Helpful Resources: IB to the Rescue!

One of the great links on our blogroll is courtesy of our own Bob Vineyard: Bob collected and organized his Patient Assistance Programs roundup as a way to help his own clients, and has graciously shared them with us.

The PAP is a compendium of links that "provide assistance to low income individuals & families when it comes to medical care."

And our West Coast contributor, Bill Halper, braved the flames to bring us a link to the Foundation for Health Care Coverage Education. At Coverage for All, "you'll find options for free or low cost health coverage," as well as other valuable and helpful tools. We've just added CFA to the blogroll.

Thank You Bob and Bill!

When I recently told a friend about these resources, he was surprised, and a little angry, that this information wasn't more widely publicized. It's really not a deep, dark secret, but I do agree that the industry could do a better job of making people aware of these tremendously helpful programs.

We're just doing our part.

And Mike has pointed out that, regardless of one's insurance plan, it may well be worthwhile to take advantage of the new generic offerings at such retailers as Walmart, Target, Kroger's and others. For some, this will be an obvious savings (i.e. those whose plans include a minimum generic co-pay, usually far in excess of $4), while for others the savings may not be as large (those without such restrictions).

Again, it's all about consumer empowerment and transparency:

How much more empowered can one be than to have so many choices? And how much more transparent can we get than "$4" in blazing neon?

UPDATE: And Faithful IB Reader Fred sends us this helpful link, which has a whole round-up of low and no cost government sponsored health care programs. Thanks Fred!

The Ratings Race Heats Up

Recently, we looked at Wellpoint's new provider survey courtesy of the folks at Zagat. While imperfect at best, it represents a move in the right direction, i.e. provider transparency.

Now the folks at Cigna, in cooperation with NY AG Andrew Cuomo, have one-upped the WP effort:

"Cigna agreed to make public how it ranks doctors, won't evaluate its physicians on cost alone and will allow an independent national standard-setting organization to review its efforts every six months."

And this won't be based on office decor or smiles-per-member, either. The rankings will take into account more critical metrics: cost and quality will figure more prominently in these measurements.

Bravo, Cigna!

For the Children: Redux

Last week, we brought you a brilliant vidclip perfectly illustrating the twisted logic behind Congress' funding of S-CHIP. Well, the mysterious nicolai1951 is at it again, with further visual commentary on our legislators' hypocrisy.

Enjoy:



h/t: Redstate

Doing the Right Thing

We're pretty quick to take insurers to task here at IB, but sometimes they get it right:

"UnitedHealthcare, PacifiCare® and SecureHorizons® are concerned about the well-being and livelihoods of those affected by the ongoing wildfires. We want to ensure affected members receive the care they need without any delays or disruptions."

So begins an email I received this morning from UHC. A link embedded in the email takes us to a 2 page summary of measures the carrier is taking to ensure that its' members' health care needs aren't too disrupted by the Golden State's blazes.

Perfect? Of course not. But it's a realistic response to a horrendous situation.

A Cold Carnival Monday

Well, cold as in our Fall southwest Ohio temps. But HOT Carnival news:

The Carnival of Personal Finance is up at Millionaire Mommy Next Door. Along with a potentially mind-numbing 92 entrries, she's running a contest, complete with prizes. As has become de rigeur lately, she starts off with a Top 10 list, and then links to the other entries.

I thought Paid Twice's post on financial incentives and health insurance was both timely and well-written. We've blogged on this subject before, but this was from the insured's POV, which is different, and helpful.

And the Start Up blog hosts this week's Carnival of the Capitalists. The SU blog is new, so it's pretty exciting to see them jump into hosting so quickly (and well). Our hosts present 43 entries, starting with a Top Five list, and then the rest broken out into 5 helpful categories.

Mine Your Own Business talks about, believe it or not, Bad Ideas. Really! But it'd be a good idea to read it.

The New Medical Tourism

It's a fairly common story these days:

"Thousands of "health tourists" are going as far as India, Malaysia and South Africa for major operations – such is their despair over the quality of health services."

But they're not leaving Hoboken or Kokomo, or even LA:

"The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration with NHS waiting lists are fuelling the increasing trend."

What's interesting is that we see "medical tourism" here, as well, but it's all about price. There are no waiting lines, and few concerns about quality of care. Americans are famous bargain hunters, and medical care doesn't seem immune.

But for our cousins across The Pond, it's quite obviously not about price (after all, it's "free"), but the very real lack of care, both in quantity (waiting lists) and quality (lack of sanitation, for example).

"More than 70,000 Britons will have treatment abroad this year – a figure that is forecast to rise to almost 200,000 by the end of the decade."

That's a lot of "tourists."

On the Health Front: Good News & Bad News

■ First, the Good News:

Many of us count on roasted (and, often, salted) peanuts for a quick "pick-me-up." They are yummy, but also less than optimally healthful: the salted ones are high in, of course, salt, and the roasting process can destroy many of the beneficial compounds that the treats originally contained.

According to a study in next Wednesday's edition of the American Chemical Society's Journal of Agricultural and Food Chemistry, "(b)oiling is a better method of preparing peanuts in order to preserve these phytochemicals."

"Boiled Peanuts." Ask for them by name!

■ Now, the Bad:

Judy Mazel, who wrote the 1981 best-selling Beverly Hills Diet, has succumbed to complications from peripheral vascular disease.

The book itself enjoyed its well-deserved "15 minutes," as did its author.

"After studying for several months with a nutritionist, Mazel came up with a theory about food enzymes and the digestive system that she formulated into a complicated weight reducing plan."

Rest in Peace, Ms Mazel.

■ And then the Sublime:

As we've noted before, the Much-Vaunted NHS continues its downward spiral:

When 6-year-old Chantelle Hill's father, David Hill, contracted lung cancer, the compassion-impaired NHS decided that the contractor really didn't need (deserve?) the life-saving med's that are available at no cost in SCotland, because in England, they're apparently not "an effective use of NHS resources."

And so, the brave little girl has been raising money to pay for her father's chemo; thus far, she's raised enough for about 2 months of treatment by putting up posters asking for help.

Ah, socialized medicine.

Is there anything it can't do?

Got generics?

