Tis the season to celebrate the joys of open enrollment

December 27, 2011
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The last quarter of the year is just packed with excitement. College football is in the midst of the bowl season, basketball and hockey are gearing up for the winter season — and, best of all, it’s open enrollment of benefit elections.

Everyone looks forward to these few months. Benefit managers have to decide how best to maximize the funds available for the coming year and get the CEO and CFO to buy into the plan. Insurance agents are going crazy with making sure the underwriters are allowing them products that are saleable, and then organizing for the introduction to and education of employees and their spouses on changes and decisions that potentially can have a dramatic impact on their lives. Everyone is scurrying around to be sure regulations are met and liabilities minimized. Oh, the joys of open enrollment.

The process is like Christmas: The plans and the toys never seem to live up to expectations, or they break when they are used the first or second time and you move on to the next potential heartbreak, hoping there are no long-term effects. The person who provided the plan or gift often wonders if the money could have been spent in a better way.

At least with Christmas toys, gift-givers can take solace in knowing they gave it a shot and probably brought a little joy to the children. There’s always next time.

With benefit plans, however, that’s not usually the case. If they don’t work as advertised, the downside is never really over. Resentment may build before the next benefits gift season. Some folks won’t even see it as a gift, but as an entitlement that was screwed up. All that is left is the next cycle of open enrollment, which is sure to be more expensive.

With gifts, there are a variety of options to pay less or get increased value. With medical benefits, the overall price never seems to decrease unless you shift who pays or reduce the value received. All the administrative hassles are just hidden costs and icing on the top. It really begs the question of why we do this in business, and why society as a whole supports a rather crazy process.

Some of it can be explained by tax laws and maximizing labor dollars spent. The insurance companies and plan administrators work their magic to make sure they don’t end up on the downside for something that seems to be required. How much is required, however, is being questioned on a more frequent basis these days. As organizations draw back from the role of benefit provider, there is a grand shift of responsibility to the employee, and to society in general.

In the process of open enrollment, a few essentials are obscured when we only focus on the end outcome: regulatory responsibility, liability for payment, and the generally unassailable concept of capitalism and free market forces.

In conjunction with these realities, we know that:

**People become ill or are injured.

**Care at some level generally is required for individuals to get well.

**People who provide the care, or the tools of healing, need to be rewarded for their work.

It is this last factor that brings all the complications.

Everyone who becomes involved in the process of providing and reimbursing for healing services adds a degree of complication. HIPAA is a perfect example. This legislation to protect patient confidentially adds a tremendous burden to all concerned and accomplishes little. It’s much too complex and is of questionable value.

Then there are those who are making money from “the complications,” and they want to stay involved. As a society, we pay the price in many ways for the complications. When people discuss the complications and how they want to improve the system of health care delivery, they rarely conceive of taking elements of complication away. The general practice is to add something on top that must work around all the prior “solutions.” It becomes another layer of complication and, subsequently, a layer of costs.

To improve our health care delivery system and rein in the costs, we must simplify the system.

This simple concept really raises the question of why we, as a society, are so adverse to a system where there is a single payer. If we took the burden away from business for all the administrative costs, including lost time of staff and employees, we would make our nation much more competitive and our businesses more profitable, even if employers are asked to pay some of the costs, such as Social Security.

What is wrong with a uniform platform of care, with caregivers getting paid a reasonable amount, based on our willingness or ability to pay? What is wrong with asking the medical community to focus on outcomes rather than fee for service, and pay a premium for those with the best results? People who want something beyond what is usually provided could always pay more, but out of their own pockets.

Open enrollment could be a thing of the past. It might allow us to spend more time on getting the best toys to the kids. Does this sound like radical thinking?

Ardon Schambers is president of P3HR Consulting & Services LLC.

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