Category Archives: Employee Benefits Distribution

What Sport is Your Benefits Business Playing?


NOTE: This was written in 2016 but don’t think I ever published it.

With firms like Fidelity entering the benefits business, others like Zenefits and Gusto raising tens to hundreds of millions of dollars, and the national firms continuing their rapid pace of acquisitions, one must wonder whether the benefits game is changing in a bigger way. Is all this money resulting in an improvement in the business? Are the rules of the game changing? Not only the rules, but one must understand what league they are competing in. And if the rules and competition change can one continue to compete? Is the price to compete greater than many firms can afford?

In business as in sports it is important to understand the rules of the game and what league you are playing in. How you staff your team and how you play the game will change as the rules and competition changes. And as we all know we don’t get to make all the rules and control how the competition plays the game.

To compete in an individual sport like golf you need a single talented person. In basketball, you need anywhere from 7-10 skilled people. In baseball, the number is around 12-15 while in football you need 20-25. At lower levels of competition, you generally have athletes playing more than one position. In high school football, I played quarterback, safety and was the kicker. In college I was the 5th best QB so I became a safety, and my kicking skills were such that nobody would have ever called me a kicker. At the professional level, you have very specialized skills and the number of skilled athletes you need to win is even higher. Some NFL teams even have two kickers, one to kick-off and another to kick field goals. At the professional level, you need 40 – 50 quality players.

In some businesses, all these rules also play out. To compete at the highest levels, you need more players with more specialized skills. Smaller firms have fewer employees often playing multiple positions. I heard this the whole last quarter where people would say, “I’m too busy, call me after the first.” So, their 2017 plans are on hold because they could not handle fourth quarter business while planning their 2017 or even starting their marketing or sales efforts. They are playing baseball with 5 fielders and don’t recognize it. Others however, in larger firms, have staff making their 2017 plans and do have the time to start their marketing and sales efforts. They have 9 players and a bench creating a competitive advantage.

How many benefits brokers wear the hat of the sales person, the finance person, marketing, and even service? In these firms, it is not possible to deliver the results that larger firms can deliver simply because of number of resources and skills needed to compete. Some larger firms also struggle because they have the numbers but because of their structure they don’t properly leverage their size or skills properly. I once spoke to a producer in a national benefits firm creating her own brochures. Certainly, not an effective use of time or skills. I am also quite sure the marketing piece did not have a professional quality.

I always felt that lead generation or telemarketing is a very different skill than sales or benefits consulting, yet in many benefits firms the person who dials for dollars is the same person that makes the sale and then does the consulting. They play the QB, safety, and kicker. And speaking from my own experience, most often not very well.

I started creating a list of all the things a benefits firm can do for themselves, their customers, and the employees of those customers, that would be of value that most brokers simply don’t do or struggle to do. If I were to start a benefits firm from scratch today this list would be my opportunity to be different in the market. At this time my list has 54 items on it. I know many benefits firms across the U.S. yet I can only think of one firm that is executing on many of the items on my list. A few others have the ability to do so but more than likely lack the vision. So, I believe the opportunity still exists.

With new entrants to the market looking to disrupt the current benefits community and driving desire to win I don’t think my 54 items will be a secret forever. The bar will get raised and raised again, in a way that the price to compete is more resources and more specialized skills. This often means more money. It can be equivalent to the difference between playing high school football and professional football. My quarterbacking skills would not have won me any games against the pros.

The benefits game may be changing faster and in more ways than people think or see. Sometimes these things sneak up on you and if it does you could be caught off guard, ill-equipped to respond competitively. There will surely be changes coming to the healthcare market from the Trump administration. These changes may be much different than most anticipate.

This benefits game may no longer be a golf event where a single skilled player can compete. It may not even be a basketball or baseball game where 5 and 9 players are adequate. It may require the army of a professional football team with 53 highly skilled players. The increased competition in sports and business is all around us.

