Tag Archives: economy

Obamacare is Working, or it Isn’t

A few weeks ago I received notice of our annual health insurance increase. This year it was 38% more to keep the same coverage. Last year the proposed increase was 22%. The year before 12%. The year before that, 18%. The next … Continue reading

Posted in Economic Trends, John's Opinions, Politics and Regulation, Strategy and Planning | Tagged , , , , , , , , , | 11 Comments

11 Responses to Obamacare is Working, or it Isn’t

  1. Will Shain says:

    John, I can’t find fault with any of your logic. I can only speak to my circumstances. Over the past year, my rates have decreased by nearly 7% compared to 2014, but I had to move to a new carrier to get them. If I stayed with the old carrier, I was facing an 18% increase for a silver-level HMO-style plan based on wellness/.prevention. I can’t say that the ACA had any impact on moving to a gold-style PPO plan with a top flight carrier here in New England, but my $500/$1000 deductibles are down from last year’s $2,000/$4,000. We’re clearly paying significantly less than 2014. Maybe it’s New England, but competition appears to be a factor. Only 2016 will tell whether our new carrier will emulate the old carrier for exorbitant price increases.

  2. I agree with you 100% – about the actual intent of the bill, about the way it was put into being, about the sneaky “boil the frog” aspect to make people who don’t think very deeply stay clueless, and about the ultimate consequences.

    I was always very proud of our company paying for all of the employee coverage and most of the family coverage for health care – something that has shifted dramatically over the last couple of years. I have my own employees going out and shopping for better deals because it’s so expensive to have the company plan now. And, we are aggressively looking for the best possible pricing/benefits.

    It’s become a lose-lose for everyone – except those in governmment who want more control over all of us.

  3. David Basri says:

    Our small business experienced outrageous increases to our small group plans year-after-year in pre-ACA times. Finally we gave up and just had ourselves and our employees purchase individual plans for about 60% less than the group plans. After getting to keep the grandfathered individual HD plan for the extra year, we are going to see a huge bump in premiums this year.Basically, all the plans are headed to where small group plans used to be for all the reasons listed by John.

    The pre-ACA environment was completely unsustainable. The ACA itself is a poor compromise instead of a rational plan, but it was all that could be done in this fractured political era.

    There is more than enough money being spent on health care in the US every year to give everyone good care. The problem is that we have the least financially efficient system anywhere in the developed world, by a wide margin. Trying to force market principles on something that is not, and frankly should not be, a market does not work very well.

    The current system is based on the the market-oriented question of whether, when, to whom and how much you would like to PAY for your health care. Under that, however, is the real question: “Would you like your health?” That is a distinctly NOT market-oriented question that people always answer “yes” to given any choice at all.

    The ACA is poorly constructed and is pushing a muddled and convoluted path towards some kind of not well planned change.If it eventually leads in 10 years to the only rational choice of a single payer system, the messy transition will have been worth it. There is not enough political or cultural will in the US to do the rational thing deliberately.

    • John F. Dini says:

      You are right, David. We could never buck five of the most powerful lobbies in the country without restructuring lobbying itself, campaign financing, tort reform, and on and on. That’s why I said ACA was brilliant. Whether we agree with it’s long-term objectives or not, it set us on what appears to be an irreversible road to national health care.

  4. John Hyman says:

    The software industry has benefited by shifting from a transactional model to a subscription model. Now you pay a monthly fee to access the application(s) and get updates to the software automatically, as they become available. The company increases revenue because, in reality, no one always pays to upgrade to the latest and greatest version of the app

    So when will we see this approach applied to wellness? I’d prefer to pay my primary care provider a fee for wellness and care visits, tests and consultations. They’d see improved cash flow, reduce office administration costs, far less paperwork and accounting (sorry, John).

    It’s simple, easier to orchestrate, and could still be subsidized by the Federal Government for people who qualify based on financial need.

    • John F. Dini says:

      You know, John, the model for traditional Chinese village medicine was to pay a monthly stipend to the local herbalist/physician. If you fell ill, you stopped paying until you were better again. Of course, that isn’t “sophisticated” enough for advanced western medicine. 😉

  5. David Basri says:

    Several large providers (Mayo Clinic, Kaiser) are starting to follow a subscription model aimed at wellness, as opposed to services, as John Hyman suggests. That helps, but still does not address the monumental waste baked into a system where the entire payment side consists of competing, for-profit insurance companies.

    At the primary care practice we use, 10% of the employees are devoted to nothing but dealing with insurance. Insane and replicated throughout the provider side of health care. That does not count the billions in advertising, overhead, executive pay and profit that is being sucked out of the system with zero benefit to health outcomes.

  6. Cheryl Swanson says:

    ACA created the worst insurance plan coverage in 2015 we’ve ever had in our entire lives. We basically paid for a family of four all year and never used it due to the high deductibles PER PERSON. It only drives healthcare into the “delay”, “don’t address”, “self-insure”, or “self-treat” categories. Good thing we know doctors personally!

