Stewart Mills doesn’t have much political experience.
Sure, the 44-year-old Republican candidate for the 8th District congressional seat ran in 2014, but he’s never held elected office — since age 14, he worked at his family’s company, Fleet Farm, and rose to political prominence on the strength of a pro-gun YouTube video.
Meanwhile, Democratic Rep. Rick Nolan, who narrowly defeated Mills last election, has a lengthy career in public life — he represented central Minnesota in Congress in the 1970s, and has held his current job since 2013.
There is one area, though, in which Mills claims some real policy experience: health care. For 15 years, Mills managed the health plan offered to Fleet Farm’s 6,000 employees, and he’s touted that resume point as a central reason why voters could trust him to be an effective policymaker.
What Mills did with Fleet Farm’s health plan offers a rare example of how the candidate puts his pro-business, anti-government philosophy into action — and gives a glimpse of how he might function as a member of Congress.
How Mills changed the Fleet Farm health plan
Mills began his dive into the world of health insurance in 1999, when at the age of 27 he took over as Fleet Farm’s director of personnel, overseeing health care benefits as well as other things like 401k and profit-sharing benefits.
He came to the post with little formal experience: he had taken health care classes while getting his degree at Northwood University, and he had participated in the Fleet Farm plan while working for the company.
For most of Mills’ time in the job, Fleet Farm had a self-insured group health plan — sometimes called a self-funded plan — which places upon the employer the financial risk of covering employees’ health expenses. Fleet Farm decided what coverage it wanted to offer employees, put up money to cover the costs in a trust, and then contracted with a third-party administrator — a company like Blue Cross Blue Shield, for example — to administer the plan.
Health care benefits were only offered to full-time employees at Fleet Farm. A typical store might have 100 full-time employees, with anywhere from 60 to 110 part-time employees, depending on the season.
Seven years into the job, in 2006, when the rates of Fleet Farm’s plan went up, Mills set out to devise a new approach to employee health care.
“We wanted to keep the same level of benefits but hold down costs,” he said. “What I did, broad strokes, is stepped back and said, anything you tax you get less of, and anything you subsidize you get more of, so let’s design a plan that is going to make our employees healthier.”
He was encouraged by studies showing that a high percentage of medical costs are preventable — as much as 50 percent, he said. “We had a $34 million plan with 6,000 people in it. Any dollar we could save is a dollar we could save employees.”
The prevention-oriented approach is what Mills said distinguished Fleet Farm’s plan — and what he claims made it a model for other companies to copy.
He explained that Fleet Farm picked up 70 percent of the employee’s insurance costs, leaving them to pay a 30 percent premium, with the money stocked in the company trust fund.
But Mills and his colleagues implemented a system through which employees could get their personal premium reduced to zero by submitting to one or more elements of a wellness program — called Mills Health Works — designed to bolster the prevention Mills talked about.
Employees could reduce their contribution by five percent by, for example, completing an online health assessment via the third-party administrator, which was Blue Cross Blue Shield. They’d get the same reduction by proving they exercised regularly, did not use tobacco products, lost weight, and improved blood pressure and cholesterol.
“If you did the online health assessment, exercised moderately, you didn’t smoke, your cholesterol and blood pressure was where it was, your BMI was where it was… You got health insurance for free other than co-pays or deductibles,” Mills said.
According to Mills, not only were employees healthier with this plan, but they were richer, too. Mills said that, at first, rates did increase, as people went on prescription drugs upon finding out they had conditions like high blood pressure.
“Then we saw a steep drop-off, when they were medicating correctly, they weren’t having the issues that were driving costs. The second year, [costs] were flat again, and the third year, because people were now healthy in the first and second years, we saw an actual decrease… in 2009, we were able to rebate money back. We gave money back to employees,” he said.
Mills was not shy about taking credit for what he called a huge success.
“I probably have, over my career, less than a dozen things I can say I did by myself. This health care plan was entirely my baby. I was the coach and the quarterback,” he said.
“It’s something I’m very proud of, and I can look at my resume and say, that’s something I did, it’s an idea I had, I put a team together, we did the work, and we did right by our employees.”
Was it a good plan?
These days, programs like Mills Health Works are common.
A 2014 piece in the New York Times cited a Kaiser Family Foundation study which “found that 36 percent of firms with more than 200 workers, and 18 percent of firms overall, use financial incentives tied to health objectives like weight loss and smoking cessation.”
