Italian Medico: True Dedication

Sometimes, it's the little things that mean a lot.

Take, for example, Naples-based neurosurgeon [ed: a real brain surgeon, not a "rocket surgeon?" Yes.] was performing a delicate operation to remove a tumor, when he had his own little medical problem.

Well, not so little, after all:

"An Italian surgeon had a heart attack while performing a brain cancer operation but carried on until he had removed the patient's tumour."

Now, an ordinary surgeon might have stepped aside, and tended to his own immediate medical needs. Not Dr Claudio Vitale (no apparent relation):

"I couldn't leave him at such a delicate moment ...I'm not a hero, I only did my duty."

I think most of us would beg to differ. There's a big difference between a headache and a heart attack, and one could easily be forgiven for immediately addressing the latter. Dr Vitale, though, was having none of that:

"Vitale suffered chest pains while he was halfway through the brain op but refused his team's efforts to persuade him to get emergency treatment."

The good news is that both the surgeon and his patient are "already on the mend."

Health insurance? Aisle 12

[Oy - scooped AGAIN! Still, mine is a bit different take on the subject. HGS]

This may start in the Golden State, but don't doubt for a New York minute that it won't catch on across the country:

"The California Health Benefit Exchange board is hoping to get retail stores to provide in-store enrollment assistance for the state's [ObamaExchange] ... Members of the ... team believe that retail stores are good vehicles for reaching uninsured residents"

In theory, these "trained and certified" employees would be able to help you choose a melon and a health plan. I have my doubts: one doesn't see a lot of rocket surgeons wearing those bright blue or red, pin-emblazoned vests. On the other hand, given how The ObamaTax policies must be structured, it wouldn't take a rocket surgeon to explain them, either.

Perhaps the model isn't the guy stocking the shelves, but the butcher or pharmacist behind a counter. That seems to me a bit more workable: someone tasked with handling the insurance questions, not where one can find the canned soups.

And I can't help but think that this is doomed to failure: after all, how would the store make money on this deal? They can "provide Tier 2 marketing support, by helping with marketing, education and referral activities, but not with actual enrollment services," but why would they? After all, they're taking all the risk (what if their advice is bad and they're sued or fined?) for zero financial reward.

Of course real, professional agents won't be much better off if they agree to become ObamaExchange Navigators, since "they cannot get compensation from the insurers selling products through a state's PPACA exchange program."

I know - we'll make up for it in volume!

There IS a difference...

Both health and disability insurance are (like auto and home) based on the concept of indemnification . That is, they are designed on the premise that one can both identify and quantify a given risk, and then offload some portion of that risk to an insurer.

Health insurance bases these quantities on the cost of health care; car insurance on the cost of a new vehicle (among other things); and disability insurance is based on one's wages.

Not exactly rocket surgery.

Most people have health insurance of one kind or another, most folks do not own disability insurance (more's the shame). But most intelligent, reasonably astute folks know the difference: health insurance pays the doc, disability insurance pays me (and, hence, the mortgage).

Apparently, our Rocket Surgeon in Chief (RSiC) is unaware of these differences:

"During the 2008 presidential campaign, Barack Obama often discussed his mother's struggle with cancer ... fighting with insurance companies that sought to deny her the coverage she needed to pay for treatment."

The story (and I stress the term story) became the centerpiece of his push for ObamaCrap.

Unfortunately, our RSiC misunderstood the very simple, obvious difference between health insurance and disability insurance:

"[ObamaMom]'s compensation for her job in Jakarta had included health insurance, which covered most of the costs of her medical treatment ... [ObamaMom]filed a separate claim under her employer's disability insurance policy." It was that claim, with the insurance company CIGNA, that was denied."

So let's get this straight: we are now facing an unprecedented limitation on our economic freedom because the RSiC misunderstood (and consistently misquoted) the difference between health and disability coverage?

Wow. Just wow.

Rocket Robin Hood

As in "rocket surgeon" Robin Hood:

"The risk adjustment program was designed to dissuade insurers from targeting only healthy people ... The problem is that measuring metrics often encourage companies to optimize their score"

Let's unpack this, shall we?

First, as we've noted before, "carriers have an incentive to make their own insureds look as sick as possible" if they want in on that sweet, sweet risk adjustment money. And let's face it, there's precious little they can do about making this happen; after all, there's no underwriting so they're actually shooting in the dark about what kind of demographic they're appealing to.

