Here We Go Again – Again

By RICK PETERS

Last Friday morning, delirious, wasted, bone tired, driving home from the Emergency Room at 8AM in my beat-up little truck with only one speaker working. Amid all of us awash in the blogosphere thank the stars for NPR and professional journalism.  Steve Inskeep, from Morning Edition was interviewing Angela Braly, CEO of Wellpoint.  Perfect! Wellpoint is the largest health insurer in the U.S. in terms of covered lives. Also, Wellpoint, the former non-profit Blue Cross of California converted into a very profitable for-profit corporation, represents the epitome of for-profit medicine.

Mind you I’ve already thrown in the towel.  Any meaningful reform seems well past doomed. Harold and Louise are already back channeled through Newt and Sarah, and fringe lunatics are getting airtime, calling Obama a Nazi because they cannot understand the difference between National Socialism and Medicare. It would be comedy writ large if not for the gullibility of the American electorate. Oh well, here we go again.

The trouble is that our problems are so deep and fundamental that any sort of government driven health reform is destined to have limited impact despite the best intentions.  That’s what was so painful and profound about Inskeep’s interview with Braly.1 If we are going to even start to move this mountain we are going to have to foster change from within the system. That change is going to have to come from all of us as a society and as patients, families, health care providers, health care organizations, and influential health care managers and executives.

Newt and Sarah know the game they are playing – they’re politicians.  Their party is out of power and they are using opposition to health care reform to rebuild their base by any means necessary. Braly and her compatriots are a whole different animal.  They know exactly what is at stake.  Listening to the interview you might wonder how this ditzy soccer mom every got recruited to run a major corporation.  It’s uncanny.  She does not answer a single question.  What she does do, however, is illustrate what will essentially kill not only health reform but also real change.  What Braly does is deflect responsibility to everyone else in the system and not once acknowledge that not only do we have a problem but that we all share the responsibility for getting here – Wellpoint, Braly, and every one of us in health care included.

Braly’s no fool.  She is the third highest paid health insurance executive having been compensated $9,844,212 in 2008 by Wellpoint.2 Only Ed Hanway, CEO of CIGNA, and Ron Williams, CEO of Aetna, were paid more.  Wellpoint’s profit in the last fiscal year was close to 4% as even Braly admits, which is equal to or greater than the entire administrative cost of the Medicare program.  Inskeep calls Braly on virtually every statement she makes but as a pro, Inskeep just lets her dig herself in deeper.

I think I fainted.  I crawled out of the car and went in to go to sleep with it all blaring in my head.  My patient with gallstones diagnosed a month ago now with elevated LFTs and awaiting an ultrasound wanting to know if she could just go out a get a carne asada burrito and then come back for the test.  The Alzheimer’s patient who could not walk or feed himself or recognize anyone who fell out of bed and broke his hip and needed a hip replacement not only because he was full code, but because it is the only humane thing to do.  The health information systems we struggle with feigning silence when we know they are archaic and are killing our efficiency.  The practice variation and flaunting of evidence every one of us is guilty of as physicians.  The elderly couple with the husband with pneumonia who has to be admitted to the ICU with the wife pleading with us that the hospital copay will ruin them this month. The healthy forty year old female executive demanding a bone density test because she ‘paid for her insurance.’  The 340 pound 53 year old diabetic back again with an ischemic leg status post three resuscitations this year alone and over $125,000 in fully covered medical expenses now headed towards $175, 000.

Ms. BRALY: Our profit is in the 3-4 percent range – I think this year, around 4 percent. When you look, though, across health care, there are profit margins in a number of sectors around health care that are three, four, five times ours. If you look at biotech margins or pharmaceutical companies or device manufacturers, they’re three, four, five, six times the margin in the health insurance business. And the irony of that is it is our job to get to the efficiency of health care.

INSKEEP: There might be another irony there, as well, because if it’s your job to make things efficient and the cost of doing business keeps going up year after year after year, doubling in five years, as the president says, somebody might suggest you’re not doing a very good job.

The key is that none of us is doing a very good job but it’s too easy to point fingers and deflect blame.  I’m a pessimist about health care reform because I think the blocking and tackling have finally begun in earnest. I’m optimistic, however, about what we can and should still do even if we end up again with the status quo.

In that vein and with Matthew’s and the team at The Health Care Blog’s permission I am going to start a series of blogs called ‘Nuts and Bolts’ to talk about the incremental things we need to do no matter what happens in Washington. We need incremental changes throughout the health care ecosystem and while some need policy changes, others just need personal changes from each of us. The first installment will not be about ‘Death Panels,’ or policy, it will be about how critical it is for each of us to make our own decisions about our own lives and our own sense of death.  It will be called ‘Nuts and Bolts – Advance Directives.’ Then we can go from there.

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Oakleigh RyanNateTimMD as HELLAlexander Saip Recent comment authors
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Oakleigh Ryan
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Oakleigh Ryan

Rick, Thank you for writing a thoughtful and action oriented article. I applaud your focus on nuts and bolts approach to reform, the idea of accountability and change from within the healthcare arena and viewing reform as a long term process. Most importantly I know you have skin in the game and see reform through the real world. And finally thank you for being an optimist. I recently wrote a Letter to my friends which i have posted on healthcareletter.com to help the lay person become involved. I look forward to your nuts & bolts blog. An appreciative reader, Oakleigh

Margalit Gur-Arie
Guest

You DO have a sense of humor….. I’m happy….

