Postcards Hung on A Distant Mirror

imagesThere is an ancient oak on the corner of my rural street that is always first to turn its back on summer. The pastel colors appear unobtrusively frosting the highest branches and whisper that change has once again found me. Life in a small New England town has its own predictable rhythm of seasons and stages. The dog days of August have been reduced to a collage of digital pictures littered across Facebook pages – a happy memorial to moments when our family once again finds each other for adventures across lakes, mountains and across two coasts of America.

My body and my priorities are shifting with middle age as I become keenly aware of the passage of time. As a helicopter Boomer, I have spent two decades along a thousand green grass sidelines and silhouetted in the deep recesses of school auditoriums. I did not want to miss a single moment of my captive constituents. It is in sharp contrast to my own childhood where we were released into the wild as soon as we could master a Schwinn bicycle. Fathers were only seen after 9PM at night and on weekends.

My Dad chuckles at the myriad photographs of our teenagers logging more frequent flyer miles than a traveling salesman.  He wonders whether my insistence on work life balance is an improvement on his T-Rex parenting or perhaps a sign of the permanent blurring of the lines between parent and child and as such, the decline of Western Civilization.

“You don’t see the Chinese attending every school concert.”  It’s always about the Chinese.

“Well, Dad, I don’t know.  I’m not living there.  And besides, most families have only one child.”

We usually end up tangled in a kite string knotted with political disagreement.

“I was not supposed to be your friend. I was preparing you,” he would retort as we argued over his logic enforcing some nuclear punishment for a molecular misdemeanor. Ah yes, grasshopper, times have changed.

I now find no greater pleasure than sitting around an August dinner table becoming the butt of my adult Millennials revisionist recounting of any day spent together – unplugged and in close quarters. As they grow old and leave our nest, the house has transformed into a listless museum of artifacts from an earlier time. I am reduced to a mere curator.

I am the ornithologist who, having spent months feeding his captive condors with a bizarre plastic hand puppet, must now release them into the wild. Our drop-offs at college have now become emotional pilgrimages as we take endless iPhone photographs and splash them affectionately across social media documenting our fledglings in their new nests. This sits in sharp contrast to 1979 when my parent’s loaded up my possessions in large hefty bags — barely slowing their car down to 15mph before shoving me out on to the curb of a blazing hot suburban, Claremont College street.

I could have sworn I heard Dad say, “Have a nice life!” as he whistled “It’s The Most Wonderful Time of the Year.” My mother yelled something about not mixing colored and whites ( she meant laundry)  and my father reminded me for the millionth time of the myriad sacrifices he had made to finance my expedition into a private college education. Within days, he would turn my bedroom into a third home office. There was no such thing as a living shrine to his collegiate children. It was his house and he was taking determined to take ground lost to his teenaged parasites…damn straight!

An hour away, I was optimistically navigating a phalanx of young men moving toward what I thought was a keg of beer but turned out to be the only good-looking girl on our entire campus. I was on my own.

My roommate, Donald, was a circumspect academic who instantly assessed that I was going to be a problem. He had arrived hours before me – with both parents. His side of the room was outfitted with a mini-refrigerator, coffee machine, photographs of his family and a stereo system that resembled a NASA workstation. He was an only child.

After living wild among four feral boys, an insane cat and a promiscuous dog, I was unprepared for this massive dose of personal consideration and responsibility. I was a slob and could leave a trail that Helen Keller could follow. I was Oscar and Donald was my Felix. I am not sure which of us was more distressed by the fickle fates that lashed us together. He was a soft, erudite Eloi – spending his early mornings reading the Wall Street Journal in the dining hall, and faithfully attending 8AM classes while I led the sullied life of a carnivorous Morlock, laboring at night – refusing to rise before the sun had arced above the trees to remind me that lunch was being served.

Over the year, the room became a collision of ideologies. One roommate – a German laser guided missile who would make provisions for events that might be years away; the other, a loud Irish skyrocket with no discernable trajectory. Donald was a genuine passive aggressive. He would not have survived a nanosecond in the house of my father. He looked at me as if I was an I-5, ten-car pile up and would talk to himself in first person when he was upset with me. As a single cell paramecium that moved only toward light, food, Grateful Dead music and the opposite sex, I was an alien – an extraterrestrial from a universe that seemed content with chaos and the sybaritic notion that tomorrow was at least 12 hours away.

I caught him one day dressed in his “church clothes”. It was a Tuesday and it seemed odd that this organized Lutheran would be attending a religious service.

“Did someone die? Are you, like, going to a funeral?” I asked.

“I’m interviewing for a summer internship with Goldman Sachs.” He sighed in the mirror as he looped his foulard tie under his collar.

