Friday, January 18, 2019

Heads' up: The weather and your home's pipes

Timely reminder from our friends at the Cincinnati Insurance Company:

Prevent frozen pipes in your home from The Cincinnati Insurance Company on Vimeo.

For whom the bell tolls: The Venerable Health Wonk Review

From email from our dear friends Joe Paduda and Julie Ferguson, co-founders of the long-running, highly respected Health Wonk Review:

"Hello, Health Wonker friends –

First, wishing you all a happy New year and extending thanks for your ongoing participation in Health Wonk Review.

After a baker’s dozen years  and more than 280 issues, we’ve decided to call it a day.  It’s become a bit more of a heavy lift to get varied hosts. We moved to a monthly issue to address that, but it’s still been slow going. Submissions are down too as more people abandon blogs in favor of social channels like Twitter and LinkedIn. Readership and cross posting appears to have waned, too.  Going forward, we may host an ad hoc issue occasionally under the HWR banner and invite your participation when health policy issues rise to the surface, but the regular issues will cease.

We can’t thank all of you enough – we’ve discovered new blogs, learned new things, shared some laughs and made good friends that we hope will continue into the future.

We’ll be preserving the archives and will send you a link to the new location.

Be well, and keep doing what you do so very well!

We'll miss the HWR, and can't say enough about how much effort Joe and Julie poured into it all these years. We are proud to have been with them from the beginning, and know that their efforts have been appreciated.

Thursday, January 17, 2019

Nectar of the Gods?

Merriam-Webster defines ambrosia as "the food of the Greek and Roman gods." If that's still the case today,  we have questions.

Why's that, Henry?

Well, because of this (apparently legit) item sent in by FoIB Holly R:

"A controversial startup that charges $8,000 to fill your veins with young blood to 'defeat aging' now claims to be up and running in 5 cities across the US"


The company was started about 3 years now, and is now up and, er, beating well, as they now boast a wait-list. And since its process is considered an off-label use of established medical procedure, it's apparently 'kosher' as far as the FDA is concerned.

How effective is it? Well,there's scant scientific proof of its efficacy (and by "scant" we mean "next to none"); on the other hand, what's the harm?

Tune in again in 2075 for an update.

Oh, and definitely go for the brand name, not the generic,and no word yet on whether or no it's HSA-eligible, but one doubts it's insurable (after all, what carrier actually has a heart?).

Wednesday, January 16, 2019

ObamaCare Open Enrollment v6.0: Anecdata version

We know that anecdotes ≠ data, but this item (to which we were alerted by co-blogger Bob V)  provides some helpful, personal perspective:

"Last week, we asked you to send in details of the insurance plans you purchased on the Affordable Care Act exchanges. We received more than 70 messages, mostly all with the same theme: This sh*t is too expensive, and it sucks."

Well, we've been saying that for years now, but welcome to the party!

There are a bunch of interesting example, none of which were surprising to longtime O'Care observers.

Feel free to share your own experiences in our comments section.

Tuesday, January 15, 2019

CanuckCare© Continues Swirling

But hey,it's free:

[Hat Tip: Dr Michael B]

Monday, January 14, 2019

#FakeHealthNews: Burying the Lede

Our friend Holly R tips us to this story currently making the rounds at FB:

[click to embiggen]

"Kentucky Sen. Rand Paul, one of the fiercest political critics of socialized medicine, will travel to Canada later this month to get hernia surgery"

Now why would he do that?

After all, we have many fine surgical centers here in the states, why would he choose a government-run one Up North?

Well, turns out that the opening sentence is rendered completely moot by the third:

He is scheduled to have the outpatient operation at the privately adminstered Shouldice Hernia Hospital in Thornhill, Ontario"


Transparency gone terribly wrong

We've been covering (and advocating for) transparency in health care pricing for a very long time:

"Gov. Rod R. Blagojevich today signed the Illinois Health Care Consumer’s Right-to-Know bill, which makes health care price and performance information for outpatient procedures available to all Illinois consumers."

That was over 13 years ago, and we can see how well that's worked out. Recently, co-blogger Bob V sent me a link to a story that not only indicates that we have a long way to go, but also implicitly explains why we likely will never really see true transparency:

"Her insurer’s price tool estimated less than $1,375 for a breast MRI. Then she got a bill for $3,200."

Ms Smith apparently did everything right: she researched MRI facilities and prices using UHC's online cost estimator [ed: and by the way, this is not an indictment of UHC in particular; I'm confident that that same would hold true with other carriers, as well], and still got socked with a larger-than-expected bill.

But why is that? Why is something so seemingly simple so difficult to obtain? After all, when I order a Big Mac and fries, I know exactly what I;'m going to shell out. Likewise a gallon of gas or an oil change. Why is medical care immune?

