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As a business owner, you know what it’s like to lie awake at 2 a.m. Maybe it has happened when you are excited and full of new ideas for your business. More often, it’s because you are worried about issues you will face the next day. Sometimes, it’s because you just woke up with the solution to a problem. I’ve experienced all those emotions about my businesses over the years. Awake at 2 o’clock? is where I share them with you, and hopefully help with answers that will let you sleep.
John F. Dini, CExP, CEPA
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Small business owners are the Hunters of the 21st century. We are 3% of the US population, and yet we create over half of all American jobs. As Hunters, we may not be inclined to manage by the numbers or stick to systems. Are you a Hunter or a Farmer?
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How prepared are you to exit your company?
The Assessment breaks down the four major categories of exit readiness; Finance, Planning, Operations and Revenue/Profit.
Tag Archives: medicare
2 Responses to Why GenXers Won’t Buy Your Business
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Generational Differences and Identity Politics
Generational differences are a hot topic for organizational behaviorists. Is this a real issue, or is it just the current management fad? “Never in history have we seen four generations together in the workplace.” That line starts thousands of articles … Continue reading
3 Responses to Generational Differences and Identity Politics
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The boomers and the millennials should appreciate the strength, knowledge and understanding of each generation, by so doing an effective structure can emerge which could yield high valuable growth and benefits for both generation.
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I believe it all comes down to empathetic listening on each generational level. This takes active listening to another level where you connect with another’s core emotional being, in addition to understanding the message. Seek first to understand and apply the platinum rule (treat others the way they want to be treated). Working with multiple generations also requires informed leadership styles: not the leadership based on the “seat of your pants”, but leadership that is adapted based on the study and application of leadership principles. Yes, different generations are products of their political, economic, and cultural environments; but this isn’t a bad thing. It has been established through many studies that the more diverse a team is, the stronger it is!
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I’m adding my two cents to elaborate on this in your article: “The “Generational Differences” seminars that business owners need aren’t just about how to deal with employees who think differently and hold different values. We need some idea of how to deal with workers who . . . are being told that the blame rests squarely on the boss.”
Okay, first a warning: Millennials probably should not read my comment or listen to my podcast: Some millennials are among the kinds of employees increasingly destroying small businesses. (And undermining larger employers.) Not all of them, but a certain kind. At the risk of offending some people, but with the intent of helping employers, my brief podcast may be enlightening (it’s on my website): http://partneroncall.com/kinds-of-employees-increasingly-destroying-small-businesses/
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Why Health Insurance Isn’t
Last week I wrote about the success of Obamacare in driving people from the private insurance market towards a national healthcare system. Clearly, I touched a nerve when I look at the tone of the responses received. Although I don’t … Continue reading
8 Responses to Why Health Insurance Isn’t
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I had a great uncle who practiced medicine from the turn of the century until the mid 20th century. In the last chapter of his book “Doctor Do Tell” dealing mostly with his experience delivering medical care to the people of rural Wisconsin……he warned of the evils of “socialized medicine”. Much has changed since the time he practiced….including the willingness of health care providers to be “paid in pickles”. The evils of non “socialized medicine” have become crystal and painfully clear.
The present health care system based on the idea that competition brings about the best result is a failure if for no other reason that there is and will not be true competition. Nationalized health care can minimize system costs….if design and operation remained focused on the goal of efficient, results oriented care measured by and paying for results. A single payer system that assures and pays for results oriented care (as opposed to pay per procedure) is probably the only way that a nation can bring about maximum care per dollar expended. The only logical single payer is government. If a clear goal (as mentioned above) was the standard to which any plan was held….much better product (our health care) could be brought about for all. -
I neglected to mention his book was written in 1945.
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Except that not everyone is going to use all they did (or should have) put in. My mother will turn 99 early next year. She is in an assisted living center that costs thousands monthly, but uses just a small fraction of the services the price is meant to cover. This is good thing. Others use much, much more than they ever did (or could have) put in.
