Matt Grieser runs a construction business. Aubrey has a graphic-design degree and stays home with their three boys, overseeing the home schooling of the eldest.
They have a new puppy, a $1,250 monthly mortgage and no health insurance.
No health insurance. Where have I heard this before?
So what did they decide to do?
the Griesers believe they have finally found a program that appears to be affordable and could help them keep their home if a medical disaster strikes — Christian Care Medi-Share.
Medi-Share is not insurance, but rather a Christian, sharing plan where members pledge to make donations to help cover the cost of medical bills incurred by other members. Kind of like a health co-op.
So what does Medi-Share pay?
Medi-Share is supposed to pick up everything — after a $911 deductible per person
Operative word here is "supposed" to pay.
Your bills may be paid in full, or they may not.
Therein lies the problem.
What do you tell your doc if they want to schedule you for a major procedure? "Well Doc, this plan is SUPPOSED to pay everything, but there are no guarantees."
And what about the hospital?
Same offer.
Wonder how many providers are willing to go ahead without a financial guarantee?
And then there is this . . .
Last year Medi-Share took in about $60 million and paid out $46 million, Baldwin said, with the rest going to administrative expenses.
Sounds like a lot for administrative expenses.
And there is more.
The fund will not cover non-Christians or smokers, and it turns away overweight people who fail to meet weight-loss goals in 12 months.
Sounds like Medi-Share isn't perfect either.
Thursday, January 31, 2008
Survey Says . . .
Ever wonder what folks DON'T like about insurance?
Other than the premium, of course.
Well wonder no more.
The number one answer?
Delays, denial of claims and unsatisfactory offers by the carrier.
According to the NAIC these account for 41% of complaints.
The number one spot by line of coverage is . . . accident & health insurance with 36% of the complaints filed followed closely by auto insurance with 34%.
You can view the summary results here.
Based on my experience, most of the complaints can be traced back to the consumer failing to understand their coverage.
Of course this is usually a direct result of failing to read their policy.
Other than the premium, of course.
Well wonder no more.
The number one answer?
Delays, denial of claims and unsatisfactory offers by the carrier.
According to the NAIC these account for 41% of complaints.
The number one spot by line of coverage is . . . accident & health insurance with 36% of the complaints filed followed closely by auto insurance with 34%.
You can view the summary results here.
Based on my experience, most of the complaints can be traced back to the consumer failing to understand their coverage.
Of course this is usually a direct result of failing to read their policy.
Party of 3, Please...
Happy Blogiversary!
When I was younger, my mother warned me that time would go much faster as the years went by. And, as usual, mother was right. While it's hard to believe, today marks our Third Anniversary.
According to Blogger, we have almost 1,700 posts under our collective belt.
SiteMeter tells us that we've had over 180,000 page views.
This past year, we:
■ Became a Charter Member of the Health Care Blogger Code of Ethics alliance.
■ Were once again a Top 10 Finalist in the Weblog Awards
■ Finished in the Top 50 of the eDrugSearch Top 100 (all the more remarkable, since we're also the only insurance-related blog in that campaign)
■ Are one of the Top 4 blogs on Wikio's Top 100 Health Blogs
■ Made our TV debut
During the S-CHIP kerfluffle, we got our first "Big Media" links. On the one hand, our traffic was through the roof, and we had more comments than I'd ever seen before. On the other hand, our traffic was through the roof, and I deleted more comments in one day than we usually get in a week.
I'll be fine if we're limited to one of those a year.
I cannot say enough good things about my co-bloggers. Truly, I read some of their posts and my jaw drops, I am so utterly amazed and impressed. Bob, Mike and Bill represent many years of experience, and it certainly makes my "job" easier knowing that even on those days where I draw a blank, at least one of them will have something interesting, provocative or humorous to say.
Sometimes all three.
In the same post.
Our commenters are also most appreciated. We have our disagreements (of course!), but we also have a lot of enlightened and enlightening discussions.
Most of all, though, I'd like to thank all of our readers for stopping by, and hopefully learning something new, or at least interesting.
And now, on to Year 4!
Obit: CA Universal Care
The Golden State legislature pulled the plug yesterday on the Governator's health care plan. Interestingly, two causes of death were officially cited: "too [deleted] expensive" and "not generous enough." Next of kin were unavailable for comment.
Even the uberliberal California legislature balked at the anticipated costs (which, as we've seen, always understate the true figures), while the "individual mandate" turned out to be the deal killer. That provision required every citizen (well, we'll quibble with that later) to buy and maintain health coverage. Folks on the lower end of the economic scale were to receive subsidies to offset the cost.
While that may seem laudable in theory, the reality is that the plan itself would have made health coverage so expensive that the subsidies would become unworkable. And the legislators also figured out something we've already known: that guaranteed issue and community rating drive costs up, not down, increasing the number of uninsured, who would then face stiff penalties, ad nauseum (literally: that's nauseating).
But like most painful lessons, we can learn a lot from failure. Although the plan was modeled after the Massachusetts program, it seemed to go even farther, and thus cost more. And as we've noted here in the past, health insurance costs are largely a function of health care costs, which this plan (like its Bay State cousin) failed to address.
Requiescat In Pace.
Lotto Healthcare
Looking for free health insurance?
Move to Oregon.
Seems the folks in the northwest seem to think the answer to the uninsured is . . . a lottery.
Uninsured residents who meet all eligibility requirements must phone in to a call center and put their name on a reservation list, but there are no coverage guarantees.
Call now. Operators are standing by.
Starting in March, a computer lottery will determine who gets on the plan and who doesn't.
A computer, huh?
Hope they don't get HAL.
Move to Oregon.
Seems the folks in the northwest seem to think the answer to the uninsured is . . . a lottery.
Uninsured residents who meet all eligibility requirements must phone in to a call center and put their name on a reservation list, but there are no coverage guarantees.
Call now. Operators are standing by.
Starting in March, a computer lottery will determine who gets on the plan and who doesn't.
A computer, huh?
Hope they don't get HAL.
Wednesday, January 30, 2008
Free Health Care
Washington state has become one of the latest states to offer free health care to all.
However, it comes with a catch . . .
Like maybe you had surgery and doc left an instrument inside you. Or, they operated on the wrong limb or organ.
Maybe you had surgery that wasn't necessary.
Or you died from a minor procedure when you were reasonably healthy before.
So the good news is, if a hospital or doc makes a serious mistake, you owe nothing for your care.
The bad news is . . . .
However, it comes with a catch . . .
Like maybe you had surgery and doc left an instrument inside you. Or, they operated on the wrong limb or organ.
Maybe you had surgery that wasn't necessary.
Or you died from a minor procedure when you were reasonably healthy before.
So the good news is, if a hospital or doc makes a serious mistake, you owe nothing for your care.
The bad news is . . . .
Service Issue: Maybe a Little TOO Personal
[Welcome Industry Radar readers!]
Regular readers know that I'm no carrier's shill. In fact, I have a favorite saying about insurers:
Regular readers know that I'm no carrier's shill. In fact, I have a favorite saying about insurers:
'Not all carriers are run by idiots - some are run by morons.'
And some, apparently, are run by Lothario's:
Now, in fairness, that last was a cheap shot: most claims aren't denied, and carriers don't exhibit compassion because they're not people, they're corporations.
My usual beef with carriers is their heavy-handedness at renewal time, and the stupid "press one for this, two for that" phone systems that make it unnecessarily difficult to get to a real, live human being (although this disease affects many large businesses, it's particularly frustrating when I've got an unhappy client on one line, while trying to connect with a CSR on another).
But this is a new one. Apparently, this guy's job didn't keep him busy enough, so he had plenty of time to cat around. There's an obvious line here about what insurers supposedly do to their insured's, and the term "ironic" seems apt, but I'll resist the urge.
Cavalcade of Risk #44 is up!
The Digerati Life hosts this week's compendium of risky business (and health, and investing, and, well, you know). Do check it out.
As SVB will tell you, hosting's fun and easy, and a little extra traffic never hurts, either. To grab your own spot, just drop us a line.
The New Millionaire's
Seems like a lot of folks are focused on wealth, and what money will buy. They sometimes are possessed about how the wealthy spend their money.
Bling doesn't mean a thing if you don't have your health.
A Washington Post article opened my eyes to some little known illnesses that can be very expensive to treat. Granted, we are talking about a very small minority who are afflicted, but still this is an issue that can be remedied in exchange for very few dollars.
The most expensive coverage is the routine, first dollar plan. When folks want copays for office visits, routine well care and so forth the price of coverage sky rockets.
Same for Rx copays and low (under $2,000) major med deductibles.
I try to discourage clients from wasting money on such phantom coverage but not everyone listens . . .
Some plans (group & individual) have low caps on lifetime benefits, while others will limit the amount they pay for things like Rx or transplants.
The WP article addresses such issues.
