Friday, February 27, 2009
“[California] already owes another $48.2 billion in unpaid costs for retiree health and dental benefits.”
In the public sector, prime example California, these future liabilities tend not to be funded.
Suggestion from InsureBlog: if in this world of increasing pandemonium, you yearn for a brief respite of total silence - ask your town manager or mayor how much is the unfunded liability in your town employees' health plan.
Years ago, FASB decreed that all private companies disclose this unfunded health plan future liability and, in fact, reflect it as a cost on their financial statements. Not so for public entities like cities, counties, and states.
You don't think California is the only government entity with unfunded future liabilities, do you?
The unfunded future liability in Medicare is something like $60 trillion – give or take a trillion.
Just who do you think is going to pay these bills? Bernie Madoff? The tooth fairy? Your children and their children and their children?
Oh, and I can’t resist noting this additional gem:
“$11 billion in new borrowing”
See, that’s how states get out of debt these days. Ain’t it swell?
‘sfunny. It never occurred to me to borrow money to avoid indebtedness. Oh well.
All these things explain why I’m not qualified to be governor of California.
Here's another interesting twist in the new COBRA rules...the 65% subsidy starts phasing out if an individual's income is above $125,000 ($250,000 for couples) and is completely gone at the $145K ($290K) income point.
Admittedly this won't affect too many people, but let's think about how this works in practice. You get laid off. You take COBRA and pay the 35% that the plan administrator bills you. Your government pays the other 65% via the payroll tax subsidy to your ex-employer. You think that this is a great deal and add Obama to your holiday gift list.
Then you get another highly paid position and end up, at year end, with taxable income above the threshold. Guess how the subsidy gets paid back to the government...
You got it. On your tax return. Not only will you face a surprise tax bill, can you say "Underpayment penalties ??"
Thursday, February 26, 2009
Wednesday, February 25, 2009
To wage this war on health care inflation, the Spendulus Bill allocates $1.1 billion of the total $787 billion to compare the efficacy of drugs, medical devices, surgery and other ways of treating specific conditions. A total of $59 billion in the package is allocated for health care.
So what about the rest of the $59 billion? The bill allocates $20 billion to move us towards E.H.R. (electronic health records) which are supposed to save significant dollars in the big scheme of things, but even that is questionable.
So $787 billion distills down to $59 billion to tweak a portion of the economy that consumes 16% of the G.D.P.
Of that $59 billion they propose to use $1.1 billion to study the efficacy of health care treatment protocols.
Seems to be upside down in my opinion, but what do I know?
Already we are seeing fallout from the spending bill and it's impact on medications that may never reach the market. Drug giant Pfizer has pulled the plug on two drugs that are in the research stage.
The good news is, newer drugs usually cost more and may not be any more effective than current treatment protocol. Eliminating marginally effective drugs can be a good thing for your wallet.
The bad news is, if you have an orphan illness, one that afflicts only a small portion of the population, you may miss out on a new medication that might actually work.
Fibromyalgia is "a condition characterized by long-standing pain, has been the subject of controversy over its legitimacy, despite being recognized as a disease by the FDA and insurers." But fibromyalgia, once thought to be psychosomatic, only affects a relative handful of people.
There are two drugs on the market that have received F.D.A. approval for treatment of fibromyalgia . . . Lyrica and Cymbalta.
A 30 day supply of Lyrica runs $75 while a 30 day supply of Cymbalta is $125. Is one more effective than the other?
Like many illnesses, it varies by individual.
Would Esreboxetine, the Pfizer drug that is being shelved any better than Lyrica or Cymbalta?
We may never know.
Tuesday, February 24, 2009
Apologies to ole blue eyes aside, why would one of the wealthiest men in the world come to New York for surgery?
Because he can.
Saudi Crown Prince Sultan bin Abdul-Aziz flew to New York for surgery.
