Brian Kruger 0:00
Welcome to Richard Helppie’s Common Bridge, the fiercely nonpartisan discussion that seeks policy solutions to issues of the day. Rich is a successful entrepreneur in the technology, health, and finance space. He and his wife Leslie are also philanthropists with interest in civic and artistic endeavors, with a primary focus on medically and educationally underserved children.
Richard Helppie 0:24
Hello, and welcome to the Common Bridge. This is your host, Rich Helppie. We’re glad that you’re joining our fiercely nonpartisan discussion about policies: policies to meet the problems and challenges of the day, and to seize the opportunities of the moment. Common Bridge is available on most podcast networks. It’s available on YouTube TV and of course at RichardHelppie.com, please register for free. Today on the Common Bridge, we are again back to discuss healthcare, specifically healthcare and healthcare policy in the United States. And today, we welcome the President of Action Benefits, Mr. Karl Albrecht. Karl, welcome to the Common Bridge. So glad that you could take some time for us today. (Karl: Great to be with you here today.) Mr. Albrecht brings us his experience as an advisor to and provider of employee benefits to many companies. His work in developing technologies to manage the health insurance business in America is probably something that many in our listening audience have actually touched and not known. And he’s also had an intense personal medical experience. Karl, our audience likes to know a little bit about our guests, and of course, your full bio will be on our website, RichardHelppie.com. What were your early days like? Are you from Michigan or from elsewhere?
Karl Albrecht 1:46
Yeah, I grew up in a small town called Chelsea, Michigan, which is same town actor Jeff Daniels is from and lives in. And that’s where I was raised, went to Eastern Michigan University, I always kind of knew I was going into the insurance business, because that’s what my dad had done more on the employee fringe benefits, which now we call health insurance or health care. I started working with a company called New York Life and did that for a number of years, and then had an opportunity to join at my dad’s company. But after a period of time and enjoyed it, it was a great fit, he did more of the retail– had a big book of business, and then we had a real big opportunity that came up with Blue Cross–it had never worked with independent agents. And this was really kind of looking at the bringing entrepreneurship into not only delivery but service of consumers. And I think that’s probably one of the missing pieces that I keep seeing on the healthcare is people are not looking at from the consumer standpoint, and a few years ago, the catchphrase was consumerism. And all of a sudden, it seemed to swing hard. And now if you see all the marketing, all the technology, all the great, brilliant ideas are all automated call center, computer this, FAQ that, when you start looking at how much people are paying for health care, and you start thinking what they’re doing to them, I think that’s probably one of the areas that the movement with health performance really become an issue for people, and I see it– I do this for a living, I tell that to people all the time, it’s like, I do this for a living and man, it could not be more confusing. You take a look at health care and you see insurance companies are unbelievable bureaucracies. And they kind of have to be just by the nature of what they do. But and then if you look at it, and you say what’s, what’s the worst bureaucracy you could ever think of other insurance companies? Well it’s the federal government. Well, two of them are got together and they have this new child called health reform. And that’s what we’re all living through right now, and in some ways, it’s working in other ways–it’s, it’s not, it didn’t have buy-in to begin with. So you have one side fighting to the death to stop it, and the other, you know, push it as a badge of honor that we got to push it through, and it’s stuck.
Richard Helppie 3:50
We plan on diving into all of that today. And look in the interest of disclosure and full transparency. I again, want to note, I believe that the era of employer-sponsored health care just needs to come to an end. It doesn’t make any sense to me and many others that the way people are employed these days, and the way the risk pools are formed, so I think we’re gonna have a great conversation and I think we’re gonna really live up to the expectation of the brand promise of the Common Bridge, and that’s where everyone will have something to disagree with. I think we’re probably already there. But we’re gonna have some education and a great conversation and let’s see if we can get to some policy ideas. And Carl if you don’t mind before we get into your professional life, to the extent that you’re willing to share with our audience, you’ve had some intense personal interaction with the medical system yourself.