You can choose to compete in places where there is less competition. Many assume this is in the small group market but there are a number of new competitors going after that business too. You can sell your business. You can also choose to build your team. To do so you can raise money and hire a team like Zenefits and Gusto. To do this you will need a unique product or value proposition that can scale. You can grow organically like a Fidelity or a Paychex but that takes capital, risk, and time. Alternatives would be sharing resources with your peers as we do at N4one.

So stop stocking your shelves with new technology tools or looking for that new idea at some conference. The technology vendors want to sell to everyone so you won’t end up with anything unique. And I couldn’t imagine finding some grand idea at a conference. I certainly wouldn’t share our secrets at some conference. Even if you found some grand new idea, getting this idea to market effectively will require resources that many benefits firms don’t have. The place to start is with a vision and a plan. Or you can call us at N4one. We have created a plan. Built an army. And we have 54 things or more we are doing that most others are not.

An Imagined Trump/Bertolini Health Care Discussion


Below is a conversation I imagine that could have happened between President Trump and ex-Aetna CEO Mark Bertolini. I would imagine this is a simplified version of a deeper conversation, but you will get it.

Bertolini – It is great to see you Mr. President.

President Trump – Same here Mark, how are things?

Bertolini – Things are great!

President Trump – Mark, as you know, health care costs are out of control. The costs are adding to our deficit and we will never control spending if we don’t wrap our arms around health care. And the citizens are beginning to really feel the pressure from these increased costs and higher deductibles. I know you have been leading the way on how to transform the health care business. What do you think we can do in the short term and long term to stop this trend?

Bertolini – Well, the number one problem is that employers are in the middle. This is a formula that can’t work and drives up costs. Until the consumer is empowered there is little chance to controlling costs. Also, in today’s environment the insurance companies make more money when people are healthy, and the health care providers make more money when people are sick. We need the health care system to be rewarded to keep people healthy.

Trump – How do we get the employers out of the middle? Everyone says you can’t take my health care away.

Bertolini – You need to eliminate the employer deduction for health insurance. As long as it is more beneficial from a tax perspective to buy through an employer than the employee buying directly, then you will have the employer in the middle. It isn’t even fair that an employer can get a deduction, but an individual can’t. Move the deduction from the employer to the employee and that will start the process to solving this problem.

Trump – The Democrats want Medicare for All. They have also don’t like the lower corporate tax rates. I have been talking to other Republicans and they are willing to trade off keeping the lower corporate tax rates and eliminating the health care deduction at the employer level. The Democrats also don’t like the fact that it is regressive. The higher income earners get a much greater deduction in pure dollars than lower income earners. If we move the deduction to the employee, they want to make it progressive. Someone making $50,000 may get the full deduction but someone making $500,000 may not get any at all. This is a compromise that could work.

Bertolini – We did the deal with CVS because we expect the employer gets out of the middle. As I said, we need to empower the consumer. If you move the deduction to the employee, you will essentially save the individual insurance market overnight. You know that right now employers are doing everything they can to dump bad risk on the individual market and you have an army of insurance brokers assisting in this process.

Trump – Well getting this done in the next year or so is going to be tough. Budget negotiations are brutal.

Bertolini – Is there anything you can do now?

Trump – Well I can work within the current laws and do something through Executive Order. What if I made an individual policy purchased through employer contributions tax deductible? I can do that real fast.

Bertolini – That’s a great start. It will put things in motion to start the focus on the consumer. Many employers want to get out of the health risk business. They would rather give employees money and just let them buy themselves. Insurance companies will start supporting the individual market much more if you do this.

Trump – After the next election we will need to pass a budget, and I think we will have to compromise and move the deduction from employer to employee. Democrats and Republicans are on board with that.

Bertolini – This will save the private health insurance market and empower firms like Aetna/CVS to really start focusing on the consumer. I always believed that the companies that provide some form of health care need to be in the risk business. The incentives need to align with the outcomes you want to get. This will do that and drive down costs.

Trump – Thanks Mark. You have been very helpful.

June 2019 – The individual Coverage HRA becomes a reality.

