Shooting An Elephant

Shooting An Elephant

In 1936, George Orwell wrote an essay about a British officer who was stationed in Burma that was called upon to shoot an aggressive elephant near a village.  Now, we don’t know if this is a true story or not, but it really doesn’t matter.  Many even believe Orwell is telling a story about himself.  But,  After three different wars, the British finally came to rule Burma, and Orwell’s story about shooting an elephant is a metaphor about British Imperialism, and the damage Imperialism had caused in Burma.

In the essay, the Burmese locals expected the man (the main character) to do a job, even though killing the elephant went against his better judgement.  Orwell vividly details his anguish as the elephant dies a slow and painful death.  Throughout the essay, he tries to convince himself that he is doing the right thing by shooting the elephant.

It was clear Orwell had hostile feelings towards imperialism, and the justifications used by the British for taking over Burma.

It’s a wonderful little short read.  Orwell demonstrated the immense negativity of imperialism, and the damage caused by the colonial masters.

It’s fairly easy to apply Orwell’s metaphor in the healthcare industry as well.  Think of the status quo in healthcare as the aggressive elephant, going about, wreaking havoc, damaging almost everything in it’s path.

But, in Orwell’s essay, he spends some time trying to convince himself not to shoot the elephant, citing the good qualities and characteristics of the elephant.  How destroying a working elephant is like destroying a valuable piece of equipment, etc.  He describes the elephant as a “machine”, like a steam roller when he says, “If the elephant charged and I missed him, I should have about as much chance as a toad under a steam roller….”

The same is true about the major players in healthcare, who have infinitely more power and influence than those who seek to shoot down the status quo.

I read Shooting an Elephant again the other day, and it reminded me of a local business man I ran into at a State of the City event recently.  Here in Amarillo, our city officials periodically hold these State of the City events, which are largely economic updates really.  How’s the local economy doing, what projects our EDC has on the horizon, how Amarillo is a wonderful place to live and work, etc…..you know about these events.  Most places probably host similar events.

I’ve been attending these events for several years, and I’ve always been stunned that HEALTHCARE is never a topic of discussion.  It’s hardly ever mentioned at all.  I mean, it’s only 1/5 of the entire US economy….why talk about it???  Seriously….healthcare makes up almost 20% of the entire GDP.  

Healthcare is arguably the largest economic opportunity in every single community in America, and no one talks about it at these events.

Not too long ago, I went to one of these local events, and when it was over, I was visiting with a friend of mine, very successful business man, and he gets what we’re doing at Butler Benefits, and what we’re doing with High Plains Health Plan.

I made the comment to him that I couldn’t understand why healthcare wasn’t a focus in these meetings…and he kind of shared my dismay…..but he said something that stuck with me in  a pretty profound way…

He said, “Ya, it’s kind of strange, but we still have our sacred cows, don’t we?”

Man, when he said that, it hit me like a ton of bricks.  He’s right…..The reason healthcare issues aren’t addressed in these economic venues, at these types of events where economics is the topic….?  Ya…we all know why.  Because from an economic perspective, healthcare hurts more people than it helps!

It’s true!  And no one wants to say it out loud, much less give a half hour keynote on the issue.  He nailed it…  Status quo Healthcare is a SACRED COW.  It is often, unreasonably immune from criticism or opposition.  Especially hospitals.  Believe me, I’ve experienced first-hand how some hospitals respond to criticism.

I want to be really clear here though….hospitals obviously do a lot of good in our communities too, from a clinical stand point.  We need them in our communities, we want them in our communities.  They do a lot of good.  But that shouldn’t keep us from speaking up when they do bad, or when they do harm, and yes….harm is being done to people BY our healthcare system, right here in Amarillo and in every community in America.  It’s mainly financial harm….but sometimes, even physical harm.  We can’t talk about it? 

I don’t think ANYONE would disagree that when a hospital cares for a patient, nurses them back to health, maybe even saves their life, which happens every single day at a hospital…that that isn’t a good thing.  Right?  Of course it’s a good thing.

But let’s just be honest for a moment….Is it a good thing when a hospital sues a patient for not paying an outrageously inappropriate bill?  I’m not talking about patients not paying reasonable medical bills….I’m talking about hospitals suing patients, or turning them over to collection agencies because the hospital is trying to collect $50,000 for a procedure when they commonly accept $10,000 from insurance companies.  Is THAT a good thing?