This being enrollment season for group insurance participants, I was helping my son review his medical plan the other day when I experienced a little epiphany. I noticed his Rx benefit pays 70% with copay limits of $10 for generics, $35 for formulary brands and $50 for non-formulary brands. Ho-hum I was thinking until I noticed this: the $10 for generics is a minimum copay. Let's say he gets a generic drug that costs $8. 30% of $8 is $2.40. But he won't pay $2.40 - he'll pay $10. That's interesting, I thought.

Then I looked at my own plan. Whaddya know, same feature except the minimum on my plan is $15.

So what's the epiphany?

Buy my medications at Wal-Mart but tell them I have no insurance.

Because at Wal-Mart each generic costs $4, period. Even I don't need insurance for that. In fact, if I tell them I'm insured, Wal-Mart will file the claim for me and, presto, collect the $15 minimum copay. I'm presently taking two (generic) medications so my copays have been running $30 per month. Not any more. At Wal-Mart, I pay $4 each, saving $22 a month.

Read your plan - maybe you can save, too.

Health Wonk Review is coming...

We'll be hosting the November 1 edition of HWR here at IB. The Health Wonk Review is a "specialty carnival," focusing on:

Health policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends ... We avoid things clinical in nature.

If you blog on any of these subjects, please feel free to submit your favorite (relevant) post from the past two weeks. Just click here.

Entries are due by next Wednesday (but please feel free to submit earlier!).

Hot Insurance Tales - Update

Almost exactly 2 months ago, we reported that AIG's Private Client Group policyholders rate extra protection, courtesy of their insurer. This was at the time of the "Castle Rock Fires" in Colorado.

According to ABC news, the same services have been made available to AIG clients in the path of the horrendous California fires. Homes and landscaping are being treated with fire retardant chemicals, at a cost of about $1,000, in an effort to stave off the flames.

This special service seems to work: according to AIG, "(s)ince the program was launched in June 2005, three homes have been saved directly as a result." Not a bad trade-off, considering the homes insured under this program average a cool (or is that hot?) $2 mil apiece.

UPDATE: Not all such solutions are insurance-based.

"As the Witch Creek fire raced through some of San Diego County's priciest neighborhoods and crept to the edge of others north and east of Rancho Santa Fe, not a single home in the five subdivisions that have implemented the strategy was lost, fire authorities said."

And what strategy (or, if you prefer, "strategery") was that, you may ask?

It seems that certain areas have implemented draconian zoning codes that require sprinkler systems, special landscaping and other measures designed to allow homeowners to ride out the fires if they're trapped "behind the lines." It's controversial, but it seems to work.

Not so Well(care)

One of our commenters, Cary, noted this morning that the Feds have "raided" a well-known Medicare/Medicaid health plan provider. According to their website, Wellcare (WC) "has been a leading provider of government-sponsored health plans including Medicare Health Plans, Medicare PDP, Medicaid, State Children's Health Insurance Programs and others."

S-CHIP, too, hmm?

Interesting.

Even more interesting for some is the connection to noted financier George Soros, who provided substantial funding to WC back in the early 90's. According to the St Pete Times' story, the company has bestowed some $105,000 to Republican candidates so far this year, and a measly $5,000 to Democratic candidates. Unfortunately, the Times' seems to have missed the $15,000 WC donated to the Democratic National Committee last year (according to opensecrets.org). So it appears that their political largess is a bit more non-partisan than one might believe from the news story.

As Mike noted in the same comments section, "Carroll [Thomas Carroll, analyst with Stifel Nicolaus in Baltimore] suspects the raid is potentially the result of a lawsuit in which an employee brought a matter to the attention of authorities."

So is it all smoke and mirrors, or is there something truly amiss?

Time will tell.

UPDATE: PharmaFraud blog has more.

Cavalcade of Risk #37 is up!

Spencer Hill, blogging at Hill's Personal Finance, presents this week's edition of the Cavalcade of Risk. Please be sure to check it out.

And please consider hosting a Cav yourself: it's fun & easy, and a nice traffic bump (just ask Spencer!).

To host, just drop us a line.

Wednesday Mini Link-Fest

■ Over at Roth & Co, FoIB Joe Kristan has some disturbing news about Section 419 plans (no, not that kind of 419).

In the life insurance field, Sect 419 plans are (or rather, were) a way to deduct life insurance premiums from income taxes. Joe reports that the IRS is cracking down on these plans, and the folks who implement them, in a big way.

■ From time to time, we like to highlight new (to us) blogs that pique our interest. IB commenter Tiffany has one such, which she's titled, eponymously, Tiffany Insurance. She's particularly proud of this post, which discusses why she thinks health insurance should be dealt with on a state by state basis.

Do check it out.

■ From the "Heartwarming Health Stories Dept:" Kevin Connolly, now a 22 year old college senior, was born without legs.

Now, though, you can catch him zipping around Bozeman (MT) on his skateboard. When he's not 'boarding or studying, he talks about his amazing adventures. Recommended.

Open Source Health Care

Okay, call me a geek.

Or a nerd.

Just don't call me late for dinner.

I've been noodling something new:

As regular readers of IB have no doubt ascertained, I'm an enthusiastic supporter of Consumer Driven Health Care. The basic premise of CDH is that, when consumers have "skin in the game," they're more likely to make informed, rational, effective health care decisions.

My friend Dmitriy Kruglyak, editor of Trusted.MD, proposes an alternative: People Powered Health(care).

Okay, freeze-frame.

Recently, I had the privilege of addressing a large group of local medical practice managers (and some of the doctors whose practices they manage). Since my reputation as an expert in CDH preceded me, that's the subject on which I spent the most time. As I was researching my presentation, though, something began to bother me:

Is that all there is?

Okay, I admit it: I am a geek. Whenever family members or friends need help fixing their PC's, I'm the first one they call. And I've begun learning about things like Linux, which is part of a (relatively) new movement collectively known as "Open Source Software."

OS Software is defined as "a development method for software that harnesses the power of distributed peer review and transparency of process. The promise of open source is better quality, higher reliability, more flexibility, lower cost, and an end to predatory vendor lock-in."

The more I consider this, the more applicable it seems to become to the future of health care (and the financing thereof). What if, instead of focusing on "consumer driven" or "people powered" health care, we turned our efforts instead to "Open Source Health Care?"

