Behind the Healthcare Cost Curtain, there is an answer

By Bob Shupe

Think for a moment about where you get your information regarding the healthcare cost crisis. Really, stop reading and think about where the information came from. Now ask yourself what motivation you think each of those sources has for giving you information. Going deeper, what motivation did the sources cited have for providing the information? If you do a little research, you will find most everyone, including the federal government, is asking those providing healthcare services, procedures, products, and those selling insurance and related services how to fix this broken system. Who are they not asking? You…and me?

"As Bob mentions at the beginning of the book, asking you this question, 'Why should you read this book?' it is important that you have probably never heard of him. Most people have not heard of him. I can tell you who has heard of Bob Shupe—those who for years took great advantage of our school system and their valuable employees, spouses, dependents and retirees. You can bet they know who he is. This group includes agents, brokers, hospitals, insurance companies, doctors, politicians and attorneys. Many of the other employers who use his services also know him quite well. Bob Shupe is the epitome of, 'It is amazing what can be accomplished when no one cares who gets the credit.'"

"You may challenge what is in this book, but you will have to work very hard to prove these concepts wrong. You really should take the time to read this book."
Mickey Hall
Deputy Director of Schools
Wilson County, Tennessee

• Language: English
• Publisher: Bob Shupe
• Release date: Jul 1, 2019
• ISBN: 9781393031307

Book preview

Other Books by this Author

The Bitter Pill, where did my benefits go?

First book on Healthcare Issues written and copyright 2006, four years prior to the passage of the Affordable Care Act. Many of Mr. Shupe’s concerns would become reality.

Published by Wheatmark, 610 East Delano Street, Suite 104, Tucson, Arizona 85705, www.wheatmark.com.

ISBN-10: 1-58736-684-3

ISBN-13: 978-1-58736-684-0

LCCN: 2006931431

The Little Brown Church in the Vale, when did the lights go out?

Written and copyright 2008. A look at the dying 21st-century denominational movement and maybe its only last hope.

Published by Wheatmark, 610 East Delano Street, Suite 104, Tucson, Arizona 85705, www.wheatmark.com

ISBN: 978-1-60494-137-1

LCCN: 2008929188

Ultimate Point of Vulnerability

Mr. Shupe’s second book on healthcare is in the form of a faction novel written and copyrighted in 2009. A cure for cancer is discovered in the 1960s, only to be covered up by a secret syndicate, The Foundation, for fear that the cure will wreak havoc on the U.S. economy.

Decades later, The Foundation, which has now gained power over nearly every aspect of American life, is trying to manage the economic crisis brought on by terrorist attacks and the same national health care system they had put in motion years before.

Now, just as economic chaos looms, it is learned that China has the long-withheld cure and intends to release it, which could further devastate the U.S. economy and its sovereignty.

Will the U.S. be able to recover? Or has The Foundation taken Americans to the brink of no return?

Is this America’s Ultimate Point of Vulnerability, a perfect storm of divergent elements—crashing together at the same time—overwhelming enough to destroy the most powerful country in the world?

Published by Wheatmark, 610 East Delano Street, Suite 104, Tucson, Arizona 85705, www.wheatmark.com

ISBN: 978-1-60494-308-5

LCCN: 2009929259

Also available on Kindle

DEDICATION

The decision to dedicate a manuscript compiled over a period of two and a half years is not something a writer just inserts at the front of their final work product. A dedication of the effort in creating a new piece of literature should be decided based upon multiple criteria: relevance to subject matter, understanding of the force behind the creation, empathy, respect for the subject matter, and relationship. There is no other individual I know who better fits all of these and other characteristics than my sister, Greta Sue (Shupe) Coates.

Sue is the only reason my baby sister, Mary Ann (Shupe) Barna, and I are able to look back at the passing of both of our parents and know without hesitation that they were cared for with the finest love and attention to the administration of their final wishes until they drew their last breath. In addition, Sue has given the same love and care to thousands of individuals with Alzheimer Disease and, just as important, their caregivers. Many of these individuals and caregivers became family to her as she watched the patient slowly disappear into their disease. Proof of the relationships she developed is evident in continued communication between Sue and caregivers after the family member passed.