Possibility – Effective January 1, 2023 Deduction for Health Insurance Moves from Employer to Employee

 

Webinar Invite – Grow Your Benefits Business by 20% by Delivering a Unique New Employee Benefits Model to Market


And Join the Movement to Reducing Health Care Costs by 15%

November 21  –  2:00 – 2:30 Eastern Time

November 26  –  2:00 – 2:30 Eastern Time

REGISTER NOW

On January 1st we are launching a whole new way to view and deliver employee benefits to the market. The model is designed to help brokers grow by 20% annually while helping employers reduce health care costs, forever. And this is NOT the short-term type solutions most other brokers are delivering.

This webinar is by invite only as we are looking for just 2 brokers per market to deliver this new model. We think leads will be rolling in. Without giving up too many secrets the agenda is as follows:

• Review of the Changing Market Trends
• Gaps in the Market and Opportunities
• The Broker Blind Spots – What Many are Missing
• How Brokers Can Grow Revenues by 20%
• Reducing Health Care Costs by 15% – Forever

To start January 1 the time to act is now. You can finish your 4th quarter while we get you the head-start you need to have a great 2020. To participate in this webinar just click on the Register Now button. If you have questions, feel free to give me a call at 508-498-7591.

REGISTER NOW

 

What Comes After the Health Insurance Tsunami?


Anyone in sales understands the idea of whether you sell pain avoidance or pleasure. The statistics show, and it is my experience, that selling pain avoidance generates better results. In my last business I estimate that 75% of my clients became clients only after they suffered the loss of an important client. We have all heard the story of Blockbuster turning down the opportunity to buy Netflix for $50 million. I believe, regardless of the sales strategy, that most of us do what we do because we want to do something good for people. Selling pain avoidance may be a necessary evil at times though we do so somewhat reluctantly. Dealing with human behavior is part of business.

In my last article I wrote about, “The Health Insurance Tsunami is Coming – and It Will End Employer Health Insurance as We Know It”. The implication is this is bad because a Tsunami can’t be good, right? Well, in reality, I think what replaces the current health insurance system is going to be great. I come to work every day in my business doing as much as I can to make that happen. The tagline for my new company is, “Helping Employees Have a Better Day”. I really don’t think the current health care system does that. My 22-year-old daughter pays what is the equivalent of 90% of her health insurance premium through work for a $5000 deductible. It is not much of a benefit. The current system is very broken and does need to be wiped out.

Many benefits brokers I talk to hope I am wrong about the Tsunami because anyone protecting the current system may be wiped out. I am not hoping people are hurt. I actually think there is the possibility of a new health care system within our grasps that could really help millions of Americans. My preferred message to brokers would be “Let’s get together and fix health insurance to help millions of Americans”. That is really what excites me every day. We can do something great.

So, what is after the Tsunami? Imagine a world where health insurance and health care costs are 20% less than today. Insurance plans are easy to understand. There may be a small copay or deductible of $500 and then everything is 100%. I won’t need a medical insurance dictionary or call center to understand my health insurance or the health care system. My doctor has an incentive to keep me healthy. I get a text message from my doctor if I gain ten pounds and he asks to see me. My health data is collected on my watch or cell phone and proactively tells me what I should be doing to stay healthy. My insurance is mine and only changes when I choose to change it. I have easy access to all my medical information, and I choose who can have it. There are no claim forms. My primary care physician advises me on the best and most affordable prescriptions when needed. New health care innovations are readily available, and I can learn about them on my cell phone. There will be no need to ever negotiate health care costs or worry about balanced bills. And, believe it or not, this is not Medicare-for-All.

What replaced Blockbuster was Netflix. Netflix is better. I don’t have to get into my car and go to a store to rent something and then pay a penalty when I don’t return it on time. Netflix is better than Blockbuster, though many people who were somehow financially tied to Blockbuster may have suffered financial losses. It is an unfortunate by-product of progress.

This could be a benefits broker’s Blockbuster moment, but it doesn’t have to be. There are companies that will thrive because they help solve a major problem in America. My mission is not to help or hurt benefits brokers. The market doesn’t care what I think anyway. However, I have been promoting a health insurance and health care model that I believe can help our whole country. I think the market is ready for this change. The pieces are coming into place. We can be part of the solution, or not. So, let’s do it, because we can!