So what would OSHC look like?

I'm not really sure. But it seems to me that it would encompass all that's "good" about CDH (consumer empowerment, personal responsibility, transparency and outcomes) and what Dimitry likes about PPHC (peer-to-peer support networks, emphasis on wellness programs, online resources) while encouraging personal responsibility and provider (and carrier) information management.

Not bad, but how would it work?

Well, let’s start with some basic premises:

1) I have a visceral distrust of gummint-run health care systems. OTOH, my own industry has to be pulled, kicking and screaming, into making things "work."

2) As much as I advocate CDH, it's slow in "taking off." Part of that is our cultural reluctance to take personal responsibility, but a part is also that we lack both the tools and the incentive to empower ourselves.

3) Dimitry's PPH relies on tech & wellness programs, but seems to emphasize the provider angle.

4) What we need is a catalyst: something to drive us forward, to give people an incentive to make changes in lifestyle, care delivery AND funding (insurance) choices.

5) It occurs to me that we're using outdated models for all of these things. We should be looking at what's currently driving our economy and society: information. And how do we access that information? Computers. But it's not about Windows and Mac's. The real action is in the Open Source community.

Why? Because there's a synergy there: folks share info and code, try out new ideas (some of which flame out, but some of which stick). The bottom line is, they're driving information delivery tech forward.

What’s appealing about Open Source Software is that emphasis on sharing: new ideas, new tech, new code. Seems to me, Open Source Health Care could emphasize sharing, too: resources, information, outcomes and pricing. The culture of OS is one which embraces and encourages change, not for its own sake, but for a specific purpose.

Could we co-opt that culture, and apply it to health care delivery (docs, hospitals, pharma, etc) and funding (insurance)? You’ll have noticed that I’m not proposing any specific ways in which this could be implemented; right now I’m primarily interested in whether the concept makes any sense.

Well, dear readers?

For the Children...

On the one hand, it's tempting to put the whole S-CHIP kerfluffle behind us.

On the other...

What's the Point?

The other night, my better half took me out to dinner to celebrate my birthday (my 29th, in fact) [ed: riiiight!]. We only recently welcomed one of those Brazilian Steak House places to our community, and I had been looking for an excuse to gorge myself on meat. Had I been so inclined, I might have headed to Zagat, which rates restaurants on such things as quality, service, price, and value.

Now, wouldn't it be nice if such a service existed for medical providers?

Well, they do, and we've discussed some of them. Today's USAToday brings news that WellPoint (aka Blue Cross/Blue Shield) has enlisted the services of the aforementioned rating giant, in an effort to better serve their policyholders. WP seems quite pleased with itself for having pulled off this amazing coup.

So what kinds of information will we be treated to? Surely we'll learn the prices of different services, as well as the success rates of given providers, right?

Wrong (and please don't call me Shirley):

"Instead of Zagat's four categories for restaurants...the ratings guide will consider trust, communication, availability and office environment."

Office environment?! Are you kidding me? Yes, it's always nice to be greeted by a smile, but isn't the whole point of health care to provide, you know, care? What possible difference does it make how friendly the staff is, if the doc is mediocre and the equipment sencond-rate?

Granted, there has been some controversy surrounding provider ranking, but instead of confronting and resolving those issues, WP has chosen "the easy route." The good news is, the service, just now coming on-line, is free.

The bad news is, you get what you pay for.

Scary Good Carnival of Personal Finance

The Dough Roller presents this week's outstanding CoPF, with a dizzying array of helpful posts, and some cool illustrations, to boot!

We've talked about ID theft before, but nothing like Art Dinkin's take at Moment on Money. Recommended.

Cavalcade #37: Submissions Due

Just a reminder that submissions for next week's CoR are due this Monday (the 22nd). Our host, Spencer Hill, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

Don't forget: we still have hosting slots available. Please drop us a line to reserve yours.

Cherry Garcia, Lipitor & You (and me, too!)

[Welcome City Journal readers!]

So what do a deceased musician, an ice cream company and a brand-name drug have to do with each other? And why should you care?

Let's take that last one first: as we've noted many times here at IB, the cost of medications has caused major increases in the cost of health care, and thus health insurance. Since this affects everyone's pocketbook [ed: "pocketbook" is so quaint; don't you mean "wallet?"], it seems to me that anything we learn that can help us to understand this dynamic must be a good thing.

And so IB reader, and City Journal editor Brian Anderson, sent me a link to this C-J article on the relationship between how we perceive ourselves and our health, and how disparate segments of the economy play on that perception:

"Call it tuning, if you prefer. Lipitor tunes our cholesterol. Anti-stroke medicines tune our platelets, antidepressants our serotonin and dopamine, heart medicines our angiotensin-converting enzymes, contraceptives our estrogen. Cancer drugs tame or kill our own mutant genes. And for every drug to suppress chemical excess, there’s another to address deficits: insulin for the underperforming pancreas, clotting factors for bleedy blood, Synthroid for the tired thyroid, and cancer-suppressing proteins to lend a hand to tumor-suppressing genes."

It's about balance as well as perception, of course; sometimes the cure is indeed worse than the disease. But it goes beyond that: if we're constantly looking to "tune" ourselves (remember our post on Jiffy Lube medical clinics?), aren't we also contributing to the increasing cost of health care?

On the other hand, if the alternative is to ignore or leave untreated potentially life-threatening illnesses, we're also responsible for raising that bar, and those costs. It's not so much a "lose-lose" or "win-win" as it is "actions have consequences."

And so does "inaction."

Health Wonk Review is up!

Our favorite Health Care Economist, Jason Shafrin, hosts this week's round-up of all that's wonky in the health care world. With helpful categories, and a 'Top 2 List," there's a potpourri of policy posts [ed: enough already with the alliteration!].

After our recent SCHIP kerfluffle, I was pleased to see Patient Blogger Lisa Emrich offer a very different perspective, as well as helpful links for folks who've fallen through the cracks.

Our own Bill Halper represents IB this week, with his take on the SCHIP "food fight."

Unconscionable Carrier Tricks

Thirty-five years ago, a since-retired colleague wrote a life insurance policy on a friend of his. That friend died on Monday (3 days ago), and his widow called me on Tuesday to let me know. I expressed my condolences, and assured her that I'd arrange for the forms we'd need right away.