That same study found that employers tend to be bullish on the positive effects of these programs in saving money and improving employees’ health. But the Times also drew on data to question how effective they really are.
“Rigorous studies tend to find,” wrote the Times’ Austin Frakt and Aaron E. Carroll, “that wellness programs don’t save money and, with few exceptions, do not appreciably improve health.”
There’s also another way of looking at health care-related financial incentives — as penalties on those who don’t comply.
“Wellness programs can achieve cost savings — for employers — by shifting higher costs of care onto workers,” Frakt and Carroll wrote. “In particular, workers who don’t meet the demands and goals of wellness programs (whether by not participating at all, or by failing to meet benchmarks like a reduction in body mass index) end up paying more… Some believe this can be a form of discrimination.”
Mills hit back at that idea. “It’s all how you look at it,” he said. “It’s either the carrot or the stick. In our case, we were charging 30 percent for individual premiums regardless, and we gave them an opportunity to buy it down to zero.”
For some people, Mills said, the program “didn’t come that easy, and saw someone else getting a benefit they didn’t get, and saw it more as a stick.” He also said there were exceptions and accommodations for workers with disabilities or injuries.
Mills resisted the notion that his program could be looked at as a way to shift costs onto workers. But his main rebuttal to the point Frakt and Carroll raise is that Fleet Farm’s plan was voluntary.
“You could take it or leave it,” Mills said. “If someone wanted to opt out, they could. There were only three or four people in my entire career, those 15 years I administered the health plan, who actually opted out of it.”
Painting his program as a success is important for Mills’ candidacy — it is, after all, his main experience really working with the kind of policy that members of Congress are engaged in on a regular basis.
Mills did not share any data on how Fleet Farm employees performed on specific health indicators, like blood pressure or cholesterol, with MinnPost.
From a health outcomes perspective, Mills’ evidence was mostly anecdotal, or related to the company’s bottom line or employees’ pocketbooks.
“We had testimonials at store meetings where people were breaking down in tears about how they were able to go on bike rides with their kids for the first time rather than being stuck on the couch,” Mills said. “We had some real Oprah Winfrey moments at store meetings.”
“We packaged it as a positive, we never saw it as a negative… We saved them money and saved our plan, our employees, tens of millions of dollars.”
Obamacare comes along
Just a few years after Mills’ new health plan went into effect, Congress passed the Affordable Care Act — a law that the candidate claims had a significant, negative effect on Fleet Farm.
In 2014 and this cycle, Mills has argued that the company was taxed to subsidize Obamacare, without receiving any of the benefits of the law.
Mills told MinnPost that once the law was implemented, Fleet Farm had to pay hundreds of thousands of dollars into so-called risk corridors — which were meant to stabilize premiums during the early implementation of the ACA by spreading financial risk across plans — subsequently driving up costs.
“We thought a six to eight percent cost increase was absolutely horrible. We did the best we could to hold it down, and we did have a rate increase, I say directly due to Obamacare.” He said the Fleet Farm plan was not supposed to be affected by the health care law, but insisted it was.
Another area of the law that still rankles Mills was how it affected Mills Health Works. In a way, Obamacare enshrined into law the use of company wellness and prevention programs: it allowed employers to reward or penalize workers up to 30 percent of healthcare costs depending on participation in wellness programs.
However, the ACA levied some major restrictions on how programs like Mills Health Works could operate.
According to the Department of Labor, the law “generally prohibit[s] group health plans from charging similarly situated individuals different premiums or contributions or imposing different deductibles, copayment or other cost sharing requirements based on a health factor.”
So, companies could no longer tie premium reductions or other rewards to specific health outcomes — only participation. For example, you couldn’t provide a reward or other financial incentive related to a smoking cessation program based on whether or not the participant actually stopped smoking.
Mills said that Obamacare robbed his program of the ability to deliver a financial boon to the company, and a positive influence on the health and fortunes of its employees.
“It didn’t gut the entire incentive program that we put out there, but it made it easier for getting people out of what they needed to do,” he said. “Obamacare made it much more difficult to give people the incentives.”
Instead of the ACA mandating employers to use the set of health indicators used by Fleet Farm, Mills said that the government should give companies space to devise the programs they want.
“I believe that a plan like this would work at a broad variety of companies and I would personally promote it,” Mills said, “but would I use force of government to mandate it on a company or individual? Absolutely not.”