Karl Albrecht 4:43
I got probably about as bad a diagnosis as you could ever expect to get as a person. I was told two years ago, almost to the day, they did biopsies on my pancreas and they confirmed it was pancreatic cancer. And, you know, up until that time, you know, you just knew that’s a death sentence. And I think if you Google a symptom or you Google really what the outcomes are for that, it’s not good. And so I’m probably the luckiest person you’ve ever met in your life, just to be sitting here, right now, when you look at the statistics. I have a legitimate shot at beating it, I have no illusions that I am going to beat it. It’s probably 50-50, and, you know, for me, that’s phenomenal odds compared to what it was. But the only potential cure is surgery. The cancer’s, you know, one of its hallmarks is spreading, and coming back, that’s two really bad characteristics, as well. And then it sits in an area that’s so central to so many functions that your body performs: digestion, the functionality of your liver, you know, that’s typically where it’ll go secondary is liver, it also has a tendency to go to the lungs, which is an interesting one. So that whole area is just very challenging. And so the other part that makes it so deadly is so frequently it’s quiet, when it’s so far advanced. And that’s where I got very lucky for some reason, it was in an area that it created symptoms, and people always ask me what the symptoms are, and so I like to share those. The symptoms I had, it just felt like an upset stomach high up in my stomach, but it didn’t change and it was day after day, it was exactly the same. And about 10 days later, I was like, you know that something’s not right here. Because you know, usually you go to sleep and it feels better. It’s just didn’t didn’t change. And so I had a follow up with my doctor for some blood pressure, and I said, you know, there’s something bugging me, and she sent me for an ultrasound. And he said, you know, it’s really inflamed, we can’t really see but there’s something there. Did an MRI– and they kind of gave me the same thing. And so, Dr. Gates, who was my GI guy was just phenomenal. He said, You know what, he goes and I think he knew looking at my blood chemistry, I think he knew something serious was going on, that something was blocking something and you wouldn’t pick it up unless you had experience in that. And he did the biopsy and six of them were clean, and the last two showed pancreatic cancer. Now by some fluke and this is the part where the health care system is kind of interesting, I had already been going to Mayo Clinic because I had some back issues, and I thought you know it just be good to be in the system and get a good Second Opinion. If you know if you get back surgery, it’s just so tenuous, as well. So I was already in their system and just by a fluke it turns out they’re literally best in the nation for pancreatic cancer. My brother-in-law, they literally saved his life about eight years ago from colon cancer. He was 38 and had a very large tumor and they resected that and he’s literally cured. He’s doing great, so in my case you know, again, they they can’t perform miracles, it’s usually not good news, my case he said let’s put you on chemo see what happens and so I did __________ which is a really awful chemo, that for some again unbelievable reason, I actually did pretty good with… I never lost my hair.. I lost it from other things, but not from that. That was good. I did a second round of another type of chemo it absolutely beat the hell out of the cancer. I had to stop a couple of times for this or that but in general, you know, he just plowed through it. The problem I had was some circulatory issues– I have an artery it’s not supposed to be where it was it was– it was in the pancreas and you learn all this amazing stuff, but one of the other things the hallmarks of pancreatic cancer– part of the reason that travels, is it’s not really good at developing its own vascular system. So what it does is it finds an artery to attach to and wrap around and it found this artery that goes to my liver which should have been out of my pancreas but was actually in it and it was wrapped around it and so the doctors looking at it says look — goes you know he goes I can use typically I can take this out he goes, but in your case this artery’s and on top of being in the wrong spot, he goes, it’s super narrow. And I don’t know if I got enough artery to attach and if I can’t attach it, your liver’s gonna gonna die because it feeds half your liver. So long story short, the chemo pulled it back from the artery, he was able to do the resection, for some reason they said they were able to do it. I developed additional blood flow, which now it’s not even an issue anymore. But he had to take my pancreas out because that seam would have been in your pancreas– he was worried about the digestive juices breaking down that seam– so long and short, he says look, you know, you come back every three months, we check it, I’ve gone a year–I go I go back end of this month and the first two years are the scariest. They say that’s the highest likelihood of it coming back but we’ll see what happens. But the Mayo system is stunning. I mean, it’s absolutely stunning. And and you look at it from the standpoint of outcomes, efficiency, use of resources, it just it hits on all those very well in the efficiency part. It’s so helpful to you as an individual that you can have an appointment in the morning and then they’ll fill up three more appointments in the day with other areas and by tomorrow, you know what’s going on. By the day after you’re getting treatment and potentially for what’s going on. It moves you so quickly–compresses the timelines, you’re dealing with the same person inputting it, and so again, it’s dealing with the system, but it’s it’s a much more even integrated system you see, that I’ve seen and I’ve been in other parts of the health care system as well. And so really, really well done. I think they kind of take the best of both worlds that most difficult, you know, anybody can really get in there. The most difficult part though is, you know, can you physically get there for treatment?
Richard Helppie 10:21
They have Scottsdale, Jacksonville, (Karl –Yeah) of course, Rochester, Minnesota. And I, I first, I pray that you will be one of the fortunate few that survive this, because there are miracles done every day within the health care system. And when people talk about costs, and they talk about reform, they often don’t talk about the advances that we’ve made, and the opportunities for cures for things that you know, were unsolvable, not very many years ago, and this is something I do think we need to keep in mind, that how do we have a system that can be as good or nearly as good as the Mayo every place? So by way of example, one of our recent guests, Nate Kaufman, talked about the Mayo Clinic, and how Walmart was sending their employees that had cancer diagnoses to Mayo and finding that oftentimes, they were being misdiagnosed. So I love the story, you’re telling about the precision of diagnostics, the integration amongst the various health care practitioners, and the very latest in treatment, and you know, you’re pretty sophisticated healthcare guy, but you’re not a clinician, but you’re able to explain what’s going on with you. And that’s, that’s where health care should be. Now, Karl, most people get their health care through their benefit plans. So you’ve been doing employee benefits for quite a while now. And so that involves a plan design and employees using the group plan, if I’m not mistaken.