Once we hung up, I called the Policy Holder Service line at Great West Life (800-274-9628) and explained the situation. The young lady who had taken my call asked me to hold on while she checked something, and came back a few moments later. She assured me that the forms would be faxed to me within the next 24 hours.

And now it's Thursday morning, 48 hours later, and no form, so I call again. This time, I'm told that it will take a minimum of 5 to 7 days for those forms to be faxed to me. I indicated that this didn't sound right, but the lady was firm, and suggested I call the Claims Department (800-537-2033) and check with them.

And so I did. And I was informed that this seemingly simple process -- simply faxing a standard form -- will take a week or more to occur. That's a week while the widow waits for the opportunity to file the claim, let alone how long these morons will drag their feet before actually paying it.

And yes, I used the "m" word; this is most assuredly not typical of the life insurance industry, and Great West Life should be ashamed of its abhorrent claims service.

There's a reason we haven't written business with them in years.

Game, Set...and Match?

While the "S" in USA doesn't stand for "svelte," our cousins across the pond are facing an even weightier dilemna:

"The growing problem of obesity risks bringing financial ruin to the National Health Service, a study has warned...Research commissioned by the Government in 2005 has warned that half the population will be obese within 25 years if current trends continue."

Seems that the increasing costs associated with a portly population threatens to bankrupt the English health care system (not that it's exactly helping ours any). Here in the States, the problem may start with our youngsters:

"Pushing diets probably won't help. Neither will teasing about weight. Instead parents should focus on having frequent family meals, creating a positive atmosphere at mealtimes, promoting physical activity and building self-esteem, the researchers recommend."

Given the reputation of English cooking, that may not offer much hope for our British cousins, though.

And this probably won't help, either:

"CONFECTIONERY giant Cadbury is to slash the cost of three of its top-selling chocolate bars by about 40 per cent in the run-up to Christmas, in a move which health experts have warned could contribute to the UK's obesity epidemic."

Now, we've touted the amazing health benefits of chocolate more than once here at IB, so this is sort of a "good news, bad news" kind of thing. But the key seems to be moderation, which may be more difficult as prices for the tasty treat plummet.

On the other hand, maybe it's time to switch to another healthy food group.

Cool New Feature...

Not here - over at the Colorado Health Insurance Insider. Host Jay Norris now offers an "Open Mic" (as in "open microphone") feature, where he and Louise will offer readers the opportunity to blast off about health insurance issues.

The inaugural edition features a "Letter to the Editor" originally submitted to HWR, but which seems perfectly fitting as the debut item.

No word yet on whether blog-karaoke is in the offing.

Playing Along at Home

It's that time of year again, where millions of employees begin to make their health insurance choices for the following year. As I mentioned at this time last year, our family's benefits come to us courtesy of the Fortune 500 company which employs my better half. And once again, in addition to the usual co-pay type plans, the company is pushing HSA-compliant High Deductible Plans. Unlike last year, however, the folks in HR (or at least those advising them) have finally "gotten it," and have done a pretty good job.

To wit: they've put together a menu of choices (hence the over-used term "cafeteria plan") whose centerpiece is the HSA. And they've done a masterful job of selling it, as well. You may recall that, last year, the HSA was clearly an aferthought, with no effort made to make it the least bit attractive. For an extremely modest premium savings, one was presented with an over-the-top out-of-pocket exposure. There was little (if any) effort made to explain the myriad benefits accruing to HSA's, perhaps because most of these were absent from last year's model.

But what a difference a year makes. Several weeks ago, for example (and well before "election time") we received a colorful, interesting, and helpful guide to HDHP/HSA's, with practical, real-world examples (which reflected real-life numbers, as well). I especially appreciated the approach: it closely tracked my own HSA sales shpiel. It was also pretty fair to the other models, explaining differences in out-of-pocket, savings and claims issues.

I'm still not thrilled with the configuration: a high deductible, yes, but they've kept the 80/20 coinsurance "corridor" in place, which I think unnecessarily complicates the product. They have priced it appropriately, though: folks who choose the HSA route pay the least in additional premium contributions. For our family, that represents $800 (minimum) annual savings versus a co-pay plan. The deductible is modest: $1200 for singles, $2400 for families. That's actually towards the low end of the deductible choice spectrum, so it's a great "introductory" program for folks who are unfamiliar with the concept.

The powers that be at the home office must be closet IB readers, because they obviously understand that rate increases on HDHP's are substantially lower than their co-pay cousins. To that end, they've offered a deal that would be difficult to refuse, even if one were so inclined: in addition to the premium break, they're "seeding" employees' HSA's with real, up-front, cash money: $400 for individuals, $800 for families. Wow!

We've also written about the new product trend towards preventive care. To that end, the carrier-of-choice (one with which I'm very familiar, and have had good experience) covers routine, preventive items (e.g. cancer screenings, vaccines, etc) at 100%, regardless of whether or not the deductible has been met. In fact, that same benefit applies to folks in co-pay plans, as well. We elected to contribute the max to the loss-fund (Health Savings Account), based on previous years' usage. It's a great deal, of course: if we end up not using it all, it rolls over (one of the great things about HSA plans).

In the event, we're looking forward to being a part of the new health insurance evolution, and I'll be sharing our experiences with it throughout the coming year. Cheers!

They chose...Poorly.

Although it's apparently not obvious, when proponents of a $35 billion expansion of the SCHIP program first chose a spokesfamily, they apparently didn't think that folks might have a problem subsidizing the misguided choices that family had made.

At the time, I opined that surely there were more appropriate examples out there, truly poor families who were forced by circumstance to choose between health coverage and meals. So I was relieved to learn that these folks had "moved on" from the unfortunate Frost episode, and found a more "deserving" family.

Don't. I. Wish.

Our new Poster Child, "Baby Bethany Wilkerson" comes to us courtesy of Dana and Brian W. The infant suffers from a congenital heart defect.

And irresponsible parents (gee, what a surprise):

During a conference call sponsored by USAction (a hard-left advocacy group), Dana admitted that she and her husband had long wanted children, and that she had voluntarily quit a job with benefits (including medical insurance) because she was unhappy there. And instead of finding another job with benefits (or at least buying an individual major medical plan), she and Brian chose to self-insure, and now expect the taxpayer to bail them out.

