The Lost Archives of Captain Hook

thMy wife surprised me this Christmas with an extraordinary gift — two decades of mothballed VHS home movies converted to DVDs. In minutes, I was pulled through a looking glass of my life as a parent and across the sweeping steppe of time – two continents, three children, four homes and one half-dozen pets. The last occasion I had stumbled across such riches of nostalgia, I had been weaving in between boxes and neglected items of my retired parents when I unearthed worn, misplaced photo albums and a vanished 8mm family film from the 1960s – cinema and snap shots that graphically depicted a middle class family of four boys as we traveled the blue and black highways of the Western United States in a modern day Conestoga called the station wagon.

The first thing you notice about most 60’s family films is an adult is always waving hello and a child is usually crying. Today, Child Protective Services would use any of these clips as Exhibit A in the trial of an unfit parent. We wander dangerously close to the Interstate as we stop at roadside rest stops for jelly stained Wonder Bread PJs chased by warm Shasta Lemon-Lime soda. There were pocketknives, BB guns, bows and arrows, and an absence of helmets, seatbelts or the restrictions of an adult. There is no sound, gratefully, as the film would quickly become X-rated when punctuated with the anxious calls for “stopping the grab-ass” by my father who had a black belt in cursing and for giving you a red hot behind.

As I threaded the fragile film through a viewing monitor borrowed from a college professor friend, the archipelago that was so many phases of my life mended into a single land mass when reunited with the young boy I saw in these photographs and movies.

He was the third of four boys with an XL head and tennis-ball buzz cut. He was nine – an advanced pyromaniac, collector and kleptomaniac. The boy loved his matted, filthy mongrel dog that the father referred to as “The Democrat”. He spent endless Southern California hours painting Airfix 56mm plastic military figures and then would burn them in epic battles behind an old two-car adobe-style, stucco garage. He lived for sports, Christmas morning, the Fun Zone of Newport Beach and girls. I watched him dart through iconic places – the Grand Canyon, Crater Lake and SeaWorld in San Diego. Memories perfume the world around me. Each moment a feeling, each file an indelible memory of the sweet bird of youth.

th-2A conveyor belt of boys with buzz cuts move in and out of photos wrestling like pups in a whelping box, only to appear on the next page with noses covered in zinc oxide and faces freckled by the sun of a Newport Beach August. A husky fourth grader, the middle child had a romantic sense for everything and a leg that twitched faster than a floundering sea captain typing a Morse code SOS. Life was we imagined of the military, endless ceremony, uniforms, chores, boredom, moments of terror and the nine weeks of leave we called summer vacation where we would travel to exotic ports of call with names like like Newport Beach, San Francisco and Sedona, Arizona.

I recall being so bored one summer that we spent an afternoon pushing a dead cat with a stick. Vietnam was thinning our ranks of young men on television each night while we rode bikes through back alleys to tree houses defiladed from any parental supervision, decorated by hobos and stacked with Playboy magazines. The purple and sienna horizon line of the San Gabriel Mountains marked the eastern edges of our future. At night, you would look up and see the flickering lights of the radio towers – a West Egg star to steer by as you contemplated turning ten. If you were masochistic you could ease drop through the heating ducts to hear adult conversations — bungling politicians, war, stagflation, incomprehensible ethnic conflict and another orthodontia bill. These were adult hemorrhoids that the boy would not have to worry about for many years – unless he sat too long on a toilet reading comic books.

The boy loved his wolf pack. Beyond the holidays and Christmas mornings, there was uncontaminated humor, eternal optimism and the larger than life David Lean longing for epic adventure.

My mother reminded me a few years back when I complained about one of my children’s short attention span that she had to endure a phase where I had self-diagnosed dyslexia.   I used the “Mislexic” defense when I got pinched for stealing candy at the local Huntington Pharmacy. My mother was furious – asking rhetorical questions like “what were you thinking?” and “do you know what they do to boys who steal?” I recall looking her in the eye and saying, “I think I’m mislexic. I wasn’t sure if I should pay inside or after I got outside the store.

I progressed to feigning deafness to avoid the pressure of being called on in class. In retrospect, I should have become an attorney. At the time, I had a middle school teacher who used the Socratic method of calling on random students. To buy time, I would ask her to repeat the question two or three times. She recommended to my mother that I get my hearing checked.

Beep! Beep! Beep! Beep! Beep!

“Michael, let me know if you can hear the beep.”

