Sunday, September 30, 2007
Saturday, September 29, 2007
I received a phone call last week from a young man with a difficult problem. I’m wondering if one of the IB readers can think of a solution.
He was working for a 50+ person company that had a self-funded plan through a large carrier. The company was having financial problems and had notified the employees that the plan would terminate as of July 31, 2007. Because of this, he enrolled on his wife’s medical plan effective August 1. On July 14, the employee was involved in a serious bicycle accident, spent five days in the hospital and incurred in medical expenses in excess of $100K.
In early August, a bank seized the assets of the company…they were obviously in default on some agreement…and sold them to a third party. This has left no money to pay the medical bills.Who’s going to pay the hospital and the doctors? There's nothing left of the company to pay anything. The health insurance carrier? They issued the Certificate off Credible Coverage showing a July 31 date termination date. It's not unreasonable to assume that a document showing a July 31 coverage end date actually means that the coverage is in effect through July 31. The company's General Liability policy? Assuming, that is, that it had employee benefit coverage. If not, would their P/C broker's E&O policy come into play? How about the Directors and Officers insurance policy? A strong argument could be made that a self-funded plan is unsuitable for a financially troubled company. The corporate officers must have known the company’s financial position...especially if the company was in (or close to) a default position on a loan. And lastly, what about the health insurance broker’s E&O policy? If the broker was aware of the company financial position and failed to recommend a change to a fully insured plan, does he (or she) share responsibility?
Beats me…I referred him to a good plaintiff attorney who works in this area. All I know for sure is that a client’s friend is lying sleepless at night, worried he’s going to lose his house.
Friday, September 28, 2007
I have known him for probably 30 years.
We used to meet for lunch on a regular basis. It has been a while since we did that.
One day I was driving in my car, listening to the radio. Normally I don't listen to commercials but this one caught my attention.
The voice on the radio sounded familiar.
The announcer was talking about a fund raiser for Cystic Fibrosis. At the end of the message the announcer gave his name. He told the audience he knows all about C.F. because his son lives with the disease every day.
The next day I called Carol, the guy on the radio. We agreed to meet for lunch. He shared his story about Adam, and his illness.
When he and his wife were told their son had the disease it meant nothing to them. They had never heard of C.F. and had no idea what it meant.
Then the doctor told them if he was lucky he might live to be a teenager.
That was 25 years ago.
When Carol called this week after getting through the small talk and catching up, I asked how his family was doing. Every time we talk, which is way too infrequent, I am always hesitant to ask about Adam.
He told me what was going on with his wife, his daughter, then he paused. He said, you remember Adam don't you?
I said I did.
He said Adam is working for an architectural firm and loves his work.
So, how old is Adam?, I asked.
Adam is 29.
Adam has done well. A few years ago he got on a new drug that breaks up the congestion in his chest. Now, instead of 5 or 6 visits a year to the hospital for 2 week stays he only goes twice a year and is usually discharged in about a week.
The medicine Adam takes is $1500 per month.
Living with C.F. is expensive. The various meds he takes run in excess of $2,000 per month.
Adam is a miracle. A young man who has already lived twice as long as expected.
When you tuck your children in tonight, say a prayer of thanks for their good health. I know Adam's parents do the same even though he is too big to be tucked in.
Had it not been for a federal health insurance program tailored for working families such as hers - ones lacking the income to purchase private health insurance - Frost is certain that she and her husband would be buried under a mound of unpaid medical bills.
The federal program referred to is SCHIP.
More than 100,000 Maryland children are covered under the federal program, according to state health officials. They estimate that the program will require an infusion of roughly $160 million in federal funds over the next five years - with the state also contributing dollars of its own - to continue providing coverage to those families.
Of course only the wealthy pay taxes.
The Frost family has a combined annual income of about $45,000, said Bonnie Frost. She and her husband have priced private health insurance, but they say it would cost them more per month than their mortgage - about $1,200 a month. Neither parent has health insurance through work.
$1200 per month for a family of 6 in Baltimore. Really? What are they smoking?
