Cavalcade of Risk - Submissions Due

Next week's C of R is on Wednesday the 5th, hosted by Trader Knowledge. Be sure to get your entry (either your own post, or someone else's) in by Monday the 3rd.

This is a great way to showcase your risk-related work, and it's easy to submit:

■ Via email,

■ At the Blog Carnival, or

■ At Ferdy's

Money Problems

When the 22-year-old son needed medical clearance before going off to law school, the mom called her excellent physician for a referral.

Oh! The doctor would begin taking new patients on July 1st!!!! Great, the son would like an appointment!

“What insurance does he have?”

Same as his mother. Blue Cross PPO.

Nevermind.

The doctor is no longer taking patients with Blue Cross insurance.

WTF?

“Oh yes, their reimbursement rates are horrible now. They hardly pay for anything after the initial $15.00 co-pay by the patient.”

Drum Roll Please . . .

Guess which state has the highest per capita costs for health care?

According to CMS, per-person costs in Massachusetts in 2004 were $7,075, compared with a national average of $5,313

This is the same state that introduced mandated health insurance for all.

The report also said the state's plan to expand health coverage to uninsured residents could be jeopardized by high costs.

Uh-huh . . .

Premium Increases

It's costing more to get coverage at the doctor's office and you wanted to know why. You asked us to check into the big health care bills and find out why health insurance keeps going up. That's this week's "You're the Boss."

In the past five years, the cost of health care has jumped 79 percent. The cost of both Medicare and Medicaid is going up, plus millions of Americans are uninsured.

Note the response here.

The cost of health CARE has jumped 79%.

Not the cost of administering health insurance.

Not the profits of carriers.

But the cost of actually CARING for those with medical needs.

Still, in its last fiscal year, Good Sam picked up a tab of more than $2-million for patients who couldn't pay

That’s a major shortfall. When others don’t pay their fair share the rest of us are stiffed with the tab.

Latest Health Wonk Review

The HWR continues to grow, and this edition is packed with over a dozen interesting entries. Our host, Jack Mason at HealthNex (for whom I subbed a while back), has done a terrific job: grouping posts according to subject, and including helpful reviews of each one.

The folks at Workers Comp Insider have a timely post about a WC claim that made it all the way to the Supreme Court. I found it quite relevant, because the outcome of this case will impact the health insurance industry, as well.

True Cost of Disability

When Cliff Sorrell of Decatur had to go on disability from his job as a laborer, his family's health insurance skyrocketed from $800 every three months to $2,300.

Between his and his wife's income, they could not afford health insurance for their two children, Cody, 7, and Indya, 5.

In the full year that their children were uninsured, the Sorrells were forced to take out loans from their bank to pay the out-of-pocket expenses of medical bills. However, with a few clicks of the computer mouse in January, Cliff Sorrell discovered that his children were eligible for the newest program of health insurance in Illinois.


Under All Kids, families will be required to pay a premium based on their yearly income, and a co-pay for doctors' visits. There is no charge for yearly checkups and immunizations. Based on the Sorrells income of between $40,000 and $60,000 a year, they will pay $80 a month for both children to be insured, and a co-pay of $10 for each visit to the doctor.

VA Pool

Governor Timothy M. Kaine signed a General Assembly bill on June 20 that allows small businesses to collectively purchase health insurance, demonstrating Virginia’s bipartisan efforts to find common-sense solutions to address health care concerns among leaders of the state’s small business community.

House Bill 761 authorizes small businesses, defined as those with fewer than 50 employees, to join together to purchase health insurance coverage for their employees. The legislation also allows small businesses that currently have a coverage plan to increase health insurance options for their employees

CHIP, AHP, MEWA . . . no matter what you call it the end result is the same.

New entrants come in to the plan when it is first established and rates are attractive. As the pool matures and rates start to climb the "good" risks leave for a better deal and the "poor" risks remain. This drives up claims, which in turn drives up premiums even more.

Eventually the plan implodes.

There are ways to minimize or prevent the ultimate collapse but no one ever does what is required to prevent it.

Government Intrusion

A celebration would be premature, but an end-of-session agreement between the state Senate and Assembly has brought New York an important step closer to requiring that mental illness get the same insurance protection afforded physical illnesses.

For more than four years, advocates have pushed for passage of Timothy's Law, insurance-parity legislation named for 12-year-old Timothy O'Clair, a Schenectady boy who committed suicide in 2001 after his parents were forced to give up custody so he could qualify for state-paid mental-health treatment. The family's insurance coverage did not cover his needs.

While this is indeed a tragic situation, one has to ask why the parents did not take responsibility and pay for the needed treatment. Several states have enacted so-called mental health parity laws that require carriers to cover mental illness as any other disease. Every time new mandates appear rates increase.

The boy's father, Tom O'Clair, heralded the agreement reached late Friday by the two houses of the state Legislature. The legislation requires health-insurance policies to provide at least 30 inpatient and 20 outpatient visits for all mental-health treatment, lowering co-pays that can now be excessive for mental-health treatment. The bill lists specific adult and childhood disorders that would receive unlimited benefits.

The measure has consistently gotten strong support in the Assembly. What has stopped it has been the Senate's concern that the extra insurance cost would put an unacceptable burden on small businesses. The agreement calls for the state to cover the extra cost for businesses with 50 or fewer employees.

At least the cost factor has been considered. Of course the question is, how valid are the assumptions?

Most disappointing for the advocates, the legislation does not cover addictions

At least there are some attempts to curb costs.

More Buckeye Shenanigans

In recent weeks, we’ve reported on a number of cases of (apparent) agent malfeasance. Courtesy of a good friend (and colleague; Thanks, Pete!), we learn that the issues are far from resolved:

"If you’re paying an insurance broker to find the best group policy for your employees, should the broker be allowed to collect a commission from the company you select? If so, shouldn’t he at least have to tell you that he is working on commission?"

The answer, of course, is Yes. Interestingly, though, only the former is a matter of law. "Full disclosure" means something contra-common sense here in the home of the Reds and "The Tribe." One would think, after the very public disclosures of the two above-referenced cases, and the penalities levied against the carriers, that some legal reinforcements would be on the way.

One would be wrong:

"Nor has the department had any luck finding a lawmaker willing to sponsor a bill that would require insurance brokers to disclose to their customers such third-party payments."

It's obviously in the clients' best interests for such protection to be in place, but implementing such safeguards may not be as simple as it would appear. For one thing, such a bill would have to be broad enough in scope to cover all the various permutations of such arrangeements, but narrow enough that it doesn't hinder the agents' ability to make a living. Incentives can also help the client: currently, the two 800 pound gorilla's (UHC and Anthem) dominate the market. One way other carriers can begin leveling the playing field is by encouraging agents to more aggressively promote them.

Competition is healthy. Obfuscation is not.