The ENT made a perplexed face at my inconsistent answers. He expanded the headphones to reach across my massive dome to cover my ears. I suddenly realized that I did not want to fail this test or I might end up with those strange plastic tubes curling around my cochlea like the deaf kid who spoke such slow exaggerated words at summer camp. So I mixed up my answers. “Yes, no, no, yes. yes… “

“I don’t know what to make of these tests. His hearing – it’s all over the map. “

She seemed to know I had been faking but could not understand why. I confessed an hour later to my mother after being plied with a number Two burger and milk shake from Twoheys restaurant — and the ironclad promise of amnesty from my father who must never know I had pretended to be deaf. My mother had looked relieved. She really only had three looks – loving amusement, anger and relief.

I’m still searching the Turpin archives for the lost episode called “To Catch A Thief” where we were lined up like POWs because four recently baked cookies were reported missing.

“Okay, I’m going to close my eyes and leave the room. When I come back I want those four missing cookies on the plate.” All four boys shifted and shuffled at nervous attention. When my mother returned to the room, four more cookies were missing. It was in fact, a pure genius suggestion. It should be noted that a future investment banker orchestrated the caper – perhaps there was some merit to the efforts of Dodd-Frank.

As I sit in our Connecticut family room and return to a warm fire and these lost films of the 1990’s, I am swimming in another slow moving river of nostalgia. I recollect how important these moments were – the dawns and dusks of living at the center of a diminutive universe. Unconditional love. I’m smiling unconsciously at the invidious daughter who wants to return her newest baby brother to the hospital via the toilet. Her only-child days have ended and she will not go gently into that good night. The home movies chronicle a young family struggling up a mountain of life — moving to England with three small children, celebrating major holidays in strange and exotic places while recording each milestone through the mongrel accents of California children as they collide with strict English grammar and syntax.

Christmas, 2002 – A 3-year-old boy appears on camera, perturbed as he opens Father Christmas gifts.

“Dad?” He asks with a silky Etonian accent. “My friend Henry hates Jesus. I don’t hate baby Jesus but Henry says he hates him.” Muffled laughter on the other end of the camera.

(Camera pans to a lattice of gloomy windowpane)

In the northern hemisphere, the English winter malingers with ephemeral mist and dreariness. The sun is a pastel color form clinging to a low horizon. The camera zooms in on a cherub-cheeked boy who looks exasperated. He is excited for Christmas but can’t seem to shake the revelation that someone dislikes the child lying in the manger. (The scene cuts to bath time.) An older sister threatens her younger brother again with the toilet. Another DVD is a hard hitting interview with a five year old boy who agrees to a rare discussion about everything that scares him.

“Let’s see. Monsters. The Grinch and oh yeah, I really, really, REALLY hate Captain Hook.”

captain-hook-disney-villains-29300024-800-600“Hide and Hook” was a favorite game among my fear-addicted children. Like J.M. Barrie’s orphans, they dreamed of an island where kids were in charge and unexplained forces of nature were clumsy and easily vanquished. This version of Captain Hook had a softer and more incompetent side. He remained permanently one step behind, incapable of following through on any threat. He was a punching bag and a deep pocket willing to bribe children with sweeties – daily dishonest attempts to corrupt a child into the life of a buccaneer’s. My middle son was our emotional canary in the coal mine – losing his feathers during any time of stress or change. He had night terrors. My brave soldier once attempted to thwart his nighttime demons by he wedging a pillow against his bedroom door. The only person he could have possibly kept out would have been a starving vegan and there were certainly none in the year of our Lord, 2001. Our youngest supporting actor appears in each scene with a Sippy-cup – clad in the robin’s egg blue soccer jersey of the Italian star “Francesco Totti”.

As I devour the home movies, the phone rings and shatters my reminiscence. It is my Dad.

He wants to talk politics. I try to explain that I’m watching old movies and we divert from toxic polemics to the past. Normally, the conversation concludes with him wishing Hillary be indicted, Bill castrated and sent to Oman to guard a Harem and Obama given a one minute head start from Seal Team Six. Tonight, we float back like Scrooge and the Ghost of Christmas Past. We talk about growing up, aging, the wonderful holidays and all the traditions that have survived the decades. Time sandpapers any hard edges. For a moment he is no longer the critic – lamenting our cultural decline and complaining about the soft accommodations we now make in the name of inclusivity. He is Peter Pan who has grown up and forgotten he was once Captain Hook. I love him. For a moment, he laughs and remembers Never Land. That flicker comes into his voice falling like the ancient pixie dust of Tinker Bell. The space between us across three thousand miles of America is filled with the simple green grass promise of childhood.