A check of a quote engine for zip code 21250 (Baltimore) finds a plan for $641 with a $0 deductible and $20 doc copays.
Adding a deductible of $750 (does not apply to doc visits) drops the premium to $452. That's almost a third of the price quoted in the article. Doesn't anyone bother to check the facts?
UPDATE: The article linked at the top of this post has apparently been pulled by the BS, er, Baltimore Sun. An alternate version, with essentially the same info, is here.
Problems include the following.
No one ever wants to admit it will require a tax increase.
No one really has a handle on how much it will cost.
And here is a biggie. No one wants to address how their plan will handle medical inflation.
Someone on the left coast is calling their hand on this. Ken Terry at the S. F. Chronicle is spot on in his analysis.
Even with the average spread of risk found among federal workers, FEHBP rates are increasing as fast as those of private plans outside the program.
Similarly, Medicare costs have been growing almost as quickly as private insurance rates for decades, when you compare benefits that are common to public and private plans. So expanding the FEHBP and adding a Medicare-like plan won't do much to control cost growth.
So all you are doing by moving folks from the private sector to the public sector is swapping one "gas guzzler" for another.
Clinton suggests other methods to curb spending. She'd require the coverage of preventive care, encourage chronic disease management, reward doctors for improving the quality of care, and kick-start the national adoption of health information technology with $3 billion in government grants. She cites an estimate that widespread use of electronic health records could eventually save $77 billion per year. But she and her advisers seriously underestimate the cost and time that will be required to get interconnected EHRs into all hospitals and doctors' offices; in fact, the RAND study she mentions assumes it would take 15 years to fully implement a national information network. Similarly, preventive care and disease management are fine ideas, but they cost money and won't save substantial amounts for years to come. And the fragmentation of our health care system will inhibit all of these initiatives. So Clinton's claim that they can save the federal government $35 billion a year right off the bat is speculative, at best.
Speculative. That's a good word.
So is ludicrous.
None of the presidential candidates - Clinton included - wants to face the fact that we can't provide comprehensive, universal health care until we find a way to control costs.
Neither the press nor the public is asking the hard questions.
Thursday, September 27, 2007
Now you can fight back and pocket some green.
The generic form of Lamisil is Terbinafine. So how much for a 30 day supply of the generic med?
$48.99 at Drugstore.
$20.63 at Costco.
Now Wal-Mart is adding Terbinafine to its' list of $4 generics.
That is a 6 year supply of generic vs. a 30 day supply of Lamisil.
P. T. Barnum said it best.
As long as you agree to receive treatment in India.
American health insurance firms, particularly from the US are offering their customers a carrot: If you’re unwell, you've got two options. Either you pay the regular premium and get admitted to a hospital in your country of residence.
Alternatively, you choose to go to India for treatment; in return for which you get a hefty 30-40% discount on the annual premium you pay.
That's a major difference.
Hospitals in India usually charge around $6,000-8,000 for coronary bypass surgery, $6,500 for a joint replacement and $6,500 for a hip resurfacing, which represent a small fraction of the typical costs at US hospitals. "India is not just known for its outsourced back-office skills any more, like reading of X-rays, medical transcription or billing. It's the actual clinical care that is now being outsourced," says Bali.
How far will this trend go?
Wednesday, September 26, 2007
Perhaps you want your Pastoral counseling to be a covered item, or your Naturopath needs some extra business.
Maybe you want your exam for STD's to be covered. After all, that is a procedure that could cost as much as $100 if your insurance doesn't pay for it.
Need a hair prosthesis? Ask your insurance carrier to pay for it. You might live in one of the 9 states where it is required.
What about Port Wine stain removal? Only 2 states require that coverage.
You can view a comprehensive list with the approximate added cost to health insurance premiums by clicking here.
I have arrived at this conclusion by carefully analyzing comments and responses of prospective clients who come to me looking for individual health insurance. This is not a scientific poll by any stretch, but I still believe it has some level of statistical accuracy.
