Daniel A. Dougan

...is glad you're here but a little
concerned that you haven't found a
better use of your time than this.

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Health care reform really is a big @$%!ing deal

Posted by danieladougan on December 10, 2011 at 10:00 AM Comments comments (0)

If there is a single issue that has defined the Obama presidency, it has been the Patient Protection and Affordable Care Act...also known as health care reform or derisively as Obamacare. On the night President Obama signed PPACA into law, a microphone picked up Vice President Biden saying that "this is a"big @$%!ing deal."

Every Republican candidate for president -- even former Massachusetts Gov. Mitt Romney -- has vowed to repeal it immediately if he or she is elected. Many Democrats have downplayed their votes in favor of it. I think the backlash against the law is due less to objections in the actual law and more to mistrust of Washington and misconception about what the law actually does.

As an employee of the nation's largest health insurance company and a graduate student in health administration, I feel I have enough knowledge of this law to be dangerous and also a duty to address some of the common misconceptions about the law. If you still object to it, that's fine, but object to it based on facts and not misinformation.

Objections based on misconceptions

Misconception #1: Death panels. Former Alaska Gov. Sarah Palin took to Facebook on August 7, 2009 to attack health care reform legislation that was, as of that time, unwritten. She wrote:

The America I know and love is not one in which my parents or my baby with Down Syndrome will have to stand in front of Obama’s “death panel” so his bureaucrats can decide, based on a subjective judgment of their “level of productivity in society,” whether they are worthy of health care. Such a system is downright evil.

This accusation is totally without merit. The law does not allow anything even remotely resembling a death panel. To overcompensate for Gov. Palin's lie (dubbed the biggest lie of 2009 by the non-partisan Politifact.com), an important, cost-saving provision was removed from the law: reimbursing physicians for counseling their Medicare patients on advance directives and other end-of-life issues.

In fact, private insurers already ration care through utilization management programs. Ever heard of "precertification?" In many cases, utilization management is a very necessary and important form of rationing. And the appeals panels that insurance companies set up frequently uphold denials.

Misconception #2: Government takeover. PPACA enables the government to do many things, but one thing it does not do is take over our nation's health care system. PPACA is, at its very core, a set of regulations for private insurance companies, guidelines for states to set up insurance exchanges as marketplaces, subsidies to help people purchase private insurance and looser eligibility guidelines for Medicaid. It is actually quite similar to the law Romney signed into Massachusetts law when he was governor.

In early versions of the legislation, including the Affordable Health Care for America Act that passed the House but died in the Senate, there was a provision for a "public option," but that did not end up in the final version of the law. There is also no trigger for a public option in the law either, although that was proposed.

Even if those things had made it into the law, there would still be private health insurance, and of course privately owned health care providers. Nothing in this law would constitute the government telling you which doctor to see or rationing care.

Misconception #3: Only good for the poorest. While it is true that the law expands Medicaid eligibility guidelines to 133% of the federal poverty level for men and women, many of the most important benefits will be for middle-income families purchasing subsidized private insurance through state-based exchanges. A family of four with adjusted gross income of $88,000 per year could qualify for a subsidy if they have to purchase individual coverage.

They'll need it too -- with new guaranteed issue (no denials for pre-existing conditions), community rating (no rating based on health) and 3-to-1 age banding (the oldest people will only pay three times as much as the youngest people), healthy people will be charged more for insurance to compensate for the sickest people who will be paying less or even newly eligible for private insurance in 2014.

Earlier in 2011, Rep. Paul Ryan (R-WI) proposed a voucher program for Medicare that would use the Medicare tax to provide subsidies for Medicare beneficiaries to purchase private health insurance. This was viewed as a potential solution to the red ink facing the Medicare program. Considering Medicare beneficiaries are, by definition elderly and/or in poor health, they are often bad risk candidates for private health insurance...but only the rating rules under PPACA actually could have made such a program workable for seniors. I, for one, hope Congressman Ryan's proposal resurfaces.

A few legitimate objections to health care reform

Objection #1: The individual mandate. The issues of guaranteed issue and community rating raise an important point about the real hot-button issue in the law: the individual and employer mandates to purchase health insurance.