Because of her involvement in this aspect of healthcare, Sue has a complete understanding of healthcare costs and, more importantly, quality of life. I count it one of my greatest treasures to call her Sis.

Sis, we love you and may God bless you and your efforts to continue to make life a joy for those who might otherwise have lost all hope.

Brother

FOREWORD

One of the first things I was told when introduced to Bob Shupe, as the school system’s benefit consultant, was that a properly funded, self-funded health plan can never go broke. That was more than twenty years ago. I believe his opinion to be truer today than when I first heard it. I say that knowing our school system now has a reserve fund equal to more than one year of cost for our entire annual benefit program. This current reserve position is even more striking when you understand the system’s reserve was in a deficit before making several of the recommended changes. Actually, there were several things I was told by Bob which at first sounded… unusual.

After years of exposure to all of the elements touching healthcare, I have come to fully understand the difference between an agent/broker and a consultant. A true consultant has no connection to any insurance company and is able to make true, unbiased third-party recommendations. As an example, I have heard Bob say on several occasions he didn’t care whom we bought services or coverage from, as long as our decision was based on solid data and references. Another similar statement was that Bob wasn’t on my side, the Board’s side, or the employee’s side regarding benefits or cost. Instead, he professed to be on the plan’s side. What was his reasoning? If the plan isn’t healthy, nobody is happy. Bob Shupe’s opinions and positions about our benefit plan have guided our school system benefit participants through uncertainty and cost escalation in the provider and insurance communities over the past fifteen years. There were times when Bob suggested things we didn’t even know were possible.

About 2006, long before the Affordable Care Act was passed, Bob suggested we open our own primary care clinic—and not just open a clinic, but let those on our health plan have access to the clinic for free, including about 180 generic drugs. He also suggested the participants be allowed to attend their clinic appointments on school system time. This could only be accomplished if we coordinated our benefit plan with the new clinic’s services. That coordination would require shifting responsibility to the participants regarding their own personal health. We would have to stop shifting plan cost by manipulating out-of-pocket expenses.

It was subtle, but we were introduced to a new phrase: health care, not healthcare. You will find a great explanation in this book regarding these two terms. After a lot of thought and investigation, the School Board approved the clinic plan and benefit coordination offered by our consultant. But he wasn’t through with innovation.

About three years ago, Bob’s company—ESP LLC—partnered with another pharmacy-consulting group to set up an innovative pricing methodology for prescription drugs: single pill pricing. The concept seemed too simple to work, and we thought it would surely not be accepted as a pricing replacement tool for an out-of-control pharmacy benefit-management community. But it worked! With little change to Rx benefits to our participants, our system began saving over a half a million dollars each year. By now, we were no longer surprised by the outcomes of his recommendations.

I would strongly encourage you to read this entire book. It is not a book you can understand by picking and choosing chapters or subjects. The healthcare cost crisis is a complicated web of interconnected issues, only understood when looked at as a whole. The book is filled with things you may not know, things with which you may disagree, and things which may disturb you—all of which will enlighten you.

At the beginning of the book, Bob asks you this question: Why should you read this book? It is important that you probably have never heard of him. Most people have not heard of him. I can tell you who has heard of Bob Shupe: those who, for years, took great advantage of our school system and their valuable employees, spouses, dependents, and retirees. You can bet they know who he is. This group includes agents, brokers, hospitals, insurance companies, doctors, politicians, and attorneys. Many of the other employers who use his services also know him quite well. Bob Shupe is the epitome of, It is amazing what can be accomplished when no one cares who gets the credit.

You may challenge what is in this book, but you will have to work very hard to prove these concepts wrong. You really should take the time to read this book.

Mickey Hall

Deputy Director of Schools

Wilson County, Tennessee

WHY SHOULD YOU BUY AND READ THIS BOOK?

It is not the answer that enlightens, but the question.

– Eugene Ionesco

While the subtitle to this book is, …there is an answer, The book is really about enlightenment that creates questions. Questions you should be asking and demanding answers. Consumers should ask themselves, Why should I spend a penny on anything? You rightfully should be asking, Why should I spend money on this book? and more importantly, Why should I spend a few hours of the time I have been given on this earth to read this book? My answer to you would be, Because you probably have never heard of me.