Karl Albrecht 12:02
It does and we work primarily with independent agents who work with companies and mainly in the small group markets, small companies that aren’t particularly sophisticated in terms of having an HR department. A lot of times, they really, they really rely on their agent to give them the background. And the agent’s not an employee of Blue Cross or Health Alliance Plan or Priority — they’re, independent. And so you’re successful as an agent by keeping your customer happy. And to me, that’s one of the pieces that is missing in so much in not only reform, but looking at health care, it’s making sure incentives in people are motivated appropriately. And in that case, that’s a perfect description you know, under capitalism, is you get paid for giving the client what they want, your job is to keep them happy. So that works pretty darn well, we work with those agents in terms of developing things like technology that helps them provide them to the small group provider. But also service backup, you know, they can’t be experts in everything. So we end up being the expert in the small group area for them, and they’ll come to us with more detailed questions. The basic stuff they know, you know, inside and out, and they know what you know, the marketplace, and that’s their, that’s the strength. So our job is really trying to try to make sure that those those employees are getting the value out of what they’re paying for and the employer’s getting the service that they deserve for what they’re paying for.
Richard Helppie 13:22
I want to comment on that just a little bit, because I’ve been the employer, and I’ve been out buying the plan. And it’s a difficult game, because you know, oftentimes the insurer wants to look at the claim history, and then up our premium for the next year, based on what happened before. Well, the odds of that happening, again, are really low, but they’re really just trying to recoup their costs of what they had to do to settle our claims. (Karl –But they are trying to get you as a client too) well, they are, but ultimately, as the employer, I’m not the client, because it’s it’s the employees and their families, and all of them have unique needs. And while we offered choice, and we offered, you know, variety of plans for you know, based on where people were living and what their personal circumstances were, there was always a few outliers that we just didn’t have the right plan for certain of our people. And to me, that’s one of the downsides of employer-sponsored health care, is that I can’t meet the needs of all my customers, my employees, and also that every year, they have to change. So we have people you know, the vast majority very happy with the plan. And then you know, we have to go put it out for bid again and we change and then there’s all those games that go on in there and the information exchange is very difficult. Moving, you know, within a plan and then you know, among the plan. You’ve done some things with the understanding of the benefits of technology and the benefits of moving information around and you were quite a pioneer at the time, if memory serves me correctly, or the what I’ve read serves me correctly, I didn’t know you then. Tell me a little bit about your take on the benefits of the information technology and the benefits of the information flow from your seat, helping independent health insurance agents.
Karl Albrecht 15:25
You know, again, you look at an industry where technology can have an incredible impact is healthcare and insurance in particular. And particularly, when I started getting involved, there literally was no technology. And it’s almost funny thinking it was carbon paper and Selectric typewriters. (Rich: you’re aging yourself there, Karl.) I know, it’s pretty scary, isn’t it? When you got when you actually think about, I mean, the smartest thing I ever did is I took typing classes in high school. I mean, it was absolutely brilliant, because you went right onto the keyboard, and you started looking and you started looking at these functions. And you know, I’m not a fan of doing repetitive tasks and stuff like that, you look at it, and you go, if I can automate that, it’s probably a pretty crappy job to begin with. It is they’re just like rote robot type functions that you know, so simple things like addressing labels, and, and you know, things, things of that nature that you know, we started with, and then it was making sure forms were electronic, so you had records, you could look back. So when you call in, or they were all service driven, when you call, I could find your record, I didn’t have to go find a file that might be out, I could actually go online, it can exist in multiple places concurrently. And I think that’s where the value if you start looking at the impact you have, and so we looked at to that technology that not only had an impact on on the consumer, but the agent who was who was required to do the service and made their job easier, and delivered the ultimate value to all of them.
Richard Helppie 16:49
You’ve made some great points about the consumer driven side of health care in your opening remarks. And it is an industry that hasn’t had to go find a customer. And it was really passive. In fact, not too many years ago, you didn’t exist until you presented at a healthcare facility, then oh, who are you? What’s your name? What’s your address? What’s your what’s your insurance? What’s your subscriber number, so there is improvement, we’re nowhere near where we need to be. We think about what, you know, Amazon or your grocery store knows about you and your buying habits versus what your healthcare provider knows, still a long way to go. But you also mentioned in your opening comments about big bureaucracies… and bureaucracies are big because they try to fill a lot of roles. And there’s always a debate on what’s the right role for private bureaucracy or a public bureaucracy. So if you thought about the role for the private health insurers in today’s health care, I mean, what would it be are we oftentimes they don’t take actuarial risk, because they’re just administering a plan, but it may be as administrator, they’re earning their keep…price negotiator, you know, plan designer or service provider, what should we be asking the Blue Cross’s and the Anthem’s and the United’s and all the smaller insurers to do today to serve the nation’s healthcare?
