Oh, Do Behave!

[Welcome Industry Radar readers!]

In his Austin Powers films, Mike Myers often jibes the Brits for their lack of emphasis on dental hygiene. While some may consider that a bit of a stretch, consider this:

"Health service dentists have been forced to go on holiday or spend time on the golf course this month despite millions of patients being denied dental care."

Play to pay?

MVNHS© dentists are given strict quotas about how many patients they can treat, and once that's met, it's off to the golf course. We tend to think of health care rationing in terms of MRI's, chemo and surgical procedures, but it obviously extends to dental, as well:

"Patients have been told they must either pay privately or return in April when the new work year begins. People suffering from toothache have been advised to go to hospital."

And of course, we know that the MVNHS© hospitals are overcrowded and understaffed already, so this will merely exacerbate that problem.

Maybe an ice pack?

The Carnival of Personal Finance is now online...

Blain Reinkensmeyer of Stock Trading to Go hosts this week's edition of the Carnival of Personal Finance. There's scads of interesting posts on everything from debt management to taxes (pretty timely, that).

SVB (the Silicon Valley Blogger) has an in-depth post on strategies to avoid identity theft. Recommended.

This Sceptered Isle - Part IX

So in the U.K. a “voucher scheme” is next up for the National Health Service.

Under this scheme, “patients will not be given money directly, but will decide themselves how to spend sums normally administered by the NHS.”

The U.K. health secretary notes the generation now reaching retirement expects "more control over chronic health conditions that affect four adults in 10." Of course, there are differing opinions. One source of controversy is that some service providers (who at present are paid directly by the government) fret that patients will not welcome the “extra burden” of deciding for themselves where they prefer to obtain treatment. But overall, this scheme seems to me yet another remarkably original, creative, and imaginative idea from the British National Health office. Don’t you agree?

And yet, reading about this scheme . . . I sense something . . .a presence I’ve not felt since . . .

Oh shucks that sensation is probably just deja vu all over again. Won't it be interesting to see how this scheme plays out, over there?

Losing at SOLItaire: Update

About a year and a half ago, we reported on the disturbing story of two California women who were apparently buying life insurance policies on homeless men, naming themselves as beneficiary, and then doing what was necessary to file a claim. We noted at the time that it appeared that the carriers' underwriters must have been asleep at the switch, since one of the principal requirements of a life insurance contract is insurable interest.

Today, an accomplice of the two "damsels of distress" testified against them at their trial for the murder of two of his "colleagues." Sometimes truth is stranger than fiction; this whole story sounds like a Law & Order plot line.

We'll keep you posted.

Accessing Healthcare: Part 2

They pulled my pin last Friday, so I now sport a new cast (they cut the old one off) and another follow-up appointment. The pain is gone, although I'm beginning to understand what folks with arthritis go through when the weather changes.

The EOB, or Explanation of Benefits [ed: a copy of which is available here], has finally arrived, and we now begin the process of paying for my slippery feet. The good news, one supposes, is that I met my annual deductible early. On the other hand, I still have quite a way to go with regard to the potential maximum out-of-pocket. Still, between the amount with which my wife's employer "seeded" the account and what we've put in (not to mention our premium savings), it's not too bad. Yes, I can certainly think of more entertaining uses for the $2,400. Still, things could have been much worse.

How's that, you ask?

Well, let's take the typical co-pay (non-HSA) plan: $25 for office visits, maybe $1,000 deductible for big ticket items, followed by the ubiquitous "80/20" (plan pays 80% of the next $10,000, insured pays 20%). Between the ER, the ortho and the radiologist, the bills total out to just over $3,400. None of these were "office visits," so they all go to the deductible and co-insurance.

So, the first $1,000 would be mine (deductible), and another $480 for the co-insurance, for a total of about $1,500. Add in my premium savings of some $1,600, and my net out-of-pocket would have been $3,100 (not to mention giving up that $800 HSA "seed money"). So, I'm ahead by about $700 ($3,100 less $2,400).

Not too hateful.

