|
Ethics Awareness Month – March 2008
AHIA is committed to the highest ethical standards within our organization and is participating with The American College in support of Ethics Awareness Month March 2008. The Center for Ethics in Financial Services promotes ethical behavior through program offerings that go beyond the “rules” of market conduct in an effort to help executives and producers be more sensitive to ethical issues and think more critically about ethical solutions.
These interactive courses, forums, and workshops provide practitioners the ability to think critically and behave ethically, particularly in the absence of clear rules and directives.
back to top
Ethics and Health Care Reform
Ezekiel J. Emanuel, M.D., Ph.D.,
Department of Bioethics, The Clinical Center,
National Institutes of Health
Ezekiel J. Emanuel, M.D., Ph.D., 2008 National Policy Forum general session speaker, agreed to share his recent presentation Ethical Dynamics of Innovations and Efficiency in 21st Century Health Care with AHIA.
Dr. Emanuel’s presentation begins with two questions:
- Considering all aspects, how well do you think the American Health Care System functions?
- Considering all aspects, how happy are you personally with the health care services you receive?
Of course the answers to the two questions are usually in direct opposition to each other — the American Health Care System isn’t rated highly yet personal services are very highly rated. Republican consultant Michael Murphy summed it up nicely “Everybody wants to change the system, but nobody wants to change their plan.”
Please note that the views expressed in Dr. Emanuel’s presentation do not represent the views of the NIH, DHHS, or any other government agency or official. Following are highlights from his presentation.
According to Dr. Emanuel, the financing system is inefficient, inequitable, and fiscally unsustainable. The delivery system is fragmented, not designed to care for chronic diseases, haphazard and poor quality, and includes a high use of unproven and marginal therapies.
True health care reform must fix both the financial and delivery systems. Unfortunately, most public discussions focus exclusively on the financing system and getting to (or close to) universal coverage. They ignore delivery system reform.
Comprehensive health care reform that addresses the failures of the financial and delivery systems will confront several important ethical challenges.
Consider three key ethical challenges:
- Is it ethical to use costs to determine what services will be covered or reimbursed?
- Is it ethical for there to be a two-tiered system based on an individual’s economic status? Should the rich be allowed to buy more services with their own money?
- Is it ethical to hold individuals responsible for their health-related?
Health care costs have opportunity costs. If we spend money on health care we cannot spend it on other things.
Emanuel asks if this is wise and suggests it depends on value of added services and a comparison to other goods and services that could be purchased.
Increasing health care costs have a huge and adverse impact, especially on coverage, income and other vital governmental services—e.g. education. Health care costs increases cause a decline in health care coverage. So increasing health care costs have the effect of denying other people health coverage. There’s a cost-coverage trade-off. Health care costs are part of total compensation. Therefore, increases in health care costs mean lower wages and income.
Corporations are not paying for higher health care costs – the burden has fallen on workers through smaller pay checks and citizens through worse government services.
Over the last 30 years:
- Consumer price index up 258%
- Health insurance premiums up 300%
- Pre-tax corporate profits up 150% (per employee)
- After-tax corporate profits up 200%
- Wages per employee down 4%
Not taking health care costs into account has a direct effect on the middle class squeeze.
As health care costs go up in excess of inflation and more people need government health programs, state governments are forced to cut other state services because they must balance their budgets. When health care costs force states to cut the biggest loser is higher education. Increases in tuition at state colleges and universities are directly related to higher Medicaid costs.
Are cost considerations ethical? Justice is based on acceptance of scarcity. If there were no scarcity there would be no need for principles of justice. Society is not required to provide people with everything they might want. There are not enough resources.
Society should provide those goods that are important for giving people the opportunity to pursue a reasonable life. Justice requires society guarantee individuals reasonable health care that keeps them living a normal life span and functioning so they can pursue opportunities.
The Federal Employee Health Benefit Program (FEHBP) is a standard benefits package that Congress gets. According to Dr. Emanuel, this is a reasonable benchmark for health care benefits citizens should receive as a matter of justice. From collective resources people should be guaranteed reasonable services.