A case in point.
Yesterday I was contacted by a man who is being downsized . . . so to speak. His job is going away in a few months and he is looking for health insurance. He is 55 years old, highly skilled, with a wife and one child still at home.
Finding a job is going to be tough.
Finding health insurance even tougher.
COBRA will be available but only for 18 months. Covering his family will run around $1300 per month and $400 just for him.
He is 6' 5" and tall and weighs 265.
He also has lost 50 pounds in the last 12 months.
He is on meds for hypertension, cholesterol, depression and RLS.
He is uninsurable.
When I told him of the issues he proceeded to tell me how "my industry" has failed the American public and that is why I will be out of a job in a few years. The government is going to take over my business and I will be out of work.
Sounds to me like the government has conspired to make people fat in order to put me out of work.
Rather than argue with him I suggested he keep my number. If he wants my help he can call, or he can wait on the government to lay me off when they provide health insurance to everyone regardless of their medical condition or ability to pay.
Sure, no problem. When you call just ask for the blue man. I am the one holding my breath while waiting on people to start acting like an adult and taking responsibility for their own actions.
Tuesday, September 25, 2007
Monday, September 24, 2007
Get rid of employer-sponsored health care and let workers buy their insurance on their own. Think it's too expensive? It wouldn't be, if we got rid of the miles of red tape that regulate insurance.
The first regulations we need to go after are the 1,901 state-level mandates dictating what health insurance policies must cover.
Why do we have state mandated benefits?
Because politicians need something to justify their reason for holding a position in the state house or senate I suppose.
The interesting thing about Ms. Pipes editorial? She refers to 1,901 mandates.
A report from 2005 by the NCPA lists 1,823 mandates.
Have we really added 78 mandates in two years time?
What are some examples?
According to Ms. Pipes they include:
In Massachusetts, for example, every insurance policy must cover in vitro fertilization, even if you're a 25-year-old male, or a nun. In California, there are 46 such mandates, which drive up the cost of insurance for everyone.
IVF for males & nun's. Yeah, that's got to be a high demand benefit.
Whether the count is 1,901 or 1,823 I think it is evident someone needs to get in touch with reality.
Sunday, September 23, 2007
Now Athenahealth seems bent on doing likewise by developing a kind of smart EMR for physician practices.
Unlike most physician practice software, Athenahealth is different. Their web-based software is designed to help docs increase their collection rate from carrier reimbursement. A testimonial from their website reveals the following.
The practice’s collections have increased an impressive 27% since going live on athenaNet®. As for days in AR, the number has dropped more than 20 days since the practice first went live. In 2003, the days in AR were 45.6 and now that average is 25.3.
“Two years ago, the physicians here were borrowing money trying to keep the practice open. Today, the practice is transformed. Money is stable and everyone is happier,” said administrator Shari Reynolds.
Of course the AR problem could all but be eliminated if providers, particularly those in primary care, would eliminate the practice of billing carriers for routine office visits and require payment at time of service.
Friday, September 21, 2007
Thursday, September 20, 2007
Wednesday, September 19, 2007
Seems Madame Hillary is further refining her stance on the government role in health insurance.
She said she could envision a day when "you have to show proof to your employer that you're insured as a part of the job interview:
"Your resume' is impressive, and you certainly meet the qualifications we need for this position. However, there is one thing keeping us from making you an offer. You don't have proof of health insurance."
One the one hand, I agree with this stance. (Agree with Hillary? Are you ill?)
In some positions you need proof of citizenship. Almost every hiring situation requires some form of picture ID such as a drivers license, and you must show your Social Security card.
Some jobs require you not only to have a valid drivers license but proof of (auto) insurance as well.
In my position I must show I am licensed by the state and that I have E&O insurance.
So why not proof of health insurance?
Foreign nationals here on visa's must show proof of insurance. Why not citizens?
Some say she is stepping on our rights as citizens. Perhaps so. But aren't those who go without insurance and skip out on paying for their health care also infringing on MY rights?
