A recent Wall Street Journal article by Daniel P. Kessler opined that we would see a single-payer system in the United States (i.e. government run health care) within the next 6 to 7 years.  While I agree with Mr. Kessler that implementation of a single-payer system has been the dream of Progressives since Harry Truman first tried to implement it in 1948, there are three huge obstacles facing Progressives and Liberal Democrats which I believe will prevent its implementation:

1. The United States is broke.  We have a $16.8 trillion dollar national debt that is projected to increase to $17.9 trillion dollars next year with little sign that this president will do anything in the way of entitlement reform to reduce it.
2. The opposition.  If you think there was a great wailing and gnashing of teeth over the passage of ObamaCare and its implementation, imagine what will happen when America is advised that the federal government is taking over the health care system.  The fight would be long and bloody and, without a Democrat majority in the House and Senate as well as a Democrat in the White House, it simply cannot happen.  ObamaCare passed because of the perfect storm.  It will be a long time before there is another one.
3. The nation’s health care providers.  The last and, perhaps, the largest reason I believe there will not be a single-payer system is this nation’s health care providers.  Health care in this country represents $2.8 trillion dollars that we spend with medical providers–that’s 27 percent more or $750 billion dollars greater than other developed countries with the same per capita high income as the U.S.  If you wonder how that number translates to preventing the implementation of a single-payer system, consider this:  at New York City’s Memorial Sloan-Kettering Cancer Center, 14 administrators are paid over $500,000 dollars a year while 6 administrators make over $1 million dollars a year.  MD Anderson, the country’s leading cancer treatment center, employees 19,000 people while Exxon Mobile in Houston, Texas, employees 14,000.00.  In addition, hospital profits, especially in not-for-profit hospitals, are huge with hospitals charging insurance carriers 30 to 50 percent more than they charge Medicare.  So if you think the health care industry will go quietly into the night and allow the government to impose a federal health care system, consider this:  the Center for Responsive Politics reports pharmaceutical health care product industries combined with organizations representing doctors, hospitals, health services and HMO’s have spent $5.63 billion dollars since 1998 in lobbying Washington while lobbyists for defense and aerospace industries spent $1.53 billion dollars and big oil and gas lobbyists spent $1.3 billion dollars.

While there is no doubt a twinkle in the eye of the Progressives wanting a single-payer system, a reality check shows this would be a long and difficult struggle with little chance of coming to profusion.

Cary Hall

America’s Healthcare Advocate

It appears that changes to the implementation of PPACA(the Patient Protection and Affordable Care Act) and the overall ObamaCare strategy are happening faster than the time it takes to change a diaper on a two-year-old.  The $365 billion dollar budget cut scheduled for Medicare Advantage plans in 2014 has been scrapped after pressure from senior advocate groups like AARP and, surprisingly (or not), from liberal senator and ObamaCare architect Max Baucus.

The 7 to 8 percent budget cuts were scheduled to begin in January 2014. That means those folks who are chronologically challenged (i.e. Medicare recipients on plans like Coventry Advantra, Humana, AARP,  United  and PacifiCare) now will not see premium increases, higher out-of-pocket limits or a higher co-pay from the carriers due to ObamaCare.

This is good news for seniors but begs the question, where is the $365 billion dollars now coming from that these cuts represented for funding other ObamaCare programs like the new health insurance exchanges?    As John Gorman, executive chairman of Gorman Health Group, so aptly stated, “It’s the old Potomac two-step on Medicare,” promise cuts to get the bill through and make it revenue neutral; then, when the hard part dials in (i.e. make the cuts and face your constituents), run like hell and reverse course.

Other New Developments with ObamaCare:

The SHOP (Small Business Health Options Program) that was going to be the panacea for employers with fewer than 50 employees isn’t going to happen.  This program was supposed to roll out in 2014 on the federal exchange and now will not be available until 2015.  In addition, HHS (the Department of Health and Human Services) is recommending that states which implement their own exchanges limit access to one plan for employees on their state run exchange.  I guess the folks in Washington at Health and Human Services are finding out this really isn’t as easy as buying an airline ticket.

Last but not least, we have our first model of a state run exchange with proposed premiums.  This model is being rolled out by “The Green Mountain State,” Vermont.  The cheapest plans on Vermont’s exchange cost $361.62 per month for an individual health insurance policy and $1,016.15 per month for a family policy.

You have to ask yourself the question, will a 22-year -old male in 2014 spend $4,332 a year on health insurance or will he choose to take the $95 penalty?