Well, there's the obvious challenge that the doc can't be sure that a particular surgery will go exactly as planned, and I get that. But simple things like non-emergency MRI's should be basic, off-the-shelf, easily priced items.

Or so one would think.

But here's the dirty little not-so-secret:

"Health-care costs are difficult to pin down because prices vary widely and are part of confidential agreements between insurers and providers." [emphasis added]

Now, I actually "get" that: UHC doesn't necessarily want Humana to know the specifics of its agreement with Dr Smith. And, of course, coverage will often change depending on one's plan's design. I just don't see how to square the circle.

On the other hand, we have newer models like Direct Primary Care and facilities like the Surgery Center of Oklahoma, which operate on a strictly cash basis, no insurance needed (or, in fact, accepted). So we know that cutting out the middleman (ie insurance and/or the heavy hand of government) is a way around the conundrum.But of course, both of these have their own problems and challenges, not the least of which is the ability of one to come up with the scratch to pay for it.


Friday, January 11, 2019

ObamaCare #Winning!

Thursday, January 10, 2019

Sad news: A client story

Over the weekend, a long-time agency client took his own life. Dan was a retired (and much beloved) pediatrician who had been (recently?) diagnosed with both dementia and Parkinson's. One supposes that, as a physician, he knew what lay ahead, and decided to forego that.

Something that often comes up in these tragedies is the issue of whether or not a life insurance policy would "pay off." As with so much insurance-related "conventional wisdom," it's not actually all that simple.As we wrote back in Aught Nine:

"Until just after the Great Depression, suicide was excluded by life insurance policies. There was, it was thought, a very good reason for this: it would be against the public interest to encourage folks to kill themselves to enrich those left behind. And there's some validity to this: we don't want to make such an outcome attractive to people to leave an inheritance at the cost of one's own life.

But a lot of people who lost everything in the Depression killed themselves anyway; not for the insurance (there wouldn't be any) but out of desperation and despondence. And this left behind a lot of widows and children who lost a parent and a spouse along with their life's savings. This was also against the public interest.

So, how to reconcile these two seemingly irreconcilable principles?

New laws were enacted that required life insurance policies to cover suicide after a "reasonable" period ("reasonable" in this case meaning no more than two years). The premise is that no sane person is going to buy a policy with the intent of waiting two years to jump out a window; that a person would do this was ample demonstration of mental illness, and that would be a covered exposure. This protects the interests of innocent family members, while still discouraging a casual view of suicide

Our condolences to Dr C's family.

Not so great HIX news: SEP edition

So by now, most folks understand that it's quite the challenge to buy ObamaPlans outside the regular Open Enrollment season; that one requires a Special Enrollment Period trigger (losing group coverage, getting married or having a baby, etc) to do so. Well, the process just got a bit more onerous.

From email from our Betters in DC©:

"Special enrollment periods (SEPs) provide an opportunity to consumers who experience certain qualifying events to enroll in or change their health coverage outside of the annual Open Enrollment period.

Beginning in early 2019, Marketplace consumers may need to choose a plan in the same metal tier category (instead of from all available categories) during their SEP window. [emphasis in original]

 This impacts consumers when they:

•Currently have a Marketplace plan,
•Experience most SEP-qualifying life events, and
•Want to change from their current plan.
You can help consumers understand that their plan choices after Open Enrollment will likely be limited later in the year, even if they qualify for an SEP and want to change plans. You can encourage them to choose a plan that will meet their needs and their family’s needs until the next Open Enrollment period."

Oh goody.

Did I mention that I'm aware of precisely zero carriers paying commissions on plans outside of the regularly scheduled Open Enrollment? How come no one seems to care (since they don't reduce the premiums to reflect that fact)?

Wednesday, January 09, 2019

The Overarching Deceit of Medicare4All

Ah, those right whingers at Kaiser strike again:
Wait, what?

Michael also points us to this more graphic illustration of the point:

Math is hard.

Tuesday, January 08, 2019

Once again: Coverage ≠ Care

The Much Vaunted National Health Service© presents the latest case in point:

[Hat Tip: Kishore J]

Monday, January 07, 2019

Cool New Blog

Longtime readers may recognize Dennis Wall, who provided us an interesting guest post about lender-forced insurance plans:

"LFPI [Lender force-placed insurance] is insurance which protects the lender’s interest in the borrower’s collateral. It is “collateral protection insurance” in the sense that it is insurance which protects only the collateral."

Dennis went on to chronicle for us some of the many problems and ethical issues that arose from this.

Well, Dennis has a new blog now
(which we've added to the sidebar), called (appropriately enough) Claims and Issues. It's less focused on insurance claims and issues, and more about just claims issues in general. Do check it out.