I still have some follow-up and, of course, therapy, so I'll need to keep a running total on those. Once the final bill's been paid, I'll post a recap. Stay tuned.

Cavalcade of Risk #48 is up!

Jim Strebing hosts this week's edition of the Cavalcade, available now at Insurance Yak.

We really need hosts for May and June, so please reserve yours now.

Told Ya So...

One of our mantras here at IB is that health care costs drive health insurance costs, which is one reason why we espouse transparency and accountability, and frown upon benefit mandates. We look at utilization as one measure of health care cost; that is, how often, and under what circumstances, a given procedure is used.

The prototypical example of this is hysterectomies: back in the day, there was quite a controversy regarding elective versions of this procedure. Part of the problem was that it was a fairly simple yet lucrative process, and so held great appeal to a certain segment of the physician community.

More recently, we learn that carriers are cracking down on what they perceive to be a similar burgeoning case of over-utilization: medical scanning technology. This would include PET and MRI scans, for example, as well as CT and even x-rays. The tech for these has dropped in cost, and as a result, we have a lot of these machines that need to be paid for. I understand, for example, that we have more MRI machines here in Ohio than in all of Canada. Is that necessarily a bad thing? Of course not, but then one must ask: "who pays for this tech?"

The answer, of course, is that we all do.

But that may be changing:

"Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there’s emerging evidence that these scans are being over-prescribed."

Buying, maintaining and operating all this equipment isn't free, and the cost is reflected, in part, in increased insurance premiums (see, health care costs more, thus health insurance does, too). In order to rein in some of these costs, insurers are starting to take a closer look at whether they're justified, and justifiable.

Folks who've bought into Consumer Driven Health Care (CDHC) already know this: it's their own money that pays for MRI's instead of x-rays, for example. So it's no real surprise that carriers have begun to second-guess their use, as well.

And there's this:

"Insurers fear some patients are being exposed to dangerous radiation levels from having repeated CT and PET scans, which use many times the radiation of a regular chest X-ray...Doctors, too, are concerned about patients getting excessive radiation exposure when they receive scans that aren’t needed or are ordered as “defensive medicine” to protect against possible lawsuits."

Not to mention the conflicts of interest when physicians also own the "imaging facilities" to which they refer their patients.

O Brave New World, indeed.

(Hat Tip to Holly Robinson)

Grand Rounds is up!

Monash Medical Student Jeffrey Leow presents a stark but compelling edition of Grand Rounds. His own interest in surgery is evident in the haunting photos interspersed throughout. And, with over 2 dozen intriguing posts, it's hard to choose a favorite.

Over at Distractible Mind, Dr Rob muses on a case gone horribly wrong, and the lessons painfully learned from it. Recommended, but heartbreaking.

2 Cool Monday

■ Last week, Cato's Mike Cannon participated in a debate about the pros, cons and effects of individual health insurance mandates. This is important, fascinating stuff, and I highly recommend the video to our readers.

■ Longtime readers may recall our guest post from Medical Office Manager Kelley Beloff. Her practice has truly embraced health care transparency, and even makes its "menu" available to their patients. With Kelley's permission, this intriguing look "behind the scenes" is available for download here. Enjoy!

Cavalcade #48: Submissions Due

Jim Strebing hosts next week's edition of the Cavalcade, scheduled for Wednesday the 26th. Please make sure to get your submissions in by Monday (the 24th). Jim 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. We have slots available for April and May, so PLEASE drop us a line to reserve yours.

Health Wonk Review is now online...

Joe Paduda, founder of HWR, hosts this week's edition. As always, it's chock full of interesting and insightful posts on medical tech, polity and policy. With over a dozen and a half wonky posts, you're sure to find at least a few items to pique your interest.

One of the great things about HWR is the opportunity to find previously undiscovered blogs, and this edition is no different. David Hamilton runs VentureBeat, and has some cool news from Aetna, which now offers some new web-based care management tools. Recommended.

Mandatory Insurance: Are We There Yet?

[Welcome Industry Radar readers!]