Working in the health insurance industry has taught me about the problem of adverse selection, namely the projected rise in costs when more unhealthy people purchase insurance. The higher the cost, the more likely people are to wait until they get sick to purchase insurance...and that, in turn, raises the cost even more. Insurers have dealt with this problem up until now by denying coverage for pre-existing conditions, but a whopping 82 percent of Americans surveyed by the Pew Research Center say that the government should ban this practice.

So the insurance industry proposed an alternative: a mandate that requires people to buy health insurance. If you own a business or are in sales, wouldn't it help your bottom line if the government required people to buy your product or pay a penalty?

Unlike death panels and the public option, this mandate actually is in the health care reform law, and it will face the ultimate constitutional test in front of the U.S. Supreme Court in 2012.

We Americans are a conflicted bunch. We support a ban on denials for pre-existing conditions but then most of us oppose the mechanism for making such a ban workable: the individual mandate. Unfortunately this very popular ban costs something, and since there is no free lunch, the individual mandate is that cost.

Objection #2: The federal deficit. The non-partisan Congressional Budget Office projected that, through 2019, the Patient Protection and Affordable Care Act would yield a net reduction in the federal deficit of $130 billion. Of course, the government's budget projections have been wrong -- very wrong -- before.

When Medicare began in 1966, the cost was $3 billion, and the House Ways and Means Committee projected (conservatively mind you) that the cost would be $12 billion by 1990. In fact the cost of Medicare was $107 billion by 1990 and $468  billion for FY 2012. Considering that we are talking about health care with its extremely rapid inflation rates, CBO's projections may need to be taken with a grain of salt.

Objection #3: It's socialism. One of the definitions of socialism in The Merriam-Webster Dictionary reads, "a stage of society in Marxist theory transitional between capitalism and communism and distinguished by unequal distribution of goods and pay according to work done."

By that definition, all social programs ranging from Medicare to food stamps to Social Security to unemployment insurance are forms of socialism. Yet people usually like these programs. As Paul Ryan was reminded, Medicare and Social Security are often sacred cows in American politics, and any suggestion of reforming them is certain to draw ire from seniors.

PPACA is on the same plane with Medicare and Social Security. There really is not an ideological distinction between one and the others. The question we should be asking ourselves is not, "Is this socialism?" but "Is socialism a good solution to this problem?" There are some who would never say yes, but most Americans support social programs to some degree whether or not they are willing to describe them as socialism.

While we cannot pretend that PPACA is cost-free, we must also consider the current system as an alternative: a system that shifts the debt from the government to individuals. In 2007, a study by the American Journal of Medicine found that 62 percent of all bankruptcies filed were related to medical expenses, and 3/4 of medical debtors had health insurance. What's worse, approximately 50 million Americans have no health coverage. When private citizens go bankrupt and cannot pay their medical bills, those costs get shifted to someone who can pay and usually does pay more...and isn't that a form of socialism too?

The fact is that the spiraling cost of health care itself underlies both the need for health care reform and the opposition to it. I, for one, am tired of hearing Republicans talk just about repealing PPACA and instead want to hear what they propose as an alternative solution.

Stupid made-up holidays

Posted by danieladougan on November 4, 2011 at 7:25 PM Comments comments (2)

You've probably heard of the "Hallmark Holiday" -- a special calendar day, week or month concocted for the purpose of selling something. (For what it's worth, Hallmark Cards, Inc. denies creating any holiday.)

One of the most notorious of these is Sweetest Day, which was created not by Hallmark but by Cleveland confectioners wanting to sell more candy in October. There's also National Boss Day, Administrative Professionals' Day, Grandparents' Day and the like. If you still have a printed calendar in this day and age, it won't take you long to find a holiday designed solely for the purpose of making money. (Never mind Halloween and Christmas, which generate plenty of sales despite having more historical significance.)

But look out -- marketers are getting more shameless and desperate by the minute. November 5 is Bank Transfer Day. March 26 is Make Up Your Own Holiday Day: a made up holiday devoted to made up holidays.

It gets worse. Did you know March is National Frozen Food Month? Or that September is Life Insurance Awareness Month? It's not enough to have a day on the calendar devoted to selling your product...now you have to have an entire month?

