Insight, analysis & opinion from Joe Paduda

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Details matter.

Someone who doesn’t do what you do may think it looks pretty simple.

Carpenters look at a house and see detailed planning, careful material selection, precise measuring, and skilled craftsmanship because they know what it takes to build a strong, sturdy, attractive, functional home. They are experts due to years of experience and hard-earned lessons and mentoring by their elders.

Me? I see walls and a roof. Building looks simple to me; get some lumber, nails, and tools, plus some other building stuff like shingles and wire and concrete, and start slapping stuff together.

Which house would you want to live in?

The same is true for any profession – teaching, medical bill processing, hitting a golf ball…right? Professionals – and we are all professionals in our chosen vocations – understand the complexity in what they do, while outsiders tell us it looks simple to them.

I’m thinking about the Presidential candidates’ positions on health care and health care reform.  Trump wants to “rip out Obamacare root and branch” and replace it with something much “simpler”.

In general, Trump’s calling for:

  • allowing insurers to sell health insurance across state lines
  • repealing the individual mandate
  • requiring insurers to cover anyone regardless of their pre-existing condition.

Sounds great…you don’t have to buy health insurance until you really need it, but the insurance companies still have to sell it to you even if you need a heart transplant or new kidney or are having premature triplets.  (We discussed the across state lines thing here)

Here’s where those “details” matter.

What will insurance companies do if they are required to cover people who don’t need to buy insurance until they get sick?

They have two choices – go bankrupt or stop selling insurance to individual sand families.

What do you think they’ll do?

Of course they will stop selling health insurance to individuals.  When that happens, the Paduda family, and most of the other 11 million folks insured thru the Exchanges will find themselves with no health insurance and no one to buy it from.

Then what?

Here’s the point. We live in an amazingly complex world, one where there are NO simple solutions.   I know, simple solutions are really appealing, but “see the ball, hit the ball” only works until you step up to the plate, when it gets a whole lot more complicated.

If health care reform was easy, it would have been done decades ago. It’s messy, complex, and there are no simple solutions where everyone wins. It requires consideration of the “what then” issues. When you move one lever, it triggers a whole bunch of reactions that, if not anticipated, will create way more chaos.

Yes, the ACA is messy and needs fixing. Yes, we need our politicians to engage, debate, argue, and work it out. What you and I do NOT need is a sound-bite solution that is NO solution at all.

What does this mean for you?

If you think health care is a mess now, can you imagine what it would look like if people could wait to buy insurance till they were sick, and insurers had to either sell it to them or stop selling insurance altogether?

It would look like this


6 thoughts on “Details matter.”

  1. Joe,
    Excellent article. The one thing not discussed is the potential impact of the two proposed mergers of health insurers that could further impact the ACA. Mandates with fewer choices is not solution. In addition, while ACA increased the demand for medical service, there has been no effort that I have heard of to increase the supply of medical services. Perhaps the federal government should subsidize the cost of medical school for qualified candidates to reduce the obstacles to becoming a physician.

    1. Hi Jeffrey
      Thanks for the comment.

      More competition is certainly better; alas last summer’s budget bill essentially killed co-ops, removing what could have been a game changer in many markets. A public option is re-emerging as an alternative and gaining some traction.

      For now it appears that the Ftc is finally taking the market consolidation issue seriously. It appears the pending mergers are going to face a very skeptical review.

      On the provider supply issue, there are many efforts underway to add nurse practitioners and other professionals to the car giver population. However, as about 1/3 of all care is likely unnecessary it is possible we don’t need any more docs.

  2. Agree Joe, we need all the stakeholders to work together. Healthcare, health insurance and the delivery of care are complex, confusing and expensive. As a healthcare professional turned patient I found out just how I important having healthcare insurance is. Last year when I was diagnosed with a brain tumor taught me an important lesson… I would not have wanted to start looking for insurance once diagnosed . What I wanted was to find a good team who could diagnose and treat me. I wa lucky to have a good outcome and the insurance they covered 99% of the cost. Today I am nearing the end of my Cobra coverage and looking for a new policy. This is another experience that is opening my eyes to how complex the process is.

  3. Thanks Joe,

    When I was training decades ago, I never once saw someone denied treatment when they would show up for care at a hospital. To do so would be illegal and we are in a society that takes its responsibility to care seriously. Often these admissions were incredibly costly. When a person in need was uninsured, I assume they got bills later that may have bankrupted them, and in the frequent case of individuals having no assets, the rest of us paid, via excess private premiums and rates, and our taxes.

    I can’t think of any good or service that is provided in our society that is sold with no credit check but credit extended. We can’t walk out of the grocery, car dealer or clothing store with stuff we have not paid for, unless the seller trusts us.

    Bringing us to Trumps plan, which he and his advisors can’t possibly believe would or could be enacted. But in a parallel universe where it was attempted, there is one other component that might make it fly: Allowing hospitals and clinics to turn away anyone without insurance or credible credit, including perhaps a 6 figure deposit for services. Then society would grapple with horrific stories of people dying, untreated accidents, bleeding to death, cancer and the like. I suppose this would be great for

    Few of us would want to live in such a world, including me, but it is a logical outcome and would create incentive for folks to buy coverage.

    On the other hand, another new business opportunity that the plan might promote would be an App for ones smart phone allowing a person or loved on to buy coverage while in the ambulance, lying on the ground injured, or in the waiting room at the cancer center. Maybe Trump would suggest we could similarly buy insurance to cover our homes if we see flames. The thousands of dollars I have wasted on property and life insurance galls me. I’m still alive.

  4. Ask a different professional carpenter to look at a house and he/she will see a different detailed plan with different materials, measuring and craftsmanship needed.

    1. Randal
      Thanks for the comment. the key is any carpenter will have a much better understanding of the building than any non-carpenter.

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates




A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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