And second, it's not as if this is a deep, dark secret: heck, we've been blogging on it for years, as have many, many others.

Frankly, I fail to see the problem: carriers are simply following (willfully stupid) rules as intended, with entirely predictable results. When you incentivize a behavior, you tend to get more of it, no?

[Hat Tip: FoIB Joseph Snable]

More Stupidity from Ezra [UPDATED]

Alleged health blogger Ezra Klein, noted rocket surgeon extraordinaire, continues to double down on the stupid. Today he opines that even the Father of Our Country liked him some mandates. As reported on Twitter:

"In 1798, Congress mandated that sailors buy health insurance. John Adams signed it into law."

The twit (tweet?) directs the unwitting to Ezra's latest contrivance, wherein he demonstrates profound difficulty discerning the difference between forcing all citizens to purchase a product as a condition of citizenship and specifying that certain individuals must buy a product in order to serve in the military.

Seems pretty clear to me.

In order to show that he really doesn't get it, Ezzie doubles down by citing a 1790 Congressional mandate that "ship owners buy medical insurance for their seamen." Perhaps noticing that there's a pretty glaring logical fallacy here [ed: is there any other kind with this guy?], he observes that "in 1798, Congress ... enacted a federal law requiring the seamen to buy hospital insurance for themselves."

Again, one can choose whether or not to be a sailor. But the [Evil] Individual Mandate applies to all citizens (well, almost all). How come you don't talk about those exceptions, Ezra?

[Hat Tip: FoIB Holly R]

UPDATE/IRONY ALERT: I can't believe I missed this before posting. Ezra Klein relies on legislation from the 18th Century to make his "point?" Is this the same Ezra Klein that pooh-poohs the Constitution because it's "not a clear document. Written 100 years ago, when America had thirteen states and very different problems, it rarely speaks directly to the questions we ask it?"

Why yes, yes it is.

The stupid burns strong in that one.

We Have Ways: An Update

Back in March of Aught 10 (just after the ObamaTax was enacted), Bob pointed out that "[a]n adult who does not have health insurance by 2014 would be penalized $95 or 1 percent of income," and went on to ridicule it.

His point then was that, compared to projected premiums, this didn't even get to "paltry" levels.

And of course he was right, and of course we still have over 27 million folks uninsured, despite [ed: because of?] the joke that is the ObamaTax.

And, evidently, other folks have finally gotten around to noticing what most have us have known for years:

"In my experience, the penalty has not been large enough to motivate people to sign up for insurance,” said Christine Speidel, a tax lawyer"

Well, she'd know, right?

And then there's rocket surgeon director of tax history Joseph J. Thorndike, who brilliantly deduces that the "penalty for violating the individual mandate has not been very effective ... If it were effective, we would have higher enrollment, and the population buying policies in the insurance exchange would be healthier and younger.”

Perhaps.

But it would be interesting to know what these folks mean when they say "more effective;" after all, if they raise it too much, then folks might start to notice that it's completely unenforceable as written.

Oh.

I think I see the problem there.

[Hat Tip: Co-Blogger Bob V]

Speaking of 50 state laboratories

Regular readers know that we've always been major cheerleaders for the state laboratory idea. That is, that each state should be free to experiment with whichever healthcare model it deems appropriate. Being the precursor to ObamaCare, Massachusetts of course comes immediately to mind. But we also note that both Colorado and Vermont have tried their hands at the universal or single payer model, with "rousing" success (for certain values of "success"):

"In 2007, Connecticut shut down its state single-payer project because it would have cost more than the entire state budget."

And a few years later, The Green Mountain State followed suit (even after hiring noted health care rocket surgeon Herr J Gruber).

Now, California's toying with implementing its own version:

"With President Trump now vowing to put forward a replacement for the Affordable Care Act in March, some California politicians and healthcare advocates are once again promoting the idea of a staterun “single-payer” system"

And that's just one of a handful of ideas (including a so-called "public option" and a MasssCare lookalike). Now one may look at The Golden State's current finances and shake one's head in disbelief, but I repeat my call for open discussion and experimentation across the fruited plain.

And good luck to Cali!