“Would I create the conditions in D.C. when people in their own free choice could put plans like this together for employees and employees’ families? Yes… What we should be doing is creating a health care economy that is more open for plans like Fleet Farm’s to be successful rather than penalize us.”
Those conditions, Mills said, should include allowing the purchase and sale of insurance across state lines, greater use of high-deductible plans, and promotion of health savings accounts. Those ideas, taken together, constitute the foundation of today’s GOP orthodoxy on health care reform.
The Stewart Mills legacy: unclear
Earlier this year, the Mills family sold their business to KKR, a New York-based private equity firm that specializes in buyouts, for a reported $1.2 billion.
Mills stresses that he was against the sale, and said he remains somewhat bitter about it. He says he is not sure what the current state of the benefits program is for the roughly 6,000 Fleet Farm employees working for the company in Minnesota, Wisconsin, North Dakota, and Iowa.
Fleet Farm declined to comment for this story, and attempts to reach employees were unsuccessful. It’s unclear how, or if, the program that Mills devised remains in place.
Regardless, as his second challenge to Nolan ramps up, Mills — who has so far devoted much time to national security issues — said health care will be a central feature of his campaign. Like he did in 2014, he will use Obamacare and his experience at Fleet Farm as a springboard to attack Nolan, who supports Obamacare.
Mills was reluctant to say how exactly he’d apply the lessons he learned at Fleet Farm to federal health care policy, if he were to win in November.
“Is there a master strategy?” he asked.
“The strategy is to get government out of the way.”
I Certainly Hope that Mr. Mills Doesn’t Plan
to claim that his ONE experience,…
with ONE small company,…
that was rapidly expanding at the time (as I remember it),…
in a particular region of the US,…
before the current era of massive pharmaceutical price gouging on routine medications,…
gives him knowledge and wisdom that are UNIVERSAL,…
and can be universally applied to ALL companies,…
whether shrinking, expanding, or stable,…
in ALL regions of the US.
A little knowledge is a dangerous thing,…
especially in the hands of someone seeking power,…
who has no clue how LITTLE that knowledge actually is,…
and how much MORE knowledge would be needed,…
if he or she were to be able to play a useful role,…
in designing effective policy for an entire nation,…
on healthcare or any other issue.
Obamacare and private health insurance
I wonder if Mills would commit to voting for changes to improve the Affordable Care Act (aka – Obamacare) or if he’s intending to only spout Republican talking points of repealing it. Is he going to be someone who really wants to make things work better or another “gridlocker?” Until he commits publicly to making positive change and tells us details of how he intends to do that, I wouldn’t vote for him.
Why is it
that Republican ‘back room’ strategists continue concentrating their efforts and working on ways to AVOID providing universal health coverage to all Americans rather than biting the bullet and agreeing, like other first world Countries, that ALL of their citizens should have quality universal health care ?
Mills has 100X more experience than any politician
Stewart Mills has 100X more practical experience than a politician who thinks they know how things work but is actually clueless, e.g. Obama, Pelosi & Reid. Obama, Pelosi & Reid have screwed up 17% of our economy because they were clueless…
Well…
It’s 17% of our economy because it was screwed up before Obama, Pelosi & Reid got there. When many other countries get better results at a much lower cost, somebody needs to change something. Obama, Pelosi & Reid were a part on an initial step modeled on conservative ideas. If Mill’s was serious he would come out and say he won’t be a part of the 60th vote to end Obamacare and instead tell us he want’s to be a part of the first vote to improve it and he has ideas on how to do it, he could possibly win. But, he won’t and Majority Leader Schumer and Speaker Pelosi will have to do it for him….
Au Contraire
Mills is hardly the only person born with a silver spoon in his mouth who has decided to run for office.
“100X more practical experience!”
I hate to be the one to point this out to you,* but the government is not a business. Government does not have the option of, say, selling the Army if it’s too much of a drain. Government has to answer to all of the voters, not just a few investors. Government has different purposes than a business.
It is an old, but not terribly amusing, joke to say “government should be run like a business.” They are two entirely different things, and work in entirely different ways.
*To be honest, I don’t, but the niceties must be preserved.
Like most adages
Overly simple words to the actual meaning. There are some common sense practices in business that don’t appear in the operation of the government. Businesses periodically reorganize to reflect how the world and markets have changed. Business (usually) looks at how to do things less expensively and farms out work not considered core and critical.
