Consumer Health Interests Are Not Being Served by the Health Insurance Companies

by Thomas Hinton

Every week, it seems like there's another news story in the newspaper, or on the television, about the plight of someone who has been denied vital medical care. I'm talking about American citizens who have health insurance and pay their bills.

Let's review the case of Scott "Scotty" Eveland, a 17-year old senior at Mission Hills High School in Oceanside, California, who was severely injured and paralyzed while playing for his high school football team last fall. While Scotty is making a slow recovery, doctors who are treating him at a San Diego County hospital, are cautiously optimistic about his progress and recommended to Blue Cross of California that he remain at their facility to receive daily physical therapy.

But, Blue Cross of California decided Scotty's care was costing too much money and ordered him moved to another facility. Despite the protests of Scotty's doctors, family, and the Oceanside community, Blue Cross of California refused to change its ruling. The family appealed the health insurer's decision but lost. The have made a final appeal to California state regulators who can -- and should -- overrule Blue Cross of California.

Blue Cross of California noted in its decision that similar care was available at a lower cost, non-medical facility. The family and physicians tending to Scotty strongly disagree. Something tells me they know best since they are involved in his recovery and care every day.

Given this scenario and the gut-wrenching experiences people and patients must suffer through, I must ask the ultimate question: Why is it that health insurers like Blue Cross of California serve as both judge and jury in these matters?

Something is fundamentally wrong here with the health care system and how it is managed. For two years, the American Consumer Council -- along with other consumer-oriented organizations and government agencies -- have rallied against the health care management establishment to challenge the injustices and unfair practices of companies like CIGNA and Blue Cross of California who serve as both judge and jury. In essence, claimants pay their insurance premiums and then, if it suits the whims and financial goals of the health insurers, they decide whether or not people like Scotty recover or remain in a vegetative state. As harsh as it sounds, that's what medical directors and other so-called "health care professionals" are deciding every day. It's a sham!

Is it possible that medical directors, who once swore allegiance to uphold the best care of their patients when taking the Hippocratic Oath (an oath traditionally taken by physicians pertaining to the ethical practice of medicine), have been bought-off by health insurers and compromised in their ability to make unbiased decisions? I think so. How else does one explain their decisions to deny care? Certainly, these men and women are intelligent people. But, it appears they've lost their ability to act rationally and in the best interest of their patient-claimants in order to save their employers a few thousand dollars! Yes, it's really money, but, it's also about the dignity of human life!

When you read the Hippocratic Oath, which dates back to the Fourth Century, and is attributed to the father of medicine, it states unequivocally what is expected of a physician. This includes the medical directors of health insurers who also took this oath:

1. To teach medicine to the sons of my teacher.
   
2. To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them.
   
3. Never to do deliberate harm to anyone for anyone else's interest.
   
4. To avoid violating the morals of my community. (Many licensing agencies will revoke a physician's license for offending the morals of the community).
   
5. To avoid attempting to do things that other specialists can do better.
   
6. To keep the good of the patient as the highest priority.
   
7. To avoid sexual relationships or other inappropriate entanglements with patients and families.
   
   

Clearly, sections 2, 3, and 4 appear to be in question with the continuing care and treatment decisions of certain medical directors of health insurers. This raises some interesting legal questions that consumer groups are exploring. For example, if the "Community" were to sue a health insurer's medical director (or other licensed medical personnel), and a jury found that individual to be guilty of violating their Hippocratic Oath, could the guilty medical director be suspended from practice?

Perhaps it's time for community leaders and families of patients to raise the stakes and organize major boycotts and protests at these companies so that legislators will take action to fix a broken system.

While many health care proposals have been put forward -- including an impractical proposal by Governor Schwarzenegger of California to require all Californians to purchase health insurance -- the ultimate answer, we believe, is for the federal government to adopt a universal health system that provides primary and urgent care for all citizens. Such a plan was introduced by the American Consumer Council and can be viewed at: www.americanconsumercouncil.org

In the final analysis, there must be a national health care program that eliminates health insurers and removes life-and-death decisions from the hands of people who have been compromised in their ability to make unbiased decisions because their allegiance is not to the patient, but rather, a for-profit company that mostly cares about making a profit and not improving the health of the patient.

