MVNHS© vs Private Insurance: An Englishman's Blog

Not many people on this side of The Pond know that our British cousins can purchase "private" health insurance to complement (or supplement) their government-sponsored health care. This despite the fact that health care in Britain is "free," "readily available," and of "high quality."

Recently, a relatively new British blogger has come on the scene. with some interesting (and enlightening) insights into what works, and what doesn't, in Merry Olde England. His name is Andrew McDonald, and he runs the Private Health Insurance Guide Blog. Andy describes himself as just "an ordinary person, who, like millions of others, is concerned by the quality of the UK healthcare system."

I've read some of his recent posts, and been favorably impressed. If you'd like to see what someone who actually lives and works under a system after which (some) folks would like to model ours, I heartily recommend that you drop by Andy's place.

Super-size Your Health Insurance

What is the most affordable way to cover those who lack health insurance?

According to Boston.com the folks in Congress believe you must

provide billions of dollars for walking paths, streetlights, jungle gyms, and even farmers’ markets.

Makes sense, right?

Walking paths promote healthy activities as well as jungle gyms. Streetlights help to keep us safe, which is healthy. And farmers markets sell healthy food.

Critics argue the provision is a thinly disguised effort to insert pork-barrel spending into a bill that has been widely portrayed to the public as dealing with expanding health coverage and cutting medical costs.

But advocates, including Senator Edward M. Kennedy of Massachusetts, defend the proposed spending as a necessary way to promote healthier lives and, in the long run, cut medical costs. “These are not public works grants; they are community transformation grants,’’ said Anthony Coley, a spokesman for Kennedy, chairman of the Senate health committee whose healthcare bill includes the projects.

It's not pork, which of course can be unhealthy, but community transformation grants. Why didn't I think of that?

“If improving the lighting in a playground or clearing a walking path or a bike path or restoring a park are determined as needed by a community to create more opportunities for physical activity, we should not prohibit this from happening,’’ Coley said in a statement.

So logical.

If you are a member of Congress.

A House version of the bill caps the projects at $1.6 billion per year and includes them in a section designed to save money in the long run by reducing obesity and other health problems.

So having jungle gyms and walking paths reduce obesity.

Then why have I gained weight since buying a rowing machine several years ago? The machine has been carefully stowed away in my basement along with my dancing to the oldies tapes with Richard Simmons.

“We will see a return on this investment if you use this money strategically for proven, evidence-based programs,’’ Levi said in an interview, citing efforts to stop smoking and to promote physical activity. “We will prevent or reverse chronic diseases such as heart disease. . . . It will pay for itself.’’

Well there you go. It is part of Obamaman's Paygo scheme.

“We spend 75 cents of every healthcare dollar treating people with chronic diseases like diabetes, heart disease, and asthma, and only 4 cents on prevention,’’ Harkin said in a statement. “But the majority of these diseases can be prevented through lifestyle and environmental changes.’’

This is all true.

The problem is, most people would rather take a pill than actually change their lifestyle even if it means better overall health. Perhaps if we paid people to live a healthy lifestyle that would work.

Since obesity is a major contributor to health issues, maybe a tax dollar credit for each pound lost.

Lose 20 pounds, take a $2000 tax credit. Every year you keep the pounds off you get the credit.

That's a change you can believe in.

Health Wonk Review: Two-fer Edition

Ken Terry and Joe Paduda team up to bring us two HWR's in one: Terry presents several great links with helpful summaries, and Joe has reaction to Bob L's Affordability Model.

Do stop by.

Told ya so...

"The Congressional Budget Office Tuesday told the Senate health committee that the latest version of the panel's Democratic health care reform bill would push millions of people out of their work-sponsored health insurance plans because it would give employers a cheaper option."

The so-called "pay or play" option has always been a non-starter for just this reason, but it's at the heart of key "health care" legislation.

We've called this more than once; nice to see the CBO finally catching up with us.

