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Iowa Employer Benefits Study© – An Annual Tradition to take a 1-year Sabbatical

All of us have established traditions in our lives, whether it be family or friend-related holiday plans, vacation travels to a favorite destination, attending or watching sporting events, and so on. Yet, due to circumstances beyond our control, such as time constraints, finances, death and adverse health problems, traditions are made to be altered, or possibly discontinued. After performing the annual Iowa Employer Benefits Study© for the past 18 years, I have decided to give the survey a ‘rest’ for one year. Believe me, this was not an easy decision. But after a great deal of personal and professional reflection, it is the right decision. My ‘tradition’ has now officially been altered.

In today’s world of perpetual political turmoil, healthcare – more specifically – health insurance, has become a political football. Hasty decisions are being made to benefit political promises, usually at the expense of pursuing sound policy practices. What has occurred in our nation’s capital in 2017 is akin to watching a surgeon perform knee surgery with a butter knife. The process has been extremely agonizing to witness and I find myself wincing as this grotesque process evolves.

Now more than ever, it is important to monitor employer-sponsored health insurance costs and components. After all, health insurance costs continue to outpace the Consumer Price Index (CPI) every year. Rising insurance costs have triggered a host of other health plan changes – forcing employers to offer the most competitive health insurance package that they can. I certainly don’t take this fact lightly.

But another fact is very important to me – the ‘value’ of care received. I firmly believe it should ALSO be on the radar screen for employers, their employees and the general public. Similar to how politician’s view our healthcare ‘system,’ employers appear to be mesmerized, rightfully so, by the insurance cost problems. Recently, Warren Buffett described medical costs as “the tapeworm of American economic competitiveness.”

This cost concern, however, tends to suck the necessary oxygen out of the room, crowding out badly-needed, laser-like attention and focus on key cost drivers that impact costs in the first place. This is ‘downstream’ thinking, the actions we take about fixing the symptoms of problems rather than concentrating on the issues that actually CAUSE the cost ‘pollution’ we find so objectionable. Being distracted with downstream symptoms has lulled us into believing that we simply need to fix the “insurance problem” and the ‘upstream’ pollution will miraculously go away. Inflated health costs are actually more harmful to us because we refuse to look beyond the insurance component to help address the cost conundrum.

This serves as the backdrop on why I decided to place the Iowa Employer Benefits Study© on a one-year sabbatical. It’s time to move ‘upstream‘ and disregard the naysayers who believe the status quo is much too difficult to confront. It is just too easy and expedient to continue the work downstream – making the appearance that something is being done to confront the cost issue. But if ‘optics’ matter, I’m in the wrong business.

In the next few weeks, I will reveal research I’ve wanted to conduct for the last number of years, but did not have the opportunity to pursue – until now. This work will be found under my companion organization, Heartland Health Research Institute. If you haven’t signed up to receive my HHRI posts, you may do so here.

Poet Robert Frost famously wrote, “Two roads diverged in a wood, and I – I took the one less traveled by, and that has made all the difference.”

This road may be lonely, but well worth the effort.

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A Tribute to My Brother Rob

My brother, Rob, passed away on Saturday, August 26, after a three-month battle with Glioblastoma brain cancer. At times, toward the end of a person’s life, he/she might share valuable life-lessons. When Rob knew his time would be cut short, he didn’t disappoint. He provided heartfelt insight of his time on earth. I was asked by his wife, Patti, to “say a few words” at his funeral. Below is my ‘eulogy’ for my brother, Rob:

The 3rd chapter in the Book of Ecclesiastes opens with “There is a time for everything, and a season for every activity under heaven.” This chapter is really about the seasons we experience in our lives – both good and bad.

How can I possibly share one, two, maybe three, poignant stories about my brother Rob in just a few minutes? I simply can’t.

Instead, I will provide my brief impressions of what I observed during Rob’s final few months while he was with us…as difficult as it may be.

Following Rob’s diagnosis and surgery in May, the reality of his longevity was no longer in question. Once he returned to Centerville from Des Moines, he wanted to spend quality time with family and friends – and many times it would involve the enjoyment of a cigar – or two, or three!

Now, to be honest, I am not a cigar aficionado – far from it. But in late June, I had the opportunity to enjoy a cigar with Rob.  During our “session,” I realized that my cigar had emboldened me to ask Rob a simple, yet possibly intrusive question – which I would attribute to my cigar being laced with a ‘truth serum!’

My question to my dying brother was simply this: “Rob, as you look back now, would you have done anything different in your life?” At that time in June, Rob’s mind was still extremely sharp, but he had great difficulty speaking, he often was only able to stitch a word or two together…which was a great source of frustration for someone who normally is very articulate with his thoughts. Rob looked at me with a resolute determination and responded, “HAVE NO REGRETS.”