About the Author. Thomas Hinton is the president of the American Consumer Council and can be reached at tom@americanconsumercouncil.org

New Year's Resolutions for Everyone Except Me!

by Bill Kalmar

Now that I have your attention, let me explain. This year I will enter a very special age group, namely, those people eligible for Medicare. The magical age of 65 provides one with certain mystical rights—Medicare benefits, of course, which means we’ll be swimming in extra disposable income. Yeah, right! And how about another increase in social security benefits without having to endure a performance review! And most importantly, the removal of all vestiges of political correctness, as if that ever encumbered me!

An added benefit is moving into the 65–69 age group for competing in sporting events or, as it’s sometimes referred to as “65 to death.” For those of you who may be runners you know that I will now be the youngest in a group of runners vying for prizes given only to the first three finishers in each age group. Not that this makes for a significant advantage because in my last 10K (6.2 mi) race, I was roundly beaten by a 72-year-old. I wonder if he passed the drug test.

In any event, I no longer have to make any New Year’s resolutions because changes to my lifestyle at this juncture could be injurious to my health, well being, and mental acuity. For me to make any personal resolutions would be a waste of time and thus I’m making them for all of you. Just chalk it up to senility.

Here’s what I’m proposing for 2008:

• I resolve that all wait staff in restaurants pay attention to me while taking my order and quit looking around to view other activities that may be going on in the restaurant. If I’m not the center of attention then perhaps my waiter should extract the tip for my meal from the people he or she is so attracted to. Is it too much to ask that the wait staff at least appear to be focused and interested in providing me with exceptional customer service?

• Speaking of restaurants, I resolve that all establishments serving food leave the hot water valve on in the restrooms. How many times have you encountered a restroom sink that only has cold water? I have a confession to make in that regard. On a regular basis when I discover a lack of hot water, I instinctively reach under the sink and turn on the hot water valve, which inexplicably has been turned off. On some occasions, I have even used my handy Swiss Army knife to override the system. How the wait staff washes their hands with cold water is beyond me. So next time you visit a restroom at McDonalds, Wendy’s, or Burger King and the water is hot, you have me to thank for it.

• I resolve that all phone calls I make in 2008 don’t contain the message: “For quality purposes this call may be recorded or monitored by a supervisor.” Do we really believe that someone is hired specifically to listen to phone calls all day? At one point in my career I managed a customer service telephone area and we found it just as effective by practicing “management by walking around” and overhearing the representatives rather then listening to reams of recorded messages at day-end. If there is to be a phone message I recommend that it be: “For truth of disclosure purposes, this call is not being monitored because we’re tired of fooling you to make you think that it is.”

• I resolve that when executives are released from an organization the words “Leaving to devote more time to other activities and family” be fully explained. What are those other activities and what does his or her family have to say about the executive's sudden arrival on the home scene? Is the family happy and content or would they rather the executive just focus on those “other activities.” Just when you thought you have heard all the reasons for someone to depart an organization try this from global chief growth officer Thomas Hernquist who spearheaded Hershey Co.’s premium and dark chocolate portfolios and who resigned from the company effective December 31. Hernquist said he intends to work on ventures that “leverage strategic consumer insights.” Wow! That is just too cerebral for my soon to be 65 year old brain! Why couldn’t he have just said that he was pursuing other activities? Or my favorite: “Leaving so I can function in a jerk-free environment.”

• I resolve that the words “merger of equals” and “synergy” be banned from business jargon forever. We all know that there is no such thing as a merger of equals—Daimler-Chrysler certainly proved that. In a merger there is always one dominant party and thus synergy means “We will look for ways to combine our processes but ultimately we bought your company so our processes will be used.” If that sounds cynical on my part, I think it’s also realistic. I, along with many of you, have been through mergers and frankly none have been pleasant. So for 2008 let’s substitute the words “Full court press take no prisoners buy-out” for “merger of equals.”

• I resolve that when organizations release staff because of the company’s desire to “go in a different direction” that new “direction” or strategy should be spelled out to the remaining staff and the shareholders. What if the new direction is contrary to the expectations of those who will now have to implement it?

