Doctor Eclectic

Doctor Eclectic
Doctor Eclectic

Wednesday, September 25, 2013


A year and a half ago I presented a lecture on the Affordable Care Act to a group of retired military officers.  It was full of uncertainties, but was timely since my position as a National Dental Director put me in close contact with the movers and shakers dealing with the newly passed law.  At the center of the presentation was an explanation of the Exchanges, which were scheduled to begin assigning members to health plans on October 1, 2013.

That date is one week from today and sadly to say I don’t believe there is one state or federal Exchange or one health plan prepared to meet that goal.  Let me explain what happened and what is likely to happen in the near and not-so-near future.

If you look at the diagram of what is an Exchange (attributes to Jeff Album of Delta Dental) you’ll see that the focus of the Exchange was on Small Group (businesses with more than 50 and less than 100 employees).  There was a reason for this.  The U.S. Health Care System kicked off with Kaiser in the late 1940’s as an incentive to provide tax-free income to prospective workers.

And, when you looked at the 56 million uninsured employed, persons in the United States, most of them were employed in Small Businesses.  So, if we want to expand the pool, and by the way, expand the risk pool to avoid healthy people choosing to be uninsured, we would need to put some teeth into requiring Small Business to insure their members.  That was the original intent of the ACA.

Then it got screwed up.

A larger number of uninsured were the Medicaid population.  These are individuals and more commonly family living below that “poverty level”.  In an earlier Post I covered how the “poverty line” was established but suffice it to say that there are two important components: first, the cost of common items included in a normal life style vary dramatically from region to region and particularly are greater in urban areas, resulting in a greater need for subsidies in our cities.  Second, most subsidies, such as food stamps and even cell phones, are not included as “income” in determining whether a family earns enough to advance beyond the poverty level.

The result is that the Medicaid eligible population in many states was financially untenable to support.  So, when the federal government, through the ACA, demanded that the states expand the health care offered through Medicaid, many states said, “No.”, even though the first few years would be paid for by federal dollars.

State options also came into play with the establishment of Exchanges.  Only about a dozen states, including my California, chose to set up their own Exchanges.  The rest fought the edit, demanding that the federal government set them up (or saying they would fight to the death the establishment of them).  And the feds have been slow in meeting that demand.

What can we expect?

A new occupation is the Navigator, a term used to define methods to steer members through the Exchange choice process.  Much money has been allocated for this function and none of it is going to actual health care.  One is reminded of how many are now employed by the TSA and how that has resulted in higher air fares with greater delays and poorer service.

One can also expect an early increase in premiums as the insurance companies cope with the new tax levied on the to support ACA subsidies.  We will definitely see huge variances in premium and coverage from state to state, since the definition of essential health benefits is all over the place.

And unintended consequences are already occurring: large employers (more than 100employees) are casting out expensive programs, such as Retired health, providing set amounts to place these people in the Exchange.  This population, by the way is exactly counter to the healthy population needed to make the Exchanges work.

And major health plans, such as Aetna, are choosing to stand on the sidelines to see how this plays out, lessening the competition among the big players that was expected to curtail costs.  My old company, WellPoint/Anthem, id a player in 12 states and in all 19 regions of California, but they are almost the exception, rather than the rule.

Regardless of how Congress settles the Fiscal Cliff and defunding of the ACA this week, rollout of the ACA will be delayed from the January 1, 2014 deadline, and the animal that we will eventually see is going to be exceptionally different from that expected in 2010.

Later today I am going under the knife for a hip replacement.  Sounds like a topic for my next Post.  Join me to see how it all turns out.

Thursday, September 19, 2013

Encore Careers

About seven years ago, when I was a willing casualty of an M & A, and found myself facing retirement.  I actually tried that for a couple of years, printing cards that said “Consultant” and waiting for the phone to ring.  My chosen avocation was Acting, and I did about three plays and got a new Agent, but I found my greater satisfaction was in independently joining the Trade Associations my companies had supported and working on committees to accomplish worthwhile goals in the Healthcare industry.  I spoke of this on my websites: and as “giving back”.