Government and Terror Insurance

From time to time, we offer other folks an opportunity to “guest-blog” here at IB. We recently received an interesting email from a company called Guy Carpenter, “the world’s leading risk and reinsurance specialist and a part of the Marsh & McLennan Companies.” Since we’re all about risk, this seemed a natural.

The challenge was that the article, while interesting, was perhaps a bit too “inside baseball” for our readers (it certainly was for us). On the other hand, this seemed to us to be an important and interesting risk management tool, and we asked if GC would be kind enough to blog about it for us. Fortunately, Chris Klein, GC’s Global Head of Business Intelligence, was kind enough to do so, and we’re pleased to present his post on how governments can act as a sort of “reinsurer” for terrorism cover:

It’s still far from the norm, but governments around the world are becoming increasingly involved in providing terrorism reinsurance. In addition to catastrophe cover, some are addressing business interruption, motor, life and other lines. While many countries still haven’t stepped into the marketplace, larger, developed nations are now quite active.

Government involvement has become necessary, in many cases, as private insurers and reinsurers would otherwise step back from these risks – either by reducing their exposure or eliminating it completely.

The United States, one of the early entrants following the terror attacks of September 11, 2001, has addressed cover at both the federal and state level – the former with an extension of the Terrorism Risk Insurance Act of 2002 and the latter through the addition of terrorism exclusions to the “1943 New York Standard Fire Policy.”

In Europe, Austria, Belgium, France, Germany, the Netherlands and the United Kingdom have implemented terror insurance schemes as a way to ease the burden on private carriers and ensure that a robust market can be supported. But, Denmark, Italy, Norway, Portugal and Sweden have not been similarly engaged.

And, the market is continually changing.

Specific threats and impacts do not stand still, resulting in a dynamic environment that can be difficult for carriers to manage. Fortunately, the tools of the trade are progressing alongside the risks. Last year, AIR Worldwide Corporation updated its damage functions to include the impact of reflected pressure waves in the wake of a conventional bomb blast. Risk Management Solutions has updated the number of targets in its U.S. model to 98 – including chemical plants, government buildings and convention and entertainment centers.

While it may seem a bit dry, this is critical information. How many folks know whether or not their homeowners policy covers acts of terrorism (not the same as “acts of war”)? What about your life and health policies? Hopefully, we’ll never have such a claim, but it’s helpful to know that both the private and the public sectors are working on this.

Thank you, Chris!

[Hat Tip: Matt Conroy]

Don't Forget the Java

It's been a while since we've had either a Food Pyramid or Alzheimer's update, and now we have a two-fer:

"Three large cups of coffee a day could help to slow the progress of Alzheimer’s disease and even reverse the condition, researchers say."

Past studies have linked caffeine with lowering the risk of developing Alzheimer's; this one actually concludes that it can "directly target the disease itself." The mice involved in the study actually demonstrated increased mental skills. How this will translate to humans, of course, is yet to be seen.

(In fairness, the scientists were really studying the effects of caffeine, not coffee per se: the mice were given caffeinated water. But they didn't say coffee wouldn't work just as well)

Best of All Worlds? The Healthcare Affordability Model [Updated & Bumped]

[Welcome Industry Radar readers!]

Bob Laszewski is one of the brightest health wonks I know, and a frequent read for me. Joe Paduda, another bright health care policy guy, sent us (and several other health care policy bloggers) a link to Bob's newest effort, called the Health Care Affordability Model.

Bob's proposal is, if nothing else, exceedingly long, and unnecessarily repetitive. It pains me to be so critical, because he's generally a very profound guy, but I fear that a lot of potential readers will be turned off simply by the length of the post (which clocks in at just under 7,000 words). Very frankly, I was disappointed in the effort, and have chosen to address a few of its problems. Readers wishing for an extended analysis may drop me an email, and I'll happily comply.