• I resolve that all meetings start and end on time. In that regard, let me share with you the thoughts of two captains of industry on being punctual. First, Bob Iger, President and CEO of Walt Disney:“Meetings need to start on time. I’m zealous about that because my day needs to be managed like clockwork. If people are late for meetings, the meetings tend to go late, which throws off my agenda thereafter. I frequently start the meeting even if all the people expected to be in attendance aren’t there. I don’t need to say to people, ‘Be on time’, they know.”

And this from Simon Cooper, president and chief operating officer of the Ritz-Carlton Hotel Co.: “I’ve always believed that if you’re late, it says something about the lack of value you have for other people’s time. Being on time for all meetings is the best use of time in the workplace. I hope I’ve instilled that in my staff. I certainly embarrass them if they’re not.” That pretty much sums it up for me. One other comment and that is at the end of a meeting if someone leaves without an assignment that person wasn’t needed at the meeting and shouldn’t be invited back for subsequent meetings on the same topic.

• I resolve that all establishments that imprint a survey request on receipts provide me with on the spot reimbursement for completing the survey. Over the years I have completed surveys for every department store, coffee shop, bagel store, and sundry other establishments without benefit of a thank you. Sure the receipt indicates that I have been entered into a drawing for $5,000 but I doubt it. Just the other day I asked the Barista at a local coffee shop if he was aware of anyone who had ever won a cash prize by completing a survey and of course the answer was a resounding “No.” So from now on, I want a free coffee or bagel for completing the form.

Well, those are just some of the resolutions for all of you for 2008. If I sound like the fictional deranged character Howard Beale from the movie Network when he said, “I’m as mad as hell, and I’m not going to take it anymore,” so be it. At my age I think I’ve earned it and, yes, I am feeling a bit deranged from service expectations not being to my liking especially when it comes to hot tap water in restrooms. Does Medicare cover my idiosyncrasies?

Just so you don’t think that I’m bonkers, I want to make one resolution of my own. That is that you the readers of QualityInsider continue to invite me into your offices and homes for another year. I thoroughly enjoy the relationship with the experienced and professional staff of the publication and how they make me look so good each month. I also resolve to provide you with some thoughts on quality and customer service and other pertinent topics that hopefully you will find interesting, informative, and perhaps even humorous.

Now time to retreat into my ice-covered hammock. If some of my resolutions have left you perplexed and troubled just keep in mind the words of comedian Joey Adams when he uttered: “May all your troubles last as long as your New Year’s resolutions.”

About the author
William J. Kalmar has extensive business experience, including service with a Fortune 500 bank and the Michigan Quality Council, of which he served as director. He has been a member of the Malcolm Baldrige National Quality Board of Overseers and a Baldrige examiner. He’s also been named quality professional of the year by the Detroit Chapter of ASQP. Now semi retired, he’s a freelance writer for the Detroit News; writes a monthly column for Mature Advisor newspaper; is a mystery shopper for several companies; is a frequent presenter and lecturer; does radio voice-overs; and competes in duathlons.

Grounded: What to Do About the Airline Abuse of Passengers

Grounded: What to Do About the Airline Abuse of Passengers

by Tom Hinton

Valentine’s Day 2007 was anything but a sweetheart experience for several hundred airline travelers who had the misfortune of boarding JetBlue flights only to be stranded on the tarmac at New York’s John F. Kennedy International Airport for more than six hours. A severe winter storm hit the northeast region and caused havoc for the popular, discount airline. JetBlue cancelled more than 250 flights and approximately 10 flights were significantly delayed at JFK with customers on board. These flights were a combination of scheduled departures from JFK and arrivals that were unable to move to a gate due to all gates being occupied.

This latest weather-related episode comes on the heels of a similar debacle two months earlier when American Airlines allowed passengers aboard a flight to sit for eight hours on a tarmac in Austin and wait-out thunderstorms over Dallas. On that same day, there were 67 other American Airline flights that idled for over three hours awaiting weather clearance. In 1999, Northwest Airlines allowed an inbound flight from the Caribbean that had been delayed 22 hours, to sit on a snowy Detroit tarmac for eight more hours.