Is Madame Hillary actually right on this issue? Or is she just saying things to warm the heart of a right wing conspirator?
Tuesday, September 18, 2007
Monday, September 17, 2007
In case you don't recall, Sen. Ted Stevens of Alaska threatened to resign from the Senate if appropriations totaling $453M for two Alaska bridges were cut. Approximately half that amount ($223M) was slated to build a bridge from the town of Ketchikan (population 8900) to the airport on the island of Gravina (population 50).
It seems the ferry that is currently used has long waits of 15 - 30 minutes and cost's $6.
The bridge, if built, would be longer than the San Francisco Golden Gate bridge and would be funded by taxpayers.
Apparently the folks in Washington think money is made of paper and there is no reason why they should be held accountable for the way they spend OUR dollars.
Now comes Madame Hillary and her proposal to provide health care for the 47M who are currently without insurance.
"This is not government-run," Clinton said of her plan to extend coverage to an estimated 47 million Americans who now go without.
Not government run, said she.
Perhaps hoping to quell the wrath of insurance carriers.
Nice of her to be inclusive.
She called for a requirement for businesses to obtain insurance for employees, and said the wealthy should pay higher taxes to help defray the cost for those less able to pay for it.
Sure. Make business owners and the wealthy pay for it.
Of course we know (even if she doesn't) that businesses don't pay taxes.
Wonder how she defines wealthy?
How much will it cost you ask?
She put the government's cost at $110 billion a year.
The government's cost.
But the government doesn't have any money.
She must mean the TAXPAYER's cost.
Let's see. $110B to cover 47M uninsured.
That works out to about $2340 per year.
For health care.
For everyone who is not insured now.
Who is she kidding?
Oh yeah. Since the tax will come from the wealthy, the majority of voters will assume that does not include them, so why bother running the numbers?
Sounds like the health plan to nowhere if you ask me.
Sunday, September 16, 2007
During those 30 years, I had a broken arm, a broken jaw, a badly injured shoulder, and miscellaneous other medical problems. To say that my income was below average during those years would be a euphemism.
How did I manage? The same way everybody else managed: I went to doctors and I paid them directly, instead of paying indirectly through taxes.
Paying providers out of pocket. What a novel idea.
(Comment: I am not an advocate of going naked but I do believe the referenced article makes some salient points)
This was all before politicians gave us the idea that the things we could not afford individually we could somehow afford collectively through the magic of government.
Sounds like a vast left wing conspiracy.
When my jaw was broken, I was treated in an emergency room and was given a bill for $50 -- which was like a king's ransom to me at the time, 1949. But I paid it off in installments over a period of months.
Personal responsibility and accountability. Sounds like an adult kind of thing.
Some hospitals -- whether public or private -- could absorb such costs, with the help of donors. There were people with polio living in iron lungs, which is why rich and poor alike gave money to the March of Dimes.
But that is very different from hospitals being stiffed every day by emergency room users whose only emergency is that they want to keep their money to spend on fun, instead of on doctors.
Spending money on fun rather than on health care (or health insurance).
Bling or health insurance. Tough choice.
The biggest of the big lies in the "health care" hype is that a lack of insurance means a lack of medical care. The second biggest lie is that health care and medical care are the same thing.
Must be a regular reader of InsureBlog.
Few people show the slightest interest in what has actually happened in countries with government-controlled medical care.
We are apparently supposed to follow those countries' example without asking about the months that people in those countries spend on waiting lists for medical treatments that Americans get just by picking up a phone and making an appointment.
It is amazing how many people seem uninterested in such things as why so many doctors in Britain are from Third World countries with lower medical standards -- or why people from Canada come to the United States for medical treatment that they could get cheaper at home.
Don't confuse them with facts. Their mind is already made up.
Besides, we have the government to take care of us . . .
Howard Rocket bought disability insurance when he started practising as a dentist in 1972.
But he let his policy lapse in 1986, when he left dentistry to start a public company, Tridont Health Care Inc.
