Health Insurance Reform

April 13, 2011

Each year in the fall, employees in my firm receive several communications relating to our “Open enrollment period” which is when we can pause and review our selection of benefits, and adjust them based on our own personal current situation.

The paucity of group health insurance options available to me which meet my needs led me again to select UnitedHealth, and they do provide a good array of benefits.

UnitedHealth is a big company. They insure about 33 Million people, and they are the largest health insurer based on revenue, which hit $94.16 Billion in 2010, with reported earnings of $4.63 Billion.

Rising costs (perhaps combined with careful attention to detail and some ‘enhanced cost-sharing’) caused my personal contribution to medical insurance coverage (for my wife and me) to increase by 24% from 2010 to 2011 – from $275 per month, to $341 per month.

Now, don’t misunderstand my position.

I’m glad to be working for a great company which not only pays me to do something I enjoy, but also offers a company-subsidized health insurance plan.

It is my understanding that my contribution is about one-third of the retail rate for this insurance, i.e. if I were retired and continued coverage under the plan, I would be paying about $1,023 per month, or just over $12,000 annually.

That’s a lot of money!

I just read that UnitedHealth Group Inc.’s CEO — Stephen J. Hemsley — received compensation totaling $10.8 Million in 2010, up from $8.9 Million in 2009.

About $1.3 Million of his compensation was salary, which remained unchanged for the fourth straight year. But his performance-related bonus jumped by 74 percent to $3.4 Million in 2010. The value of his stock and options also rose.

He is probably worth every penny of that to the shareholders of UnitedHealth, but not to me.

I would like the option to select from at least one, not-for-profit, public benefit corporation to provide for my health insurance needs. No dividends to pay out to shareholders. No big bonus to the executive team. No stock options to key employees.

When I was younger, we had Blue Cross and Blue Shield. These entities were organized as tax-exempt (not-for-profit) health insurance providers, and I recall being generally pleased with both the cost and the coverage provided.

When President Ronald Reagan signed the Tax Reform Act of 1986 into law, the federal tax exemption for these organizations was eliminated, helping to pave the way to where we are today.

Presently, we are hearing sound bites from Rep. Paul Ryan of Wisconsin and others telling us that they have solutions.

>>> Repeal the “Obama Care” legislation & make significant changes to both Medicare and Medicaid.

Great ideas, but before we repeat the apparent mistakes baked into the Tax Reform Act of 1986 — and possibly other examples since — let’s stop to take a look at what other options might be available to address two important outcomes: (1) reducing costs; and (2) improving outcomes.

I know of two really great things that happened in 1918.

The best was that my Mother was born on November 28. She lived to be 92, sadly leaving us on February 26, 2011.

The second best contribution from 1918 was the creation by Anna M. Harkness — a pioneer female philanthropist — of The Commonwealth Fund, “to enhance the common good”.

The current mission of The Commonwealth Fund is “to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults”.

The Commonwealth Fund has commissioned plenty of research on health care and health insurance. As a not-for-profit, public benefit entity, we expect this research is factual and unbiased, and completely outside the political process.

In one recent report, they tell us, “To achieve a high performance health system, health reform must go beyond ensuring affordable coverage to addressing health system changes that will improve outcomes and the quality of care, increase efficiency, and slow the growth in total health system costs.”
http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2010/Sep/Analysis-of-the-Payment-and-System-Reform-Provisions.aspx

We can’t deny that Rep. Paul Ryan is a brilliant guy. Yet, I’m puzzled by his contention that his budget proposal fulfills a moral imperative “to lower Medicare-related costs”.

As he has structured it, overall health expenses would actually increase because people would be required to get care through private plans, which have been proven over and over to cost more than the current system. Seniors and others on fixed or limited incomes would be left to pick up the extra costs.

Ryan’s proposal apparently would convert our current fee-for-service system—in which patients go to any doctor that takes Medicare—to one in which beneficiaries would get a capped annual subsidy to help them purchase private insurance.

Critics of Ryan’s proposed system – some call it a “premium support” model — say it is really just a voucher system where elderly, disabled and otherwise disadvantaged people would appeal to private plans for services.

A great deal of truly objective and non-partisan analysis is needed here before we get into an even more emotional and politically charged debate.

The real question is: Do we possess the decorum, civility and intellectual curiousity to allow for an impartial analysis? Or have we crossed over into the War of the Roses, where no one really knows why we are fighting, but we know which side we are on, and we need to win!

I keep trying to figure out why we are paying so much in local property taxes to support K-12 public education across New York State while our results are mediocre, at best.

I’ve spent countless hours combing through data from the NYS Department of Education (http://www.p12.nysed.gov/irs/) looking for some sort of closure.

Lots of data, not easy to interpret or digest.

What I have learned is that our eventual outcomes (HS graduation rates) across NYS are pretty awful. 

Back when the Walrus was a pup, they used to tell us how fortunate we were to be growing up in New York, where we had real quality public education.  They would tell us that children growing up in the South were at a real disadvantage.

