Cone Of Silence

Those of us over the age of 60 are used to receiving an incredible amount of junk mail.  I am, of course, referring to the unrequested, unwanted, and unneeded solicitations from Medicare insurers, call centers, and marketing associations.  Many of these mailings are designed to look like official communications.  We also get unwanted solicitations on our home phones and cells.  And don’t forget the misleading television and radio commercials from the washed up athletes and C List celebrities.  It is hardly surprising that the Centers for Medicare and Medicaid (CMS) receives tens of thousands of complaints each year.  What is surprising are the steps CMS is taking to solve the problems.

Step One:  As per CMS: Agents must provide the following disclosure

  • Verbally conveyed within the first minute of a sales call
  • Electronically conveyed when communicating with a beneficiary through email, online chat, or other electronic means of communication (regardless of content)
  • Prominently displayed on Third Party Marketing Organization websites (regardless of content)
  • Included in any marketing materials, including print materials and television advertisements, developed, used or distributed by the Third Party Marketing Organization

Step Two: Recording Telephone Conversations

“Beginning October 1, 2022, for all 2023 activities, all TPMOs, including all third-party marketing/lead generation vendors, agencies, 1099 agents and brokers (captive, independent street brokers, TeleDigital agents, etc.), will be required to record all beneficiary calls (sales, enrollment, administrative, etc.) – inbound and outbound – in their entirety, with no exception. Other important requirements:

  • Applies to all telephonic activities, even if it does not result in an enrollment.
  • Requirement applies to all beneficiaries and members. There is no distinction made between new and existing clients.
  • Consent to record must be obtained for all calls.
  • Recordings are not required for in-person activities.
  • Medicare requires all records be maintained for 10 years”

In English, we are now required to record ALL telephone conversations that have anything to do with Medicare.  There are no exceptions.  For example, if you live in Billings, Montana and call your local agent on October 2nd to confirm your October 17th appointment, the conversation will sound like this:

Bob Smith, Insurance Agent – Thanks for calling Smith Insurance.

Larry Jones, longtime client – Hi Bob.  It’s Larry Jones.  I’m just calling to confirm our appointment for Monday, October 17th at 11 AM.

Bob Smith – Hi Larry.  Before I can go any further, the government requires me to read the following disclosure to you: “We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact or 1-800-MEDICARE to get information on all of your options.”

Larry Jones – What the Hell does that mean?

Bob Smith – Wait, there’s more.  I need to ask your permission to record this call.

Larry Jones – Why?

Bob Smith – Every Medicare related phone call has to be recorded and kept for ten years.

Larry Jones – You’re kidding!

Bob Smith – I’ve been your agent for over 10 years.  I wish this was a joke. May I have your permission to record this call?

Larry Jones – Fine.  Just do it.

This is going to work as well as the Cone of Silence.

Your local agent is working through this process.  We are researching different recording systems all the while hoping that this rule will be put on hold for a year or two or hopefully twenty. Smart agents already retain copies of all emails and take copious notes during in-person meetings.  Recording phone conversations will complicate our lives and undoubtedly feel like one more intrusion into our client’s privacy, but we will all survive.

As per the disclaimer, HELL YES, WE DON”T REPRESENT JUST ANYONE.  Your local agent is solicited daily by the insurers and marketing organizations.  We each choose which companies we want to represent based on our experience with their service, networks, and product design.  I refuse to represent certain well-known carriers because of issues I’ve had with their service.  Not offering every plan available in the area is not a negative.  Your local agent is proud to represent only the companies he/she selected.

#          #         #          #          #

The doctor is a social acquaintance.  He is not really a friend.  He is not a client.  Doc wanted me to know that we are “just breaking the surface” on COVID.  He used the phrase several times to emphasize how much more there was to know and how little those of us in the general public knew.  As a doctor he was privy to so much more, none of which he planned to share with me, a mere insurance agent.  I’ve known him for a number of years.  This wasn’t the first time I had encountered his demi-god shtick.  Still, I would have been happy to learn any useful information he might have been willing to share.