Those who need organ transplants or who have hemophilia, Gaucher disease or other costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies
Until now, I had never heard of Gaucher disease. The "standard" high claim issues anticipated by carriers has been premature births, head & spinal cord injuries, and burns.
While these make up the majority of the large claims, they are not all inclusive.
Low lifetime caps are somewhat common on government plans. Given that the cost of increasing the lifetime max from $1M or $2M to $5M is relatively small, one has to wonder why we still see plans with such low caps.
In many cases the cost of increasing a lifetime cap from $2M to $5M can be in the range of $4 per month.
At age 6, Hayley Resk was diagnosed with primary sclerosing cholangitis, a progressive liver disease that scars and inflames the bile ducts, and whose most famous sufferer was the late football great Walter Payton. The family's insurance had a lifetime benefits cap of $1 million per person, but it also limited coverage for transplants to $250,000 -- not enough to pay for the liver transplant that Hayley, now 14, received from her mother on Feb. 12, 2007.
Limits on organ transplants are less common, and seem to show up more frequently in individual major med plans as opposed to group plans. But group health plans are not immune.
Hemophilia is an illness that is common enough that the public is aware, but still somewhat rare as far as illnesses go. The Fatula's have 3 boys with hemophilia.
The clotting factor they take to prevent and control bleeding costs about $150,000 a month, and at various times each has been hospitalized for internal bleeding or to treat infections of the ports that allow them to take medication intravenously, Kerry Fatula said. For now, Medicaid pays medical bills for all three. But the eldest, Paul, a senior in high school who physically can do "90 percent" of what his healthy peers can, recently turned 18 and must qualify as a disabled adult to retain federal assistance, she said.
The family could try for new insurance if Chuck, 42, a field service technician for a specialized engineering company, found a new job, but he has invested more than a decade in the company, and finding a comparable position elsewhere would be difficult, she said. Kerry Fatula, 40, does not get coverage through her work with the hemophilia foundation's western Pennsylvania chapter.
Now that's a bit of irony.
Kerry works for the Hemophilia Foundation, but does not have an employer sponsored health plan.
One would think . . .
Never mind.
Bling doesn't mean a thing if you don't have your health.
A Washington Post article opened my eyes to some little known illnesses that can be very expensive to treat. Granted, we are talking about a very small minority who are afflicted, but still this is an issue that can be remedied in exchange for very few dollars.
The most expensive coverage is the routine, first dollar plan. When folks want copays for office visits, routine well care and so forth the price of coverage sky rockets.
Same for Rx copays and low (under $2,000) major med deductibles.
I try to discourage clients from wasting money on such phantom coverage but not everyone listens . . .
Some plans (group & individual) have low caps on lifetime benefits, while others will limit the amount they pay for things like Rx or transplants.
The WP article addresses such issues.
Those who need organ transplants or who have hemophilia, Gaucher disease or other costly chronic illnesses can easily rack up medical bills that blow through the lifetime benefits cap of $1 million or more that is a standard part of many insurance policies
Until now, I had never heard of Gaucher disease. The "standard" high claim issues anticipated by carriers has been premature births, head & spinal cord injuries, and burns.
While these make up the majority of the large claims, they are not all inclusive.
Low lifetime caps are somewhat common on government plans. Given that the cost of increasing the lifetime max from $1M or $2M to $5M is relatively small, one has to wonder why we still see plans with such low caps.
In many cases the cost of increasing a lifetime cap from $2M to $5M can be in the range of $4 per month.
At age 6, Hayley Resk was diagnosed with primary sclerosing cholangitis, a progressive liver disease that scars and inflames the bile ducts, and whose most famous sufferer was the late football great Walter Payton. The family's insurance had a lifetime benefits cap of $1 million per person, but it also limited coverage for transplants to $250,000 -- not enough to pay for the liver transplant that Hayley, now 14, received from her mother on Feb. 12, 2007.
Limits on organ transplants are less common, and seem to show up more frequently in individual major med plans as opposed to group plans. But group health plans are not immune.
Hemophilia is an illness that is common enough that the public is aware, but still somewhat rare as far as illnesses go. The Fatula's have 3 boys with hemophilia.
The clotting factor they take to prevent and control bleeding costs about $150,000 a month, and at various times each has been hospitalized for internal bleeding or to treat infections of the ports that allow them to take medication intravenously, Kerry Fatula said. For now, Medicaid pays medical bills for all three. But the eldest, Paul, a senior in high school who physically can do "90 percent" of what his healthy peers can, recently turned 18 and must qualify as a disabled adult to retain federal assistance, she said.
The family could try for new insurance if Chuck, 42, a field service technician for a specialized engineering company, found a new job, but he has invested more than a decade in the company, and finding a comparable position elsewhere would be difficult, she said. Kerry Fatula, 40, does not get coverage through her work with the hemophilia foundation's western Pennsylvania chapter.
Now that's a bit of irony.
Kerry works for the Hemophilia Foundation, but does not have an employer sponsored health plan.
One would think . . .
Never mind.
Tuesday, January 29, 2008
Group vs Individual: Mixed Feelings (Part 2)
As we discussed in Part 1, there's a (relatively) new game afoot in the employee benefits business. In that post, we examined a USA Today article detailing that sea change; now, we'll turn our attention to some of the factual problems of the article on which that was based. As promised, we'll also look at another proposed solution.
We'll start with this little gem:
"Critics say the change would end the long-standing, implicit social pact to provide coverage to sick and healthy workers alike."
Balderdash! There is no such compact. The truth is that the whole employer-based health insurance system is relatively new; it began as a direct result of the wage freezes put in place during the second World War.
There are other gross misstatements, as well. For example, the article claims that "everyone in the group pays the same premium." No they don't. Depending on the group, there can be different rates for men and women, older and younger employees, and those with dependents.
But Ms Appleby isn't content to misrepresent only group coverage:
"In most states, insurers can reject individual applicants for health reasons and can charge widely varying premiums based on the applicant's age, health history and other factors. Only in a handful of states, such as New York, Massachusetts and New Jersey, must insurers sell coverage to everyone, regardless of their health."
It's also true that water can kill you, but there are some pretty explicit circumstances where this holds true. What's not mentioned in the preceding quote is that "guaranteed issue" and "community rating" states have signficantly higher average premiums, as well as higher rates of uninsured. Again, there's a tradeoff of benefit versus cost [ed: I get it, I get it!].
The article continues with this little doozy:
"The idea comes as the percentage of employers providing insurance shrinks and the number of uninsured Americans grows."
There follows more of the discredited 47 million. Of course, we've already debunked that number, and one also wonders how many of these folks are uninsured by choice. Still, it's reasonable to ask: what about those folks who want to buy coverage, but find it either unavailable or unaffordable (and I mean by our own very strct definition)? In the individual market, it's slim pickin's indeed. There are state mandated (e.g. HIPAA) plans, some folks qualify for COBRA continuation (for a while, anyway), and there's a raft of new guaranteed issue "mini-med" plans available. None of these, however, seem to me to really address the underlying problem: the gummint-mandated plans are expensive and offer mediocre coverage, COBRA is available only in certain circumstances and for a limited time, and the mini-med plans offer less-than-ideal coverage.
Seems pretty grim, hunh?
I painted that picture to illustrate that, although I'm a fan of the free market, I'm not a sycophant (literally: psychotic elephant). Rather, it seems to me that we need to step back and take a look at some different ideas. The Association of Health Insurance Plans is an industry trade group that has come up with one such potentially helpful proposal: they've called on the states "to create guaranteed-access plans that would make insurance available to people with serious medical conditions. The group said insurers should provide coverage to those who aren't sick enough to qualify for the state plans." As I've stated many times, I'm all for state-based experimentation. It's true that what works in Kentucky may fall flat in Arizona, but whatever damage is done is contained. And, those things that work well can then be transferred and adapted.
In other words, incremental change. The challenge that I've seen so far is that politicians and consumers alike all want a "quick fix," ignoring the fact that it took us a very long time to get to our current situation. I certainly don't advocate taking 60 years to come up with a viable solution (or solutions), nor do I think it will take anything like that long. One place to start, of course, is to begin the dialog by agreeing that health care and health insurance are not the same thing, and that each system has its own set of problems, and solutions.
Okay, off my soap box.
Monday, January 28, 2008
Grand Rounds Fiasco
One of the most well-known and -read blog "carnivals" is Grand Rounds. It's a round-up of posts from medbloggers (those who blog primarily in the health field). We've been enthusiastic participants for several years.
Most carnivals stick with one, primary means of submission. This can be (for example) Blog Carnival, which automates the process, or through email. Grand Rounds typically goes the latter route; one submits a post via email to the host blog. Entries are due by the Sunday before a 'Rounds.
Last Friday, I clicked over to the host for tomorrow's scheduled edition to see if there were any last minute changes or suggestions. The hostess had two 'Rounds-related posts, both directing bloggers to use her email address. So, I did so.