From private resources people should be free to pursue their preferences. Health insurance and government programs should not take into account individuals’ preferences regarding risks and benefits. Similarly individuals do not deserve whatever they and their physicians decide. That would be like saying I deserve whatever meal at a 3 star restaurant I want because I need food to survive.
Individuals deserve the health care benefits society deems reasonable. Society should provide health services society deems urgent and vital, not the services preferred by individuals. Otherwise an individual is robbing people of other needed goods society deems valuable.
Private health insurance is a collective, communal good. It is insurance which pools money from people for the benefit of individuals in the pool who need health care. When one person uses money they are either depriving others of those resources or forcing people to pay higher Furthermore, private health insurance is subsidized by a tax benefit now worth well over $200 billion. If health benefits are limited to protect collective resources, who should benefit?
- Shareholders and executives of private insurance companies
- Other members of the insurance pool
- The public at large
For-profit status of insurance companies make it hard for the argument that services should not be provided to protect the other members when it is just as likely that the beneficiaries are stockholders. But when private insurance denies benefits and invokes the need to protect collective resources there is a problem if the collective resources are going to stockholders who are not also in the insurance pool.
The ethics of economic status — should the rich be able to buy more health care services than other people?
The rich can always, always buy up and out. Canadians come to the United States. Americans will go to the Cayman Islands or Harley Street or wherever to get the services they want. In Canada, despite equality and deep commitment to the single tier health care system, the rich get more especially of scarce resources that forces queuing.
Worrying about economic status/two-tiered system mistakes the ethical challenge. The fundamental ethical consideration is not whether the rich can “buy up,” but whether the standard health benefits for the “worst off” are good enough. The ethical violation of the current system is not that the rich have more, it is that the uninsured and Medicaid patients have inadequate coverage.
People should be able to spend their money as they see fit. If people want to spend their money on education or vacation or fine wine they should be able to as long as they leave “as good and as much” for other people. Why should people be able to spend their money on an SUV rather than a Corolla or on a vacation to Bhutan rather than Yellowstone, but not be able to spend their money on more medical services? This does not mean people should have the liberty to spend their money buying absolutely scarce medical resources, such as organs for transplantation.
In a country with 2.4 doctors per 1,000 population; 3.0 hospital beds per 1,000 population; and 26.6 MRI scanners per million population, it seems far fetched to claim that if the rich buy concierge medicine there will not be enough good doctors, hospitals, MRI scanners, or drugs for other Americans.
To prevent the rich from buying more health care services is a form of “leveling down” — increasing equality by bringing everyone down to the level society can afford. This only makes some worse off and no one better off — hardly an ethical stance.
Precluding a two tiered system seems to be based on envy not justice. Justice is concerned with both liberties and needs. Public expenditures are based on what society believes individuals need to pursue a reasonable range of life plans.
Private expenditures are based on liberty or individual autonomy, what people want to do with their own lives and resources. Not only does justice permit a two tiered system, but because justice is concerned with individual liberty it actually requires a two-tiered system.
Is it ethical to consider health care costs in determining coverage and reimbursement? Absolutely. It may be unethical not to consider costs. But cost considerations must benefit those who are sacrificing not shareholders and executives.
Is it ethical to permit the rich to buy additional health care services with their own money? Absolutely. To prevent them from spending money as they want violates liberty which is part of justice. But their purchases must not infringe the liberty and needs of other people. Restrictions are permitted if health care services are scarce.
You can learn more about Dr. Emnauel’s suggestions for healthcare reform in his new book Healthcare Guaranteed – A Simple Solution for America.
back to top
Mental Health Parity Compromise
The House of Representatives approved H.R. 1424, the Paul Wellstone Mental Health and Addiction Equity Act, on March 5 by a bipartisan vote of 268 to 148. The bill would apply to group health plans with 50 or more participants.