Karl Albrecht 18:10
I think you hit the nail on the head. I think it’s a great, great question. Because I think one of the things you know when you look at health reform, one of the things that kept looking at was your cost of doing business and the financing mechanisms. To me, neither one of those are the problem. Those are not going up at double digits, those are going down at double digits, but that’s what everyone’s focused on as well, the insurance companies this and we need to find it, you know, even your comments about, you know, them looking back, well, the only reason they’re looking back is because they have actuarial tables that you can wipe all that out and just say the feds will guarantee– “X” and then they don’t need actuarial tables anymore, now, they’re just pure administrators. The federal government, both Medicare, Medicaid, state government, they hire the insurance to do tremendous numbers of these functions, because they’re very, very, very good at it. And they’re very inexpensive. And so even though they’re paid a lot of money, they’re doing massive volumes. And I think that’s one of the other things when they start looking at whether it’s insurers, you know, a few years ago, I remember hearing people were talking about well, you know, how much the president of “X company” makes and you know, “X insurance company” like oh, yeah, he makes a lot of money. Now take how much he makes and divide it by the total number of members per month, and it’s like 15 cents a month per member it’s it’s you’re not moving the needle, you’re focusing on the wrong problem. The problem is, is the cost of health care is going up in double digits and why is that. And that’s what we got to take a look at is saying, you know, why when the hospital comes back, why when the doctor comes back and and clearly they’re having costs increased. So what what is so unique, that is driving these costs, so dramatically higher in those areas. In my case, you know, there wasn’t, you know, I’ll give you an example at Mayo, I had radiation treatment before I had surgery, you can submit that, which I did, and it’s going to take a period of time for the insurance company to come back, and I hate to say it, I’m part of the system, rightfully, they rejected it. Then the Provider put an appeal into– put a provider appeal and said, Look, we’re doing pretty advanced stuff, you’re at Mayo, we’d like you to reconsider it, they rejected it a second time. And I’m not necessarily saying they shouldn’t reject it a second time. I am now going to be doing a personal appeal that falls as a member appeal, so they may end up rejecting, I’m gonna have to pay that cost myself. If you’re not in a position to do that, Mayo Clinic may not be an option for you. I don’t know how to fix that. And I don’t know if there is a way to fix it. I’m not sure you want to fix that either, because somebody is going to be taking the lead and somebody is going to be paying, and it may end up being for naught, and that’s why the insurance company doesn’t pay for it. But that’s the role the feds play. They should be saying this should be covered. If you tell me as an insurance company, how much.. what should be covered, I can tell you exactly what the costs are, I know precisely what they are to the penny. My middle son is an actuary for Blue Cross, he understands this, implicitly. I mean, they’re they’re very, very good at the head. But the minute you start saying that you’re taking risk, now I got to calculate that risk. And I have to build in factors for that.
Richard Helppie 21:16
So I think you’re making an argument about some of the downsides of the private insurance. So, and I’ll again cite Nate Kaufman’s commentary that why is something medically necessary if you’re insured by Insurer A versus Insurer B versus Insurer C? It’s either medically necessary or it’s not medically necessary. There’s a lot of things that don’t lend themselves to coding. You know, the energy, the age, the overall health versus the diagnosis and the proposed treatment plan. But we know that from your own description there that the incentive on that part of that claims paying organization– the insurance company in this case,–they want to say no. And they know a number of people will give up on the first no, and others will give up on the second, you’ve chosen to persevere. It seems like a rather cruel place to put a person that’s already got their hands full. And the reason the insurance company doesn’t have the right economics is because we don’t have enough people in the pools.
Karl Albrecht 21:28
I love the statement, and the way you framed it, that sounds correct. But it’s incorrect. And I think part of it is this: they’re on the front edge of of treatment. So insurance companies don’t pay for experimental, they don’t pay for research, they pay for proven services. But there’s no one group that says what it is and what it isn’t. And that’s where I think the feds can say that: this is covered and this is not. Now you fight insurance companies over who’s best administering this coverage. The feds aren’t very good at that. The feds are terrible at that. So the feds need to be setting the rules and being umpires versus being umpires, players judge, jury, which is what they’re doing right now. And I think that’s what creates part of the problem. So the insurance company itself in terms of having it paid for, if you were if the federal government was looking at that right now, I had the ability to appeal it, the answer would be no. Period. Periods. Now that relieved me of any stress of having to think about it anymore, but I was able to get it done. And I think or I’m hoping I’ll get it done. But at least I had the treatments. But if the feds run it, the answer would be absolutely no, because one size fits all, is how the feds…and that’s why there’s so many departments and so many… it’s we got to be fair. We got to make sure everybody’s treated exactly the same.