And the email bounced. I tried again, and it bounced again. Thinking that I had inadvertently copied an incorrect "addy," I popped over and found that I had, indeed, been using the (supposedly) correct address. I also noticed that both of her 'Rounds entries had comments from other bloggers who had experienced the same problem. I joined the growing chorus, and waited. As of this evening, she has made no response in either post, nor has she contacted us to let us know that she was aware of the problem.
Is this a "big deal?"
Of course not.
But what's the point of blogging if you can't whine once in a while?
Can You Hear Me Now? (MVNHS© Edition)
For nine years, or 80% of Jerome Bartens' young life, he was deaf. MVNHS© doctors were stumped: what could possibly be wrong with the young lad?
Finally, the specialists agreed (apparently without testing) that it was simply a build-up of wax, and that Jerome would "probably grow out of it."
Really?
The "when" was left to fate, or chance, or time, and the boy "struggled at school, couldn't hear the TV properly and was fed up with people having to shout at him" in the meantime.
Over the intervening years, other specialists examined Jerome, but simply reiterated the original prognosis. They could (or would) do nothing more.
And then, quite recently in fact, he had a life-changing experience:
"(W)hen playing pool with his friends in a church hall Jerome felt a sudden pop. He put his finger in his ear and there was the tip of a cotton wool bud which had been wedged there for almost 10 years."
Yes, a piece of a Q-Tip, which went undetected for almost 10 years. He's just lucky he's not elderly or fat.
Gotta love that free health care.
HSA Update
Received this from one of my vendors today (I've gussied it up a bit); if you have an HSA (Health Savings Account) plan, you may find them quite helpful:
First up, the ol' W-2:
W-2 reporting should include all HSA contributions made on a pre-tax basis by the employee and any HSA contributions made by the employer. If you started your HSA in 2008, please make sure to make note of this required reporting. Many employers did not include their contribution on the W-2 and now must reprint all W-2s in order reflect employee plus employer funding (Oops!).
Second, folks who contributed to their HSA last year will also receive a Form 5498-SA, which details HSA contributions for 2007. Please note, HSA owners have until April 15, 2008 to contribute monies into their HSA that may be applied toward their 2007 maximum contribution amount (as annually indexed). Of course(!), custodial banks will not mail these forms until May 2008.
Third, the ubiquitous 1099-SA (aka 1099). Folks who took distributions from their HSA in 2007 will also receive a 1099-SA detailing distributions from their HSA for 2007. This report is mailed by the end of January from the Bank Trustee. At least this form does not have to be attached to the filing.
Ever heard of Form 8889? Every health savings account owner must file IRS Form 8889 along with their personal tax return. The IRS is tracking who is purchasing and using Health Savings Accounts (HSAs). IRS Form 8889 makes sure that you receive all your tax credits and use the money for qualified medical expenses only. You can be penalized if the HSA money is used for non-qualified expenses. If you've already filed your taxes, we'd suggest that you complete IRS Form 8889 and send it with an explanation to the IRS along with a copy of your previously filed tax return.
Whew! But we're not done yet:
New Health Savings Account Regulations
■ The 2008 maximum annual contribution limit is $2,900 for single coverage and $5,800 for family coverage. Even though your 2008 deductible amounts may be less, you may choose to fund to these new annual maximums. In other words, you can "overfund" the HSA account in order to stockpile cash for potential future claims.
■ Employers are allowed to make a one-time transfer of the balance of an employee’s FSA or HRA account to an HSA. Of course, there are special rules for this; see your tax professional for details.
■ Individuals are allowed to make a one-time, tax-free, trustee to trustee, irrevocable distribution from their IRA into an HSA as long as the distribution amount does not exceed the annual contribution limit under most circumstances. Unlike the FSA/HSA transfer, the IRA transfer is not treated as a rollover contribution. Thus, any amounts transferred from the IRA to the HSA during the year reduce the amount that may otherwise be contributed to the HSA that year.
■ If you are over age 55, then you're eligible for an annual catch-up contribution of $900 for 2008. This is over and above the established maximums above. Again, see your tax pro for more information.
Did I mention that you should always consult with your own tax professional about these?
Carnival of Personal Finance is up
If you're passionate about blog carnivals (and who isn't?), you'll love the latest edition of the Carnival of Personal Finance. Hosted by The Dividend Guy, it's almost overwhelming (I stopped counting at 60 posts); there's an Editor's Choice section to kick things off, and then a slew of interesting posts, in helpul categories, follow.
Dan, blogging at MoneyMyths, has a poignant, and helpful, post about how the tests we face in life also teach us valuable lessons.
Group vs Individual: Mixed Feelings (Part 1)
[Welcome Industry Radar readers!]
Here's the thing: I am not, in general, a fan of tying health insurance to employment. Yes, there are advantages to group coverage, but these are a result of such a system, not a raison d'etre. On the other hand, simply deleting the current system creates its own problems, especially vis folks who might find it difficult to find individual coverage (affordable or otherwise).
Here's the thing: I am not, in general, a fan of tying health insurance to employment. Yes, there are advantages to group coverage, but these are a result of such a system, not a raison d'etre. On the other hand, simply deleting the current system creates its own problems, especially vis folks who might find it difficult to find individual coverage (affordable or otherwise).
In the past, I've pooh-poohed the "105'ers" who champion the idea of wholesale deletion of group plans, with little (if any) regard to those latter folks. I think their approach is simplistic and overly optimistic. And yet...
In a recent USA Today article, writer Julie Appleby looks at one proposed solution to the employer-based insurance conundrum. She also makes some incorrect observations of, and assertions about, how insurance works. We'll want to deal with those, as well; sometimes, there's just so much material that it's difficult to know how to write a meaningful, yet reasonably sized, post. And so, this particular effort will come to you in two parts. In this first post, we'll look at the issues and challenges of the aforementioned "solution" to the employer-based insurance conundrum. In Part 2, we'll debunk some of the side issues raised by Ms Appleby.
Let's begin, shall we?
As mentioned, we've been pretty hard on what we've called the "105'ers." The name comes from their use of Section 105 of the Internal Revenue Code, which (under certain circumstances) extends tax advantages to individual plans that mirror those for group. Our issue with these folks has always been their "I have only a hammer, thus everything looks like a nail" approach to benefits management.
But maybe they were on to something, after all:
And he's not the only one. Recently, Bob and I have had a major email conversation about a friend of his who's doing this kind of work in Florida. Rather than a straight 105 plan, he's using the newer Health Reimbursement Arrangement (essentially the same thing, with a different wrapper). But the end result is the same: a defined contribution plan in lieu of a defined benefit one.
NB: Most group health plans are Defined Benefit plans; that is, there's a group insurance plan (either fully or self-insured) with covered expenses which are clearly stated up-front ('this deductible, that co-pay'). The premiums within the group may differ, depending on age, sex, family status, etc (but not health). A Defined Contribution plan, on the other hand, is one which promises a stated cash contribution, from which employees are free to pick the plan of their choice.
The problem is that the safeguards currently in place for group plans don't exist in the individual market. This is neither good nor bad, it just is. The reason "it's not good or bad" is that, while these safeguards are helpful protections, they come at a (literal) price. So there's a trade-off of safety versus cost.
"The healthy employees don't have to pay for sick employees," says Pilzer [ed: author of a book on this subject]...employers can save money because they contribute a set amount per employee — often far less than they pay for group coverage."
And there's the rub: the basic idea behind insurance is to spread the risk; "spreading the risk" means that healthy folks are, to some extent, subsidizing the unhealthy (younger subsidizing older, etc). When you remove the "invincible youths" from the larger risk pool, you upset that balance.
Now, it's tempting to say "so what?" - and that's what I've called the 105'ers out on in the past. But I also know that insurance costs continue to rise (thanks primarily to more and more government mandates, and the ever increasing cost of health care itself). And that needs to be addressed.
Some folks think that we should do away with group cover in favor of individual plans, but only "if Congress passes national rules requiring insurers to take everyone, regardless of his or her health." Great, more gummint intervention and complication.
Actually, I agree with the first half of that statement: we should do away with group coverage as it exists now. But not for the reasons we've seen thus far. No, my issue with group cover is far more simple, and fundamental: the basic premise behind group health insurance is that "one size fits all" (I know, what about "cafeteria plans?" We'll address that in another post). As anyone who's ever bought gloves can tell you, "one size fits all" is only half of the statement: "but not very well" completes the phrase. Thus, you have folks who really want an HSA forced into an expensive and "ill-fitting" co-pay plan, and folks who just want to know how much the doctor's visit will cost shoved unceremoniously into an HSA plan.
And that's where individual plans become attractive: when you're in charge of buying your own health insurance (just as you're already in charge of buying - if not necessarily paying for - your own health care), you tend to want what you want (and/or need). Yes, many folks buy "too much insurance," but that doesn't negate the basic idea. Under a Defined Contribution plan, each employee can buy the kind of insurance that (hopefully) fits their own needs, rather than those of others in the group. That fits in neatly with another InsureBlog meme: personal responsibility.