Americans are manipulated every nanosecond of every day. It used to be large publishers who controlled your access to reading material. They determined who was published and what was released for publication. Under these earlier terms, content was much more important than who wrote it. With this priority, you often found books by relatively unknown authors. Today, social media and the internet have turned on those giants of publishing. Authors like me now have a greater chance of talking to the world and, for the most part, we are unfiltered.

As a result, those giants of publishing have changed what they look for in an author. It is easy to see, after reading most of the big house books, content is no longer high on their priority list. The most important element for almost any publisher to turn a profit is a popular author. You get published after you become famous for non-literary reasons and establish an audience. What made you famous doesn’t even have to be legal or ethical, just as long as a lot of people recognize your name.

To further validate this new phenomenon, check out most non-self-published books. All over the covers are famous names and pictures. I thought about asking some of these folks to appear on the cover of my book, but I don’t really know anyone famous. So, after three previously self-published books, here I am again with another attempt at getting a message out with unbiased content.

Let’s return to the original question about why you should buy and read this book. I listen to information shared on multiple media sites, read extensively, research, and ask questions. I belong to organizations whose specific focus is on healthcare delivery and cost. I don’t sell insurance, but I have consulted with some of the most successful groups in America in controlling healthcare costs. I’ve been in these trenches for more than thirty-six years, and I have a music degree. I will explain more about the music thing in a bit.

Think for a moment about where you get your information regarding the healthcare cost crisis. Really, stop reading, and think about where the information came from. It is important you not go any further until you stop to think about your sources. I will skip to the next paragraph in a moment to give you a fresh place to start.

Brain Pause….

Okay, I am going to trust you thought my previous question through. Now ask yourself what motivation you think each of those sources has to give you information. Going deeper, what motivation did the sources which your sources cited have for providing that information? If you do a little research, you will find most everyone—including the federal government—is asking for ways to fix this broken system. They are asking those providing healthcare services, procedures, and products, and those selling insurance and related services. Who are they not asking? You…and me?

Now, before I share my outstanding, common autobiography with you, let me ask one more question. Do you purchase or do you receive healthcare services, procedures, or products? Which one is it: purchase or receive? After answering this last question and reading the autobiography below—the story of a guy you probably have never heard of—take this book to checkout, or go to Amazon or any other online book site and complete your purchase either by buying the book or downloading it on your eReader. There is a lot to see behind this curtain. Go ahead, pull it back…

Autobiography

This accounting of my life will likely sound a lot like yours. Abraham Lincoln is attributed with saying, God must love the common man, He made so many of them. Then there was Phineas Taylor Barnum who is quoted as saying, There is a sucker born every minute. Assuming both of these gentlemen actually said these things, I am certain I fit both profiles. In other words, you and I have a lot in common besides our class in society, which is defined by those living in a class above the one they define. For the most part, your problems associated with paying for your well-being is controlled by many of the same individuals who control much of the rest of your life.

This book is an opportunity for you take control of your health and related cost. Here is my story, and I am sticking to it.

I was born and raised in the small, southwest Virginia coal-mining town of Norton, in Wise County. My father moved our family to West Melbourne, Florida in April of 1959 in hopes of a better life. My dad, Glenn Shupe, packed everything we owned into our 1946 Chevy, along with my mom, Melissa, my sister Sue, and me. He drove to our new location, eager to take on his new job as an auto parts manager for a struggling small business. He was successful. He moved us from outhouse poor to lower middle class airconditioned plumbing.

I lived in the mid-Florida Atlantic coast area with my parents until I graduated from high school in the spring of 1968. During those years in Florida, I discovered—thanks to my mother—that I had a gift for music. I also felt called to foreign mission work. After high school, I headed for college to further my foreign mission and music calling. I landed in Nashville, Tennessee at the Free Will Baptist Bible College. After failing freshman English three semesters in a row, I decided foreign mission work—and learning a foreign language—were probably not my calling. Music, on the other hand, continued to take up a great deal of my time and academic pursuits.