  7. Hello John,
    Perhaps a view from outside of the US, up here in “semi-socialist” Canada. This is also likely more of a big picture comment on national governance than anything.
    I of course cannot comment specifically on rates for medical insurance in the US, but I do think it is a fact that the US is the only really industrialized country that doesn’t have true universal health care. Now, I am by no means holding up our system as the model – after all we were ranked 30th by the WHO and the US, 37th, so clearly we both have a great deal to do in this 21st century world in this regard. (I realize these rankings a re a bit old and do have their flaws).

    What I will say though is that there is plenty of evidence to show that as a country’s healthcare and education systems go, so goes the overall success of the country in the long term. Its a bit like you are only as strong as your weakest link. If you do not provide general access to healthcare and education for all citizens, it is only a matter of time before the social fabric begins to erode – the cost of which is far, far greater than the specific costs of delivering those programs. My observation is that you are seeing some of this in the US – it is likely a key factor that is causing such massive division and polarization in the country politically.
    I personally don’t agree with fully private health-care. I have many friends in many countries in the medical system, and none of them agree with “medicine for profit”. I think the best models are private delivery within a publically managed system that provides equal access. I know many people in the US when they hear this rush to the – “well you have long wait lists in Canada – we don’t”. That really is not a complete picture. If you need treatment, you get it. But if its not required and/or elective, yes you will go on a wait list. Most Canadians (and Europeans) are fine with that. I have a friend who got sent for an angiogram, which found 4 major blockages in his heart. He had quadruple by-pass surgery the next morning – by a team rated as one of the best in North America. This would all be covered by Health Canada and paid in his taxes – no co-pay, no deductibles, no having to take a 2nd mortgage to pay his medical costs.

    At the end of the day, its how you view things – you have lower tax rates than we do, but we pay for our health care in our taxes. Lastly, I think this is a tough transition for the US – it is not going to be easy. You are likely where the National Health or Canada Health or Germany were 30 years ago. But what I think you cant afford to do is leave this to politicians to use as an election football (There is a difference between “politicians” and “public health care” – the former change frequently – the later should be enshrined in law).

    This is not meant to be criticism – like I say – we have much to work on too – but I think objective debate that takes this vital topic out of being called OBAMAcare is needed for long term success.

    • John F. Dini says:

      Your point is very well made, Malcolm. I will point out, however, that Canada shares a 3,000 mile border with a pay as you go system, which is open to any Canadians who have the money to opt out of their system. That said, I’m not arguing against universal health care, but rather a system that tries to deliver that care in a market with no cost (not price) controls. Despite our low WHO ranking, the US spends a higher percentage of our GDP on health care than any other nation.

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Will Small Business Win in the End?

A few weeks ago Schumpeter, the nom de plume for each current author of the business op-ed column in The Economist, postulated the decline and fall of the Western Corporation. Could small business be the little furry mammals of the 21st … Continue reading

Posted in Business Perspectives, Economic Trends, Leadership, Politics and Regulation, Strategy and Planning | Tagged , , , , , , , , , , , , , , , , | 4 Comments

4 Responses to Will Small Business Win in the End?

  1. There is innovation which comes from smaller sized organizations. Then they get absorbed by ← larger fish in the food chain. Economic set backs create the groundwork for entrepreneurial growth – starting a business in lieu of not getting a job with bigcorp or the government. it is a cycle. the proven successful small businesses get acquired by larger companies with capital and no innovation. mom and pop video stores were acquired to make Blockbuster but even these have a life cycle and big does not always mean an enconomy of scale. red box in your grocery store lobby seems to be doing just fine as a vending machine operation.
    none of us lead active business lives in the historic perspective of 100’s of years. We have to make payroll or the rent this week, satisfy the customer with good qualty at a market price which is not increasing and do all of the other things required of us by the community we operate in. Small business people are heroes but because we do such a poor job of economic education in our schools their success is viewed as a lucky lottery instead of hard work.
    we will be in trouble when they start saying why bother?!

  2. Hi John,

    I see small businesses growing and playing a bigger part in the US, and heck, around the world, in supporting economies. As more entrepreneurs get the gist that they are making a difference and with the ease of buying a domain and hosting more folks are growing prospering small businesses. Side note; I’m awake and it’s almost 2 😉


  3. Luis says:

    The longer insterest rates remaiin at zero or below zero levels, the more difficult things will be for SMBs and middle classes. Because real zero rates are just for Big corps, banks, etc. in most of the Western world. This means they can almost print money.
    On the other hand, all the rest of us are deeply indepted with them (either through credits or public bonds), and we have no other resources but our working hours to pay them, competing on a global basis to sell them.
    Inequality is absolutely inevitable, and it will get much much worse beacuse politicans and central banks are into this strategy of ‘asymmetrical capitalism’.

  4. Mike Wright says:

    Last night I heard on the presidential debate that they were going to do something for small business in new tax codes. They also said they were going to do something for the middle class and those at of near the poverty level. All of the money of the wealthiest people cant come close to covering the budget. Maybe the politicians have a plan to bleed the dinosaurs. But, in true financial wealth theory we need to grow companies capable of moving large sums of money into our economy. Curious! When might we start focusing on educating future voters on economics and understanding how capitalism works as a whole. Small furry mammals or cockroaches? We must remain nimble to stay out from underfoot of Big Business, Big Government and Big Labor.