Bob starts out by positing that, under his plan, providers and insurers who fail to toe the line would lose tax advantages. He specifically states that premiums "for a non-qualified health plan would no longer be tax deductible for individuals or plan sponsors who used these unqualified plans."

Is he so out of touch with the current system that he doesn't know that premiums for individual plans are not generally deductible now?

He then posits that providers "who were not in a tax qualified health care network would lose patients to networks that did control costs." I'm not convinced that this follows: quality of care may be more important than cost.

He next claims that "insurers and providers would be required to first begin to stabilize and then control their costs." A noble goal, to be sure, but he never really lays out specific ways for that to be accomplished.

Bob then moves on to a Nine Point strategy to implement his recommended policy; as noted, I'll address only a key few:

■1. "(L)ive healthier lifestyles and more often practice good prevention." Well, that's certainly preaching to the choir as far as IB and its readers are concerned. But how do we encourage and/or enforce this? Maybe no tax deductions for fatties or smokers? Rotsa ruck with that.

■2. "We Have to Work Together." No kidding. But, and I realize that I'm beginning to sound like a broken record, what policy needs to be changed/implemented for this to occur?

■4. "Payers and providers generally know...where waste is." Really? How does he know this? And what's "waste" versus "defensive medicine?" If that's what he means, then let's see tort reform on the table.

■5. "During the last decade quality has slipped and health care costs have doubled." I reject that. First, care has improved and second, I suspect cost has more than doubled.

■7. "Patient-centered solutions cannot occur in a system driven by central planning." No argument, but no real progress, either. Lots of pretty words, and yes we're very bright people. But there needs to be incentives and/or "consequences."

■8. He calls for stakeholders to meet "face to face." And that's why there are so many insurance AGENTS being asked to the table? We have a unique and valuable perspective to offer: we know what works, and doesn't work, from all three sides (consumer, provider and insurer). Why isn't our input being actively solicited?

Keep in mind that saying "health insurers have been consulted" is meaningless in this context: their interests and perspective do not often coincide with agents'.

Once he's outlined his starting assumptions, Bob makes a rather startling new one: that we can "begin to slow, and then moderate, and even reduce the climb in America’s health care costs."

Okay, but HOW? I don't see concrete suggestions here. There's reference to tax consequences, but I don't see them delineated. Did I miss something?

He says his plan "would not impose government controls over insurance or provider prices." But, as we'll see in a moment, that's (at best) disingenuous.

He goes on:

In fact, insurers and providers have had compelling reasons not to make the health care system cost effective—providers and insurers get paid more not to."

Bull----. First, there's the substantial cost-shifting as a result of government programs (I'm looking at YOU, Medicare). Second, technology ain't free. I think he really misses the mark on this one.

"Simply lopping off the fees either providers or insurers receive (as the Public Plan Option would do) would do little to create a sustainable system over the long-term."

Agreed; in fact, this is the first - maybe the only - thing he's said that makes sense in terms of "the big picture."

He completely misses the mark, though, with his diatribe against profitability of insurers and providers. For one thing, he seems not to understand the difference between "profit" and "profit margin" (the latter is significantly smaller than he seems to believe).

And he seems not to have been reading the WSJ for the past, oh, nine years or so:

"Between 2001 and 2008, private health insurance costs increased between 6% and 14% each year—multiples of inflation and growth in the overall economy—while health insurers, drug companies, and device companies booked record profits, and most hospitals and doctors did well."

Correlation is not causation. He's overlooking a major (likely THE major) contributor to those profits: Wall Street. Look at where the "story" ends: 2008. Ring any bells?

"Under the Affordability Model there would be less money available than what would have been in the relatively unfettered system with costs exploding as they are today."

Really? Why is that? I see the conclusion, but I don't see the facts to back it up.

Unfortunately, he takes a seriously wrong turn here, advocating that "a new system of insurance exchanges would be created for the individual and small group health insurance market."

Right, because it's worked so well in Massachusetts (for example).