Nate
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Nate

why are you singling out the aussies?

Margalit Gur-Arie
Guest

I meant all political funding Nate. Left, right, up and down under. This is not a partisan issue.
Tim, I’m sorry, but I don’t quite understand your argument. Conservatives are regarding government as corrupt, but are still trying their hardest to become part of this corruption. What does that make them exactly? Better equipped to navigate the waters?

Nate
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Nate

“is to outlaw election campaign contributions from businesses”
compared to Unions who only have the nations good at heart? How about Soros, now there is a stand up guy. I disagree with Margalit most of the time but I can’t believe she would be so openly politicial to try and cut of conservative funding while leaving the liberal funding base in place. I sincerly hope she meant all politicial funding and vote buying. Including Obama’s foreign credit card donars.

Alexander Saip
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MD as HELL,
Government doesn’t have to collect money from us, taxpayers, to appease special interests. It creates a legislative and regulatory environment that can favor one group of businesses over others.
What Margalit proposes, if I understand her correctly, is to outlaw election campaign contributions from businesses, who almost always expect a certain ROI on that money.

Tim
Guest
Tim

“…people view elected government as a clunky, inefficient, corrupt institution that is not to be trusted to act in the best interests of the people it represents.” Margalit, Congratulations. You just articulated perfectly the worldview of the founders of this country, and it remains the baseline conservative world-view, and it is our worldview despite what those in power say they intend to do at any given time. Which — though you might disagree with us in substance — is behind the resistance to healthcare reform, not some desire to protect industry profits, like the left likes to say in their… Read more »

MD as HELL
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MD as HELL

Margalit,
The people never expected direct benefits from the country when it was hatched, because they were getting rid of an overbearing, oveertaxing monarchy that did not have their interests at heart. Now too many people want the government to be the babysitter, the equalizer and the provider. It cannot work that way.
Special interests were nonexistant when the government had no power to grant favor upon special interests. Let’s quit giving the government money they should not have. Then you can vote again.

Alexander Saip
Guest

Margalit, To me, the current state of healthcare reform reflects the fact that even though most of us agree on the general objectives, like covering the uninsured, improving quality and cost containment, we half-heartedly admit the need to make or accept certain changes at the personal level. It is like until both coasts go under rising water, and tornadoes become well too common in all parts of the country, we will eventually decide to get more eco-friendly and actually do something about the environment. There are quite a few bills going through House and Senate committees. The Kaiser Foundation website… Read more »

jd
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jd

I thought I could use html tags to bold the quotes. Hard to know what’s mine and what is quoted without that.

jd
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jd

Dr Wonderful, what planet are you on? “fully exempt from all anti-trust laws?” You seem to have no idea that big health insurers sometimes have to divest parts of their acquisitions, or fail to make acquisitions at all due to anti-trust concerns. See two recent cases with United: In December 2005, the company received final regulatory approval for its $9.2 billion purchase of PacifiCare Health Systems. It agreed to divest parts of PacifiCare’s commercial health insurance business in Tucson, Arizona and Boulder, Colorado to satisfy antitrust regulator concerns, and also agreed to end its network access agreement with Blue Shield… Read more »

Stephen J. Motew, MD, FACS
Guest

Where is the health insurance and pharma blog where members are posting their ideas for cost-cutting reform plans? I would suspect it doesn’t exist. Let’s be real, our politicians have done a great job leading the public to believe that the ‘income incentive’ problem with health care costs sits with the ‘greedy test-ordering’ specialists and ‘inefficient’ primary care docs. There is very little mention of the growing profit percentages of the industrial health care complex. Simply put, their job is to make money with health care dollars, so whatever reform plan will work, it will have to rein-in this expression… Read more »

Margalit Gur-Arie
Guest

What a great post!!! And how sad…. I lost all hope: I started out in January this year wishing that President Truman would be able to observe our times somehow, because health care would be fixed in a few short months. We elected a charismatic President committed to the cause, gave him a mandate to make the needed changes and topped it off with a majority in both houses. Failure was not a consideration in my mind. So what happened? Why are we here today? Do the people really not want affordable care for all? Is this the Republican political… Read more »

DrWonderful
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DrWonderful

Is is so sad that no one can see the massive pink elephant in the room. This pre-produced and manipulated campaign against resonable health insurance reform is clearly the work of the health care industry. One thing they are terrified of is actually having to compete like any other industry. As it stands now, there is no competition and they want to keep it what way. They’ve actually become a dormant insdustry just laying there while rivers of money flow passively to them. It’s actually very unhealthy for the country. How can this be? Well, it’s because they remain the… Read more »

Betty Rider, FACHE
Guest
Betty Rider, FACHE

Rick: As a health policy wonk, I must admit that my crystal ball shattered a few weeks ago as a result of an overdose of cognitive dissonance coming from both sides of the aisle and stakeholders of all type/sorts. What I am certain of is that with a few sentences, you have refocused us all on a critical-to-healthcare-reform strategy and tactic: “If we are going to even start to move this mountain we are going to have to foster change from within the system. That change is going to have to come from all of us as a society and… Read more »