Journalist; OB Story Wrong

So, I’m innocently reading the news and find myself researching a reporters comment.

Okay, so I’m conflicted. Either the reporter misquoted, misunderstood or is intentionally quoting incorrectly. Screen Shot 2015-09-17 at 8.32.09 AM

This is an unusually long post, but it has a number of good points. I didn’t wake up today planning on writing this post. But, it’s a good chance to write about things I’m passionate about that most people don’t spend their day thinking about.

  1. journalist integrity
  2. healthcare rules and how Universities shape our physicians
  3. how rules and word smithing is important
  4. how abortion is learned
  5. how insurance companies rely upon this training
  6. how us as Americans pay for this
  7. that rationing exists in our system today, this is an example
  8. the inconsistency in thinking that is soooooo costly

For those doctors and healthcare professionals who follow me, please engage with me on this note.

The reporter writes about, “The decades-old relationship between MU and Planned Parenthood,” says of medical school education;

Nursing and medical students were never required to work at any Planned Parenthood clinic, work at the clinic was not part of the core curriculum in either the nursing or medical schools and the placement was an optional…

Columbia Missourian, Elise Schmelzer, Sep 15, 2015; “State investigation focuses on decades-old relationship between MU, Planned Parenthood”

http://www.columbiamissourian.com/news/local/state-investigation-focuses-on-decades-old-relationship-between-mu-planned/article_de825b18-5bd9-11e5-b5d3-8b294f78e0ba.html

A small amount of digging

But, in doing a small amount of digging, I found the association responsible for setting out the rules for residence in training for OB work are required to train on abortions. My brain is a word smith brain which means I can’t reconcile what the journalist wrote with what I found in a quick look at her own link on the topic. I didn’t perform any further analysis but I’m sure the topic has much more detail.Screen Shot 2015-09-17 at 7.47.29 AM

When I read a journalists article that might be misleading I have to look for the detail. I want to know why does this not sound correct to me. I have an advantage over a young journalist with 29 years in healthcare finance. In this case, I wondered if the reporter intentionally left out an important fact, or skewed a statement. You decide. I think if they asked a few more questions they may have blown open a different discussion. And, an important one at that. They may have discovered the school is training residence on abortion, just not at planned parenthood. Makes you wonder if they use the tissue like planned parenthood, but they use it for University research. It is universities that use the tissue. The article and title make it sound like the university isn’t using planned parenthood clinic and are innocent of any relationship with the abortion business. Innocent enough I suppose on the surface, but what is the rule for OB’s? Where do the residence at this University get their required training?

A very small misquote, or misstatement changes the flavor of the article completely, upon close inspection, the phrase, “at a student’s request” conflicts with the written rule for the Universities accreditation.  Here is the authors quote, it’s there in bold.

The agreement with the medical school was required to meet Accreditation Council for Graduate Medical Education requirements that mandated schools provide training on abortion procedures at a student’s request, MU Chancellor R. Bowen Loftin said in a letter to Schaefer.

Columbia Missourian, Elise Schmelzer, Sep 15, 2015; “State investigation focuses on decades-old relationship between MU, Planned Parenthood”

http://www.columbiamissourian.com/news/local/state-investigation-focuses-on-decades-old-relationship-between-mu-planned/article_de825b18-5bd9-11e5-b5d3-8b294f78e0ba.html

It might seem silly but I live in a world of insurance where rules guide how our medical system works including how much it costs. Think about it this way, our educational institutions work because they have many rules to guide education. They are the one’s who write the rules, and these rules are used to train your favorite doctor. These rules make it possible for insurance companies to pay claims.

So, here’s my word smith problem. The quote below is a rule from a body that gives accreditation to medical education programs and this quote says it is mandatory for University programs, to be accredited, they must provide abortion training. It does not say, what the journalist wrote, “at a student’s request.” The rule as quoted says, they must train residence in abortion.

See, it says it right below in bold.

It’s on page 15 of the ACGME instructions, rules and guide (the journalist provided this link in their article). These rules are used by insurance companies to make sure doctors are properly accredited by properly accredited university training delivering the best care to the insurance company patience. These things, these rules, matter.

Screen Shot 2015-09-17 at 8.31.30 AM

“IV.A.6.d) Family Planning and Contraception IV.A.6.d).(1) Programs must provide training or access to training in the provision of abortions, and this must be part of the planned curriculum. (Core) IV.A.6.d).(2) Residents who have a religious or moral objection may opt-out, and must not be required to participate in training in or performing induced abortions. (Core) IV.A.6.d).(3) Residents must have experience in managing complications of abortions and training in all forms of contraception, including reversible methods and sterilization.”