Why do  marketers keep doing this stuff? Because it works. Because we as consumers allow it to work. Think about it: a made-up holiday is a marketer's dream...they simply find a period during the year when sales tend to slip and then inject an artificial sense of urgency by making up some reason to care about their product right now.

So just remember, the next time you feel an urge to buy frozen food in March, life insurance in September or a Boss's Day card, remember that someone cooked all of this up just to make you part with more of your hard-earned money.

Finding a new meaning

Posted by danieladougan on October 23, 2011 at 1:30 AM Comments comments (0)

It's a great big universe

And we're all really puny

We're just tiny little specks

About the size of Mickey Rooney

-- Animaniacs, "Yakko's Universe"

If you're anything like me, you've probably played existential games with yourself before. I often wonder why it is that I am here.

This game is an simple one for religious people to play and win -- they are here because God put them here and gave them a unique purpose. (The Westminster Shorter Catechism reads, "Man's chief end is to glorify God and enjoy Him forever.") Furthermore, these people often look forward to some sort of afterlife that they will enjoy but that is not afforded to everyone. They feel a sense of privilege at that.

Some people find meaning in their children...they have a biological drive to love their children and ensure (to the best of their ability) that these children are healthy and successful. I am a son after all, and my parents have expressed their desires about this to me. I realize that not all parents actually have this motivation, and their children often end up as damaged adults. I have met adults like this throughout my life, and I sympathize with them for the difficult road they have traveled.

In my case, I don't really believe in God and I don't have any children. And, contrary to what some have suggested, I don't see the answer as merely changing course on either of these issues. These are important choices I have made for how I wish to live my life, and I hope people will respect that. Some do, some don't.

So what is left for me to find meaning in? I have always measured myself based on what I have accomplished and contributed to the world in this life. Unfortunately, my level of accomplishment has not reached anything near the heights that I would have hoped. I wanted to be Superman, but I'm not even Clark Kent yet. As I approach yet another birthday, I cannot help but be reminded about how short I have fallen of my goals.

I am told by some expert people that this line of thinking is a trap. I am inclined to believe them since it does not lead to positive feelings. My fulfillment is contingent on measurable external factors, and when I don't measure up, I cease to be fulfilled.

So it's time to carve out a new path. I'm not sure what that even looks like. I know it does not look like the paths that most other people have charted. It's about the relationships that I have with people. It's about doing good in small ways. It's about living the best life I can each day, not where I fall on some 10-year plan. 

This is not an easy path to take. It requires intense focus. It requires a commitment not to think too far out in front of my headlights. It's about living life in the present. We'll see how it works.

Putting all of my time in learning to care

Posted by danieladougan on October 17, 2011 at 11:20 AM Comments comments (0)

Putting all of my time

In learning to care

And a bucket of rhymes

I threw up somewhere

Want a locket of who

Made me lose my perfunctory view

Of all that is around

And of all that I do

-- Rufus Wainwright, '"I Don't Know What It Is"

Lately I have been putting all of my time in learning to care about my deeper desires for life. Away from work. Away from distractions as much as possible. Just like when you listen to another person, you want to be able to focus, you have to work immensely harder to listen to what it is you are saying to yourself. This is not the mark of insanity -- we all have our own little voice inside. It's part of human nature.

Recently I caused myself a tremendous amount of pain by (figuratively) yelling at that little voice. Of course, I had my reasons. After all, the voice was distracting me. It was sabotaging me. It seemed like I was blindsided by one thing after another in life, and you cannot bob and weave when you don't even know what it is you're dodging. My response was to turn into a disciplinarian...after all, inner children are to be neither seen nor heard.

Thanks to some caring people in my life, I learned that yelling at the voice to be quiet was not productive. It only made things worse. I was more distracted. Instead, I had to sit back and listen to it. I had to care about it. What was it telling me? 

Unfortunately that little voice does not typically use words, so it can be very hard to interpret. It's sort of like figuring out why a baby is crying. The baby cannot tell you in words, so you have to use a process of elimination. Does its diaper need to be changed? Is it hungry? Does it just want to be picked up and held? 