You can expect more changes.  It’s only April, and this is just the tip of the iceberg as we move closer to the implementation of PPACA.  Stay tuned.   There‘s more to come.

Cary Hall

America’s Healthcare Advocate

A recent New York Times article disclosed that more than half of American adults are now considered overweight with nearly one quarter of the adult population (40 million people) clinically defined as obese.  The number of kids considered obese is over 12 million now.  And food manufacturers are being blamed on all sides:  academia, the Centers for Disease Control and Prevention and the American Cancer Society just to name a few.  So who is really responsible? 

We all make choices in our daily lives and we are responsible for those choices.  You can decide to stay out of the middle of the grocery store and shop the perimeter for fruits, vegetables, meat, fish and dairy products that are not packed with sugar, salt and processed flour.  Or, you can buy the processed, canned and boxed foods that are the primary reason our country faces a crisis of 24 million people who are Type 2 diabetics and another 79 million who are pre-diabetic.  Think about that.  In a nation of 365 million people, 103,000 are either diabetic or predisposed to becoming diabetic.

How much responsibility does the food industry have in promoting these products to the general public?   Michael Mudd of Kraft foods states, “As a culture, we’ve become upset by the tobacco companies advertising to children, but we sit idly by while the food companies do the very same thing.  And we could make a claim that the toll taken on the public health by a poor diet rivals that taken by tobacco.”  He goes on to say, “If anyone in the food industry ever doubted there was a slippery slope out there, I imagine they are beginning to experience a distinct sliding sensation right about now.”

If you doubt this, look at the example of Mayor Bloomberg in New York City banning large or oversized sugary soft drinks in establishments that receive inspection grades from the health department, including restaurants, movie theaters and street carts.  The question is will government try to regulate us out of this mess or will the food industry, healthcare providers and the average American have enough sense to realize we are killing ourselves with salt, sugar, high fructose corn syrup and white flour? It’s not rocket science; it’s common sense.  Unfortunately Americans seem to be short on common sense and are embracing the attitude of “let’s let the government fix it.” 

The children of this generation are the first children who are not projected to have longer life spans than their parents.  If that doesn’t scare the hell out of you, I don’t know what will.  It’s time to wake up, America.  Start eating what our farmers grow and raise in their fields and on their farms and stop buying boxed, canned and processed foods that are quick fixes but long-term killers. 

Cary Hall

America’s Healthcare Advocate

Will Spirituality, Mindfulness, Yoga and Pilates Really Improve Brain Function as You Age?

In a study done by Lisa Miller, Associate Professor of Psychology and Education and Director of Clinical Psychology at Columbia University’s Teacher’s College, people who practice spirituality and mindfulness coupled with yoga and Pilates showed a significant increase in brain function.  This was illustrated in brain imaging studies that revealed cortical thickening in “people who, over the preceding five year period, had attached a high degree of importance to religion or personal spirituality.” 

What is even more fascinating for people who are chronologically challenged like me is to harken back to the 1960’s and 70’s when we were told by intellectuals and major publications like Time Magazine that God was dead.  Evidently He’s alive and well according to the study featured in TC Today (the magazine of Teachers College, Columbia University).

What’s the connection between spirituality, mindfulness, yoga and Pilates?  Well, in my case, as a practicing Catholic, I began on a journey five years ago to enhance my mindfulness and spirituality.  I read books like Excuses Be Gone by Dr. Wayne Dyer and The Untethered Soul by Michael Singer and explored the meaning of mindfulness by spiritualists like Deepak Chopra. 

I started practicing daily meditation and spend at least four hours a week in yoga and Pilates.  While it certainly improved my ability for concentration and spiritual connectivity, it also has had a significant impact on my health.  I no longer consume alcohol. I’ve improved my diet and significantly improved my skeletal range of motion through Pilates and yoga.  I am more focused on my health and wellbeing than ever.  My energy level remains very high and rarely do people guess that I am 63 years of age. 

So what does all this really mean?  Well, I guess it proves God really is alive, and you can significantly improve your quality of life through greater connectivity utilizing spirituality and mindfulness while improving your health through disciplines like yoga and exercises like Pilates.

I guess Satchel Paige, the great Negro Leagues baseball player who played professionally into his late fifties, summed it up best when he said, “Age is a question of mind over matter.  If you don’t mind, it don’t matter.” 

Who knows, perhaps Satchel Paige was practicing yoga all along. 

Cary Hall, America’s Healthcare Advocate

The election is over. The great wailing and gnashing of teeth over Obamacare has ended. The Patient Protection and Affordable Care Act is the law of the land. The question now is, how do businesses adapt and deal with PPACA in the most effective manner?