And he continues down the wrong path:

"Health insurers would be required to offer at least the standard option benefit plan in each state in which they operate through the insurance exchange. Through competitive bidding each plan would establish its baseline costs in the first year."

So he knocks Medicare, but then basically buys into the MC Supplement model. I'm not claiming that that model's "fatally flawed," but look at where we are today (MC Advantage Plans or Part D, anyone?).

Bob then proposes that "(s)elf-insured plans would be required to provide an actuarial certification attesting to the relationship its overall plan costs had compared to what they would have been had the plan offered the standard plan option to all employees (including age and severity adjustments). In the first year, that cost would become the baseline for future year costs."

Uh-hunh. And guess what those first year numbers are going to look like. Color me cynical, but methinks there will be some major benefits and cost-shifting juggling going on. And I'm still waiting to hear how we cap medical inflation.

Here's a doozy:

"An employer who chose to terminate their health plans in favor of their employees purchasing benefits through the insurance exchange would be required to “cash-out” their benefits"

DING DING DING! This is one of the most insidious parts of the Public Plan, and he wants to adopt it? Sheesh.

"Legislation would set national health care affordability goals expressed as a percentage of growth in the nation’s GDP—as defined and measured by the Department of Commerce."

Oh great: because they've been so accurate on all the other metrics? Tell me about the Spendulus and unemployment rates.

He believes that his model would "reduce national health care expenditures as a percentage of GDP."

There's an assumption here that I'm not sure I buy into. What's the "appropriate" ratio of health care costs to GDP? Isn't that pretty much an arbitrary number? Yes, 17% (or whatever) SOUNDS like a lot. But is it? I'm not saying it's not, but I'm not sold that it is.

"A Health Care Actuarial Certification Board would administer the goals."

DING DING DING again! Yes, the gummint will be in charge of setting health care costs, reimbursement and inflation. Lovely.

So we get a Health Czar, too.

Frankly, I'm done. That killed any cred this plan MAY have had. Once you've ceded the cost and valuation functions to the gummint, you can call it anything you like, but it is de facto government-run health care. Period.

Mike is more succinct (no surprise there):

"The biggest obstacle for me, in deciding whether to try to read a 7,000 word paper from one of the policy wonks, is that Bob seems to be deep into solution mode at a time when you can barely find 10 people at once who agree what the problem is.

It would be easy to determine if we're going at this the wrong way, in two easy steps:

1. Ask Bob if he can succinctly (less than 7,000 words) define the problem(s) that he thinks must be solved, and then

2. Ask a broad sample of people if they agree with his definition.

My bet - this proposal will stir up conversation and argument, but not much more."

And I suspect that this post will generate some interesting comments; we ask that the level of discourse be polite and respectful.

Have at it.

UPDATE: Joe sent along this link to an abridged version of Bob's Affordability post. I'm pleased to see a tightened-up version, but there's not enough substantive difference to justify a major revision to this post.

There are, however, two items in this abbreviated version which I'll address:

1) Reference to the newer Wyden bill (about which I intend to blog shortly), which seems to be a winner, and

2) Continued reference to the mystical (likely mythical) "30% waste" figure. First, the only place I've ever seen this number applied is to Medicare, and I don't see Bob discussing major changes to that soon-to-be-bankrupt system. Second, I'm skeptical that this alleged 30% can be cut, for the simple reason that no one has ever budgeted 30% waste in the first place.

Dr Lego Diagnoses Health Care

[Welcome Industry Radar readers!]

Mike passes this along:

Still want a government-run health care plan?

Free Health Care, Canadian Style

The Maine Problem is . . .

Seems the folks in Maine are lobbying outside the offices of their RINO senators (Snowe & Collins), trying to get them to support the health care for all initiative.

You may recall, Sen's Snowe and Collins were two defectors from the Republican ranks that led to Senate passage of the pork filled Spendulus Bill. The $800+ billion package of taxpayer money that promised to save or create jobs.