I was perplexed. “Why would you want to work at a department store for the summer? I mean you could do much better working in a warehouse or washing windows.”

He started talking to himself again. “He thinks it’s a department store…a department store…” He left the room. I waited a few minutes and then helped myself to some Chips Ahoy cookies from his refrigerator and turned on an old episode of the Twilight Zone on his television. I laughed to myself thinking of Don working in the Men’s department in some lonesome mall.

It all flooded back to me as I dropped my son off at college this week. In many ways, he is my carbon copy – and each of his life experiences flood me with déjà vu moments of amusement. His departure has left our home with only one child remaining – me. My sixteen year old is unervingly responsible to a point where I am uncertain whether he was a changeling from the hospital.  There is now no one to blame for a mess or accuse of eating the last cookies. My collegiate was my air cover and my deflection and I was now releasing him into the wild.

We lugged his bedding, lacrosse gear, clothes and yes, coffee maker up to a pleasant two-bedroom suite on a heavy, humid afternoon. Students swirled like fireflies in blazing red shirts flashing smiles that masked apprehension and nervous sense of adventure. His roommate arrived – another lacrosse player and wide-eyed freshman excited to be free of his hand puppet feeders. Once the all-important beds were made and clothes put away, it was time to leave. The Resident Assistant stopped by to remind them of an orientation session while they stared out the window at a gaggle of girls confidently moving across the quad toward the cafeteria.

He seemed happy. I leaned in, “Be a good roommate. Don’t be a slob. Don’t waste this opportunity.” I was running out of advice – since most of it had already been heaped ad nauseum on his shoulders through four years of high school micro-management.

I turned one last time.

“Hey, if UBS or any of the local business guys interview on campus, let me know. You should get an interview.”

He gave me an odd look. “Why would I want to work at a postal company? I’m wanna make money. Besides, next summer is so far away.”

I opened my mouth and instead just took a deep breath.

Yep, that’s my boy and I already miss him.

To The New Canaan Class of 2014 – Vive Le Difference

my-brain-is-fullIt’s June – a special time of year when we dump three million fingerling seniors into the ocean of adulthood. As graduates of the “we will love you until you learn to love yourself” school of helicopter parenting, you don’t want more advice. But, you’re going to get it any way. Most of you just want to head west or south to find sun and towns with no police blotters or curfews. Good luck with that.

Many of you were born in 1996, the Chinese year of the Pig. This explains the state of your bedrooms, motor vehicles and your penchant to leave wrappers wedged between pillows on the couch.

When you were born, most of us read something by Malcolm Gladwell or an article in Parents magazine telling us that if we desired high performance outliers, we had to hold you back a grade. As a result, your graduating class is an uneven skyline of red-shirted college students and overachieving youngsters. Some of you have been driving since your sophomore year – a few legally.

When we were born before the Civil War, the mid wife gave us a swat to make sure we would cry. It was also a preemptive punishment for all the stupid things we were likely to do. When you were born, swatting was considered child abuse, so the Obstetrician merely asked you how you were feeling. You naturally did not respond and so you got a few free nights in neonatal intensive care and we got a bill for $900,000.

1996 was a wild year. A computer called Deep Blue beat the world chess champion Gary Kasparov. Kasparov later found a website on cheats and shortcuts and subsequently beat Deep Blue. In 1996, a wonderful microcosm of America passed away before you could get to know them. You know their iconic images but you never really felt their physical presence. Gene Kelly was a star who danced while George Burns reminded us that age was merely a number. Erma Bombeck told us never to give the car keys to a teenager and Timothy Leary, well, let’s just say he explored inner space while Karl Sagan came back from outer space to tell us we were not alone. Ella Fitzgerald improvised her way to become the first lady of jazz while militant and talented Tupac Shakur died as violently as the lyrics of his brilliant rap. Tiny Tim was our first trip through the tulips in light loafers.

You were pretty normal. Like all children, you loved the notion of having special powers. We played Pokemon, watched Dragon Tales and Arthur, read Harry Potter and observed you with fascination as you got your first taste of dystopia in The Hunger Games. Up to that point, your idea of dystopia was a house without a pimped out basement and any kind of “because you live here” chores.  A few years later, we all went to Washington DC for a family vacation, and got a real taste of futuristic dysfunction.

We tried to stop you from using violent video games but found them so much fun that we joined you on Black Ops missions. You always shot us in the back. When it came to inappropriate movies, it always seemed that you managed to see gory cinema du jour at someone else’s house. We still can’t figure out whose house because we all claimed that we did not allow blood and guts programming — unless of course, your Mom was out for the night and then we agreed that you would not tell about my smoking a cigar if I let you and your friends watch Jeepers Creepers 4.