Richard Helppie 23:44
But let me react to that. If the feds are saying what’s in and what’s not in, and in effect, there is no appeal, because it lets one bureaucrat point to another bureaucrat and say, that’s not something we’re going to do. And one of the I think, flaws, in the Patient Protection and Affordable Care Act, also known as Obamacare, and we’ll get to talk about that in just a minute, is that there was not differentiation among plans, because it was all dictated and prices were dictated. And with no market differentiation, you’re not letting the consumer make choices for that consumer’s situation. I don’t know that, you know, moving everything to a federal platform, or in fact, giving them the rulebook and letting them make the call is the right way to go, at all. But I think you also make an important point. Most people that aren’t in health care don’t understand what a fiscal intermediary does. So that when you’re submitting a claim for Medicare, for example, it’s going through an insurance company who has the ability to process the claim and pay the claim. Okay, that’s what a fiscal intermediary does. Nobody would dispute that the insurance companies are really good at paying medical and hospitalization claims. Now, pharmaceuticals, not all that good at this point. And that’s one of the flaws there. But at a broader level, Karl, policy level, does the tax-favored treatment of employer-sponsored health care make sense today?
Karl Albrecht 25:26
Well, you know, the last thing you want to be doing is making health care more expensive right now. So it doesn’t seem like taking that away… I think one of the challenges, you know, you try to do is find ways to try to consolidate aggregate business at the end, at the employer level, that’s been a good place, because you’re getting the social security information, you’re going over the other benefits, I want to attract employees to my firm by giving good benefits. Is that legitimate? I, you know, to me, I think it is to say, I’m going to give better benefits and better vacation policy.
Richard Helppie 26:01
Let me unwrap that just for a second. So you and I are neighbors, okay, we live right next door to each other. In fact, let’s just say we’re in the same apartment building with the exact same floor plan paying the exact same rent, and I work for Employer B, and you work for Employer A, and your employer says, you know, we want to really give a grand plan and it costs $25,000. And that’s your employee benefit, and you pay zero tax on that compensation. And my employer is a little tighter, they say, yeah, you know, you don’t need that much. And I got a very skimpy plan, that cost $12,000. You just got $13,000 of tax-free money, where I have to go into the market and make up that difference. And to your point about adding cost, what I would propose is this, we tax those benefits, like the compensation they are. If there’s one change you could make in health care, I’d tax the benefits today, and here’s why: First of all, that provision in the tax code was only spawned out of wage freezes in the mid 1940s. And employers couldn’t give raises. So instead, they offered benefits, and they got that tax break. It’s never gone away. Well, the world’s changed a lot since that time. But also, if let’s go back to that example, you’ve got the $25,000 plan, and I’ve got the $12,000. Now you’re on your W-2, here’s $25,000. You’re gonna go Whoa, whoa, wait a minute. Why do I have a $25,000 bill? Oh, well, Karl, you’re paying, you know, first dollar on primary care, you’re paying for this network, you’re paying for these specialized services, you’re probably gonna go wait a minute, take that out. And now we start getting medical inflation, worked out. Let me give you the last word on that, because we’ve got a lot more to cover today.
Karl Albrecht 27:51
So So now, now your diabetes is not being treated, your high blood pressure isn’t being treated and your circulatory issues aren’t being treated? I don’t know how you’re saving costs. And I think that’s…
Richard Helppie 28:05
Well, no, I mean, if if I, no that’s, I think that argument as a… if my employer came to me and said, the reason your health plan costs $25,000, it’s because we’re treating your blood pressure and your diabetes, okay, at a price point that you can’t get, because we pooled the risk. I’m like, Okay, that makes sense. But I would probably ask, Well, what could come out of that plan? (Karl, Right. Absolutely. ) That I shouldn’t be paying for?
Karl Albrecht 28:38
Yep. And there’s not too many options left. I mean, under under Obamacare, they pretty much have established and I don’t think that’s I don’t think that’s necessarily a bad thing. Again, because we’re looking at what’s driving health care inflation, and it is going up at double pace, and it’s drugs. It’s it’s high blood pressure, it’s diabetes. It’s all a function of the society we live in. But, I think what people don’t understand is our health care system also is unlike almost any other nation in the world, fully absorbs the social ills that are pretty unique to this country. And they show up in the emergency room. And you look at other countries, I mean, the, you don’t have anything like this. And for every shooting you have, where someone’s murdered, there’s probably 20 people that survived getting shot, and that is not cheap.
Richard Helppie 29:30
Essentially, open the door here, you’re talking about the Obamacare Patient Protection and Affordable Care Act, and that it does mandate much of what goes into the health care system. What are some of the top two or three positives that you’ve seen from the Obamacare act of 2010, as it’s amended today?