In contrast government is prone to inertia and consistent growth given the political pressures that prevent departments from being reduced. See closing military bases or ordering equipment as examples. How many times have we heard of the military strong-armed into a procurement of jets or boats thry said they didn’t need, or keeping a military base open they don’t need, because if the votes in that town or city? Those are practices you don’t see in well run businesses.
Overly simple words convey an inaccuracy. There are many “common sense practices” that can’t, for whatever reason, appear in the operation of the government. Sometimes, it is due to “inertia and consistent growth,” two issues that I hear are absent from corporate America. Sometimes, it is due to the voiced concerns of the citizenry (In a democracy, voters in any given town or city have a right to be heard, and not be overridden just because their concerns are deemed inefficient). Sometimes, it is due to constitutional or other legal requirements.
And, too often, it is due to profiteering by those efficient business people. Who do you think is strong-arming the military into procurement of jets and boats they don’t need? Could it be defense contractors?: As more and more of the work not considered core and critical (Prisons? Diplomatic security in war zones? Public education?) gets farmed out, there are incentives for the private sector to participate. This participation has led to moves to continue filling substandard prisons, even when the crime rate has gone down and mass incarceration looks less and less like a good idea. It’s why we have disasters like the Blackwater massacres in Iraq. It’s why we have the folly of charter schools. Making a buck, preferably without back-chat from voters in a town or city is the goal.
Of note, yet again
Are Republicans promoting high-deductible health care plans out of one side of their mouth and complaining about the high deductibles of ACA plans.
Looking at the data
If you want to look at the success of a program over time, you need to look at a bunch of things that are not discussed by Mills. What is the health status of people coming into the plan, which relates to a number of facts – their average age, the gender breakdown, their health history and their lifestyles? What the outcomes of the program in terms health improvement, the break out of costs between the company and whether people continue to work their in good health?
If you employ younger employees to begin with, and make an effort to eliminate older employees who have more health issues and hold down your corporate costs, you keep your costs down and your employee’s can more easily handle the occasional health issue. Whether intentional, if you punish those who get sick financially to save corporate funds and financially reward those who through no effort of their own are healthier, you fail to understand the purpose of health insurance, to make sure employees with real persistent problems get the care they need.
Encouraging healthy lifestyles is of course a good idea, but you need to be careful how you do it. Some of us get a bad draw genetically. I person knew for 25 years before I got it, that a genetic condition would some day mean I would need a kidney transplant. Nothing I could do would alter that fact – and that treatment was 1) extremely expensive and 2) somewhat toxic, as after effects are the norm. Early death was the only way to avoid the need. Only the very rich could fund this treatment out of their personal funds and all of us face the cost of a chronic illness that will be tremendously expensive, if not soon rather than later.
People don’t think of these things, but benefit managers do. When I had the surgery, obviously any smart employer knew my continuing costs would be high. For self funded companies, there is a big temptation to get rid of those with these problems. In fact, it was necessary for Congress to ban genetic discrimination in hiring and firing. This didn’t pass without strong Republican opposition. I suspect that if Mills had he been in a position to vote of this law, he would have opposed it, as genetic discrimnation would allow him to cut corporate spending.
So ultimately, for a program like company health insurance, one needs to look at what motivates a company to offer things like wellness programs. If they call on employees doing things that they have some control over, produce better health status and don’t discriminate against older, sicker employees, OK. However, if they are designed mostly to lower corporate benefit costs, increasing employee risk of neglecting their care need or experiencing medical bankruptcies, it is not OK. It is never right to weed out those who are less health due to their genetics and the aging process.
It is not clear where this company comes out. However, if worker interests are not served well, then any person who designed such a program should not be rewarded by being allowed to impose their wrong-headed notions on the country. If Mills has desgned program that is more beneficial than not, then he should back up his claims with supporting data.
Better Ideas Welcome
My company just implemented one of these plans and did a terrible job of explaining it. However after studying how it worked I think they are a step in the correct direction. (maybe)
You are correct that as long as the company is paying a large part of the employee’s healthcare cost, there is an incentive to employ young healthy people. I was talking with a friend and found that their company’s premiums are much lower because their workforce has many young single men in it, whereas my company’s employee pool is very diverse.
So exactly how much more should the young single men with excellent lifestyle habits at my firm have to pay each month to subsidize the premium of older peers who make poor lifestyle choices?
How do you think we can encourage the older person to change their life long habits to become healthier?
With obesity and overweight sky rocketing in the USA, we need to do something about it if we truly want to reduce healthcare costs. I think programs like that set up by Mill’s is a good start.
