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About the Author
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In Need of Treatment
Health care is a drug. In a world of addictions, including caffeine, tobacco, opioids, and social media, we are a society influenced by our modern dependencies. The challenge with many vices is we often don't even realize when we are hooked. It wasn't always this way, and dependencies are not always addictions. I depend on water and air in the same way that, to live life to the fullest, I depend on health care. However, over the past century, the United States has perverted the way health care is delivered, accessed, financed, and consumed. As such, the health care industry, acting the role of a drug dealer, has made addicts of us all.
Chances are you've experienced challenges while navigating the health care system, or you know someone who has. How have unexpected bills and confusion about what your insurance does and doesn't cover impacted your life? How about insurance networks? Do you really know how to determine what's in and out of network? Should the government come in and simply take the entire thing over? Is that the only way out? Health care is at the forefront of many minds and has been an issue of continual debate in our homes, in the workplace, and throughout our politics.
The purpose of this book is to discuss where American health care is right now, how we got here, and where we are heading. The situation is dire, to be sure, but don't let that discourage you; we can alter our course and navigate a different outcome. We can break the addiction and reestablish a health care system meant to positively impact the lives of our citizens, without destroying businesses or establishing oppressive price fixing.
I've been part of the health care industry for nearly twenty years, working in various facets, and believe me: I've seen it all. I've seen the good sides of health care, things like the delivery of new life or times when patients endure hard times and emerge stronger and healthier on the other end. I've witnessed surgery and later physical therapy that led to a wonderful outcome and a better quality of life. I've seen the ugly, too — when people go through the pain of losing a loved one or unnecessary testing and treatments. I've known those who have gone bankrupt while caring for their loved ones, while hospitals concern themselves more with money than care and procedures and prescriptions are handed out for no reason other than to raise the bottom line.
And it's because of the ugliness that we must find a cure, all the while preserving what is good and great about our system. It's time for an intervention: a serious conversation to break us from the negative aspects of the health care system and instead "reformat" a system that achieves great things, serves the masses, and sustains our pursuit of happiness. But how? This isn't some friend who lost their path; this is the American Medical Complex, an industry so large it makes up a sixth of the US economy, impacts millions of jobs, and has the single largest lobbying group in Washington. Where do we even start with a system so vast and so vital that to fail could crash the entire American economic engine?
Pundits will tell you that there are many layers to these problems and that those layers are very complex. Some will say it's all about ingenuity, but the United States is responsible for nearly 70 percent of all technological medical advancements throughout the world, yet, according to the World Health Organization, the United States ranks thirty-seventh in overall health, while ranking number one in overall cost (nearly double that of most other First World countries). Infant mortality is nearly double of that in other comparable nations, while the United States ranks nineteenth overall in obesity (with 33.7 percent of the population listed as obese). In addition, with all of the brilliance behind our system, we lose more of our citizens to heart disease, diabetes, and cancer, than we do to all other causes of death combined. Some will say we have an access problem, but we don't. It's not that the single mother with two kids in just about any metro area of the United States can't walk to a street corner to access the health care system, it's that she can't afford it once she's gotten there. So if ingenuity and access aren't the problem, what is it? Cost — or dare I say, profit. Plain and simple, it's all about the dollar, and while that, in and of itself, can be a challenge, it's not necessarily always a bad thing! I'm a free market capitalist and firmly believe that our economic system in the United States is the greatest on the face of the earth. It is the nature of our system that encourages the advancements and innovations in medicine, but when an I.V. bag costs less than $1 to make but is billed, on average, $546 per unit by hospitals (a 54,000 percent markup), we have a serious problem. Yes, when it comes to one person's health blended with another's profit margin, we can often find ourselves in a conflict of capitalism versus care.
There are numerous books outlining where the system went wrong, and while we will touch on some of those things, the title of this book is The Cure, so rest assured that, instead of finger-pointing, we're going to outline ways to actually solve these problems. And, in so doing, we'll address the four influencers of the health care system (the government, the delivery system, the finance/insurance market, and the consumer) and their roles in curing the system as it sits today.
This book does not intend to take a political side or to promote any particular agenda. I've spoken on media outlets endearing themselves to a particular side of the political spectrum — FOX News, NBC, CBS, ABC, and others — and I frequently discuss health care on radio stations big and small: AM, FM, and XM. Inevitably, I have been called out by members of both political parties as advocating the other party's policies (which I tend to find amusing). My hope is that, by the end of this book, you won't know which political affiliation I keep or how I might vote from one election to the next. I say this because the problems within the US health care system are not partisan problems. Diseases don't have a party affiliation, nor should solutions to cure them.