ACGME Program Requirements for Graduate Medical Education in Obstetrics and Gynecology, ACGME approved major revision: September 28, 2014; effective: July 1, 2015, Page 15.

https://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/220_obstetrics_and_gynecology_07012015.pdf

This quote is current, the document doesn’t dictate any specific place for the training, it doesn’t even mention planned parenthood.

Rationing is a phrase I use and when I do most people do one of two things; their eyes glaze over in confusion, or they object out of ignorance because they incorrectly believe rationing will never happen in America. In fact, this article, this misquote or misstatement by the person quoted leads to rationing.

Let me try a different tact.

You’ve been to school and you know from the office of the registrar to commencement day policies, paperwork and rules are required before you get your diploma. It shouldn’t surprise anyone then, that there’s rules for medical school.

Ever wonder where the rules come from?  Who writes them, why they write them a certain way? Ever wonder why these rules are important? Did you ever consider these rules influence the healthcare you pay for? Do you understand how this simple language has an evil twist for medical students? Ironically, what the author wrote would be the logical way most people would write the rule, “students have the choice if they want the training.” But, the fact is, the training is required and students at that University are getting it. I haven’t researched this, maybe, the University is outside the norm and their doing it as quoted. Then, the national standards for OB’s is not being followed and this is not a good thing….

It leaves me in this article examining the person in the article who the journalist quoted as not telling the truth, or answering the journalists question about planned parenthood with a strictly narrow answer. And, the unknowing journalist innocently took them at their word. Or, the journalist intentionally wrote an untruth.

The point? The point is OB residence are mandated to take abortion training, it’s not optional. They can opt out for religous beliefs. This is opposite what the journalist wrote. She wrote, students can opt in for that training. This would be how most Americans would assume it’s taught, as an option for medical students. It is a small, razor thin edge isn’t it.

Okay, shift for a minute with me to the actual topic of abortion

Consider that our country makes physicians learn how to perform induced abortions and kill babies. They are in fact babies because this same system pays million upon millions to keep alive babies at the exact age. The contrast to me, originally a claim payor is almost too much to bare. Why, how, as a country did our healthcare system get to a point where this contrast is so great.

It’s because the masses follow what they read from journalists, because they’re not word smiths, because they don’t have time, blah, blah, blah.

This is where the problem starts, it’s where the evil begins. It’s where medical students, in the hallowed halls of educational institutions are provided the means to promote abortion, to agree with them as a course of study and health for a women. You have promoted this behavior by paying for the medical school education, by paying insurers premium, by having policies that promote the idea this is healthcare, that new physicians are mandated to learn about and accept abortion as care. The societal endorsement for doing abortions is trained, it is a medical school endorsed practice.

For the baby, for the voice of the babies, for increased medical premiums, for rules that don’t provide health but death we need to change our methods in the US.

Editing needed

If you’ve slugged through my poor grammar today I hope the overall point was worth it. I’ll return to edit grammar and such but for now, this should suffice.

How Google Proved I’m Right

The title of this post won’t win me the humility award of the day but Google’s insight about Diabetes and Heart disease proves why my White Paper is still on target. America’s leading tech firm, Google, can’t even get the details of two serious illnesses right.

google search result health information box 9-4-16Diabetes and heart disease are almost entirely weight related illnesses (not enough room to describe here but it is exploded in the White Paper). The epidemic of obesity is not a secret and yet the treatments recommended in Google’s health search box depicts the solutions commonly discussed. These solutions keep individuals sick, mask symptoms and provide little long term hope for those with the illness.

I applaud Google for recently adding these informational boxes. As the article linked explains Google recently added health information boxes for 900 health conditions.

The concept is spot on but the execution is terrible, at least, it’s terrible for the two samples I show in this post.

If we’re going to repair our nations healthcare system, easy access to accurate health condition information is a critical improvement that is needed. Only 1 in 20 searches are health related but that was enough for Google to make the investment in creating these health info-boxes.

The information provided is incomplete, it’s incomplete because it doesn’t tell those with the condition what their options are beyond conventional methods. There’s not room in this post to talk about those other options but we explore it in the White Paper.

Rationing

However, I made this post to use it as an example of what I call rationing. Our current system controls healthcare information which in many cases can be detrimental to the health of an individual. If you control information, your rationing options. Incomplete information about a health condition is clearly an example of how rationing already exists.

There is an economic cost to this bad information and unsuspecting employers and individuals will continue to pick up the tab. There’s outrage about cost but no discussion about real solutions. Watch my video about the system and why it will perpetuate itself unless change occurs.

Look for more to come as we discuss the US healthcare system the costs and solutions. But, first follow our posts and look for the White Paper in the  future.

 

Hard Working Americans Trust Their Leaders

Do You Think Leaders are Making the Same Decisions You’d Make?

