Are High Deductibles Really About Patients Having “Skin in the Game”?

Each year more of us, the insured population, are being rolled into health insurance plans with high deductibles. As a technical matter a high deductible health plan (HDHP) is one with an individual deductible of at least $1300 and at least $2600 for a family.

The reason for high deductibles that is most often given, is consumers (patients) need to have an incentive to not over use health care services. While there may be a certain small sub-set of the insured population that might use these services in a wasteful manner the simple truth is that most people are healthy most of the time. About 50% of the health care spending in a given year, for people under 65, is attributed to just 5% of the non-elderly population. At the other end of the spectrum, 15 percent of the population recorded no spending whatsoever in the year, and the half of the population with the lowest spending accounted for just 3 percent of total spending.

My experience using the healthcare system support these figures. We know preventative care is cheaper in the long run than allowing a condition to fester and manifest into a full blown acute or chronic condition. These expenditures are preventative and discretionary. My major expenditures have been surgeries and treatments that were completely non-discretionary so the presence and size of the deductible and out-of-pocket never entered my decision-making process – I simply had no other choice.

If 20 million more people now have health insurance as a result of the ACA and most people still get their health insurance through an employer why have high deductibles become so increasingly common for both individual and group policies?

The short answer is that health insurance is a business that exists to make money for the stake-holders. These businesses are not very transparent. The obligations of both parties are governed by impenetrable legal language in policy contracts that are written by the legal department of the insurers. The insured seldom have legal advice to help them understand the coverage, conditions and limitations. They often learn what the fine print says after the fact.

Most people believe their insurance is there to help them when they get sick and that their insurer spreads their risk across all their policy holders. This concept of sharing the cost of care for the sick across a broader group is known as risk pooling. The majority of healthy people pay for the few sick ones. Segmenting risk pools has the opposite effect. It saves money for the currently health part of the group while increasing costs for those with health problems.

We’re all small business owners trying to figure out how this works and where things are going. If you have questions or want to discuss please give us a call.

Next time I will go into more depth about policy terms that sound innocuous and are means to segment risk pools and make for money for the insurer.

The Importance of New Year’s Resolutions

2010-04-07 16.09.41-1

The two most powerful warriors are patience and time.

~ Leo Tolstoy

I was at an event recently where the audience shared their personal practices regarding writing New Year’s resolutions. I was shocked to see in that group that only 50% of the participants created resolutions. I am completely ritualistic about starting a New Year. It is a time to revisit my last year’s resolutions and to come up with new ones. During the month of January I also have my annual viewing of the movie Our Town. My dad and I used to watch that together, and as the years pass the poignancy of the message is even stronger. Life passes so quickly and our time with people we love is incredibly precious. The movie really gets me in the mood to tackle my resolutions for the coming year. New Year’s resolutions are an important annual ritual of closure and intention for me.

I start with the list of intentions I had for the past year. What was accomplished, what became less important, and what remains incomplete that is still a goal? The list for the New Year starts with the ones that were unfinished that I still care about. I like to divide what I hope to do in the next year into categories. For 2016 these include health and wellness, work, family, and experiences. At the beginning of the year I jot down things that I’d like to accomplish, and over the next few weeks more things will come up. The process crystallizes my intentions for the coming year, and gives a moment to celebrate the gifts of the past year. We find ourselves a year older and wiser with more clarity to our goals. So often, we keep dragging the same goals and intentions forward to the next year when we clearly no longer have any desire for them anymore. Streamlining our list and releasing that which is no longer useful is an exhilarating and empowering process. Just like Elsa sings in Frozen, “Let it go.” Sometimes it isn’t happening because we really don’t care that much. I am positive that the process of setting annual intentions has given me some real traction knocking items off of my own personal bucket list. There are things I know wouldn’t have happened if I didn’t start imagining it in January and giving it more form throughout the year…

For all of you, I hope that 2016 is a year filled with focus on what you truly want, celebrated accomplishments big and small, wonderful surprises, and loving connections with friends and family!

Choosing Our Path

June 1, 2014 -

As often happens on the spiritual journey, we have arrived at the heart of a paradox: each time a door closes, the rest of the world opens up. All we need to do is stop pounding on the door that just closed, turn around—which puts the door behind us—and welcome the largeness of life that now lies open to our souls. The door that closed kept us from entering a room, but what lies before us now is the rest of reality.  

~ Excerpt from Let Your Life Speak, by Parker J. Palmer

For Christmas my mother gave each of her seven children the book Let Your Life Speak: Listening for the Voice of Vocation by Parker Palmer. Each book included a handwritten note about what she thought we may find in Parker Palmer’s search for a vocation that may be relevant to our own personal journey. It is a beautiful book, and I found embracing the no’s in our life to be particularly poignant. How many times are you with a dear friend or family member listening to them process the untenable? There is no way to retell their story with a happy ending and blaming themselves is always completely unsatisfying. Sometimes it is so much more rewarding to look away from the locked or broken door. The entire world opens up in front of you.

At Just In Time Direction we often meet with people that have worked in a career for many years. They have been successful in projects or businesses, and have hit a juncture where they can no longer settle for what their career is offering. We rarely work with someone starting their career with an amazing technology innovation to bring to market.

Hard Luck Cafe
Hard Luck Cafe

Our customers are more often successful searchers who believe something more is possible. They are usually financially in good shape and may be in a changing work situation, or they may hear a calling to something more fulfilling and want to explore stepping off the linear path. They are excited and afraid and are often tempted to turn back. It is so exciting when they choose to stay the course.