What Bob's friend and folks like Pilzer are doing is wrapping that cash contribution in a tax-advantaged HRA (yes, that's redundant, but I'm trying to make a point). By doing so, they hope to give employers and employees the best of both worlds (or at least a part of the best): the tax advantages of group with the flexibility of individual. And that's not necessarily such a bad idea.
Or is it?
For the most part, group insurance is subject to HIPAA. Briefly, this means that they can't exclude or charge unhealthy folks more, and coverage is "portable" (generally, you can go from group plan to group plan without worrying about pre-existing conditions). But group plans can cost considerably more than comparable individual ones; hence the attraction of these new programs. The problem is, I haven't seen either our old 105 "friends" or Bob's colleague address an issue which Ms Appleby throws in at the last minute:
"Berneche had to certify on his individual insurance application that his company was not reimbursing him. Yet the contributions his company provides are at least a partial reimbursement."
That is, carriers who offer individual plans want to make sure that their policies aren't subject to the more regulation-intensive group environment. So they make sure at the outset that there's no connection between the employer and the insurance. But, as Ms Appleby (correctly) points out, the key word in HRA is "reimbursement," which now renders the application (and perhaps the policy itself) suspect. There've been a lot of stories about rescission, both here and in the popular press, and this may be a major can of worms.
"The Department of Labor and the Treasury Department are considering whether federal rules that apply to group insurance also apply in programs such as Zane's, in which an employer makes a contribution but doesn't offer a group plan, a statement from the Department of Labor says."
If they do (and this certainly seems at least plausible), then I really have to question the concept's long-term viability.
In Part 2, we'll discuss some of the problems inherent in group coverage, and another intriguing proposal.
Sunday, January 27, 2008
Unhealthy? The MVNHS© Says: Too Bad!
[Welcome Industry Radar readers!]
This is too good:
This is too good:
We cannot afford to provide free care to everyone.
Nationalized health care in a nutshell.
Thank you, doctors, for your honesty.
Saturday, January 26, 2008
Life's Tough, Get a Helmet
[Welcome Industry Radar readers!]
Bob tipped me to this:
Turns out, a group of British researchers have found that low-level, infrared light apparently stimulates certain brain cells, causing them to regenerate and repair themselves. The theory is that even modest exposure can halt, perhaps even reverse, Alzheimer's symptoms.
While the research is still nascent, it seems to hold a lot of promise. We'll keep you posted.
Friday, January 25, 2008
Battle of the Bucks
There is a war going on.
The battle is taking place in doctors offices all across the country. It pits the carriers against the pharmaceutical manufacturers.
What is at stake is your wallet.
Carriers are trying to help you become a better consumer of health care. In doing so they are fighting big pharma.
Health plans are drawing scrutiny for offering financial incentives to entice doctors to prescribe cheaper generic medicines, including paying doctors $100 each time they switch a patient from a brand-name drug.
Pharmaceutical companies have long gone to great lengths to try to get doctors to prescribe their brand-name pills. They spend billions of dollars, plying physicians with samples, educational lunches and speaker fees. But as the patents for a growing number of blockbuster medicines expire, some health insurers are trying to trump those perks with bonuses or higher reimbursements for writing more generic prescriptions
So how is it working so far?
Blue Cross Blue Shield of Michigan says the program was a one-time event to take advantage of the recent introduction of simvistatin, the generic equivalent of another brand-name statin, Zocor. It says the $2 million its HMO spent in payments to doctors saved Blue Care Network $5 million in drug costs and its individual members $1 million in co-payments.
Three to one return.
We like it.
The battle is taking place in doctors offices all across the country. It pits the carriers against the pharmaceutical manufacturers.
What is at stake is your wallet.
Carriers are trying to help you become a better consumer of health care. In doing so they are fighting big pharma.
Health plans are drawing scrutiny for offering financial incentives to entice doctors to prescribe cheaper generic medicines, including paying doctors $100 each time they switch a patient from a brand-name drug.
Pharmaceutical companies have long gone to great lengths to try to get doctors to prescribe their brand-name pills. They spend billions of dollars, plying physicians with samples, educational lunches and speaker fees. But as the patents for a growing number of blockbuster medicines expire, some health insurers are trying to trump those perks with bonuses or higher reimbursements for writing more generic prescriptions
So how is it working so far?
Blue Cross Blue Shield of Michigan says the program was a one-time event to take advantage of the recent introduction of simvistatin, the generic equivalent of another brand-name statin, Zocor. It says the $2 million its HMO spent in payments to doctors saved Blue Care Network $5 million in drug costs and its individual members $1 million in co-payments.
Three to one return.
We like it.
Work for Free
How would you feel if you were forced to work for free. In other words, forced to volunteer your time, ability and even provide materials to complete the job . . . at no cost to your client?
Would you feel any different if the one forcing you to work for free was the government?
If the New Hampshire legislature gets their way, it can happen.
Roland and Bonnie Currier, of Middleton, said New Hampshire should become the nation's first state to make a patient without health insurance equally likely to get an organ transplant.
Nicholas Currier, 21, died Jan. 20 in a Boston hospital that his parents said refused to place him on the list for a liver transplant because he had no health coverage.
I am not insensitive to the plight of his parents, but I must also ask, why did they allow their son to go uninsured?
"From the first moment we were there, it was, 'Where is your insurance?' They were harassing us from beginning to end,
Harassing.
One could also say the state is attempting to bully medical providers into working for free.
Where will it stop?
Would you feel any different if the one forcing you to work for free was the government?
If the New Hampshire legislature gets their way, it can happen.
Roland and Bonnie Currier, of Middleton, said New Hampshire should become the nation's first state to make a patient without health insurance equally likely to get an organ transplant.
Nicholas Currier, 21, died Jan. 20 in a Boston hospital that his parents said refused to place him on the list for a liver transplant because he had no health coverage.
I am not insensitive to the plight of his parents, but I must also ask, why did they allow their son to go uninsured?
"From the first moment we were there, it was, 'Where is your insurance?' They were harassing us from beginning to end,
Harassing.
One could also say the state is attempting to bully medical providers into working for free.
Where will it stop?
Cavalcade of Risk #44: Submissions Due
Silicon Valley Blogger hosts next week's Cavalcade, scheduled for Wednesday the 30th. Please make sure to get your submissions in by Monday (the 28th). SVB 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
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post
Thursday, January 24, 2008
Free, or Not At All
Want to discourage folks from health care?
Charge them a fee.
Seriously.
Seems a lot of folks are more than willing to access the health care system as long as it is free.
Screening rates from 2001 through 2004 were nearly 11 percent lower for women who had to contribute a co-pay as low as $12, compared to women whose mammograms were free,
$12 for a mammogram is too much to pay.
Sure. I can see that.
Why, for $12 you can get two Gigantous Latte's . . . apparently a much better use of funds.
Studies have suggested that mammograms may save lives by detecting breast cancers at an earlier, and more curable, stage. "This is a case where co-payments adversely affected health,"
Copays adversely affect health.
Seems to me that copays must can lead to stupidity.
"It would make clinical sense, and probably economic sense, for a health plan to eliminate a co-payment for a mammogram,"
Why stop there? Just make everything free.
But even though nearly all women know the value of mammograms, many did not get them when they had to pay.
Hold the mammogram and give me a double shot latte.
Charge them a fee.
Seriously.
Seems a lot of folks are more than willing to access the health care system as long as it is free.
Screening rates from 2001 through 2004 were nearly 11 percent lower for women who had to contribute a co-pay as low as $12, compared to women whose mammograms were free,
$12 for a mammogram is too much to pay.
Sure. I can see that.
Why, for $12 you can get two Gigantous Latte's . . . apparently a much better use of funds.
Studies have suggested that mammograms may save lives by detecting breast cancers at an earlier, and more curable, stage. "This is a case where co-payments adversely affected health,"
Copays adversely affect health.
Seems to me that copays must can lead to stupidity.
"It would make clinical sense, and probably economic sense, for a health plan to eliminate a co-payment for a mammogram,"
Why stop there? Just make everything free.
But even though nearly all women know the value of mammograms, many did not get them when they had to pay.
Hold the mammogram and give me a double shot latte.
CAB across The Pond: MVNHS© in a Tizzy
Dr John Crippen practices in the UK, and writes at the award-winning NHS Blog Doctor. Recently, he reported on the National Health System's "much vaunted Choose and Book (CAB) system" [ed: methinks he owes you a shilling for "much vaunted"], which is essentially a government overseen referral process for folks who need the care of a specialist.
Some group insurance plans here in the States also require a referral to a specialist. The thing is, one's primary care physician is free to recommend any qualified specialist (although it's to the insured's benefit that the specialist is "in-network").