Karl Albrecht 29:53
I would say to me personally, and a lot of people would be kind of shocked by this, but the medical loss ratio, I really like. And it by federal law requires that a insurance company spends 85 cents of every dollar on patient care. And you know, there’s things that go on in and around that. But in general, you got to run everything from marketing, to contracting, to billing. And I think that’s what I was talking about. Insurance companies are very good at it. But that’s also driven consolidation, because now it’s just a function. And the more efficient you are at doing that, the better, but but the temptation is to stop giving service now, because that’s just a cost item. And my concern is that service is becoming a form of underwriting. If you if you need service, you might have some health issues, and therefore by not providing service, I am deflecting you to someone else. (Rich: what are some of the negatives regarding the Affordable Care Act?) Just dramatically over promised and did not… I think there was enough energy to do a bipartisan deal, and it wasn’t, and we’ve doomed it long term. But you know, we were all supposed to, you know, and the comments were made, you’re gonna save $2,000 a year as a family, you know, you’re going to be able to keep your doctor, it’s, you know, you know, people’s costs went up significantly. Their deductibles went up. What the government didn’t tell you was, you’re going to save a lot of money, but they’re going to keep the savings. And that’s how they’re going to try to cover additional people. But the whole thought of telling a 27-year-old kid that you should be paying as much as a 58-year-old person who’s been smoking and drinking and not working out their whole life is insane. And, and that’s part of what was put in place was a structure…it was so it was more… it just hit too many political buttons and not enough basic, suck it up, logic business, this is you know, someone’s going to lose, and you just got to make some of the decisions. And I think that’s something that I am trying to point out, it’s like, you know, I don’t I don’t want to say any changes in the system are wrong whatsoever. Just be aware that they’re not a panacea, in what you’re what you’re giving up. And it’s kind of like capitalism, it’s, you know, again, it’s got problems. But I haven’t seen anything any better than that. And in our case, we’re spending a lot of money, I think there’s some pretty simple things that we can do going forward. Hopefully, we’ll start doing those.
Richard Helppie 32:28
I’ve been deep into this, and the “Shall Issue” rules, I think were very, very helpful. And when they talk about more people covered, what we’ve really done is we’ve expanded Medicaid of higher income point for able-bodied adults with no children who used to not be able to get Medicaid. And we know that people that get Medicaid and a well administered plan do get their preventive care. Again, I think a step in the right direction, and, you know, Medicare for people that get to 65. But we have this vast problem in the middle. And that is, you know, people that are not yet eligible for Medicare, and are doing too well to be on Medicaid, and particularly if they’re gig workers or independent, they’re stuck having to buy a mandated policy- to your point -that might be really appropriate for an older person or a person that hasn’t taken care of themselves. And they’re bearing all that cost. You know, it could be for a single individual, you know, six, seven hundred dollars a month, and then a 12 or $15,000 deductible. That’s a heavy lift. And when people talk about the cost of health care, this is not anything mysterious. There’s, it’s, it’s this simple. How many people are there, times how long do we live, times how much stuff can we do, times how often do we do it? And it’s not about unit cost. But that’s the multiplication right there that comes out. That’s the cost of healthcare. And actually, the number one thing driving the increased cost of health care is we’re living longer. And as we live longer, we’re now past the point where cardiac events used to kill us. They don’t. We get cancers, stroke care is so much better, people survive to get a cancer later. So it just plays into that how many people, how long do we live, and then to many of your early points, there’s new technologies and treatments coming on board. Oh, that’s more things we can do. That’s more cost, then how often do we do it? That’s the simple cost line. I have recommendations on health care and we’ve had Dean Clancy on who talked about health savings accounts for everyone. And we’ve had Brian Peters on from a national policy view. We’ve had Rob Casalou, who runs a major health network in a multiple state area. And of course, Nate Kaufman on a couple times, Chris Allen coming from a public health view and taking care of people in real need. And we all kind of come around to what we think health care insurance ought to look like today. What’s your view? How would what would you recommend that the health care insurance policy of the United States would be today?
Karl Albrecht 35:14
If you don’t mind, let me just talk about that Medicare point for a minute, if I can drop back. One of the concerns I have about Medicare is you have tremendous numbers of people that retired in 1995, and they’re getting 2021 care. Where did that money come from? And and I think the problem is, is, you know, politicians are not being honest with people and saying, a) it’s expensive, and you’re not going to get everything. And we need to make some pretty tough decisions on some of that. I remember a few years ago, a new drug came out for macular degeneration, which was an injection into the eyeball, and it was literally like $100,000 per year. And there was 100,000 Medicare patients that would apply and it would bankrupt Medicare. What do you do? You don’t if you don’t get these injections, you might go blind. But what do you do?
