The
Other Armstrong With Foot in Mouth Disease—Maybe

By

Leonard
Zwelling

       One of the lead stories today, Monday,
February 10 now that both Beatlemania, gay footballers, and the Super Bowl have
passed to make way in the public’s collective ADHD, is the report of the CEO of
AOL and his retreat from changing the company’s 401(k) plan.

It seems that AOL had announced a change in
its retirement payment to employees from once per pay period to once per year.
This means whatever earnings the money would have made during the year were now
in AOL’s coffers and that anyone who left the company before December 31 was
out of luck with regard to retirement contributions for the preceding year.

What was really grating to some is the
explanation given by AOL CEO Tim Armstrong. He attributed his cost saving
decision to two “distressed babies” born to couples covered by AOL’s insurance.
Each accounted for about a million dollars in payouts and that was more than
the CEO was willing to pay without having a means to make it up. (It is
presumed that AOL’s reinsurance acted as a stop-loss beyond the million dollars
each child probably accrued in hospital costs). Thus, AOL proposed to hold back
the 401(k) payments until year’s end.

The howls were heard far and wide and the
CEO retreated reinstating the previous 401(k) plan, but this is a teachable
(and perhaps learnable) moment for the American people. Essentially, if we
really want to decrease the costs of health care we are going to have to learn
a new word. That word is NO.

I am not suggesting that Mr. Armstrong was
very adept at communicating or ethically on firm ground when he said what he
did, but he is right about one thing. Health insurance is expensive BECAUSE we
want to cover everyone for everything and we all feel we have it coming to us.
The benefit has become an entitlement. One need look no further than those
wanting to keep the “government out of their Medicare” to see evidence that the
public has no idea who is paying for whatever care they receive. Most know it
is not they picking up the full bill. But in fact, it is. Not only are they
paying for their own bills but also for the bills of the uninsured receiving
emergency care throughout the country at medical facilities that will never see
a dime for the care. Thus, the facilities make it up with higher prices for
those with insurance and the result is higher premiums for everyone.

Again, I am not saying any of this is evil.
All I would like is that we consciously approach the question of health care
costs and determine what is worth doing and what, unfortunately, is beyond the
scope of others to pay for. High cost cellular transplantation for cancer in
the clinical situation that requires such desperate measures to save a life are
reasonable, especially when that costly therapy is applied with curative intent.
Three MRIs in the same week for an 89 year old grandmother on a ventilator in
an ICU is not reasonable, even if grandama is paying the full freight in cash.
There is an opportunity cost of her getting those MRIs. It is the MRIs that
aren’t getting done but need to.

Care in most westernized countries is not
governed by the law of bottomless pits as it is in the United States. As long
as there is money in the kitty, some provider or biller will squeeze until the
cat howls in America. We need to engage in a rational discussion about what is
worth doing and what is not. That includes proton therapy for primary prostate
cancer, massively invasive intensive care for the very elderly and yes, the
cost of distressed babies born only 5 months after conception.

I don’t have the answer. I just have the
question. When are we going to get the courage to ask it?

Was Sarah Palin right all along? Do we need
death panels? Or, do we already have them based on insurance status and cash on
hand?

Leonard Zwelling