The concept has become quite popular; the most well-known celebrity being Bill Gates, who in 2008 gave up his business to a supporting staff and went full-time into saving the world from Malaria and other deadly diseases.  It turns out that there are literally millions of Americans aged from 50+ who have done similar things.  The term has been defined as a “second career attempting to help in a field understaffed, with little concern for financial gain.”

In my case the financial gain, if any, was the ability to write off travel and registration to meetings as a business expense, since I was making modest income from consulting.  Then, about the same time as Bill Gates left Microsoft, my consulting opportunities dramatically improved.  The beauty was that I still had ample time to devote to my Encore Career of committee work.

I spent some of that time writing my first book, Harnessing a Heritage, and subsequently a Blog, , and recently getting a new, more aggressive Acting Agent, MZA.  I have already been on six major project auditions and am hopeful something good will come soon.

The New York Times article referenced above was written before the bottom fell out of the financial market, so I assume the movement has slowed somewhat, but I thought I would test that theory when I returned to Mason City Iowa for my 60th high school reunion.  As a schmoozed my way around the room, noting that there was an increasing amount of sitting in my age group than at the 20th, I did fid a few interesting Encore Careers.  One gentleman, Brian Birch was showing his 2009 book, Highlighting the Good News, a 150 page synopsis of the Bible.  He also had the most recent translation, Arabic, with a rather unique tab system, allowing opening to certain favorite passages.

Peace Corps Swearing in 2008
A second attendee had completed three tours with the Peace Corps, but most were involved with family, a worthy endeavor, especially for those who have remained involved with the mid-western farms.  Very few children could remain on farms, many in their third or fourth generation, without financial assistance.

I can relate to that as, without my setting out to do so, I have become a financial resource for family in education, health, and housing.  And Mary has been volunteering as her Encore Career for more than twenty-five years, in teaching ESL, assisting in the library system, and raising funds for the Performing Arts.

I hope that reading this might stimulate some of my followers who have not done so, to look at opportunities for Encore Careers.  And, if you are so inclined, please comment to this Post of what you have done or are planning to do.

In my next Post, I plan to share some of my involvement with rolling out the Affordable Care Act and how that might impact us in ways we do not imagine.  My Encore work gives me a detached perspective that I think you will find interesting.

Wednesday, September 11, 2013


There is an old Jewish Proverb that goes, “Man plans and God laughs”.  I was thinking about that the other day while in, of all places, my shower.

For years, beginning perhaps fifteen years ago when we were invited to attend a considerably younger co-worker's wedding, Mary and I have held a common opinion regarding tattoos on young ladies. .  The bride was beautiful, of course, as were the bridesmaids and especially her Maid of Honor, a sister with the knock-me-down dark beauty that so many of our Southern California Latinas display.  The gowns were strapless and of some shade of orange that seems to be reserved for wedding apparel.

Showing its fiery breath just short of the sister’s neck was the mouth of a four inch dragon’s head, whose body and tail would proportionately reach below her waist, had the dress not covered it up.  I’m sure the tattoo was designed to accent her beauty rather than detract from it, but we both commented that as she grew older and her body parts began their inevitable shift, she might have second thoughts about the process.  In fact, one of our continued hypotheses is that some LASER-wielding dermatologist is right now making a fortune, as the Boomers and Gen-X children reach middle-age and beyond.

Last Sunday were had dinner with a group that included a young gentleman who had just, moved to one of the less-populated areas of Texas.  His planned business is a tattoo parlor where he expects to hire several artists besides himself to meet the demand.  The expected draw will come from the Army Camp, Fort Hood, which is in the news because of the trial of a Muslim Psychiatrist who killed nine solders about to deploy to Afghanistan.

Lawn Mower Tattoo
When I was a Navy Dentist serving with the Marines, a CO had to give  permission to get a tattoo, and it couldn’t show when in uniform.  I presume that has all changed now.