[Hat Tip: Drew M]

The Geniuses Behind ObamaCare©

Noted rocket surgeon and ObamaCare© advocate Rep Hank "Geophysicist" Johnson (D-GA) puts us some knowledge:



Get that? "“My fear is that the whole island will become so overly populated that it will tip over and capsize.”

And this is the kind of scary-smart DC-insider who will be determining your health care.

Does it make sense?

Last week, we noted the curious case of Joaquin Shadow Rams, who seems to have made a habit of collecting on life insurance policies he took out on family members (one hesitates to use the phrase "loved ones"). Last we heard, he was on trial for the murder of his year old infant son, on whom he had purchased a sizable ($500,000) life insurance policy.

Now, as then, we're going to focus on the underwriting aspect of this case, specifically:

"What rocket surgeon underwriter approved a half million dollars of life insurance on a toddler?"

Since that post was published, I've had a fruitful conversation with my underwriter at our primary life carrier, whose bottom line observation provided the title of this post.

In addition to the various issues we discussed previously, he explained that, if the father was, in fact, applying for multiple policies on his son's life, this would (likely) generate an "excessive applications" hit at the MIB (Medical Information Bureau), which tracks these over the course of several years (let alone one). This alone would have set off a red flag or three.

Alternately, if Mr Rams had purchased just the one $500,000 policy on his infant son, this too would have raised some eyebrows. As FoIB Jeff M noted in comments to the previous post:

"Every life insurance company that I have ever used required an amount of life insurance on the parents to be at least 2x that which was being applied for on a child."

My underwriter confirmed that, for the most part, this is true, but that New York has recently ruled that the child's death benefit amount allows at certain ages a face amount equal to the parents'. Still, there's a floor. We also discussed my observation that, if this was Bill Gates, Jr there might very well be justification, and my underwriter added that there may be other extenuating circumstances.

For example, he mentioned a case where the parents had no life insurance, but were applying for a large amount on their son (who, it should be noted, was not an infant, but a teenager at the time). When queried, it turned out that Dad didn't have coverage because he was uninsurable, and the primary reason they were seeking coverage on the progeny was to protect his future insurability. So it made some sense in that case.

Of course, the MSM can't be bothered to do even that much rudimentary fact-checking, so we have no idea how much - if any - life insured Mr Rams had on himself (there's no mention of a Mrs Rams).

The bottom line, it seems to me, continues to be that there were some highly questionable actions taken by whichever insurer is left on the hook for this tragedy, which apparently failed to ask "Does it make sense?"

[Many Thanks to FoIB Rob P]

Friday Afternoon LinkFest

■ On the tech front, Humana's developed a new app "that helps employees make sound healthcare decisions." Over the next few years, according to Humana, more than a half a billion folks will be using their smart phones to help them manage their health care.

Who knew?

■ From the "Scant Comfort" files:

"Cost increases for health care are perhaps finally slowing down, with employer health benefit expenditures not expected to increase in 2012 at the same explosive growth in recent years. Costs for all types of medical plans are expected to increase by 9.9% for 2012"

This is what drives me so crazy: it is not health care costs, it's health insurance costs, you moronic cretins. And these folks are supposed to be a premier industry resource?

Sheesh!

■ FoIB Holly R tips us to this item from the "Department of D'uh:"

"Hospitals targeting well-insured patients, report says ... Targeted expansion to “capture” well-insured patients is a hot trend across the country ... Hospitals that are dominant in their market are the most likely to be pursuing geographic expansion"

For real?

And this is a surprise, why?

Of course hospitals (and any other provider that wants to stay in business) needs to shore up their revenues, and it doesn't take a rocket surgeon to know that increasing services and/or locations is the way to go.

A *Really* Big Case (of fraud)

We seem to be on something of a life insurance fraud roll here. Almost exactly a month ago we reported on the case of a rocket surgeon greedy wife's efforts to collect on her husband's life insurance policy after arranging his premature demise (spoiler alert: she failed).

The case now at hand is particularly intriguing; at first, I was somewhat dumbfounded as to how the insurer could have been so easily duped, but as the story unfolded, it got even weirder. And that this all took place about a half hour away from me added a sense of the macabre.