The Health Insurance Tsunami is Coming – and It Will End Employer Health Insurance as We Know It


By Joe Markland and Mike Davis

This article is being written after an open and honest discussion with my benefits broker friend Mike Davis this morning over breakfast. Mike is a 30-year veteran in the business who had already sold his first benefits business around 10 years ago. After some in depth thinking we drew the same conclusion as it relates to the employee benefits business. A tsunami is coming at the employee benefits broker and most don’t see it, but it is out there. This tsunami can reduce commissions from $30 PEPM to $15 PEPM overnight. For those not prepared it could be catastrophic, however for those prepared, there may be fertile ground on the other side. Regardless, it is coming.

Mike – While this is something I have thought of as inevitable for several years, this renewal season has somewhat sealed the deal in my mind. Large increases and even a non-renewal in a market where recent tax law changes are giving employers an “out” have made me conclude it is imminent. The problem with employer-based health insurance is the perpetual gamesmanship required to find a different or better risk pool. Solutions like hiding in the pool, self-funded, level-funded, referenced based pricing, captives, and associations are all short-term solutions designed to “game the system”. In reality, the types of plans or funding are segmenting the risk pool which contributes to the larger problem of rising health care premiums in America. Many don’t want to admit this, but we are all whispering to ourselves that this is the reality. As a result, health insurance and then health care is about to change in significant ways and distributors like myself need to act or get wiped out. The phase-out of the current system and opportunity to morph has just begun.

Joe – I have been watching this market for some time and have conducted webinars and written articles about the “Coming End to Employer-based Insurance”. I will be honest, I have taken many arrows from brokers who have not liked my message, though my message is simply based on listening to people like Mark Bertolini, ex-CEO of Aetna, and an advisor to Donald Trump. Both are saying that employers should not be in the middle of health care. Bertolini took action selling to CVS. Trump through Executive Order made an individual policy tax deductible and allows the Employer to use the HRA as a contribution conduit for their contribution. They spoke. I listened and acted myself by forming my new company, N4one HR and Benefits, that is designed to thrive whether the health insurance market changes or doesn’t.

We aren’t saying the sky is falling for the sake of selling fear. From others perspective the current employer-based healthcare market is already very broken. Employers and employees’ skies are already falling because the cost burden of health insurance is significantly impacting profitability and for the individual their personal financial health. For much too long the existing ecosystem of carriers, brokers, and administrators have simply pushed the costs around. And the argument that health insurance costs are high because the cost of healthcare is high will fall on deaf ears. Healthcare costs are high because the current health care financing models do not create incentives to control costs. Those incentives need to change which include empowering the consumer.

Employers are sick and tired of being in the health insurance business. Some have started the process of getting out by looking to offer individual products through an HRA. There will be some this year, more next year, and before long there will be a Tsunami moving to individual options. We believe that after the election the deduction for health insurance will move away from the employer and to the individual, ending traditional group health insurance forever.
People and businesses are slow to change. Employees at Blockbuster were Netflix subscribers and Blockbuster could have bought Netflix. We think this is your Blockbuster moment. The Tsunami is coming. We don’t know when it will hit but it could be much sooner than anticipated. It really doesn’t matter to a certain extent because if 5% of your clients want out and you don’t know which 5% then you need to address them all. This must start NOW as the renewal season has begun, and the law takes effect for this renewal.

We have built a model that we believe can help a broker not only survive but thrive when this wave hits. However, it takes careful planning, hard work, and flawless execution. This takes time and scale. Our model shortens that time and delivers the scale needed.

Mike – Joe has been talking about this for some time. I was a doubter too (as to so soon), but his predictions have come true. A simple stroke of the pen and the world has changed. It can change even more. His argument about market dynamics simply makes sense. I read 3 weeks ago of Cigna’s re-entry into the individual market, then the same last week of United. The ACO/Value Based tight network plans are emerging from commercial carriers and Health Systems as well. While difficult for an employer to choose one ACO plan that serves all, if each individual can choose on their own, the viability increases exponentially…not to mention the individual’s ability to purchase very rich or very lean benefits to suit their needs. Like you, I can’t take the chance that the market doesn’t change. As the saying goes, “Hope is not a strategy.”