H.R.1424 amends ERISA to forbid employer-provided group health insurance plans from including limits, financial requirements or out-of-network coverage limitations on mental health treatments unless comparable limits and requirements are also imposed on medical and surgical treatments. The mental health conditions covered by the bill include all those described in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). The bill also restores and makes permanent the $100 per day excise tax imposed on group health plans that violate the mental health parity rules.
The House also added H.R.493, the genetic discrimination bill, to H.R.1424. H.R.493 would prohibit discrimination by group health plans and health insurers based on genetic information. Those provisions of the bill would also forbid insurers from requiring genetic tests. (The Senate has not yet acted on the genetic discrimination companion bill, S.358.)
H.R.1424 is now ready for a formal House-Senate conference between it and the Senate-passed mental health parity bill, S.558. A key conference issue is the breadth of the mental health parity rules—the number of mental health/addiction conditions impacted by the Senate bill is considerably smaller than the number included in the DSM-IV.
AHIA prefers the Senate-passed version (S.558) that represents a more balanced, workable approach. S.558 has broad support and passed the Senate unanimously.
AHIA will work with the House-Senate Conference to find an acceptable mental health parity measure.
back to top
Health Care Costs Drive Up the National Retirement Risk Index
The National Retirement Risk Index has shown that even if households work to age 65 and annuitize all their financial assets, 44 percent will be ‘at risk’ of being unable to maintain their standard of living in retirement.
More realistic assumptions regarding earlier retirement and reluctance to annuitize 401(k) balances or tap housing equity would put the percentage ‘at risk’ even higher. These analyses have not addressed rapidly rising health care costs.
When health care costs are included explicitly, the percentage of households "at risk" increases dramatically, according to the Center for Retirement Research (CRR) at Boston College.
A recent CRR brief explores how rapidly rising health care costs enter the NRRI calculations. The results show that once health care is considered explicitly, the percentage of households that will be "at risk" rises from 44 percent to 61 percent.
back to top
Promoting AHIA and the Role of the Advisor
In addition to its regular communication with members and leadership, the AHIA Board members continue to spread the AHIA message through appearances in various press and industry magazines as well as participation in state and local NAIFA chapter meetings, and various conferences and forums. Recent visits/appearances include:
- AHIA President Tom Vander Wal – AHIP National Policy Forum.
- AHIA President Elect Robelynn Abadie – MainStreet
- AHIA Secretary William Foudy – Managed Care vs. Medigap Insurance, The Society of Certified Retirement Financial Advisors (CRFA), Las Vegas, Nevada.
- AHIA Membership Chair Ed Anderson – NAIFA-MO Day on the Hill
- AHIA Legislative Chair Christopher Schneeman – NAIFA-MN Day on the Hill
- AHIA Executive Diane Boyle – NAIFA-CO Day on the Hill, AHIP National Policy Forum and various congressional meetings.
Here are a few way in which you can help communicate your association’s message:
- Contact AHIA Marketing Coordinator Caitlin Kubler to request the AHIA Booth for an upcoming meeting.
- Download the AHIA Rx For Health Care PPT and present at a local civic or business group (remember to view in the notes format for a ready-to-use script).
- Forward an application to a non-AHIA member.
back to top
'08 Health Care Debate
AHIA member Ralph Weber participated in a panel of medical and insurance experts discussing the positive and negative aspects of the US healthcare. In this segment, Ralph explains the myths, costs and realities of private and universal healthcare in America and Canada.
New DVD release: Hope4Health Care: The Reform You Can Live With DVD features Dave Racer, author of Your Health Matters and Facts Not Fiction, discussing reform in front of a live audience. To order at special AHIA members pricing visit www.alethospress.com/ahia.htm.
back to top
Employee Benefits Educational Symposium – September 2008
The Association of Health Insurance Advisors (AHIA) – NAIFA’s health and employee benefits advocate - is hosting an Employee Benefits Educational Symposium in September 2008. This program held in conjunction with the NAIFA Annual Convention and Conference will provide attendees with the knowledge to improve even the most successful employee benefits practice.
Members can register for the symposium on the NAIFA Convention Registration form. Please visit www.naifa.org/convention to register online.