Just as some parents intuitively know what their child wants, some people are in touch with themselves to a degree of pinpointing their deepest desires in an instant. They act on their gut feelings, and they usually get their needs met. Anyone who knows me well will agree that I am not one of those intuitive people...and, in fact, all of this seemed like hippie psychobabble to me at first.

So I am putting in some time now. Everything is on the table. There are no sacred cows in my life.

I really have never made time for this process before. I always had to get on to the next challenge or the next paycheck. I never took a moment to breathe. The irony of this is that not committing to my deep desires has been quite costly to me over time. Repress that little voice for long enough, and it starts acting out.

So...maybe I need a locket with a mirror so I can see exactly "who made me lose my perfunctory view."

Why I Can't Even Be a C-E Christian

Posted by danieladougan on April 24, 2011 at 7:01 PM Comments comments (0)

I'm not particularly religious. But a lot of people who aren't particularly religious still trot themselves into church on Christmas and Easter...which happens to be today. People who only go to church on Christmas and Easter are dubbed "C-E Christians."

I remember when I was a kid that I loved Easter. I loved my Easter basket. I REALLY loved rabbits like the Easter Bunny and the Cadbury Bunny...to the point where I eventually had a couple as pets. I never understood what all of that had to do with the stuff they taught me at church regarding Easter, but hey it was fun and there was candy.

Back then I never gave a lot of thought to it all. As I got older I found out that the Easter Bunny wasn't real...it was kind of like finding out Santa Claus isn't real. A rabbit could never deliver baskets to all the Christian children in the world in one night. Besides, how would he even get into the house? 

And yet, even as I got older, I had no trouble believing an equally implausible story about how a man could be executed by the most cruel and torturous method ever invented on Friday and then walk out of his tomb (rolling a stone away) on Sunday morning. After all, all of the adults I knew claimed to believe it. It was not just a miracle but it was THE miracle that saved us from the eternal torment we deserved.

When I got to college, I learned some disturbing facts about the Jesus story. I had always heard that the Christians had placed the holiday of Easter at a particular time in order to supplant pagan fertility rituals usually celebrated around the same time..

But what I did not realize was that so many details of Jesus's life -- the virgin birth and the resurrection in particular -- were unoriginal. The story of Jesus mirrors many stories that came hundreds of years before him...and it would make complete sense for someone interested in gaining a new convert in the pagan world to merely tack on these stories to the real life story of Jesus in order to make it more palatable for pagans.

During the period of the Roman Empire, history was simply not written the way we think of it today. There were no pure biographies...only legends and folklore that were intertwined with facts. It was even more true with religious texts. We can learn a lot about ancient history from these documents, but to suggest that they represent history in the same way that a biographer or historian would write history today ignores their context.

Imagine someone from the future picking up a copy of Major League and thinking of it as a documentary about baseball. It was a comedic farce and never intended to be an historical film...even though there really was a baseball team called the Cleveland Indians.

Resurrection in the ancient world was a symbol for the new fertility that came with each spring. It turns out the rabbit and the eggs are more closely aligned with the original meaning of Easter than the stories about Jesus are.

Indeed, these two stories of virgin birth and resurrection that comprise Christmas and Easter are the two most ridiculous stories in all of Christianity. 

The last time I attended church, it was on Christmas Eve of 2005. I thought it was a nice tradition. It was my idea. However, once I got there, all I could feel was anger at the myths that these leaders were spreading and reinforcing as if they were historical facts. The same thing happens at Easter, and that is precisely why I cannot attend anymore.

Set my hair afire, Lord!

Posted by danieladougan on August 15, 2010 at 2:50 PM Comments comments (2)

Set my soul afire Lord

For thy holy word

Burn it deep within me

Let thy voice be heard

"Set My Soul Afire" -- Hymn

December 24, 1996 was a date I will probably never forget. My mother will never let me.

I was 17 at the time -- in my junior year of high school. We had gone to our church for the Christmas Eve candlelight service. My friend Matt, who was quite religious but also quite alone in the world, chose to come with us. He even stayed at our home that night at my mother's insistence because she believed nobody should be alone on Christmas.

As we were walking outside of the worship center (unlike Catholics, evangelical Protestants are very careful not to ascribe spiritual significance to physical objects like buildings...so they could not call it a sanctuary), I was having a little adolescent fun with my candle. My mother was directly in front of me, and I was teasing her by blowing the flame not so much out as forward.