If all this sounds familiar, don't be alarmed: it is.

So I'll ask again: isn't there some family somewhere that actually needs this program? How come its advocates can't find any?

FACT-CHECK UPDATE: Since in this case there's no indication that the parents even bothered to shop for individual coverage, let's see "what might have been:"

[Phone rings]

Agent: Hello, how may I help you?

Dana W: Yes, I'd like a quote for health insurance for my husband and me. We're both 30 years old, don't smoke, and are in good health.

Agent: Great. Since we're on a nationally-broadcast phone call, I'll use Humana's quoting site because they're available pretty much everywhere. I'll plug in a Tampa zip code that I got from Google; if it's the wrong one, the numbers won't be too far off. Of course, people listening in can feel free to use whatever quoting source they choose.

Dana W: That's all very interesting, I'm sure, but what's the damage?

Agent: Well, for a pretty decent co-pay plan ("Autograph Share"), your premiums will run about $132 a month, or about the cost of a latte per day.

Dana W: Hey, that's not so bad. How much more will it be when we add our daughter? I'm not pregnant yet, but we have plans...

Agent: Oh, I understand. Figure about $60 more each month, or a biscotti a day.

Dana W: Thank you!

Everyone listening in: Yeah, Thank You!

[click]

It's a Tough Life, Pilgrim

A few months ago, I was asked by a colleague to track down any information I could find about Pilgrim Life Insurance Company, originally domiciled in Indiana. I checked with the "usual sources" (Google, A M Best, etc) to no avail.

And then, a good friend of mine came through for me. Fred's actually the field rep for my "carrier of choice" for non-medical products (group life and dental, disability and the like). What Fred found is a fascinating story, one that begins with that "peculiar institution," and ends with free men (and women) founding a successful business venture:

"Founded in 1898 in Augusta, Pilgrim Health and Life Insurance Company became the first insurance provider for African Americans in Georgia. A black-owned and -operated company, Pilgrim was one of the largest employers of African Americans in Augusta and issued tens of thousands of policies in the first decades of the twentieth century."

About 20 years ago, the company was bought by the Atlanta Life Insurance Company, which was founded just a few years after Pilgrim Life. In fact, today Atlanta Life boasts that it's the "No. 1 African-American reinsurer of group life benefits," no doubt building on its previous absorption of Pilgrim Life. Atlanta Life was founded by a former slave (Alonzo Franklin Herndon); Pilgrim Life by a young black man (Solomon W. Walker), whose day job had been delivering groceries.

Atlanta Life's Alonzo Herndon became a successful barber and real estate investor, who saw a need for low-cost insurance products for a then-burgeoning working class. Investing some $140, he was able to build his fledgeling enterprise into a company that today boasts over $200 million in assets.

Meanwhile, Mr Walker also saw a need for a "benevolent society" that would offer insurance policies to an underserved market. What a lot of folks don't know is that, years ago, life insurance applications asked not just one's height and weight, but race, as well. This is not something of which my industry should be proud, but it did happen, and I'm pleased that this practice was discontinued long before I began my own practice. In the event, Mr Walker saw a need, and determined to fill it.

Although Pilgrim Life no longer exists as a separate entity, one imagines that the founders of both companies would be quite proud of the legacy they've left behind. I would encourage our readers to take some time and read about a chapter of our nation's history that doesn't get a lot of airplay.

And thanks, Fred, for the tip.

Grand Rounds is up (and You Can, too!)

This week's Grand Rounds is all about emergency-related health care (which makes sense, since it's hosted by NY Emergency Medicine). With over two dozen posts, you're sure to find at least one that'll pique your interest.

Kerri at Six Until Me, has an emergency tale, all the more compelling because it's her own.

Well, well, well...

According to some of our recent commenters, we're right-wing nut-jobs who hate children and the poor, and don't understand the juggernaut that is the Democratic party's 35 billion dollar expansion of SCHIP.

Maybe so, but it appears we have lots of company:

"A slim majority, 52%, agreed with Bush that most benefits should go to children in families earning less than 200% of the federal poverty level...A larger majority, 55%, said they were concerned that the program creates an incentive for families to drop private health coverage for a public program."

Ooops.

Lost in this debate, of course, is the underlying issue of personal responsibility. For folks who can afford even catastrophic coverage, it seems prudent to shop for it before there's a claim, not after. And the clear message from the second part of the poll is that, if you choose to self-insure, don't assume the taxpayer is going to cheerfully bail you out.

"Emergency" Bleg

In all the hussle-bussle of the SCHIP kerfluffle, I missed that the 2007 Weblog Awards nomination process had begun, and it ends today (10/15/07).

Any IB reader who is so inclined is invited to nominate us in either or both of these categories:

Medical/Health

and/or

Best of the Top 5001 - 6750 Blogs

Thank you!!

UPDATE: Looks like they've extended the deadline to Wednesday, but Thanks to Tom and Fred, we snuck in today. We'll let you know when voting begins.

Health Care Blogger Code of Ethics

Recently, we submitted InsureBlog for consideration to join the growing ranks of those who have been accredited by the Health Care Bloggers Code of Ethics:

"The Healthcare Blogger Code of Ethics was designed in response to problems experienced by medical bloggers. The goal of this code is twofold

1. To give the readers of a medical blogger a clear idea of the standards by which the blog is maintained.

2. To give bloggers (especially anonymous ones) a clear set of guidelines they can show employers, patients, or other concerned parties as to the nature of the blogging.

Since healthcare blogging is sometimes dealing with extremely sensitive information, it is extremely important that these blogs maintain the highest of integrity."

After several weeks under review, we are pleased to announce that IB has been approved as members of this community. Regular readers know that we take the issue of ethics very seriously here, so we're delighted and proud to be recognized by our medblogger peers.

As members of the HBCE, we're entitled to display its "badge" on our sidebar, which is where it now resides. For more information about what the HBCE certification means, just click here.

Again, Thank You to the folks at HBCE, and most especially Dr Rob Lamberts, who came up with the idea and made it happen.

Another good hospital story out of the UK...