Link: http://www.pacificresearch.org/home/article-detail/?tx_ttnews%5Btt_news%5D=6814&cHash=b34e1ec79d3e473aab5f27222d25d467
Ordinary Consumers Are Paying For ObamaCare’s ‘Savings’

Obamacare is not “affordable” because it wasn’t intended to lower costs, only increase them (see video why). Obamacare created a way to give an insurance card to 16 million Americans. The lie was that it would save money.

As a medical economist, a veteran of rating and pricing, of more than 28 years, it’s time to consider real reforms before we leave more decisions to poor leadership. The direction we’re headed will guarantee us a healthcare system that looks like our struggling cities and schools.

Ordinary Consumers Are Paying For ObamaCare’s ‘Savings’

“ObamaCare may cost the feds less than anticipated, but it’s extracting far more from consumers’ wallets than they bargained for.  …

Meanwhile, overall health-care spending has increased drastically under ObamaCare.”

Source: Pacific Research Institute, quoting Investors’ Business Daily, April 7th, 2015, Author Sally C. Pipes. It can be found at this link: Pacific Research Institu…r ObamaCare’s ‘Savings’ 4-7-15 and from the original web source at:
http://www.pacificresearch.org/home/article-detail/?tx_ttnews%5Btt_news%5D=6814&cHash=b34e1ec79d3e473aab5f27222d25d467

When Obamacare was conceived it threatened the existence of many players in the “healthcare system.” These players gathered together to stop Obamacare from becoming law. To get the law passed and accepted by the healthcare system stakeholders, Obamacare authors provided access to all these parties to participate in Obamacare in a way that helped their position. Maybe you’d call this “bellying up to the bar.” They were afforded the opportunity to lobby their position and were offered incentives to accept Obamcare, or at a minimum not fight it. All the Stake holders got something except the American public. They were not represented and as a result they are now paying the tab in these higher rates.

Are you suspect of that this is true? If you want proof, read the law and you will find revenue that is earmarked for every stakeholder in the system who “bellied up to the bar.” If you unravel what was signed into law five years ago you will find only a token measure or two that helps Americans. And, at that, they’re only there because they made good sound bites for the public.

It’s amazing that with the intellect of so many, that so little was done.

Making the systematic changes that will make healthcare more affordable are not pie-in-the-sky ideas but ideas that will work. They will require hard work, if you want to help out, call me.

5 Reasons to Avoid Self Funding Your Health Plan

Bring balance to your decision making with an independent evaluation.
Bring balance to your decision making with an independent evaluation. www.DonWatza.com

Small Businesses are putting their businesses at serious risk

In talking with prospective employers one of the most popular topics that arise is self-funding. It being sold like it is the magic solution for employers. The fact is, it’s being sold because it’s an expedient way for carriers and group agents to “stay in the group market.” This means, by offering self funding as the preferred option to “save money” the agent can keep an employer in a “group” policy.

A group policy is much better for a group agent because they can maintain the employer relationship and write greater premium with one policy, the commission is greater too. It is much easier to sell the “popular” fad solution than to dig into the specific details of your plan. There is a large investment of time needed to do the best job comparing all the possible options.

Unfortunately, in the process to “win the sale” important facts about self-funding are left out. There are pitfalls to self funding no matter what your agent, consultant, carrier, TPA or administrator may say. Employers must consider the small print about self-funding before jumping in.

For larger employers, there are benefits to self-funding, but for a group of 25, 40 or 75 employees it is a bad idea. The proposed gain can easily be outweighed by an unexpected $1,000,000 unpaid claim.

Here’s a short list of reasons that should give a small business owner pause before self funding.

1 – Being an Insurance Company Isn’t On Your Bucket List

Being self funded means you move out from under the safety of having an insurance company paying claims. There’s the potential that you may have to pay claims when the TPA/administrator/insurer decides not to pay.

Not to mention, all the new rules and obligations.

2 – You Want to Buy Coverage, Not Be the Coverage

Here is a quote that most people would call the “small print.” You won’t find it in the typical sales material or presentation. You will find it when you’re asked to defend the non-payment in court.

“The participating employer agrees to be solely responsible for compliance with all laws, including the payment of any required benefits that are not covered as illustrated in the Summary Plan Description or the stop loss policy.”

Administrator Actual Policy Language

3 – You Become The Expert In Making This Decision

This carrier is being honest when they say, you should have experts telling you what to expect before you choose self-funding. This quote is a warning found in the sales material.

“While many employers can benefit from a self-funded plan, it may not be the right choice for every business. The biggest question a small group employer has to consider is if the additional risk will jeopardize their business.”

Administrator Advertising Materials

If you self-fund you will need a qualified person to evaluate your risk before making the decision. Your sales agent, consultant, insurer, CFO, HR person are not qualified to make this assessment. Will they pay the claim or will that come from you, the owners pocket?

This is a skill that is working for others every day why not ask for help after all, you hope people hire you for your expertise.

4 – You Didn’t Have Time to Read the Small Print

"If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim."
“If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim.”

