WILL INDIANA BE “HIP” OR UP THE CRICK?

The Author attended an Affordable Care Act (Obamacare) seminar yesterday. It was very well presented by Doug Powers of the firm of Beckman, Lawson, LLP.

Here are some points that we can all take away:

A.   The Affordable Care Act (ACA) is the law of the land. It will likely be tweaked, but it is a done deal, a fait acompli.  It is the medium-term future of American healthcare.

B.   There are numerous components to the ACA, but one is health exchanges for the uninsured to buy “reasonably priced insurance.” The ACA envisioned that states would operate them. Many states will, some states will not, and some states will operate them jointly with the federal government, or as Professor Cox used to call the “G,” “Uncle Sugar.” Indiana will let the federal government operate its health exchange.

C.   Medicaid Expansion. One of the key components of the ACA is the expansion of Medicaid. Medicaid under the ACA was to insure people between 100% and 133% of the poverty line. People above that line can go to the exchanges and get subsidies.

1.    The US Supreme Court held that states could not be forced to expand Medicaid. So some states are, some states are not, and some are trying to get their current Medicaid Waiver Plans approved as a Medicaid expansion. Currently, Indiana is trying to gets its Healthy Indiana Plan (HIP) approved as a method of Medicaid expansion. Uncle Sugar did extend the plan but did not get blanket approval for HIP.

2.    Some states are appearing to have some success with convincing Uncle Sugar (through the Center for Medicaid and Medicare Services (CMS)) to approve state plans. Arkansas is having some success.

D.   The Author will close the article with some political cartoons courtesy of Doug’s powerpoints and another of Doug’s powerpoints placing the ACA within a political left and right framework. HINT: The ACA is right of center. It ain’t socialized medicine, gentle readers.

WHAT IS IT THAT “WE” DON’T GET ABOUT HEALTHARE?

The Author began a long and vainglorious career as a healthcare attorney in 1991. Blessed with the heart of an economist and the firm belief in never underestimating the other guy’s greed, he quickly saw that something was amiss.

The Author was first tasked with trying to collect money. There was a hierarchy of payors, or more properly, a list of better positioned suckers. Collecting money to pay for patient care was a game to find other people to pay for healthcare. For all this talk about “personal responsibility,” and keeping “gubmint” out of healthcare, Americans have an entitlement view of healthcare.  It goes like this:

A.   Insurance, which employers, or former employers, should pay for, must pay the healthcare bills. That system worked well until about 1980, when the unexplained “decoupling” of American healthcare costs from the rest of the developing world began. Before 1980, US healthcare costs were on the high end of the healthcare costs paid by other countries, but moved in the same curve as our world partners. But something happened in 1980 that ran the train off the tracks. US healthcare costs decoupled and began dramatic rises. The graphs on the linked sources, demonstrate this “decoupling”, as the Author calls it.

 In and around 1980, most Americans had health benefits. The poor, through Medicaid, the elderly through Medicare, and the workforce through their employers.  That last source started to change and American workers began losing coverage, especially those in lower-wage positions and in temporary positions. And we have not looked back.

 

      B.   If insurance does not pay, the government should pay. In regards to this point, the     Author is not talking about government paid health benefits for employees and retirees. The Author is talking about needs-based welfare in the form of Medicaid and entitlement welfare in the form of Medicare. Many poor, but nowhere close to enough, have Medicaid. Anyone over 65 or who has received SSDI for more than two years receives Medicare.

 C.   The payor of last resort, the poor sucker herself. The individual that is finally “responsible.”

So in collecting money, the Author discovered, that you worked the hierarchy, hoping to avoid the last resort, the patient himself. And one can understand the natural desire to stick someone else with the bills for the bills that most Americans still see as a god-given entitlement.

WHAT IS IT THAT THE STATE OF INDIANA DOESN’T GET ABOUT HEALTHCARE?

In the next installment of this article, the Author will take a look at Indiana’s decision not to expand Medicaid, a decision that the Author believes may be reversed.

PIVOT IN THE TIME OF BASKETBALL. OR WHEN THINGS CHANGE…

March madness is just around the corner and I suspect a good number of readers remember the pivot foot in basketball from their youth. But where else can a pivot come in handy? Maybe a tech startup in Carmel, Indiana?