Our solution requires three things:
• First, prepare for a world where you can handle twice as many clients with the same amount of staff. This can happen in a future world where service demand decreases substantially as it is supplanted by on-line/telephonic enrollment and member services.
• Two, expand your revenue capabilities by expanding your product/services capabilities.
• Third, market, market, market, the new value proposition to sever existing relationships

We think that the small brokerage firms with deep local knowledge and relationships, and entrepreneurial work ethic, armed with the technology tools and support can adapt most quickly…. yet they don’t have the capacity or capability to do this on their own without a significant capital investment. Our solution is to do this in a shared services model through our N4one HR and Benefits organization, which is an organic broker consortium that will grow and be directed by its’ members. This isn’t merely a technology buying group or scaled product procurement Broker Association. It is a business transformation company.

We are looking for just a few brokers per geographic area to bring a new model to market. Collectively, with a unique value proposition, professional marketing, and educated and armed professionals on the front lines, we can do something great for employers and their employees. However, it requires some clean thinking and a willingness to change. If interested give us a call at 508-498-7591.

I Can Make a Roast Beef Sub Better Than Subway


Every now and then an idea comes to my mind that I want to share. For those of you in sales, I am sure you can relate. Today I was making a pitch to a benefits broker on our new business and value proposition when he said, “I am all set. I can do that.” We all have heard that “I am all set” response before, even though we know the person may not know what it is we are really selling.

This brought me to my latest business thought which I used with my son the other day. I asked him, “Can you make a roast beef sub?”. He said “yes”. Then I asked, “Can you make a roast beef sub better than Subway?” He said “yes”, again. Then I asked, “Can you outsell Subway?” His answer was “No way”. Making a sub is easy. Making one better than Subway is not real tough either. However, outselling Subway would be extremely difficult.

I have known the broker I was selling to today for 10 years. He has had 3-5 employees in his business since I have known him. Conversely, I have another broker friend who had 5 employees in his benefits business 10 years ago and today has 55. (with no acquisitions). From my seat, the first broker has always been saying he could “make the roast beef sub”, thinking that he is “checking the box’ of products and services he could offer. The second broker, however, was building his “Subway”. These two brokers approached their business everyday in a very different way yielding significantly different results. If you were to read their websites, they say they do the same thing, but they don’t.

There is a difference between stocking your shelves with tools and resources for your business and delivering them to market in an effective way. I will go out on the limb and say many in the benefits broker world have been stocking their shelves with the latest shiny object for the past 15 years. All the vendors know this and sell to brokers who want to make sure they have the latest and greatest. Then when something doesn’t sell, they say, “I tried that, and it didn’t work.” Well maybe it didn’t work for them.

Having dealt with “I am all set” at least 3000 times over my career, I know how to deal with objections. Maybe they are all set, and maybe not. I am certain that many people can “make the sub”, however, few can build a Subway. So, ask yourself, are you making subs or building a Subway? In my last business I will say I helped people stock their shelves. The difference this time is I am helping them build their Subway. There is a big difference.

A Zombie Movie and the Relationship to Trump’s HRA Changes


Rarely do I watch a Zombie movie and when I do, I don’t look to get lessons in business from the movie. However, one movie did give me a lesson in business and since then it has been a conscious part of my daily work-life. If you read previous articles that I had published on LinkedIn or on my blog at http://www.joemarkland.wordpress.com , you will see a somewhat constant theme which is also the tagline to my blog titled, “Challenging Everyday Thought”. The movie, Word War Z, and its lesson have contributed to my writing. It also has also somewhat prepared me and my business for the changes Trump made to the Health Reimbursement Account (HRA) rules where effective January 1, 2020, an employer can give money to employees on a pre-tax basis to purchase personal health insurance.

