Thursday, August 16, 2018

Making Strides Against Breast Cancer: v2018

Once again, I'm raising money with my team: Love, Hope and Faith. Our walk is Saturday, October 20th, and I'd really like to break the $500 mark.

Will you please help out by making a donation - Thank You!!

Thank you!

We've got questions

Some may recall the tragic story of a star-crossed love affair that ended tragically on the Hudson River on a Spring afternoon in 2015:

"[Angelika Graswald] pulled the drain plug on Viafore’s kayak while they were paddling on the Hudson River in 2015 and watched him drown."

This seems to have been as cold-blooded a murder as I've ever read of, and compounded by the fact that she and the victim, Vincent Viafore, were actually engaged to be married. He had apparently named her as one of the beneficiaries of his almost half a million dollar life insurance policy.

Okay, we know that criminals aren't allowed to profit from their crimes: arsonists don't get their houses paid off, murderers don't collect on their victim's life insur....

Wait, what's this?

"A woman dubbed the “kayak killer” -- who drowned her fiancé by pulling the plug on the couple's small boat -- was awarded a portion of his $491,000 life insurance payout Monday."

How could this be? I get that the arrangement included her dropping her appeal, and the victim's family dropping their wrongful death lawsuit, but I didn't understand how this deal worked until I got to almost the end of the article:

"The criminal plea did not disqualify our client from taking these funds. They still had to prove that she recklessly or intentionally committed this murder."

Okay, but how would that work? I'm not aware of any law that says "well, if you commit just plain vanilla murder you get the cash, but if it's reckless or intentional you get zip." This seems ... illogical.

So I reached out to FoIB Brian D (a carrier rep of outstanding repute) for insight, and he offered this explanation:

When carriers have a disputed claim (such as a murder or other suspicious circumstance), they will pay it out to the state to be held in escrow until the matter is resolved. Looks like this is what happened with the Kayak Killer case here.

Thanks, Brian!

Wednesday, August 15, 2018

Another CanuckCare© success story

For certain values of "success," of course.

Friend of mine (Canadian ex-pat) just posted this on Twitter*:

"My cousin just called. She was diagnosed with thyroid cancer in March, was put on the urgent list for surgery. It’s mid-August. “Oh well I just have to wait”, she says. Every day untreated means progression of disease. #CanadaWaits #socializedmedicinekills"


"It’s “a good cancer to have”, in that typically they can just cut out the affected organ. But who knows if, in the ensuing time, it’s affection other systems?"

"I am so angry that people are treated like this. Six months almost with no surgery date. In a first-world, technologically advanced country."

From another friend in response:

"I’ve had arguments online w/Canadians about how this kind of thing doesn’t happen & I’m a stupid American & don’t know what I’m talking about. A friend of a friend came to the US for hernia surgery because he was in excruciating pain & the wait was 1.5 years."

And finally, from my ex-pat pal:

"My father’s first oncologist appointment was scheduled for after he died."

But hey: Free.

(*Anonymized to protect her identity)

A Triggering Scenario

Back in July, I posted my skepticism of a claim by Life Settlement industry players that insurers were (surreptitiously?) raising the cost of insurance in viaticated policies:

"Some life settlement companies have responded to universal life cost-of-insurance increases by suing the life insurers  that issued the policies"

Of course, they're free to pursue their own interests, but I suspect that they'll have quite the uphill battle.

Why's that, Henry?

Well, as I noted in that previous post, there's no mechanism for singling out specific policies for increases. For another, policies themselves have specific, stringent definitions on how, why and when these internal costs may be raised. I took the liberty of screencapping the relevant verbiage from one such policy I recently wrote (and which I believe to be fairly typical):

 [click to embiggen]

As one can plainly see, the cost of insurance (COI) is pretty well locked down, and applies to only a few specifically-worded populations, none of which are "life settlement brokers."

The other interesting thing to note is that the other internal costs are left more freely to the carrier's discretion, so it's possible that policyholders could experience those, regardless of the company's mortality experience. But again, there's no singling out of the life settlement folks.

Based on this, I don't see how they'll prevail.

But then, I'm not a lawyer, and I didn't stay in a ...

Tuesday, August 14, 2018

Medicare Open Enrollment

Medicare Open Enrollment. Not to be confused with Obamacare Open Enrollment.

Time to review you Medicare Advantage or Medicare drug plan.

Medicare supplement plans do NOT have annual enrollment periods in most states.

Medicare open enrollment begins October 15 and ends at midnight December 7.

Medicare Open Enrollment Pre-Planning

Before enrolling in Medicare at age 65 for the first time, or planning your next move during Medicare open enrollment, there are things you need to do first.

