By: Ron E. Peck, Esq.

I really enjoy the quote, attributed to Haruki Murakami, that “Pain is inevitable. Suffering is optional.”  This really hits home for me for a few reasons, personal and professional, but for our purposes – let’s consider how it relates to the health benefits industry and healthcare as a whole.

Anyone paying attention to the media and political debates will no doubt make note of the constant rhetoric regarding healthcare, and more to-the-point, the “cost” of healthcare.  I’ve (here and elsewhere) discussed ad-nauseam my position that health “care” and health “insurance” are not the same.  That insurance is a means by which you pay for care, and is not care itself.  That by addressing solely the cost of insurance, and not the cost of care, you build a home on a rotten foundation.  So, you can likely imagine some of the “ad-nauseam” I feel in my stomach when I hear the candidates talking on and on about how they’ll “fix” the problem of rising healthcare costs by punishing insurance carriers and making health “insurance” affordable (including Medicare-for-All).

The issue is that, ultimately, whether I pay via cash, check or credit… and whether I pay out of my own bank account, my wife’s account, or my parent’s account… at the end of the day, a beer at Gillette Stadium still costs more than a beer from the hole-in-the-wall pub, and if I keep buying beer from (and thereby encouraging the up-charging by) the stadium, prices will increase and whomever is paying (and in whatever form they are paying) will be drained, and no longer be able to pay for much longer.  In other words, making insurance affordable (or free) without addressing the actual cost itself is simply passing the buck.

So, this brings me to the quote: “Pain is inevitable. Suffering is optional.”

Pain – the pain we feel as we are forced to deal with a costly, yet necessary, thing … healthcare.  As technologies improve, research expands, and miracles take place every day, I absolutely understand that with the joys of modern medicine, come too the pain of cost.  We must identify ways to reward the innovators, the care takers, the providers of life saving care.

Yet, we – as not only an industry, but as a nation – also assume that with this inevitable pain, so too must come the suffering.  Suffering in the form of bankruptcy for hard working Americans and their families.  Suffering in the form of unaffordable care, patients being turned away by providers, and steadily rising out of pocket expenses.

I do not believe that this suffering needs to be inevitable.  If instead we accept the inevitability of the “pain” inherent in healthcare, and the costs of providing healthcare, but instead identify innovative ways to address those costs, then we can avoid the suffering.  Our own health plan, for instance, rewards providers that identify and implement ways to provide the best care, for the least cost.  Our plan rewards participants who utilize such providers as well.  We educate our plan participants regarding how, unlike in many other aspects of life, in healthcare you do NOT “get” what you “pay for.”  That fancy labels, advertisements, and price tags do not equate to better care.  We teach our participants how to leverage not only “price transparency,” but also quality measurements to identify the “best of the best” when seeking care – providers that perform as well or better than the rest, for the lowest cost.  Rather than accept the “inevitability” of suffering, we embrace the pain – we endure the costs, the time, the resources necessary to actually care, and make ourselves educated consumers of healthcare.

The result?  Plan participants – employees that have been on the plan for five or more years – will, beginning in 2020, not make any contribution payment to our plan.  That’s right; their “premium” is zero dollars.  The cost of their enrollment is covered, 100%, by the plan sponsor.  The plan sponsor, meanwhile, can afford to do this thanks to efforts it has made, as well as efforts made by its plan participants, to keep the costs down.  Indeed, a self-funded employer like us can make a choice – either assume that the suffering is inevitable, and pass the cost onto the plan members (incurring the wrath of your own employees and politicians alike), or, see that the suffering is optional, and nip it in the bud.  We have identified ways to better deal with the inevitable pain, thereby minimizing the suffering endured by our plan participants.

It can be done, and we did it.  You can too, but the first step is accepting that some things are inevitable, and others are not.  Assigning inevitability to something that is not in fact inevitable is a form of laziness and blame shifting; and the time has come to stop that behavior, accept responsibility, do the painful work necessary to change things, and recognize that – no pain, no gain.