According to the Air Transport Association (ATA), the air-carriers’ trade group, such delays are isolated incidents. But, when you examine the most recent delayed flights statistics from the U.S. Department of Transportation, it appears the airlines are operating with a broken process. I believe this issue is more serious that simply bad weather conditions that force the airlines to improvise. According to the Department of Transportation, in 2006 some 36 domestic flights were subjected to waits of more than five hours before taking off; and, 60,000 flights were subjected to tarmac waits of up to two hours after leaving their gates. What are the airlines doing to correct the situation that has caused this latest uproar among the traveling public? The unfortunate answer is not much.

The ATA contends that the problem was fixed in 2000 when it promised to voluntarily regulate its members through a 12-point customer service agreement that encouraged its airline-members to embrace guidelines to meet passengers’ essential needs during long on-aircraft delays. Interestingly, however, when a member airline fails to honor its end of the industry agreement, there are no repercussions other than the negative press and ill-will the airline suffers from disgruntled passengers. JetBlue has been feeling that pain all week long.

It is also interesting to note that Senators John McCain and Ron Wyden proposed legislation shortly after the 1999 fiasco with Northwest Airlines. The draft legislation would have forced airlines to treat their passengers better. But, the ATA derailed this congressional action through its powerful lobby and the bill sponsors caved-in by accepting the ATA’s meaningless 12-point customer service agreement.

Now, a more consumer-friendly Congress led by feisty Senators Daniel Inouye and Barbara Boxer are planning to revisit this untenable situation by holding hearings on JetBlue’s misstep and, possibly, propose long-overdue legislation to give airline passengers meaningful protection against further airline abuses. Such legislation cannot happen soon enough given the dismal track record of airlines in such weather-related situations. New legislation would also strengthen the U.S. Department of Transportation’s ability to penalize airlines for future mishaps and put teeth in regulations that deal with on-aircraft delays and other passenger abuses such as lost luggage and missed connections that are deemed the fault of the airlines.

Hopefully, any congressional hearings also will determine why airlines consistently make bad decisions when considering the welfare of passengers amid weather delays. As one of those frequent flyers who once sat on a tarmac at JFK Airport for over four hours waiting for a second de-icing of our jet before we could take off, I would like to recommend three issues Congress should carefully examine when it holds hearings to address this untenable situation:

1. Airline Greed.
Basic economics tells us that when an airplane doesn’t fly, it doesn’t generate any revenue for the airline. So, it’s in the financial interest of airline management to get their planes boarded and in the air. Of course, that’s assuming there’s not an ice storm blanketing the region. If anyone at JetBlue had bothered to step into the passenger terminal at New York’s JFK International Airport and read the arrival-departure screens, they would have noted that many other airlines were canceling their flights in and out of the northeast. Certainly, the management team at JetBlue watches the Weather Channel! Predicting the weather might be a science, but reacting to a snow storm that is already dumping ice and snow on the airport doesn’t require much more than common sense. JetBlue could have read the Farmer’s Almanac and learned the same forecast two weeks in advance! Of course, when airline greed is the primary motivator, management is often blind to the obvious.

Why was it that savvy Southwest Airlines canceled many of its flights as early as Tuesday afternoon, February 13, the day before the storm socked the northeast? I think Southwest Airlines and other air carriers that took pre-emptive steps to cancel flights deserve kudos for demonstrating their concern for customers and placing the welfare of their passengers ahead of potential revenues. JetBlue reportedly suffered losses of $7 million as a result of canceling nearly 250 flights affecting some 10,000 passengers over three days. Certainly, canceling ten more flights – that is, those flights that sat for six hours on JFK’s tarmac -- would not have broke the bank. But, the damage JetBlue’s image and brand will suffer as a result of their decision to get those airplanes in the air will likely cost JetBlue an estimated $25 million in lost customers who have had enough and no longer trust JetBlue. So much for trying to make a buck!