But I have information, too.  I have a couple of years’ worth of conversations about COVID with my clients.  I know that some of my clients have spent time in the hospital and that, sadly, some have died.  We’ve discussed the lingering effects of long COVID and the question of when/if the individuals will ever fully recover.  And some of my clients have had other non-COVID illnesses that seem to last for months and months.

My clients share their health concerns with me.  We discuss their fears about tests and procedures, the potential costs of hospital stays and the newest drugs.  Another big topic are the doctors who don’t listen to my clients’ concerns and only ask the questions from the pre-printed checklist.  Some of those conversations are with people under age 65 and some are with Medicare beneficiaries.  Most Medicare beneficiaries will refrain from deep, personal conversations once their calls are recorded.  That’s a shame.  Our in-person meetings will just have to be a little longer.


Picture – Would You Believe A Shoe Phone? – David L Cunix

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When The Goal Is FAILURE

The answer was, “NO”.  I hate to say, “No”, and I hate to disappoint a perspective client.  And yes, I hate to fail.  Joseph (name changed) has had a lot of disappointing news lately.  Joe has worked for the same employer for over ten years.  He and his family are covered by the employer’s group health insurance policy.  The employer has always paid a portion of both Joe’s (employee) premium and also part of the family’s (dependent coverage) cost.  Now, as of June 1st, the employer will only pay part of the employee premium.  Joe is left to pay all of his wife and son’s premium.  The cost is prohibitive.  Here are options we could pursue:

  • Were it not for the Family Glitch, discussed in my last post, we might be able to get a tax credit subsidy to help him pay for his spouse and son’s coverage through
  • If Joseph’s spouse and child didn’t have any preexisting conditions, we could move them to short term major medical coverage. Short term policies are less expensive because they are not guaranteed issue.  The application is underwritten.  You can be declined.  Preexisting conditions are NOT covered.  This is not a good option for them.

Joseph and his family can not be without insurance coverage.  He does not want to look for a new job.  They will be forced to cut back and find the money for the premiums for the rest of 2022.  We can only hope that the Biden administration’s plan to fix the Family Glitch will be in place by this year’s Open Enrollment Period that begins November 1st.  My goal is to view this  as a set-back, not a failure.

But what if the goal is failure?  What if you have spent the last ten years or so working every day to make it harder, not easier, for Americans to access and pay for health care?  And that brings us to Senator Pat Toomey (R-PA).  You probably don’t think about Senator Toomey when you are thinking about health care legislation.  He has spent most of the last decade decrying the introduction of the Patient Protection and Affordable Care Act (Obamacare), voting for the repeal of the law without any replacement, and still talks about the debunked theory that everything will be fine if we could only purchase health insurance across state lines.  Now in the waning moments of his last term (like Rob Portman (R-OH) he beat the electorate to the punch and chose to not seek re-election), Mr. Toomey has decided to make a last attempt for both relevance and to gain the attention of some future employer.  Mr. Toomey is too committed to the failure of Obamacare to suddenly want to help Americans afford their health care.  Instead, on May 11, 2022 he and fellow consumer advocate, Senator Richard Burr (R-NC) have attacked the Biden administration’s attempt to fix the Family Glitch.

This is the link to the Toomey / Burr press release.

The opening sentence dispels any possibility that this is a good-faith effort by Senator Toomey to help Americans access and pay for health care.

“This action would further the reach of the federal government into Americans’ daily lives, placing more federal red tape between patients and their doctors.”

Helping American workers pay for their health insurance does not insert the government between the patient and the doctor.  People like Joseph will have a choice.  He will be able to keep his employer’s coverage for his family if he can afford it and if it serves his family’s best interest.  Or, he might be better off purchasing a policy through the government’s exchange, possibly with a tax credit subsidy.  Joseph is not alone.  According to the Kansas Health Institute, a nonprofit, nonpartisan educational organization based in Topeka, approximately “40,000 Kansans are not eligible to receive premium tax credits due to what is known as the ‘family glitch’.”  The Kaiser Family Foundation estimates that over 5 million Americans are affected by this across our country.