I've been thinking about one of the "givens" in the universal coverage debate, and wanted to share some of that with our readers. We operate under a few assumptions here at IB and, although we obviously don't think in "lock step," I'm pretty comfortable in stating that, for the most part, we all agree that:

■ Health insurance costs rise primarily because health care costs do
■ Mandatory benefits impact premiums
■ Personal responsibility and accountability are desirable

None of the legislative initiatives currently on the table substantively address these issues. Which is not to say that there's nothing of value to be gleaned from them.

But first, a slight digression (which I'll then tie back in):

So-called "mandatory insurance" simply posits that citizens be required to purchase (and maintain) health insurance coverage. Leaving aside underwriting considerations (we'll get to those), the question arises: is this a good idea?

One of the arguments that proponents of mandatory coverage espouse is that health insurance should be treated like auto insurance; that is, one is required to have some kind of insurance in order to operate a car. We've touched on this before: health insurance is indeed similar to Property/Casualty in that both are based on the concept of indemnification. Mandatory auto insurance requires some minimum amount of liability cover. The idea is that this protects those whom one may injure in an at-fault accident; it does not, however, pay for repairs to one's own vehicle (that would be "physical damage").

Nor does that "physical damage" coverage (a.k.a.comprehensive/collision) pay for routine maintenance, blown tires, gas, and the like. Those are solely the owner's responsibility. As Bob would say, "there's no co-pay for new windshield wipers."

But the state (the "public") is well served by requiring drivers to protect the interests of others, so there's a net positive social benefit to mandatory auto insurance. Could the same argument be applied to health insurance?

I'm beginning to believe so.

The challenge has always been balance; that is, the inherent conflict between personal responsibility ("you should carry health insurance") and the public good ("you must carry health insurance"). From a practical standpoint, the analogy between auto and health breaks down over what the requirements are. As noted, mandatory auto coverage is pretty simple, and relatively modest: bodily injury and property damage, usually with very low thresholds. So the question becomes: can we fashion a health insurance plan with just a few moving parts (i.e. a minimum of mandatory coverages), thus rendering it more affordable?

The second piece goes to underwriting (see, I told ya we'd get to that): good drivers pay less for insurance than those with (for example) multiple DUI's and speeding tickets. Could we fashion a "minimum" health plan that mimics that (i.e. takes folks' health history into account)?

It seems to me that we can do both, by using a model that's already beginning to find more widespread acceptance: limited benefit ("mini-med") plans. These are relatively inexpensive, and can take into account a more diverse range of underwriting classes. By setting the "minimums" at a realistic level (drug discounts into of co-pays, for example), it seems to me that these could be made readily available, and affordable, to a large percent of the chronically uninsured. And just as folks with Jaguars can "upgrade" their policies to include rental reimbursement and GAP coverage, those who want "more bang for the buck" can opt instead for regular major medical plans (although I certainly hope that more folks will at least consider HSA's).

Is this a "perfect" solution? Of course not. But it's pretty well established that Americans prefer incremental changes to drastic and immediate ones, and this seems to me to be a more "doable" solution.

By the way, I'm not the only one who's giving this some thought of late: both Jason Shafrin at the Healthcare Economist and Amy Tenderich at Diabetes Mine have some intriguing ideas on the subject, as well.

Cannon Fodder

FoIB (and MedWonk Biggie) Michael Cannon has an interesting article in this month's Forum for Health Economics & Policy journal. In it, he proposes his solution to the health insurance issue:

"The creation of tax-free health savings accounts presents a new opportunity to reduce the distortions created by federal tax preferences for health-related expenditures that ultimately could help eliminate those distortions."

What he's talking about here are so-called "Large HSA's" with deductibles starting at $8000 ($16,000 for familes). His contention is that these plans, with ultra-low premiums, will allow employers to funnel more cash away from insurance carriers and into their employees' pockets.

A laudable goal, to be sure, but I have some issues with it. Last year, Michael was kind enough to share with me the "white paper" on which this was based. I found the idea intriguing (after all, I am a major proponent of CDHP and HSA's), but had some reservations, which I shared with him at the time.