Richard Helppie 36:10
Your personal situation, I think speaks volumes to that. Everybody says, Well, we only want proven, effective therapies. Sounds good, right? What is it before it’s proven? Somebody comes up with a better mousetrap? By definition, it’s unproven. And that, you know, going way back, that was one of the chief issues with the Clinton Care bill, and that it basically wanted to freeze everything in place at 1992, which is ancient history in medical care today, because that was the way they were going to shut out that that third item on that cost line, how many things we can do, and how often we do that. The real savings is, as you’ve hinted at, it’s in personal care, are we eating right, not smoking, exercising, sleeping, stress free as much as possible. And again, I’d encourage everybody to listen to the episode with Chris Allen, I want to say it’s Episode 35. But I wouldn’t go that far, we have ways to get people healthy versus taking care of them when they get sick. And that’s what I feel. And look, I will tell you what I my view on health care policies, we should take all the tax-supported systems Medicare, Medicaid, TRICARE, VA, put it in one system, one bureaucracy, if you’re a United States citizen, you get it. And if you’re a taxpayer, it’s a percentage right off your 1040 that goes to pay for that program. Second item, if the employer wants to offer an additional policy above and beyond that, they can do that. But the cost of it’s compensation, and I would let there be a private market for people that want to go buy additional coverage. Perhaps you’re buying access to the Mayo Clinic, or your or, you know, Sloan Kettering, or Cedars-Sinai or some other group that says, Yeah, they’ll take some of those higher risk patients, and then you could sell that as an insurance. And then you wouldn’t give up the innovation aspects that have made American health care a place where miracles do truly happen every day. We’ve got the financing side of it messed up as big as you can mess it up. But, but you can we have great doctors and hospitals and clinics in the country. So Karl, when you think about the best policies and things and things you’d like to see changed, I don’t know if this is even a good question. But what’s the greater risk that just inertia, you know, doing nothing, or a bad policy approach? Or is there a you know, if you said, there’s two things you could change about the health care system today, what would they be?
Karl Albrecht 38:50
You know, to me, we just can’t afford to make another mistake. And that that was the problem I had with with Obamacare was, it was like, you know, this has to be bipartisan. So figure out a way to sell it, you have to do it that way, or it’s doomed. And we’ve seen that in because we know what’s going to happen out there. And so a small number was able to do a lot more impact. You know, when I look at the health care system, again, I think, you know, the insurance companies have been the bad guys, and I think if you really step back and look at the bigger picture, it becomes pretty intuitive that the bigger picture is a lot different than that. The doctor or hospital I mean, their pen can write millions and millions and millions of dollars in costs. And, you know, how many times have you know, clinics, you know, you find out the spouse is running a separate clinic their referrals are going into and so there’s a lot of protection on that needs to be — you know is it medically necessary. And so I think that type of stuff has been left to insurers, if you start looking at you know, taking over some of that more federally, it’s really easy to not you know, they did the ame thing with drugs, You know, the drug issue is you say, look, we’ll give the opportunity to write everything off instantly, but you got to drop your patent, give them something to think about, or we’ll give you an extended patent if you focus on these drugs, which have a stronger community need. There’s ways to do that, it’s just the shouting has gotten out of control, but if you look at the insurance company, you say, they’re the only one who has got any leverage to negotiate with a doctor or hospital, a patient sure doesn’t. And the insurance company does and so, but the insurance, the balance to that, is the insurance company’s got to keep you at least happy enough as a customer that you come back. Otherwise, you’re not worth anything to them staying a year. You have to stay a period of time before you’re worth something, the game getting played at larger companies a total different deal than what’s what’s going on at the smaller level. So, you know, really kind of a different functionality. But ultimately, I think the government needs to grow up, it needs to tell people, you’re not going to get everything, healthcare is like outer space, it goes on forever and ever and ever. And I guarantee you, I could look at you in 10 minutes come up with a whole bunch of stuff that we medically could do, but does it have any value, patient value, and I think that’s part of where we’re, it’s hard to get around that. And then you look at the patients or the individuals and you say, some could not care less if they go to the doctor down the street and some want to go to Cleveland Clinic. Everybody’s different. If you work hard your whole life and you want to spend it on health care or food or travel, that’s your choice, too. But if you look at some of the other countries like Britain, they tie-barred the health care system together so that you didn’t create two different systems. And that’s what the concern becomes if you allow people to buy separately, you end up with two different systems. So I do I do have a lot of you know, insurance is protection against unforeseen risk, right out of the blacks, we know that you have basic health care functions that should just be paid for and should just be part of a normal…and again, the feds make data requirements, which you saw a lot of that change. It really drives innovation, so the government can really step in and key spots and go, here’s the rules. And the insurance companies will come right around and follow those rules. So whether it’s, we’ll back up the underwriting on this, therefore, now your risk is totally gone. So drop the price. And you do that at the time. If you want to start taxation, you do that shift all at the same time. But it’s got to be bipartisan, it has to be bipartisan.