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Germany Makes a Business Decision

Germany just announced that it could accept an additional 500,000 refugees when other countries are jockeying to accommodate as few as possible. As much as the announcement was portrayed as a humanitarian effort, it is just as likely a simple business decision. Few members … Continue reading

Posted in Economic Trends, John's Opinions, Politics and Regulation, Strategy and Planning, Top Blog Posts | Tagged , , , , , , , , , , , , , , , , , , | 7 Comments

7 Responses to Germany Makes a Business Decision

  1. Dan Bowser says:

    Thanks for putting a face on the other side of the immigration issue. Our country benefited greatly economically from immigration in the past. We can benefit now while helping many people at the same time.

    I wonder if we as a nation can get past the frustration of extreme political self-interest and see through the pandering on the part of some candidates.

    I’m hopeful but concerned.

  2. David Cunningham says:

    This observation is spot on. Japan will suffer worst because their racial intolerance is so bad that they cannot contemplate the an immigration program at any scale that would save them. On a visit to Yokohama I had repeated experiences in being denied access to jazz clubs, because they were “Japanese Only”. It was a trivial discrimination but it made me aware how bad it can make you feel.
    The least intelligent of the current US immigrant phobias are the proposals to repeal the 14th Amendment to the Constitution – “All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the state wherein they reside.” and to repeal the Dream Act that removes the threat of deportation for children of illegal immigrants. In most cases, we have already educated these young people and they are an economic benefit to their communities.
    I wish “Cost / Benefit” analysis could be applied to many of the challenges that face the USA.

  3. Katrin Anger says:

    Good point!
    While there are many perspectives that can be taken on this topic, this is certainly one with a positive side effect. – Whilst I don’t think that this is the main motivation for the German government, it could indeed prove true and benefit Germany in a few years … if they succeed on integration.

  4. Several years ago I was traveling in Norway and was struck by the large population of Somali immigrants there. Norway also has a negative population problem and had been attracting immigrants from many countries including the US becuase they seem to be color blind according to several former American black people I met. they would rather raise their children there there away from gangs and low expectations. Norway only wants you to commit to raising your children there and will subsidize you to do so with parental leave, education and job training for the parents. I was surprised to see so many olive and dark skinned people in the land of the blond, blue eyed Norsemen even outside of the urban areas..

  5. Mike Wright says:

    On Point. One other factor in Germany’s favor is the effectiveness with which they assimilated a less skilled East Germany population back in so efficiently and effectively. We must make education and training of the new immigrants a priority so they can help our economy grow, and not just to perform low skilled low paying jobs.

  6. We all should be champions for open immigration and free movements cross the borders, as long it is based on the trader principle. If you have the right to your life, you should be able to live and work wherever you want, in a free world.

    Immigration as become a hot topic in Scandinavia. I hope people will learn from the melting pot and the land of opportunity: the United States of America.

  7. As with most European countries, meetings etiquette in Germany relies on professionalism, good business sense and formality. Bearing the above in mind, together with a positive attitude will ensure good results.

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Owners Live in Two Different Worlds

Business owners live in two different worlds. If you are a Baby Boomer, the title of this column might bring memories of any one of the many covers of the song by the same name. (Everyone from Nat King Cole to … Continue reading

Posted in Building Value, Economic Trends, Entrepreneurship, Exit Options, Exit Planning, Exit Strategies, Selling a business, Strategy and Planning, Top Blog Posts | Tagged , , , , , , , , , , , , , , , | 1 Comment

One Response to Owners Live in Two Different Worlds

  1. David Basri says:

    There is no question about the difficulty in the Main Street market. Another strategy besides fading into the night is to find someone to pass it on to. That likely means finding someone years in advance, nurturing them and at some point starting to share equity. Having said that, I fully recognize that many small businesses are not in a market where a successor is easy to find. While I own a small software company, it is not so easy to find someone willing to start work at 3 AM so there are fresh bagels ready by 6 AM. Thank goodness there are such folks.

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Minimum Wage and the Middle Class

“Amongst the novel objects that attracted my attention during my stay in the United States, nothing struck me more forcibly than the general equality of conditions.” – Alexis De Tocqueville (Democracy in America, 1831) Americans have always considered themselves “middle … Continue reading

Posted in Economic Trends, Entrepreneurship, Managing Employees, Politics and Regulation, Strategy and Planning, Technology | Tagged , , , , , , , , , , , , , , , , , , , , | 1 Comment

One Response to Minimum Wage and the Middle Class

  1. Mike Wright says:

    The only real way to solve the problem of the shrinking middle class is through technological advances and higher levels of universal education. Governments at all levels have failed to provide the education required and continue to take more money away from the private sector. Money that could be used to develop new technologies and train their workers to move into higher paying jobs. They are taking actions to get the political support of those who cannot, or choose not to, understand that their simplistic approaches will fail. The envy of astronomically higher salaries of CEO’s are playing right into their political strategies that are definitely not “for the people”.

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