In 1971, at the urging of choral director David Randlett—who later became the head of music at Liberty University—I transferred to what was then Belmont College, now Belmont University. I spent the next two years and two summers earning my bachelor’s degree in church music with an emphasis in vocal performance under the direction of Bob Mulloy. Mr. Mulloy was, at the time, creating what would become the premier Music Business degree in the United States. Under the close guidance of these two men, I graduated in the summer of 1973 and immediately took a job as Minister of Music and Youth at the First Baptist Church of Portland, Tennessee. Despite all the years of calling and preparation, after a year and a half on the job, I walked into the pastor’s office and resigned. Everyone, including me, was asking why.

I met Ronnie McDowell during that period. After all, I lived near Music City, USA—so why not pursue a performance music career? It didn’t matter that I had been successful at the Baptist Church. I left because something was just not right. I spent several months working with Ronnie and an eight-piece country band he had put together. He and I also wrote, produced, and recorded a few jingles for local banks and car dealerships in a four-track studio I built above a local hardware store next to a railroad track! I recorded Ronnie’s first 45 rpm record: You’re the Life and Breath of Me. Ronnie could sound just like Elvis, and he recorded his first big hit when Elvis passed away. Somewhere in there, we parted company. Ronnie went on to a great, well-deserved career. I went back to trying to figure out what I was supposed to do.

Those were dark years in my life. Thankfully, I didn’t lose my loving wife, Valerie, and we had not yet had children. After a couple of years of experimenting with vocations—and an eventual move back to Nashville in 1976—I made a phone call to a close friend who was in the car business with a large, local dealership. I asked him if I could speak with him about what he did for a living. He was a finance and insurance officer with the dealership. This was my first encounter with the insurance profession. It was not a good experience.

My friend helped me get an interview with a company that trained individuals for the finance and insurance industry. I spent three solid weeks in Chicago learning how to manipulate and put people in debt. I was also taught how to sell credit life insurance, one of the most profitable and least-used products in the market. Within one year I had taken my last call from the owner telling me he had just given away a car on price and I’d better make it up on the back end with his cut of financing. Many things have changed in that industry, and new disclosure rules have driven most of the unscrupulous people out of the market.

Just prior to resigning in 1978, another good friend of mine, Skip Morris, dropped by one day to visit. My wife and I had our first child on the way after nine years of marriage. I had known Skip for some time, since he married a good friend of mine. Skip dropped by with every intention of selling me a life insurance policy. Instead, he actually sold me on his company, Nationwide Insurance. I kid him to this day that he never did sell me a life insurance policy.

Skip introduced me to his District Manager and I was soon in Columbus, Ohio at the Nationwide Insurance Group training center. I spent the next eleven and a half years as an employee agent, district manager, commercial group and property and casualty trainer, and finally, as an independent agent. I learned almost everything I know about insurance mechanics from those experiences. Nationwide was, and is, an excellent organization. I still have my personal insurance with them to this day.

During my final years with Nationwide, I met a gentleman named Robert Sanderson who worked for three of our mutual clients. At first, I could not figure out what he did, but he was always at my client meetings. More troubling, he would remain in the room with clients after I left. I finally figured out he was a consultant. I had heard the term consultant before, but it was always just another name for an insurance agent or broker. This guy was weird; he didn’t sell insurance. We became close friends, and I learned a great deal from him.

In 1988, I received what I thought was a routine phone call. Mr. Sanderson—as I felt I needed to address him—called and invited me to lunch. I assumed he intended to discuss one of our mutual clients, as we did on occasion. I was in for a surprise.

No sooner did we sit down than Mr. Sanderson spoke. Bob, I am sixty-five, and I am going to retire. I have no children and no business partners. I am going to either sell my business or I am going to let it go away. If I sell it, you are the only person I will sell it to—and I will finance it.

Every once in a while, life slaps you in the face without warning. This was such a moment. No preparation, just a decision to be made. I asked for some time to discuss it with my wife. Mr. Sanderson thought that to be a good idea. I don’t remember much about the rest of the meal due to the increasingly muffled voices inside my head shouting out a million questions.

My wife and I discussed it, prayed about it, cried, stressed, and then listed every reason we should decline the offer. I had a great business and a retirement plan with Nationwide. I was a leading commercial salesperson with potential for continuous renewal commissions for years. I wasn’t looking for another job. By now, I also had two children and the coming expense of their educations. After about six months, we finally decided to take the leap of faith.