So far the only thing it has created is a bigger hole in the federal budget.

But I digress . . .

So perhaps because Snowe and Collins seem to be an easy touch for spending money Congress doesn't have, Maine-iacs are lining up voicing their support for massive health care reform.

In Presque Isle, Ms. Matson and others recruited by the Service Employees International Union, delivered dozens of handwritten letters to Ms. Snowe’s office. The union is campaigning for a so-called public option — a government-run insurance plan, similar to Medicare but open to more people, to compete with private companies.

I often wonder what these folks really know about Medicare. Good chance they are totally misinformed or else they would not be chanting for an expansion of Medicare.

Though Maine has only 1.3 million residents, the challenges of insuring the entire population are complex. The state has large rural, poor and elderly populations with significant health needs. It has many small businesses and seasonal workers, and few employers large enough to voluntarily offer employees insurance. Meanwhile, most insurers no longer find it profitable to sell individual coverage here, leaving a few companies to dominate the market.

Let us not overlook the reason why there are only a few companies operating in Maine.

Maine is a guaranteed issue, community rated state. Any carrier offering health insurance in the Badger state must offer coverage to anyone regardless of their health history. Not only that, but they must charge a rate that is commensurate with others who have similar coverage within a geographic area.

Perhaps this is why Maine has some of the highest health insurance rates in the country.

But back to the topic at hand, the folks in Maine want a federal bailout, much like GM and Chrysler. Their own Dirigo plan is belly up so they want the rest of the country to pony up to pay for their problems.

I have a better idea.

Why not just secede from the union and become part of New Brunswick, Canada. After all, Canada's health care solution is so much better than ours.

Actually part of Maine's problem is their own doing. If the state government would quit meddling with health insurance rules and allow free market rule more carriers would enter the market and premiums would become more affordable.

Of course some residents have their own idea.

Stavros Mendros, a consultant from Lewiston, is equally wary of insurance companies but his solution is to avoid them completely and risk going without coverage. Mr. Mendros said that when his 4-year-old daughter got sick recently, he took her to the hospital and paid the $1,200 bill, which he said was cheaper than a single month of an insurance premium for his family would be.

“Not having insurance saves me boatloads of money,” he said. “My biggest concern with the government taking over health care is the waiting lists. My daughter didn’t have to wait. I’d rather have a bill than a dead daughter.”

Saving boatloads of money. Easy to say when the bill is only $1200.

I doubt he would be singing the same tune had the bill been $120,000.

As the lead opposition to the Democratic plan in Maine, Mr. Bragdon has emphasized the failures of the state’s own experiment with universal health care, a law enacted in 2003 with the goal of covering all the state’s roughly 130,000 uninsured residents by this year. The plan currently covers only a small fraction of the target, partly because the state capped enrollment because of financing problems.

That number would be 8,300 . . .

How's this working for you?

That Dirty, Dirty MVNHS©

Bill's chronicled the "sanitation problems" of Brits' hospital facilities before, but we like to keep our readers up-to-date on that system's chronic problem with filth.

Seems that Tereza Tosbell, a seasoned housekeeper herself, found herself "in hospital" recently:

"The sick 48-year-old was so disgusted at the conditions after three days on a 'filthy' ward that she grabbed the antibacterial fluid dispenser at the end of her bed and some hand towels from the bathroom."

Well, we've certainly banged the "personal responsibility" drum quite often here at IB, but we never quite thought that it should extend to cleaning one's own hospital room. One would think that, after cleaning for over an hour, the staff might at least offer to lend a hand.

One would be wrong:

"The nurses and other staff saw what I was doing but just left me to get on with it."

Certainly, though, this was but an isolated incident, right?

Nope:

"The Patients' Association yesterday said what Miss Tosbell had experienced was 'nothing unusual'."

What may be even scarier, at least for the patients, is that, in a recent review, this hospital "scored maximum marks for safety and cleanliness."