Here are the 10 most important things business owners need to know about the law and how it will impact them:

• Counting Employees: Counting employees for PPACA compliance purposes is about to become very important and more complicated than business owners think. If businesses assume they are a small group for benefit purposes, then, come 2014, they may be wrong. The law defines small and large groups differently by provision, and the old small group definition of 1–50 or 2–50 lives isn’t the gold standard anymore. It’s entirely possible to be a small group and a large group at the same time under this law!

• Divide and Conquer: If you are a business with 50 or more employees and you are contemplating dividing your company into two or more entities for the purpose of avoiding the PPACA provision for mandatory employer-sponsored health insurance, think again! Health and Human Services, the IRS and the Department of Labor will be taking a very hard look at companies that try to get around implementing PPACA by this method and have made it clear to industry experts that they will aggressively pursue any employers who try this.

• Let’s Send Everybody to the Exchange: If an employer drops coverage and sends employees to the exchange, then ALL employees, including those who do not qualify for subsidies (typically owners and corporate decision makers), have to go to the exchange for coverage too. That coverage on the exchange is probably going to be much more expensive than the existing group policy (particularly with no government or employer subsidy).

• Penalties for Failure to Insure: For businesses that do not offer any insurance and have more than 50 employees and that have at least 1 employee receiving insurance subsidies, these businesses will be taxed at $2,000 per person per subsidized employee. The tax is applied to all the business’s employees (after excluding the first 30) not just those that are subsidized. For example , a business with 51 employees would pay $42,000 in new annual taxes, and an additional $2,000 tax for every new hire.

• Multiple Class Plans: Employers can no longer offer different plans with higher benefits to executives or most valued employees while offering lesser plans to the remaining employees. Everybody must be equal under Obamacare.

• Compliance: Even though none of the employer requirements have been officially released in regulation yet by HHS, employers will have to start complying in less than one year.

• Subsidized Coverage: Employees cannot leave an employer-sponsored health insurance plan and move to the exchange to receive subsidized coverage. This means if the employer offers an affordable quality plan, then employees and their dependents cannot peel away from the group to get reduced-cost coverage through the exchange.

• Seasonal Employees: Part-time just became full-time for a lot of employers, specifically those with seasonal employees like landscape companies, construction companies, restaurants, etc., where a combination of employees working 120 hours per month count as 1 employee. Additionally, the new full-time employee standard is about to change to 30 hours per week for benefit purposes. Like it or not, this is the new reality under PPACA.

• Tax Advantages: There are no business tax advantages to dropping coverage and paying penalties, and employees do not benefit from employer penalty dollars. That money goes straight into the U.S. Treasury.

• Cost Increases: For groups of 100 or less, the looming changes, taxes and other requirements on how health insurance policies must be structured and priced and what they must cover will have a dramatic impact on premium costs. Wellness programs and driving down the actual cost of health care have never been more important, whether you have 20 employees or 2,000 employees.

So, you may remember these famous words out of Washington during the great debate on Obamacare: “Buying health insurance is going to be as easy as buying an airline ticket.” Maybe so—if you’re planning to buy a one-way ticket to Siberia on Aeroflot.

This is a very scary and uncertain time for business owners, a time when the licensed benefit professional will be able to help businesses of all sizes work their way through the maze of government regulation and requirements to ensure that, as business owners, you make choices that make the most sense and that fit your employees’ needs, as well as your budget.

Cary Hall, America’s Healthcare Advocate

The above article is also featured in the December 2012 issue of Ingram’s.

If you thought that under PPACA, the Patient Protection and Affordable Care Act (otherwise known as ObamaCare), that the much-debated and discussed public option or government provided health insurance was not to be, think again. 

In a little known section of the bill, the federal government is now going to create a substitute for the public option according to The New York Times.  This substitute for a pure, government-run health insurance program (the public option sought by many liberal Democrats) will compete with many private health insurance plans.  This is the NFL equivalent of the referees in a football game working for one of the teams that is playing.  In other words, they make the rules and then turn around and compete with private industry. 

It appears Barney Frank was right after all when he stated that the passage of PPACA was only the beginning of the march toward a single-payer system, and it appears that the first piece on this road to total government control is about to be put in place. 

These two not-for-profit government entities will directly compete with health insurance carriers on a national level and will be offered on the federal health insurance exchange.  The question now is…what will happen to the level playing field? 

The National Association of Insurance Commissioners expressed alarm at the prospect of the double standard these plans represent since they will not have to comply with the state mandates that private insurance carriers are required to maintain. 