As I noted last month, members of the National Association of Health Underwriters (NAHU) go to Washington every year to fight FOR our clients.  We have asked Congressmen and Senators to address this issue for over 10 years.  We know how the laws passed by Congress and regulated by the various agencies impact our clients.  It is that information that we bring to our elected representatives.  We are so close to making life easier for our clients.  This doesn’t solve everything.  It doesn’t make Obamacare anywhere near perfect, just a little better.

Our efforts have been focused on helping Joseph and millions of Americans like him.  That was our goal.  Once again we have been reminded that for some, the goal is failure.


Picture – When Failure Is Inevitable – David L Cunix


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A Glitch Can Be Fixed

It may have been on my first day as an insurance agent.  It could have been the second.  Regardless, this was one of the first and most important lessons I learned about employer-sponsored group health insurance:

The purpose of group insurance is to attract and retain good employees.

Our job as agents was to help the employer find the sweet spot, the package of benefits that was both cost effective and yet appropriate for both the particular industry and job market.  Highly competitive industries offered more comprehensive health insurance coverage.  Some employers felt that even though their competitors offered little or no benefits, they had a moral responsibility to provide health insurance coverage.  Sometimes though, the system prevents this.

November 24, 2014 was The Day We All Lost.  My blog post told the story of Thomas Roberts (name changed) who was forced to cancel his company’s group health insurance policy.  I noted that some of his employees migrated to individual policies and wondered how many would still have coverage four or five months later.  Both Thomas and I were concerned.

It is now seven and a half years later.  Some of Mr. Roberts’ employees retained the individual policies.  Some left his company in search of a job with benefits.  He and I still talk on a regular basis.  He wants to provide group health insurance to his current employees and, of equal importance, he is having difficulty hiring new employees.  Group insurance would help.  I may have some good news for Mr. Roberts, his employees, and millions of other Americans.

The Biden Administration has proposed new rules to fix the Family Glitch.  This is a quick definition of the Family Glitch from an April 2021 Kaiser Family Foundation article:

“Financial assistance to buy health insurance on the Affordable Care Act (ACA) Marketplaces is primarily available for people who cannot get coverage through a public program or their employer. Some exceptions are made, however, including for people whose employer coverage offer is deemed unaffordable or of insufficient value. For example, people can qualify for ACA Marketplace subsidies if their employer requires them to spend more than 9.83% of his household income on the company’s health plan premium.

Currently, this affordability threshold of household income is based on the cost of the employee’s self-only coverage, not the premium required to cover any dependents. In other words, an employee whose contribution for self-only coverage is less than 9.83% of household income is deemed to have an affordable offer, which means that the employee and his or her family members are ineligible for financial assistance on the Marketplace, even if the cost of adding dependents to the employer-sponsored plan would far exceed 9.83% of the family’s income. This definition of “affordable” employer coverage has come to be known as the “family glitch.”

The link in the quote takes you to a KFF August 2011 article.  This is not a new problem.  Members of the National Association of Health Underwriters (NAHU) go to Washington every year to fight FOR our clients.  We have asked Congressmen and Senators to address this issue for over 10 years.  Too many of our elected representatives have been too busy trying to repeal the Patient Protection and Affordable Care Act (Obamacare) to have any time to try to make it work.  The Biden Administration has put forth real effort to make health care more accessible and affordable.  This is just one more step.

What might change?  Let’s go back to Thomas Roberts and his business.  Mr. Roberts’s business is in a highly competitive industry.  Most, but not all, of his employees are unskilled or semi-skilled workers.  He can afford to pay most of his employees’ health insurance premium, perhaps as much as 90%.  He can not afford to pay the premium for their dependents.  Under the current interpretation of the law, the spouses and children would be ineligible for a tax credit subsidy to help to pay their premiums.  Forced to pay the full cost, they are more likely to be uninsured.  Instead, Mr. Roberts will be able to put in to place a group health policy for his current and future employees.  The families will be able to apply for health policies through the Marketplace and if their incomes warrant it, get a tax credit subsidy to help pay the premiums.