In an article in Small Biz Journal in the Indiana Business Journal, “As important as business planning is, the path to success is rarely without obstacles—or opportunities. Savvy entrepreneurs recognize that and adjust along the way’.

Take the web service local tech veterans Danielle McDowell and Janell Shaffer debuted early last year. Carmel-based MyBestFriendsHair.com started as a consumer review site for hairstylists. This month, they rebranded and relaunched the site at JadaBeauty.com with an emphasis on selling salon-quality products.”

REBOOT AND RELAUNCH?

JadaBueaty takes an interesting market opening. JadaBueaty allow stylists to e-mail clients a “hairscription” for specific products—and a link to buy it on the site. A portion of each sale goes to the referring stylist or an education fund, which McDowell said will help pay for online professional development modules.’

As more hair professionals strike out on their own—a 2011 study predicts half of all salons will rent booths to independent stylists within two years—Jada Beauty should be poised to serve the growing market, McDowell said.”

THE PIVOT NOT THAT UNCOMMON

Business pivots are not that uncommon. Sometimes a business will have trouble finding a supply or some special expertise. They may discover in the process that their need is the need of many others. The Author and his brother-in-law had a company that attempted to market a beverage related advertising specialty some years ago. We had trouble finding screen printers that would print our products at a competitive price. Guess what. Before we knew it, we became screen printers, with a printing devise that could print foam can coolers in small runs at an effective price.

SOMETIMES THE PIVOT CAN TAKE YOU IN A BETTER DIRECTION THAN A DRIVE TO THE BASKET!

Fire Me, Maybe???

The post of Saturday may have mega backfired. The Author did not mean to demean Keith Busse. He is one of the sharpest businessmen around. And the author loves entrepreneurs. They are the wheels that drive the nation. And the Author did not mean to make the post a political statement. The Author did not even know what Mr. Busse's politics wre, except friends and colleagues have since told the Author that the post seemed to have political undertones. That was not meant, either. This is not a political blog. It is a business blog and law blog. So if Democratic businessman Harvey Weinstein (Weinstein film company) would seek to be the US CEO, he would be similarly frustrated. And Weinstein is reportedly a bigger jerk than most humans that speak. So he would have the same problems of many others. The Author's point is and always was that American politics is greasy business. Power is so diffuse that General Colin Powell himself could not get many compromises. Joe Flacco would not be much better at things than Joe Biden. Even Old Abe would have a hard time getting a budget passed.

"Fire'em All! I'll Fix Things!"

There are a couple of articles that predictably appear and are predictably savaged by those in the relevant sectors that understand the issues. Or at least want to keep their jobs.

First, are those articles where a politician or business leader decides to “take on healthcare.” They identify two or three salient problems, anoint themselves as the original discoverer of an issue that apparently went unnoticed by tens of thousands of experts in their fields, and then promise to fix those problems if just given the “magic wand.”

The author sees about one or two of these a year, laughs heartily, sighs a bit, and then erases the sectors on his hard drive that have been sullied by these supercilious electrons.

This week brings the other variety of predictable articles, published in the Greater Fort Wayne Business Weekly.  It is entitled “Executive Power: The political system in Washington, DC is broken, so Business Weekly asked local leaders how they would fix it.”

Keith Busse of Steel Dynamics and Tower Financial says hire me as the CEO and I will “get things done.” Let’s start over. Fire half of them. “They don’t understand the problems.” “They are a roadblock.”

Translated, make me dictator. I will get things done the way I want them done. And which half would he fire?

Some responses are similarly tyrannical and simplistic. But Joe Dorko, CEO of Lutheran Health Network, makes infinitely more sense. Build on agreements. Identify disagreements. And recognize the progress that is made. But large hospital organizations, like large universities, are closer to Gerry-rigged democracies than police states.

The author is of course cynical and dismissive of the arguments of business leaders, people that effectively run dictatorships for the good of themselves and their shareholders. That is what they do and they are darn good at it. And he has infinite respect and admiration for what they do. But their worldview ends where Washington begins.

The Founders gave us a government that is intentionally weak and power is diffuse. They did not want tyrants. In effect they courted gridlock and we are getting what they gave us. Who among us could seance them back up and tell them they were wrong?

And if you don’t like it, amend the Constitution. You only need two-thirds of the House and Senate and three-quarters of the states to agree.