To summarize the clip from the movie, it is about threat assessment. The Israeli’s (in the movie), because of constant threats against their nation, developed the concept of the 10th Man. In their threat assessment process, they have a panel of 9 people who look at evidence of a threat and vote as to whether it is a threat of concern and would require action. The job of the 10th Man is to take the opposite position of the vote and try to prove them wrong. In the movie, the Israeli’s were assessing a threat of a virus spreading in a small African village that turned people into Zombie’s. The 9-person panel voted that it wasn’t a threat but the 10th Man convinced the other 9 they were wrong. (You can see the clip below.)

In my own business I play the role of the 10th Man. I don’t have a panel of 9 people assessing threats to my business, but I do read many articles in industry magazines and attend webinars and seminars on the health insurance and health care industries to try and get some idea as to where the business is going. My staff has their share of opinions too. I do this because I need to make sure my business stays relevant. The thing is, I have almost always disagreed with what I was hearing in the mainstream media of the industry. I wrote about this in my article, “Sometimes I Feel Like George Costanza”. The current health care and health insurance system is broken, and I see ways to fix it that everyone is seeming to ignore, that is until now, with these changes by Trump.

As one who looks for potential business threats, I have paid close attention to signs from those who have no interest in protecting the status quo. Those voices are hard to find. I did, somewhat accidentally, come across two instances where I heard very credible people talk about the coming changes in the health insurance and health care markets. One was Mark Bertolini, past CEO of Aetna, who I referenced in my article, The Coming End to Employer-based Health Insurance back in December 2014. (See article link below.) In Mark’s presentation to the Mayo clinic, he drew the picture of a future health care system where employers were no longer in the middle. Individuals would choose their own health insurance.

The other I heard while on a hike one Saturday morning in the summer of 2016 while listening to the Larry Kudlow radio talk show about economic issues. HIs guest was from the Trump administration, and they were talking about health care. The Trump advisor stated that somewhere in the second half of Trump’s first term, or the beginning of the second if he were re-elected, he would propose moving the deduction for health insurance from the employer to the employee. He said that the power of the individual consumer would create a new competitive environment and would be the catalyst needed to drive down health insurance and health care costs. While Trump has not done this though tax law changes yet, the new HRA rules are a start to giving the consumer the power. It just happens that Larry Kudlow is now part of the Trump administration as his Director of the National Economic Council.

I find it amazing that I had never heard any reference to the Bertolini presentation, or the position stated by Trump’s advisor, in any other media source including all the health insurance industry publications or at conferences. When I have written about these changes in the past I have often been chastised, as if I was the one proposing these changes.
After hearing these two positions, I evaluated the threat and took action, which is now my current business. However, these current changes to the HRA rules are just the tip of the iceberg and I am not naïve enough to think I have it all figured out. What I do know is that we are in the first inning of a new game and Trump just started this game. I believe there will be much bigger changes in the next 5 years that will transform health insurance and health care in America forever.

If you listen to the same people over and over, you won’t hear anything new. I think most people tend to seek out others whose opinions mirror their own. However, if you listen closely, you can hear those out there telling a different story. So, become your own 10th Man and either take action, or maybe you will need to watch out for the Zombie’s.

Article References:

You Tube of the World War Z Scene

Sometimes I Feel Like George Costanza

The Coming End to Employer-based Health Insurance

 

Sun Life Buys Maxwell Health – So What?


Today it was announced that Sun Life acquired Maxwell Health. The first thing I asked was why? I don’t see the benefit to an employer or their employees. I see no benefit to the broker distributors. In fact, I hardly see a benefit to Sun Life. I can see the benefits to Maxwell if they either needed cash or their investors wanted out. I don’t really need to speculate around that here, but I am sure someone will tell me I am wrong. Someone please tell me why this is a good or even “relevant to the market” transaction. I will print it if the reason is sound.

If I am an employer, why would I want a technology solution coming from a single vendor? Technology to manage benefits, HR, and payroll should be owned by the employer, with no attachments. It should be something you invest in to make better every day. It should be engaging and provide employees with all the relevant company information that they need. In a survey I had done, the number one thing employees wanted to see via web or mobile in an employer sponsored HR system was how many vacation days they have left. Most employee benefits technology systems don’t track time off and those that do are bad at it.