Apparently, that is no longer true.  Recent data from the National Center for Educational Statistics show that less than 70% of New York State high school students actually graduate.

We are doing better than South Carolina, and we are in a dead heat with Florida, Georgia, North Carolina and Alabama.  Meanwhile, Arkansas and Virginia are kicking our butts.

Why should we care?  On average, we are spending close to $20,000 per pupil for each of the 3 Million students in New York.

State Grad Rate Per Pupil Spending
Vermont 88.6% $14,300
New Jersey 84.4% $16,491
Connecticut 81.8% $13,848
Virginia 75.5% $10,659
Arkansas 74.4% $8,541
New York 68.8% $17,173
North Carolina 68.6% $7,996
Alabama 67.1% $9,103
Florida 65.0% $9,035
Georgia 64.1% $9,788
South Carolina 58.9% $9,170

Why are we in such dire straits?  Is it teacher salaries?  Probably not.

There are 2 very clear issues that have driven our K-12 public education spending way over the top.

First is the cost of Special Education.  Urban districts in NYS typically have 15% of their students in an “Individual Education Plan” – IEP– , and they are paying about three times as much to educate IEP students as they pay for general education students.

Second is the sheer number of school districts in NYS.  The majority of efficient states have large, regional school districts where they are able to take advantage of ‘economies of scale’ – spreading the cost of administration over a very broad base. 

We have over 700 school districts in New York, each with its own administration building, Superintendent, various Deputy Superintendents, and all of the infrastructure needed to run an independent business. 

The structure of public education in NYS no doubt made sense in 1904 when it was last defined. 

Isn’t it time for an independent commission to review how we manage K-12 public education and to make some recommendations in the area of efficiency?

Tax Reform in New York?

March 24, 2011

Henry David Thoreau said, “There are a thousand hacking at the branches to one who is striking at the root.”  He was talking about evil, but the same concept seems to apply to almost every problem.

If you want to fix something that is broken, first you need to determine, “what is the root cause of this problem?” 

I think no one could successfully argue that the cost of public services in New York State has spiraled out of control. 

School districts face huge deficits.  The same is true at the village, town, city and county level.  And New York State itself is grappling with a $10 Billion budget deficit. 

In the private sector, such a situation would be met with rapid re-engineering.  Analyze the revenue streams, match them against the expense base, and move quickly to optimize and/or balance the revenues against expenses. 

Throw in the vested interests of Elected Officials, and the private sector model does not seem to easily apply to the public sector.

Our public sector in New York State has not been re-engineered since the beginning of time.

Look at our system of counties: there are 62 counties in New York State. This hasn’t changed since 1914, when Bronx County was created from the portions of New York City that had been annexed from Westchester County in the late 19th century.

The five counties which make up the City of New York do not have functioning county governments, thus the regional government of New York City seems to create a much greater efficiency than might otherwise exist.

Immediately to the east of New York City lies Nassau County, ostensibly one of the wealthiest counties in the U.S.  Census data tells us that Nassau has the highest median household income of any county in the state at $92,221.  Currently struggling to close a $176 million budget gap, Nassau officials face either a 21.5 percent property tax increase, or a workforce reduction of 513, of which 213 will involve involuntary terminations.

Within the 287 square miles of land in Nassau County, we find 2 cities, 3 towns and 64 incorporated villages. Nassau County presently has a total population of about 1.4 Million, and the County employs about 9,000 workers, operating on a budget of about $3.23 Billion.

Compare Nassau to Maricopa County, Arizona with a land area of 9,203 square miles, 32 times greater.  Population:  more than 4 Million.  Phoenix is the largest city in Maricopa County, and there are 13 other cities there, plus 12 towns, and no villages.  Proposed Maricopa County budget for FY 2012 is $2.2 Billion, with 13,000 employees.

How is it that cities and counties in other places — even other states in the U.S. —- are able to operate so much more efficiently than we can in New York State? 

Isn’t it time for independent review and re-engineering?

Close Indian Point?

March 23, 2011

 

Well, they are back at it again.

Eliot Engel is my Congressman, and he mostly does a good job.  He wrote an op-ed piece which was published March 23 in the Journal News which draws on almost all of the emotional arguments that exist to implore the NRC to close down Indian Point.

I have said before, “I don’t like Indian Point.”  If it were being proposed today, I would be working full time to oppose it.

That said, what Rep. Engel fails to disclose is that operating or shuttered, the site contains a huge amount of “spent nuclear fuel rods” and whether the reactors are operating or shut down, that nuclear waste will stay on site. 

He also fails to tell us that the facility contains 3 reactors, and that Indian Point 1, which began operations in 1962 and was closed down in 1974, has never been fully decommissioned.

In fact, according to the NRC, “IP-1 operated commercially from August 1962 until October 31, 1974. The plant was shutdown because the emergency core cooling system did not meet regulatory requirements. By January 1976, all spent fuel was removed from the reactor vessel, and is in dry storage at the Indian Point Energy Center ISFSI in 5 casks.”