Some time back, I wrote a post on the potential clash between sanitation and health care in a financially constrained system. To paraphrase what I said then, if you have a certain amount of money, and you can either spend it on medicine or on a bucket, the bucket's going to lose...

Well, it appears that I was right on the money. An article appeared yesterday on the BBC news web site describing truly horrific conditions at a UK hospital. Without going into the rather nauseating details, it appears that unsanitary conditions, and the resultant spread of Clostridium Difficile infection, caused the deaths of at least 90 individuals and contributed to the deaths of another 124.

The official report summarizes it nicely:

We are concerned that where trusts are struggling with a number of problems that consume senior managers’ time, and are under severe pressure to meet targets relating to finance and access, concern for infection control may be undermined.

At least in the US, the legal system acts as a check against this kind of medieval barbarism. There are standards of care that are to be followed. A hospital where patients were left to lie in their own waste would be sued and possibly closed. The supervisory medical personnel could lose their licenses and be held financially accountable to those affected.

In the UK, patients and their families complained to the authorities, but it appears that there was no corrective action. The situation continued, and people died, for years. Only now is something happening...and it appears that it took from October 2006 until now to investigate and write a report. How could this happen? How could a government run facility, charged with maintaining the health of the populace be so poorly run?

More importantly, as the US healthcare system grows more and more expensive, and steps are made to constrain that growth, how do we prevent the same thing from happening here?

Oy Canada (Part ??)

What if you were an expectant mother, covered under Canada's much-vaunted national health care system? Everyone's covered, the care (according to Michael Moore, et al) is excellent, what could possibly beat that?

"I'm a born-bred Canadian, as well as my daughter and son, and I'm ashamed," Jill Irvine told FOX News. Irvine's daughter, Carri Ash, is one of at least 40 mothers or their babies who've been airlifted from British Columbia to the U.S. this year because Canadian hospitals didn't have room for the preemies in their neonatal units.

Ooops.

Anyone who's ever bought those "one size fits all" gloves knows that the copy is missing a key word: "one size fits all, poorly."

And that seems to be the problem with nationalized health care systems, such as the one in place for our Neighbors to the North:

"Canada's socialized health care system, hailed as a model by Michael Moore in his documentary, "Sicko," is hurting, government officials admit, citing not enough money for more equipment and staff to handle high risk births."

Say it with me: Ooops.

Does this mean that our system is perfect?

Of course not.

But it's kinda like saying "well, the police don't catch every crook, or solve every crime, so we should scrap the entire justice system willy-nilly." That's obviously silly.

But then, so is nationalized health care.

Gay Paree (TX) Update

Several months ago, we reported on the efforts of the Paris Regional Medical Center to squelch criticism of its practices, by asking the courts to identify the anonymous blogger(s) who had dared to question them [ed: nice run-on sentence, Prof].

Well, according to The Paris (TX) News, the "6th Court of Appeals in Texarkana Tuesday issued a stay of 62nd District Court Judge Scott McDowell’s order for internet service provider SuddenLink to reveal the identity to the court."

It's only a brief reprieve, however, because "the Court of Appeals granted a stay of the disclosure until Wednesday, Oct. 24. At that time oral arguments from both sides are to be heard to determine whether the information should be revealed."

This poses somewhat of a dilemna for me: as a blogger, I can choose to post anonymously (or not), knowing that my privacy is maintained. On the other hand, anonymity can also be a shield protecting one from the consequences of malicious or inaccurate posts. It's a delicate balance, and I can actually see both sides of this.

My natural inclination is to side with my fellow blogger (after all, at IB we've often been critical of insurers and providers), but if the information the blog put forth was indeed obtained illegally (as has been alleged), then it seems to me that justice is better served if that cloak of anonymity is removed.

My turn...

It’s my turn to comment on the reaction to Bob’s post. Normally I would have written this as a response in one of the comment areas, but I am putting it up as a separate post; it’ll otherwise get lost in the noise.

All of four of us who write for InsureBlog are very experienced in the health insurance marketplace. Personally, I've worked over 20 years in this business. Bob, The_Prof and I can all cite personal experiences where people have tried to purchase health insurance after a serious medical problem arose. For these people, their families and frequently their extended families, it's a disaster.

I have enormous sympathy for these people. They didn't intend for this to happen. And a percentage got trapped because they fell through a crack in the system and/or they didn't know what options were available to them. But, a substantial percentage, at least in my experience, had made a conscience (and retrospectively stupid) decision to gamble and they lost that bet. I can’t tell you the number of times I’ve said to somebody, “But why didn’t you call me a month ago?”

Many people perceive an inexpensive high-deductible medical insurance plan as worthless because it won't pay the day-to-day doctor bills. But a plan like that would at least mitigate the financial disaster that a serious illness or accident can bring. They're not expensive...I just obtained coverage for a 41 year old with some minor chronic problems for $160/month. It won't pay the first $3500 in bills, but, if lightning strikes, it'll pay the next $5 million. (Standard disclaimers apply...No promises...All applications are subject to acceptance by the carrier's underwriting department...etc, etc...)

Is that policy available to someone who's recovering from a heart attack? No, it's not. But, as in the case of a gentleman who called my office a number of years ago, maybe he owns a small business. And in California, small businesses are guaranteed issue. The specifics vary from case to case. The Frosts, at least in California, would most likely be able to obtain a policy for no more than a 10% surcharge.

There are programs available for those who can't afford or can't obtain traditional health insurance. If you don't know what they are, look at The Foundation for Health Coverage Education web site. The state-specific matrices that they publish list both public and private programs that are available throughout the country.

An Open Letter to TNR (The Plank)

[I emailed this letter to Mr Cohn this afternoon, but it has been returned as "undeliverable." I offer it here as a lesson in how Old Media deals with criticism]

Mr Cohn:

I vehemently object to your libelous characterization of my colleague, Bob Vineyard. If you had bothered to read the story, and follow the comments, you would have seen that this was never about the Frost's SCHIP eligibility, nor their insurance experience.

It was solely about media accountability and fact-checking, which the "Professional Reporter" failed to either do or disclose.

Bob never averred that the Frost's could have bought a policy for that amount, for the simple reason that their health histories were never disclosed in the story on which he was commenting. He simply saw that the reporter took a number at face value, without questioning it or even checking its accuracy, and spent a few minutes doing the research that reporter was presumably paid to do.