In the same way, this book does not contain a magical, one-step switch to either a single-payer or free-health care-for-all platform; nor does it advocate for a continuance of the system we have now, with crony capitalism run amuck. Those are the cries of the politician, who is trying to secure votes. I'm going to simply "tell it like it is." Here's the truth: we worked hard to build this country, and we will also need to work hard to repair the health care industry. This book is about the small steps that we can take to alter some of the core tenants of the health care system. We will need to reform how care is delivered, how it is financed, how it is advanced, and finally, how it is obtained. Like pieces within a puzzle, we must look at all parts of the health care system to begin to provide solutions to cure it.CHAPTER 2
Health Care — It's Personal
When I began writing this book, I was told by many that my efforts would be futile, at best. Health care is too big and too complex a problem to solve in one book. While the better part of me might agree with this perspective, I was raised to consider that those crazy enough to think they can change the world are oftentimes the very ones who do. In the same manner, I was also taught that to solve big problems, one must identify the various aspects of that problem, quantify them, and create a plan of action to solve them. Much like when building a house, it must be done brick by brick, with the foundation being your purpose or your "WHY." There must be a blueprint of action to guarantee success at each juncture. I have been in the vocational health care sector most of my adult life — it is "WHAT" I do, but "WHY" I do it has become the internal alarm clock that gets me up in the morning, pushes me to continue to learn, and is the motivation behind writing this book. To better understand my "WHY," and thus my key inspiration behind this project, I'd like to tell you my story and personal interaction with health care.
While I was growing up, our family didn't have health insurance. My father was the pastor of a small church in Midland, Texas, and the congregation operated on a limited budget. For this reason, health insurance for its staff was not an option. By the age of twelve, I would require more than ten surgeries because of a nonlife-threatening medical condition. While minor in nature, these procedures created a significant financial burden on our family. Not realizing the reasoning at the time, I watched as my father would take jobs outside of his role at our church to be able to either obtain health insurance or earn enough money to pay cash for the treatments of my condition. This was the 1980s and the early 1990s, so the ability to access the market without insurance and to negotiate a cash deal was still a viable option — a feat that would be all but impossible in today's health care climate.
Both of my parents were selfless, always putting their family first, others second, and themselves last. While I was growing up, we were not poor, but we didn't have a lot of money, either. I don't recall ever going without; as a matter of fact, I always thought we must have had significant means, given that my brothers and I always seemed to have more than we needed or really wanted. We were rich — not in the monetary sense but rather in that we had two parents who loved each other, who loved us, and who shared their love with us.
Contrary to the belief of those that know me best, I did not grow up with aspirations of being in the health insurance finance and health care industry. While other kids were wearing superman capes, fire fighter helmets, or police badges, I wasn't wearing a suit and carrying a briefcase ... okay, maybe I was, but not with the idea that it would lead me to the career I have now. Like most children, I dreamed of being a policeman, a cowboy like John Wayne, or a fighter jet pilot (it was the 1980s, and Top Gun was a big deal). Yes, my childhood visions of the adult version of me were similar in nature to those of most kids, I suppose; however, there was always something within me that liked to fix things.
My mother loves telling the story of the time when I was three years old. I would go outside, get in my little red foot-powered car, with my toy tool bag, and proceed to go door to door down the block on the street on which I grew up. My purpose for this adventure was to visit our neighbors, asking if they had anything that needed "fixin'" (as we say in Texas). Obviously, at three years old, my capacity limited my ability to actually accomplish any task associated with home improvement, but our neighbors were gracious enough to let me try — and usually to let me think I'd provided them with high-quality service. Regardless, the idea of repairing that which was broken has always been part of my core.
By college, I was, I suppose, like many adolescents, attempting to find my purpose and place in the world. It was actually my college counselor who helped guide me into the health insurance space by encouraging me to pursue something I enjoyed. It's not that I enjoyed insurance (who does); rather, I enjoyed playing golf, and, per her recommendation, I began asking those who got to play a lot of golf what they did for a living. I would focus my inquiries towards those who not only got to play what I would consider to be an acceptable amount of golf but also, specifically, those who got do so throughout the week — during working hours. An overwhelming number of those with whom I engaged informed me they were in the insurance business. With this helpful information in hand, insurance became the "WHAT" that would allow me to pursue my "WHY" — golf. Numerous jobs, rounds of golf, and more than a decade would pass before my "WHY" would become what it is today.