It’s hard to avoid his fate and I yield a little more each day to the emotional calcification of one who has bitten the apple and been banished from Eden. I’ve played many lead and supporting roles in these movies of my life: ingénue, feckless husband, sybarite, world traveler, director, evangelist, coach, paternal sage and aging oracle. Yet across time, my favorite character was always the supporting role of Captain Hook – adversary to the Lost Boys and incompetent foil to those who seek to live for today and never grow old.

Is The Price Right? – An Early Look Into H.R 2300 – One Proposal for GOP Replace and Reform

This overview is a very early attempt to get you up to speed on the areas of health reform that are likely to emerge from the confirmation process of Rep Tom Price. There’s a temptation to dismiss everything being discussed as rhetoric or too early in the regulatory process. However, there are key themes and elements that will impact employer-sponsored healthcare that are likely to survive. In addition, other market trends are unlikely to change and as a result, require our continued vigilance and strategic discussion. In other words, the cavalry has not arrived in our battle with rising costs.

Tom Price’s Empowering Patients First Act (H.R. 2300) is of particular interest. It is unlikely to be accepted as a “replacement” bill but it offers keen insights into the GOP mindset guiding the notion of “repeal and replace”. It is likely if any legislation is approved, it would take years to completely implement and not unlike the ACA, reform could be whipsawed by another sudden political shift. Given the profile of the 2018 mid-term elections, its unlikely the GOP grip on the WH and Congress will change – at least until 2020 – more than enough time to drive a new legislative solution.

H.R. 2300 is important because its the only GOP-authored proposal that incorporates many elements of a “repeal” plan; and, despite the partisan acrimony of today’s confirmation interviews, Price is likely to gain confirmation and guide Health & Human Services and those charged with setting policy for commercial insurance, Medicare and Medicaid.

It’s impossible to summarize H.R. 2300 in one page but we wanted to underline and key talking points for you should you get cornered by anyone requesting a point of view on what employers should expect over the next four years. With the help of a recent Kaiser Foundation white paper, we want to offer an opinion. Clearly, it’s going to be a challenge to confidently predict whether the new administration will/can meet its promises. Yet, we are taking the liberty of staring deeper into the crystal ball and offering some insights. In no particular order:

H.R. 2300 Key Elements: Repeal ACA entirely, including individual and employer mandates, private insurance rules, standards for minimum benefits and maximum cost sharing, and premium and cost sharing subsidies. Provide refundable tax credits of $900 to $3,000 based on age to individuals to purchase insurance in the individual market. Require insurers to offer portability protections for people who maintain continuous coverage. Pre-existing condition exclusions and rate surcharges based on health status can otherwise apply. Implement state high-risk pools with federal grant support for three years. Establish Association Health Plans and Individual Membership Associations through which employers and individuals can purchase coverage. Permit sale of insurance across state lines.

Encourage use of Health Savings Accounts. Cap the tax exclusion for employer-provided health benefits and permit employers to contribute toward workers’ premiums for non-group health policies. Permit enrollees of public programs, and employer-sponsored group health plans to opt out of coverage in favor of private non-group insurance with tax credit subsidy. Repeal Medicaid expansion. Repeal Medicare benefit enhancements, savings provisions, and premium for higher-income beneficiaries, taxes on high earnings, and quality, payment and delivery system provisions. Eliminate certain constraints on private contracts between physicians and Medicare beneficiaries and the amount that can be charged for services. Individual mandate no requirement for individuals to have coverage

Commentary: This legislation is about establishing universal “access” to the individual market and to create a robust range of products whose coverage and cost will vary dramatically – well beyond the percentage of AGI and actuarial values mandated by the ACA. The creation of tax credits and vouchers to purchase in the individual market and guarantee issue based on coverage continuity could create opportunities for employers to offer financial incentives for employees to opt into coverage pools other than those of the employer. H.R. 2300 relies on financing much of the legislation through a cap on the taxation of benefits

Premium subsidies to individuals – Provide a refundable, flat, tax credit for the purchase of health insurance in the individual market ($900 per child, $1,200 age 18-34, $2,100 age 35-49, $3,000 age 50 and over; indexed by CPI.) Tax credit can be applied to any individual health insurance policy sold by a licensed insurer, including short-term policies, but not excepted benefits (e.g., insurance only for specific disease); excess credit can be contributed to HSA. Permit individuals eligible for other health benefit programs to receive a tax credit instead of coverage through the program. Repeal ACA cost sharing subsidies.