For many of you, your biggest problems have arisen out of how to deal with a caste system borne out of prosperity. In life, as in nature, the seeds of true character only germinate during the wet winters of personal crisis. Some of you have already felt the sting of broken homes and tragedy. Green lawns and clean streets don’t immunize us from life. Some of you handled your challenges with incredible grace. Through these challenges, you guys cared for and loved each other. That capacity to put someone or something ahead of you is a sign of great emotional intelligence.

Like all of us you don’t like trials and tribulations. Hell, some of you don’t even like the dentist although it is ten times better now than when we were clutching the chair having cavities filled by escaped war criminals. I digress. The fact is you will need to have your fair share of failures and would prefer to avoid them. Woody Allen once shared “I’m not afraid of dying.  I just don’t want to be there when it happens.”

You are part of a demographic cohort called the “Millennials”. Authors Strauss and Howe educated us that your tribe is characterized by extreme confidence, social tolerance, a strong sense of entitlement and the narcissistic tendency to take photographs of yourself and post them 100 times a day. Like the generations that preceded you, you are regularly accused of being pampered and unprepared. Yet, Strauss and Howe boldly predict that you will become civic-minded and in the face of some yet to be defined great crisis, emerge as a hero generation. It will reassure us if you occasionally start looking up from your phones – if for no other reason than to see the bad guys when they are coming.

We see you seniors like Internet start-ups — full of promise, cool ideas and with a market cap that far exceeds the fact that you still don’t make any money. However, our irrational exuberance for you keeps us investing.

Please understand we do not like regulating your every move as teenagers but we are now being told that we are bad parents if you screw up. The headline seems to now be that life is over if you get caught doing something stupid. Here’s the good news: You’ll recover. America loves a comeback — just ask Bill Clinton who is the only head of state in US history to generate successive budget surpluses, be unsuccessfully impeached, have an affair, stay married, be President and possibly become a First Lady.

You are smart. You adapt rapidly — some of you resemble human thumbs. But please don’t use your handheld devices as an excuse to avoid social interaction. Nothing will ever replace the joy that comes from helping and interacting with other people. Be fearless. The only thing that seems to really scare you is Tony’s Deli being closed on a snow day.

You are a tolerant contrarian bunch that don’t seem to buy into any rigid dogma that excludes others, labels them or requires a greater than thirty hour workweek. You are like the French. You appreciate the finer things in life and prefer to be on vacation when you are not eating, making out or sleeping. You look great in shorts and Capris while the rest of us are putting in 25 watt Blanche Dubois GE light bulbs – ostensibly to conserve energy.

You have a chance to fix the financial mess we have left you but you have to decide between austerity or trying to grow your way out of the hole. Just remember that a strong middle class anchors any society and the true measure of any civilization is how we treat the least among us. Don’t watch MSNBC or Fox, you’ll live longer. South Park is okay. Life outside our bubble is hard – and not every body wants to play by the same rules. Being a humanist is hard. If any of you start a new political party, count me in – especially if it includes eating Nutella crepes and drinking cappuccinos.

Focus on other people because as a rule of thumb, most of you are your own worst enemy. You will spend your lives on a schizophrenic quest for interpersonal unification — trying to merge the tripartite of personalities that is you — the person you project to the world, the person you secretly believe yourself to be and the person your mother knows. The day those three people become one, you will be officially self-actualized or possibly doing thirty days in the can for having the guts to throw a shoe at a public official.

Life is messy, like your bathroom.  You will fail and it will seem weird the first time you don’t immediately hear that familiar whump-whump of the parental helicopter on the horizon. You’ll have your Khe Sahn moments, isolated, no air support surrounded by circumstances that trigger all your self-centered fears. It’s in these moments you will find your capacity to dig in and fight harder. You’ll appreciate everything that you truly earn more than what is given to you.

That sore thing on your hand that you once got shoveling snow is called a callous. It’s a badge of honor suggesting that you worked hard. We can tell when we shake someone’s hands if they have ever met a rake or put in a day’s hard work. Although, be careful being fooled by golfers, they have callouses but tend to avoid late afternoon meetings.

If you choose to attend college, don’t waste your next four years. Get your butt out of bed and go to class. It costs about $2,230 per class so go and learn something. There’s more to life than knowing how to make a mean Mai Tai. To succeed in a flat, competitive world, you’ll need the equilibrium of a jet pilot and the guts of a burglar. You acquire those skills in alleyways, not in your room watching six consecutive seasons of Breaking Bad.

Don’t be a victim. I assure you that whatever higher power you worship has the same desire for you that we do — for you to be happy and to leave the world a better place than when you found it.