Quick, let's have a nationalized system here!

That, and government-provided Swiffers all around.

Happy Birthday, America!

A very Happy Independence Day to all of our readers and their families.

The (Tea) Party's Over

There's a classic scene in TV's "Happy Days" in which The Fonz, wearing his trademark leather jacket, water skies over a shark, thus giving birth to the term "jumping the shark." It's come to mean a pivotal event which goes too far, thus destroying its own credibility.

This evening, I witnessed the Tea Party movement leap mightily over that sea creature.

At April's event, I was impressed with the enthusiasm and optimism of those attending, and found most of the speakers informative and inspiring. Perhaps it was the fact that we were all gathered in a relatively small space in downtown Dayton, almost all standing through the entire 2+ hour celebration of American values.

That Tea Party started (roughly) on time, and was over at a reasonable hour. There was a chemistry among those of us present, and the folks in charge seemed to understand that this was a key moment, when the nascent movement would begin to pick up steam and reach out to a broad range of fellow Americans.

Tonight's, by contrast, showed nothing but contempt for its own supporters, and destroyed any hope of a broader outreach to Democrats and Independents who may have begun to feel betrayed by the direction this Administration, and its enablers in Congress, are taking us.

Instead of choosing (again) a central location, the promoters booked the event at a very nice park some 20 miles or so from Dayton. Worse, they held off starting for a full half hour, effectively telling those of us who'd made the effort to be punctual that our time was worthless, certainly not as important as all the folks still driving in. At one point, I spoke directly with one of the organizers (whom I know slightly), and told him that the clear message that they were sending was that we weren't important. He thanked me for my input, but it was still another 15 minutes before the program got under way.

This is inexcusable; it says that the most ardent supporters are simply unimportant.

The venue itself was another problem: unlike the packed downtown location, this was a park complete with ice cream and soft pretzel vendors; folks spread out, many on blankets and stadium chairs, for an evening of entertainment, not enlightenment or inspiration.

There was no chemistry, no sense of urgency. It was simply a very pleasant evening in the park, with music and the occasional speaker.

And then, in what can only be described as one of the most stupendously ill-advised and movement-killing decisions I've ever witnessed, they brought on an Obama impersonator, who proceeded to make a complete fool of both himself and the organizers. If there had been any hope of reaching out to those on the left, indeed, to anyone with any respect for fellow citizens, this killed it.

It's a shame, really: "what could have been."

Needless to say, if there actually is a third Tea Party, I won't be attending. Nor, I daresay, will very many others. The right (often correctly) accuses the left of stifling bi-partisanship: Pot, meet (tea) kettle.

Public Plan or Bust

All protestations to the contrary, it certainly appears that our political class is dead-set on making the Public Plan the only plan.

Hunh?

Well, the most widely-supported proposal currently making the rounds requires employers to pay almost three quarters of each employees' premium, or face substantial penalties. We've already seen the effect that a 65%, temporary subsidy has had on the group market; one can only guess at the consequence of a larger, permanent one.

Our best guess: employers will quickly drop their group plans altogether, leaving millions of previously privately insured folks to hop onto the new Public Plans. As Bob notes, a similar program in Massachusetts has led to major shortages and cost overruns, while doing nothing to address the underlying problem of escalating health care costs.

Regardless, the plan makes it a "no brainer" for medium and large businesses to delete their group insurance plans:

"Businesses that don’t provide that minimum level of coverage would be required to pay the federal government a fee based on 8 percent of their payroll. Small businesses under a yet-to-be-determined threshold would be exempted from that “play or pay” requirement."

Eight percent? What percentage of payroll is taken up by insurance premiums now? At least 8%, I daresay. Again, the Public Plan becomes the only economically viable alternative for these employers.

As for "small businesses," who knows? My guess is that they'll take a page from their "big brother" counterparts and send their employees to the Public trough, as well. Why even hassle with the group plan, when it's likely that that exemption will be fleeting anyway?