"I was drawing about $30,000 a month from the business," he says. "So why did I need insurance? I had money and I could self-insure."
Certainly a rational thought.
However, there is nothing rational about sudden illness, accidents or economic set backs.
Tridont went bust in 1990, but Rocket kept a career as an entrepreneur. In 1995, while playing touch football with friends, he fell and landed on his neck.
Six weeks later, he had a massive stroke. He was in rehabilitation for years and still hasn't completely recovered.
"I paid about $1 million in hard costs – things like wheelchairs, canes, drivers, physiotherapy, occupational therapy, massage, chiropractic therapy and acupuncture," he says.
This is why self insuring is a foolish wager.
"To me, self-insurance is net-worth reduction. And insurance is net-worth protection."
Couldn't have said it better myself.
Anthem, AKA Blue Cross of Indiana, is the winner of Indiana's booby prize.
Officials expect that the 44 cents per pack increase in the cigarette tax that took effect July 1 - to 99.5 cents - will raise enough money to provide health insurance to more than 100,000 low-income Hoosiers and fund other health initiatives.
Some have a problem with so-called sin taxes.
I am not one of them as long as the money is used as outlined.
I also prefer the term stupid tax over sin tax. I feel it is much more fitting.
The program approved by legislators this spring calls for the state to provide subsidized health care to adults who earn too much to qualify for Medicaid but less than twice the federal poverty level - $41,300 for a family of four. Children can receive other government-subsidized health care.
Sounds like a plan to me.
The state estimates as many as 367,000 Indiana adults qualify for the subsidized coverage, but the legislation provides funding for only an estimated 140,000, so enrollment will be on a first-come, first-served basis.
Rationed health insurance from the government. Where have we seen that before?
Annual deductibles for the plan are not exceed 5 percent of household income, up to $1,100 a year.
I am sure there will be cries of foul over this one.
Still, it is a start in the right direction.
Saturday, September 15, 2007
Reform? What kind of reform?
universal insurance coverage, coordinated care, value and payment reform.
OK, let's see what they propose.
Keep in mind, the Mayo clinic is the supply side of the economic equation. They don't have to worry about how to fund the changes.
Provide health insurance and access to basic health care for all Americans -- regardless of their ability to pay.
Health insurance (and basic care) regardless of ability to pay. How do they propose this will be handled?
Move from employer-based insurance to portable, individual-based coverage. Employers could still help finance a portion of their workers' health care expenses and should be encouraged to promote employee wellness.
Portable individual insurance. I'm all for it.
Employers can finance a portion of the cost. Of course we all know that employers don't finance anything.
Employee wellness has been tried for years with almost no success. More recently employers have switched from the carrot to the stick and are now getting the attention of their workers. When smokers, those who are obese or have preventable medical conditions (HTN and Type II diabetes for example) are charged extra premiums, only then are lifestyle changes implemented.
Create a simple mechanism (similar to the Federal Employees Health Benefit Plan) to offer private insurance packages to buyers.
The Federal Employees Health Benefit Plan is a self funded MEWA. Will someone tell me what this plan does to control health care inflation?
Require individual ownership of health insurance, with sliding-scale subsidies for people with lower incomes.
Low income people already have access to free or subsidized care.
Appoint an independent health board (similar to the Federal Reserve) to define essential health care services. Allow people to purchase more services or insurance, if desired.
Why do we need a governmental body to define "essential health care"? Is the general population really that ignorant?
Patient care services must be coordinated across people, functions, activities,
sites and time in order to increase value. Patients must be active participants
in this process.
Coordinated patient care. I believe case managers already do this.
Realign the health system toward improving health rather than treating disease.
Nice idea, and it can be handled with more free or sliding scale clinics (such as Minute Clinic).
This is well and good, but until we find a way to tame the XXL generation all the clinics in the world are not going to do much good.
Increase quality and patient satisfaction. Decrease medical errors, costs
This sounds more like fluff than anything.
Reward consumers for choosing high-quality health plans and providers
Rewards? You mean like air miles and trips to exotic places?