UPDATE: Kathie Bracy has a related post, asking if the State Teachers' Retirement System is involved in this brouhaha. Ripples and eddy's.

Fat Chance

Overweight? It’s not your fault.

Potential contributors to obesity besides diet and exercise, and concluded there was at least some support for 10:

1. Inadequate sleep. (Average sleep amounts have fallen, and many studies tie sleep deprivation to weight gain.)

2. Endocrine disruptors, which are substances in some foods that may alter fats in the body.

3. Nice temperatures. (Air conditioning and heating limit calories burned from sweating and shivering.)

4. Fewer people smoking. (Less appetite suppression.)

5. Medicines that cause weight gain.

6. Population changes. (More middle-agers and Hispanics, who have higher obesity rates.)

7. Older birth moms. (That correlates with heavier children).

8. Genetic influences during pregnancy.

9. Darwinian natural selection. (Fat people outsurvive skinny ones).

10. Assortative mating, or "like mating with like," as Allison puts it. Translation: fat people procreating with others of the same body type, gradually skewing the population toward the heavy end.

And now for something completely different...

In looking through our logs, I saw that we've had a visitor from this site. It's fun, and interesting, and eye-opening.

Take a look.

Mazel Tov, Joe!

FoIB Joe Kristan has been named as a Best Blog by Tick Marks:

"Tax blogs are primarily written by attorneys, but there is a significant number of accountants who write tax blogs...My four blogs in this category that I read most frequently presently would be: Roth CPA Updates (Joe Kristan)"

Way to go, Joe!

Your Next Doctor May Not Be

Marguerite Harris and her staff of eight provide prenatal care and child immunizations, write prescriptions, and diagnose and treat ailments from diabetes to the sniffles.

Though it may sound like a typical doctor’s office, no one on staff at Project Salud is a doctor. The medical center is run by nurse practitioners — registered nurses with specialized training and advanced degrees — whose numbers have risen from 30,000 in 1990 to 115,000 today.

When PCP’s get squeezed often someone new steps in to treat the routine illness. Your next doctor may not have M.D. after their name but rather P.A. or N.P.

More doctors are choosing something other than primary care, opting instead for the more lucrative specialties. A specialist generally earns considerably more and works fewer hours.

Given this trend, your next doctor may not be a doctor. Paging Maria Welby?

(Authors note: I recognize the fact that N.P.'s and P.A.'s are and can be either gender. The last comment was to simply make a point and not intended as sexist).

Super Grand Rounds

Our host for Grand Rounds this week, Dr Stuart Henochowicz, has organized almost 40 entries, assigned each to a general topic, and provided interesting and helpful capsule summaries of each one. WoW!

Dr Rob Lamberts, posting over at Healthy Voices, has an interesting, provocative but ultimately informative article about dietary supplements. This is a $14 billion industry, which is largely unregulated. Recommended.

Just Swell...

In what may (or may not) be a harbinger of the times, installation of (and enrollment in) self-funded (S-F) plans seems to be on the rise:

According to Benefit News (an industry newsletter), there has been a dramatic rise in the popularity of such plans. Interestingly, this seems to be an "across the board" increase: affecting pretty much every permutation of product design, including (apparently for the first time) Consumer Driven Plans.

What does this mean?

Good question [ed: thanx!].

First, let's examine how S-F plans work. S-F plans are a way for employers to purchase health care insurance. Typically, an employer pays $x to an insurer, which administers the plan and pays the claims. The premium is fixed for a period of time (almost always a year), at which time the premiums are reevaluated (Latin for "jacked up"). At the end of the year, one of two things will have occurred: the claims will have greater than the premiums paid in, in which case the employer owes the insurer: zilch. Or, the claims will have been less than the premium, in which case the insurer will refund: zilch. Pretty simple.

With S-F plans, the employer agrees to pay for the first $x, and will turn to the insurer only if the actual claims exceed this previously agreed-to amount. The idea is that the premiums are lower, because the employer has, in effect, chosen a VERY high deductible. Again, two eventualities are possible: claims are less than expected, so the employer saved money. Or, claims are higher than expected, and the employer will owe the insurer some cash [ed: this is a highly abbreviated explanation of self-funding].

Employers who choose the S-F route do so because they believe that it will save them money. And apparently, a lot of employers must feel this way, because a lot more of them are choosing S-F. Whether or not they are correct, of course, only time will tell.

UPDATE: Please be sure to read the comments for additional factors that make S-F attractive.

Monday's Money

The Carnival of the Capitalists is up at Financial Methods blog. With 60 entries, that must be some kind of record! Divvied up into helpful categories, it's easy to "follow the money."

Bob has blogged before about the sometime hidden dangers inherent in regulating specific businesses. The Boring Made Dull (catchy, no?) has a related post, which guages the economic impact in real dollars.

And the Carnival of Personal Finance is also up, hosted this week by Mighty Bargain Hunter. It weighs in with 51 submissions, bulletpointed (?) and summarized.

Single Ma relates a funny, frustrating, enlightening and utterly fascinating experience in her quest for high-speed internet service. Way to go, SM!

Insurance Dispatch...

This week's column is up over at The Medical Blog Network. Using a real life example, we look at High Deductible vs Co-Pay plans.

Enjoy!

(Really) Cool Insurance News

Our friend Chris Parks, over at MedBill Advisor, has an interesting, and provocative, idea:

Med Bill Manager is a web-based tool that folks with HDHP's can use to help sort out what they really owe a provider. It's still in "beta," but you can get a rough idea of how it will work by clicking the link. Chris has been working with another FoIB, [Redacted], as he gets this new program up and running.

Perhaps the best part is the cost of this service: nada. Wow, a free tool to help save money. That surely has legs.

(Really) Strange Insurance News

I've always maintained that one can insure anything, so long as money (the premium) is no object.

Apparently, I have been wrong:

"Insurers have withdrawn the cover on their virginity taken out by three sisters in the event of the second coming of Christ"

Seems that the sisters purchased insurance against this unlikely event some 6 years ago. The policy, written for 1 million pounds (approximately $1.8 million), was "meant to pay for the cost of bringing up Christ if one of them has a virgin birth." The premiums for this unusual policy were about $180 per year, and was actually donated to charity by the underwriter.

As I have no horse in this race, I suppose that I should have no opinion either way. And, truth be told, I am ambivalent about it:

On the one hand, it seems to me that, if the policyholders were willing to pay the premium, where was the harm?

On the other hand, this seems (in my admittedly uninformed opinion) to be potentially offensive to my Christian friends.

Either way, this is one of the strangest insurance schemes I've ever seen.

Laser Rip

Smokers who pay hundreds of dollars to be zapped by lasers purported to help them quit are victims of fraud, a watchdog group alleged Thursday in seeking a federal crackdown.