Still doubt that the Public Plan is the endgame? Maybe this will change your mind:

"Americans who refuse to buy affordable medical coverage could be hit with fines of more than $1,000 under a health care overhaul bill unveiled Thursday."

Of course, no one's yet defined "affordable," but that kind of thinking has no place in the hallowed halls of the legislature. A thousand dollar hit is roughly $83 a month, a nice chunk towards paying for that "affordable" health insurance policy. So, faced with that kind of hit, how many folks will say "okay, I get it, I'm on board with the Public Plan."

Thought so.

The pro-national-health-plan folks would also have us believe that this Public Plan would have significantly lower admin costs, modeled as it is after Medicare. They claim that Medicare admin costs are a paltry 3%, compared to upwards of 20% for insurers.

But are these numbers accurate?

According to Tom Bevan at Real Clear Politics, the answer is a resounding (and provable) "no!" He took a look behind the figures, and found some disquieting information:

"The statistic cited by [its claimants] uses administrative costs calculated as a percentage of total health care costs (For Medicare it's roughly 3 percent and for private insurers it's roughly 12 percent)." [emphasis in original]

Because Medicare is geared toward an elderly demographic, with correspondingly large claims costs, "it generates significantly higher expenditures than private insurance plans, thus making administrative costs smaller as a percentage of total costs. This creates the appearance that Medicare is a model of administrative efficiency. What [its claimants see] as a "miracle" is really just a statistical sleight of hand."

Ooops.

Mr Bevan also points out that a substantial percentage of private insurer's overhead can be laid directly at the feet of state premium taxes. Absent those, the numbers become less differentiated.

But it gets worse:

"(W)hen you compare administrative costs on a per-person basis, Medicare is dramatically less efficient than private insurance plans." He even links to a Heritage Foundation study comparing admin costs for both MC and insurers, which demonstrates that these costs are almost 50% higher for MC than private insurers.

That sound you hear is the hissing of "gummint is more efficient than the private sector" balloons as they rapidly deflate.

Michael Jackson's Prescription Drug History

If you are looking to buy Aetna health insurance, you don't have to be Michael Jackson to justify a look into your prescription drug history.

Reports are circulating that the King of Pop's death has caused the DEA to take a look into his prescription drug activity.

The L.A. County Coroner's Office confiscated a number of controlled substances from Jackson's rented Holmby Hills mansion Monday as part of the ongoing LAPD case. The DEA's diversion control program, which also assisted in various investigations related to the death of Anna Nicole Smith, regulates controlled pharmaceuticals.

California Attorney General Jerry Brown tells the L.A. Times that the Bureau of Narcotic Enforcement has also come onboard and will be utilizing the state's Controlled Sub-utilization and Evaluation System (CURES) to examine the prescription-drug aspect of the case.

Narcotics are highly regulated and tracked. This is much more than the old days when parents only had to sign a book at the pharmacy before they could purchase paregoric to sooth the pain of a teething baby.

The database, also used in the Smith case, holds the name of every doctor authorized to prescripe medication in the state, as well as a record of all prescriptions.

"If it's about doctors, drugs and patients or anything that touches that, it's in our database," Brown said. "We've been in touch with the LAPD and I've talked to Chief [William J.] Bratton."

Having access to prescription drug histories is not just for celebrities, nor is it limited to narcotics. Health insurance companies have access to similar information and routinely use it when you apply for health insurance. Medications play a key role in treatment, so this is a natural resource.

Health insurance carriers like Aetna, Blue Cross, Humana, United Healthcare, Cigna and more will check your application against a prescription drug database. They want to know what you have been treated for in the last few years so they can develop a complete medical history.

These health insurance companies have immediate access to your prescriptions by subscribing to services like Ingenix and IntelliScripts. In seconds a 3 - 5 year drug history can be reviewed and cross referenced against your application.