Aspiring entrepreneurs and new business owners always have limited resources—particularly time. They don’t have the time to figure out what they need to know and what they don’t know. So often taking the leap to business ownership is followed by drowning in unexpected details. What industry will I be in? What structure should I choose? What skills and talents do I have? Where do I need support? What do I think I know that is wrong, and what do I need to know that I have no idea about? The list goes on and on, and wrong or avoided decisions can derail the dream. It is good to remember that there are many that have walked the path before and they are eager to share lessons learned with other seekers. Sometimes the best answer to the daily grind can be “no” in service to a more heartfelt, unique, and personal “yes”.

Reflections on Motherhood

EPSON MFP image

Things get much better when we internalize 2 truths-

1. Nobody owes you anything (no, not even a thank you)

2. It is actually you who owes the world and its denizens. You take up space (physical and emotional). And you better have something good to show for it.                     

                                                   Seth Godin

 

 

It is startling to read these points so close to Mother’s Day, and to realize how well they capture the gift of being a mother. Clearly, my three sons were born knowing they did not owe me anything. They learned to walk holding my hand, and I was a cheerleader in their moves towards greater independence. And the way they saw it, I was meant to be that kind of permanent and uncomplaining fixture in their lives.

Kids give you lots of opportunities to think about what you care about, what feeds your soul and what doesn’t. As a mother you let go of all but the most important pieces of your old life, and the most important pieces find a new Petri dish to flourish within. The lessons I learned from my sons helped me to get less concerned about what the world owed me and more focused on what I owed the world—and more importantly, myself. For me, poetry, writing, journaling, social justice, and meaningful work all rose to the surface. I outsourced house cleaning from the beginning of our childbearing years, recognizing that one woman cleaning house for four boys/men was a recipe for resentment.

So, though I part ways with Seth Godin a bit and believe that, like my sons, I do not owe any more than my kids do, I want to thank my amazing sons Devin, Mason, and Harte for unapologetically teaching me that my life and joy are my own responsibility. On the way to that lesson, we have laughed deeply, shared our struggles and accomplishments, and reflected on best options in each of our lives. We have also played together and watched more Sports Center than I EVER would have chosen. Being your mother has been an honor and a privilege and nothing like I thought it would be. As my own mother suggested about my siblings and me, each of you has been an exciting ride to places I would never have had a chance to go to without you. Thank you for the ways you have transformed who I am and how I live my life through travelling this road together.

Committing to our own relationships….

Louis Focht reacts after striking out.

Every small business owner knows the feeling of over commitment intimately.  We start a small business so we can have more flexibility to be there for our friends and family, as well as an opportunity to do the work we love.  It sounds so promising…

Then the reality sinks in, and our customers trust us and count on us to solve their problems.  The best ones have our cell phone numbers and can call us anytime.  But sometimes anytime is when we are at our son’s baseball game and he is at bat, or at a zoo field trip with our daughter’s class.  You want to be available for your customers, of course.  Somehow, though, commitments to the people who are always there for us get lost in the shuffle, and we never formally commit to make their events a priority in our lives.

I personally have been at important family events and watched my son roll his eyes at me when I take a call that must be answered.  I have also answered a call I thought might be important and really regretted the disruption when I get stuck in a long, unnecessary conversation.  I saw the disappointment in the face of my son and was missing something I value much more than my business obligation.

As an entrepreneur with little cash flow, you may think you don’t have options for support.  You do, though.  There are business resources right-sized for solopreneurs and small business owners.

You don’t have to do it all yourself, just because you are a small business.  For example, at Just In Time Direction we offer custom phone support packages based on the needs of your business.

It is important as a business owner to continually reevaluate your business model and your life goals.  Small business ownership can be a path of personal development and joy unlike any other, or, if done without reflection, can create a job situation you would never willingly accept.

Concrete Dreams: From Startup Fantasy to Reality

© Sandy Matzen -Dreamstime Stock PhotosThe safest dreams we experience are dreams with no hope of coming true…Living with the possible takes guts. ~ Seth Godin

I received a book for Christmas this year that I love, entitled What to Do When It’s Your Turn by Seth Godin.  It’s a book about living your life on your own terms, which is so inspiring.  Seth Godin came up with a new term I really love–Concrete Dreams.  It is one thing to daydream about leaving the job you hate, or to play “what if…” about changes you could make that you’ll never initiate.  All of us have those friends that are painful to talk to because they focus on what they hate in their lives and never take the steps to do something with their frustration.  They are playing it safe, collecting a paycheck, and hoping for a big payoff after years in misery.

 

The business owners (or aspiring business owners) we work with at Just In Time Direction are seriously considering, or have already taken a leap of faith.  They have faith that the net will appear, and they will recognize it when it happens.  A new business startup is full of uncertainty, and the best laid plans will no doubt morph into something unexpected.  If you are game for it, you’ll be okay with that, and you’ll know the newborn business has a personality and it will get clearer as it interacts with the world.  Those of us who have had a few children, know the surprise of having a second child and realizing we haven’t really broken the universal code of child-rearing.  This new being is a new adventure that will have to be taken on its own terms.  That is what makes being a parent so rewarding–and it is what makes launching a new business so exciting for a business owner, too.

 

No matter what happens with our business on the skinny branches of concrete dreams, I’ll always be delighted to have taken the leap and buried my hands in the clay of starting a business.  The advisors, consultants, and small business experts that have helped us on our way have been invaluable.  There is a community of us out there, and we want to help each other succeed.  Every one us that lives with the possible and gives their Concrete Dreams legs, helps to forge a trail for those that follow.

 

If you are standing on the edge of living with the possible, we wish you every success in making the best choice and getting the guidance and support you need to fearlessly consider your options and making the best choice.