Public Citizen petitioned the Food and Drug Administration to halt five companies from promoting low-power laser therapy for smoking cessation. The companies do not have FDA clearance to market the lasers for that purpose, nor is there any scientific evidence they are safe or effective, said Dr. Sidney Wolfe, director of Public Citizen's Health Research Group.

Somehow this does not surprise me.

The companies claim laser therapy triggers the release of endorphins, or the body's natural painkillers, that can help smokers cope with withdrawal.

Wonder if it does anything to reduce the pain of being ripped for $349?

Book 'em Dano

The U.S. Labor Department said Wednesday that it has obtained a consent order against a Coeur d'Alene health-insurance benefit-plan management company.

The department said ePEO Link Inc. Group Accident and Health ERISA Medical Care Plan, and its principals, will be barred from serving as fiduciaries or service providers to any employee benefit plan governed by the federal Employee Retirement Income Security Act, or ERISA.

A settlement will result in payment of $2.37 million toward the ePEO Link plan's unpaid health claims, Labor Secretary Elaine L. Chao said.

"The defendants' misconduct caused workers and their families to be burdened with millions of dollars in unpaid health claims," Chao said. "I am pleased that the court barred the defendants from ever again being in a position to harm workers by mismanaging employee benefit plans."

And . . .

The ePEO Link health plan provided health benefit services as a multiple employer welfare arrangement (MEWA) to approximately 1,500 employees of participating employers in 22 states. The department sued ePEO Link and IPIS in 2005, alleging that the defendants failed to properly evaluate and underwrite benefits, collect sufficient contributions to pay promised benefits, adequately fund the plan and maintain reserves, obtain appropriate reinsurance and maintain plan reports and records required by the plan. Olmstead was separately charged with receiving commissions from the plan's contracts with re-insurers

What’cha gonna do?

For all the talk about Consumer Driven Health Care, the first step must be for the Consumer to want to take the wheel.

Unfortunately, it seems that many of us never got the memo:

“The [Great-West Healthcare] 2006 survey shows one in four consumers has set aside no money to pay for health care expenses, while only 39 percent have saved more than $1,000 and just 28 percent more than $2,000...Additionally, only 5 percent have used online cost or quality comparison tools, and just as few people associate the concept of responsibility with CDHPs [Consumer Driven Health Plans]."

In other words, of the 1,000 working adults (ages 18 to 64 – thus excluding Sir Paul), most have just not bought into the notion that there must be some personal responsibility for the cost of our care. Compared with a similar survey done last year, the researchers found that these folks are a little better at guesstimating the cost of health care, but are generally unaware of the real cost of it.

Apparently, less than 1 in 5 of this year’s participants claimed that they had learned the cost of medical treatment either before or at the time of treatment. This is disheartening, because it represents a 5% drop from last year, down from 22% in 2005.

Some of that, of course, rests with providers and insurers: if there is to be cost awareness, then consumers must have tools available to enlighten themselves. Thus, transparency rears its head. True, more carriers are buying into the idea, and at least going through the motions of providing access to this information. But until this is seamless and ubiquitous, I suspect that next year's survey will echo this one.

Also discouraging is the news that less than 2/3 of those surveyed believe that they can improve their own health, and thus mitigate costs, by adopting a healthier lifestyle. I’m not sure why that’s the case: we’re bombarded with that message 24/7: in print, on TV and radio, and of course here on the InterWeb.

Food for thought.

Price Controls

Time is running out for the Senate to act on a key bill to protect small businesses from another year of double-digit health insurance premium increases.

Currently, health insurance rates for small businesses are unregulated. Until 2000, all rate increases of more than 10 percent were subject to prior approval by the Insurance Department, and regulators used this oversight authority on many occasions to reduce and even reject some increases outright as unwarranted.

Price controls simply don’t work.

They never have. They never will.

When a carrier is constrained by law from increasing rates to a level that will profitably support the risk several things happen.

Benefits are reduced either explicitly or implicitly. Explicit reductions occur when the policy is restructured in such a way as to remove benefits that are high cost items. Implicit reductions occur when pre and post-sale underwriting and claim review intensifies. Implicit reductions lead to fewer policies being sold, and more policies and claims rejected post-sale.

Another way to deal with price controls on renewals is to increase new business rates. When this happens the healthier risks are priced out of the market along with the poor risks.

Carriers can also simply withdraw from the market. Either they leave the state entirely or stop writing the lines of business that are no longer profitable due to government constraints.

When the government interferes with market forces the overall result is fewer choices and higher prices.

Fighting Back: An Update

As you may recall, one of my carriers has put in place a “freeze,” prohibiting agents from freely choosing with whom they do business (click here for details). When last we discussed this, I was awaiting an opportunity to discuss the situation with the Attorney General’s office.

That opportunity knocked yesterday. In a conference call arranged by my state rep’s able assistant, I had the pleasure of speaking, for about 45 or 50 minutes, with an attorney in the Anti-Trust office.

And it was a very interesting conversation.

First, she asked me to explain for her the nature and significance of the problem, which I did [ed: why didn’t you point her to the blog post, smart guy?]. She then asked a number of probing questions:

■ Is this switching very common? Is it an easy or difficult process? I told her that, as far as I am aware, it is not a very common practice; that is, I don’t know a lot of agents who switch around often. It does seem like a fairly easy process, though: just sign a form (much like an Agent of Record letter that a client might use).

■ Could an agent have more than one GA (General Agent)? Yes, but not for the same carrier. That is, perhaps GA #1 offers access to XYZ Mutual and ABC Life, while GA #2 offers Anon Life and ASAP Health. I could sign up with both of them, because each offers different carriers.

■ Are GA’s local, regional, or national? I’m not aware of national GA’s, at least in the types of insurance I generally sell.

■ Do I think that several GA’s got together and pressured the carrier to put the freeze in place? That was, as they say, the “money question.” I knew immediately that she was looking for evidence of conspiracy. The problem is that, really, I have no such evidence, merely speculation and logic. I explained to her that, much as I’d like to help on that issue, I really had no proof that this was the case. Of course, it’s the most logical explanation, but that’s not the same thing. Still, since it’s a possibility, perhaps she can use that.

I certainly hope so.

■ Do other carriers have such restrictions? Another great question, on a number of levels. Unfortunately, I didn’t know the answer, but promised to get it for her as quickly as I could.

By the way, here’s why I couldn’t answer that one: I cannot imagine a scenario where I would want to switch GA’s. I’ve had a terrific working relationship with my current GA for almost 10 years, and have no desire or reason to switch. BUT, it is appalling to me that a carrier could prohibit me from doing so.

Since I’ve had no (recent) experience in switching, I didn’t know whether or not other carriers also had a freeze on. The only reason I knew about this one was because a colleague had called to ask me about it, and I subsequently received a letter which confirmed it.