Weird Caller Tricks

So I get a phone call this past Friday from "Pam," who's looking for help with "personal health insurance." Turns out her husband's "idiot boss" had neglected to pay the group health insurance premiums, and as a result that plan had lapsed. At which point her "idiot husband" went on the Exchange (during Open Enrollment) and signed them up for a plan with Molina, to the tune of $2,100 per month (you know, 'affordable'). Pam was unhappy with both of these events (no kidding), and wanted to make some changes.

In the meantime, she had signed up for a UHC short term plan that will expire on the 20th.,

It should also be noted that Pam has a pre-existing shoulder injury for which she receives periodic treatment, and her "idiot husband" was recently diagnosed with a (thus far benign) thyroid nodule.


I explained that there really weren't a lot of insurance options here: since we're outside Open Enrollment, and I don't see any Special Open Enrollment triggers in her situation, there's not much we can do with ACA-compliant plans. Nor would another Short Term plan be advisable, since both her shoulder and now her "idiot husband's" thyroid condition would be pre-existing and thus excluded.

I then turned to some non-insurance (but ACA-compliant) options, and asked if she was familiar with Health Care Sharing arrangements; she was not. So I explained to her that, although I don't write these myself, I do know that there are a lot of folks who think they're pretty good (and also a lot who think they're a rip-off, of course). I also asked if she knew about Direct Primary Care (DPC) and, unsurprisingly, she did not. And so I explained how DPC worked, and how to use the DPC Frontier site to see if there's a nearby practice.

I also explained that many folks combine these two plans, and why that is often effective.

Keep in mind that I've now spent about 45 minutes with her answering questions and offering advice, and that since I wouldn't be selling her anything myself, this was completely uncompensated. On the other hand, The Sticker pretty much dictates this course of action.

At the end of the conversation, I asked if she had any other questions, and she said "no, I'm going to call the Exchange number and get my plan changed." And then she hung up.

Gee, Pam, you're quite welcome.

And rotsa ruck with that.

Sunday, January 06, 2019

In Memoriam: Joe Beyerle

Some 35 years ago, I had the pleasure of meeting a man who would become my boss, friend and mentor. Joe was the very definition of "larger than life." He passed away, peacefully, his family at his side, last night.

About 25 years ago, the local TV news did a report on laughter in the workplace, and the segment opened with a shot of our office from across the street.

You could hear Joe's laugh.

Joe's business model was pretty straightforward: do the right thing for our clients, always.

A devout and passionate Catholic, Joe organized a city-wide rosary prayer-a-thon that gained national attention.

Everyone knew Joe: I used to joke that if aliens ever landed here, the first thing they'd say would be "hey, where's Joe, I need insurance for my UFO."

He and the love of his life, Joan, were married for over 60 blissful years, and they have the kids, grandkids, and great grandkids to prove it.

He'd been in failing health for a while, and over the weekend preceding New Year's he was hospitalized. I was fortunate to visit them on Thursday morning, and had them all to myself for about an hour. He was still, well, Joe, and I got to experience his trademark smile more than once.

He quizzed me about my girls, and even offered a (tremendous) suggestion for my youngest.

We're members of a synagogue in northern Cincinnati, about 35 minutes away. At services yesterday morning, I mentioned his name for the healing prayer list. After services, a friend came up to me and said, "I recognized Joe's name." Because of course he did. Why was I even surprised?

I will miss you, Joe, and your laugh, and your compassion, and your love of the Reds.

But mostly, I will miss your warmth, and love, and compassion.

Baruch Dayan HaEmet. Rest in Peace, dear friend.

Friday, January 04, 2019

Outstanding Vendor Tricks: ID Theft Protection Done Right

Some time back, we had the opportunity to both buy and sell LifeLock ID Theft protection (we earned a modest commission on those sales). Eagle-eyed readers may have noticed that the LifeLock sidebar link has been gone for quite a while.

This was primarily as a result of this news last summer:

"Identity theft protection firm LifeLock — a company that’s built a name for itself based on the promise of helping consumers protect their identities online — may have actually exposed customers to additional attacks from ID thieves and phishers."

In the event, we discontinued our association at that time, and removed the link from the sidebar.

But we still had a need for the protection, and a good friend (and colleague) recommended Zander Insurance Group as a helpful and more economical alternative. In fact, their package includes all the features that we had appreciated from LifeLock, at a fraction of the price.

Of course, "cheaper" often means "lower quality" but that hasn't been the case at all: Recently, our primary credit card (from which our Zander ID plan premiums were charged) was hacked and we had to get replacement cards (and numbers). This in turn generated an email from Zander when our premium "bounced." So I called up the customer service number, and was almost immediately connected to a delightful young lady named Elizabeth. Not only did she offer great service with a smile, she also recognized that I had inadvertently set up a duplicate account and was being double charged. She immediately cancelled that second, unnecessary account, and arranged for a full refund of the fees.

It just doesn't get much better than that.

Thanks, Elizabeth!