I don’t see how that’s a good thing at all.

This is the side of healthcare that no one wants to talk about at the State of the City addresses.  This is the side of healthcare that needs to be discussed, but no one wants to talk about.  The sacred cow.  The elephant in Orwell’s essay.  The steam-roller he wrote about.

Healthcare financially steamrolls millions of Americans every year.  Is THAT good?

Fast forward a great deal from Orwell’s essay in 1936 to May 1, 2021.  Why May 1, 2021?  Well, there was nothing really historic about that day really.  Medina Spirit won the 147^th Kentucky Derby, and India became the first country to record more than 400k new Covid cases in a single day…..

But something else happened that day, something most people don’t give a hoot about…..Berkshire Hathaway also had their annual stockholders meeting that day.  You all know about this meeting, you know Berkshire Hathaway….and each year, Warren Buffet and Charlie Munger sit around for hours hours discussing the economy, business ventures and investments…answering all sorts of questions while drinking 56 diet cokes and cherry cokes throughout the day.….ya, that stockholders meeting. 

It’s become quite the thing actually….tens of thousands of people attend this thing and even more tune in remotely…it’s a pretty interesting conversation every year for sure.  You should check it out.

But in the 2021 stockholders meeting, Warren Buffet answered a question about their failed joint healthcare venture with Amazon and JP Morgan Chase….a venture they called Haven.  You all remember Haven….where Berkshire and Amazon, and JP Morgan all got together to change healthcare through this project, this experiment…. and it failed.  It was big news, especially in our industry.

Well in this meeting in 21, Buffett made the now infamous remark, “We fought the tapeworm, and the tapeworm won”…as many of you know, Buffett has called healthcare the “tapeworm” of the American economy for many years because of the negative financial impact it has on our businesses and economies.

But it’s what he said next that was so telling.  He went into “why” Haven had failed in it’s bigger mission to change 20% of GDP, and he also said they had learned a lot, and fixed many things within their own health plans.  But he explained “why” Haven failed…..and one of the reasons he cited was the same thing we’re talking about here, about the elephant.  He said, “The most prestigious people in the community are on the hospital boards…”, “…a lot of people are fairly happy with the system.”  Then Charlie chimed in, “It’s hard for anybody to get enthusiastic about losing part of their income”…and he was referencing hospitals.

Munger said he was shooting at an elephant, and he missed.

Just like in Orwell’s essay, when he said that if the elephant charged, and he missed, he would be steam rolled.  Haven was steam rolled folks.  Steamrolled by a lot of prestigious people who are pretty happy with the status quo system.

Lots of companies are enriched, very handsomely, within healthcare….hospitals for sure.  Even brokers….let’s not leave my industry out.  It’s true too.

This is why we work so hard to effect change in our community.  Right here in Amarillo.  How do we stop healthcare from being a tapeworm?  How do we get our civic leaders to see that healthcare is the single largest opportunity for economic growth in this community?

Did you know that a person’s ZIP CODE has a 60% impact on their life expectancy?  Just a 5 digit code.

It’s because not everyone has equal access to healthy food, medical care, stable jobs, quality education, and safe housing.  These are what are known as social determinants of health.  Lack of resources is an issue folks, right here in Amarillo.  Lack of affordable healthcare is a major issue in this community, that also has a profound economic impact as well.

Let’s make the connection folks.

This is why I’m so passionate about what we’re doing with High Plains Health Plan.  Through multiple collaborative efforts within the City, we are delivering quality/affordable healthcare to people through employer sponsored health plans.  Most people access our healthcare system through an employer’s health plan….it’s their gateway. 

When actual care doesn’t cost so much, companies can then afford to invest in higher-value benefits.  Things like $0 deductibles.  Let’s just cover that one real quick….put a $0 deductible in perspective from a patient/employee perspective.  Imagine needing a surgery, and maybe you live in a household on a tight budget….like most families.  And instead of facing a $5k, $6, or $10k deductible for the procedure, you pay $0.  For many, that’s life-changing.  For many, that is LITERALLY the difference between getting care and not getting care.

Now, imagine having a benefits program in place that does this, and still reduces employer costs by 20% or more….