By the way, the program I am part of allows employees to get their Doctor to sign a medical waiver if the employee truly has a condition that prevents them from attaining the normal and is under the direct care of a doctor for that issue.
Business Success?
Heading up the HR organization, no offense; but at the company I worked for, if an executive got moved to HR, they knew they were on their way out.
More Health Plan Experts
without portfolio here.
The reality is
that Fleet Farm gave it’s employees a power financial incentive to proactive manage their own, personal health. Those who became engaged and made good health choices helped lower the overall company’s healthcare cost. I don’t find this surprising at all – there are millions of case studies showing that empowering people (in their jobs, in their schools, in grass root politics, etc) most often leads to greater success.
The ACA provided access to medical care for millions – with absolutely no financial incentive for them to manage their healthcare wisely. Convenient healthcare has become the normal (see the huge growth in the number of emergency room visits) while appropriate healthcare takes a secondary position. Convenience always comes at a price. So it is any wonder that healthcare costs are soaring as more people use more healthcare without any incentive to do so wise.
Often people here want to compare our healthcare cost / results to other countries. All the while neglecting to normalize the data for lifestyles and other variables. I find this fascinating since we are likely nearly the wealthiest and most over weight country in the world.
http://www.oecd.org/health/Obesity-Update-2014.pdf
Then when people try to punish bad choices and reward good choices through premium cost adjustments, some people cry foul. As I asked above, how do they want to promote exercise / healthy eating and dissuade people from sloth and bad diets?
Or do they think we can make costs lower without making people healthier?
Which of course will have questionable success.
The ACA provided access to medical care for millions – with absolutely no financial incentive for them to manage their healthcare wisely.
The incentive people have to pursue healthy lifestyles is the prospect of better health. I don’t think any modification of health insurance policy can have the impact of that. Folks don’t refuse second helpings because they are afraid their insurance rates will go up.
Ideas
Hiram,
We know from the American obesity / over weight statistics that the “prospect of a better life” has been an terribly unsuccessful incentive. And as you are aware from our previous correspondence, the $3,000 / year incentive I now have on my family plan has done wonders to help me bypass the grilled / deep fried foods, go to the salad bar and say no to seconds. Now I have no plan to give those things up totally, however I think I have lost ~10 Lbs since June…
My point is that if we want Americans to live a more healthy lifestyle and we are serious about reducing healthcare costs, the rewards for doing so need to get bigger. Something that helps motivate people to walk away from the table, leave the chip bag in the cupboard, go for a walk, etc. Do you have any better ideas than going after their pocket book? It seems to be helping with reducing the number of cigarette smokers.
Money is a pretty good incentive
You’re right Hiram – health insurance rates alone aren’t much of an incentive but that doesn’t mean we’re powerless to change things.
The health insurance plan I had with my last employer provided significant financial incentives to quit smoking. When that incentive was first implemented, the smokers I worked with complained and bi#$%ched and moaned loudly about it but when they sat down and looked at the additional cost to continue smoking vs. doing something they knew they should do anyway, one by one most of them quit. Our small office probably had 70% or more of the smokers quit over a 2 year period. That’s a pretty dramatic change.
Weight loss, cholesterol levels, hypertension etc. were not as easy to tackle but the company plan provided incentives to a) get tested so you’d know if you had a problem and b) start working on doing what you could to fix it if you did have a problem. Lots of incentives, games, “biggest loser” competitions and things like that. They put lots of thought and effort into it and it seemed like it was paying off. The company had plenty of problems with their health insurance plan but this part of it was well run, well thought out and was producing results.
Could this sort of plan be translated into an ACA plan? Don’t know but I know one thing for sure. It won’t get done until we get both sides serious about working together to make it happen. Today’s gridlock is stopping all progress towards improving what we have. That’s one of the real costs of the way our political system is working today.
We know from the American obesity / over weight statistics that the “prospect of a better life” has been an terribly unsuccessful incentive.
I am sure it is. That’s why I am not that interested in basing health care policy on incentives. We never had universal health care coverage in this country because we could never agree on stuff. Incentives, for the most part, are just another stumbling block, another thing we disagree on.
Obamacare is basically a Republican plan, and it’s defects are characteristic of a Republican approach to health care. While repeatedly repealing Obamacare, the Republicans, despite being in the majority in both house of Congress have never once passed an alternative. They haven’t even put an alternative an alternative in bill form. That’s because if forced to be specific, their plan would be roughly the same as Obamacare, with perhaps a slightly different set of bells and whistles.