The NRC offers 3 options when a reactor is to be permanently shut down.  IP-1 is currently in “SAFSTOR” mode, and is not scheduled to be fully decommissioned until 2026.

In short, before we ask Entergy to leave New York State, we ought to be asking, “How can we ensure that when the IP-2 and IP-3 reactors are closed down, the company follows the NRC protocol for “DECON” (for both of these and for IP-1), so that the site is made “more safe”? 

We need a great deal more information, Rep. Engel. 

I hope you will do more research, get us all the facts, and not let us down.

Every time something happens in another place that involves nuclear energy, we find advocates and politicians waving their flags:  Let’s close Indian Point!  It’s dangerous!  It’s a security risk!

Let me be clear: I’m not a fan of nuclear electric generation.  If there were no Indian Point facility today, and a proposal was on the table to create a nuclear power generation facility along the Hudson, I would be 100% opposed.

However, the Indian Point facility is real, it is part of our landscape, and we need to find rational ways to deal with it.

Indian Point houses 3 nuclear reactors:  Indian Point 1, Indian Point 2, and Indian Point 3.

Indian Point One (officially known as ‘Indian Point Unit 1’) operated from 1962 to 1974.  The plant was shut down because the emergency core cooling system did not meet regulatory requirements.  That plant has been partially “decommissioned.”

The current operating license for Indian Point 2 expires in 2013; the IP 3 license expires in 2015.  Applications for 20-year renewal of both were submitted in 2007, and are winding their way through the NRC process.  Meanwhile, the two reactors currently provide about 2,100 MW of electricity to the New York metro region

What does this imply?

On a typical day, the combined output of the 2 operating IP reactors supplies about 30 percent of the electric demand in New York City and the surrounding region. With no identified alternatives to replace this power, closure of these reactors would result in an economic catastrophe for our region.

While closing the reactors is a great “sound bite” (and apparently has helped some politicians raise huge sums from some contributors), it seems that many experts fear the on-site stored spent fuel rods more than the reactor itself.

Apparently, the process used in a nuclear reactor to heat water to generate steam which then generates electricity is not very efficient.  By some accounts, only about 10 percent of the rods’ fuel is used up during the process, leaving potential energy (and nuclear waste) sitting on-site in storage canisters for eternity.

After Indian Point One was shut down in 1974, it was slowly but only partially “decommissioned.” The Nuclear Regulatory Commission has said in prior reports that Indian Point One has had a long history of leakage, and has the dubious distinction as the only nuclear site in the country that had leaked Strontium-90, a highly radioactive isotope.

Fact is, operating or not, nuclear waste will remain onsite at Indian Point until the federal government builds the Yucca Mountain’s repository in Nevada or comes up with some sort of an alternative. 

In France and other countries, nuclear waste is being recycled in reprocessing facilities, not without some controversy.  According to the NRC, “There is no commercial reprocessing of nuclear power fuel in the United States at present; almost all existing commercial high-level waste is in the form of unreprocessed spent fuel.”

As stated earlier, I’m not a fan of nuclear reactors to generate electricity, but until we come up with a better solution, I’d like to see all of our attention focused on remediating the on-site storage issue.

A nuclear waste reprocessing demonstration project in West Valley, NY which operated between 1966-72 is commonly recognized as a disaster. 

That doesn’t mean we couldn’t do a better job today.  Before we talk about closure, let’s find a viable way to move the waste, reprocess it, and find permanent storage for the residue.

School Taxes Bronxville

March 10, 2011

An investment banker who lives in Bronxville is upset his taxes are way too high (http://www.nytimes.com/2011/03/09/business/09bronxville.html?ref=nyregion) Seems that Mr. Pulkkinen and his wife, Sarah, bought their 5 bedroom house on The High Road in late 2004 for $1.5 Million. Now, Bronxville is a place people move to because they have children and they want their children to attend the very best public schools in America. Great public schools need great teachers, and the teachers in Bronxville are both highly regarded and highly compensated. Yet, Mr. Pulkkinen believes the way to control ever rising property taxes which go to pay for the best schools in America is to reduce teacher compensation!

You would think a competent and (hopefully) well-informed investment banker would be able to figure out that teacher salaries are variable costs, and that the way to control overall expenses (whether in a school district or a private company) is to control fixed costs and to spread those fixed costs over as large an operation as possible.

Fact is, Bronxville is a very small village in the Town of Eastchester. The other village in Eastchester is Tuckahoe which was profiled in the Real Estate section of The Times on March 6, 2011.

The Town of Eastchester is just 5 square miles, with a total population of 32,000 people. Yet, the Town contains 3 independent K-12 public school districts, each with its own superintendent, school board, district headquarters, etc.

Where Mr. Pulkkinen seems to be focused on reducing teacher quality by reducing compensation, I would argue that the road to success is more likely to be in consolidation and sharing of services between the districts.