And so, I called my own GA, and asked them. Currently, none of their other carriers have such a freeze, although others have had, in the past. I’ll pass this information on to the Attorney General’s office, and await further developments. She did, however, ask me to send her a copy of the letter, which I promptly did.

Toward the end of my conversation with the AG, the subject of what outcome I’d like to see came up. That, too, is a good question. I thought for a moment, and answered that I really didn’t want “heads to roll;” rather, a simple cease-and-desist would be just fine. In other words, all I really want is for the AG to tell the carrier that this is wrong, and to stop it (and, of course, refrain from any future such freezes).

See, I’m not unreasonable. Just stubborn.

Cavalcade of Risk, #2

The second edition of the C of R is now up, presented by It's Just Money. As usual, it's an interesting and diverse group of posts, ranging from insurance to sunscreen. Best of all, each post is accompanied by LA Money Guy's summary.

Perhaps the most unusual is this post from Jeffrey at FoIB Personal Financial Advice. Having occasionally seen this show, I can see why he's hooked. I must confess, though, that I never made the connection between a game show and risk management. Very interesting.

You can learn more about the Cavalcade, including a schedule of upcoming hosts, at the C of R homepage.

S.F. Weighs In

The latest venture in public health care comes from the Golden Gate city.

Mayor Gavin Newsom unveiled a proposal today that would make San Francisco the first city in the country to provide health care for all of its uninsured residents through a plan that covers everything from patient doctor visits and surgeries to prescription drugs.

San Francisco's estimated 82,000 uninsured residents who typically go to public clinics and hospitals for treatment would be covered under the plan, dubbed the San Francisco Health Access Program

This is not insurance, but a public access plan.

The plan differs from other proposals because it is not health insurance. Those who sign up would have access to care only in San Francisco and, despite paying monthly premiums, would not be covered by the plan if they sought treatment outside the city limits.

And the estimated cost?

The estimated $200 million-a-year price tag, or $2,400 per person, would be paid for through a combination of sources, including tax dollars, local business contributions and the payment of individual premiums

Details are sketchy, but a quick check of health insurance pricing in the bay area shows a 20 year old male in good health can obtain a plan with no deductible, no coinsurance and $25 copays for $188 per month. The plan covers everything in the HMO service area with an out of pocket limit of $2500 per person per year.

At the risk of sounding skeptical, the S.F. plan appears on the surface to have understated the cost of providing care. Details on the actual benefits are not provided but it seems as if anyone who can fog a mirror would be covered and the only out of pocket expense would be the monthly premium.

Approximately two thirds of the funding comes from taxpayers, the remaining one third from premiums. That means anyone can have this cover for about $70 per month.

If this happens, I give it 3 years before it starts to come apart at the seams.

Grand Rounds Today...

Hosted by Dr. Deborah Serani, a psychiatrist-cum-blogger. She posts at her eponymously named blog, and has done a terrific job organizing and highlighting 45 submissions. I also like the way she grouped them in a sort of movie storyboard motif, and appreciate that each "clip" has a note explaining its subject and significance.

Interested Participant contributed this compelling post about the British version of the AMA, which organization seems to condone, if not encourage, "non-voluntary" euthenasia. Talk about slippery slopes.

While You Are in There . . .

A lawyer for a Santa Fe man who accuses an orthopedic surgeon of misdiagnosing his kidney ailment said he hasn't been able to serve the doctor with a malpractice complaint because the doctor moves around as a medical-circuit rider.

Traveling docs (and nurses) are becoming common place. I have a client who is a trauma doc and travels to 6 states working in various emergency rooms.

Stephen Gables, a 41-year-old Santa Fe computer specialist, says in a complaint filed May 4 that Schillen treated him for a fracture to the lower right leg at St. Vincent Regional Medical Center in November 2004.

Blood tests indicated Gables had "critically low levels of calcium" and other symptoms that, the complaint says, should "have led to the diagnosis of a condition known as primary focal and segmental glomerulosclerosis ... which, if left untreated, will progressively become worse and ultimately be terminal."

The failure to diagnose the condition means that Gables "is now facing complete kidney failure and the probability of a kidney transplant," the complaint says.

I do find it curious that an orthopod was expected to make a diagnosis that is clearly outside the domain of his specialty.

According to sources, the diagnosis of glomerulosclerosis is done via urinalysis . . . a procedure not normally done during treatment of a fracture.

So doc, while you are fixing my leg, how about checking out my stomach too. I have been having problems when I eat Mexican food.

Sauce for the Goose...

Interesting post over at Marketplace, MD:

“In support of consumer-directed health care and an end to the mystery of medical prices, the American Medical Association (AMA) today called on the health insurance industry to end efforts to conceal their pricing systems for medical services.”

Bravo! Transparency, as we’ve noted many times here at IB, is necessary if folks are to become more proactive in their consumption of healthcare.

I’m having trouble, though, finding the corresponding AMA resolution requiring doc’s to prominently post their prices above the receptionist.

It must be there, somewhere.

Right?

More Healthful Food News...

Who says you can’t eat your cake and have it, too? In this case, of course, we must be referring to chocolate cake, perhaps made with Nestle’s brand chocolate:

“In a move that recognizes the modern world's twin obsessions — indulgence and guilt — chocolate maker Nestle said Monday it would purchase weight loss product maker Jenny Craig Inc. for $600 million.”

That’s right, the giant food conglomerate has us now, coming and going. We can indulge our sweet teeth, and then shed those unwanted pounds (and inches) when we’re sated.

If nothing else, one must applaud the company for its ingenious (if somewhat cynical) marketing synergy.

Just one more step toward the new food pyramid.

Just One More Reason . . .

Drunk driving. Don’t do it.

Besides all the obvious reasons here is one more to add to your list. All health insurance policies have provisions that allow them to deny claims that fall in to certain categories. The majority of the denials have to do with procedures that are not medically necessary. These would be things such as plastic surgery to reshape your body or face for the simple reason that you don’t like what you see in the mirror. There are also denials of benefits for intentional self inflicted injury, whether sane or insane; and there is denial of benefits for injury sustained while committing a felony.

Most people think of this as getting shot while robbing a liquor store. That will certainly qualify but that is not the only felony situation.

How about accidental overdose while using Class A narcotics? In many jurisdictions simple possession of drug paraphernalia is a felony.

So is DUI.

In some places a DUI alone is a felony. In most places, if someone else is injured or killed, that will almost certainly lead to felony charges.

A felony conviction can result in denial of your health insurance benefits.

Think about it.

Quite Sunny Money Monday

It's days like this that makes me regret that I'm one of the six insurance agents in the known universe that doesn't play golf. Oh well...

The Anniversary Edition of the Carnival of Personal Finance is up, hosted by the folks at Consumerism Commentary (the carnival's founders). It's an especially interesting mix this week, because folks were asked to submit both a "regular" post and a favorite from the past year.