"This operation is the completion of medical tests and treatment his Excellency had received recently and it was ... successful,"
Details were not released.
the prince had arrived in New York for follow-up medical checks and treatment after undergoing a "prescribed convalescence" in Morocco.
Prescribed convalescence in Morroco. My guess is he doesn't have an HMO.
So why come here?
One would presume because the standard of care here is the best in the world.
Try convincing Michael Moore of that . . .
Monday, February 23, 2009
Friday, February 20, 2009
Thursday, February 19, 2009
Washington works in strange ways, if you can say it works at all. One part of the recent legislation, which no one read before voting on, provides subsidies for COBRA.
Or does it?
We found several resources that have their take on the subsidy. Of course, like anything else having to do with new rules, the devil is in the details.
Problem is, we don't have any details yet.
But here goes.
The folks at Fox Rothchild, Attorney's at law, offered this perspective.
the American Recovery and Reinvestment Act signed into law today. It is going to create some change to COBRA administration that require some attention very soon. It provides for a 65% employer paid subsidy for COBRA premiums for 9 months.
An employer paid subsidy. That's an interesting wrinkle, especially since the ex-employee normally makes the election and is responsible for paying the premium.
The subsidy applies to those who suffered an involuntary loss of coverage between September 1, 2008, through December 31, 2009. But the Act does not specify what it will consider an involuntary loss, and it also provides that all qualified beneficiaries, regardless of the reason for their qualifying event, must get the notice. Employers and plan sponsors should go back to September 1, 2008, and review records to determine everyone (including dependents) who had a qualifying event and confirm that these individuals will get notice. This can be for voluntary or involuntary termination or reduction of hours, but it also applies to those made eligible as a result of divorce, death or aging out of coverage. They may not get the subsidy, but you must be prepared to send them the notice.
This is like watching sausage being made.
You not only don't know what is going in, but what is coming out either.
The Act includes a retroactive provision that allows those who were eligible for COBRA and did not elect. It creates a window for them to now elect continuation coverage retroactive back to the first date of the qualifying event subsequent to September 1, 2008.
So what if someone bought coverage other than COBRA? Can they drop it and pick up COBRA going forward?
Or say they did nothing, but had a major claim in the interim. Can they elect COBRA retroactively and expect COBRA (and the taxpayer subsidy of course) to cover the claim?
Recognizing that now there is an added cost to reductions in force that equates to paying 65% of COBRA premiums, employers must consider this added expense when considering the cost benefit of a reduction in payroll. Not all eligible employees will elect COBRA because of the subsidy, but it can reasonably be anticipated that more will than would without the subsidy. If you are in the process of reducing the workforce, affected employees should be advised that the subsidy is available, but application of the subsidy will not be finalized until the close of the transition period.
OK, so the employer is laying off employees to save money. After the RIF, say half decide to opt for COBRA. Since this is an employer subsidy, the employer must pay their share, collect the balance from the ex-employee, and then ask the government for a refund of their share.
Or something like that.
Regardless of the mechanics, the RIF was to save money, but the COBRA SNAFU might create cash flow issues for the employer, leading to more lay offs, creating more COBRA elections, which creates more cash flow issues, leading to more . . . .
I know I am.
UPDATE (HGS): New details on this issue have come to light, including news that this may apply to smaller groups, as well. Click here.
Wednesday, February 18, 2009
Tuesday, February 17, 2009
Wouldn't it be nice to be able to forget bad memories? What if there were a pill you could take to wipe out the memory of bad things that happen in your life.
According to my wife, I don't need such a pill. She claims I already have selective memory.
And a hearing problem.
But I digress.
Dutch researchers have discovered that taking a generic beta-blocker "significantly weakened people's fearful memories of spiders."
So much for a fear of spiders, but what about other things?
The findings published in the journal Nature Neuroscience are important because the drug may offer another way to help people suffering from post-traumatic stress disorder and other problems related to bad memories.
That sounds promising.