This Time, It’s Medicare for All

One of the reasons Bernie Sanders’ sun has risen - and Hillary Clinton’s has set – is their differences over government-paid medical insurance.  (Which, of course, most people still call “healthcare”).

Bernie favors Medicare for All.  This is becoming more popular among the self-described progressives in the Democrat Party, and among the American far left. That’s because its leading advocates – e.g., Bernie – promise it will give everyone better insurance coverage, cost less, and be simple. What’s not to like?

Contrast Hillary who favors fixing Obamacare, or at least has always said she favors fixing Obamacare.  Her major objection to Bernie’s idea is that Medicare for All would cost too much, and require even higher taxes to pay for it. But that’s become a less popular policy position partly because of the growing recognition that Obamacare already costs too much, and is probably not fixable even if Hillary says it is.  So for the first time in more than 25 years, Hillary has lost the high ground on medical insurance.

There’s a backstory here.  At least two states have already tried to design single-payer plans for their residents. Both gave up because of high cost. In 2007, Connecticut shut down its state single-payer project because it would have cost more than the entire state budget.  And in 2014, Bernie’s own State of Vermont shut down its project for about the same reason.  But when have facts mattered to progressive/leftist Democrats who clothe themselves in robes of social justice? I expect that in the next national presidential campaign, Medicare for All will be a prominent Democratic Party talking point.  

So it’s important to recall that back in 2010, the Democratic Party had to deceive America to sell us Obamacare. Thanks to Professor Jonathan Gruber, we learned that all along the progressive/leftist Democrats considered Americans “stupid” and easily fooled.  

My opinion? None of the promises about Medicare for All – more insurance coverage, for less cost, and simple administration - survive thoughtful analysis from experts other than the partisan progressive/leftist Democrats themselves. 

Fool me once, shame on you.  Fool me twice, shame on me.

Thursday, January 03, 2019

Direct Primary Cult? A Reality Check [UPDATED]

[Please scroll down for Update]

In which its adherents fall into the same trap as those who conflate health insurance and health care.

Look, I have long been a fan of the Direct Primary Care (DPC) model: in fact, we were among the first to interview one of its pioneers, way back in Aught 12.

There is much positive to be said about DPC: it satisfies the ObamaTax mandate (which may or may not matter for this year), and offers the opportunity for better clinical outcomes based on more patient-focused care.

Unfortunately, it seems that its advocates think a lot more highly of the model than is actually justified. For one thing, it is literally a blip on the health care radar: there are about a quarter of a million primary care doc's in the US, and less than 1,000 of them are DPC (that's about 4/10's of 1%). As I recently pointed out to one of the more outspoken DPC folks, it's not that DPC is a bad thing, it's just not a thing. And the idea that it can be easily or quickly (or realistically) scaled up to meet a meaningful number of patients' needs is, frankly, laughable.

And of course, we've discussed numerous times (here for example) how DPC folks continue to make the fallacious argument that it makes economic sense for patients*. Until true Catastrophic medical plans are allowed once again (they're currently illegal under ObamaCare), then one of two things will continue to be true:

1) That folks will be double-paying for primary care (since it's already covered under ObamaPlans) or

2) They'll drop their major med plans in favor of DPC only, leaving themselves exposed to potentially massive catastrophic claims.


So what's your point here, Henry? Or are you just blowing off steam?

Good question - mostly the latter.

Happy New Year!

UPDATE: From our friend Mike Bertaut (an economist with Louisiana Blue Cross):

"Insurance carriers depend on primary care docs with a free flow of patient health data via EHR's to keep patients healthy. A huge slice of care coordination (especially post-discharge) and much of predictive modeling, both of which are now big contributors to keeping claims costs down require in-network, EHR sharing PCP's. To me this makes the idea of carving out primary care not only counter-intuitive, but bad for the patient and his healthcare costs overall."

I can see that, although I do see a role for DPC in the area of access and more patient-centered care.

*To be fair: Many (most?) DPC practices do offer discounted rx options, which has the net effect of lowering the subscription cost.

Wednesday, January 02, 2019

This is scary: CVS vs Your health

But just what makes this development so troubling?


"Thanks to NICE guidelines, millions of British citizens are on waiting lists at any given time for procedures, hundreds of thousands are waiting for basic diagnostic tests, and thousands of operations are regularly cancelled."

Opening soon here.

A CanuckCare© Two-fer


"Had a patient today who had a skin cancer on her nose. 6 month wait for Mohs surgery removal in Toronto and no pathway for Facial Plastic Surgery nasal reconstruction following. She went to the US and was treated the next day."

Regular readers know that situations like this are a common occurrence under Canada's state-run health "care" system. Unfortunately, those who advocate such a system here seem to be, well, oblivious (or just don't care).

Chaser (courtesy of our friends at OOC):