My favorite this week comes from the Holistic Economy blog, with this post about a new type of savings plan called an Individual Development Account. Very interesting.

And this week's Carnival of the Capitalists is hosted by Blog Business World, which collected, and organized, almost 50 posts!

A lot of folks in my industry back the estate tax. Joe Kristan at Roth & Co agrees that it's necessary, but suggests a better model.

Another First...

My debut column at The Medical Blog Network is now up. The plan is for one every Sunday, so wish me luck.

Happy Father’s Day!

Cavalcade of Risk: Nudge

The next Cavalcade of Risk is next Wednesday (the 21st) at It's Just Money. Submissions are due by Monday evening (June 19th):

■ Via email,

■ At the Blog Carnival, or

■ At Ferdy's

Check the C of R site for updates and schedules.

Our debut edition was great, please help out our hosts by submitting your great posts (or someone else's). Thanks!

IED

Disease mongering has reached a new level of ridiculousness with the widely-reported announcement that millions of American now have undiagnosed Road Rage Disorder, also sometimes called Intermittent Explosive Disorder(IED). Desperate to scrounge up new diseases that can be treated with high-profit prescription drugs, Big Pharma and its disease-pushing sidekick, psychiatry, is now pulling diseases out of thin air, making them up as it goes along, and hoping enough impressionable consumers (and journalists) can be hoodwinked into thinking every fictitious disease is actually real.

Road Rage Disorder is merely the latest disease quackery drummed up by the pharmaceutical industry. Many people don't know this, but Big Pharma actually hires psychiatrists to invent, then publicize new "diseases." They actually sit around in rooms, brainstorming new disease ideas and figuring out how to convince the public that those diseases exist. That's where they come up with junk science statements like, "This is the most common disease you've never heard of!"



This is how we get Road Rage Disorder, Restless Legs Syndrome (an extremely rare condition that drug companies are now trying to push onto half the population) and even the idea that menstruation is now a "disorder" that can be treated with drugs to stop a woman's natural cycles from being expressed. Merely being a woman, apparently, is a state of ongoing disease and biological dysfunction according to Big Pharma's disease pushers.

It's so outrageous, and based on such obvious non-scientific psychobabble, that only a complete fool would actually buy into it. Yet the public, the FDA and the mainstream media are currently exhibiting zero skepticism about these wholly fictitious diseases. Newspapers, magazines and broadcast news programs continue parroting headlines and press release handed to them by the public relations firms bankrolled by Big Pharma. There is no science here; no scrutiny, no genuine journalism and nothing resembling "evidence-based medicine." It's just plain old hucksterism dressed up to look like a mental health discovery.

Got angry? You have a mental disorder.

You will have to excuse me while I go run someone off the road . . .

ER is Dying

The U.S. emergency medical system is in critical condition and on life support -- overburdened, under-funded, and highly fragmented, according to three new reports released Wednesday by the Institute of Medicine (IOM).

According to the reports, ambulances are being turned away from emergency departments and patients can wait hours or even days for a hospital bed.
Longer waits, less availability of services.

Why do we have this problem?

Insufficient funding and uncompensated care have taken a toll on the capacity of the emergency medical system.

Hospitals are prohibited from turning away patients who need emergency care, regardless of their ability to pay. The 17% of the population that is uninsured is creating a financial burden on a system that is already in crisis. And as we know, about 60% of those who are uninsured have the means to obtain coverage, they simply refuse to take responsibility.

In 2003, emergency departments saw nearly 114 million patients -- a 26 percent increase over the previous decade -- but during the same 10 years the United States lost 703 hospitals and 425 emergency departments, one report noted.

More patients spread over fewer facilities. This is a recipe for disaster.

A growing number of uninsured Americans are looking to emergency departments as their health care "safety net," and much of this care is never paid for.
ER’s were never designed to be a primary care provider.

So what is the solution?

The reports urges Congress to allocate $50 million to reimburse hospitals for uncompensated emergency and trauma care and to increase funding to provide hospitals with resources needed to handle disaster situations.

Well of course! Completely abandon personal responsibility and abdicate that role to the government. Of course the government really doesn’t have any money to allocate. What they can do is steal these funds from the taxpayer and redistribute the wealth to those who would rather buy a plasma TV than health insurance.

NOTE: Bob, prescient as always, also blogged on this a few weeks ago, with other interesting stats and perspectives.

A Wonktastic Review

FoIB Julie Ferguson, of Workers Comp Insider, hosts this week's Health Wonk Review. I've despaired of late at recent "carnival" hosts who simply post links. Julie has done an exemplary job of providing enough information to make each post a "gotta click," without giving away the store. Bravo!

There were a number of interesting posts, but I especially liked Joe Paduda's slap-down of both insurers and providers; seems that at least one carrier pays less for a procedure done in-patient as opposed to out, in an effort to micromanage care.

More onto the Plate...

Apparently, I just have too much free time.

So, in an effort to resolve that problem, I have agreed to take on another task:

Dmitriy Kruglyak has started the Medical Blog Network, the purpose of which is to spur the transformation of the healthcare industry. TMBN is a sort of super-aggregator of medical news, analysis and commentary, and has already created a sizeable "buzz" in the blogosphere.

In addition to the website, there is a weekly digest, available by (free) subscription.

So what does all this have to do with lil ol' me?

I have been invited to contribute weekly articles as a Featured Columnist. I'll be writing about insurance [ed: dunh!], focusing primarily on Consumer Driven Health Care.

My first column will be available on Sunday, and I'll post a link to it here.

Since this is a weekly "gig," I don't anticipate that it will impact IB (other than introducing new readers to us). On the other hand, I'll be tackling some new issues, so that it won't be a re-hash of my work here.

Wish me luck! [ed: he'll need it.]

Adventures in (Consumer Driven) Health Care

Three interesting stories illustrate that, whatever the ultimate outcome of CDHC turns out to be (boom or bust), the industry is at least giving it a shot.

As you may recall, we've discussed Aetna's transparency pilot program before. At the time, I expressed my hope that the program would be expanded to other venues.

Well, looks like they listened to me [ed: yeah, right!]:

"Aetna today announced that it is enhancing its industry-leading health transparency initiatives to help consumers make informed health care decisions based on the actual costs of care and the clinical quality and efficiency of physicians...Aetna will provide online access to physician-specific cost, clinical quality and efficiency information in select markets, including:

■ Connecticut

■ Washington, D.C.

■ Northern Virginia

■ Maryland

■ Cincinnati, Cleveland, Columbus, Dayton and Springfield, Ohio

■ Northern Kentucky

■ Southeast Indiana

■ South Florida

■ Kansas City, Kan. and Mo.

■ Las Vegas

■ Pittsburgh, Pa."

It's nice to see that program expanding. Of course, the true test will be if (and when) other carriers follow suit. Right now, it's a novelty, perhaps even a marketing gimmick. But as such information becomes more and more readily available, the pressure on other carriers to launch their own transparency initiatives should become quite powerful.