This is OUR way of contributing to the solution.  We are digging in to the fat in healthcare by aligning employers with health care providers that agree the status quo in health care is unsustainable.

Higher healthcare costs also hurt a company’s competitiveness, and that was really the crux of Warren Buffett’s tapeworm analogy.  Status quo Healthcare is syphoning resources and money out of companies.  And the larger the company, the more is being syphoned…

I recently shared that just a small handful of Amarillo companies could inject $31 million PER YEAR back into the Amarillo economy, simply by reducing their PER EMPLOYEE PER YEAR medical costs by $2000, a goal that isn’t too difficult to actually achieve.  We are achieving that with employers within High Plains Health Plan today.  It’s not a pipe dream.  It’s a reality.

If Amarillo Independent School District reduced their healthcare spend by $2000 PER EMPLOYEE PER YEAR, it generates a savings of $6.8mm per year.  What do you think?  You think AISD could find a better place to spend $6.8mm per year?

Out of every dollar spent by Amarillo Independent School District, 61 cents goes to pay teachers and aides.  10 cents goes to keep the lights on and keep the school clean and well maintained.  6 cents goes to staff and stock the cafeterias.  3 cents go to extra curricular activities and after school programs.  And 2 cents goes to the library!

What could 680 million additional pennies do for AISD every year?

Solving healthcare stimulates business by saving real money.  I had a guest on this program a few weeks ago who is saving hundreds of thousands at his company.  The way he put it, he said, “Josh, this isn’t paper towel money.”  It’s substantial amounts being saved.

And the kicker….we’re improving the value of health plan benefits at the same time.  In a time when so many organizations are raising deductibles, and their brokers are advising them to raise deductibles yet again….we’re eliminating them.  In a time when companies are tweaking their benefits, making the financial burden to get quality care higher year over year for their employees, we’re going in the opposite direction.

It’s quite possible to spend less, and get more out of healthcare.  Companies and people just have to be open to new ideas, new solutions.  They have to be open to change.  And they often have to confront the elephant and face the steamroller. 

I say this all the time.  Ideas don’t become solutions until a brave employer is willing to implement them.  It takes courage to shoot at elephants. 

What’s encouraging is more and more organizations are finding that courage.  They’re asking questions and having conversations.  They’re getting their data and doing analysis and finding answers.  They’re waking up and recognizing the damage the elephant has caused. 

And listen…it’s no longer enough to just “trust your broker” or “trust your TPA”.  They’re taking care of me….It’s not enough anymore.  Employers are expecting more out of brokers and TPA’s, and I believe that’s a good thing.  Trust but verify as Ronald Reagan used to always say.

By the way, Reagan was dealing with a rather large elephant himself when he coined that phrase, as it was an old Russian proverb he came across when preparing for negotiations with Soviet leader Mikhail Gorbachev.  Just an interesting history side bar there…..Trust but verify.

Employers should follow Reagan’s advice, really they should.  And listen…. there are systematic ways to verify your healthcare expenditures.  We do it through what we call a feasibility analysis, or opportunity analysis where we are analyzing where every employer dollar is being spent in healthcare.  The answers aren’t just in claims data.  We discover millions of dollars spent in companies that are tucked away, hidden within complex contract language, rebate guarantees, and indirect revenue streams created by a contract or agreement.

 And every time we do one of these analyses for companies, they always say things like, “We never knew this” or “the information is so useful”…and that’s when the real conversations start.

How do we stop this, or how do we fix this…..what can we do to improve this.

Solving healthcare represents one of the single largest opportunities for economic expansion anywhere, including right here in Amarillo.

WE also acknowledge that healthcare is still a sacred cow in this community, and that more work is needed to bring about meaningful change.  I’m encouraged now more than ever because we are seeing that work spread.  More companies, more healthcare providers, more people are stepping up and choosing to leave old models behind.  Progress is slower than we’d like to see, but progress is progress.

I’m inviting anyone and everyone to go to our website, butler-benefits.com and go to the High Plains Health Plan segment and just look at how we’re building it out for regional employers.  How we’re partnering with local care providers to bring a unique solution to people in this area.  Read some of our case studies.

And when you’re ready, reach out to us for that analysis I mentioned earlier.  Happy to show you where the bodies are buried!!!