I called my district manager at Nationwide and told him to come and pick up my files. He was as perplexed as the Baptist pastor had been when I resigned from the church. So, with a check equaling one year of previous commissions and several thousand dollars of new debt, we began the journey which has now lasted thirty-plus years. Several of our clients have been with us for more than twenty-five years, and one has been there since we bought the business. We are proud to have served so many public entities for so many years, saving their taxpayers tens of millions of dollars.

During my career, I have belonged to two very important associations: the National Association of Health Underwriters (NAHU) and the Self-Insured Institute of America (SIIA). I have served on numerous boards and committees with both associations.

It is important you understand that everything stated in this book—with the exception of endnotes—are my opinions alone and do not represent in any way the mission or the individual or collective opinion of either of these organizations.

Autobiography Prolog

Before you decide to buy this book, or before you commit to read it, you should know what became of my original life goals and direction. It is important to me you know how things worked together for a purpose in my life. I pray my suggestions and thoughts woven into the pages of this book will also make sense once they are applied.

I started by telling you what I thought would be my vocation(s) when I first began developing a career. It’s funny how life works out. I actually accomplished every one of them, after what many would consider failed attempts at finding my purpose in life.

In the beginning, I thought I was supposed to be a foreign missionary. I was able to take two music missionary trips, spending more than a month in the middle of Colombia, South America in the early 1990s. I was given the opportunity to meet and teach music harmony to several Hispanic teenagers. Many years later, I was still receiving postcards from them telling me what they were doing in music ministry in their country. In the later 1990s and early 2000s, I was blessed to be on a denominational board working with Sudanese refugees coming to the United States and fleeing the brutality of their country. I was able to assist in training ministers and establishing a church in the Nashville area still in existence today.

I thought I was supposed to be in music performance early on. Beginning in 1983, a friend and I started a contemporary Christian Rock band which lasted twenty years, eventually playing all over the US as well as South America in the previously mentioned mission trips.

My desire to direct a choir was fulfilled beginning all the way back to 1969. I was able to direct the Tusculum Cumberland Presbyterian Church Choir and Choral Ensemble—with three breaks for various reasons—for forty-eight years. What gave me the resources and ability to accomplish all of this was my discovery of the need for someone with an unbiased skill and ability to help manage insurance programs for tax-funded public entities.

There is another reason for you to buy and read this book. You might never have heard of me, but I’ll share the testimony of my clients who already have the answer to the healthcare-cost crisis. Their stories will verify that I know what I am doing.

Buy it, read it, take action on its contents.

Thank you,

The Author

I

INTRODUCTION

For those in any area of the healthcare industry reading this book, I am certain you are going to come across an item or a topic you know is no longer correct or has changed. Since you are in this industry, I trust you will also understand how fast it moves and changes. Change is one of the things that initially kept me away from this project. Realizing there was nothing I could do about change, I decided to keep up as best I could, knowing at some point I would have to launch and release my ideas, opinions, and facts based on a snapshot effective the day this book went public. If you do find something no longer relevant or incorrect, I congratulate you! You are one of a few keeping up with this issue. I hope you are as adamant as I about fixing the problem.

A few things never change. Telling the difference will determine if the information contained in this book will move the gauge forward or backward in your efforts to change the paradigm. This book is not intended to fix the healthcare cost problem. This book is to give you the tools to do it yourself.

I began writing this book on July 4, 2016. On that day, 240 years previous, a group of radicals ratified the Declaration of Independence, forever setting in motion a vehicle of change which would literally reset the face of the world. It is worth noting, one out of five of those supporting revolution were against ratifying the Declaration. The odds are much worse today against a successful revolution regarding meaningful healthcare reform in the US. Accompanying the one-to-five odds on July 2, 1776, when the Declaration was actually signed, there was also a mixture of emotions fueling reluctance to change. Some of those same emotions—ignorance, bias, financial worry, inferiority, and plain, unadulterated fear—were also present on July 4, 2016.

Three questions need to be answered about our willingness to do something meaningful and long-lasting regarding stabilizing quality, affordable healthcare: Do we need to revolt, why do we need to revolt, and who should sign the declaration?