He found that a "typical" Baltimore-area family could indeed purchase excellent coverage for much less than the article stated. If there were exigent circumstances that would have precluded the Frost's from buying it, these should have been noted.

Before you chime in with "but their kids were in a horrible accident," please note that it is never made clear exactly when the Frost's were shopping. We can only reasonably assume that the Frost's were shopping prior to the accident. All the "professional reporter" had to do was to verify (and disclose) when the shopping was done, and how the numbers were determined.

Your comment that Bob didn't mention the pre-ex issue is thus a red herring, and an egregious attempt to change the subject from the media's inept handling of this issue.

I look forward to a written, public apology at your earliest convenience.

Milestone reached...

Apropos of nothing, sometime last night we had our 100,000th visitor to IB.

Thank You! to all of our readers, "regulars" and "newbies," for your support and interest.

Have a great Wednesday!

Healthy Booze News You can Use

[Welcome Industry Radar readers!]

Dr James Bond was apparently on the right track with his quaff of choice:

"Australian doctors said they plugged a poisoned Italian tourist into a vodka drip after running out of the medicinal alcohol they would normally have used to save his life."

Turns out, the young man had swigged a quantity of anti-freeze (I'm guessing there was a wager involved), and was in danger of losing his life. The hospital, having gone through its supply of "pharmaceutical-grade alcohol" (was that with or without a twist?), was forced to rely on the old martini standby.

I just love the headline on this story of alternative medicine:

UPDATE: Bob wants to know if it was Grey Goose or Valu-Rite. Unfortunately, the "professional reporter" failed to disclose this vital information. It's important because the former may be considered "brand name" while the latter would be "generic."

Cavalcade of Risk #36 is up!

Host Bob Laszewski, proprietor of the Health Care Policy and Marketplace Review, presents this week's edition of "the Cav." Bob is himself a noted expert in the subject of risk, and brings that experience to this edition.

Thank you, Bob, for a job well done!

YOU don't have to be an expert in risk to host a Cavalcade. Simply drop us a line, and we'll walk you through it.

Mea Culpa!

I'd like to apologize to regular IB readers for the dearth of new content these past few days. As a result of Bob's SCHIP post, we've been blessed with an (over)abundance of traffic and comments. On the one hand, being linked by both major media outlets and high profile polibloggers is quite flattering. On the other, it makes normally routine house-keeping chores quite challenging.

Please bear with us a little longer, and I promise you won't be disappointed (although I already am: I did a SCHIP post, too, and no one's calling me names for that).

A Capital Carnival

The Carnival of the Capitalists is up, hosted by CotC co-founder Rob (who has sold his blog for an undisclosed price. Sweet!). He presents this week's edition in the now-traditional "Fav's at the Top" format, and includes the other submissions below that list.

With both parents now living in a nursing home, I'm particularly sensitive to those who would prey on the elderly. Matthew Paulson at Finance is Personal shares that concern, noting "you need to make sure that you keep a close eye on your senior parent’s finances and make sure that they don’t get scammed." Kudos, Matthew!

Not to Brag, but...

Bob's recent post on the SCHIP program was featured today on National Review Online's The Corner, linked to by none other than Mark Steyn himself.

Wow, and Mazel Tov, Bob!

(Hat Tip: Joe Kristan)

UPDATE: And now we're linked at The Weekly Standard, as well. But don't worry, we won't forget "the little people" who made it all possible.

Saturday Miscellany

■ I hope that Bob doesn't mind me traipsing in his territory, but this story caught my eye. Several months ago, he wrote about folks heading to the border for dental care "on the cheap." Apparently, someone in the Turkish press was impressed with his style, because they've picked up on the issue:

"With aching teeth and a need to cut expenses, throngs of Americans are marching into neighboring Mexico for dental care, and saving hundreds to thousands of dollars in the bargain."

So, Mexican dentists are able to treat a variety of oral ailments less expensively than their colleagues stateside, and that includes procedures such as root canals and fillings.

Of course, this article on "dental tourism" just had to reference that number of uninsured (debunked here, for one), which seems to have grown to include those who have no dental coverage.

So how come there's no great hue and cry for nationalized dental care?

■ On the tech front, Dr Bill Gates and company are working to bring the tech and health care worlds closer together:

"Microsoft executives have long talked about their plans to push technology further into the health-care field...HealthVault, as the company is branding this effort, allows users to create an account online that will store data such as medical history, health-plan information, prescriptions, images, cholesterol and blood-pressure readings."

The idea is that consumers can store and track their health care histories on-line, making it even easier to fill out health insurance applications.

Um, no:

The idea is to empower [ed: you just love that word, don't you?] consumers to be more proactive in tracking their own care, and can even be used to text oneself reminders about appointments based on that information.

Gotta love the tech.

Cavalcade of Risk #36: Submissions Due

Just a reminder that submissions for next week's CoR are due this Monday (the 8th). Our host, Bob Laszewski, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

Don't forget: we still have hosting slots available. Please drop us a line to reserve yours.

Polling Update

As you may have noticed, the poll at the top of the sidebar is closed. In all, we had a total of 10 votes, which was a bit disappointing, considering that we get hundreds of folks through here every day.

Given such a low "turnout," I'm reluctant to draw any conclusions from the results (even though I agree with them). Perhaps the most interesting thing about this little experiment was something of which I had been unaware: that particular polling tool [ed: say THAT 10 times fast!] includes a map of the locations of those who voted:

In the event, we'll consider whether or not to do weekly polls. Your feedback is welcome (indeed, encouraged) on that.

Health Wonk Review: SCHIP Edition

Health Affairs blog's Jane Hiebert-White presents a fascinating HWR, with a special emphasis on the recently vetoed SCHIP legislation. There's also a good mix of other topics, making this a well-rounded Review.

"Welcome to (Doctor) WalMart!" may be what you hear next time you stop in for your kids' school supplies or that new chair. FoIB Joe Paduda, proprietor of Managed Care Matters, reports that the retail giant is truly driving at least some health care costs down.

Making the Top 10

Over at the (new to us) Nursing Online Education Database, host Jimmy Atkinson has compiled a Top 100 Health and Wellness Blogs, and we're in the Top 10 (at #6, to be exact).