The net gain will be more insured Americans.  And we again have confirmation that a glitch can be fixed.  All it takes is someone to care.


Picture – Glitch – David L Cunix


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Blog-Mitzvah, The Thirteenth Anniversary Of Health Insurance Issues With Dave

Today’s post marks the thirteenth anniversary of Health Insurance Issues With Dave.  Thirteen years and 325 posts.  A surprisingly large number of you have been regular readers for years.  Others, like some agents in Arizona and California, are new to these posts.  I started on BlogSpot and added the WordPress version on my website.  Some of you are reading this on the AOL Patch system and others on Linked In.  Four different locations and four different formats.

At the top of each post are the four guiding principles of this blog:

  • PURPOSE Short Articles designed to illuminate different aspects of the health care discussion.
  • CORE PREMISE If you think you know all the answers, you probably don’t understand all of the questions.
  • CENTRAL BELIEF Absolute Power Corrupts Absolutely
  • AUDIENCE Our current health care system impacts all Americans.

Some of the articles weren’t quite that short.

My first post focused on an elderly gentleman with multiple health issues who was waiting for a kidney.  Should he get one before a younger, healthier individual?  Should we pay for this through Medicare?  Who decides?  The post then notes:

The payment and delivery of health care in the United States must change. There is too much pressure, political and financial, for Congress to ignore. This is good. Our current system is a hodgepodge of stop-gap measures masquerading as a solution. Unfortunately, some of the most vocal proponents of change have some of the most unrealistic answers to this question. We can not have unfettered access to any and all care without restriction or cost.

Since then I interviewed hospital administrators, elected representatives and their staffs, and had a couple of guest posts.  I have analyzed both the Democratic proposals and the Patient Protection and Affordable Care Act as well as the Republican proposals.  And when our entire system was under attack by either the State of Texas or the White House, I didn’t shy away from detailing exactly how we would all be impacted by their blatant disregard for our access to health care.  Though a Centrist Democrat, I have ticked off Democrats and Republicans equally.  The truth, as I saw it, was my goal.  I hope that I have come close.

I’ve had a lot of fun doing this.  When the editors of the local AOL Patch came to my office and asked for me to post on their then 17 local publications, they said that I needed to have a picture.  The pictures were a new element and a challenge.  I hope that you have enjoyed some of them.  The links are often my favorite part of each blog.

It was important to me that this blog was more than just my opinion.  The links are what made the difference.  It wasn’t enough to cite a law or a court case.  The blog linked you to the actual document.  And when the Supreme Court weighed in, you were linked to both the decision and to SCOTUS Blog, the definitive analysis of each decision.  Details.  The internet and cable TV are filled with opinions.  It was my goal to provide enough information that you could, if you wanted, read the source material and form your own opinions.

And speaking of fun, some of my readers search the blogs for the links to the songs.  Every blog has at least one.  Always topical and often of a live performance, the music allowed me to add a bit of levity to some very serious posts.  Some politicians even had their own theme songs.

I never imagined doing this for thirteen years.  Thank you for indulging me.  Thank you to the attorneys, financial planners, CPA’s, and bankers who have forwarded this blog to their clients in an effort to explain our health insurance system.  Thank you to the insurance agents around the country who use this blog as a resource and are kind enough to let me know.   And thank you, all of you, who take the time to email me your thoughts.  It is the feedback that lets me know that I’m not talking to myself.

One of our traditions is to make a donation to a charity in honor of a young man becoming a Bar Mitzvah.  Should you be so inclined, please consider your local food bank.


