’s, and the Morning After Pill are all FDA approved forms of contraception and as valid a part of preventive care for women as mammograms and Pap tests.

The PPACA therefore forces employers to not only cover Birth Control Pills, IUD’s, and the Morning After Pill, but it also eliminates the copays for these items. They are free to the insured employee. This shifts the cost for these items to the insurance which in turn shifts the cost to the employer.

So, if you own a factory and you are opposed to these forms of birth control, you will soon be paying for your employees’ pills. Fair? Most of us will say Yes. We don’t want our employers to dictate moral positions to us.

But what if we aren’t talking about a factory? What if we are discussing a church or a church funded organization? Is there a difference? According to the Obama administration, the answer is No. Every employee has a right to preventive care and preventive care includes birth control. The Supreme Court may disagree.

We are constantly trying to define property rights in this country. Ron Paul takes the Libertarian position that the government doesn’t have the right to force you to conform to other people’s wishes. If you don’t want to serve African-Americans in your restaurant, the market should push you to reconsider, not the law. That is one extreme. The other extreme has the government involved in many of the day to day decisions of businesses. This involvement manifests itself in smoking bans in bars, the elimination of trans fats in restaurants, and forcing businesses to not only provide health insurance, but to determine the very nature of the coverage. This is where we are again.

Where is the line? Can the Catholic Church, which is adamantly opposed to most contraceptives, limit access to its priests, nuns, and church employees? Can the Church limit access to the employees, Catholic and non-Catholic, of its schools? What about Catholic hospitals that may employ hundreds of non-Catholics? How much influence is the employer granted?

The Supreme Court, in a 9 – 0 decision, recently ruled that the First Amendment “gives special solicitude to the rights of religious organizations” in how they treat their employees. This decision was reached in response to a lawsuit brought by a teacher who had been terminated by her employer, a Lutheran school. Chief Justice Roberts challenged “government interference with an internal church decision that affects faith and the mission of the church itself”.

Will the Patient Protection and Affordable Care Act allow you to provide access to birth control for all of your full-time employees? Yes. Will you as an employer pay for it? Yes. Will you be forced to provide access if you don’t want to? If you are a business the answer is still Yes. If you are a church or a religious based institution, the jury is still out.

The new president of the Ohio Jaycees, back in the early 1980’s, was a good old boy from the southern part of our state. We’ll call him Bubba. I was a state level officer and had been very involved in the other guy’s campaign.

Bubba was a nice enough guy who was incapable of stringing four words together without saying the word “great”. No other superlative, just “great”.

The Ohio Jaycees were holding a state-wide meeting and Bubba was going to give a fifteen minute presentation. I created the Great Great Contest. I divided an oversized sheet of cardboard into a thousand numbered squares and allowed the guys to predict how many times Bubba would say “Great”. Each block cost $1. Half would go to the winner. Half to charity. You could hear the crowd counting throughout Bubba’s speech.

Bubba isn’t running for President, but I think about him every time I watch the Republican hopefuls debate. Which candidate will be the first to say that he will “Repeal Obamacare”? It is a race. I half expect Mitt Romney to be mouthing the words as the cameras focus on him during the introduction.

There are two more debates this week. Get out a sheet a paper and keep score. Who gets to be the first to promise to “Repeal Obamacare”? Who says it the most? How many times are Obamacare, and its orphaned cousin, Romneycare, decried in each debate? You may need a large piece of paper.

Now grab a post-it note to score how many times any of these candidates propose an alternative. My prediction – ZERO.

This blog has been clear. The Patient Protection and Affordable Care Act (PPACA) is a terrible overreach and a badly written bill. The numbers don’t add up. The stated goal, the motivation for this whole endeavor, was to cover the uninsured. The PPACA has not solved that problem. But, what does repealing it accomplish?

The PPACA is almost two years old. Businesses and insurance companies have spent millions of dollars to comply with the ever-changing regulations. President Obama was clear, prior to the bill’s passage, that “if you like your current health insurance plan, you can keep it”. That didn’t happen. The cost to maintain a separate series of “grandfathered” contracts compliant with the contradictory regulations emanating from Katherine Sebelius’s Health and Human Services was beyond reason. One by one, the insurers eliminated all of their old contracts. If you repeal the PPACA, do you have to go through the expense of changing the majority of the group and individual health policies in our country?

The PPACA made preventive care a mandatory benefit. Does that stay or go?

The PPACA allows children to stay on their parents’ insurance until age 26. How many pregnant 24 year olds would lose coverage if you suddenly repealed the PPACA?

Would the repeal of the Patient Protection and Affordable Care Act eliminate the health policies that were created for the chronically uninsured?

You get the idea. The PPACA may be a mess, but it, just like the problems it purported to fix, exists. Repealing the Presidents’ health care plan without having a well-crafted replacement might be worse than retaining it.