The Big Print makes promises but the small print takes those promises away. When your self-funded administrator, TPA,insurer decides not to pay a claim, you’re on the hook. You as a business owner become the checkbook.

It’s true, in today’s sophisticated and complicated healthcare world it’s becoming more necessary to independently evaluate your options.

CAN YOU SAY DOUBLE TALK

This is just one example of the big print:

“Your maximum self-funding cost for the plan year is determined up front – and it’s guaranteed not to change, …

And here’s one example of the corresponding small print written into the policy of the carrier who published the “big print” quote above. There are many statements like this and you should know them all, or have someone who does.

  1. “We issued this coverage in reliance upon the accuracy and completeness of the information provided in the application form and during the enrollment process. If a material or fraudulent omission or misstatement is made in the application form, We have the right to deny any claim, rescind the coverage and/or modify the terms of the coverage or the premium amount.”

Actual policy language, page 1.

5 – You Didn’t Make a Benefit Plan to Tell Employees They Aren’t Covered

It happens, google the topic of “self-funded plans that couldn’t pay claims” and you will find 42 million website hits (graphic below).  The point is, there’s not shortage of problems for those who get in over their head.

Google search on self funded plans that couldn't pay claims.
Google search on self funded plans that couldn’t pay claims.

 

Do you Still Need Convincing?

Show me the options in front of you and I’ll show you the trouble.

Send any quote you have received and the comparisons I’ll give you my two cents for free.

This offer is available to owners only. Send them to my email without PHI, [email protected]

Source: Actual administrator and carrier language from marketing promotions and specimen policy.

Psychology of Food

An American Food Journey

People should be put ahead of profit. I’m a business owner and would like more profit, but not at the expense of people.  Well, that statement will send people zooming to another site. But, some read-on and those are the one’s ready to hear the message.

Are you still reading? That’s amazing. I’m not making a mass appeal, but I want to make the connection for people that our food profits are costing us more in healthcare premiums. Yep, our food system is making profit and sending people to the hospital in record numbers. Think it’s not true follow my white paper – owners health initiative.

25 years ago

my sister Patti said to Linda and I, we should drop sugar. Really, I said, what kind of hair brain idea is that I thought? Instead of engaging in a meaningful conversation over a bowl of ice cream, I, just like most people, did the only rational thing. I ignored her. We went on to talk about the kids, hers, mine weren’t born yet.

Okay, so I demonstrated what I call the psychology of food. What do I mean? Food is one of the last places of freedom. I mean, no body is, or was, going to tell me how or what to eat.

Don’t tell me what to eat

Disability is now a disease
Disability is now a disease

Americans do not want to be told what to do and food is a place where individuals can exert their independence. Who’s against that? I’m not, but, if you’re premium is increasing because people are being diagnosed with obesity as a disease (recent health news – see today’s google search image).

For a limited number of us, obesity is a hereditary issue, but for most Americans  I think our food production system and profit is the problem (conservatives did you leave?). I’ve recently watched “Food, Inc.” and you should too. Then, I watched Aziz Ansari, comedian, poke fun at food but makes a good point. I merged both together into a 3 minute clip on food, watch for it on the Ben-TV channel (once I get their approvals to use their video). Or just watch them, their both on Netflix.

If obesity has an ally who or what would it be? If there is such a thing as an ally to obesity who wants that? Maybe a better way of thinking is, who is the enemy to obesity?

Not just my opinion

Our government makes bad decisions on topics like this. They don’t use science, they use popular, attractive notions to sooth the public (liberals did you leave?). Well, the public is you and me and if obesity is covered as an illness watch out for the coming tsunami of cost baked into your premiums. As a medical economist I guarantee you this recent policy change will increase our costs. Over the last 28 years in this business I’ve watched awful public policy and we’re not changing the way we make decisions and everything we try to legislate isn’t working. And, frankly, neither party is offering suggestions (did conservatives and liberals leave now?)

Is anyone still reading?

Trusting politicians and political decision making with our healthcare, medical system and food system is not a solution.

The problems in this country can be viewed in many ways. If you’re liberal big company profit is bad. If you’re conservative, pandering to the poor and lazy is bad. Really? Are these the only positions? While the off the chart right and left argue the problems just get bigger.

Obamacare is not solving the problem and never will and republicans don’t have an answer.

I like my white paper – owners health initiative.

Oh, what about my health?

Fortunately, I have a great internist and a homeopathic Doc arrangement that is working quite well. I struggle with weight but otherwise am in good shape (for those using the numbers, I’m a BMI of 28, not great but okay). BTW – I did drop sugar and other things. Oh, about those movies, last summer we dropped regular chicken in favor of what Linda and I call, “happy chicken.” If you watch the video’s or my clip if gets approved, you’ll drop unhappy chicken.