Picture – The Proud Parent – David L Cunix

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Forever Young

Sally’s phone was buzzing.  It must be important.  It was a text message at 7:30 on a Saturday morning.  She checked her phone.  It was another message from  I asked her how often the marketplace was sending a 66 year old woman a text to purchase individual health insurance.  Her answer was, “almost daily”.  I was shocked.  She was amused.  With you are forever young.

The pendulum has swung to the other extreme.  The individual health insurance market survived four years of sabotage.  Now we have an administration so eager to have everyone covered that Pete Buttigieg might personally drive you to my office.  We have good, positive advertisements on radio and television.  We had an extra Open Enrollment Period this spring and summer. The marketplace worked really well this year.  And consumers who have purchased policies through have received lots and lots and lots of reminders to visit the site to renew their plans.

But do you need to visit to renew your policy?  NO.  The policies renew automatically.  Check your subsidy.  If you want to keep your current policy and you haven’t had any changes in your income, there really isn’t a reason to go into  Confirming your status could be five minutes over the phone with your agent.  If you want to explore your options or adjust your subsidy, yes, visit either on your own or with your agent.  The policies are the same price with or without an agent, so you might as well find someone you trust to guide you through the process.  But if nothing is going to change, don’t let the daily texts, emails, and calls push you.  If you are fine, you’re fine.

The system does not pick and choose who should reevaluate their plan and who can just let the policy renew. contacts everyone who has had a marketplace policy.  Heck, it even nudges people who have turned 65 and are now on Medicare.  Because assumes that you don’t know about Open Enrollment and that you are forever young.


Picture – A Wild Ride – David L Cunix

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Second Notice!

We got the envelope in the mail on Friday.  Second Notice!  The nerve of us.  We had failed to respond to the first solicitation and now we were being admonished with this, our second notice.  How dare us?  Why didn’t we jump on the opportunity to subject ourselves to a high pressure sales pitch from some cubicle junkie to purchase some crappy Medicare Advantage policy?  The call is free.  The results are devastating.  In just a few minutes I could lose the benefits of Original Medicare and my Medicare Supplement to gain ___.  To gain what?  Routine dental?  Mediocre vision? Maybe, just maybe, I’ll score a plan that puts a week or two’s worth of meals into my freezer after I’m hospitalized, which might sound good if you ignore the thousands of dollars I might have to pay for that hospital stay.  I guess I’ll be getting a third and fourth notice before the end of Open Enrollment on December 7th.

One of my clients told me about a phone call she had recently received.  She normally doesn’t answer her home phone, but was waiting for a call from a repairman.  The call was a solicitation for a Medicare product.  She was too polite to just hang up, but when she said that she wasn’t interested, the caller became abusive.  She objected and his response was that it was her own damn fault.  She shouldn’t answer her phone if she didn’t want to hear his pitch.  That is the world we live in today.

A woman called my office and asked me if she was “getting all of the benefits she was entitled to”.  I told her that she was entitled to the peace of watching her TV without misleading Medicare commercials.

Last year’s post, Who Is Selling Your Name? was about solicitations we were all receiving because Follow My Health (University Hospitals) and My Chart (Cleveland Clinic) sold our names to an online/call center Medicare marketer.  As noted at the time, the marketer was no better and no worse than any other call center.  The odd part was that it looked like the hospital systems were recommending the patient to change coverages.  Of course they weren’t.  This was simply another way for someone to make money off us.

This year many of my clients have received a similar solicitation.  This time our names, yes mine too, were sold by Giant Eagle pharmacy.  Giant Eagle has provided our names, addresses, and who knows what else, to that same online/call center Medicare marketer.  The clients called to ask me why they got these solicitations.  Were our specific prescriptions provided? Probably not.  Were our phone numbers provided? I hope not, but who knows?  We all agree that this feels more egregious, a greater abuse of our trust.

Privacy is an illusion.  I tell my clients that we are undressing in front of the windows.  Smile and wave.  Still, there are times to stand up for ourselves.  I will be moving my prescription to a new drug store and I am suggesting that my clients do the same.  The only way to express our displeasure is by hurting their bottom line.