Answer
So your answer regarding how to help/push people choose to live healthier lifestyles and reduce their healthcare needs is to remove all carrots / sticks from the system?
You like Steve below would apparently choose to implement a system where who pays for the healthcare is totally separated from who receives the healthcare…
I think that would be bad for the health of many Americans, and very bad for the healthcare costs of America. I have visions of Americans looking like the people in Wall-E. 🙂
So your answer regarding how to help/push people choose to live healthier lifestyles and reduce their healthcare needs is to remove all carrots / sticks from the system?
I don’t believe in pushing on a string. One of the things that characterizes the Republican approach to health care is that it shifts the burden of caring for the least healthy onto the taxpayers. That tends to be characteristic of Obamacacre as well. But you notice, the burden only shifts, it doesn’t go away.
We can debate endlessly about the details of health care policy. It is something that’s well suited for that. But our willingness to do that has led to no health care policy, which is surely the most expensive and least healthy choice of all.
Policy
Actually we have a policy now and had one before ACA.
~100 years ago people were expected to take personal responsibility for their lives, or they would need to be assisted by charities.
~ 75 years ago citizens felt for the old folks who had not saved adequately and decided that the tax payers would help them.
~ 50 years ago citizens felt for the unfortunate poor who needed help and decided that tax payers would help them. Forgetting that often you get more of what you pay for.
~ 8 years ago ACA was passed with it’s good and bad aspects. Thankfully it mandated people to buy health insurance, unfortunately the penalties for not doing so are too low. It expanded free healthcare and health insurance subsidies, an additional burden on the tax payers.
It will be interesting to see what future health policy looks like.
Let’s see here
100 years ago: Charity, as always, is insufficient to meet the demand, lots and lots of people suffer and die needlessly, apparently all is well since “personal responsibility” is maintained, those suffering and dying disagree.
75 years ago: Many still suffer and die needlessly, but the elderly are afforded some measure of dignity in old age, warning cries about the dangers of socialism first arise.
50 years ago: Multitudes of needless deaths are prevented and a great deal of suffering is lessened. Many needless deaths still occur, and suffering still exists. We’ve become communists, apparently, and social order is on the verge of collapse according to segments of the populace.
8 years ago: Further needless death is averted, suffering is lessened, yet again. The apocalypse is nigh, build a bunker now, it’s all over.
I’m sensing s pattern here.
no it’s not
a Republican idea, yes, Massachusetts did similar that doesn’t mean republicans universally have to support it for everyone, quite the contrary! Mandating what one state does for everyone is a dem idea.
and, no, don’t say the heritage foundation founded obama care, the two ideas are not even close, the HF says so too.
Self-insured
the paper-mill I worked at was self insured and the story agrees with my understanding; the mill plan did have some wellness provisions in it and I cannot speak as to the success or failure of those provisions. The way the plan worked was the mill payed 80%; the employee 20%; as usage and costs went up the plan costs were passed along at that 80/20 rate with Blue Cross-Blue Shield skimming a sizable cut off the top. Over the course of a thirty year career at the mill premiums went up; the last few year at a rate much faster than inflation. Even so the only reason cost were kept down was the inclusion of young workers. Young workers are generally healthier and their premiums were the same they in effect were subsidizing the sicker older employee. That is where the Affordable Care Act has it wrong; healthy young men & women don’t have to sign-up & the penalties are small so why participate? So the solution to all this is universal health care; with the costs spread among all American; the case of the healthy helping the sick. Medicare for All; I know it sounds Socialist but we are all in this together and as a society we need to help those who need help. If this sounds like the position a Social Democrat would take; well I’m one.
prove that
Where can you verify a dangerously fraudulent statement like “blue cross skimming a sizeable cut off the top”. that is so wrong!
most companies over 100 employees have self funded plans, it’s the law of large numbers and claims are predictable year to year.
Correct
The insurers do not “skim.” In self-funded plans, BCBS and others act as fiduciary claims agents for the company sponsor, who pays those claims monthly from corporate cash as long as they remain below specific and aggregate stop-loss limits. After that particular limit, the re-insurer pays the claim.
What people here don’t know about this topic is typical of lunchroom chatter. Most of them cannot “verify a dangerously fraudulent statement.” As one who spent 15+ years as a Third-Party Administrator, overseeing many numeric and statutory details of such corporate plans, I can and do verify that statement as “dangerously fraudulent.” Thanks for making the call here.