You don't have to be famous to have your prescription drug history laid bare. All that is necessary is for you to apply for health insurance and your prescription drug file is opened and reviewed.

What Do You Say to a Naked Man?

Beware the naked man in the seat next to you. He might be a deviant, he might be proud of what he has, or he could be bipolar.

Keith Wright, 50, of the Bronx in New York, was taken into custody by airport authorities after he disrobed while sitting in his seat in the back of Flight 705 on Tuesday evening, authorities said. The plane was carrying about 148 passengers from Charlotte to Los Angeles, the airline said.

Wright was unresponsive when a flight attendant asked him to put his clothes back on, said Dan Jiron, a spokesman for the Albuquerque airport. "She asked him on more than one occasion to put on his clothes. She covered him with a blanket and he took that off," Jiron said.

Or maybe he was hot.

Temperature, not hot like a stud.

Wright told the FBI he is suffering from a bipolar disorder and had not taken his prescribed medication before leaving New York that morning

Oh, yeah. The old "I forgot to take my medicine" routine.

As the plane took off again, Keegan said the usual announcement to please fasten your seat belts came over the loudspeakers with a twist. The message included "a reminder to everybody to please keep your clothing on.

To be sure . . .

Oy Canada: Doc's Bailing, NICU's Missing

Even as we rush towards a similar model, it may be instructive to see how well nationalized health care's actually working out for our Neighbors to the North©. While in Chicago earlier this week (for our daughter's college orientation), my wife and I overheard a Quebecois gentleman, in the Windy City on business, telling his associates about health care, Canadian style. I was able to take some notes, which I'll share with you.

When asked about Canadian health care, he responded "when you can get it, it's pretty good." He went on to say that "if you can afford it, the best doctors are available." I didn't quite understand this at the time, since Canadian health care is, after all, "free." As you'll see in a moment, this isn't really true.

He followed up by observing that you "take what you get;" again leaving me puzzled: haven't we been told, ad nauseum, that health care is readily available Up North? And again, I later learned the bitter truth.

In his very next breath, he admitted that "care in Canada is not as good as what you get in the US." I should point out that he said he was from a city "100 kilometers from Quebec."

So what, exactly, is the truth here? Is he simply a dissatisfied Canuck, or does his opinion reflect reality?

You be the judge.

Is quality health care truly available in Canada? Well, it depends on where in Canada you live. The gummint-run health system is administered at the provincial level (as ours is regulated, for the most part, at the state level), so quality and accessibility of care can vary greatly. While critics of our system point to Canada as a role model, perhaps the tragedy of little Ava Stinson can serve as a useful rebuttal:

"A critically-ill premature-born baby from Hamilton is all alone in a Buffalo, N.Y., hospital after she was turned away for treatment at local facility and transferred across the border without her parents, who don’t have passports."

Turns out, there were no (as in: zero, nada, zilch) Neonatal Intensive Care Units available in the whole of Quebec.

Not. A. One.

So of course, they headed south (as have so many others before them), in order to save their baby's life. Thankfully, medics at Buffalo's (mmm, wings!) St. Joseph's Hospital will apparently be able to help, thanks to American medical technology and care. In fact, a (very) quick Google search revealed four NICU facilities in Buffalo alone.

Would it be presumptuous to ask the national health care proponents why they hate Canadians?

But certainly good quality care is available to all?

Not so much:

"Private for-profit clinics are a booming business in Canada ... Facing long waits and substandard care, private clinics are proving that Canadians are willing to pay for treatment."

As we've repeatedly pointed out, one of the problems with our own national health care system, aka Medicare, is that there are a lot of doc's who shun MC patients, and the concomitant reduced reimbursement rates. Looks like that particular virus has spread North; more and more Canadian physicians are opting out of the government-run system and (back?) into private pay, private practice. That was apparently what our Quebecois businessman meant.

Does this all sound familiar?

It should: the Canadian government does, indeed, spend less on health care for its citizens, proving the old adage about getting what one pays for.