Just remember, people are not FTEs or headcount, we are souls on a spiritual journey. Everyone has value. Be a rock of predictability and an oasis of empathy. Never take the last of anything. Make your bed when you stay at someone’s house and strip the sheets. Don’t wear shoes without socks. If your first roommate is nicknamed “Lysol” or “Candyman”, ask for a new one. The semester won’t end well.

Remember Rome was not built in a day and that it rotted from within because of weak politicians, foreign wars and the fact that everyone was inside with their air conditioners on and could not hear the Vandals coming. For that reason alone, always keep a window open.

Be French and live well. Study history and remember the famous line of De Tocqueville, “When the past no longer illuminates the future, the spirit walks in darkness.”

Class of 2014, Vive le difference !

 

ACA 101: Hammers. Nails and An Employer’s Search for Objective Advice

Image

In ancient Athens, the philosopher Diogenes wandered the daylight markets holding a lantern, looking for what he termed, “an honest man.” It seems since the dawn of the consumer economy that customers and buyers have traded most heavily on a single currency – trust. Three millennia later, our financial system still hinges on the basic premise that the game is not rigged and any trusted intermediary is defined by a practitioner who puts his client’s interests ahead of his own.

Anyone responsible for procurement of healthcare may feel like a modern-day Diogenes as they wander an increasingly complex market in search of transparent partners and aligned interests. The art of managing medical costs will continue to be a zero-sum game where higher profit margins are achieved at the expense of uninformed purchasers. It’s often in the shadowed areas of rules-based regulation and in between the fine print of complex financial arrangements that higher profits are made. Are employers too disengaged and outmatched to manage their healthcare expenditures? Are the myriad intermediaries that serve as their sentinels, administrators and care managers benefiting or getting hurt by our current system’s lack of transparency and its deficit of information?

Who’s to Blame for the Failure to Rein In Healthcare Costs?

In his recent column “Yes, Employers Are To Blame for Our High Medical Prices,” Princeton political economist Uwe Reinhardt controversially lays partial blame for the healthcare cost crisis at the feet of employers. Reinhardt suggests that some employers have been passive, uninformed and in some cases, unable to muster the internal energy to get their own leadership teams to commit time to becoming more informed purchasers of health services. Where corporate procurement might realize aggressive discounts from vendors, healthcare has remained outsourced to insurers who have been largely unsuccessful in controlling rising costs and conflicts of interest.

Poor procurement arises out of a failure to act properly – to be informed, to be prepared and to ask the right questions. Some critics of our broken system complain that employers are simply getting poor advice from consultants, agents and brokers who often move at the speed of disruption-averse clients. Some point to government for public-to-private cost-shifting, poorly conceived legislation, and poor regulatory oversight over an industry that has witnessed the rapid consolidation of hospitals and insurers into an oligopoly of control that is difficult to deconstruct.

As the next phases of reform plays out across public and commercial markets, unintended consequences, odd alliances and new conflicts of interest will arise out of the ground fog of purchasing choices. Employers without a firm grasp of the key elements of healthcare cost-management are likely to fall prey to flavor-of-the-month stop gap solutions or Trojan Horse cost-shifting schemes that may control employer costs but will do little to ameliorate underlying negative trends.

Will Self-Centered Fear Reveal the Worst of the Industry?

Healthcare industry stakeholders are scrambling to remain relevant as the locomotive of Obamacare leaves the station. Players once considered essential stewards and stations along the tracks to controlling healthcare costs are worried that they may soon be bypassed. Disintermediation is weighing heavily on anyone who sits in between those that deliver care and those who consume it. The national vision seems clear: universally affordable health coverage leading to lower costs for both the private and public sectors. And while we are at it, let’s toss in a free flat-screen TV.

Employers are naturally cynical to the legislative complexities of the ACA and are having a tough time trying to figure out how to use the momentum of health care reform to make changes that will insulate them from future cost increases. But, it’s hard to know which direction to go – especially when opinions diverge around the likelihood that market-based reforms can lead to sustained low single-digit medical trend. It’s getting hard to know whose opinion to believe, and worse yet, what is motivating their point of view.

The anxiety around disintermediation is causing many stakeholders to explore how to move up and down the services value chain in an effort to carve out a permanent role as a participant in the new age of healthcare delivery. In doing so, many firms are discovering inherent channel conflicts and developing facilities that may cannibalize their own existing business models to survive the digital transformation of an analog industry.

If we believe that any 2.0 version of a solution should be better, faster and cheaper, we should be excited about the changes that lay ahead. The challenge for employers will be to see through to the institutional incentives that are causing many players to pivot into new business models – consultants selling products, hospitals selling insurance, insurance companies becoming providers, and employees being asked to become consumers. Just how muddy is the water getting? Consider the following positions.