Will I contact Giant Eagle to explain why I’m pulling my business from them?  No.  I don’t think they deserve a second notice.


Picture – More Junk Mail – David L Cunix

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The Ghost Of Ronald Reagan


Can’t Buy A Thrill

Can Always Spot A Shill

We are about to enter Open Enrollment season.  There are lots of commercials on television hawking plans for those of you under age 65 elbowing their way between the ads from washed up athletes and C List celebrities.  And don’t forget all of the smiling, happy people having fun while the voice-over describes the dangerous side effects of the newest medications.  Now is the time to remember that the focus of our organized health care system isn’t health.  This is a payment system structured to compensate medical providers and, to a slightly lesser degree, help fund political campaigns.  That isn’t a good thing nor necessarily a bad thing.  It just is.

There was a time, not so long ago, when Americans retired from their jobs, said good-bye to their work provided group health policy, and hoped to either have the resources to cover their final medical expenses or to die cheaply and quickly.  A lingering illness could lead to financial devastation.  Bills were introduced in Congress to address this issue.  Opponents claimed that providing for the elderly would inevitably lead us to Socialism.

The most vocal opponent in the late 1950’s early 1960’s was the American Medical Association.  The organization and the doctors it represented were worried that a national program to provide insurance to senior citizens might limit their income potential.  And to a point, they were right.  So in 1961 they hired an actor, one with political aspirations, to record a presentation for the association’s Operation Coffee Cup.  Here is the full recording.  Even with all of the self-deprecating humor and the scary imagery, the American public could spot a paid shill and ignored Ronald Reagan.  It only took four more years.  We got Medicare on July 30, 1965.

We intuitively understand the difference between advocacy and exaggeration.  Many organizations believe that whatever is best for them is also the best for you.  Just ask them.  In 2021 an industry group can always rely on a friendly think tank, the compliant evening talk show host, or, if necessary, a recently formed consumer group to promote their interests.  Throw enough money in the right direction and you can find a group of hogs promoting the benefits of bacon.

That squeal you’re hearing on television is from Big Pharma.  Trudy Lieberman recently wrote for the USC Annenberg Center for Health Journalism:

Pharma and ideologically allied groups are also promoting the message that drug negotiations are bad public policy. Between July and early October, 10 groups opposing such negotiations, including the trade group PhRMA, have will have spent at least $23.7 million mostly in TV advertising to promote its message that drug negotiations are bad for patients. The 60 Plus Association, an organization claiming to represent seniors, ran an ad on broadcast and cable channels “I’m Sorry They Just Said No,” telling viewers Pelosi and Schumer want to cut their benefits. The American Action Network spent about $5 million also on broadcast and cable outlets warning viewers about Pelosi’s “Socialist Drug Takeover Plan.”

The American public isn’t buying it anymore now than they did in 1961.  A recent poll by the Kaiser Family Foundation found that most Americans want the federal government to negotiate drug prices. Even after being presented arguments from both sides on this issue, the results were:

  • 95% of Democrats
  • 82% of Independents
  • 71% of Republicans

favored government involvement.  Whether this means the end of the “noninterference clause”, the passage of one of the bills currently pending in the Senate, or some new legislation has yet to be determined.  What is clear is that the American people, the ones paying for the medications, know that the time has come for action.

You will see a lot of commercials on television and the pharmaceutical industry is shoveling cash to elected officials at a record rate.  And there will be a lot of squealing about Socialism.  Just remember what Ronnie would have said. “There you go again”.


Picture – I Can’t Compete With Big Pharma – David L Cunix







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Procrastinators Rejoice!

Elections do have consequences.  Four years ago the Patient Protection and Affordable Care Act (Obamacare) was under attack. We were preparing for the first Open Enrollment under the Trump administration.  Funding for the Cost Share Reduction had been eliminated which cost the insurance companies millions of dollars.  Some insurers responded by leaving the market.  And the annual Open Enrollment was shrunk to just six weeks.   The damage that couldn’t be done legislatively was accomplished by Executive Order.