Friday, September 5
Employee Benefits Symposium Breakout Sessions
Choose from a variety of workshop sessions focusing on employee benefit issues including HIPAA, COBRA, HSAs, Flex Plans and Wellness Programs.
Sponsored by 
Employee Benefits Symposium Luncheon Presentation: When Everything Goes WRONG!
A dramatic presentation of an HR/Benefits department at its worst! Come to enjoy lunch, have a few laughs, and see what can go wrong in the world of employee benefits.
Sponsored by 
Employee Benefits Symposium Wine and Cheese Reception
Join the speakers and panelists from the Employee Benefit Symposium as well as other attendees for networking and refreshments!
Sponsored by 
Saturday, September 6
Employee Benefits Symposium Expert Panels
Join us for two expert panels; “Building Your Agency” puts the focus on alliance building, cross-selling life and employee benefits, and handling transitions such as retirement. “Meeting Expectations” will address the expectations small group, large group and carriers have of the employee benefit agent. A legislative update and discussion on the state of health reform on the state and federal levels will be held between the panels.
Sponsored by 
Monday, September 8
AHIA Annual Meeting & Luncheon
Featuring keynote speaker Roger Schultz: “Building a Million Dollar Practice.”
Roger Schultz, CLU is a national speaker and trainer on employee benefits and has published more than 50 articles on the subject. He is the founder of the nation’s first administrator of direct reimbursement plans for dental and vision care, a model now used by more than 3,000 employers. Schultz established 250 direct reimbursements plans covering 200,000 participants in 21 states. As a practical expert in the highly complex and competitive field of employee benefits, Schultz helps other agents develop innovative services, products and concepts.
Sponsored by
back to top
AHIA – NAIFA Health & Employee Benefits Kudos
There are a number of state and local NAIFA associations making a difference in the health and employee benefits arena. Following is a recent example:
NAIFA-Maine has been struggling with the desperate situation in Maine's individual health insurance market. According to NAIFA-Maine, the solution is stuck in the Maine legislature with extremists on the left blocking any reform. Maine’s only hope is to have a referendum on Free Market Health Insurance Reform. It will either spur the legislature to act or let the voters have the final say in November 2008. NAIFA-ME really didn't want to pursue a referendum, but they believe they have no other resort. Fortunately, NAIFA-Maine isn’t going at it alone, there are a number of coalition partners
AHIA is pleased to report that the AHIA Board of Directors and the NAIFA Board of Trustees both unanimously approved Maine’s request for financial assistance from the AHIA War Chest. In accordance with the State Assistance Policy, a check had been issued to cover one-third of NAIFA-Maine’s unreimbursed expenses in connection with NAIFA-Maine’s referendum on Free Market Health Insurance Reform.
Share how your association is favorably influencing the health and employee benefits arena by sending an email to ahia@naifa.org.
back to top
50 Ways To Boost Your LTCI Sales
Interested in increasing your sales and making more money? Obtain helpful tips with 50 Ways to Boost Your LTCI Sales. Margie Barrie’s long term care insurance marketing advice is read by 35,000 people every month. The “LTC Insider” has written 50 Ways to Boost Your LTCI Sales, the first book to give practical sales advice to LTCI producers. Purchase the book today to stay at the top of your game.
50 Ways to Boost your LTCI Sales is available to AHIA members for $27. To purchase visit the AHIA Store.
back to top
2007-2008 AHIA Board of Directors
 PRESIDENT
Thomas J. Vander Wal
PRESIDENT-ELECT
Robelynn H. Abadie, LUTCF, CSA, RFC, RDA
SECRETARY
William J. Foudy, LUTCF
TREASURER
Sam J. Cunningham, CLU, ChFC, RHU
IMMEDIATE PAST PRESIDENT
Lawrence E. Lounds, CLU, ChFC, LUTCF
DIRECTORS
Christopher K. Schneeman, CLU, LUTCF
Ed Anderson, CLU, LUTCF
back to top
|