It was a navy man, Captain Cook, who brought tattoos to the Western World.  The natives of New Zealand and nearby islands thought decorating the skin with indelible ink set them apart from the riff-raff.  European young ladies of the day took to the fashion as a means of showing they were current with fashion.  Of course most died earlier than our women do today.

For those who feel as Mary and I did, there are now excellent tattoo parlors specializing in non-permanent tattoos.  I might have one of those done as I was impressed by a tattoo on the head of a man with a hairline similar to mine.

What made me think of the proverb and this subject while in my shower is that I find myself with a variety of liver spots and varicosities arranged in seemingly random fashion on my body.  I am confident that as more appear to connect the dots, God will show some recognizable pattern He has in mind.  When that happens I am sure God will laugh at my plan to avoid tattoos.

I am off tomorrow to return to Mason City, Iowa and my sixtieth high school reunion.  Since all who will be attending are likely either retired completely or in some occupation they have chosen as a second career, I hope to have enough ammunition on my return to fire off a Post on Encore Careers, including my own. Please join me.

Monday, September 9, 2013


Mask - drawn in PTSD therapy
Two things recently brought my attention to what I know, or more appropriately what I don’t know about PTSD.  The first was a report of several thousand military, assessing whether they were more at risk for suicide than civilians of a similar age.  The conclusion was that they were not.  The second was a speaker I arranged to speak to our local Military Officers Association: Art DeGroot.  Mr. DeGroot was interviewed in the Orange County Register about his book, Bu Ku Kilo, a not-so-approving story about his year’s tour in Viet Nam.

I met with Mr. DeGroot to discuss what approach he might use in his presentation.  We agreed on his answering three questions:

·         Why did he write it?

·         Why did it take so long to write it?

·         What has been the reaction since he published it?

The conclusion of the questions was that he suffered from PTSD with all the typical conditions: hyper-arousal; with anger, and violent dreams, re-experiencing; evidenced by daytime reliving the occurrences, and avoidance; with detachment or isolation from family, friends, and daily events.  Fortunately for him his wife stayed with him and supported him until he was able to cope with the problem.

PTSD does not just come as a result of exposure to combat.  Actually it is a response to a particularly violent event in one’s life and affects almost 7% of U.S. adults.  The most common precipitant is sexual, rape or molestation, often as a child.  That explains why more women are victims than men, since only 1% of our population experiences the trauma of combat of first responders.

The term may be relatively new but the condition has existed since early history of man.  A movie from the 60’s starred Gregory Peck as Captain Newman, M.D. who was vexed by the prevalence of Combat Fatigue.  Treatment is complicated by the fact that the patient, and it is now considered a medical condition, is generally in denial that there is a problem and is reluctant to seek assistance.

Yesterday I attended a Polo match in Del Mar, which honored veterans (including me).  One of the more interesting booths was soliciting interest and funds for a program called Horses Joining Forces, which seeks to bring veterans suffering from PTSD into a feeling of trust by having them form trusting relationships with horses.  The program was started by a combat Marine who saw what value there was in horse therapy for disadvantaged children.

There were other booths at the Polo Field, reminding me that many organizations are assisting the overworked and underfunded Veterans Administration.  Even before Sequestration the VA was behind the power curve of need for Veterans.  An organization I belong to, the Military Officers Association of America has a great program preparing separating veterans for the work force.  An organization called Veterans 360, which has a similar mission, had a booth at the Polo Match.
Goya - Rape by a combatant Soldier

So, the point of this Post is that I now know PTSD is not a malingering phenomenon, nor is it “all in the mind”.  I have a greater respect for those who suffer from it and even have a greater respect for what my wife experienced from my long-term absences while in the Navy.  I don’t think I ever suffered from PTSD, but her adjustment while I was deployed might very well have had the same consequences.

On a lighter note, my next Post will be titled “Varicosities” and will explain my feelings on tattoos.  Please come visit.