Later in this same conversation, Rob was able to make a point that smoking a cigar was most satisfying or fulfilling during the final third of the cigar…I don’t know if the smoke gets thicker, smoother, or is loaded with additional flavor – but it seemed to be the best part of the cigar experience, according to Rob. I believe that Rob was making a point about his remaining time with us.

As I now look back at our simple, yet revealing discussion, I can’t help but make an analogy between Rob’s cigar experience and his own life. You see, maybe a full cigar represents one’s entire life. Each puff marks a season that defines who we ultimately become – whether by choice or by circumstances.

Once the cigar is lit, life’s journey begins, supplemented with a great amount of anticipation and hope, and yes, even peppered with setbacks and pain. Rob’s journey included countless joyous occasions, whether growing up in Fargo with his family and friends, his marriage to Patti, the birth of their four children and their marriages, and now their grandchildren. The tapestry of his life is full of so many examples.

Rob was a planter, both literally and figuratively.  We know about the greenhouse and his beautiful gardens – this was the literal part.  Every season at the greenhouse and with his garden, he would reap what he had sown.  But he also had the uncanny ability to establish (or plant) relationships with others that stood the test of time.

And, in the last few months of his life, he quickly learned that what he had sown with countless friends and acquaintances throughout his life, returned a bountiful harvest of love and cherished friendships that painted a beautiful landscape for him to enjoy. This most satisfying harvest, I truly believe, was Rob’s final puff in his life.

Patti, Liz, Pete and Alex, on behalf of our entire family and all who love Rob, thank you for taking such good care of him, especially during this most difficult time. Your love for your husband and father has been absolutely amazing!

To Rob’s friends and colleagues in Centerville and beyond, your outpouring of support and love for him has been both inspiring and gratifying – words cannot adequately express our feelings.

And, finally to Rob – thank you for sharing these life-lessons with us. You will be deeply missed.

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Prescription Drug Pricing – The Reenactment of Harry Houdini

Noted for his sensational escape acts in the late 19th and early 20th centuries, Harry Houdini used chains, ropes, locks, straightjackets under water and a host of other props to escape from assured harm, if not death. Crowds were enthralled with his heroics, and they paid him for this gross but thrilling form of entertainment.

To protect his unique career, he was a master on safe-guarding his escape secrets, and was very quick to sue others who imitated his escape stunts.

Fast forward to today. We continue to be entertained by protégé’s of Houdini, now better known to be ‘magicians.’ Some are quite well-known: David Copperfield, David Blaine, Ricky Jay, Penn & Teller, among others. One common rule that all legitimate magicians adhere to is quite simple:

NEVER reveal the magic secret.

The biggest magician we have today, is not really a magician, but certainly ‘appears’ to act like one.

The pharmaceutical industry – and many key middlemen side players, such as pharmacy benefit managers (PBMs) – are in the business of obfuscating facts from reality. In June, I wrote a piece about this problem on my The Health Autonomist blog. Like magicians, who know how to manipulate their audience into a false sense of free will, pharmaceutical players want the public to believe that efforts are being made to keep the medication costs as affordable as possible and, in return, ‘reasonable’ profits are justly-earned to keep costs down.

The chart below shows just how unbridled the costs of prescription drugs have become (found in the yellow line since 2013). Rarely do I repeat the same visual, as this one appeared in last week’s blog, but this chart demonstrates just how rampant drug prices have become when compared to other types of health services.

Yet, a host of games are being played that cause the patient to receive minimal benefit from their actions – with much of the financial gain being retained by the ‘altruistic’ players who tout their allegiance to the patient. One example is found on the Kaiser Health News webpage:

A very insightful report, “Getting to the Root of High Prescription Drug Prices,” was recently released by The Commonwealth Fund, that provides an in-depth description of the many problems inherent in drug pricing. More importantly, the report describes many possible actions that policymakers and stakeholders can agree on to find bipartisan solutions to many identifiable problems. By the way, regulating drug prices or purchasing drugs through Canada are not long-term solutions, just band-aid approaches to a persistent open wound.

A newly-published ProPublica article, “Take the Generic Drug, Patients are Told – Unless Insurers Say No,” reveals that pharmaceutical companies are increasingly cutting deals with PBMs and insurance companies to push more expensive name-brand drugs over their generic-equivalents. Such actions suggest that higher profits are being sought, often at the patient’s expense. ProPublica’s other new article about generic drugs serves notice that pharma continues to find innovative ways to make money at the public’s expense.

I enjoy infographics, as they can help make something that is very opaque appear a bit more understandable. Even within the insurance industry, the shenanigans that happen in the PBM world are often difficult to understand – leaving many of us to sort truth from fiction. Through Pembroke Consulting, SSR Health, Kaiser Health News et al., an infographic was produced that does a reasonably good job of exposing the secrets behind the curtain of obfuscation on drug pricing.

Like tricks performed by accomplished magicians, the drug-pricing profession profits from sleight-of-hand tricks that must never be revealed to the public.

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