The only solution is something based on the underlying concept of insurance. Many put in
X and a fewer number take out Y. Even in countries where there is universal government provided healthcare, the concept is the same with taxes substituted for the bulk of premiums.The problem in the US is that the insurance paradigm is private and discretionary. Not everyone has to pay in, so healthier lower cost people opt out at a disproportionately high rate. The insurance companies are profit driven, so left to their own they simply do not want to cover those who represent a higher risk.
Average life span in the US is into the 70s. That means both individuals and companies have to think very long term to justify the equation. In a system where participation is discretionary, and the actuarial pool is private and focused on making shareholders and executives happy the following quarter, the actuarial numbers will not to add up.
Human nature simply does not work well in multi-decade time frames. Only an external entity can make the health care actuarial equation work. The ACA is bending the curve, but it is a poor mishmash trying to influence an inherently unworkable model based on private insurance and discretionary participation.
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I have always thought it strange that people expect routine doctor visits and long term prescription medications to be covered under a health insurance plan. When you buy car insurance your tires and oil changes are not covered are they?
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It is only strange if you try to equate health care with consumer goods. Same basic problem as trying to force market principles to “control” health care costs. It is not a market or a consumer good, and should not be.
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If the legislature is required to live under the same laws, regulations, and healthcare systems that their constituents live under and lifetime healthcare benefits are eliminated for them, things will change. This will never happen as the fox rules the hen house. Corruption in government has become epidemic and it comes in too many forms and sizes.
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Most members of Congress may not like it, but could easily afford, good private health insurance. To really understand they should be forced to live six months or a year in the shoes of someone who either cannot afford the insurance, or can buy insurance but not possibly handle a $5000 deductible.
The sad irony is that far more than enough money is actually being spent on health care in the U.S by citizens, employers and the government to provide excellent health care for everyone. It is the ridiculous wasteful way that we collect, allocate, bill and distribute the pool of money that is the problem.
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Obamacare is Working, or it Isn’t
A few weeks ago I received notice of our annual health insurance increase. This year it was 38% more to keep the same coverage. Last year the proposed increase was 22%. The year before 12%. The year before that, 18%. The next … Continue reading
11 Responses to Obamacare is Working, or it Isn’t
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John, I can’t find fault with any of your logic. I can only speak to my circumstances. Over the past year, my rates have decreased by nearly 7% compared to 2014, but I had to move to a new carrier to get them. If I stayed with the old carrier, I was facing an 18% increase for a silver-level HMO-style plan based on wellness/.prevention. I can’t say that the ACA had any impact on moving to a gold-style PPO plan with a top flight carrier here in New England, but my $500/$1000 deductibles are down from last year’s $2,000/$4,000. We’re clearly paying significantly less than 2014. Maybe it’s New England, but competition appears to be a factor. Only 2016 will tell whether our new carrier will emulate the old carrier for exorbitant price increases.
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I agree with you 100% – about the actual intent of the bill, about the way it was put into being, about the sneaky “boil the frog” aspect to make people who don’t think very deeply stay clueless, and about the ultimate consequences.
I was always very proud of our company paying for all of the employee coverage and most of the family coverage for health care – something that has shifted dramatically over the last couple of years. I have my own employees going out and shopping for better deals because it’s so expensive to have the company plan now. And, we are aggressively looking for the best possible pricing/benefits.
It’s become a lose-lose for everyone – except those in governmment who want more control over all of us.
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Our small business experienced outrageous increases to our small group plans year-after-year in pre-ACA times. Finally we gave up and just had ourselves and our employees purchase individual plans for about 60% less than the group plans. After getting to keep the grandfathered individual HD plan for the extra year, we are going to see a huge bump in premiums this year.Basically, all the plans are headed to where small group plans used to be for all the reasons listed by John.
The pre-ACA environment was completely unsustainable. The ACA itself is a poor compromise instead of a rational plan, but it was all that could be done in this fractured political era.
There is more than enough money being spent on health care in the US every year to give everyone good care. The problem is that we have the least financially efficient system anywhere in the developed world, by a wide margin. Trying to force market principles on something that is not, and frankly should not be, a market does not work very well.