A brief underwriting refresher: when applying for life insurance (especially anything over $100,000) one is required to undergo (at least) some sort of physical exam. Depending on the amount at risk, this can range from simple blood and urine tests to EKG's and stress tests. In this case, West Coast Life was set to be on the hook for just shy of $3 million, so of course the medical underwriting would be vigorous.There's another angle (financial) but we'll elide over this for purposes of this post.

Here's where it begins to get weird: the application was apparently written in Ohio, but the applicant chose to have the exam done in Texas. I'm thinking that right there's a red flag, but apparently WCL wasn't bothered by it (or perhaps, they became retrospectively concerned). In the event, a person claiming to be the applicant shows up, all 176 pounds of her.

Which would not necessarily be weird in and of itself, but the person who actually died clocked in at almost 400 pounds [ed: Hey. it could happen! Spend a few days at the Golden Corral and Bob's your uncle]. Kind of a clue. The fact that the applicant indicated no substantial health history, and yet was dead within a few short years of (presumably) natural causes was likely another.

And so now the family of the insured is being charged with life insurance fraud; one presumes a lawsuit on behalf of West Coast Life will follow directly.

[Hat Tip: FoIB Holly R]

Stupid "Beneficiary" Trick

A few years ago, we reported on a "widow" who tried to collect on her husband's life insurance policy. The challenge? He wasn't dead, and the woman was charged with fraud.

But at least the perp had her paperwork in order.

Not so with this rocket surgeon wannabe:

"A newlywed accused of soliciting her firefighter husband's killing to collect $100,000 in insurance money has been convicted of aggravated murder in a scheme that was flawed from the start: His ex-wife was still the beneficiary of his policy."

Ooops.

Oh, and it gets better (for certain values of "better"): she'd recruited her teenaged daughter and her boyfriend to do find a someone to actually do the deed.

But wait, there's more:

The boyfriend thought it'd be a good idea to "keep it in the family," and reached out to his cousin to pull the trigger. Be sure to click on over for even more twists.

"Cornhustler" Sen Nelson: NOT a Math Whiz

Had an interesting discussion the other day about miracles and what defines them. I had an issue with the specific example at hand, and observed that "if everything's a miracle, then nothing is."

So what does that have to do with rocket surgeon-cum-Senator Ben Nelson?

Just this:

"Under the terms of a deal Nelson cut with Senate leaders to secure his crucial vote for the health care package, Nebraska would be exempted from having to pay for the coverage of its new Medicaid enrollees ... Senator Nelson said it would be ‘fixed’ by extending the Cornhusker Kickback (100% federal payment) on Medicaid to every state."

Interesting hypothesis there, Ben.

So if we understand this correctly, every state, not just the one that sent you to the Senate, is eligible for this little "fix?" Would you then explain why Sen Harry Reid has a different take:

"You’ll find a number of states are treated differently than other states."

And:

"And if they don’t have something in it important to them, then it doesn’t speak well of them."

So which is it? Either Ben "Cornhustler" Nelson or Harry "Let's (Not) Make a Deal" Reid is, to put it nicely, obfuscating.

Frankly, that's not even the biggest problem with Big Ben's little tap-dance: to bring it 'round full circle, if every state gets the same deal, then, in reality, no state gets any deal, since (as we know) the gummint doesn't actually have any money - it simply takes money from us taxpayers who, of course, live in all the states.

But hey, it's only money, right?

Look for the Union Label (ObamaTax Schadenfreude Part Deux)

Politically astute readers already know that The ObamaTax had major Union backing, both financially and manpower-wise. Now that it's in full-swing, though, those same folks are experiencing a bit of buyer's remorse:

"Union leaders say many of the law's requirements will drive up the costs for their health-care plans and make unionized workers less competitive"

Ya think?

They're counting on their lower-paid member having access to the much-touted "subsidies" that promise to lower their net cost. But as Bob pointed out earlier today, these subsidies are often elusive, meaning that the very folks that The ObamaTax was ostensibly designed to help may feel its pinch the worst.

So what's a Union to do?

Ah, so glad you asked:

"A handful of unions say they already have examined whether it makes sense to shift workers off their current plans and onto private coverage subsidized by the government."

Here's a free clue, fellas: Yes, yes it does.