  • Make a list of all doctors including name, address, phone
  • List all area hospitals, especially the ones you have used
  • Make a list of all medications including dosage, refills, prescribing doctor and pharmacy
  • Be aware of the donut hole and look for ways to avoid that trap
  • Make use of generics and off plan purchases
  • Look for FDA approved generics and ask your doctor before making a change
  • If renewing, get your drug list ID and password date from your last drug plan finder
  • If renewing, study your ANOC for changes
  • Use for reviewing Advantage and drug plan options
  • Avoid using for drug plan comparisons prior to October 25
  • and your state DOI site are essentially useless when comparing Medicare supplement options
  • Most Medigap quote engines only list a handful of options and rarely have plans with the best value
  • Many quoting sites will sell your information to numerous agents; some don't provide instant quotes

Never put anything on auto-renew unless you like unpleasant surprises.

You have questions. We have answers.


Monday, August 13, 2018

Promising Cancer Treatment Breakthrough

In a promising development, a new kind of weapon in the fight against cancer is about to be deployed:

"His oncologists delight in observing that if you saw Rulli on the street, you’d never guess he was sick. At 66, he still is 6-foot-1, still 215 pounds thanks partly to golf-course beer, still an easygoing husband and father of two children, now rejoicing in granddaughters"

In 2013, Bob Rulli was diagnosed with a glioblastoma, a rare but extremely nasty brain tumor. I know, because I lost my baby sister to one a few months ago. These are almost always a death sentence, and difficult to treat; the average life expectancy is about a year and a half.

Now, thanks to some true medical adventurers, there appears to be a real reason for hope, and so far it also appears to have few (if any) side effects):

"On that day in September 2016, for the first treatment, Rulli spent the day at UC with Wise-Draper and Morris keeping vigil for bad reactions. He had none. He felt fine."

Over the next year and a half, Mr Rulli continued to receive the medicine, called BXQ-350, in ever increasing dosages. Repeated MRI's showed that the tumor continued to shrink.

And then there was a glitch...

This is such a great story, I really recommend it. There's no rosy glasses here: there are definitely hurdles left. But so, so promising.

[Hat Tip: FoIB Holly R]

Oh, SNAP! (vs Medicaid)

So, FoIB Michael Bertaut offers 1,000 words on how Medicaid really reimburses providers, and its implication viz both Medicare and commercial health insurance:

[click chart to embiggen]

Money quote:

Friday, August 10, 2018

That was then, and this is now...

On the one hand (nine years ago):

On the other (6 years ago):

On the Gripping Hand (a few days ago, as tipped to us by FoIB Holly R):

Okay, wait a minute, "analysis" is very different from "results." What gives?


"Confounding is a classic problem of selection bias ... But that’s hard to do with a wellness program."

And thus, when accounting for the actual variables being  measured, there "seemed to be no causal effects."

Which is, of course, disappointing to those with an axe to grind, but I'd also point out that there didn't seem to be any evidence, or even any suggestion, that engaging in wellness activities was harmful.

So we've got that going for us, which is nice.

Thursday, August 09, 2018

EBA whiffs it - Again

So the rocket surgeons at EBA (which, ironically, touts "benefits" in its very title) continue to double-down on the stupid:

"Here’s one option advisors can help them explore: health savings accounts. These accounts, which are offered in combination with high-deductible health insurance plans"

First of all, they keep conflating "High Deductible Health Plan" with "HSA-compliant" plan, thereby confusing laypeople (and irritating us pro's). As we pointed out on Monday:

"[U]ntil the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example)."

And second, they seem oblivious to the fact that HSA contributions are down for a very good reason: with premiums and out-of-pockets continuing to soar, who the heck has extra cash laying around to put in the account?

They even offer proof of this in their article:
[click chart to embiggen]

So, a 1,000 words in self-rebuttal.

Nice job, guys.

CanuckCare© Takes a Shot

So it seems that Britain's Much Vaunted National Health Service© has some competition in the race to the bottom. From our friend The Political Hat:

"Canadian Hospital Pushes Euthanasia on Disabled Patient"

As we've oft-noted, killing off pesky, expensive patients is a sure-fire way to rein in out-of-control health care costs.

(And by the way: have we noticed yet that even nationalized schemes have been unable to keep health care costs in line? Just wondering)

And it seems to be becoming a pretty routine, if final, "solution:"

"Foley tells the man that he’s “always thinking I want to end my life” because of the way he’s being treated at the hospital and because his requests for self-directed care have been denied."

This is far form Dr K's assisted suicide apparatus: no matter what one thinks of that process, at least it was (ostensibly) voluntary. This is full-blown actively pushing for the patient to pull his own plug not for his own betterment, but for the savings to the health "care" system.

Which begs the question: what, they ran out of ice floes?

Wednesday, August 08, 2018

When health care is a "right"

We've long maintained that this notion of health care being a 'right' is fraught with peril:

"The noble-sounding idea that "health care is a right" doesn't even pass the smell test: health care must be delivered by a provider, so if it's a "right" then that person is being forced to provide that care whether or not he or she is remunerated for doing so."