Not so in Merry Old England: The CAB system's "commissar" requires physicians to send "a page and a half of instructions, to the patient. We no longer write to a specialist we know and trust. We send a circular to a medical tombola." In other words, the primary care physician is removed from the decision making process altogether, leaving the patient with few (if any) resources to rely in making important health care decisions.
Now, there are some who would say "but Henry, you're always touting consumer driven health care, and agitating for more personal responsibility in the process," and they would be right. But that's a patient's choice; there's no gummint bureaucrat mandating that he do so. And for seasoned citizens, the problem is exacerbated:
"Many elderly patients, particularly those who live alone, do not understand the system and do not know how to get help."
This is particularly troublesome, as these are folks who are likely to have greater health care needs than younger citizens. And it underscores another issue that seems to be growing "over there:"
"Patients are not turning up for appointments...So now the GPs are being asked to take responsibility for the system and chase the patients with a third reminder."
As Dr Crippen notes, this is an additional burden on NHS providers, and it's one that's unlikely to be successful. Not a ringing endorsement of government-sponsored health care.
Hat tip: Bob Vineyard
Health Wonk Review is up
Even as the Carnival of the Capitalists appears to wane, the Health Wonk Review continues to grow and blossom. First time host Vince Kuraitis, blogging at e-care Management, presents an outstanding edition, well laid out and easy to follow.
Take a wonky tour.
Take a wonky tour.
Wednesday, January 23, 2008
The List . . .
Seems these days everyone has an opinion on what is wrong (and occasionally, what is right) with the U.S. health care system.
A fellow blogger started a list. Here are just a few of the things on . . . the list.
1. Health care is expensive
2. Sometimes it is worth it, but sometimes the expense is unnecessary
3. Our ability to improve quality of life has grown dramatically over the past 30 years
4. Our ability to manage many chronic diseases has grown dramatically over the past 30 years
5. In general we have too high a proportion of medical school graduates entering subspecialties and not enough entering generalist fields
Worthwhile reading, and commenting on.
A fellow blogger started a list. Here are just a few of the things on . . . the list.
1. Health care is expensive
2. Sometimes it is worth it, but sometimes the expense is unnecessary
3. Our ability to improve quality of life has grown dramatically over the past 30 years
4. Our ability to manage many chronic diseases has grown dramatically over the past 30 years
5. In general we have too high a proportion of medical school graduates entering subspecialties and not enough entering generalist fields
Worthwhile reading, and commenting on.
From the P&C Side: A Monstrous Idea...
If you've been to a movie or surfed the web recently, you've no doubt seen the trailer for the new horror flick Cloverfield. Like Godzilla before it, the goal of the monster is to destroy a city (whether it's New York or Tokyo, these guys are pretty destructive). There are often morals to these kinds of efforts: nuclear weapons, global warming, Brittany Spears, etc.
But when that monster is bearing down on your house, you have to ask yourself this question: Am I covered?
Fear not:
Tuesday, January 22, 2008
Low Margin Patients
Got Medicare?
Love it?
Think everyone should have it?
Might want to reconsider.
Mounting pressure on doctors stemming from Medicare has New Jersey physicians thinking about dropping patients with the federal insurance.
Dropping patients.
That would be . . . rationing of services.
The group says Medicare reimbursements are falling behind the rising cost of running a doctor’s office in New Jersey,
Falling behind.
Scott says spine surgeons and some other specialists have already stopped taking Medicare users, mostly because they can’t afford to see “low-margin patients.”
Low margin patients.
Kind of has a ring to it.
“Doctors need to think of their practice as a business, and they need to come up with creative ways to deal with changing reimbursements,”
Sounds like docs are for-profit practitioners. Some feel that profit and medical care are mutually exclusive terms.
That is mostly coming from low margin patients.
Love it?
Think everyone should have it?
Might want to reconsider.
Mounting pressure on doctors stemming from Medicare has New Jersey physicians thinking about dropping patients with the federal insurance.
Dropping patients.
That would be . . . rationing of services.
The group says Medicare reimbursements are falling behind the rising cost of running a doctor’s office in New Jersey,
Falling behind.
Scott says spine surgeons and some other specialists have already stopped taking Medicare users, mostly because they can’t afford to see “low-margin patients.”
Low margin patients.
Kind of has a ring to it.
“Doctors need to think of their practice as a business, and they need to come up with creative ways to deal with changing reimbursements,”
Sounds like docs are for-profit practitioners. Some feel that profit and medical care are mutually exclusive terms.
That is mostly coming from low margin patients.
Mama was right
Remember when you had the sniffles as a kid, and your mom brought you some nice, warm chicken soup (maybe with those cool mini-star noodles floating around in it)? She told you it was good for you, and after a few tentative sips, as the warmth flowed through you, you believed it.
Well, she was on to something:
A healthy and comforting thought on a blustery winter's day.
H/T: But You Don't Look Sick.
Throwing Out the Baby with the Bath Water
Seems like most of those railing against the private health care system (and health insurance) want to scrap what is working and start all over. Many favor a "Medicare for all" approach without really understanding, or studying the ailments of Medicare (not the least of which is underfunding).
But here is an idea that has not been given much press. Why not run a tandem system and let the public decide?
competition between a new government plan and private insurance programs, has been overshadowed by the political horse race
Keep the current system. Allow the public to buy the Medicare plan if so desired.
In essence, create a new form of competition rather than insisting on a monopoly controlled by the government.
I like it.
Under the proposals being advanced by Clinton, Obama and Edwards, the government would offer coverage for middle-class workers and their families, with benefits comparable to those now provided for federal employees and members of Congress.
You can buy private insurance, or you can buy the same plan Congress has.
Your choice.
What McClellan and other critics say they fear is that the government plan could underbid private insurers
That is the downside.
Since Congress fails to understand the concept of limited funds, they may opt to siphon off increasing taxpayer subsidies to keep the plan competitive.
Only the government can continue to operate by spending more than they take in without collapsing. Private enterprise eventually has to either come to Jesus or go under.
Moon suggested that a government plan could be used to test ideas for reducing waste and improving quality, such as cutting payments for treatments of dubious value
Cutting payments. Sounds like rationing. Is that part of the deal?
Wanna bet some folks won't like that?
"You could allow a government option as a way of setting a standard, as opposed to issuing lots of regulations that would apply to every insurer,"
Give people a choice.
Buy the government plan that covers IVF (as an example) or the private plan that does not.
Granted, this type of approach has its' downside. Of course the government decided to get into the over 65 health care funding business 40 years ago. Rather than driving carriers out of the business it actually created new opportunities. Carriers are still one of the primary sources for supplemental coverage.
You know, insurance to cover the things Medicare does not cover.
I am not saying I am all for this tandem system, but I do believe it can result in a system that allows the public to see there are no free lunches. Some states, Georgia being one of them, are considering allowing individuals and businesses to buy the same plan offered to state employees.
As long as taxpayer dollars are not used to subsidize the cost, I like it.
But here is an idea that has not been given much press. Why not run a tandem system and let the public decide?
competition between a new government plan and private insurance programs, has been overshadowed by the political horse race
Keep the current system. Allow the public to buy the Medicare plan if so desired.
In essence, create a new form of competition rather than insisting on a monopoly controlled by the government.
I like it.
Under the proposals being advanced by Clinton, Obama and Edwards, the government would offer coverage for middle-class workers and their families, with benefits comparable to those now provided for federal employees and members of Congress.
You can buy private insurance, or you can buy the same plan Congress has.
Your choice.
What McClellan and other critics say they fear is that the government plan could underbid private insurers
That is the downside.
Since Congress fails to understand the concept of limited funds, they may opt to siphon off increasing taxpayer subsidies to keep the plan competitive.
Only the government can continue to operate by spending more than they take in without collapsing. Private enterprise eventually has to either come to Jesus or go under.
Moon suggested that a government plan could be used to test ideas for reducing waste and improving quality, such as cutting payments for treatments of dubious value
Cutting payments. Sounds like rationing. Is that part of the deal?
Wanna bet some folks won't like that?
"You could allow a government option as a way of setting a standard, as opposed to issuing lots of regulations that would apply to every insurer,"
Give people a choice.
Buy the government plan that covers IVF (as an example) or the private plan that does not.
Granted, this type of approach has its' downside. Of course the government decided to get into the over 65 health care funding business 40 years ago. Rather than driving carriers out of the business it actually created new opportunities. Carriers are still one of the primary sources for supplemental coverage.
You know, insurance to cover the things Medicare does not cover.
I am not saying I am all for this tandem system, but I do believe it can result in a system that allows the public to see there are no free lunches. Some states, Georgia being one of them, are considering allowing individuals and businesses to buy the same plan offered to state employees.
As long as taxpayer dollars are not used to subsidize the cost, I like it.
Carnival of Personal Finance
Hosted this week at Green Panda Treehouse, this week's C of PF is finally up. It's a large edition, helpfully categorized.