Hospitals

As inpatient admissions continue to decline and larger healthcare systems find themselves burdened with brick-and-mortar overhead and high unit costs, there is pressure to continue to pivot into integrated health delivery and higher volumes of ambulatory and outpatient services. So far, so good.

With healthcare reform, these same hospitals are being encouraged to form risk-bearing Accountable Care Organizations (ACO) to help manage population health of retirees and share in the subsequent savings that could be achieved by focusing on value instead of volume. It seems an easy jump to turn an ACO into a commercial venture offering employers the ability to contract directly with the large hospital system as their medical home – essentially becoming an HMO, bearing risk for the health of its members. Incentives change from treating illness to keeping people healthy. The big problem is most of the hospital systems putting their toe in the water of these risk arrangements are also the most expensive hospitals in any PPO network.

Will these hospitals be able to achieve competitive unit cost and low year-on-year trend increases, or will they simply reduce some cost by disintermediating insurers but continue to charge higher costs for services? Once risk shifts to integrated healthcare delivery systems, expect more liability arising out of alleged conflicts of interest and rationing of care.

Insurers

Many argue that insurers, not unlike banks, have become highly risk averse and are rapidly moving toward a new role as health service and technology infrastructure providers. Most insurers have failed to become trusted consumer brands. Much of this distrust is arguably deserved given their historic insensitivities to customer service and business practices that left purchasers unable to decipher the complex and seemingly arbitrary calculus of pricing and claims payment policies. Most small and mid-sized employer renewals have become frustrating annual rites of passage.

Truth be told, most fully insured employers are beginning to understand that healthcare is like a Las Vegas casino – if you play long enough, the House always wins. The deck is further stacked against business as employers are often scared away from more efficient financing methods like self-insurance to fully insured, bundled programs where all health services are provided through a single insurer including RX, behavioral health, chiropractic and radiology. Bundling affords insurers ample pricing mobility to move required margins across a range of services to achieve their profit targets. While there is nothing illegal with these business practices, it does give rise to healthy cynicism regarding the industry’s commitment to achieve affordable care over personal profit. As one healthcare executive commented, “Look, our job is to hide the Easter eggs and your job (as an advisor) is to find them.”

Public managed care stocks are enjoying 52-week highs as Wall Street clearly sees no signs of near-term pricing pressure. Optically, the new insurer business model, which is now expanding into Medicaid and Medicare, gives the appearance that insurance firms are operating at lower margins while their health service subsidiaries report record growth and profit. It’s hard to trust a vendor who is both serving clients as claim payer and providing services through a subsidiary for undisclosed transfer pricing. This practice will give rise to conflicts of interest as payers pivot into providing care.

Consultants

Large consulting firms have long-since laid claim to the high ground of objective employer advocacy. As retiree medical and RX costs began to balloon in the late 2000’s, consulting firms saw value in carving out elements of these costs from insurers — creating owned and managed facilities to purchase drugs and offer defined contribution retiree exchanges. A rush of mergers and consolidations introduced additional services to traditional Human Resource and Employee Benefits consultants offering outsourced administration and defined contribution exchanges for active employees. The success of these first-generation facilities led to higher margin annualized revenue streams and a pressure to expand proprietary product solutions into a culture that had historically been agnostic to solutions and vendors.

As employers express interest in exchanges and alternative delivery models, consulting firms see an opportunity to leverage their trusted relationships to steer clients to owned and operated facilities. While clearly believing their owned solutions offer a better mousetrap, the fee for service consulting community is now confronted with a business model conundrum. Do we create products and proprietary facilities to meet the profitable and growing demand for administration and service platforms? If so, will our own consultants consent to steering our customers to our own facilities?

To add additional pressure, Wall Street has rewarded public consulting firms and defined contribution/benefits administration companies with generous valuation uplifts – increases in market cap well ahead of actual enrollment, creating internal pressure to promote exchange participation to deliver on analyst expectations. Certain analysts are convinced that the majority of large employers will convert to exchange-based purchasing in the next decade and in doing so, they are seeking to invest in firms that seem positioned for these future purchasing trends.

The administrative services that accompany many proprietary online enrollment platforms will benefit exchange managers, creating almost captive relationships as employers see higher frictional costs moving from one exchange to another. Employers may essentially be stuck paying annual administration and commissions as part of an exchange-based relationship. Where a consultant should play the role of trusted advisor to help choose the exchange that is best for their client, firms will now be pushing their people to endorse their own exchanges, and in some cases, promote financing arrangements that defy decades of empirical data — in particular those exchanges that are encouraging employers to convert from self-insurance back to fully insured financing as a means to promote purer competition between carriers. Befuddled HR professionals are increasingly torn between long-term institutional relationships and a nagging suspicion that their consultant is now promoting a model out of self-interest. Now armed with hammers, it appears that every client is beginning to go look like a nail.