We are a little over a month away from the SECOND Open Enrollment of the Biden administration.  Recognizing the importance of access and the affordability of health care, this administration and a friendly Congress instituted an emergency Open Enrollment from March 15, 2021 until August 15, 2021.  Almost three million Americans took advantage of this opportunity to either acquire health insurance or to lower their premiums.  I met with people stuck on Share Plans, short term major medical plans, and those without any coverage who were excited to have the chance to purchase comprehensive health insurance, plans that covered preexisting conditions.  And this week it was confirmed that our annual Open Enrollment will be restored to the full November 1, 2021 to January 15, 2022.  It may not seem like much, but many Americans aren’t really ready to commit to the following year until the very end of December or the first week or so of January.  Agents around the country will now be able to help these people acquire comprehensive health policies.  And yes, that will also help the procrastinators who always seem to call the week between Christmas and New Year’s.


Picture – More Wine, Less Whine – David L Cunix

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Your Money Is Only Whispering

My friend was trying to prove that it is never too late to get interested and involved in politics.  Ralph (name changed) finally got excited about a political candidate and donated money to the campaign.  How much?  Let’s just say it was a lot of money to him.  And when the candidate won, Ralph expected to be recognized, thanked, and mentioned on the Congressional website.  Ralph was now a Player, at least in his own mind.

An individual was allowed to contribute up to $2,800 to a particular Congressional candidate per election in 2020.  Ralph was nowhere near that amount, but even if he was, Congressional campaigns raise and spend millions of dollars.  He contributed less than 1/10 of 1% of what his candidate spent.  I’m sure that Ralph and his donation were momentarily appreciated by whoever processed the check before he/she opened the next envelope.

To put this into perspective, let’s look at what the pharmaceutical industry (Big Pharma) donated to Ohio politicians in 2020.  The Columbus Dispatch and the website Lobbyists for Citizens are the source of this information.  It was noted that Ohio politicians, Republicans and Democrats, received over $250,000 in the 2020 election cycle from Big Pharma.  To no one’s surprise, the top recipient, even though he wasn’t up for reelection, was Rob Portman.  Here are the numbers:

US Senators

  • Rob Portman – $65,000
  • Sherrod Brown – $0

US House

  • Brad Wenstrup – $64,000
  • Bob Latte – $41,000
  • Steve Stivers – $26,000
  • Jim Jordan – $15,000
  • Bill Johnson – $14,500
  • Marcia Fudge – $11,500
  • Joyce Beatty – $7,500
  • Tim Ryan – $4,000
  • Steve Chabot – $2,500
  • Anthony Gonzalez – $2,000
  • Troy Balderson – $1,000
  • Bob Gibbs – $1,000

I showed this to Ralph and had him look at Senator Portman’s website.  Big Pharma isn’t mentioned or thanked.  Portman has found other ways to thank them and earn their favor.  Our political donations are whispering while the real money, the PAC money is shouting.

Prescription Drug prices have spiraled out of control for years.  The creation of Medicare Part D in 2003 was a license to print money.  Every couple of years Washington flirts with the concept of regaining control.  Success is hardly guaranteed.

A quick bit of history:  Medicare Part D specifically prohibits the government (the Secretary of Health and Human Services) from negotiating with the drug manufacturers over price.  This is called the “noninterference clause”.  My clients are still surprised by this.  What is not surprising is that the Congressman who co-authored the legislation, Billy Tauzin (R-La) was also negotiating with Big Pharma to become their top lobbyist at a salary of $2 million per year.  He had that job from 2004 through 2010.  We continue to be impacted by his efforts to this very day.

Congress, or at least some members of Congress, would like to eliminate the noninterference clause.  As you can imagine, Big Pharma is not happy.  They have two tools (weapons) at their disposal, money and emotion.  We know that the money is flowing to elected officials.  Emotion and fear are on full view on our TV screens.  By now you have been introduced to Sue from Ohio, an ad that the Washington Post rated 3 Pinocchios.  There will be more Sue’s and more misleading BS.