Thank you to Jimmy, and the NOEDb, for taking the time to review our blog, and for recognizing our efforts.

...a failure to communicate (Conclusion)

[In Part 1, we learned that some simple things can get complicated pretty darned fast. Here's how they can get untangled. ]

I finally connected with the lady at the top of that particular heap, who went back to the carrier to see about a resolution. We went back and forth for a number of days (I took pains to keep my client - the law firm - in the loop all the while).

Finally, the carrier agreed to make an exception, based on the understanding that I would obtain the outstanding forms when I delivered the policy. In the meantime, they would overnight a check to the annuitant within 24 hours. Of course, it was now the first week in September, so we were already behind, but it seemed like an appropriate compromise. I agreed to it, and hoped for the best.

Several days later, I was informed that the check had arrived (Yippee!), but that it was post-dated for September 17th (take back the Yippee). This was not in keeping with our agreement, and so I informed the nice lady at XYZ. I further informed her that I would not be forwarding the additonal paperwork, since the carrier had breached our agreement. She asked if she could forward that to the carrier, and I of course said "sure!"

The folks at the carrier were not happy. You see, they now had a major problem: if they were ever audited, and the auditors saw this case, the carrier would have insufficent paperwork to justify having sent any money. This would be a bad thing for them.

On the other hand, I had all the documentation I needed (copies of the emails, the FedEx forms, etc), and so had no such problem. They needed the paperwork, and I needed an explanation for the post-dating, and for the fact that we never received the August payment (or so I understood), and that August payment itself.

Again, a flurry of emails, and then the carrier called me, demanding that I pony up the forms. The not-so-nice lady from the carrier explained in detail why they needed them, and how she would never have made the exception if she'd not had my assurance that I would comply.

I listened politely, and when she was finished replied "I understand everything you've said, but I don't care." I wasn't being snide [ed: yes, you were], but honest: the only leverage I had was that paperwork. Without it, they were up a creek, and they had no leverage with which to pry it from me*.

There was a pause (no wonder), and she then repeated her little shpiel. I listened attentively, and replied again "I understand, but I don't care. You agreed to make timely payment, and a check post-dated for 10 days isn't timely. You breached the agreement, and the only leverage I have is this paperwork. You need it, and I have it, and my client has her check. Where shall we go from here?"

She was so flustered by this that she said "you know what? Have a nice day" and hung up on me. I, of course, burst out laughing: she had called me, and then hung up on me. Droll, and yet humorous.

I called my client to apprise them of the latest developments (such as they were), and then called the nice lady at XYZ to discuss the latest round. She had just gotten off the phone with the carrier, and was motivated to get this resolved (after all, this was 100% her company's fault: neither I nor the carrier had really done anything wrong).

So, we set up a conference call between her, the carrier (represented by the lady with the less-than-stellar phone manners and her assistant) and my own charming self. We went back and forth, until finally we had a breakthrough: turns out, aside from the paperwork issue, the real sticking point was that they couldn't honor a 31st-of-the-month payment date: it had to be no later than the 30th. Well, this was the first I (or XYZ) had heard of this, and it helped to clarify the timing problem. The post-dated check, it turns out, was the August payment, and she would be receiving her September payment at the end of this month (and so on). We had understood, incorrectly, that the post-dated check was for September, and were holding out for the August payment. Had they bothered to explain this in the first place, we would have avoided some blood pressure issues.

In the event, all's well that ends; I sent the requisite paperwork up last week, and everyone's satisfied (if not happy). Just goes to show that a little communication can help one avoid a lot of complication.

*[It may have occured to IB readers that the carrier did, in fact, have one piece of leverage. Fortunately, they apparently weren't sharp enough to see or use it. I'll leave what it was as an excercise for the reader]

Ethics and Fraud

I fired a client today.

Well, to be more precise, I refused to help a potential client commit insurance fraud. The lady in question has had auto and home insurance with us, and inquired about health insurance. She was referred to me (d'uh), and I proceeded to ask her the usual litany of questions (height and weight, smoker or non, medications, etc). She claimed to be in good health, and I started to fire up the quoting engines.

My first set of numbers met with some surprise, until I realized that she was really looking for a short term medical plan. These plans are convenient, because they require minimal underwriting and are designed to be issued quickly. They are also of limited benefit, since they don't cover any pre-existing conditions.

Pre-ex; aye, thar's the rub!

Turns out, she had a specific gastro-intestinal condition in the recent past, and was also due for a specific medical procedure in the near future. She has not had health insurance for quite some time (well past the "magic 63 days," which would not have helped her, anyway), but she wanted the coverage so that XYZ Mutual would pay the lion's share of the upcoming procedure.

When I explained to her how pre-ex works, she immediately replied that she was fine, and had no health problems. I was understandably (and uncharacteristically) silent for a moment, and then explained that whether I knew that not to be the case wasn't really at issue here; what was important is that she knew that. As I explained to her, if I sold her the plan, at least one of two things would occur come claim time: the policy would be rescinded, and/or she would face charges of insurance fraud. She was non-plussed.

At that point, it became clear that I could not sell her a policy. Still, she was a client of the agency, to which I also owe a duty. That I would not sell her a policy was not at issue, but how I handled it may have been. I put her on hold for a moment, and went in to briefly discuss what I was about to do with the agency principal. Of course, I knew that he would have no problem with my decision, but I did owe it to him to put him in the loop. Once that was accomplished, I headed back to the phone.

I explained that I could not [ed: don't you mean would not?] sell her a policy, but that I could get her the numbers for HMO's in the area (these plans often have open enrollment periods for folks in exactly this lady's position). She wasn't interested, and we concluded our conversation.

Fortunately, this kind of thing doesn't happen to me very often (I like to believe that it's because most people are basically honest, but then I've also been told that I've led a sheltered life), but I did know exactly how to handle it. It's very simple really: always do the right thing. It's not because I'm particularly devout or arrogant enough to think that this makes me "better" than others; it's just that it makes life a lot easier if I don't have to keep track of lies (even with my Palm Pilot, that would be an arduous task).

Do I feel "good" about this? Not really: I hate to tell folks that I can't help them. In this case, though, she was the one who created that dilemna: I can usually help honest folks find at least some kind of cover.

As they say, all's well that ends.