Brokers/Agents

Brokers and agents have long enjoyed a too-cozy rapport with their HR and Benefits counterparts in small and mid-cap America. In the world of middle-market brokerage, generalists are often advising generalists and relationships routinely trump fiduciary accountability. Brokers leverage relationship-based trust and are often heavily influenced by how they are remunerated. Some brokers prefer fully insured plans as administrative costs, taxes, fees and commissions are commingled and not as visible to a cursory review of costs. One could argue that commissions by their very nature create conflict of interest. The continued practice of volume and contingent-based bonus payments also clouds the broker’s ability to claim total objectivity.

Most relationship-based employers do not question or understand their broker’s remuneration arrangement or in some cases, may knowingly pay higher commissions to their broker so the broker might serve as an outsourced benefits staff – using headcount that HR could never successfully justify internally because of finance and staffing controls.

Healthcare 2.0 will be characterized by data – lots of data and an increased dependence on compliance and technical resources that will shake the traditional transactional broker profit model to its core. Informed clients will desire transparency and accountability for all services, and judge value based on a numerator of outcomes divided by a denominator of cost of services. Brokers will need to be able to demonstrate actionable interventions, improve clinical trends, assist with optimal financing arrangements (including actuarial support for plan value-setting and financial forecasting), provide strong communications and HR support for concierge and employee engagement tools, and understand healthcare economics expertise to hold insurers accountable for achieving network discounts while limiting hidden margins and fees. Transactional placement skills will be table stakes as the 2.0 broker reinvents themselves as a solutions provider with no embedded conflicts of interest. The big question remains: Is it possible for the broker’s goals to align completely with the client’s goals?

Human Resources

A Human Resources manager facetiously shared with me, “I got into the business because I really liked people and I hated math. I now spend my days with a calculator trying manage a massive human capital spend and I don’t really like people.” If you watch where most HR and Benefits Managers’ feet go, it is not in the direction of disruption and greater intervention into the personal and consumer healthcare habits of employees. America’s C Suite has been surprisingly unwilling to spend the time with HR to understand the root causes of their healthcare costs and instead condones what is now a regular and unimaginative annual cost-containment exercise of cutting benefits and increasing contributions as a means to achieve a workable healthcare renewal price point.

While Professor Reinhart’s gentle rebuke of HR may have been a bit undeserved, it is not completely without merit. Structure has long since trumped strategy in employer healthcare plan management. A good renewal sees very little changing, when in fact, change must occur if behavior is going to change. “Disruption” is a broad, amorphous HR term used to describe anything that creates additional work in the form of employee complaints and additional distractions from the job of doing one’s job. To avoid the steeper slopes of the healthcare cost-containment mountain, those charged with overseeing Human Capital have travelled the easier, well-trod trails of cost-shifting, resulting in the erosion of take-home pay.

Given that 90% or more of America’s HR and Benefits professionals are responsible for healthcare but are not rewarded for delivering low, single-digit medical trend, it’s no wonder that their focus is on where they do get rewarded – limiting noise, smoothing feathers and keeping the planes and trains of human capital running on time.

One HR Manager related, “It’s hard to get management to focus on the complexities of healthcare spend. They want to see the year-over-year costs and whether their doctor is still in the PPO network. They don’t have the attention span or interest in tackling all these issues.” Sound familiar?

So Who Can An Employer Trust?

Trust and transparency must be the currency that anchors the employee benefits marketplace of tomorrow. No one in a corporate HR and Benefits role can afford to be seen as a friend and not be seen as a fiduciary. Stakeholders – insurers, consultants, brokers, providers – are all scrambling to preserve their roles as trusted B2B advisors while nervously anticipating a growing consumer market. While public exchanges limp along and blue states and red states fight over the notion that reform is succeeding, employers will be on their own for the foreseeable future – forced to revisit their vision, strategy and structure for healthcare and benefits. In the end, it’s all about aligning incentives. If a CEO tells his/her HR team that 2015 bonuses hinge on managing medical costs to a 3% trend or less – without raising contributions or reducing benefits – one wonders whether friends will become overnight fiduciaries.

In the months and years ahead, employers will find themselves wandering among the tall trees of monolithic insurers and a dizzying new roster of online and consumer engagement tools. It will be all about alignment of interests and holding people accountable for results – not bedside manner. Purchasing will require a lot of homework, faith and a strong sense of the corporate values of the partners you choose to help you shape your plans.