But it goes even further: if health care is a 'right' then, by extension, the government can force health care professionals to provide their service regardless.

Think that's far-fetched?

Well, our Neighbors to the North© are about to put that into practice in real-time:

"Vowing to maintain public dental services in the province, Quebec’s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system amid a bitter standoff over contract negotiations."

Now, I have no idea how much force of law the gentleman can bring to bear on this, or whether he has the ability to actually force these dentists to provide care, but the fact that he believes that he does is chilling, no?

Next up: pediatricians.

Hat Tip to Physics Geek, who notes "Hey, so Canada is kind of cool with forced servitude. Kind of thought slavery was illegal, but whatever."


On BernieCare

Medicare For All (M4A) has been front and center in health care news this past couple of weeks.

Charles Blahous of Mercatus Center performed a study showing that the cost to move to this program would be $32 Trillion over 10 years. In his analysis he used some very favorable assumptions that the law would hit all of its targets - including dramatically reducing payments to health providers, reducing drug prices, and lowering administrative costs.

Senator Sanders countered with a Tweet claiming that the study shows that our country will save $2 Trillion dollars in moving to M4A. He thanks the Koch brothers and Mercatus for "proving" that his plan will work.

So where does the savings and funds to pay for the government program of Bernie's? If you read the media reports it will come from higher taxes, elimination of the insurance industry, and pay cuts to doctors who will accept 40% less at Medicare reimbursement.

On top of the likelihood that M4A will have to double tax rates what is most telling is the last point. For M4A to "show savings" the entire medical world will have to see their average reimbursement cut by 40%. Who all is in the medical world? Well, lets start with a few of those who would see their incomes whacked or in many cases see their jobs eliminated:

Nurse Practitioners
Billing Specialists
Insurance Agents
Speech Pathologists
Insurance Customer Service Representatives
Medical Device Manufacturers
Insurance Underwriters
Occupational Health and Safety Specialists
Dental Hygentists
Physician's Assistants
Pharmacy Technicians
Lab Technicians
Home Health Aides
Certified Nursing Assistants
Medical Transcriptionists
Medical Records Technicians
Research Associates
Pharmaceutical Research Investigators

Maybe Senator Sanders should send out another tweet thanking all of these fine people who work hard to save lives and provide us with care needed to remain healthy. Because if his plan ever comes to fruition they will be the one's paying for it.

Tuesday, August 07, 2018

What to make of *this*?

Hmmm. On the one hand, monetizing my health habits (or lack thereof) is appealing.

OTOH: This smells so much of Big Brother.

On the Gripping Hand: not sure how'd I'd be harmed even if the data were hacked.

What say you, dear readers?

(And would love to hear your thoughts on this in the comments)

Medicare Doesn't Cover Everything

Medicare doesn't cover everything. Here is a partial list of what is not paid by Medicare.

Routine dental care, dentures, crowns, bridges, routine eye exams, eyeglasses, contacts, cosmetic surgery unrelated to illness or injury, OTC vitamins and supplements, hearing exams, hearing aids, long term care, medical treatment outside the country.

Most of these items were not covered by your employer group health plan either. Things like vision, dental and hearing were covered by insurance plans OTHER THAN your major medical. You probably had a separate plan for dental and another for vision care.

Different policy.

Different insurance carrier.

Should You Buy Extra Insurance?

In many cases you can purchase separate insurance coverage for the following.

- dental care
- vision coverage
- hearing exams and hearing aids
- international travel medical
- hospital indemnity
- cancer plans
- critical illness

The list goes on.

But before spending good money on these kinds of insurance, ask yourself if you really need it?

I make an exception for International Travel Medical. That is something you should definitely consider when traveling outside the country. But for the rest of the list . . .

Do you need to spend $40 - $60 per month for a dental plan that limits your annual benefit to $1,000?

Do you need to pay monthly premiums of $50 per month for a plan that pays $600 per day for inpatient care only?

Most people would be better off stuffing that money in a mattress than paying for additional insurance that may never pay off.

Monday, August 06, 2018

They keep using that word....

Tweet from EBA Magazine about Congress' current effort to expand HSA's:
Thing is, folks in the "benefits press" (for lack of a better term) keep referring to ACA-compliant "High Deductible Health Plans" as if this has any actual meaning.

Okay, Henry, what the heck are you going on about?

Well, until the age of ObamaCare, HDHP's meant HSA-compliant true Catastrophic coverage, no bells or whistles, just policies that paid for the truly disastrous claims (think cancer or brain surgery, for example). Not low cost maintenance meds, flu shots or simple primary care. In other words, what insurance should be.