The current system is based on the the market-oriented question of whether, when, to whom and how much you would like to PAY for your health care. Under that, however, is the real question: “Would you like your health?” That is a distinctly NOT market-oriented question that people always answer “yes” to given any choice at all.
The ACA is poorly constructed and is pushing a muddled and convoluted path towards some kind of not well planned change.If it eventually leads in 10 years to the only rational choice of a single payer system, the messy transition will have been worth it. There is not enough political or cultural will in the US to do the rational thing deliberately.
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The software industry has benefited by shifting from a transactional model to a subscription model. Now you pay a monthly fee to access the application(s) and get updates to the software automatically, as they become available. The company increases revenue because, in reality, no one always pays to upgrade to the latest and greatest version of the app
So when will we see this approach applied to wellness? I’d prefer to pay my primary care provider a fee for wellness and care visits, tests and consultations. They’d see improved cash flow, reduce office administration costs, far less paperwork and accounting (sorry, John).
It’s simple, easier to orchestrate, and could still be subsidized by the Federal Government for people who qualify based on financial need.
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Several large providers (Mayo Clinic, Kaiser) are starting to follow a subscription model aimed at wellness, as opposed to services, as John Hyman suggests. That helps, but still does not address the monumental waste baked into a system where the entire payment side consists of competing, for-profit insurance companies.
At the primary care practice we use, 10% of the employees are devoted to nothing but dealing with insurance. Insane and replicated throughout the provider side of health care. That does not count the billions in advertising, overhead, executive pay and profit that is being sucked out of the system with zero benefit to health outcomes.
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ACA created the worst insurance plan coverage in 2015 we’ve ever had in our entire lives. We basically paid for a family of four all year and never used it due to the high deductibles PER PERSON. It only drives healthcare into the “delay”, “don’t address”, “self-insure”, or “self-treat” categories. Good thing we know doctors personally!
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Hello John,
Perhaps a view from outside of the US, up here in “semi-socialist” Canada. This is also likely more of a big picture comment on national governance than anything.
I of course cannot comment specifically on rates for medical insurance in the US, but I do think it is a fact that the US is the only really industrialized country that doesn’t have true universal health care. Now, I am by no means holding up our system as the model – after all we were ranked 30th by the WHO and the US, 37th, so clearly we both have a great deal to do in this 21st century world in this regard. (I realize these rankings a re a bit old and do have their flaws).What I will say though is that there is plenty of evidence to show that as a country’s healthcare and education systems go, so goes the overall success of the country in the long term. Its a bit like you are only as strong as your weakest link. If you do not provide general access to healthcare and education for all citizens, it is only a matter of time before the social fabric begins to erode – the cost of which is far, far greater than the specific costs of delivering those programs. My observation is that you are seeing some of this in the US – it is likely a key factor that is causing such massive division and polarization in the country politically.
I personally don’t agree with fully private health-care. I have many friends in many countries in the medical system, and none of them agree with “medicine for profit”. I think the best models are private delivery within a publically managed system that provides equal access. I know many people in the US when they hear this rush to the – “well you have long wait lists in Canada – we don’t”. That really is not a complete picture. If you need treatment, you get it. But if its not required and/or elective, yes you will go on a wait list. Most Canadians (and Europeans) are fine with that. I have a friend who got sent for an angiogram, which found 4 major blockages in his heart. He had quadruple by-pass surgery the next morning – by a team rated as one of the best in North America. This would all be covered by Health Canada and paid in his taxes – no co-pay, no deductibles, no having to take a 2nd mortgage to pay his medical costs.At the end of the day, its how you view things – you have lower tax rates than we do, but we pay for our health care in our taxes. Lastly, I think this is a tough transition for the US – it is not going to be easy. You are likely where the National Health or Canada Health or Germany were 30 years ago. But what I think you cant afford to do is leave this to politicians to use as an election football (There is a difference between “politicians” and “public health care” – the former change frequently – the later should be enshrined in law).