The Obama administration and Health and Human Services Secretary Kathleen Sebelius have yet to release guidelines or information about these plans and are obviously waiting until after the election to unleash the government hounds on the American public and the private system.

One thing is certain:  Democrats and liberals in government certainly have not given up their determination to put in place a single-payer, government-run health system.

Cary Hall, America’s Healthcare Advocate

With the choice of Paul Ryan, I truly believe Mitt Romney is willing to tackle the most significant issues facing our country today:  the reform of Medicare and Social Security. 

Congressman Ryan’s plan to reform Medicare is a sensible approach which affects no one 55 or older even though opponents of Ryan’s plan are trying to scare the hell out of senior citizens (those of us chronologically challenged) by stating it will destroy Medicare as we know it.  That is a lie, and the people who are saying it know it’s a lie. 

So what does Paul Ryan’s Medicare reform actually do?  Well, as I stated, for those 55 or older nothing changes.  For those 54 and younger, they would have a choice: remain on Medicare as it is structured today or move to a private insurance program that would be subsidized by the Federal government with guaranteed benefits but run by private health insurance. 

The issue is that the last thing the Democrats and the left-wing loons want to see is the efficiency of the private marketplace introduced to Medicare which currently loses 65 billion dollars a year to fraud and waste because Medicare in its genius pays all claims that come through the door first and then checks for fraud, waste and accuracy later.  This is just the opposite of how private carriers work which is why they only experience fraud and waste of approximately 2 percent.

The private Medicare offerings would be modeled on the current Medicare Advantage plans which have 13 million seasoned citizens as current enrollees and are growing each year.  Surveys conducted by the CMS (Centers for Medicare and Medicaid Services) show that 83 percent of the folks on these plans are happy with them.  So the real issue is that Democrats and left-wing ideologues know that if Ryan’s plan is put in place it will open the door to revolutionary changes in government spending, and this is what they’re truly afraid of.  If you want to know how fearful they really are, listen to the cacophony of accusations, misstatements and misrepresentations coming from these folks.  The louder the volume, the greater their fear. 

Paul Ryan is a man of courage, and, as he said on my broadcast recently, until now everyone was afraid to touch the third rail of politics, Medicare and Social Security, because it meant instant political death. Mr. Ryan not only touched it, he started the train rolling down the tracks. 

Cary Hall, America’s Healthcare Advocate

With fifty-one percent of the American public wanting the mandate thrown out according to the Pew Research Center in its June 15^th polling data, it’s obvious the public is not going to receive Justice Roberts’ and the Supreme Court’s ruling favorably. 

When you couple that fact with a recently released report (released prior to the Supreme Court decision) by McKinsey and Co., an international consulting company, which states the uninsured will reach forty million by 2016, it is obvious that ObamaCare is a bigger mess than when it was originally passed. 

With the court deciding that the Commerce Clause argument for enforcing the health insurance mandate is invalid and that it is, in fact, a tax, obtaining health insurance is now optional.  Here’s why.  You can choose to pay the tax and therefore choose not to have health insurance. 

We now have a train wreck waiting to happen in the health insurance industry.  What the court ruling does with health insurance is best illustrated by asking the question, could you insure your house when it’s on fire?  The answer is obviously not.  However, the tax makes the purchase of health insurance optional while at the same time ObamaCare forces insurance carriers to accept anyone (even those people with pre-existing conditions) at any time they apply for health insurance, eliminating the current system of adverse selection. 

This means you can wait until you get sick to purchase your health insurance.  So, on your way to the emergency room for that gall bladder or hernia surgery or other unforeseen condition, you can download an e-health insurance app and voila! you are covered as you roll through the doors of your favorite hospital. 

With the penalty tax beginning at ninety-five dollars a year, how long do you think it will be before the American public figures out how to game the system?  You can pay the ninety-five dollars, wait until you get sick and then apply for health insurance which the insurance carrier is forced to provide for you.  And here’s the best part:  after you recover from your illness, you can cancel the policy. 

If you think this is far-fetched or probably won’t happen, think again.  The Massachusetts Health Connector is the model for ObamaCare and this is exactly what occurs in Massachusetts, causing premiums to be some of the highest in the nation and for the Massachusetts Health Connector to run a forty-four million dollar deficit to date. 

So ask yourself a question.  Given the above facts, how long do you think it will be until we have a single-payer government run healthcare system with private insurance carriers driven out of business?  Wasn’t that the Democrats’ and President Obama’s desire all along? 

Cary Hall, America’s Healthcare Advocate