Consumers have access to more information than ever before on health care and ways to finance the cost of their care. Yet they are overwhelmingly lazy in taking advantage of information that is literally at their finger tips.
We have a society of quick-fixes. Instant food from package to microwave to table in under 5 minutes. Instant cash from an ATM 24/7. We demand quick results from our health care providers in the form of a pill and shy away from lifestyle changes that could be much more beneficial than introducing more chemicals into our bodies.
Change the way providers are paid in order to improve health and minimize waste
As in an all cash system like we once had?
Design payment systems to provide patients with no less than the care they need and no more than fully informed, cost-conscious patients would want.
That would be cash.
Pay providers based on value.
Further develop and test models of payment based on chronic care coordination, shared decision-making and mini-capitation (i.e., one bundled fee for the physicians and hospital delivering acute care).
Capitated fee structures already exist for many routine procedures such as normal delivery. I doubt it will work that well on chronic situations.
"Well Mr. Jones, it seems you have hit your limit on insulin for this month. Come back in two weeks when the new month begins and we will start you up again."
Yeah, that works.
Friday, September 14, 2007
As they say: Check your local listings.
Received little in return.
Who buys an insurance policy hoping for a return? Where does this kind of mentality originate?
But making a combined salary of $90,000 from their dog-training school, "we were in this pocket where we made too much to get assistance but couldn't afford a good plan," says Babette, 39.
$90,000 disqualifies them for public (taxpayer funded) assistance.
Wow. Who woulda thunk?
So in 2002 the couple decided to drop their policy and go off the health insurance grid.
Wonder what kind of return they will get on money they did not spend on premiums?
It seemed like a reasonable gamble at the time: Pay out of pocket and maybe spend less than premiums and co-pays combined. For a while it worked too.
When Babette became pregnant with their second child in 2004, she negotiated with her doctor for delivery costs - and spent $2,000 less than insurance would have charged in premiums alone.
So far it looks like they gambled and won.
But everyone knows the customer rarely wins.
The only way to "win" (get back more than you pay in) with an insurance policy is to suffer a major loss. What kind of logic is that?
Then baby Sarah was diagnosed with Leber's amaurosis, a congenital eye disease that leaves her legally blind. Over the next few years, the doctors say, she'll require about $1,500 a year in ongoing care, a test that will cost $20,000 and possibly surgery costing $5,000 or more.
With Sarah's pre-existing condition, the Brennans feel like they won't get an affordable insurance policy at this point. Yet with little savings, they face the prospect of borrowing money from family to pay for Sarah's care or getting a corporate job just for the benefits.
Sounds like they gambled and lost.
I bet they wish they had done things differently.
Thursday, September 13, 2007
I just talked with a lady visiting in the states from Australia. Her husband is here as part of an exchange program with the University of Georgia.
They are here legally.
He has a J-1 visa, she and their daughter have J-2 visa's.
They are looking for health insurance.
They have been here long enough to satisfy the residency requirements. They were covered under an employer plan but that is going away the end of this month so they contacted me.
It seems that the U.S. State Department has certain requirements for folks here on a visa. Among those being, they must have health insurance.
Not only must they have health insurance, but the deductible can be no greater than $500. The maximum benefit per accident or illness can be capped at $50,000.
Wow. That's the government for you.
We don't want you to have more than $500 in deductibles but you can stiff the docs & hospital if your bill runs over $50,000.
What kind of stupidity is that?
Want to know the real kick in the butt?
Foreign nationals here legally must have proof of insurance.
U.S. citizens are free to go without coverage with impunity (other than running the risk of losing their home, car & wages).
Who thought up that rule?
The folks in Washington.
Wednesday, September 12, 2007
The only reasonable response is "And so?"
In the very same edition of USAToday, we find that housing costs (which include ever-increasing property taxes) easily eclipse even health insurance, while the price of gasoline continues to climb to Olympian levels, as well.
What do these things all have in common (other than the obvious)?
Things cost more to buy.