If you love accounting, and you love free stuff...um, if you love free stuff, check out FIRE Finance's cool webfind: Microsoft Accounting, gratis.
Mindless Insurance
Need medical care? No problem. You have insurance. They will pay your bills.
How much does it cost?
You have no idea. The insurance company will pay the bill.
Or will it?
On Aug. 17, my 14-year-old son was kicked in the groin during a preseason soccer match. . . The urologist at our community hospital suggested an ultrasound to make sure there was no internal damage. Since it was late on a Friday afternoon, the doctor recommended that my son go to the hospital's emergency room for the scan. The results, fortunately, were benign and my son recovered quickly.
But a month later, the bills started flooding in: hundreds of dollars from the hospital ER, plus a few hundred more from several ER doctors and the urologist who treated my son. We also owed hundreds more for other medical services my family and I had used. On top of that, we still were obligated to pay hundreds to the orthodontist for my son's braces and several hundred dollars to podiatrists for services not covered by our plan.
By last fall, we owed nearly $3,000 in medical expenses.
ER, ultrasound, braces, podiatrist . . .
Sounds like $3,000 out of pocket is a bargain.
Especially for services that are not covered . . .
The bills had begun accumulating shortly after my husband, a social worker, switched jobs and we were forced to change health insurance from a local Blue Cross plan to a for-profit national plan. My husband was not offered a choice of health plans, and when we signed up it was not made clear that our deductible for the year would be $3,000 (for in-network expenses; $4,500 for out-of-network expenses).
Not made clear.
Was the policy written in Chinese?
Nor did we understand that once we met the deductible (i.e., spent $3,000 to $4,500 of our own money), we would then have to pay co-insurance: 15 percent of every in-network expense we incurred and 45 percent of any out-of-network expenses.
Is English their primary language?
Does anyone bother to read their policy, or do they just sign up for Mindless Insurance and assume anything they want is covered?
How much does it cost?
You have no idea. The insurance company will pay the bill.
Or will it?
On Aug. 17, my 14-year-old son was kicked in the groin during a preseason soccer match. . . The urologist at our community hospital suggested an ultrasound to make sure there was no internal damage. Since it was late on a Friday afternoon, the doctor recommended that my son go to the hospital's emergency room for the scan. The results, fortunately, were benign and my son recovered quickly.
But a month later, the bills started flooding in: hundreds of dollars from the hospital ER, plus a few hundred more from several ER doctors and the urologist who treated my son. We also owed hundreds more for other medical services my family and I had used. On top of that, we still were obligated to pay hundreds to the orthodontist for my son's braces and several hundred dollars to podiatrists for services not covered by our plan.
By last fall, we owed nearly $3,000 in medical expenses.
ER, ultrasound, braces, podiatrist . . .
Sounds like $3,000 out of pocket is a bargain.
Especially for services that are not covered . . .
The bills had begun accumulating shortly after my husband, a social worker, switched jobs and we were forced to change health insurance from a local Blue Cross plan to a for-profit national plan. My husband was not offered a choice of health plans, and when we signed up it was not made clear that our deductible for the year would be $3,000 (for in-network expenses; $4,500 for out-of-network expenses).
Not made clear.
Was the policy written in Chinese?
Nor did we understand that once we met the deductible (i.e., spent $3,000 to $4,500 of our own money), we would then have to pay co-insurance: 15 percent of every in-network expense we incurred and 45 percent of any out-of-network expenses.
Is English their primary language?
Does anyone bother to read their policy, or do they just sign up for Mindless Insurance and assume anything they want is covered?
Monday, January 21, 2008
Flea-Bitten (Revisited)
This past summer, we explored the strange case of (now former) medblogger Dr Flea. The good doctor, you may recall, was caught blogging about his own patients, and making fun of the attorneys prosecuting a malpractice case involving the death of a teenaged patient. At that time, it was revealed that Dr Flea and the defendant were one and the same. As a result of his "outing," Dr Flea apparently pulled his blog, never to be heard from (at least in the blogosphere) again.
Until now.
As our friend Dimitriy reports in his post at Trusted.MD that the erstwhile Dr Flea (aka Dr. Robert Lindeman) was interviewed in a recent article in the Canadian National Review of Medicine (NRM). Our Friends to the North© were writing about the risks and rewards of medblogging, and asked Dr Flea/Lindeman about his experience.
In keeping with his, um, less than circumspect style of prose, he responded that "(n)o wonder when doctors write, they write namby-pamby noncommittal crap...it might get you in trouble someday."
Actually, nothing could be further from the truth.
Don't believe me?
Well, one has only to consider Dr Ford's interesting and often provocative posts. That good doctor isn't afraid to take on "big pharma," or little widgets. He also offers solid advice, without rancor or sarcasm (well, sometimes a little sarcasm, but it's always well done).
Still not convinced?
Well, Dr Zagreus (a 2007 MedBlogger Award Finalist) is nothing if not cutting edge, unafraid to take on some dragons (or even innocent, mild-mannered insurance bloggers). And he does that without resorting to "namby-pamby noncommittal crap," as well.
So Dr Flea's fled, and that's not such a bad thing, after all.
Sunday, January 20, 2008
Silly Candidate Tricks: P&C Version
A few months ago, we reported on Sen Edwards' empty threat to strip congressgritters of their elite medical coverage. Lest folks believe that we only ding the Democrats, we bring you the latest goofball idea from the Republican side:
"Rudy Giuliani is trying to edge out his fellow Republican presidential contenders by pledging to make homeowners insurance more affordable in high-risk areas - a key issue in this hurricane belt state."
On the one hand, it's comforting to know that our P&C brethren aren't immune from folks looking for gummint solutions to private sector challenges. But if such schemes are unworkable with regard to health insurance, why would this be a good idea for homeowners cover? After all, they share many characteristics.
Indeed, as we reported back in November, the Sunshine State already has a gummint-run insurance plan. And that one is in the hole by almost $400 billion (with a "b"). So what's Rudy's plan?
"(A) federal "backstop" fund to spread insurance risks associated with hurricanes and other disasters."
Essentially, he's proposing to make the Feds a sort of hyper-reinsurer. There's precedence for this, of course (cf: 9/11 victims fund), but is it a good idea? Yes, this may prove quite popular in Florida, where homeowner's insurance tends to run high, but why (other than for vote-pandering reasons) would someone propose making that a permanent fixture, with untold billions of future liabilities?
Oh, looks like I answered myself.
"Rudy Giuliani is trying to edge out his fellow Republican presidential contenders by pledging to make homeowners insurance more affordable in high-risk areas - a key issue in this hurricane belt state."
On the one hand, it's comforting to know that our P&C brethren aren't immune from folks looking for gummint solutions to private sector challenges. But if such schemes are unworkable with regard to health insurance, why would this be a good idea for homeowners cover? After all, they share many characteristics.
Indeed, as we reported back in November, the Sunshine State already has a gummint-run insurance plan. And that one is in the hole by almost $400 billion (with a "b"). So what's Rudy's plan?
"(A) federal "backstop" fund to spread insurance risks associated with hurricanes and other disasters."
Essentially, he's proposing to make the Feds a sort of hyper-reinsurer. There's precedence for this, of course (cf: 9/11 victims fund), but is it a good idea? Yes, this may prove quite popular in Florida, where homeowner's insurance tends to run high, but why (other than for vote-pandering reasons) would someone propose making that a permanent fixture, with untold billions of future liabilities?
Oh, looks like I answered myself.
IB on TV
It never ceases to amaze me that we have become so well-known: among other things, we've been invited to teleconference with a Senator, review books, and even be on TV.
Whoa there....TV?!
Yup. Last spring, some folks from the the Fine Living Channel invited us to participate in the pilot for a new program called "Stop, You're Paying too Much!" We discussed it amongst ourselves, and Mike Feehan volunteered to take the gig. So this past summer, he went in front of the camera, and into the history books (well, TV history, at least). The show aired last month, and we were fortunate enough to have several IB readers volunteer to Tivo it for us. One of those folks is Tom Tullis, who yesterday delivered to me a DVD of the show.
Thanks to the technical wizardry of my eldest daughter (who not only knows how to set the clock on the VCR, but how to make these things playable on my PC) we present for your edutainment our own Mike (aka John) Feehan:
Whoa there....TV?!
Yup. Last spring, some folks from the the Fine Living Channel invited us to participate in the pilot for a new program called "Stop, You're Paying too Much!" We discussed it amongst ourselves, and Mike Feehan volunteered to take the gig. So this past summer, he went in front of the camera, and into the history books (well, TV history, at least). The show aired last month, and we were fortunate enough to have several IB readers volunteer to Tivo it for us. One of those folks is Tom Tullis, who yesterday delivered to me a DVD of the show.