Just a couple things about Mill’s claims
It’s unlikely that his program ever produce the effects he claims. To begin with the claim that up to 50% of health care costs are preventable is not founded on any reliable metrics so any system based on that assumption isn’t going reach those goals. Here’s the problem: Children are experiencing an alarming number of concussions while playing organized sports. That’s “preventable” if they don’t play organized sports. Likewise, pointing to correlations between high BP, cholesterol, etc. “implies” that strokes and hearts attacks could be prevented by more exercise and better diets, but they can also be prevented by prescribing medications, so the mode of “prevention” isn’t just about lifestyle. Some of these estimates about preventability don’t distinguish between modes of prevention. Furthermore the lifestyle changes that are typically recommended can be far more difficult to attain than is generally thought. Fleet Farm premiums may have fluctuated here and there but we’ll never know the back story on that and if it happened, (we have no independent verification of ANY of Mill’s claims) it likely happened for some other reasons, instead of the fitness program.
The most common and likely scenario is that already healthy people who don’t need healthcare get a financial break while those who actually need it get “disciplined” or financially punished. The people who don’t need a carrot get a carrot and the while the people who need carrot get the stick.
One other thing that’s frequently not mentioned in these discussions is the nature of the metrics used to carrot or stick people. It’s important to note that things like blood pressure, cholesterol, and even BMI’s are typically contained in otherwise confidential medical records. When you’re forced into a program like this (opting out usually means doubling your insurance premims, another fact left out of this article) you surrender medical confidentiality. You’re employer now gets to peek into your medical records in order to decide whether you qualify for a carrot or a stick.
Details
From the program I have thankfully been pushed into. They are only monitoring the Spouses and both Spouses need to “pass”. Logic is that household diet, exercise, choices, etc work best if both spouses are aligned. And if both Parents are good role models, the kids will follow.
The program is indifferent to if you take medication, control your diet, exercise regularly and/or other in order to keep your glucose, triglycerides, blood pressure, LDL, etc under control. And if you are proactively working with a Doctor, they can apply for a medical waiver if they think you have an illness that makes the goals unattainable. So actually anyone who is making good life choices and / or under the care of a Doctor can get the healthcare insurance credit.
And yes if you avoid Doctors, smoke, and fail the tests, you will pay more for your insurance. And shouldn’t you?
As for data privacy, a third party does the blood testing, reviews the medical waivers, etc. So all HR knows at our company is how much our premium will be… I mean they need to know how much we have to pay.
Its a struggle
Do we basically take bad actors and cast them aside if they can’t perform? You take the idea and run it out to its logical conclusion. From the fiscal stand point, why should the insurance pool pay for folks that are abusing the pool?
Wording matters
“cast them aside if they can’t perform?”
I take exception to the word “can’t”. I mean there are some people who are truly physically addicted. Which is an illness that can be treated. But most of what we do each and every day is “choose”.
Do we watch more TV or go Outside and walk/bike?
Do we take seconds or do we turn it into leftovers?
Do we take the whole bag of chips to the couch or do we take just a handful?
Do we eat the salad or burger/fries?
With this in mind.
Should the people who make healthy choices pay more for those who do not.
What should society do to pressure people who are making unhealthy choices, to change their behaviors?
Why should the insurance pool pay for folks that are abusing the pool?
What Do We Do?
Do we go outside and walk/bike, or do we work two or more jobs to keep our heads above water, leaving us no time to exercise?
Do we eat the burger/fries because salads and nice, fresh food is too expensive?
Discipline and health care.
I hope people have been paying attention to the last few comments. The morally bankrupt idea that health care is about punishing the sick and injured for bad behavior (classifying the sick and injured as “bad actors”) is bizarre rationale for a health care system. You let people with this dystopian mentality design your health care system at your own peril. Instead of a health care system that delivers necessary care when needed, you get the health care that would-be dictators of “healthy” lifestyles decide you deserve. It’s actually spooky.
Goal
Okay, I’ll bite. What is your goal for American Healthcare? Is it just to have all healthcare bills covered for everyone?
My goals include promoting Americans to live healthier lifestyles, thereby reducing the amount of time they spend in the healthcare system and reducing the total healthcare burden that is carried in the USA.
Please note that my examples above apply no punishment to the sick or injured. (ie medical waivers by Doctor) They simply ask people who choose to neglect their diet, exercise, medication, doctor’s visits, etc to pay more.