It's called economics, and it's not that complicated: prices for goods and services rise to meet demand, and some things are more in demand than others.
And so, to borrow a line of thought from Mike, how come we don't see a push for nationalizing mortgage brokers? Or gas stations?
It's kind of frustrating that, according to USAToday, health insurance premiums rose a measly 6.1% last year, but that's not good enough: that increase was higher than the rate of inflation. But that really tells us very little: as noted above, the cost of a lot of things we need and use increased at a higher rate. What's critical, and missing from the article, is the rate of medical inflation. After all, the increasing cost of providing care drives the cost of financing it.
The other salient fact which jumps out in that story is this 'throw away:' a business owner, by simply adding a modest deductible, saw his rates climb a paltry 5%, two years running. That in itself is remarkable, but he also added an HRA (Health Reimbursement Arrangement) to mitigate his employees' increased exposure. The best part? "So far, not very many of his workers have needed to take him up on the offer."
Now what does that tell us?
Well, for one thing, the owner has a wise and competent agent, who helped him to see how a simple rearrangement of benefits could help his own, and his employees', bottom line. But the other, perhaps more important message is that a lot of folks pay for insurance that they don't even use.
Unfortunately, according to the Kaiser Foundation study on which the article's based, the number of insured employees who've enrolled in higher deductible plans hasn't grown much, which is a shame.
Just think how much lower rates would be if they did.
You may be wondering about that photo. Every week, my better half bakes two special loaves of bread, called challah; one for our family, and one for another, older couple who are among our dearest friends. It is traditional to bake a special challah for Rosh HaShannah; it's the same basic recipe, but the bread is braided into round loaves, and topped with a sprinkling of sugar (for a sweet new year).
Those two pictured above came out of our oven just a few minutes ago (and boy, do I wish we had pod-smelling technology!). What a delightful, special, and meaningful way to usher in the New Year.
This season is also a time to thank those who have been helpful, indeed inspirational to us through the past year. And so I especially thank our readers, and my esteemed co-bloggers: Bob Vineyard, Bill Halper and Mike Feehan.
May your New Year be filled with joy, health, prosperity and peace.
Tuesday, September 11, 2007
“Over 20,000 Georgians visited the emergency room last year with dental problems,” said Cagle. “The top condition treated in Georgia’s emergency rooms last year was an upper respiratory infection — mainly just a cold.” Treating that cold at a doctor’s office could cost $100; at the emergency room, $1,400. Non-emergencies added $33 million to emergency room expenses last year.
Who goes to the ER for a cold?
Apparently quite a few.
create something he calls Safety Net Clinics for indigents, something similar to the clinics for paying patients now being added by chains such as Walgreens, Publix and CVS, which has 224 MinuteClinics across the nation and is opening 28 in the metro area.
This is an idea from a politician I can actually applaud.
The next step, then, is to increase affordability, by allowing consumers to shop for policies across state lines, free of mandates interest-groups have coerced state legislatures into adding on.
I have never understood this thought process. Policies in NY are higher than those in GA for a reason. When yankees start buying policies in Georgia and carting them back home where medical costs are higher do you think the carriers might catch on and reprice those products?
This is not like those who trek to NC to buy cigarettes and take them back home.
At least he made a good start.
That was it. A name, a face, a place.
Monday, September 10, 2007
State sponsored health care pitched at Fenway. What a novel idea.
The state will help you pay if you cant afford it. And the state has worked with a handful of insurance companies to offer several low cost policies that are much cheaper (family plan with drug coverage, $662 per month) than what the rest of us could buy on the open market, where the average price is $11,000.
The state will help you pay. Isn't that special.
Whose money are they using?
Lower cost policies.
Any guess how that 30%+ reduction is achieved?
It was hilarious to watch that stream of raving Red Sox fans juggling cheese dogs, tankers of beer-- and flyers for health insurance.
One has to wonder how much they pay for hot dogs & beer at Fenway. My daughter took me to see a Braves game for my birthday a week ago. That outing costs $10 for the seats, $6 to ride MARTA, $7 for a beer and $10 for the hot dog "meal".