Thanks to the technical wizardry of my eldest daughter (who not only knows how to set the clock on the VCR, but how to make these things playable on my PC) we present for your edutainment our own Mike (aka John) Feehan:
Saturday, January 19, 2008
Aetna Repo Man
Miss a few payments on your car? The repo man will hunt you down and take away your car.
Can't afford to continue paying for the big screen TV? The repo man will come and take it away.
Buy the wrong arm? The Aetna repo man will come take it away.
Eric Simpson was strangely calm when the insurance company called last week, saying it was sending a man for his right arm.
The woman on the phone told him he should have known he had only $2,000 of coverage through Aetna for artificial limbs. And the arm, which he'd just received that week, cost more like $37,000.
Whatsa matter? Didn't Eric read his policy limits?
Angelo Russello had the job of taking Simpson's arm. He works for Allied Orthotics & Prosthetics in Northeast Philadelphia.
Nice job.
All week he'd been visiting Simpson at Moss Rehab in Elkins Park, fitting the device, teaching the 32-year-old Germantown man how to flex his muscles to move the thumb and fingers.
"I felt like a fool," says Russello. "I've got to tell you, this has never happened before."
Simpson read his face and said, "Just take it."
Eric Simpson is growing used to being disarmed.
My guess is, moonlighting as a repo man probably wasn't covered during the initial job interview.
So what does Aetna have to say about this?
"A miscommunication," Aetna spokesman Walt Cherniak said yesterday.
Miscommunication?
Perhaps the repo man was told to break his kneecaps too?
Aetna officials had mistakenly considered his new arm medical equipment rather than a prosthetic, which is covered in full. They called Simpson to apologize.
And as for Eric's arm?
And the next day, Friday, Russello returned the arm.
This is really bizarre.
Can't afford to continue paying for the big screen TV? The repo man will come and take it away.
Buy the wrong arm? The Aetna repo man will come take it away.
Eric Simpson was strangely calm when the insurance company called last week, saying it was sending a man for his right arm.
The woman on the phone told him he should have known he had only $2,000 of coverage through Aetna for artificial limbs. And the arm, which he'd just received that week, cost more like $37,000.
Whatsa matter? Didn't Eric read his policy limits?
Angelo Russello had the job of taking Simpson's arm. He works for Allied Orthotics & Prosthetics in Northeast Philadelphia.
Nice job.
All week he'd been visiting Simpson at Moss Rehab in Elkins Park, fitting the device, teaching the 32-year-old Germantown man how to flex his muscles to move the thumb and fingers.
"I felt like a fool," says Russello. "I've got to tell you, this has never happened before."
Simpson read his face and said, "Just take it."
Eric Simpson is growing used to being disarmed.
My guess is, moonlighting as a repo man probably wasn't covered during the initial job interview.
So what does Aetna have to say about this?
"A miscommunication," Aetna spokesman Walt Cherniak said yesterday.
Miscommunication?
Perhaps the repo man was told to break his kneecaps too?
Aetna officials had mistakenly considered his new arm medical equipment rather than a prosthetic, which is covered in full. They called Simpson to apologize.
And as for Eric's arm?
And the next day, Friday, Russello returned the arm.
This is really bizarre.
Friday, January 18, 2008
I Like THIS, too...
"Emily Lisker was hesitant to see a doctor, no matter how bad she felt...last winter, when she came down with a bad cough, Lisker immediately called her doctor and immediately got an appointment."
So what, you ask?
Well, it may help to know that Emily is uninsured (by choice), and that she chose to avail herself of an "innovative program called HealthAccessRI."
And what, you may further ask, is HealthAccessRI?
It's a program sponsored by the state of Rhode Island which, for a modest $30 monthly fee, gets her priority access to a primary care physician. What started as a pilot program recently went statewide; it was originally conceived by Dr Michael D. Fine, whose practice became the testing ground for the plan. He must be an IB reader, as well:
"The premise underlying the plan, Fine says, is that primary care is both inexpensive and effective, and for most people, it’s all they need."
Exactly!
He's also quick to point out that this is "not insurance," which is a useful admonition. But it also serves to underscore our long-running contention that health insurance is not the same as health care. That's a critical distinction, and one which it appears that the folks behind HealthAccessRI understand.
Hat Tip: Neal Boortz
So what, you ask?
Well, it may help to know that Emily is uninsured (by choice), and that she chose to avail herself of an "innovative program called HealthAccessRI."
And what, you may further ask, is HealthAccessRI?
It's a program sponsored by the state of Rhode Island which, for a modest $30 monthly fee, gets her priority access to a primary care physician. What started as a pilot program recently went statewide; it was originally conceived by Dr Michael D. Fine, whose practice became the testing ground for the plan. He must be an IB reader, as well:
"The premise underlying the plan, Fine says, is that primary care is both inexpensive and effective, and for most people, it’s all they need."
Exactly!
He's also quick to point out that this is "not insurance," which is a useful admonition. But it also serves to underscore our long-running contention that health insurance is not the same as health care. That's a critical distinction, and one which it appears that the folks behind HealthAccessRI understand.
Hat Tip: Neal Boortz
Middle-age Nintendo Mutant Surgeons
[Welcome Industry Radar readers!]
(Patient) "Say doc. Just how many of these gallbladder surgeries have you done?"
(Doc) "On real people?"
(Patient) "Well, yeah . . ."
(Doc) "Including you?"
(Patient) "Yes . . ."
(Doc) "One."
Far fetched? Maybe not.
playing certain video games on the Nintendo Wii helps surgical residents to hone their fine motor skills and improve their performance on a serious surgery simulator.
Sounds like a Doogie Howser episode.
Or maybe Revenge of the Nerdy Doctors.
OK, maybe "mutant" was a bit over the top.
(Patient) "Say doc. Just how many of these gallbladder surgeries have you done?"
(Doc) "On real people?"
(Patient) "Well, yeah . . ."
(Doc) "Including you?"
(Patient) "Yes . . ."
(Doc) "One."
Far fetched? Maybe not.
playing certain video games on the Nintendo Wii helps surgical residents to hone their fine motor skills and improve their performance on a serious surgery simulator.
Sounds like a Doogie Howser episode.
Or maybe Revenge of the Nerdy Doctors.
OK, maybe "mutant" was a bit over the top.
Storm Front
Want to smoke?
Buy your own insurance.
Health insurance costs have been a major sore spot for employers over the last several years. It can easily cost a thousand dollars or more per month to insure a family, and much more if a company has sick employees or a particularly generous health plan. In an effort to help cut those costs, employers are turning to their employees who smoke, eat poorly, and are overweight to foot the bill. 16% of employers are now making smokers pay the toll for their bad habit
Great idea.
However the D.O.L. has a different view.
Any bet's on who wins this battle?
Buy your own insurance.
Health insurance costs have been a major sore spot for employers over the last several years. It can easily cost a thousand dollars or more per month to insure a family, and much more if a company has sick employees or a particularly generous health plan. In an effort to help cut those costs, employers are turning to their employees who smoke, eat poorly, and are overweight to foot the bill. 16% of employers are now making smokers pay the toll for their bad habit
Great idea.
However the D.O.L. has a different view.
Any bet's on who wins this battle?
Thursday, January 17, 2008
Give Me A Break!
[Welcome Industry Radar readers!]
Ron Norton, a Massachusetts professor, says he cannot afford health insurance under the Massachusetts mandate.
He earns $40,000 per year but his "employer does not provide health insurance" (for 1099 employees).
His wife works for an employer that provides health insurance . . . but her income, combined with his, pushes them above the level where he can get a taxpayer subsidy.
"I'll probably have to quit teaching after this year, even though I love it, and look for a clinical radiology technician job with benefits
So this 40 year old man cannot live his dream because his state requires their citizens to buy health insurance and his employer does not "provide" coverage for him.
Cry me a river.
Ron Norton, a Massachusetts professor, says he cannot afford health insurance under the Massachusetts mandate.
He earns $40,000 per year but his "employer does not provide health insurance" (for 1099 employees).
His wife works for an employer that provides health insurance . . . but her income, combined with his, pushes them above the level where he can get a taxpayer subsidy.
"I'll probably have to quit teaching after this year, even though I love it, and look for a clinical radiology technician job with benefits
So this 40 year old man cannot live his dream because his state requires their citizens to buy health insurance and his employer does not "provide" coverage for him.
Cry me a river.
Wednesday, January 16, 2008
Carnival of the Capitalists: Requium
The good news is that the Carnival of the Capitalists is (finally) up, hosted by its creator. The bad news is that this seems to be the final CotC, at least in its original format. Out of 43 submissions, only a third made the final cut (our post on insurer audits was among that latter group).
I must say that I disagree with the host, who avers: "Blog carnivals as a concept are dead." It's true that they are changing; indeed, they need to change. Many of them have become unwieldy and off-topic. But change is not death, it is transformation.