Unfortunately, I did not have as much control over the flame as I thought I had, and the ribbon in her hair caught fire. Matt and I rushed up to her and quickly stamped out the flames, which did end up singeing her hair a bit. Men who were walking out behind us were in the midst of removing their coats so they could push her to the ground and put out her hair. 

For a couple of years later, whenever the congregation would sing "Set My Soul Afire," I would emphatically replace the word "soul" with "hair" just to tease her. I think I get that from Dad -- Mom was not amused.

Mastering my own mind

Posted by danieladougan on July 27, 2010 at 6:23 PM Comments comments (3)

I have made more than my share of mistakes in life. At times I think I'm balancing out those super-successful, effortless types. All of them.

Being physically uncoordinated (I actually received a "Two Left Feet" award once) is a bad start. That problem has crossed a number of sports off my list altogether. 

But there's perhaps a larger problem that sets me back: it's the way my mind (if your philosophy does not allow for a "mind," then feel free to substitute "brain") functions.

No, I haven't been diagnosed with any sort of neurological disorder...at least not yet. Yet I often feel and act as if I'm missing the part of my brain that's supposed to make me step back and focus.

I can't just chalk it up to senility or memory loss. I bumped into an old college acquaintance today, and I shocked him by remembering what he majored in and his wife's name all these years later.

Yet I couldn't remember to take my head out of my ass long enough to buy everything I needed to buy (for work) at the store or get every box into my car before I ventured out prematurely. My flakiness inconvenienced other people, and it quite justifiably made me look foolish and incompetent.


I was searching for a good quote on the subject when I ran across this:

"Mental toughness can take you to the top, and mental weakness straight to the bottom." -- John Schiefer

If this were just a once-in-a-blue-moon kind of occurrence, then I might not fret so much about it. But I see it as a particularly serious pattern in myself.  When things are moving quickly, I simply can't think straight. I tend to collapse mentally and make dumb errors just like the over-excited defensive end who jumps off sides on the first play of the Super Bowl. Sometimes, when I'm under pressure, I can't perform even the simplest tasks correctly. 

So how does one develop this sort of "mental toughness?" I don't quite know yet, but I think I owe it to myself and those I work with to figure it out and master my own mind. For too long I have allowed my mind to master me. 

Have you driven a Mercury lately? Neither has anybody else...

Posted by danieladougan on June 21, 2010 at 5:59 PM Comments comments (0)

There have been many unfortunate casualties of the recent economic downturn. Companies have folded. People have lost their jobs and their homes in appalling numbers.

So in the midst of all that, it's hard for me to be wistful about the demise of Mercury. For those of you who aren't quite as attuned to all things automobile, Mercury is a not only a planet and an element, but also a brand of car under the umbrella of Ford Motor Company. 

You can be forgiven for not knowing that because somewhere along the way, the Mercury brand became irrelevant to Ford in much the same way that Oldsmobile became irrelevant to General Motors and Plymouth became irrelevant to Chrysler.

Quite simply, a Mercury Milan is a Ford Fusion with a Mercury badge. A Mercury Sable is essentially a Ford Taurus. A Mercury Mariner is mechanically identical to a Ford Escape. 

Mercury used to stand for something. It used to be Ford's slightly more refined (but not pretentious) cousin. It used to be to Ford Motor Company what Buick was to General Motors...nicer than a Chevrolet but not quite a Cadillac. It had its place.

But then the weird economics of the automobile industry took over, and brands ceased to have meaning. Ford repackaged its Pinto as the Mercury Bobcat: an affront to the upmarket image Mercury was made to convey. Chrysler rebadged the low-rent Dodge Omni (I have firsthand experience with this horrible car) as the Plymouth Horizon. GM secretly swapped out the Oldsmobile engine for a Chevy power plant in the 1977 Delta 88 and ruffled the feathers of more than a few loyal Oldsmobile customers - after they had purchased the Delta 88.

The most egregious example I have seen in recent years is the Pontiac G3: a rebadged Chevrolet Aveo that offers not the tiniest shred of "driving excitement." The only reason this car existed was so Pontiac dealers could have a "value leader" vehicle, regardless of how meaningless it made the Pontiac arrow.