Transparency, though, is but one facet of CDHC. Plan design and popularity are more accurate indicators of market penetration. United HealthCare has seen the ranks of its CDHC plan membership swell recently. According to UHC, "consumer-driven health plan members surpassed 1.75 million people recently. The company has a little more than 710,000 people enrolled in health savings accounts and another one million and change in health reimbursement accounts." [ed: link not yet available] That represents an increase in HSA/HRA participation of some 75%. And that's without a transparency program like Aetna's.

But the “acid test” is whether, after all of the hype (or maybe because of it), do HDHP’s (High Deductible Health Plans) really save money?

According to a report offered by eHealthInsurance, health savings accounts seem to be accomplishing two worthy goals: lower premiums and a fewer uninsured folks. Last year, apparently, consumers paid (on average) about 17% less for individual plans than the year before. And eHealthInsurance says that almost half of the folks who bought their HDHP’s had been previously uninsured. Kudos!

If there’s any real downside, it’s that agents and brokers still aren’t sold on the idea. How can they be, when almost half of us "can't make a cogent argument for or against them.”

Interesting developments.

La Plus Ca Change...

A very good friend shared this with me. It's a newspaper clipping warning of the dangers we face every day.

I won't tell you when it was published (yet).

You guess (click here to enlarge):

UPDATE: Okay, I think it's fixed. When you "click to enlarge," you'll see a little "gizmo" that lets you move or enlarge the picture. Thanx, Bob!

Time for Grand Rounds

Our host this week is (Navy) Lieutenant Niels Olson. Neils is a med student at Tulane University, and blogs at The Haversian Canal. With over 40 entries, it's quite a list.

My favorite came from David Williams at the Health Business Blog. In it, David explores some problems with cancer treatment protocols.

Money Monday

The Carnival of Personal Finance is up and running at Financial Fruition. Our host has posted over 40 links. In keeping, I suppose, with the "new trend," there is no context: it's simply a collection of links (they are alphabetized, however). Looks like I'll have to get used to that.

I especially liked this post at It's Just Money (the next host of the Cavalcade of Risk), exploring some of the benefits of recycling.

This week's Carnival of the Capitalists, on the other hand, is a treat! Our host, Mike, is a (very mature) 15 year old investor, who has aggregated 42 posts, complete with summaries. All the more remarkable, because he stepped in for this week's scheduled host.

Because I tend to keep things bottled up, this post at Entrepreneur's Journey was most welcome. Yaro, from Down Under, has some great perspectives and tips on managing stress.

Good news, bad news...

In our on-going (albeit sporadic) efforts to highlight advances in nutrition and health, we try to bring you the very latest and most important such discoveries. So I was pleased to read that:

"A main ingredient in beer may help prevent prostate cancer and enlargement, according to a new study."

Of course, the temptation is to stop right there, but alas, there's bad news, as well:

"(R)esearchers say don't rush out to stock the refrigerator because the ingredient is present in such small amounts that a person would have to drink more than 17 beers to benefit."

[ed: I thought you said there was bad news]

According to researchers, the hops in beer contains something called "xanthohumol," which affects a particular protein in the prostate. This protein is believed to be a "trigger" for prostate cancer, which (according to the CDC) is the most common form of cancer among men in the US. It's also one of the leading causes of death among men, as well.

The researchers are hopeful that big pharma will now look into synthesizing or reproducing the compound, providing an alternative treatment regimen.

I do have one question, however: how do I sign up to help with this research (the beer drinking part)?

UPDATE: And for what is beer the natural accompaniment?

"Researchers claim eating pizza regularly reduced the risk of developing oesophageal cancer by 59%. The risk of developing colon cancer also fell by 26% and mouth cancer by 34%"

Apparently, tomatoes contain a naturally occuring antioxidant called "lycopene." The idea is that, in addition to giving the 'maters their beautiful red color, it may provide protection against certain cancers.

Of course, the jury's still out on all this, but I'm picturing the new food pyramid.

Insure Montana

Margit Arthun was leery when she first heard about the state's new insurance program. If something sounds too good to be true, it usually is, she said.

Addendum: If it originates with government there is a tax increase in the works somewhere.

Arthun, who manages Stillwater Mercantile's lumberyard in Columbus, is one of 3,300 Montanans benefiting from Insure Montana, an insurance program funded by a $1-a-pack cigarette tax. Authorized by the 2005 Legislature, the program offers two ways for small-business employers and employees to save: tax credits for businesses that already offer insurance and a purchasing pool, plus state assistance payments, for businesses that couldn't afford insurance before.

According to census figures, there are about 900,000 folks in that state. If only 5% smoke, and average a pack a day, that is $1,350,000 in monthly revenue to subsidize health insurance coverage.

Once the paperwork came through, Arthun learned that she would pay $179 a month for comparable coverage with a $2,000 deductible. But there's a bonus: the state assistance program reimburses her for more than two-thirds of her $179 premium.

The purchasing pool is set up so that premiums are deducted from an employee's paycheck. But each employee also receives an "assistance payment," from the state, which varies from 20 to 90 percent of the premium, depending on the family's annual income. The average reimbursement runs $107 per month.

On the surface, that’s a good deal.

Pat Moore also works at Stillwater Mercantile. Until he signed up with Insure Montana, he was one of the 170,000 Montanans lacking health insurance.

That’s 19% of the states population . . . a bit higher than average.

Of course, apply the 40-40-20 rule and the numbers become clear. About 40% of the population will earn in excess of $50,000 per year. These folks COULD afford health insurance, but opt not to do so. Surprisingly, many of those will still qualify for Insure Montana.

Another 40% have an income that is low enough to qualify them for existing taxpayer funded programs such as Medicaid, but for some reason are not participating.

That leaves the remaining 20% of the uninsured (around 180,000) who earn too much to qualify for existing assisted programs (or earn enough to pay for their own coverage without assistance).

The Legislature allocated $3 million for the pilot year and an additional $10 million for the second year. After that, it's up to the next Legislature.

Either there are fewer smokers in Montana than I guesstimated (at 5%) or the money is disappearing somewhere else.

At $1 per pack and 5% smokers at a pack a day, that should generate over $16,000,000 per year.

Personally, I like the idea, however like many government plans I will reserve judgment.

It still is (from all appearances) a guaranteed issue plan with little or no underwriting, richer benefits than are available in the market place and is offered at a lower price (before the subsidy). My gut tells me the plan is over-promising and will eventually under-deliver.

I also have a problem with subsidizing premiums for someone who earns as much as $75,000 per year.

We will continue to watch and see what happens. The plan is about a year old so it will take another 12 – 18 months for them to actually get a handle on results.

Stay tuned . . .