Will we, the consumers, win this time or will Big Pharma win again?  It is way too early to tell.  There is legislation pending that may pass as currently written, be watered down to irrelevance, or just defeated by filibuster in the Senate.  You can contact your Congressman and/or Senator. But it is important to remember that you may donate what seems to you a lot of money, but it is, in truth, but a whisper.


Picture – Take One Daily – David L Cunix

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Donald And Susan Deserve Better

Donald needed to talk.  He was very upset.  He and his wife, Susan (names changed), moved to Greater Cleveland in 2020.  He came to see me for health insurance when his COBRA ended.  They had a choice between Medical Mutual of Ohio with access to University Hospital and its affiliate doctors and facilities or the Cleveland Clinic + Oscar policy that would get them into the Cleveland Clinic.  They had yet to see a doctor and had no preference.  Medical Mutual was a little less, so University Hospital won this round.  Donald was calling to change policies and provider networks.

Donald’s problems started when he tried to schedule their initial appointments.  Friends had recommended a couple of doctors.  None of those doctors had an opening for a routine exam for three to six months at the soonest.  Annual Preventive Care is a covered benefit under the Patient Protection and Affordable Care Act (Obamacare), but the money is in treating conditions.  Very little time is set aside in today’s medical practices for routine care.  Donald gave up and scheduled an appointment.  Susan had more immediate needs and accepted an appointment with a physician who was very available.

Susan’s appointment did not go well.  The doctor failed to focus on her patient, or ask good questions, and seemed intent on getting the exam done as quickly as possible.  Follow-up testing was ordered without adequate explanation.  This precipitated Donald’s first email to me.  No action was taken at that time.  Today’s call came after they saw Susan’s medical records.  They were shocked to learn that the doctor had completed a series of questions as if she had actually discussed any of these topics with Susan.  She hadn’t.   Their solution was to schedule a meeting for next week when they would drop Medical Mutual and move to Oscar so that they could access the Cleveland Clinic and get better care.  They will be here on the 11th.

To be clear, I receive most of my health care at University Hospital facilities.  The facilities are world-class and a lot of the doctors are excellent.  A lot, but not all.  There are great doctors and there are people who might do a better job at something else.  Donald and Susan may live in a Cleveland suburb, but this isn’t about University Hospital or the Cleveland Clinic.  They could just as easily have encountered the same level of care in Philadelphia, Seattle, or any other place in this country.  One of the complicating factors in our health care system is the number of medical practices owned by the institutions, corporate entities, and private equity firms as reported in the recent Radiology Business:

The COVID-19 pandemic has accelerated this decade-long trend as business interests “dramatically” reshape the practice of medicine. Corporate entities own half of the nation’s medical practices, with private equity and similar stakeholders producing the sharpest increase (32%) in acquisitions between 2019-2020.

I would like Donald and Susan to think this through before we change plans and networks.  Politely, but firmly, they need to assert their rights as consumers.  I needed to remind them that the doctor is a PAID service provider.  If the service provided is less than satisfactory, you should fire the doctor.

All large institutions have a patient care office / ombudsman / patient experience office.  I urged Donald to find the one for University Hospital and call it.  Susan should tell UH about her experience and the substandard level of care she received.  Sure all of the medical systems send out surveys, but who knows if a human being every reads them.  It is time to let someone, other than me, know about this visit.

Some of us still remember House Calls, when the doctor came to your home to treat you.  That time has come and gone, but you can still demand the undivided attention of the person you hire to attempt to treat your illnesses and keep you healthy.  I don’t know if Donald and Susan will follow through and call UH, and if they do, whether anything will come of it.  My job is to help people access and pay for health care.  I also think that my job is to help people understand that they should expect to be respected, valued as customers (patients), and given the best care possible.

Donald and Susan deserve better.  And so do you.


Picture – What Could Be Better Than A Lake Erie Sunset? – David L Cunix

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