To pay more
You answered your own question. You balance your ledger on others’ suffering. The ability to be alive and healthy should be a right not a commodity.
Goal?
Obviously the goal is provide universal health care for every single human being in the United States. You can promote healthy lifestyles as well, but first you have to pay the bills.
The problem with “lifestyle” promotion of some kind is that it’s simply irrelevant as far as actual health care is concerned. People with healthy life styles get sick and injured, they have heart attacks, they break bones, they age, they have blood pressure and cholesterol problems just like anyone else. Here’s the thing: no matter what kind of lifestyle you have, the treatment for a heart attack, high blood pressure etc. is exactly the same. You want to create a system that provide the same exact treatment to one person for less than another based on a false premise that you can reduce illness and injury by 50% with some kind of lifestyle modification.
The fact is we’ve actually increased injuries in this country by promoting “healthy” lifestyles. All these obsessions about fitness and diet have spawned one of (if not THE) largest populations of people with eating disorders on the planet. The fitness craze has quadrupled sports and exercise related injuries and related disabilities in the last three decades. Mills would label all these people as “good” actors while piling additional financial burdens on others in the middle of a medical crises.
The idea that orthopedic surgery or eating disorder programs are better or cheaper than high blood pressure medication or something else you’d link to “lifestyle” is simply medically ignorant.
The idea that you need a “waiver” of some kind to prove that your health care is necessary is simply incoherent and places a dubious burden on people who need health care. The fact that a doctor is treating you “proves” you need care and no doctor can predict the outcome of individual lifestyle changes, sometimes they help, sometimes they don’t. It’s not medically possible to issue a definite judgement about the benefits or attainability of a lifestyle change. People who quite smoking still have heart attacks and die from lung cancer for instance.
Health care always takes precedence over lifestyle promotions of any kind, first you provide care, then you talk about lifestyles. We all want a healthy and fit population, but the idea of linking health care cost or availability to someone’s idea of lifestyle is probably barbaric.
All
Thank you for an excellent discussion. There are definitely different beliefs regarding this important topic. Thanks again.
There’s something
very troubling about the last quotes of the article:
Mills was reluctant to say how exactly he’d apply the lessons he learned at Fleet Farm to federal health care policy, if he were to win in November.
“Is there a master strategy?” he asked.
“The strategy is to get government out of the way.”
This statement is duplicitous and unnecessarily ideologically partisan. There was nothing that Fleet Farm did that was forbidden or affected by ObamaCare or any other government rule.That’s because Fleet Farm is self-insured and ObamaCare did little to affect that portion of the market other than allow children to stay on their parent’s plan until age 26.
This antipathy toward government and how he sees his potential role as a elected lawmaker is the number reason why Stewart Mills does not belong anywhere close to government.
This partisan, ideological obsession with getting government out of the way should be considered a red flag to voters. What is the point of having an elected official who is not interested in using his power to 1) identify problems that affect his constituents 2) use the power of government to solve those problems?
Instead, it is a dog whistle to voters who consider government to be our number one problem and the number one solution to downsize, dismantle, government.
But the number one reason the health care spending consumes 17 percent of our economy is precisely;
Because we have refused to harness the power of government to put downward pressure on prices throughout the system;
Because we have refused to acknowledge the immorality of having such a fractured, unequal system, a system that places the emphasis on which category you belong to to determine how easy it is to gain access to necessary care and how that care will be paid for (Medicare–age, employer based program-employment, Medicaid-income-, individual purchase subsidized, individual purchase non-subsidized, uninsured, VA, etc. etc. etc.,
Because we have refused to put everyone into the same pool, under the same rules. Instead, everyone belongs to a different pool and therefore, premiums are wildly unequal based solely on the size of the pool they belong to. This is why insurance companies can claim they are losing money and justify pulling out of the health care exchanges or raise premiums–when the profits on the other portions of their business is in the billions of dollars.
Exactly
This idea that all the government ever does is “interfere” and that the private sector always delivers superior results is stereotypical thinking pretending to be economic principle. Mills is a perfect example of the problems we create in this country by assuming that a 29 year old “executives” who know absolutely nothing about health care or health care systems can be put in charge of a health care system.
It’s really important to understand and remember that republicans, guys like Mills, and their supporters never thought we actually had a problem with health care and expenses in the first place. We have a market, what more could we possible want?