If ever there was a time for honest, unfiltered advice, it’s now. The search is on for affordable healthcare and for stakeholders who are beholding only to their client’s interests to get costs under control

Swimming Towards the Light

 pedestrians-falling-ice-new-york-cityWinter…was a purifying engine that ran unhindered over city and country, alerting the stars to sparkle violently and shower their silver light into the arms of bare upreaching trees. It was a mad and beautiful thing that scoured raw the souls of animals and man, driving them before it until they loved to run.  – Mark Helprin, Winters Tale

I am swimming through March like a hulking creature trapped under a layer of ice.  During this annual period of prolonged hibernation, I only move towards food and light.  I am restless, irritable and discontent.  If a scientist espousing the irrefutable evidence of global warming were to cross my cantankerous path, I would beat him with my snow shovel and bury him in a shallow grave filled with rock salt.

Each weekend, I don my running gear, desperate for exercise and dopamine.  On this particular Saturday, weak sunshine courses through the family room windows suggesting that spring has indeed arrived on the wings of red-breasted robins and lavender crocus

I open the front door to a blast of Alberta air that slashes my face and causes the dog to retreat into the foyer.  Brody, my fearless Aussie, looks up at me to gauge my resolve to exercise.  He seems to be suggesting that we stay home and forage for leftovers.  As it stands, we are already likely to be last to die in a famine.

It is 30F with a wind chill that has reduced the sun to a useless dead apricot in the sky.  It seems to have lost much of its potency after a prolonged stay in the Southern Hemisphere.  Clouds course overhead casting frigid shadows as they rush to the Northeast to deposit more snow.  The bloated pirate Winter mocks us, declaring us summer landlubbers, unfit for the brittle day that hangs like an icicle. Screw it.  We are going outside – even if one of us has to eat the other.  We brave four miles of northern wind and frozen inkblot ponds. Not a robin or crocus in sight.

We later retreat indoors while the persistent wind claws at our windows.  Heat courses out a decade of unattended cracks, broken weather stripping and an attic that could double as a meat locker. My front hallway has more cold spots than a haunted house.  Growing up in in Los Angeles, we opened the windows for air conditioning and closed them for heat.  It now costs me $100 a month for each precious degree I wish above 55F.

At this time of year, the dividends of four-season living elude me.  I don’t really mind the snow but temperatures under 20F really piss me off.  As a native Californian I know I have a choice to live here but my home state has changed. I am not sure I am attractive enough now to live in California.  I left the Golden State a svelte thirty-eight year old and now resemble a friendly manatee – a work out video’s permanent “before” photograph.

It hurts to know it is 80F in LA. Despite its fiscal woes, a recent 4.7 earthquake (we call these baby tremblers “jello-jigglers”), a 100-year drought and a few mudslides, it still looks pretty damn good.

I recall almost succumbing to the early March Lion just walking five blocks up 10th Avenue after a cab driver dropped me prematurely in ten-degree weather.  During my right-angle walk into a fierce headwind, I tried to speak to a mummified pedestrian who sounded like Kenny from South Park. I needed the shelter of a coffee shop.

“I…Cold…Coffee…What…So…Cold”

The faceless bundle of laundry pointed toward a brown awning whipping in the north wind.  I exploded into to the coffee shop on a jet stream of angry wind. The pierced, tattooed girl behind the counter considered me with classic militant disdain.  She looked uninterested as I struggled to recover the use of my face.

I sat in a corner and considered this subzero moment.  The City was now a clenched fist – – rigid, fighting to hold on to everything much like a hoarder refuses to part with any possession.  It will not release heat in the summer and clutches to its infertile chill in the winter.  We lunge down its streets and cut through its passages, tightening into pill bug pedestrians that hobble between cars and plumes of frozen air.

I enter the lobby of a building on Madison Avenue as a bitter gust courses through the revolving doors.  I take the elevator to my client’s floor.  It is now like a Native American sweat lodge.  I may soon discover my spirit animal as I almost pass out from the ninety-degree heat.  In the client’s foyer, I have a heat stroke vision of the great white manatee.  The aquatic behemoth moves nimbly under the water, twisting as he scours the ocean floor for turtle grass.  He turns and grins with his bizarre prehensile upper lip.  He has my eyes.  Opal blue optimism shines as he jerks to one side and disappears under a dust devil of underwater sand.

The winter daylight seems to last less than four hours before a purple twilight canopy is cloaked over the frigid boulevards. I exit the office to catch the 6:09 train only to slip on an agate piece of ice that causes my foot to shoot into the side of a fire hydrant. I can almost hear the salt pulverizing the leather of my shoes as I hop on one foot across 38th Street and stumble toward Grand Central.

