Unintended Consequences

Unintended Consequences

In the US health care system, the people are represented by three separate yet equally important groups; the doctors who treat patients, the employers who offer health care benefits and the insurance companies who administer them. This is their story. Donque Donque (start Law and Order theme song)

Actually, many people wish that could be their story – affordable health care coverage offered by a stable and well-endowed employer. However, for an increasing number of us, decent health care coverage has emerged as an elusive dream, resulting in gerry-rigging and scrambling around in a stunning display of unintended consequences. This is our story.

Nick and I are both consultants associated with companies that do not subsidize health care benefits. While we are both happy in our jobs, the rising cost of our health care coverage is a nagging issue and has prompted both of us to investigate other arrangements.

Unintended Consequence No. 1: Employment decisions are based not on the job or career opportunities, but primarily on access to health care insurance.

Nick had some preliminary discussions with another consulting company that did not offer health care benefits, but they claimed that they had come up with a nifty workaround. They advised us to join the Independent Cattlemen’s Association (ICA) of Texas and get health insurance through them.

Unintended Consequence No. 2: Two life-long Midwesterners, with no ranch, no cattle and not even a hat would consider joining a Cattlemen’s Association.

The Cattlemen’s Association states that it is “the premier representative of the cattle industry, providing an effective legislative voice for all cow/calf ranchers with the vision to accept and promote changes impacting their well-being.” For a moment I thought that “their well-being” might refer to the cows and calves and not the ranchers, but that was just the vegetarian in me talking. Membership is a great bargain, ranging from $20 to $1,000, and comes with a variety of goodies, such as T shirt, cap, an unspecified “special
gift,” and an aluminum gate sign for your ranch. And, of course, you can also sign up for their health benefits. Basically, we could team up with the cattlemen and help spread the risk across a larger group. I had a colleague once who said that he got his health benefits by joining some sort of bee-keepers society. Frankly, if I had to choose between the two societies, I would choose the bees over cows, I just feel more simpatico with bees and I can use the honey.

Unintended Consequence No. 3: I would be willing to become an apiarist and be stung by bees on a routine basis in exchange for stable health care benefits.

There are other types of affinity groups, for example a Chamber of Commerce might offer health benefits to local merchants, thus grouping together a number of small businesses. This would seem to make sense, since this is the basic premise of insurance, i.e. spread the risk across as large a pool as possible. However, in practical fact, this arrangement usually doesn’t work since there is no contribution from an employer to keep the premiums down. Without this sort of subsidy, small businesses with young healthy individuals – perhaps a mountain bicycle shop – will get a better rate if they get insurance on their own. At this point, they don’t need a group to spread risk and share costs, and they don’t want their premiums to subsidize, for example, the elderly couple who own the shoe store across the street. With the departure of the healthy sector, the remaining businesses in the group will see their premiums rise. Of course, the small companies that initially departed will return if one of their employees has a significant illness and they need to seek shelter in a larger group. Pretty soon, the affinity group is attracting only the least desirable and group goes into a death spiral of punitive premiums. Yes folks, this is our health care system.

I’m looking for an insurance plan that will take Nick and I warts and all, no questions asked. Let’s face it, we’re all going to be a little dinged up as we close in on 60 – a bad hip, shoulder or knee here or there, perhaps a clogged artery, and hopefully, at most, a minor but nerve wracking brush with a biopsy. Based on age alone, we’re nobody’s idea of a good prospect to share healthcare costs, most likely we’ll only add to the burden. In the metal, we are the dross, in the wheat we are the chaff. The insurance industry considers us millstones and they can hardly wait to offload us onto Medicare at age 65.

Unintended Consequence No. 4: The only insurance actively soliciting our business is some sort of paltry life insurance designed just to cover our “final expenses.”

We’re both basically healthy, except that Nick had a little episode with a bulging disk in his lower back that required surgery. It was nothing really – really nothing more than the spinal equivalent of trimming a hang nail, although admittedly the hang nail was inconveniently located. Completely successful surgery with no sequela over the past 10 years, but BANG! what we’ve got now is a permanent wart on our medical record referred to as “a preexisting condition.” Our new BFFs, the Cattlemen, would exclude any claim for anything to do with the entire spine, which could be a good foot and a half away from the original surgery. The take away message here is to only use your health insurance for the really big stuff, don’t submit claims that will establish a pre-existing condition that will follow you for the rest of your life.

Unintended Consequence No 5: Even though you are spending a fortune on health insurance, try not to use it. However, once a pre-existing condition is on your record, go and see that chiropractor or physical therapist for those back twinges as much as you want. It can’t hurt your long term insurance prospects any more than it already has.

We ultimately decided that we could not accept the Cattlemen’s half-assed offer, and opted to limp along with what we have. I also have a suspicion that they would have kicked out of their Association anyway, based on an incident that happened to Nick almost 25 years ago. We were feeling slightly restless, wondering if our predictable paths of suburban life and corporate jobs were just a little too safe, so on a lark Nick decided to fly out to Great Falls, Montana to interview for a job at an advertising agency, the state’s largest. We had vacationed in Bozeman, Montana many times and loved being near the mountains, and with Montana State University in town, the town seemed very vibrant with many cultural opportunities. The major flaw in our logic was the assumption that Great Falls would be like Bozeman– the same kind of innocent mistake East coasters make when they come to the Midwest and are surprised that they can’t see across Lake Michigan. The first clue was that Great Falls was not near the mountains, and the second clue was that the city was circulating a petition to ban the TV show NYPD Blue. Apparently the lurid plot lines and bare butts were too much for this conservative town. But Nick pressed ahead and went through the usual interview process, discussing background, prior experience, etc. And then the interviewer announced that since some candidates exaggerated their experience on their resumé, Nick would have to pass an intelligence test. Now Nick had some pretty snappy East coast credentials based on college and business school and his prior clients represented the epitome of market driven companies. So perhaps this intelligence test was just a way of putting him in his place, but there he was dutifully filling in an answer sheet with his two number two pencils. Once the written part of the test was completed, the interviewer announced that the last portion of the test would be an oral spelling quiz. It was at this point that Nick clearly knew that even if he aced the spelling test, Great Falls would never work out.

Most of the words were gimmees, like “triangle” or “antique,” but there was one stumper: “heifer.” There were two main questions in his mind. First, one “f” or two? Based on his German roots, he knew how to spell hasenpfeffer, and that had two “f’s,” but “heffer” just didn’t look right. The second issue was the “i.” He knew it must have one but where? Somewhere in the dusty depths of his brain he remembered the grammar rule “i” before “e” except after “c.” But then he remembered all sorts of exceptions. There is the word “science” for example, and the word “weird,” both in flagrante to the mnemonic (now there’s a great spelling bee word). So was it going to be “hiefer” or “heifer?” Even scribbling the word a few times on a piece of scrap paper did not give him a good vibe, so in the end he just guessed.

“I’m sorry,” said the interviewer sadly, “you spelled heifer wrong.”

“Does it really matter?” asked Nick.

“Well around here it does,” said the interviewer.

So even if the Cattlemen don’t care if we have a ranch, cattle, or hat, I do think that they’d be horrified to know that not only do we not how to spell heifer, but we are also a little unclear as to what kind of cow it is.

Unintended Consequence No. 6: I now know that a heifer is a female cow that has not given birth.