And here is some good news as well.
Propanolol is not some new miracle drug. It is generic and available for $4 at many pharmacies.
That's cheaper than getting drunk to forget.
Monday, February 16, 2009
Roland Burris, newly appointed to the U. S. Senate to fill the vacancy of Barack Obama was repeatedly asked if Governor Rod Blagojevich had solicited donations or any form of remuneration in exchange for the appointment.
According to testimony, and news conferences, the answer was emphatically "no".
Now comes word that, while it is apparently true that Gov. Rod Blagojevich did not ask for money, his brother, Rob Blagojevich DID ask for money in the form of campaign contributions.
So if you ask the wrong questions, you will never get the answer you really want.
Same is true when shopping for insurance.
If you ask the wrong questions, you will never get the right answer.
"Are prescription drugs included in this plan?"
"You will receive a discount on medications equal to the lowest price negotiated by the carrier."
Note: Receiving a discount is not the same as covering the drugs as part of the major medical. Your discounted price for Abilify will be $450 but the carrier will never actually pay for the drug.
"Is my blood pressure medication covered under this plan?"
"There is a rider for blood pressure medication but you may still receive the discounted price"
Note: Many people will dismiss this as insignificant since many BP meds are available in generic form for $4. Most, but not all, riders exclude coverage not only for the named medical condition but anything that could be related to high blood pressure. This means, no coverage for heart attack, stroke, renal failure. However there are some riders that are not as broad and will only restrict coverage to outpatient treatment of the high blood pressure.
"Is maternity covered?"
Note: Most major medical plans issued in Georgia are required to cover complications of maternity but may not cover normal delivery. Most, but not all, plans covering females of child-bearing age require an extra premium to cover normal delivery. Most, but not all plans have waiting periods of up to 12 months before maternity is covered. And just what are complications? It varies by carrier. Even if you have maternity coverage, once the pregnancy becomes "complicated" you start a new deductible and most people do not know that.
Because they asked the wrong questions.
Sunday, February 15, 2009
Employees will be asked to pay more for health insurance if they smoke, are overweight or have other "high risk" health factors.
That could double their premiums, which would go from $25 a pay period to $50.
“It’s just a good incentive to help the members and owners of the plan to save money,” Mathews said.
Makes sense to me.
The higher premiums for employees who don’t want to participate in the wellness program were proposed by an employee benefits committee, Mathews said. He said he has not heard from any employees concerned about the proposal.
At least, not yet . . .
Friday, February 13, 2009
And neither is her doc.
It seems the good Dr. Kamrava has almost a fetish for assisting in the procreation process. He is already under fire for his handiwork with Ms. Suleman. Now we find out she is not the only woman wanting to create their own population explosion.
The woman, who has three adult children already, is around five months’ pregnant, and has been admitted to hospital where she is expected to remain until the birth, the Los Angeles Times reports. It is understood that Dr Kamrava transferred at least seven embryos, made from donor eggs, into the woman.
Let's parse this out.
The woman is 49 years old, with three adult children.
She had 7 embryos from DONATED eggs. In other words, these are not (genetically speaking) her children.
Dr Kamrava is under investigation by the American Society For Reproductive Medicine (ASRM) and the Medical Board of California after Nadya Suleman, 33, gave birth to octuplets last month . Women Miss Suleman’s age should have a maximum of two embryos implanted in the womb during a single cycle, the ASRM says.
Did the doctor lose count? Or is he just hoping the National Enquirer will come knocking?
The LA Times reports that the 49-year old expectant mother has three adult children, but wanted a baby with her new husband, who is believed to be almost 20 years her junior.
It would seem that a psychiatric evaluation is not required before undergoing this procedure.
According to Federal Records, Dr Kamrava’s West Coast IVF Clinic has one of the worst success rates of any fertility clinic in the country. Of the 61 procedures conducted in 2006, only two resulted in births — one of which was Miss Suleman's twins.