But the winner of the coveted "Rocket Surgeon Union Honcho" has to be John Wilhelm, the leader of Unite Here Health, who:

"recalls standing next to Barack Obama at a rally in Nevada when he was a 2008 presidential candidate.
"I heard him say, 'If you like your health plan, you can keep it,' " Mr. Wilhelm recalled. Mr. Wilhelm said he expects the administration will craft a solution so that employer health-care plans won't be hurt. "If I'm wrong, and the president does not intend to keep his word, I would have severe second thoughts about the law."

Might want to clean those specs, Mr W.

Customer Service ProTip

When you want/need customer service, don't curse at the agent.

One would think that this is obvious, but yesterday a former customer called asking/yelling/complaining about an older long term care policy. But he didn't make that clear to the receptionist, who transferred the "gentleman" to one of our auto/home agents, whom he began to berate and curse. She tried valiantly to ascertain what he needed, and finally understood that it was about his LTCi plan. She told him that he needed to talk to me, but that she wouldn't transfer him until he'd calmed down.

He continued to curse at her, so she hung up, and then buzzed me with a heads' up.

Sure enough, this rocket surgeon called back, and demanded to talk with me. I had already decided how to handle him. He immediately started in, insulting the CSR. I told him that I didn't appreciate his cursing my colleague, and that I would give him the phone number he needed and then I expected never to hear from him again.

At which point he very deliberately said "f*ck you" and hung up.

Without getting the information he needed.

Genius!

I have decided that if he calls back, he will be subject to my (just made up and completely arbitrary) $100 consulting fee, payable in cash, in advance.

Hope he calls.....

Friday Morning LinkFest

■ A few weeks ago, we mentioned that Cato Institute director of health policy studies Michael Cannon had fired a volley across the bow of the ObamneyCare© Exchanges. Now, at least one state is paying heed:

“I’ve suspended the talks on the Illinois insurance exchange until the Supreme Court makes its decision, which we expect in June,” Rep. Frank Mautino (D- Spring Valley, IL)"

How many of the other 57 states will follow his lead?

■ Last time we looked, LabCorp was in a heap o' trouble. And it seems that they still haven't bailed themselves out. FoIB Ania Kapla tips us that "[m]onths after U.S. senators requested financial documents in an investigation of how medical lab and insurance companies bill customers, LabCorp is the only company that hasn’t provided information to the Senate."

Blowing off the United States Senate? Is that really a smart business move?

■ FoIB Holly R sent along this interesting item:

" [O]ne place where handwriting persists is on medical prescriptions, and that’s unfortunate ... Studies show that errors are much less likely if a doctor clicks to select medications from an onscreen list"

There's a lot of tech out there that one would think might be up to the task, but so far there's no clear path to adoption.

■ From the "Poor Baby" Department, it just doesn't get any sweeter than this:

"IRS Wrestles with Coverage Reporting Rules ... The IRS is on track to be in charge of managing or helping with administration of many of the [ObamneyCare©] health coverage provisions ... [and] has issued one document, a tax return information disclosure rulemaking notice."

Bottom line: they, like HHS Secretary Shecantbeserious, are clueless.

■ Finally, a life insurance-related item:

"Genworth [Life Insurance Company] has announced that as of 5/07 they will no longer be selling 30 year term"

This just months after pulling their 15-year level term products. It also appears that their 10 and 20 year level term products will see major new-business premium increases shortly.

It doesn't take a rocket surgeon to divine why this is happening: with the economy in the doldrums, and no clear signs of relief, carriers can't count on major investment profits. And with term insurance rates currently at historic lows, there's not much in the way of underwriting profit to be had, either.

Rock, meet hard place.

Passive vs Active Mortality

A couple of months ago, we blogged on the fact that, among other failures, ObamaCare hasn't actually saved any lives, and that "public health trends since the implementation of the ACA have worsened."

Bad as that may be (and it is awful), it pretty much describes a status quo as regards pre-O'Care healthcare financing (insurance) and delivery.

But what if it's actually worse than this?

Well, thanks to FoIB Holly R, we learn that it is:

"Mortality Rates Suggests Obamacare Could Be Killing People ... equivalent to an excess 11,000 annual U.S. adult deaths relative to the pre-Obamacare steady state trends"

This despite correcting for the increasing death toll from the opioid crisis (and similar factors). In other words, ObamaCare has a body count:

Now, it's fair to say that we don't know which part of The ObamaTax is responsible for this spike, but I would argue that this is just another reason for its full repeal, not DC rocket surgeon tweaking; the stakes are just too high.