Commentary: It’s likely the number of those insured under reform will reduce if the government moves toward less generous tax credits as well as grants Medicaid block grants to states to manage those expenditures as they see fit. The increasing of uninsured and a greater emphasis on high deductible plans could lead to higher incidents of bad debt and increases in unreimbursed care.

Benefits Design/Reporting – Repeal ACA essential health benefit standards, preventive health benefit standards, mental health parity requirements for individual market and small group market policies. Repeal ACA prohibition on lifetime and annual limits. Repeal ACA limits on annual out-of-pocket cost sharing. State flexibility to mandate benefits; state benefit laws preempted for policies sold through associations, or by insurers selling across state lines. Proposed Price bill/legislation is silent on self-insurance exemption for larger self-insured employers.

Small employers can buy coverage through association health plans (AHPs). For fully insured small group AHPs, state rating laws and mandated benefits are preempted. Self-insured AHPs permitted; for federally certified self-funded associations with membership of at least 1,000, State regulation is preempted. Maintain dependent coverage to age 26. Repeal ACA minimum loss ratio standards, rebate requirements for insurers with claims expenses less than 80% of premium revenue (85% for large group policies). Repeal ACA right to independent external appeal of denied claims. Repeal ACA transparency standards, including requirement to offer standardized, simple summary of benefits and coverage, and requirement to report periodic data on denied claims and other insurance practices.

Commentary: Insurers are likely to benefit from specific changes although Price has historically been at odds with insurers – particularly in areas where insurers attempt to intervene between a treating physician and a patient. Employer reporting requirements should be simplified and the most cumbersome elements of the ACA are likely to be eliminated.

Employer requirements and provision – No requirement for large employers to provide health benefits that meet minimum value and affordability standards; repeal prohibition of excessive waiting periods. Cap annual tax exclusion for employer-sponsored benefits at $8,000 for self-only/$20,000 for family coverage, indexed annually to CPI. Require employers that sponsor group health plans to offer employees an equivalent defined contribution for the purchase of health insurance in the individual market. Permit employers to automatically enroll individuals in the lowest cost group health plan as long as they can opt out of coverage. Wellness incentives up to 50% of cost of group health plan permitted. Encourage use of Health Savings Accounts (HSAs) with one-time refundable tax credit of $1,000. Also raise annual tax-free contribution limit to $5,500; Allow tax-free transfer of HSA balances at death to any beneficiary. Repeal ACA prohibition on pre-existing condition exclusions. For people with at least 18 months of continuous prior coverage, no pre-existing condition exclusion period can be applied. For people with less than 18 months of continuous prior coverage, exclusion periods up to 18 months are permitted, but must be reduced by prior continuous coverage.

Commentary: Capping the annual exclusion for health benefits at $8k/$20k is credible foreshadowing that the taxation of benefits is on the horizon. Those that breathed a sigh of relief that delay and subsequent change of POTUS meant the defeat of the Cadillac tax, must be prepared to review the value of their plans. Taxation could set in motion a mass migration toward high deductible plans. Offering an equivalent defined contribution to employees to purchase on the individual market could give rise to associations and individual purchasing groups competing with or attracting employees into alternative purchasing groups. The emphasis on defined contribution could further accelerate the move toward private exchanges.

Health system performance- Health care professionals engaged in negotiations with private insurers and health plans over contract terms are exempt from federal antitrust laws. Create a health plan and provider portal website to provide standardized information on health insurance plans and provider price and quality data. Provide states with funding to implement the standardized health plan and provider portal website.

Commentary: Doctors can now organize purchasing cooperatives and in doing so likely to drive up unit cost through more collective bargaining with insurers.

Tax revenues – Repeal ACA tax changes, including the individual and large employer mandate tax penalties, Medicare Health Insurance (HI) tax increases on high earnings, Cadillac tax on high-cost employer-sponsored group health plans, and taxes on health insurers, pharmaceutical manufacturers, and medical devices

Commentary: Revenue increases from new cap on tax exclusion for employer-sponsored group health benefits

Source of policy insights on H.R.2300: The Henry J. Kaiser Family Foundation http://kff.org/health-reform/issue-brief/proposals-to-replace-the-affordable-care-act/