Richard Helppie 42:39
Well, let me first of all, to support your view on bipartisanship and being fiercely bipartisan is what the Common Bridge is all about. And getting people to talk together and trying to solve the problem. And at the top of this interview we talked about everybody should get the kind of extraordinary medical care that you’re receiving, and, and leading hopefully to an outstanding outcome. That’s the goal, and to do it at an affordable price, and that both of those are achievable if we continue to actually focus on the problem. But today, there really is no constituency for telling people let’s grow up and act responsibly. There’s a lot of constituency out there for someone else should pay for it. And you should just get whatever you want. I can tell you that this was from years ago, but I was behind a woman in a pharmacy, and she’s on the phone and she said, Hey, I’m at the pharmacy (and these prescriptions are bagged up,) and she said, neither Medicare or Medicaid will pay for grandma’s cough syrup. Do you still want me to get them? Okay, I mean, hey if it’s free to that person, I’ll take it, but if you know, it’s a question if I have to reach in my pocket and pay for it. And to me that really sums up the issue right there.
Karl Albrecht 44:02
So now look at this– to look at how crazy the healthcare system is that it’s forced you to look down to something that’s $7.99, because we’re not handling the diabetes on the other side of it, okay. I mean, that’s so obvious to me that you’re diminishing returns on going after something like that, as I’ve seen. When you look at the other end of it that if you just stopped one diabetic, you just wiped out that whole community’s costs– the costs are up for the year.
Richard Helppie 44:31
The paying for covered lives and there’s been various forms of you know, capitated payments, now for years. The Medicaid systems are doing a good job of this about managing the disease versus reacting to the symptoms, and in trying to get those ER visits down. You know, Carl, a question I ask all my guests or nearly all them. Has there been any change to you know the issues or your thinking or theories since the onset of the pandemic, has the pandemic have changed anything for you?
Karl Albrecht 45:01
Um, I think, you know, I, I’ve been a big believer in technology and health care, so you know, again, you need to have people where they need, there needs to be people. You need to have technology when there’s technology. So I think one of the things that pandemic did is, is it shifted, so many people that were reluctant to embrace technology as a communication platform– large numbers have embrace that and for medical purposes, because they had no choice. There was a period of time when I was getting treatment where nobody would see me. And there was a period of time when I couldn’t get the vaccination, and I had to go get treatments done, and I’d have to be in a room full of cancer patients, and so that was pretty frustrating. So again, you look at logic, the government’s not immune to making dumb decisions too (Rich, laughing and that’s an understatement!) Right, so I think we need to be aware of when you know, when when we look at, you know, ceding control, the government tends to be one way. And I’m not an anti-government…they have a critical role, not only in the financing, but setting the rules, because the buck has to stop somewhere. But they just can’t, they can’t cross that line until they put their thumb on the on the scale, and that’s what they’re doing right now. And I think that’s, that’s what they need to get off of that and be honest about it with the people.
Richard Helppie 46:22
Karl, this has been a great conversation. I’ve really enjoyed having you as a guest. What didn’t we cover today, maybe that we should have covered or any closing thoughts that you’ve got for our audience on the Common Bridge?
Karl Albrecht 46:36
Yeah, I don’t know if you put this in or not, but my situation with pancreatic cancer, you can’t follow what I did and get the outcome I did. It is just, it is honestly a miracle. You know, when I look at where I started this is I can’t come to any other conclusion that there’s some other intervention in this. But my point being is I don’t want to give false hope to people, but the flip side, and I’m part of a pancreatic cancer group on Facebook, and it is the most depressing thing, because the outcomes are so terrible that I feel I need to speak up to say there is some of us do get somewhere. And I don’t know if it’s gonna keep going, but I’ve got two years since diagnosis, and that’s, a miracle. And two guys I’ve worked with, one from my hometown, passed away. He was just diagnosed in December. And another guy was a friend of a friend, which I can’t can’t believe he was going to the same doctors. I was at Mayo, and he just passed away about three weeks ago. So you know, even when people talk about Alex Trebek, I mean, he was terminal. They just had him somewhat under control, so he was not a good comparative for people to look at because he was not going to walk out of that alive. So, you know, my point is, I want to make sure that people understand that this…you know, the thing I always used to compare it to was March Madness is, you lose one, you’re done. That’s it. You have to win every single one, all the way to the end. And you look at those odds, and that’s what you face. Gut somebody’s gotta make it.
Richard Helppie 48:09
Karl, you’re a brave and forthright man and pancreatic cancer has touched my life with family members, close friends, business associates, employees, and it is one of those diseases that I hope that our children or grandchildren look back on and oh, yeah, we used to have that. And we, through the grace of God, and through the miracle of modern medicine, and through all the incredible medical technology and people that are serving healthcare, that we do come up with a cure. And I hope and I pray that you will be the next one on the cure list. (Karl: thank you.) This is Rich Helppie today on the Common Bridge with our guest, Karl Albrecht talking about healthcare, talking about his personal journey, talking about the role of private insurance talking about his experience, trying to serve customers, make sure they’re happy with their health care and health care insurance. You can read more about Karl at RichardHelppie.com and when you’re there, please register for free. See you on YouTube TV at Richard Helppie’s Common Bridge channel and on podcast wherever you get your podcast. So with our guest today, Karl Albrecht, this is Rich Helppie signing off on the Common Bridge.
Brian Kruger 49:29
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