Do we need to revolt? I say yes. Do I have any of the above-named negative emotions? Yes. Will some people be sacrificed if a revolt takes place? Yes. Could it be me? Yes. Could it be you? From the evidence baked into this book, yes—whether you join or don’t. What were the reasons for the Declaration of Independence in 1776? There were many, but at the top of the list was taxation without representation. To be clear, while I respect the mission statement of the Tea Party (Taxed Enough Already), it has no correlation to my position on healthcare. It isn’t the actual taxation, as most understand it, but money paid by every American—money never directly touching their need for health care. And that leads me to the why, the reason we need to revolt.

Words have meaning. Healthcare has many definitions, depending on who is using it and who is hearing it. Even the word itself can be stated two different ways: healthcare or, as I prefer, health care. I will further define this duality inside the following chapters, but for now, it is important to understand how the term affects who needs it, who sells it, and who pays for it.

Simply stated, every individual on earth will eventually need health care. This need will include someone to assist with bodily functions, mental well-being, and the monitoring of chronic care. It gets complicated, however, when we combine two words, health care into one word, healthcare, and begin to see who is selling these services and products to individuals under such a definition. As mentioned earlier, I will define these two terms later in context.

It’s important to understand who sells healthcare as a business, for profit and not for profit (non-profit). Even more critical is who has the greatest influence over this process. Are those who are directly paying for healthcare having the greatest influence, or those who sell it, or those who need it?

Once understood, it becomes clear we not only need a revolution, but a successful revolution with the right people leading the charge and with the right stuff as signatories. The surprising and revealing answer to this situation leads to the alarmingly weak, disjointed voice of those on the front line—those who pay for all aspects of healthcare.

Who will lead this charge? What will it take to convince the doubters? What will it take to get the odds to at least one-in-five?

Looking into the future, who will be the catalyst and the force behind the greatest revolution since 1776? Who will the next generation read about as the champions who risked everything to save an economy that supports much of the world and defends freedom throughout most of the world? Will they read that the United States of America finally stopped spending more on healthcare than the rest of the world, and conversely began having better health care outcomes? Will history record it to be doctors, hospitals, universities, the financial world, politicians, the government, pharmaceutical companies, research institutes, the media, the patients, or the employers who finally won this war?

Looking at the previous list, note there are only two groups not selling healthcare: the patient and the employer. This is where the story of a second revolution should begin. And to win the revolution, these two distinct groups must step forward.

The primary revolutionary must be the employer. Employers are the ones paying the vast majority of the cost for our current, broken healthcare system. They have the most to lose and, therefore, the most to gain by figuring this out. They must also have a single voice—a voice uninterrupted by special interests or large gifts influencing their political voice. Those who profit or gain power by manipulating the healthcare system already realize and fear the power a unified employer group could wield.

Complicating the delivery, cost, and payment for healthcare by the employer is not an accident or coincidence. It appears intentional. Until the recent upset election, those trying to monopolize control of healthcare were winning. Many employers reached the conclusion healthcare had become too complicated and required too much administration to offer. Cost was becoming a major obstacle to profitability for private, commercial business and was making it impossible for local and state governments to balance budgets without enormous tax or rate increases. For those reasons alone, employers were abandoning their offer of healthcare coverage to employees and accepting the fixed cost of penalties (later ruled taxes by the Supreme Court.)

The second distinct group—by a slim margin—is comprised of individuals who use healthcare. These are the patients. Employers must stop shifting cost to artificially stabilize health care cost and begin shifting responsibility to the end user. Individuals must start taking better care of themselves. Early detection and chronic disease management is the answer that will stabilize and manage health care over the long term—not more money!

It doesn’t matter who you are or what you do for a living, you fit into one of the following two groups. If you are not an owner of a company, board member, stock holder, director, or in some elected capacity within a public entity, then you are most likely a patient. You are or will be a healthcare consumer.

What follows, chapter after chapter, is a revelation concerning America’s healthcare system in language most everyone can understand. After more than forty years wandering around in this environment, I am convinced two things must occur before we can claim victory over this healthcare cost crisis: employers and patients must realize the manipulation poured all over them, and we must all stop shifting cost and start accepting responsibility for our own health care.

II

BACKGROUND

With good, factual reason, most of us have accused the federal government of uncontrolled spending. The only proof we need is the projected deficit at the end of fiscal year 2018 totaling $21.48 TRILLION DOLLARS!¹