By the time I was thirty, I had worked numerous jobs throughout the health insurance market, my first as a junior associate with small agency in Midland, Texas, where I grew up. I would leave that job a year later to start my own firm, and, after a few long years with very little success, I took a position with a national Fortune 500 insurance carrier. It was this job where I learned about underwriting, rating methodologies, insurance profit margins, marketing strategies, and the many tentacles and motivations within the health care system. The knowledge I gained at the national carrier provided me with the opportunity to join a consulting firm where, at twenty-nine, I would find myself about to be named a partner. I had, so I thought, found my place in this world and was even able to find time for a round or two of golf each week.
It was a Thursday — I'll never forget — when all my "plans" changed. December 30, 2010, was a day that would end one season and begin a new one, but one more focused and determined than ever. On the eve of being named partner at the firm that I had called home for nearly five years, I was informed by the existing partners that they had, instead, decided to sell the organization to a national brokerage. Looking back, I don't fault them for their decision — the employee benefits and health insurance landscape was (and still is) in a season of massive uncertainty. Our firm was small but successful, and out of a desire to maintain that success, the leaders of our firm believed the best option was to align ourselves with a larger, more powerful, and more influential organization. I myself was crushed. Sitting in the conference room as I learned the news of the coming acquisition, I could not fight my emotions. It was as if a family was breaking apart and with it, all my plans for the future. I had grown to love our organization, the people within it, and what we stood for. Times were changing, however, and I was not prepared for this change.
Given the speed by which the acquisition was to take place, I did not have time to plan for alternatives. Twelve short hours after I learned of our firm's coming change, the announcement was made and went into effect two short days later. While I was deciding whether or not to join the larger firm that was acquiring us or to determine my alternative next steps, something was mentioned that dramatically changed my career course and life goals. During the brief window of time that I had to make a career decision about my future, it was said to me that if I were to join the larger, more powerful firm, I would "make more money that I ever dreamed possible."
It was at that moment that I flashed back to a conversation that my father and I had almost twelve years prior. It happened in the center field of a baseball stadium in Abilene, Texas, during my senior year of high school. I was preparing to play what would be the last baseball game of my life, and as was part of the pregame routine, my father and I would visit while I stretched and got prepared for the game. Much like the career situation in which I found myself in 2010, twelve years earlier, I was also struggling to make an impacting decision in my life, but this time, it was the decision about which college to attend and whether or not to continue my baseball career. While on that field in West Texas, my father said something to me that I had forgotten, until that fateful December afternoon in 2010. He said, "Whatever decisions you make, promise me this — never chase money, because you'll find that you will never catch it."
Up to that point in my career, I was focused on the title, a country club membership, and the dollar. How high I could climb the ladder, what status I could obtain, and how much money I could make. I don't believe I was arrogant or pretentious, but my purpose lacked proper focus. My "WHAT" was obvious, but my "WHY" required some adjusting.
I appreciated the statement "more money than I ever dreamed possible" that was made to me as I struggled with the decision about my next steps. It was those exact words that hurtled me back to the wisdom my father had shared with me regarding money. I had known for some time that our health care system was fractured, but I recognized, in that moment (as if a light switch had been turned on), that I was part of the problem. The health care system was (and still is) benefiting the bottom line of hospitals and providers, insurance companies, and me, the insurance broker, who was compensated for my efforts to stay "in the box" and maintain the status quo. I began thinking differently about the health care system: instead of it being a vehicle to provide me with wealth, I started thinking about those that were truly impacted by it. There were many winners in the current system, but those that the system was meant to serve were often losing. I could change that — I would change that. With the unwavering support of my wife, I decided that I would refocus my goals and change my "WHY." I desired to return to the dream I had when I was three years old and to begin the process of "fixin'" things. With a new and fresh purpose and focus, I set out to change the world — but little did I know that I soon would find myself on the receiving end of the health care system, which would take my "WHY" to a whole new level.(Continues…)
Excerpted from "The Cure"
Copyright © 2019 Seth Denson.
Excerpted by permission of Clovercroft Publishing.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Foreword By Larry Linne xv
A Note from the Author xix
Chapter 1 In Need of Treatment 1
Chapter 2 Health Care-It's Personal 5
Chapter 3 Where the Solutions Lie 13
Chapter 4 Don't Hate the Players; Hate the Game 21
Chapter 5 The Referee 31
Chapter 6 The Doctor Will See You Now 39
Chapter 7 Hospitals-America's New "Too Big to Fail" 51
Chapter 8 Your Money or Your Life 63
Chapter 9 Fee for Service 73
Chapter 10 There's a Pill for That 81
Chapter 11 Health Insurance-The Tie that Binds 97
Chapter 12 The Real Solution 111