And the tickets were discounted.
We had fun and it is something I hope to repeat next year. I wonder if I could set up a booth hawking health insurance in the stadium?
Sure, it is not a much fun as quaffing a cold brew on a hot day but you gotta admit, it is different.
Reducing the number of uninsured. Truly a noble gesture.
Two of the plans, proposed by the Colorado State Association for Health Underwriters and the Committee for Colorado Health Solutions, would require all state residents to obtain health insurance.
Mandated coverage. Great!
Under the plans, the state would provide subsidies to residents who cannot afford to obtain health insurance
Subsidies for the poor. Outstanding!
Of course we already know who is doing the subsidizing. It is the taxpayer. Rob from those who are financially successful and redistribute their wealth to the poor.
The report found that the SEIU plan would insure 40% of the current uninsured population, mostly through a new limited-benefit plan that would be offered by private insurers
Limited benefit plans.
Like putting a Bandaid on a severed artery.
Sounds like Charles Dickens Mr. Bumble is alive and well.
Sunday, September 09, 2007
Regarding insurance agent commissions, we reported in the story that Blue Cross paid out $15 million in sales commissions last year, or 3 percent of the entire premium dollar collected from customers.
Three percent? Wow! No wonder he was chaffed.
Wonder how much the state of Montana makes?
Insurance companies in Montana now do more than $2 billion worth of business every year. The insurance department collects more than $40 million dollars every year for the state government through submittal of fees and premium taxes.
My calculator says 2% commission.
And what does the state do to earn their commission?
So that's 3% to be active in the sales & service of the accounts and 2% to do nothing.
But back to the topic at hand . . .
Blue Cross won't reveal the amounts paid to top agents, but did confirm it has about 120 agents selling its policies.
Out of 24,000 agents in Montana, only 120 sell coverage for Blue.
That's a stretch.
Sources familiar with the company also told the Gazette State Bureau that as much as 80 percent of commissions goes to about half the agents, who are the top sellers in the state.
And your point is?
Seems to me that Mike Dennison has a case of paycheck envy.
Saturday, September 08, 2007
The results have not been pretty.
In a report commissioned by AHIP and numbers crunched by Milliman, the financial outcome of legislation designed to make health care more accessible is a disaster.
In 1994 the Kentucky legislature adopted rules requiring carriers to offer guaranteed issue individual medical insurance plans and institute community rating.
(Guaranteed issue means policies are issued to anyone who applies regardless of their current health.
Community rating is a formula whereby everyone within a specific geographic area pays the same rate regardless of health. Carriers may, in some situations, charge different rates based on age or gender but may not charge more to someone at deaths door than they would someone in perfect health.)
The result was an almost immediate exodus of 40 carriers from the individual market in Kentucky.
In 1998 community rating was repealed. In 2000 guaranteed issue was repealed.
In 1994 New Hampshire adopted guaranteed issue and a modified community rating model. Prior to the legislation about a dozen companies offered individual major medical. Only one carrier entered the market in NH after the legislation. In 1997 they exited the market due to heavy losses.
By 2000 only two carriers domiciled outside of NH were still in the market.
In 2002 both the guaranteed issue and modified community rating rules were repealed.
Since the repeal of these provisions the number of insured lives in the individual market has risen from 7,119 to 36,143. During this same time the average monthly premium for individual coverage has dropped from $144.34 to $141.85.
In 1993 New Jersey enacted legislation requiring guaranteed issue AND guaranteed renewal. They also required community rating and standardized plan designs.
In 1993 157,000 residents had individual health insurance. By 2006 the number had dropped to 83,000.
At this time NJ still maintains guaranteed issue and community rating requirements.
In 1992 Vermont adopted guaranteed issue and community rating.
In 1994 31,247 residents were covered by individual major medical plans at an average annual premium of $806. By 2005 this number had dropped to 9422 and an average annual premium of $2769.
This is what can happen when states go wild.