As a broker, one would think you would want to represent the employer’s interests. You would want to have more options than representing a single vendor. And why would I need a carrier to bring me a technology solution as I could easily pick up the phone and find ten systems in one hour? Providing choice in health insurance, disability, and other benefits is an asset and the core to being an insurance broker versus an agent for a single company.
Other carriers are already out there providing a broad range of technology solutions. Many are providing discounts. This move by Sun Life could create a competitive advantage, to everyone other than Sun. In my business I could bring a dozen benefits enrollment systems, HR, and payroll to any employer, all with carrier subsidies available from many carriers. I have choice for technology. Choice of carriers. And subsidies for the employer if needed. It is easy to do, and I would add not a real differentiator.

Now if Maxwell develops something real special then maybe there could be something there. However, as I have learned from being in the technology business for years, technology is easily replicated. As the saying goes, “You can’t win or stop a technology war”. So, Sun Life better have a real lot of money to continue to fight the battles of this very active HR/Benefits/Payroll technology war that is going on. I would expect investments of over $100 million per year in their technology would be required simply to compete.

So, my assessment of this transaction is, So What? It is just more noise in a very noisy market that in my opinion doesn’t change the world a bit. (Other than for some employees or investors in Maxwell.)

When Things Don’t Make Sense – Prepare for a Change


I was out having a beer after work a few weeks ago with a few friends when a woman across the bar started telling everyone how her son just made $500 selling Bit Coin. The first thing I thought was 2008, when the housing market tanked. When things just don’t make sense, there is big change coming and with it may come a lot of pain. In the movie the Big Short they found waitresses in Florida owning 5 houses when they had little income. Back then I remember thinking, “how can housing prices continue to rise at this crazy pace.” Like most others, I did nothing, and would never have imagined things were as screwed up as they were. Whether it be Bit Coin, Housing, or the Tech Bubble of the late 90’s, it seems like these Ponzi schemes with a product are not going away. In the industry I play around in, the health insurance business, is going through this now. Things don’t make sense. Change will come.

A few other things don’t make sense which is a sign of the times. My daughter is spending her semester of college in Barcelona. It will cost me less to have her study a semester in Barcelona and travel throughout Europe than have her study at the University of New Hampshire, where she will graduate next year. It doesn’t make sense. High college costs need to end. Nobody seems to care.

I saw a medical plan the other day that an employer was providing that had a $6800 deductible. That is not insurance in a country where 70% of the population is living paycheck to paycheck. The system is broken. It must change.

This same health care system has people getting on planes in our version of Domestic Medical Tourism to have surgeries in lower cost areas across the U.S. This is just plain stupid. How do you move populations of people all over the place to get health care when they would prefer it closer to their homes where friends and family can support them? I wonder how this idea can support the 6.5 million people in the Boston area. Are they going to get on planes and fly to Kansas? When you see something real dumb, change is on the horizon.

I would add that my medical insurance premium renewal was +29% this year. This was after +16% last year. It goes on and on. Then it will crash, and it should. Unfortunately, until then, our health insurance will continue to cause pain. And please, don’t tell me how you saved someone money by putting them in a captive with medical tourism, some new RX plan, and a personal direct primary care physician. All are symptoms of the problem. Aetna and CVS get this. They are trying to change this. Most perpetuate the insanity.

In the health insurance industry, we have seen private exchanges, then captives, now the buzz is referenced based pricing, domestic medical tourism, and direct primary care. For someone who has been in the business for 20+ years all of these seem like old ideas rebranded as something new. Some see this as change. I see all this as symptoms of a bigger problem. These trends will come and go. They may hide the problem for a while or simply push the problem forward a few years. But it doesn’t make sense. So, things will change.

Let 2018 be the year where we start tackling some tough problems. Health care costs, college debt, market bubbles that create havoc, Ponzi schemes with products, are all things lurking behind the scenes that for some reason most of us are blind to. Others we see yet push to tomorrow. The bubbles continue to grow. Tomorrow will come. Look around, if it doesn’t make sense, it should change. We can continue to ride on this rollercoaster of steep ups and steep downs or choose to do something about it. Let’s start.