This is not meant to be criticism – like I say – we have much to work on too – but I think objective debate that takes this vital topic out of being called OBAMAcare is needed for long term success.
Malcolm
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Iron Rice Bowls and the Impact of Government Funding
There was an interesting editorial item in The Economist that unintentionally says a lot about the impact of government intervention on industry. In the last generation, the average number of working hours needed to purchase an automobile, clothing or other … Continue reading
11 Responses to Iron Rice Bowls and the Impact of Government Funding
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We must never let our guard down.
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While I completely concur with the article with respect to education and housing, healthcare is a different beast entirely. The United States has by far the least efficient healthcare system of any developed country because of a deficiency of government involvement, not an over-abundance of it.
By depending on a vastly greater level of market-based forces, instead of control, the U.S. has created a monster. This is because healthcare by definition does not work on market principles. When any individual’s health is at stake they do not care what it costs, they just want to be treated. That means the suppliers have total coercive control over the “market”.
Can anything realistically be called a market when it a) is difficult or impossible to even determine what a product costs before it is purchased; and b) there is not really choice about whether it should be purchased? Do you operate that way in any other aspect of your life?
U.S. healthcare has evolved to a level of insanity beyond what even a pure market system might produce. The stakeholders: people, providers, insurers, employers, state government and the federal government all have competing interests. The result is that if you are lucky in terms of employment, insurance, income and location, you might get absolutely world class healthcare. If not, you might get none at all. Meanwhile the entire system thrashes against itself creating unbelievable inefficiency and overhead, resulting in costs 3 to 4 times higher than necessary. Small example: our local hospital system has 12 executives making over a million a year.
ANY other business operating this way would have been bankrupt a very long time ago. Some things should not be market driven. I submit access to roads, clean water and healthcare for starters.
I would say, “Don’t get me started. . . .” but too late for that.
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To take the average working hours concept a step further: (1) the average working hours to purchase an automobile has decreased, yet vehicles haven’t remained static — they’re loaded with many more safety, comfort, and entertainment features today than ever before; (2) a student leaves school with about the same amount of basic knowledge today compared to say the ’70s or ’80s and pays considerably more.
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Don’t forget (3) healthcare: The amount we SPEND on healthcare is up considerably, but the value we receive is up considerably too. I agree healthcare isn’t a normal marketplace, but 40 years ago we did not have the choice to have life saving and life improving MRIs, Cat scans, organ transplants and many prescription drugs. All of those innovations come with a cost.
As the slice of our income pie needed for basic needs shrinks, the rest of the pie necessarily grows. If not to healthcare, housing and education, then to where? Smaller homes with larger flat screen TV’s?
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My issue is not with MRIs, medical technology, research or even prescription drugs (though that is also an outrageous “market”), or anything else that directly relates to delivering healthcare. I get riled up over the incredibly high overhead, inefficiency and waste. These are the direct result of competing interests and multiple layers of profit motivated entities exploiting a distorted system.
For example, billions of dollars are spent annually on prescription drug advertising. That is entirely a function of profit motive, not any objective to improve health. If everyone had access to preventive care on a regular basis, decisions about prescription drugs would be made by doctors and patients discussing someone’s health, not a TV or magazine ad.
Add to that the fact that a significant portion of the population has limited or no access to healthcare, and the overall situation is just plain dumb.
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Sadly, your response is entirely correct.
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Thanks for introducing me to the Iron Rice Bowl concept. You guys in the beltway and Washington DC area, it is time to listen up!
When will we bring back an objective money standard, i.e., gold or silver?
John, the video is a compelling review of the events that have created our exit dilemma. I would add the impact that automation will have on our consumer driven economy, when workers are displaced and the population can no longer buy what the robots build. A more immediate challenge is that companies like Amazon and Uber have used high risk investment dollars to provide superior service at lower cost without a current imperative to make a profit. The end result will be those companies becoming monopolies, eliminating SMBs. Millenials can see the writing on this wall.
Good points, David. Both job displacement and the Internet come under the general heading of Disintermediation (the elimination of the person in the middle) and none of us can stand up to the Internet.