But maybe that's just me.

Stupid Mommy Tricks

Several years ago, we caused a kerfluffle with a series of posts explaining why IVF (In Vitro Fertilization) should not be covered by insurance. At the time, it never occured to us that we should have added "or by the taxpayer."

Ooops:

"A big share of the financial burden of raising Nadya Suleman’s 14 children could fall on the shoulders of California’s taxpayers."

Turns out, the young "lady" (who had already spawned 6 children) has been receiving gummint subsidies, at least in part because she is unemployed. For some reason, this rocket surgeon decided that having a slew of additional mouths to feed would be appropriate, and that it would also be appropriate for thee and me to pay for their care.

Perhaps the hardworking taxpayers of the Golden State (or should that be "Goldbrick" State?) had other plans for those dollars; alas, those tireless workers weren't consulted, only forced to pay up.

But wait, it gets better!

"(T)he hospital where the octuplets are expected to spend seven to 12 weeks has requested reimbursement from Medi-Cal, the state’s Medicaid program, for care of the premature babies, according to the Los Angeles Times. The cost has not been disclosed." [emphasis added]

Oh, great: a blank check!

The good news is that Ms Suleman "doesn’t consider the public assistance she receives to be welfare." Well good on her! After all, it's only important to consider what one calls it, not that one is expected to pay for it.

Surprisingly, "bloggers rained insults on Suleman." Gee, I wonder why?

If it walks like a duck...

It's probably not Gilbert Gottfired....er, uh, Gottfried.

Some of the more annoying TV commercials are from the the Aflac folks, known for their worksite marketing of specialty disability, critical illness and other policies. Apparently, the former rocket-surgeon-turned-washed-up comedian thought it would be a good idea to "tweet" a series of tasteless jokes about the earthquake/tsunami and its aftermath.

According to the WSJ, "70% to 75% of Aflac’s earnings come from Japan."

Ooops.

A Puzzling Crime [UPDATED & BUMPED]

[Scroll down for Update]

We've posted before about folks who concoct elaborate schemes in order to profit from another's death. It's against public policy (and, of course, the law) to profit from one's crimes. So if you're caught burning down your house, your insurance isn't paying off, and if you kill someone and get caught, you're not getting that sweet life insurance cash.

But there's another facet to this, and it has to do with underwriting.

Here's what I'm talking about:

In this story, tipped to us by FoIB Holly R, we learn about Joaquin Shadow Rams, who seems to have a habit of buying, and then collecting on, life insurance policies for his intended victims, including (allegedly) his mother and his girlfriend. And he might still get away with his most recent adventure:

"Prosecutors say Rams drowned his son after taking out more than $500,000 in life insurance on the boy."

Of course, Mr Rams is still entitled to his day in court, and that's fine, because I really want to focus not on the (alleged) murder itself, but on a much more curious item (from an insurance agent's viewpoint):

What rocket surgeon underwriter approved a half million dollars of life insurance on a toddler? Perhaps if the family name was Gates or Rockefeller, but here? I just don't see it. That just screams moral hazard.

I don't get it.

UPDATE: A Twitter buddy asked me "is it possible though he took out a whole bunch of smaller policies?"

Which is a really good question, because if there were a series of smaller plans, then theoretically the underwriter wouldn't necessarily know.

Here's where that falls apart, though:

When applying for insurance, one must list other plans already applied for or in-force, and then that particular plan is underwritten based on the sum of all those others, as well.

For example, Johny owns a $100,000 policy with Acme Life, and applies for $150,000 with Mutual of Podunk Life. The agent would have to use Podunk's underwriting requirements for $250,000.

Let's say, though, that the agent didn't know about the Acme plan, and the client didn't disclose it. That's called a material misrepresentation, and Podunk could deny the claim when Johny passes.

It gets better, though (for certain values of "better"): the Incontestibility Clause in a policy limits the amount of time that an insurer can contest a claim to the first two years. So it's possible that Mr Rams "jumped the gun" (so to speak) by not waiting until his son was at least 2 years old.

Oh what a tangled web...

(I've also reached out to my underwriter at our primary carrier to see if there's any circumstance where they'd approve $500,000 on a baby. I'll update again as appropriate)