I am starting by writing my book about how to fix health care in America. I think I have a good solution. I may never finish it, or I may be the only one to read it, but I am going to try. Maybe after that I will tackle the high costs of college. My kids will be out by then, but the madness needs to stop.

Redefining Employee Benefits


When it comes to the benefits brokering business you get people or companies labeling themselves in many different ways. When I started in the business the common title was a Group Insurance Broker. Some added the label “Consultant”. Over time the term changed to Employee Benefits Advisor or Employee Benefits Consultant. I guess in the end you can call yourself whatever you want but the market really doesn’t care. What an employee values as a “Benefit” to working at some employer is something that is personal to that individual. The consumer or customer, or in this case an employee, will determine for themselves what is a benefit and what is not. Even the employer may be offering “benefits” that their employees don’t value much as a benefit to working there.

I think we are in the middle of a redefinition of what Employee Benefits is. A 23-year-old entering the workforce with a ton of college debt more than likely does not view a health insurance plan with a $3000 deductible as much of a benefit. Most don’t see themselves incurring claims over $3000, and if they did, they don’t have the $3000 in the bank to pay the deductible. My son is that 23-year-old and that is what he and his friends told me when I asked them. Granted, this is not a large sample size.

Mark Bertolini, CEO of Aetna, who has implemented some of the most progressive employee benefits programs for their employees says, their goal is to help employees be “happy, healthy, and economically viable”. Not a bad objective, and I would assume this would help their employees be more productive. I think most people strive to be happy, or at least happier, so helping people be a little happier is a worthy goal.

When a 25-year-old single mother with no money in the bank has her refrigerator break down that is a bad day. When a 40-year-old has their spouse ask for a divorce unexpectedly that is a bad day too. And when your 87-year-old father has dementia and needs to be put in a nursing facility that is a bad day for you and your 89-year-old mother who is slowly losing her partner. These bad days suck the happiness out of most people and this almost always leads to lost productivity at work, at home, or almost at any endeavor. It is hard to stay focused when something else consumes you.

This emerging market demand to help people through their workplace has resulted in a significant amount of capital being invested in new companies providing products and services to fill the need. These solutions include wellness, nutrition and smoking cessation programs, financial fitness, college loan payment support, employee loan programs, help with bad credit, and more. At Aetna, they promote yoga and pay employees to sleep more in additional to many other programs. Aetna claims that these programs have saved them millions of dollars through improved employee productivity and a reduction in sick days. This is certainly a different employee benefits world.

For employers, the idea of providing a benefit to employees should be a good thing. Who doesn’t want healthy, happy, financially viable, and productive employees? For many though, the number one employee benefit, health insurance, has become a necessary evil that still leaves employees with a financial burden. And what employer wants to come to work and worry about managing the health claims of their employees to keep down costs and maintain profitability? You would think they already have enough to do running whatever business they are in. In addition, they are essentially delivering “bad news” once per year when they raise employee contributions. This change has made health insurance much less of a benefit. And many people believe that it is rising health care costs that is holding back salary increases. So, indirectly, employees are really paying for the health insurance through lower incomes.

As these “new benefits” enter the market there are challenges. Employers aren’t sitting there with the budgets to provide all these solutions. HR departments, that are already strapped for time, don’t have the capacity to evaluate, purchase, communicate, and administer such programs. And many programs only address a subset of a population. A 48-year-old overweight diabetic has different needs than a 23-year-old triathlete with no money who just crashed his car. Meeting the needs of a broad employee population is not easy. While today these may be new ideas, there may be a day in the near future when this will be an expectation of employers.

Helping employers meet the needs of this changing market is an opportunity that can also be exciting. The idea of helping someone have a “better day” because you provide an outlet for an individual that has some immediate need, can be rewarding. But, as stated above, this is not easy. As the definition of employee benefits is redefined, it may also redefine what people call themselves who serve this market. It may start separating the traditional Group Insurance Broker/Consultant from those providing redefined Employee Benefits Consulting. Those lines are blurry today. They may not be in the near future.