I am absolutely thrilled for Michael to have been published in such an august journal, and hope (and presume) that his piece will spark a much-needed discussion.

I'd also like to share with our readers my response to Michael last year. Hopefully, this too will help move the ball forward:

1) I've always been a believer in "rising tides raise all ships" (paraphrase): when folks talk about the inequity of the employer write-off, they always talk about deleting or capping it. I've always wondered why it wouldn't make more sense to expand it; that is, enable everyone who buys their own cover to deduct it. I see that you've taken some of that with your bigger/better HSA idea, and that's a good thing.

2) Your idea about basically taking the whatever the e'er/e'ee pay for h/c insurance and running the whole thing thru an HSA is intriguing. Seems to me that this is a variation on (expansion of?) "cafeteria plans." I really like that.

Putting those two together (plus whatever else I haven't gotten to yet), I can see where there would be some significant progress. My only reservation is one of pragmatism: how likely is it that the class-warriors would embrace this (or even consider it at all)? Obviously, that's not a reason not to pursue it, but do you have a strategy in mind for dealing with the inevitable obstructionists?

ADDENDUM: In subsequent correspondence, I also pointed out to Michael the feasibility conundrum such a plan would face. Briefly, insurers know that there is an absolute premium "floor," below which they cannot go. These include fixed and administrative costs, morbidity and reserves. In other words, no matter how high the deductible gets, there's really only "so far" the premiums can be trimmed, until there's no savings to be had. That's why, for example, you save (say) $100 going from a $3000 to a $4000 deductible, but only $25 going to the $6000.

The other problem is that, while I remain convinced that HSA's are a potent weapon in the fight against health care costs and consumer apathy, I don't believe that it is the only such. While "Large HSA's" may appeal to some "large employers," I'm not convinced that they'll play well with smaller groups (or in Peoria, as they say).

Nevertheless, Michael's made an impressive beachhead in the ongoing battle to solve the health insurance "crisis," and we applaud him for that.

Grand Rounds is up...

With a decidedly Western feel, I half expected to see Doc sauntering down the streets of Dodge. But Dr Scott, blogging at Polite Dissent, presents a laid-back and visually attractive compendium of the best of the medblogs. I particularly appreciate the shorter version, a nice break from the massive linkfests that often characterize the 'Rounds.

Do you own you, or do you belong to the gummint? In a somewhat lengthy essay, Sandy Szwarc discusses this intriguing (and disturbing) question.

Weather Update

As many of our readers know, Bob lives in the Metro Atlanta area. Hotlanta was assaulted yesterday by the Forces of Nature©. I spoke with Bob yesterday afternoon, and he and his family are all safe (well, as safe as they can be with Bob around).

March (Hare) Madness

[Welcome Industry Radar readers!]

It's that time of year again: brackets and pools, byes and wins, vasectomies and frozen peas.

Whoa!

Vasectomies and frozen peas? What's that got to do with basketball?

"When March Madness approaches you need an excuse . . . to stay at home in front of the big screen," says the ad on Eugene's sports radio AM 1320, aka The Score. "Get your vasectomy at Oregon Urology Institute the day before the tournament starts."

Oh!

What will they think of next? (Wait, don't tell me!)

An inexpensive health insurance option?

[Welcome Industry Radar readers!]

An article in Thursday's Wall Street Journal reports on a few inexpensive health insurance plans that are now being marketed as a solution to the serious problem of the uninsured.

Although this insurance is quite affordable, the article properly acknowledges that the cost is sensitive to the rising cost of health care – specifically that more services are now available and more people are willing to take advantage of those services – as examples, the article cites hip replacement and cataract surgery.

The coverage sounds OK, if unremarkable – deductibles are available between $50 and $125 and the coinsurance is 80% to 90% depending on the options you choose. To keep costs down, very strict medical underwriting applies, and there seem to be three different levels.