Now comes O'Care, with $6,000+ deductibles and $14,000+ out-of-pockets, but with a panoply of first dollar preventive care "benefits" (well, mostly just for women), and premiums that look like mortgage payments on a mansion.

These are not what we should be calling "HDHP's," confusing non-industry folks who just want to be able to afford their premiums (and to use their plan).


Friday, August 03, 2018

A most cromulent question

From FoIB @dabz:


O frabjous day!

Well, it's that time of year again, when agents must decide whether or not to participate in ObamaCare Open Enrollment (this year: v6.0). For most folks, this year's festivities run from November 1 through December 15 for a January 1, 2019 effective date.

I say "most folks" because DC and Golden State citizens have their own, quirky schedules:

"California has enacted legislation that permanently establishes different enrollment dates within the state, both on and off-exchange. From now on, open enrollment in California will begin on October 15, and end on January 15. So for 2019 coverage, California residents will be able to enroll starting on October 15, 2018, and will have until January 15, 2019 to enroll."

Californians who sign up after December 15 will have February '19 effective dates.

"[O]open enrollment in DC will begin November 1, 2018, and will continue until January 31, 2019. DC residents who enroll between December 16 and January 15 will have coverage effective February 1, while those who enroll in the second half of January will have coverage effective March 1."

Everyone got that?


Adding a little fuel to the fire is the fact that folks in DC will get their own insurance mandate:

"[T]he District of Columbia City Council approved a requirement for all DC residents to purchase health insurance ... The D.C. mandate contains three elements that make it just as bad as, if not worse than, the federal mandate it is intended to replace."


(Click on through for the details)

As for my part? Well, regular readers know that I've long since bailed from actively engaging in the Open Enrollment circus process, but that I continue to do the online training necessary should I change my mind (or, as in recent years, be available to help folks out from the sidelines). This week, I got email from CMS announcing that:

"Marketplace agent and broker registration and training for plan year 2019 is now live!"

I can choose the free (no Continuing Education credit) version from CMS itself, or pay for the training (which includes CE for most folks) from their preferred vendor, AHIP.

Not an AHIP fan, and don't need the CE. So: hard pass.

Thursday, August 02, 2018

Obamacare Rear View Mirror

Way back in 2013 #JohnHawkins had this to say about Obamacare. No one has a crystal ball but he got some things right, and some not so right.

What he got right.

If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what.”
 Well, that promise turned out not to be true and I can tell you that from personal experience. -
Mr. Hawkins was notified he would be losing coverage well before the clock struck midnight ending 2013.

It's difficult to blame my insurance company for that (cancelling his coverage). After all, it's hard for a service to be viable when the government forces consumers who buy it to pay a massive new tax for the privilege


Currently, I pay $191 per month. That will go up to $274. That's nearly $1000 a year more for a service that I already have. In addition, the deductible on my current plan is $200 and that will be going up to $6000.

And that's just for 2014. Wonder what he is paying now?

What he got wrong.

Originally, my health insurance provider told me that my plan wasn't going to be canceled. The agent just said it wouldn't qualify under Obamacare and so, I'd have to pay a tax to keep it.

Grandfathered plans exempted.

Technically his agent was wrong. Can't put all the blame on John.

When you hear about people who are going to be paying an extra $6000 a year out of $47,000 in income 

Those folks SHOULD have qualified for a subsidy. A rob-from-the-rich-give-to-the-poor taxpayer funded subsidy. Depending on many factors, their premium could have been $0.

What a country!

The law couldn't pass today and had Obama told the truth instead of lying shamelessly, even Democrats would have never voted for this law in the first place

Half right. Half wrong.

The law would not pass in 2018. But I do believe the left wing party would still vote for it if given a chance.

Pretty damn scary.

Wednesday, August 01, 2018

Finally, some *good* ACA news

Our Betters in DC© have released their final regs on Short Term Medical plans.

On the only piece that truly matters, they fall short (again):

"Such coverage can now cover an initial period of less than 12 months, and, taking into account any extensions, a maximum duration of no longer than 36 months in total"

The good news is that they've lifted the 3 month max, the bad is that they've left a potentially huge gap in that 365th day.

Still, one should avoid letting the perfect be the enemy of the good, and this is at least a step in the right direction.

As to why they've made this change, well, let's just say that ObamaPlan signups have been ... disappointing:

"[T]he number of people enrolled in the individual market without subsidies declined by an alarming 20 percent nationally in 2017 ... Many state markets experienced far more dramatic declines, with unsubsidized enrollment dropping by more than 40 percent in six states"


Now, it's important to remember that coverage ≠ care, and these plans have their own limitations, including exclusion of pre-existing conditions. But they are generally much more affordable, and offer much lower out-of-pocket options, than ACA-compliant policies.

Will be interesting to see how this plays out, and what impact it has on Open Enrollment v6.

[Hat Tip: HAFA]