Recently, I had some correspondence with Julie Ferguson, the hostess of this week's Cavalade of Risk. In part, I wrote that "The thing is, the caps & personal finance ones have gotten so big, they're sort of overwhelming (and that happens sometimes with grand rounds, as well). I think that's why I like hwr & cor: they're a lot more manageable: I enjoy clicking thru a dozen or so posts; 40 or 50 or 60? Not so much."
[ed: "caps" is Carnival of the Capitalists, "personal" is the Carnival of Personal Finance]
Smaller, more niche-intensive carnivals like Health Wonk Review and Cavalcade of Risk represent, I think, the transformation to which I alluded above. By focusing a more narrow beam, and thus appealing to a more limited audience, such round-ups offer a better "value;" in this case, how much useful, relevant information can I glean in the least amount of time?
We'll definitely revisit the CotC down the road, to see how things are going there.
Something New Here...
I subscribe to the school of thought that short blogrolls are better. That is, a huge laundry list of links is less useful than a shorter, more directed one. So I rarely add to ours.
Segue: There exists a whole community of "patient bloggers" ("patient" as in under the care of a physician, not necessarily easy-going) who write about their experiences. IB frequent commenter Marc is one such. Within the medblog community, though, few are as well-known and respected as Amy Tenderich, who blogs at the award-winning Diabetes Mine.
Amy writes poignant, insightful posts on her experiences as a diabetic, as well as reporting on the latest diabetes research and news. There is no self-pity. Rather, she inspires others to stay strong and positive.
I am proud to add her terrific site to our blogroll. Do check it out.
Cavalcade of Risk #43 is up!
Julie Ferguson, of Workers Comp Insider, hosts this week's Cavalcade. As usual, she does an outstanding job, with a bunch of great posts.
While you're there, be sure to catch Joe Kristan's important post on S Corps and health insurance tax deductions.
We'd love to have YOU host a Cav. It's fun and easy, and a nice traffic bump. Just drop us a line to reserve yours.
The D.O.L. Wants You Fat, Dumb & Happy
[Welcome Industry Radar and Wall Street Journal readers!]
Looks like the D.O.L. is meddling where it does not belong. It seems employer incentives to get you off the couch and into a gym are not in your best interest.
Same goes for stop-smoking incentives, drug & alcohol rehab incentives and health screenings.
The D.O.L. thinks you are better off as an overweight, smoking alcoholic. After all, the carrier is paying the bill for the abuse you are inflicting on your body.
Regulatory guidelines recently issued by the department are likely to curtail the ability of employers to motivate workers to kick unhealthy habits. In effect, the guidelines close a legal loophole that could have allowed employers to make health insurance more expensive for unhealthy workers than for their colleagues.
Loophole.
Nice choice of words.
workers enroll in an employer-sponsored health plan with a high insurance deductible. They can offset the deductible by earning "wellness credits" for meeting certain health benchmarks -- such as for cholesterol count -- issued under a separate supplemental policy.
So healthy people, in effect, are rewarded with lower total health care costs.
Isn't that like offering better interest rates to those who are financially healthy? Or better pay to workers who perform better on the job?
So is the D.O.L. trying to socialize the employer health market? The homogenization of the workforce.
Looks that way.
Proponents liken the rewards to giving a good-driver discount, arguing 70% of health-care expenses are lifestyle-related. Exposure to higher out-of-pocket costs motivates employees to improve their health, which saves employers money.
OK, but doesn't it also save the EMPLOYEE'S money?
Seems that way to me, but who am I to question the D.O.L.?
So the D.O.L. not only wants to promote an unhealthy lifestyle, they want you to pay more for health care and health insurance.
What kind of logic is that?
Oh yeah. This is the gubbermint. It doesn't have to be logical.
Looks like the D.O.L. is meddling where it does not belong. It seems employer incentives to get you off the couch and into a gym are not in your best interest.
Same goes for stop-smoking incentives, drug & alcohol rehab incentives and health screenings.
The D.O.L. thinks you are better off as an overweight, smoking alcoholic. After all, the carrier is paying the bill for the abuse you are inflicting on your body.
Regulatory guidelines recently issued by the department are likely to curtail the ability of employers to motivate workers to kick unhealthy habits. In effect, the guidelines close a legal loophole that could have allowed employers to make health insurance more expensive for unhealthy workers than for their colleagues.
Loophole.
Nice choice of words.
workers enroll in an employer-sponsored health plan with a high insurance deductible. They can offset the deductible by earning "wellness credits" for meeting certain health benchmarks -- such as for cholesterol count -- issued under a separate supplemental policy.
So healthy people, in effect, are rewarded with lower total health care costs.
Isn't that like offering better interest rates to those who are financially healthy? Or better pay to workers who perform better on the job?
So is the D.O.L. trying to socialize the employer health market? The homogenization of the workforce.
Looks that way.
Proponents liken the rewards to giving a good-driver discount, arguing 70% of health-care expenses are lifestyle-related. Exposure to higher out-of-pocket costs motivates employees to improve their health, which saves employers money.
OK, but doesn't it also save the EMPLOYEE'S money?
Seems that way to me, but who am I to question the D.O.L.?
So the D.O.L. not only wants to promote an unhealthy lifestyle, they want you to pay more for health care and health insurance.
What kind of logic is that?
Oh yeah. This is the gubbermint. It doesn't have to be logical.
Tuesday, January 15, 2008
A Presidential Grand Rounds
Blogger Alvaro Fernandez, who hosts Sharp Brains, presents a tremendous 'Rounds. It's in the form of a letter to our next President, offering a myriad of ideas, opinions and insights on health care delivery and financing. There are over 3 dozen items from which to choose, all categorized and annotated.
Over at the Health Business Blog, FoIB David Williams discusses new research on (and for) kids with attention deficit issues.
THIS, I like...
Regular IB readers may recall our early piece on "minute clinics," and how impressed we were with the concept. The idea is to move away from traditional (and expensive) delivery models for routine care, and toward more economical, cost-effective ones. Interestingly, the latest breakthrough in this practice comes to us from, of all places, the Bay State:
It's not clear why such delivery systems would be "controversial," except to those who have a vested interest in the older model. But if those entrenched interests were paying attention, they'd know that:
"In other parts of the country, in-store clinics are a fast-growing business. Since 2000, MinuteClinic has opened 465 clinics in 24 states."
And that's just one "brand." There are others, and the demand is apparently (and unsurprisingly) growing.
What's also interesting to me is that these kinds of service providers dovetail nicely with the burgeoning supply of "mini-med" insurance plans. And that makes sense: if one's health plan reimburses office or clinic visits at, say, $60, then one's out of pocket for such is (at worst) minimal. Are we seeing a natural growth pattern here, one which would anticipate (and perhaps mitigate the need for) gummint-mandated schemes?
Of course, there are no "minute hospitals" (yet?), but the basic idea seems promising.
[H/T: Coyote Blog]
ADDENDUM: I'm kinda disappointed that I missed this application myself, but one of the commenter's on Coyote's post points out that this might be a good use for HSA funds, as well. Depending on a given service's cost, a minute-clinic visit may actually be less expensive than even an in-network provider. And if there is no in-network provider nearby, then it may be an even better deal (versus an out-of-network "traditional model" provider).
Monday, January 14, 2008
I just love National Health Care...
[Welcome Industry Radar readers!]
From an article in today's Telegraph.co.uk about the organ shortage in the UK...
From an article in today's Telegraph.co.uk about the organ shortage in the UK...
The proposals would mean consent for organ donation after death would be automatically presumed, unless individuals had opted out of the national register or family members objected.This sounds like a cross between Jonathan Swift's "A Modest Proposal" and something out of China.
The Government will launch an overhaul of the system next week, which will put pressure on doctors and nurses to identify more "potential organ donors" from dying patients. Hospitals will be rated for the number of deceased patients they "convert" into donors and doctors will be expected to identify potential donors earlier and alert donor coordinators as patients approach death.
Oy Canada (Part XII)
It's been a while since we last looked in on our Friends to the North©, but Bob sent this along earlier today:
But wait, it gets better (or worse, depending on one's perspective):
"(W)e have community after community with patients who are unable to access a family physician for themselves or for their families."
Ooops.
Turns out, Canada would have to come up with over 26,000 new physicians to meet "global standards" (whatever they are), which doesn't seem, um, likely. Of course, they could simply "import" a few more, but the health system's certification process apparently makes that quite challenging (which may actually be a good thing).
But hey, it's free.
Carnival of Personal Finance
This week's Carnival of Personal Finance is now available at Plonkee Money (cool blog name alert). It is GIGANTIC: including a Top 10, there are over 7 dozen entries, alll categorized, all with helpful context. WoW.
Even with such a plethora of choices, I found a standout: Bob McDonald's thoughtful piece on why one ought to delay going on Social Security. Very interesting.
UPDATE: Bob's updated that post to include the cost of health insurance from ages 62 through 65. This is a critical piece of the puzzle, and if you have a chance, definitely stop by to check out the revised edition.
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