First, the insurance company will not issue a policy if certain health problems already exist. (Oddly enough, having a bladder stone problem is one of the reasons reported that can result in refusal to issue a policy.) Other specific pre-existing conditions that “manifest” within a 30-day look back period following policy issue are automatically excluded – and, if the insurer rescinds the policy at that point, the first month’s premium is refunded. Still other pre-existing conditions are insurable subject to limitations. Message here is - watch out.

Wellness assistance benefits are available as add-on coverage, but the coverage is not all that generous - the insurance pays as little as 40% and some wellness regimens such as special diets are not covered.

The premiums run anywhere from about $350 to $480 per year. Oh, and I forgot to mention. This is pet insurance.

MVNHS©: You Know the Drill

Then again, maybe you don't :

"An eminent British neuro-surgeon has been performing complex brain operations using a £30 [ed: about $60] do-it-yourself cordless power drill at a clinic in Ukraine."

And because the Ukrainians (U-craniums?) are "very tough," the doc foregoes a general anesthetic, leaving the patient wide awake through the procedure.

In fairness, when the doc's back home, he uses a $60,000 pneumatic number, and (presumably), an anesthetic.

Or so we're told.

UPDATE: It appears that Dr Marsh may simply be reviving an ancient medical practice:

"Greek archaeologists believe a large hole in the skull of a third-century A.D. skeleton is rare evidence of ancient—and failed—brain surgery."

We certainly hope that Dr Marsh's patients enjoy better outcomes.

My Southern Co-Blogger: NostraBobus

Exactly one month ago, Bob wrote:

"Patients are finding it increasingly difficult to find a PCP (primary care provider). There are many reasons but most revolve around economics...All of this is occurring while demand for PCP services is increasing."

And in today's McPaper, New Hampshire PCP Kevin Pho (aka medblog biggie KevinMD) writes:

"We need to address the fundamental issue at the root of our problems: the primary care shortage...Contrary to popular belief, the more physicians taking care of you does not guarantee better care."

Mazel Tov to Kevin for making USA Today's op-ed page!

Kevin makes some cogent and persuasive argumements about why this needs to be addressed, as well as suggestions on how to do so, but I'll give Bob the last word here:

"We don't see clinics totally replacing the need for a fully staffed PCP but their business model seems to be a hit."

MailBag: Breaking Financial News

Most reader emails that we receive are in the form of requests for help with a problem or clarification of coverage. We're generally able to help, and often refer readers to local pro's who can lend more hands-on assistance.

Once in a while, though, we get intriguing industry-related bits, such as this one, received yesterday from a regular reader (and industry pro):

"Any word on a corollary with Wellpoint and Humana? Humana took a 30% hit when wellpoint announced adjusted earnings. Is there something I am not seeing? I can see an industry dip, but that is a huge number for Humana. I can’t connect the dots on this one."

I was unaware of these figures, but I knew whom to ask. One of the benefits of blogging has been to widen my circle of professional friends, and this afforded me an opportunity to call on one. Rick Byrne is a market analyst for HealthLeaders-InterStudy, an insurance industry information company. He's a regular reader and commenter here, and is someone whom I trust. So, I forwarded the email (anonymized, natch) to Rick, and asked for his take (if any).

He replied this morning. I of course asked for, and received, his permission to post this:

"I've got a bud at [large, well-known financial services firm] HQ who sends me his analysis that the big-paying customers get. It made its way around our office like wildfire yesterday. He noted that WellPoint adjusted its profit projections down for the year because it was coming up short in both enrollment and MLR in its Medicare Advantage products, particularly HMO and PFFS. [He] suggested that might drag down the other companies that are heavily weighted in MA, which does mean Humana and Coventry. Humana has abruptly cancelled an investor meeting scheduled for this week. We might also be looking at WellCare, Universal American and HealthSpring to see what their stocks are doing, although I imagine WellCare has already fallen based on its prior problems. I also noticed that Universal American adjusted its profit projections down last week, as did Aetna."

I thought that was pretty intriguing on its own, but there was another twist or two. A little while after the email quoted above, I got a follow-up:

"Humana cuts first quarter profit projections"

and

"And WellPoint announces the resignation of its Chief Accounting Officer"

Ze plot, she thickenz...