This blog has consistently doubted the Republican’s sincerity about repealing the PPACA. I view it as a safe fundraising ploy. It would take way too much effort to create a viable alternative. There is no risk to denigrating legislation disliked by over half of our populace. Creating an alternative would expose them to the same type of scrutiny and probably the same results. Even modifying the law was more effort than the Republican House could muster.

Bubba said “Great” 123 times. The winner received $140. Bubba isn’t running for President, but I am convinced that he was one of Michele Bachmann’s speechwriters.

When is selling not selling? Where is the line between helping your customer and primarily helping yourself? Determining that becomes harder each day.

One of my clients needed to talk. She had received a disturbing phone call at her home and wanted to know if she had handled it correctly and if I knew the back story. Mary (not her real name) was contacted by a national pharmacy. We’ll call the pharmacy chain Mega Rx. Mary was advised that her insurer would no longer cover medications for her and her family from their local Mega Rx. Since they knew that Mary would hate to loose access to Mega Rx, they would be happy to connect her to someone who could help her find an insurance policy that would allow her to retain them. All she had to do was stay on the line. Mary thanked them but said that she already had an agent and hung up.

Think about this for a second. The national drug store chain had fought and lost a battle with a national insurer. They were mining their records for anyone who had that insurer and had had a prescription filled in the last year or so. And if Mary was gullible and not paying attention, she might have somehow been talked into different insurance that would have definitely covered Mega Rx, but might not have covered her doctor, or given her and her family the same level of coverage.

The appointment to change individual health insurance policies usually takes an hour in my office and involves a lot more than whether or not Mega Rx is in the network. This silliness is taking place under our current set of rules. The states and the federal government are still writing the new rules. Some people don’t think we really need licensed agents. Why not let anyone sell insurance?

I just spent twenty minutes completing my application to renew my license to sell life and health insurance. I had to prove that I had completed 21 hours of continuing education and 3 additional hours of ethics training in the last two years. I actually had a total of 42. That does not include the 7 to 9 hours per year for Medicare products or the mandatory additional training for long term care coverage. I then attested that I haven’t been convicted of any crimes, haven’t had my insurance license suspended or revoked, and that I don’t owe back child support. This is true. You can not sell insurance in the State of Ohio if you owe back child support. I paid my $5 and I should get an approval notice some time next week.

All states have seen a value in licensing insurance agents. It is obvious that one value of the requirements is to weed out the part-timers. The public is better served by committed professionals who are willing to take the time and effort to stay current. And though insurance agents (me included) will never be confused with rocket scientist, we do serve an important function in the market as we help the insured public acquire coverage and navigate the process to get the most from their contracts. The insurers long ago (begrudgingly) accepted our value.

This brings us to the Patient Protection and Affordable Care Act (PPACA). The authors of this legislation did not believe that the public is capable of calling an insurance agent or company or shopping online to purchase health insurance. Since finding health insurance was so difficult, insurance exchanges, a marketplace, would be created in each state. As you can see from the Obama administration’s website, the exchanges, an additional layer of bureaucracy, is going to save you money. And how will you get to the exchange and who is going to help you choose the right type of policy for you? That would be the Navigators.

The PPACA is pretty sure that almost anyone that can fog a mirror is capable of doing my job. Any employee of trade association or union can walk you through the process. In fact, the PPACA spends more time on the notion that the Navigators can not be compensated by the insurers than it does on training or qualifications.

A well publicized letter from David M. Casey, Senior Vice President of MAXIMUS, a company that specializes in Medicaid enrollment, details the Patient Protection and Affordable Care Act’s aversion to professional insurance agents.

John Doak, the Oklahoma Insurance Commissioner, is succinct in his judgment. He has consistently challenged the federal government’s intrusion into insurance regulation and health insurance. He has asked what kind of training the Navigators will have in insurance products, health information privacy regulations (HIPAA), or ethics. And of course we already knew the answer, none.

The other question is “Who will be paying the Navigators”? You have two choices. Either the Navigators eventually become employees of an endlessly growing government program, or they are employees of organizations who have something to gain by you and I being steered into one policy versus another. And that brings us back to Mega Rx. The major pharmacy chains are currently exploring ways to have employees become Navigators under the future exchange program. Will they be impartial? Will they be looking out for your best interest? Will the sun rise from the west tomorrow morning?

This is too easy and way too transparent a case of conflict of interest. What if a major insurer is donating money to your local trade group? The employee of that trade group would work to navigate people to that company’s policy. There is a lot of money involved. This won’t be subtle. And it won’t be easily traced.

So when you get that phone call from the drug store, or the doctor’s office, or the Chamber of Commerce, and you will one day, ask yourself why. Slow the process down and try to determine who is getting paid and for what.

In the interest of creating transparency and simplicity, we have failed at both.