A Different Kind of Bottle “Cap”

Last week, Bob discussed “caps” (limitations) on outpatient medications. In a related development, researchers report that even though capping drug benefits did lower drug consumption, it also resulted in more negative clinical outcomes and higher medical costs. The study, of some 200,000 Medicare+Choice beneficiaries, was conducted by folks from Kaiser Permanente and two universities (UC and Harvard). Their findings, recently published in the New England Journal of Medicine, included some startling statistics:

“(S)ubjects whose benefits were capped [at $1,000] had pharmacy costs for drugs applicable to the cap that were lower by 31 percent than subjects whose benefits were not capped…but had total medical costs that were only 1 percent lower. Subjects whose benefits were capped had higher relative rates of visits to the emergency department, nonelective hospitalizations, and death.”

Ouch.

Their conclusion:

"A cap on drug benefits was associated with lower drug consumption and unfavorable clinical outcomes. In patients with -- chronic disease – [emphasis added], the cap was associated with poorer adherence to drug therapy and poorer control of blood pressure, lipid levels, and glucose levels. The savings in drug costs from the cap were offset by increases in the costs of hospitalization and emergency department care.”

In other words: cheaper isn’t always better. Now, in fairness, they studied a select group of people, in a population that does seem to use a lot of med’s. And they carefully avoided extrapolating their findings to the population at large.

Still, it does give one pause, especially when one considers (click to enlarge):

Kinda scary, no?

Pennsylvania Health Reform

Bloated. Dysfunctional. Sinking beneath waves of cost hikes.
That’s the modern U.S. health care system, in the view of many.


But reformers in Pennsylvania are working to transform it. Their sweeping universal coverage initiative is called The Pennsylvania Balanced and Comprehensive Health Reform Act.



The $40-to-$45 billion bipartisan package would extend full health, dental and prescription drug coverage to every citizen while eliminating co-payments, caps and deductibles. It would invest in a “culture of wellness,” offer tax rebates to volunteer emergency responders and defuse the medical malpractice crisis with a no-fault program.

Sounds great, but pardon me if I seem skeptical . . .

At its heart is a single-payer, state insurance plan supported chiefly by a 10 percent levy on employer payrolls and a 3 percent individual wellness tax.

So it appears to be a total of 13% of payroll unless there are things not yet revealed.

HealthAmerica president and chief executive officer Robert L. Dawson said last week in an e-mailed statement that universal coverage has dim prospects.


The concept “doesn’t address the underlying root causes that are threatening the health-care system today,” he said. “

I will have to agree.

The driving force behind rising health insurance premiums is NOT who is administering the plan, but who is making a claim against the coverage, how often they make those claims, and for how much.

Today’s chaotic mishmash of intensely competing private providers, plans, forms and payment schedules breeds massive waste and inequity, said Lancaster software entrepreneur Charlie Crystle, who helped shape the Pennsylvania universal health-care model over the past couple of years.


“None of us knows which of us are going to get cancer. ... None of us knows which one of our kids is going to be autistic.


“We want employees to be anxiety free” and not have to worry about going broke trying to pay medical bills.

So you accomplish this with a “free” plan that covers everyone for everything. Does anyone think health care might become even more inequitable under this kind of plan?

Apparently not.

Private insurers, who contain costs by controlling health-care access, are invariably at odds with patients, Crystle said.

When coverage is free and there is absolutely no financial responsibility for treatment, health care will become even more rationed than it is now.

If you want to turn around the auto industry, or airline industry in this country, start offering free cars and free airline tickets to anywhere in the world. Not only do you get a free car but free gas, free tires, free oil changes for life.

Not only do you get a free airline ticket, but free hotel, free meals and free tickets to Disney World.

Now apply the same rules to health care.

This plan is a joke. If it passes, and I don’t think it will, at least not in this form, my guess is it will run aground in 3 – 5 years.

You don’t even have to cross borders to find what happens when the government gets involved in the health care system. Just look at TennCare to see another good idea gone bad.

Tangled Web, Redux

Why am I not surprised by this:

“Ohio’s sixth-largest school district says it was a victim of fraud resulting from secret commissions that its health-insurance company paid to a broker in return for delivering the district’s business.”

As Yogi Berra once observed, “it’s déjà vu all over again.” Two weeks ago, it was United HealthCare and a Columbus area broker named Grady.

Today, it’s UHC and a Columbus area broker named Fritz Neuhart; once again, a rather ordinary web-site and a nondescript agency name. Nothing to indicate that Mr Neuhart had (allegedly) pocketed a cool $1 million in fees and commissions. Kinda makes a piker out of poor Mr Grady.

For now, the Department of Insurance is mum on this, although they’re "aware of the situation."

So far, that’s two school districts caught up in similar webs. I wonder how many other superintendents are even now rifling through their insurance files, trying to determine if they, too, have been stung.

A Slick Operation...

What if your employer paid you to have that knee surgery in India? How about that carpal tunnel correction in Thailand? Or your hip replacement in Singapore?

Sound far-fetched? It’s not:

“With US medical costs out of control, companies like Blue Ridge Paper Products of Canton, N.C., see outsourcing as an employee benefit. The carrot? The patient would get to take a family member and then pocket some of the firm's substantial savings.”

“Medical Tourism” has become big business. The idea is that folks can travel to a foreign country, receive medical care equal to (or potentially better than) services available here, and still save money (even factoring in travel expenses). Companies like Blue Ridge Paper have determined that, by encouraging their employees to go this route, the company and the employee save money.

I’m not so sure:

For one thing, such expenses are not going to be eligible for reimbursement under a qualified plan (HSA, HRA, FSA, etc). For another, what about accountability? For all the grief we hear about malpractice insurance rates here in the good ol’ U S of A, at least (most of) our providers have it. Will the same be true of Dr Singh in Bombay? Don’t know. And what about complications?

“A Rhode Island woman died in India after traveling there for cosmetic surgery that she believed was too costly and difficult to obtain at home.”

The single mother of three apparently died of a blood clot (a not uncommon complication). She did, however, save almost $16,000 by undergoing the surgery overseas. Where’s the gecko when you need him?

According to Time magazine, this business is booming:

“Trehan [a renowned robotic cardiac surgeon] plans to launch next year, in partnership with GE, the first installment of a vast, $250 million specialty Escorts hospital complex near New Delhi that will feature luxury suites, a hotel and swank restaurants for patients and their families. "We will be the Mayo Clinic of the East," he says. Max Healthcare is also planning a specialty complex in New Delhi.”

Whether these types of facilities will begin seriously impacting US providers remains, of course, to be seen. And we also know that there is currently a large supply (foreign facilities and providers) with little demand (it’s still somewhat of a novelty). But if and or when that changes, and demand begins to mount, it will be interesting to see if those low, low prices will stick.

So far, I haven’t had any of my groups (or prospects) ask me about this; be interesting to see if that changes.