(Special Thanks to Rick Byrne, who has this advice for IB readers who live and/or work in Indianapolis and Louisville: "don't stand under any tall buildings. Those leaping WellPoint and Humana execs might land on you.")

(And HatTip to Matt H, for bringing this to our attention)

Shackle Free Blogging

Our friends at the LexisNexis Insurance Law Center clued us into a fascinating post by lawblogger David P. Rossmiller. David opines:

"Blogging is like music, you’ve got to play it the way you feel it, you’ve got to give your own interpretation to the material."

If you're interested in some of the mechanics of successful blogging, this is a good place to start.

Cavalcade of Risk #47 is up!

March Madness prevails as John Cogan hosts the latest edition of the Cavalcade. Be sure to check it out.

We have hosting slots available for April and May, so PLEASE drop us a line to reserve yours.

Oy, Canada (Again!)

Thank goodness for medical tourism:

"Inside Sylvia de Vries lurked an enormous tumour and fluid totalling 18 kilograms [almost 40 pounds!]. But not even that massive weight gain and a diagnosis of ovarian cancer could assure her timely treatment in Canada."

So she did what an increasing number of ailing Canucks are doing, and headed for the border: Pontiac, Michigan. There, she had the foot-long tumor removed by a skilled American surgeon, and just in the nick of time: a few more weeks, and she faced the failure of multiple organs. Yikes!

But it gets worse: because she didn't cross all the t's and dot all the i's, the Ontario Health Insurance Plan refuses to cough up the $60 grand to cover the potentially life-saving procedure. The result is that her life savings are now depleted, and she faces huge medical bills and further treatment.

But hey, it's free!

Right?

Terror Insurance, Iraq Style

Typically, life insurance policies contain few exclusions; these would be for fraud, acts of war, etc. Terror attacks aren't considered "acts of war" in the traditional sense, so aren't usually excluded. Now, if one's job requires spending quality time in the oil fields of Saudi Arabia (for example), that might raise an underwriter's eyebrows.

So I'm not sure exactly what to make of this developement:

"The director of Iraq’s state-owned national insurance company has launched a program that offers the world's first-ever life insurance policy against terror attacks to professors and other business professionals."

Anyone who reads the news knows that there is certianly cause for at least some concern about terrorism in that neck o' the woods. It's interesting, too, that different countries (markets) face different risks and needs. One supposes that this should be obvious, but that's not always the case.

This particular effort seems to me to be more of a marketing ploy than anything else (NTTAWWT): by "targeting" [ed: nice word choice there, Prof] certain professions and professionals, it's hoped that more sales can be made. A beneficial effect of that is hoped to be a lessening of the "brain drain" currently manifest in Iraq; for some time now doctors, engineers, academics and highly skilled workers have been streaming out of the country. Staunching this flow is a primary goal of the new plan and marketing designs.

Should make for some interesting sales calls.

Grand Rounds is up...

Canadian Medicine blog hosts this week's anthology of top-notch medical posts. I really liked this edition: it's well laid out, easy to follow, and each link has plenty of context. It helps, too, that it's of manageable size.

For those who continue to think that socialized medicine is a panacea, I recommend this post at Mousethinks, which goes behind the scenes, and beyond the numbers.

Blogging Liability

Over at Funny about Money, blogger vh has an intriguing (if not disturbing) post about blogging and slander. Regular readers may recall our post last summer about the anonymous blogger(s) and the Paris (TX) Regional Medical Center. While that post focused on anonymity and accountability, it could just as easily have focused on liability:

"...work-for-hire journalists (as opposed to freelancers) are generally covered by their employers’ insurance. Also, working journalists are a great deal more savvy about libel, in my observation, than are bloggers, who naively publish the most amazing and actionable things. Anyone who publishes online, including bloggers, is at risk."

vh recommends checking with your homeowner's insurance carrier to be sure that your online activities don't take your finances offline.

I know I will.