A bike messenger screams at me as he tears through a red light dressed only in a cotton shirt and spandex pants.  He will most likely be dead in one hour but I respect his sartorial protest.  He probably thinks he is a snow leopard.   I am uplifted by his refusal to allow this frozen season to defeat him.  He yells into my face and races toward a different fate.

I am suddenly exhausted and crave caffeine, and carbohydrates.  I cannot think too far into the future.  I have already overdrawn my bank account of thoughts of warmer days and French jazz spilling out on to a café on the Champs D’Elysse.  I am frozen and pissed off.  It’s March, for God’s sake.  Until May, I will be crowded in a shadowed glen of denuded trees that slowly push buds toward the arching Southern light.  Spring cannot arrive too soon.  This manatee needs sun, warm water and a little turtle grass.

As I walk across 42nd , I am approached by a gray, shaggy oracle. He greets me in mid-sentence as if we are picking up on a conversation that had been cut short.  He is speaking a strange frozen gutter dialect.  We are having a NY moment.  Crazy always finds crazy.

This prophet speaks to me about the cold weather through a gray tangle of hair, inebriation and filth.  He is either asking me for some money or informing me that a group of trolls will begin hunting me tonight.   I have violated my Mother’s golden rule of never making eye contact with the insane. Our senses lock and he continues his three-tooth soliloquy that is unlike any language I have ever heard.  I am transfixed.  He senses my winter lunacy.  He has found a soul mate and I’m going to miss my train. I hand him a sawbuck and tumble inside the station.

Two things stay certain: it is still winter and crazy always finds crazy.

Buy a T-Rex Book for Someone You Love….

Buy a T-Rex Book for Someone You Love….

We all have that certain special someone in our lives – that angry, disaffected, the world-is-going-to-hell and our President is really an enemy agent kind of friend or relative who needs to either be euthanized like a lame horse or trained to laugh…Arsenic is expensive and unless you live in Oregon, I suggest you give him or her a copy of T-Rex By The Tail or Bicentennial Rex for Christmas or Hanukkah. Hell, get them both books!

At a minimum, do your patriotic bit to stimulate the local economy and buy a copy from Elm Street Books or simply click on this web site’s masthead and help Jeff Bezos make an extra $10k to tip his pedicurist by using Amazon.com.

According to one angry T-Rex, “each dollar you spend helps prime the economy, keeping  people employed and paying taxes – taxes that go to fund do-gooder give-aways, socialized medicine and stitch together a social safety net that is becoming a massive European style hammock….Grrrrrr!”

A few reviews:

5.0 out of 5 stars LOVED IT, July 29, 2012
Amazon Verified Purchase(What’s this?)
This review is from: T-Rex By The Tail (Paperback)

I knew it was going to be a good read, have known Mike for years. All I had to do was get past the first few pages , it was tough, and the rest was easy. I do remember being raised by a “dinosaur” and even see Woody in alot of the chapters. Mike has done a great job of allowing the younger generation to see what child rearing was, and maybe still should be, like . Congrats to a great author, and THANKS !!!!!

5.0 out of 5 stars Not Your Father’s Brady Bunch, July 29, 2013
Amazon Verified Purchase(What’s this?)
This review is from: BiCentennial Rex (Tales of The T-Rex) (Volume 2) (Paperback)

This is a fun book. What self-loving Baby Boomer wouldn’t love to take a trip down a memory lane lined with humor and keen insight? And it’s a very fun and realistic trip at that. Turpin captures the charming idiocy of the adolescent male (I apologize for the multiple redundancies in this sentence) growing up in the 1970’s with wit, verve and understanding. The Patton family is much more realistic (and amusing) than that “other” southern California tribe, the Brady’s. Just as clearly, Central Casting could never have managed to find an appropriate Karl (“Rex”) . . . the Patton patriarch – a cross between an Old Testament prophet and a sleep deprived George Patton.

This is a great and funny read, full of smarts and happy memory ghosts. I highly recommend it.

Bicentennial Rex is ready for your summer reading.

Bicentennial Rex is ready for your summer reading.

In 1976, it was a hell of a time to be a conservative. OPEC embargoes, women’s liberation, Carter, Watergate, the fall of Saigon, Laos and Cambodia as well as sex, drugs, rock & roll tugging at the pant legs of teenagers. It’s indeed a dark ( and humorous ) time in the Force of the Alpha Jedis…Read the book and expand your mind!  Here:s the link !  Pop it in your URL and buy some for friends and family.  Don’t let your kids read it.  It will blow your cover. http://www.amazon.com/BiCentennial-Rex-Tales-T-Rex-Volume/dp/1481200054