So why does this guy still have a license to practice medicine?
One other interesting tidbit about this new mommy. She was initially admitted to Good Samaritan hospital but then transferred to USC hospital.
Good Sam is a private hospital.
USC is taxpayer funded and treats patients who do not have insurance.
Thursday, February 12, 2009
Wednesday, February 11, 2009
Tuesday, February 10, 2009
"In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye."
[Hat Tip: Joe Kristan]
I hate to be negative about the Stimulus Bill and the myriad of provisions which will affect all of us, but please read:
If the Bill passes with the provisions relating to health care still in it, you need to think about how it will affect you. As the article says:
"The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors." (ed. And how often have you had duplicate tests???)
"But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”
Read the comments about his book. Daschle will not be a cabinet member, but no doubt a similar thinking individual will be.
Next time your doctor says he can't prescribe what he wants or treat you the way he wants because the government deems the treatment or medicine not cost effective (even if you want to pay for it) you can blame the Stimulus Bill. If you don't have blinders on, you might even blame Sen Reid, Speaker Pelosi, and oh, yes - President Obama.
You might ask what such provisions have to do with stimulating the economy, but don't. Those questions aren't allowed. If the law isn't passed, it will be a catastrophe. Just ask the President.
Monday, February 09, 2009
Saturday, February 07, 2009
Friday, February 06, 2009
But not just any drugs.
Mood altering drugs.
As Tommy Chong might say, "this is some good stuff, man."
United States demand for anti-psychotics is a $12 billion dollar market and continues to grow each year.
Top sellers include Zyprexa which runs $400 per month at discounted carrier pricing.
Following close behind is Risperdol at $120 per month, and Seroquel at $120 per month.
But closing in fast with a 54% jump in sales is Abilify. Thanks in part to DTC (direct to consumer) advertising, Abilify is becoming the drug of choice.
At $450 per month is it any wonder that Abilify is the darling of maker Bristol-Myers Squibb?
Abilfy, along with another heavily promoted drug (blood thinner) Plavix, comprise more than a third of B-M S revenue.
Existing patents on these drugs will expire in 2012 so B-M S needs to do what they can to pump up sales and DTC advertising is a proven winner.
And speaking of pumping up, sales of Viagra were $5 billion last year and still growing.
But I digress . . .
Abilify is used to treat depression, bipolar disorder and schizophrenia. Sadly, the latest thing is to diagnose these severe psychotic conditions in children as young as 6 years of age. Such diagnoses are highly controversial in children so young, and to put them on high powered, mood altering drugs so young is equally controversial.
The facts about anti-psychotic drugs don't support the sales figures.
Some studies suggest that newer, more expensive meds are no more effective than older, less expensive drugs.
The analysis found four second-generation drugs, amisulpride (Solian), clozapine (Clozaril), olanzapine (Zyprexa) and risperidone (Risperdal) were more effective than first-generation drugs, with "small to medium effect sizes."
But, other second generation drugs, such as aripiprazole (Abilify), quetiapine (Seroquel), sertindole (Serdolect), ziprasidone (Geodon) and zotepine (Nipolept), were no more effective than first-generation drugs, the researchers reported.
So more expensive, and newer, is not necessarily better for the patient.
only aripiprazole and ziprasidone among the second-generation drugs did not induce more weight gain than the first-generation drug haloperidol (Haldol), the study found.
Comparing first- and second-generation drugs, Davis's team also found that second-generation drugs produced fewer "extra-pyramidal" side effects such as unintentional muscle contractions, Parkinson-like symptoms and restlessness than Haldol.
However, only a few of these second-generation drugs reduced these side effects compared with low-dose Haldol, the researchers noted.
So why is information like this buried in medical and scientific journals and not broadcast in commercials to generate consumer awareness?
That was a rhetorical question. We all know the answer.
Oh, and in case you are wondering, Haldol is $10 per month.