Cavalcade of Risk (Debut Edition)

Welcome to the very first Cavalcade of Risk. In keeping with its mission statement, the following entries run the gamut from insurance to finance, taxes, and even murder. Several are from blogs that are new to me, but to whom I gladly say: Glad to meet ya!

And now, on with the show:

■ It's Just Money

LA Money Guy tells us about two (not so) Golden Gals who weren't relying on Social Security alone. He also raises some pointed questions for insurers.

■ Trader Knowledge

Knowledgeable Trader Dominic takes a look at momentum trading and how, if properly applied, it can lead to a high probability of financial gain (with low risk).

■ Jon Swift

Jon asks: "Why should I pay for diseases I'll never get?" A much better system would be to have insurance companies sell insurance for different diseases individually. He avers that a la carte insurance could be applied across the entire industry.

■ Workers Comp Insider

As if worrying about host liquor liability isn't enough, WCI's John Coppelman takes a look at hidden risks in company-sponsored summer outings. Employers beware the $200,000 "umbrella torpedo!"

■ Wenchypoo's Warehouse

Blogress Wenchypoo (no kidding!) explores the phenomenon of "luxury-creep:" material things once the province of the well-to-do (stainless steel kitchens, SUV's, even polo shirts) are now just everyday items to us peons. But when is enough, enough?

■ Med Bill Advisor

Why are accurate and current medical records so important? Host Chris Parks explains why they're crucial for our financial health.

■ Roth & Co

When disaster strikes, our first thoughts aren't necessarily about our tax records. But Joe Kristan has some great tips, and warnings, about the need to safeguard our financial info.

■ Health business blog

What do tuna fish and tea have in common? David Williams tells us about the potentialy dangerous amounts of mercury in some herbal concoctions.

■ California Medicine Man

One of my favorite bloggers, Dr John Ford (who posts, IMHO, all too infrequently), has an online debate with the founder of a new diet craze. Interestingly, he's not as concerned about the diet itself, but how it's being "pushed."

■ Cato Blog

Dr Ford's not the only debater in this edition: Cato Institute blogger Michael Cannon dukes it out with Matthew Holt on the merits - and potential downsides - of HSA's (Health Savings Accounts).

■ InsureBlog

Our own Bob Vineyard tells us of his recent epiphany regarding specific-disease policies. Sometimes, even the best health insurance doesn't cover all the potential risks.

The next edition is June 21st, hosted at It's Just Money. Be sure to check the C of R home page, for upcoming hosts.

A Truly Grand Rounds...

Grand Rounds is up over at Health Voices. Our host, Dmitriy, has used his new submission gizmo to organize over 40 posts, including insights and info on each one. Bravo!

Since Bob and I have both recently posted on medical records, I found Carol Kirshner's post on electronic medical records timely and informative (and I share her frustration).

Habla Espanol?

The two out of five Los Angeles residents who speak Spanish at home would find it easier to buy a can of paint at Lowe's than explain to a public hospital emergency room doctor where it hurts.

The home improvement store offers foreign language interpreting in less than a minute over a special telephone line at the customer service desk. But there is only one fulltime, trained, Spanish-speaking medical interpreter in L.A.'s five public hospitals and clinics;

This is a little talked about side effect of immigration, illegal or otherwise.

“Mastering any language well enough to describe your symptoms to a doctor takes years, and the same federal government that wants immigrants to learn English and to assimilate is doing little or nothing to support either process.”

OK, but how difficult can it be to learn enough English to respond to "tell me where it hurts"?

Two decades ago, Miami paramedics defined "intoxicado" as "high on drugs" instead of "nauseous." This led to a series of emergency room miscommunications and a malpractice settlement that could amount to $71 million over the lifetime of a former high school athlete. William Ramirez was 18 and able-bodied before he collapsed; when he awakened, he was quadriplegic. More than 36 hours reportedly passed without treatment for what really ailed him -- an acute subdural hematoma and other brain injuries.

I am thinking there is more to this story.

Intoxicado does translate as intoxicated. Surely they could find SOMEONE nearby who could translate. I mean, this is Miami . . .

The 1964 Civil Rights Act bans discrimination based on national origin. This requires any health care provider receiving federal funds -- practically all of them do -- to offer free interpreting to patients with limited English skills.

Don't you know there a lawyers just waiting to make a few bucks off this?

It would cost about $268 million annually to pay for professional medical interpreting in the United States,

So who is going to pay?

Two guesses . . .

A Ticket for HIPAA

[Editor’s note: Great minds really do think alike. As I was writing the following, Bob was posting his take on the same issue. Wow]

While I'm no fan of HIPAA (IMO, it created more problems than it solved), it is the law of the land. So I am puzzled, bordering on angry, that

“(i)n the three years since Americans gained federal protection for their private medical information, the Bush administration has received thousands of complaints alleging violations but has not imposed a single civil fine and has prosecuted just two criminal cases.”

According to the WaPo, the complaints reported most often fall into these categories:

■ personal medical details were wrongly revealed
■ information was poorly protected
■ more details were disclosed than necessary
■ proper authorization was not obtained
■ patients were frustrated getting their own records

I can sort of see that last: most physicians' offices charge a fee for those records. Contrary to popular belief, they are not "your own," any more than the service records your mechanic keeps on your car are. Still, it's not supposed to be a frustrating experience.

In this day of identity theft, there really is no excuse for personal information to be "poorly protected," either.

Turns out, three quarters of the cases were deemed to be non-violations, which seems about right: just because you’re ticked with a given provider doesn’t mean they’ve done something illegal. I’m not as sanguine about that other 25%, though:

“(H)ealth plans, hospitals, doctors' offices or other entities [were allowed] simply to promise to fix whatever they had done wrong, escaping any penalty.”

Certainly there needs to be some flexibility in the system, but that’s an awful lot of it. HHS counters that they’re striving for “voluntary compliance,” which they think is working. Of course, the providers are all in favor of the voluntary model (preferring carrots to sticks), but privacy advocates are nonplussed:

“The law was put in place to give people some confidence that when they talk to their doctor or file a claim with their insurance company, that information isn't going to be used against them," said Janlori Goldman, a health-care privacy expert at Columbia University.”

As the clock is ticking toward across-the-board implementation of EMR (Electronic Medical Records), the stakes are getting higher. Part of HIPAA requires that medical record safe-keeping adhere to a set of stringent federal guidelines, instead of on a state-by-state basis, but that raises its own set of problems, namely: security of the records. As we saw recently with the VA, this is far from a slam-dunk.

I’ll let a “neighbor” have the last word:

"It's like when you're driving a car," said consultant Gary Christoph of Teradata Government Systems of Dayton, Ohio. "If you are speeding down the highway and no one is watching, you're much more likely to speed. The problem with voluntary compliance is, it doesn't seem to be motivating people to comply. "