Inspired by the monthly Harper's Index, this is 2019's first index on healthcare and finance. The average ratio of Medicaid-to-Medicare payments spending across the US across all services: .72; In CA: .52. The factor by which commercial insurance payments exceed the reimbursements from Medicare: 1.88x The net assets of HCA, the largest publicly-traded hospital in the … Continue reading January’s Healthcare Index
November has past and healthcare open enrollment is behind us. It's the time when spreadsheets are pulled together, employees and spouses (even actuaries) run front and back of the envelope calculations to decide where to enroll. Stock photos of happy couples in the 30-page guides beckon workers toward a tortuous process. It's usually a choice … Continue reading Stats on High Deductibles
Some call them clients, others guests or customers. Costco (Ticker: COST, revenue $141B) calls them members, a term that makes you feel like you're part of a special club. It's a club that will not sell you junk*. They do not exaggerate. Theirs is not fake-Enron-style-ethics-bragging, and they actually list shareholders' interests last. Focus on the … Continue reading Costco: Lessons from Member Obsession.
Mothers and psychologists remind us that we have a built-in bias to do what's easiest or to follow the path of least resistance. Water and electricity are like this. We are naturally lazy so to stick to an exercise plan, it should be something we like, with shoes left by the bed, perhaps done with … Continue reading Cadillac Consequences
It has taken over 40 years for index investing to reach 20% market share. That's longer and less heft than most people would guess. But it's also a reminder of how a good idea can take generations of incremental awareness and results to move beyond shallow roots. Index investing is a form of passive investing, … Continue reading Passive vs. Active in Investing and in Health
A couple of weeks ago I was with my family in Guanajuato, a beautiful and historic colonial city in central Mexico. Imagine a hillside version of Venice with winding alleys and colorful buildings. We arrived and settled in the rented apartment. We met Don Chava, owner of the corner store, and then ventured out to … Continue reading The All-You-Can-Eat-Healthcare-Buffet
$45,000. That's a conservative estimate of the 30 year opportunity cost of having family PPO coverage instead of a high deductible health plan (HDHP). Allow me to explain. According to Kaiser Family Foundation ("Kaiser"), the average annual family premium for a HDHP is $1,900 cheaper than a preferred provider plan (and has averaged $2,000 over … Continue reading The Cost of Being Over-Insured
There's an employee benefit that ranks higher than flexible work hours, more vacation time, student loan assistance, triple-strained yogurt, organic tofu, or German ping pong tables. It's outlined in a 20-40 page document, relates to your health and finances, can be useful in pay negotiations, and is the most valued benefit by job seekers. It's a … Continue reading A Transparency Lesson from Harvard
They've been called blunt, unfair, cruel, likely to lead to bankruptcy or avoided care, consumer directed health plans, account based health plans. They've also been called necessary, cost effective, ways to align interests. With all the debate, high deductible health plans (HDHPs), have become a way to save on premiums--the fixed costs that affect all, … Continue reading High Deductible Health Plans: Good or Bad?
What do vendors say about Health Savings Accounts (the triple-tax savings accounts, or the 401k+ of healthcare) and how they're promoted by the brokers and consultants? These often decide which vendor is chosen amidst the fragmented market for the 20M+ Americans who have these accounts. Optum (UHC): We're No. 1. UMB Financial: “Healthcare solutions that … Continue reading Health Savings Accounts And Promotion