For the nostalgic car people out there, the end of Plymouth, Oldsmobile, Pontiac and Mercury may be painful to watch, but the mourning should have started a few decades ago when their parent companies started committing slow brand suicide.

Not as cool as you might think

Posted by danieladougan on June 18, 2010 at 10:24 AM Comments comments (0)

I am something of a geek. Now I know this will shock and confuse many of you who saw me as a James Dean, Rebel-Without-a-Cause type, but it's true. Technology fascinates me.

So for a few years now I have had a techie fantasy of getting an HDTV and using it as a big computer monitor. After all, LCD projectors work very well for displaying PowerPoint presentations for a whole room. Of course, a nice TV like that costs money (and I could forget about the projector too), so my dream was deferred. That was, however, before, Craig's List. 

Over the weekend I found an ad for a 26-inch Samsung CRT (read: heavy, bulky tube, not flat screen) HDTV for $125. I contacted the seller, saw the TV and talked him down to $100. That's a $100 HDTV, folks. And the widescreen picture looks fantastic. I throughly enjoyed watching the NBA Finals on it even for an over-the-air signal.

My laptop not only has all the regular connections but also an HDMI output designed for doing this very thing. So I bought an HDMI cable from Walmart and hooked it up. And that's when my heart sank.

There's nothing wrong with the TV or the computer at all. Everything displays properly. In fact, Windows Media Center does a fantastic job of bringing high-definition Internet content to my TV screen. 

But then I tried to surf the Internet like I normally do on my laptop, and that's where the laws of physics betrayed me. Major fail. Reading text on the "big screen" only works if the font size is bumped up to somewhere around 20 points. That is, of course, why PowerPoint works so well on a projector...because it uses text that's already big and blows it up to a size much larger than a 26-inch TV screen.

If anybody has any ideas on how I can correct this text problem, please record a video of how to do it so I can actually see it. I wouldn't be able to read an e-mail on the big screen anyway.

Check your ego at the office

Posted by danieladougan on June 8, 2010 at 8:09 PM Comments comments (0)

I'm going to start this off by acknowledging one of my more significant flaws. I am not particularly good at being "self aware." That is, there are a lot of things I do that I don't even realize I do.

Additionally, I often make decisions without regard for the specific people involved. (This doesn't mean that I don't have regard for others or I dislike the people involved...merely that I don't differentiate much between one person and another when making decisions.) I'm going to go about my business and do what is right, regardless of what people will think. 

This is far less impressive than it first sounds. After all, most of our decisions are not big moral judgments but small, mundane tasks. For example, today I sent what I thought was a perfectly polite e-mail full of pleases and thank-yous asking for feedback from a manager of a different department (his name is Mark). I was on a tight deadline, so I added, "please respond ASAP." It seemed reasonable enough to me, especially for a simple request. This was related to a conversation I had just had with my manager Cathy (who actually sits at the opposite end of the building from me), so I copied her on the message.

Within one minute, my phone rang. It was Cathy. Now Cathy is very polite and easygoing, but she was calling in a less-than-giddy tone to tell me that my message had the tendency to go over like a lead balloon. I must admit, I was puzzled. 

Apparently, the request to "please respond ASAP" made the message sound like the recipient worked for me when really the relationship is the other way around and I was asking for a favor. He could have sent me that message in perfect decorum, but not the other way around.

I don't have any evidence that Mark was actually offended, but Cathy said that I needed to be more careful for the future because I could have unintentionally damaged the relationship between our two departments. I don't think this was a major problem, but I would like to avoid even the minor ones if I can...they add up.

I must admit this is not the first time I have been caught making this type of faux pas, but I honestly didn't see it coming. I can't imagine myself being offended if the roles were reversed, but I am not Mark. I cannot project myself because I am not like a lot of people in the business world. For one thing, you have to try pretty hard to bruise my ego. I don't know of anyone who has offended me by accident. I plan to get a Ph.D. some day, but I refuse to be one of those people who gets angry when someone calls him "mister" instead of "doctor."

That makes it all the more critical that I make every word I communicate at work as deliberate and careful as possible. Life can be a minefield that way.