2. Bad Judgment by Management:
There’s an old axiom that says, ‘You can’t fix stupid.’ In the case of airlines that force passengers to wait on a crowded airplane on a dark tarmac for hours at a time before deciding to cancel their flight and return them to the gate suggests either ineptness or stupidity. What were these guys thinking? Despite the mea culpa by JetBlue’s CEO David Neeleman, his tony airline has suffered an ugly black eye. Trying to buy back disgruntled passengers’ loyalty with apologies and promises of free tickets just doesn’t cut it. JetBlue needs to take a bold, third step in terms of its customer recovery efforts and that bold step is to take the lead in championing a Passengers Bill-of-Rights through Congress. Such action will help restore JetBlue’s image and credibility among the flying public. What JetBlue proposed on February 22 in response to the call for a Passengers Bill-of-Rights doesn't go far enough. JetBlue is suggesting that a five hour delay is still tolerable. It is not.

Most passengers understand reasonable travel delays. We’ve tolerated the security screenings and the loss of our liquids and gels that exceed three ounces in order to get past the airport security checkpoints. But, JetBlue’s 30 million passengers will not tolerate bad management decisions. Passengers are people, not cattle. Did anyone among JetBlue’s management think to get rolling stairs out to those planes to disembark stranded passengers? And, what were the pilots thinking? Ultimately, the pilots should have taken charge of these chaotic situations and used their common sense in the cockpit. In the end, JetBlue only created a public relations disaster for which it will pay a hefty price. Passengers have many choices when it comes to flying; and, in this era of tough competition, JetBlue’s bad management decisions will certainly cost it dearly in terms of lost revenue and passenger disaffection.

3. Fix the Broken Process:
While the ATA and many of its members want to maintain the status quo by allowing the airlines to fix this problem, a better long-term solution must be considered. To date, the airline industry has not fairly represented the concerns of paying passengers who keep their member airlines aloft in the not-so-friendly skies.

Perhaps, a good first step would be for the airlines and its trade industry to acknowledge that the current process for handling weather-related delays is broken. And, since the airline industry is unwilling to truly fix the problem, legislation should be approved quickly by the Congress that sets forth strict guidelines for weather–related delays and imposes financial penalties on airlines that mistreat or abuse passengers.

Since the airlines cannot agree on a definition of ‘passenger torture,’ let me offer a definition. When there is a tarmac delay beyond two hours for any reason – weather or mechanical-related – passengers should be given the option to disembark. Beyond two hours, it is torture for passengers who are apt to lose their cool, get angry, and even threaten the safety of the flight crew. I know. I was aboard a weather-delayed flight for four hours and experienced a near-passenger revolt one snowy, December afternoon at JFK Airport.

The airline industry will argue that such measures are too costly and will only further encumber an already dysfunctional airline hub system. So be it. Has the airline industry become so smug as to forget who the paying customers are? Isn’t it time that the airlines start treating their customers with some degree of dignity and respect? It’s bad enough that service performance aboard the airlines have dropped off the radar screen. Passengers shouldn’t have to suffer additional anguish because the airlines can’t figure out what to do with them when extensive weather-related delays hit an airport.

If this was simply a case of flying cargo across the country, nobody would be screaming mad. But, when human beings are factored into the equation, the airlines need to think and perform differently. Unfortunately, it appears that too many airline executives have become callous in the ways of running a business and lost site of the fact that passengers are human beings. And, passengers will vote not only with their pocketbooks, but they will organize and fight back when they’ve had enough. I believe I hear a rallying cry. The trumpet calls from angry passengers are blaring in the distance and the airlines had better heed the warning if they don’t want a full-scale passenger revolt led by consumer champions Senators Daniel Inouye and Barbara Boxer on their hands.

Frankly, I think an airline passenger revolt is long-overdue. We’ve suffered enough. We’ve tolerated an inept hub system. We’ve sat squished together like sardines in those flying aluminum tubes. We’ve lost our appetites due to the slosh airlines consider food; and, we’ve been subjected to monotone in-flight announcements ad nausea. It’s time for Congress to get tough with the airlines and approve a passenger bill-of-rights to protect the flying public since the airline industry will not.

And, while Congress is at it, could they please do something to shorten those ridiculous in-flight announcements passengers are forced to listen to before departure? Any adult who doesn’t know how to fasten a seat belt probably should take the train.