Swedish Medical Update #2

Based on Part 1, and this new development, one wonders if there is (at long last) a socialized medicine scheme that we can finally sign on to:

"Sweden's state-owned pharmacy chain Apoteket on Thursday said it plans to help satisfy Swedes by adding sex toys to its shelves."

Talk about Big Pharma! Now, if this were to take root here in the 'States, then I could see a whole new market for HRA's and HSA's, no?

Health(y) News: I'll Drink to That!

Palmetto State-based scientists have (re)discovered exciting diet news:

"Middle-aged non-drinkers can quickly reduce their risk of heart disease by introducing a daily tipple to their diet."

Take that, Carrie Nation!

Interestingly, the best "bang for the buck" (as it were) came from imbibing only wine, as opposed to beer or hard liquor. The study also found that drinkers' HDL (the "good" cholesterol) also improved when former tea-totalers went off the wagon (no mention of a fast-food diet, though).

Well, off to lower my heart disease risk. Cheers!

Financing Health Care

So, had my initial follow-up with the orthopedic surgeon and, while going over some paperwork with his staff, noticed this brochure in a handy rack on the desk:

"We offer No Interest Payment Plans..."

Given that I don't know yet the final cost of all the medicine that was (and continues to be) committed upon me, I was curious about non-insurance options in these circumstances. Credit cards and home equity loans are popular and well-known choices, but this alternative intrigued me, and seemed to be interesting blog-fodder.

On a consumer bulletin board that Bob and I frequent, we often see posts by folks looking for ways to trim and/or manage large health care bills. It makes sense that a surgeon's office would have this kind of option available; perhaps other big-ticket providers offer similar plans. I'd be very interested in IB readers' experiences with such a plan (a note in the comments, perhaps, or an email).

Regular reader Rick B alerted me some time ago to one carrier's financing option, as well. This "CareCredit" plan offers two alternatives: a kind of "90 days same as cash" deal, and an extended version which offers discounted interest rates (although discounted from what is not entirely clear). The interest-free option seems to be available to more mundane services (under $300), while the low-interest plan is for higher ticket (over a grand) procedures.

I also noticed that my orthopedist and my vet can both offer this plan:

"CareCredit...can be used repeatedly for yourself, your entire family, and even your pets." [ed: emphasis added]

Nice to know.

Rats! It's the MVNHS©!

One of the, um, benefits of socialized medicine is the dedication of its providers to timely service (if not an emphasis on sanitation). Unfortunately, that "rush to excellence" may have been a bit misplaced:

"A patient was told there was no reason why he couldn't have surgery in a hospital, despite the smell caused by a dead rodent trapped in the building's ceiling."

One supposes that a dead rodent is preferable to a live one, perhaps scurrying around the OR supervising the procedure.

Or perhaps not:

"(D)espite being told that the trust's infection control experts had stated that Mr Cowper was not being exposed to an infection risk, he decided not to proceed with the operation."

I'm sure he was comforted by the fact that he had waited only a scant 11 months for the surgery to take place.

Cavalcade #47: Submissions Due

John Cogan hosts next week's edition of the Cavalcade, scheduled for Wednesday the 12th. Please make sure to get your submissions in by Monday (the 10th). John 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. We have slots available for April and May, so PLEASE drop us a line to reserve yours.

Screwing the Pooch

[Welcome Industry Radar readers!]

I’m normally fairly circumspect when writing these blogs, but this time I may make an exception. I’m pissed. Blue Cross of California (shortly to be known as Anthem Blue Cross) just announced rates for their Small Business plan focal renewal. These will also be the base (aka "standard") rates for both new business and for renewals from May 1 forward. (Before all California readers panic, the focal renewal only applies to plans originally purchased prior to December 2003. Plans purchased after that won’t see these increases until their normal annual renewal. This also only applies to the Small Business plans, not individuals or groups with more 50 employees)

A bit of background…After years of incessant price increases, Blue Cross announced last November that the average January rates would decrease by roughly 5%. HSA policies would stay flat. Amazing. Finally a bit of stability in this slightly insane business. Needless to say, quite a few clients switched to Blue Cross.

Roll tape forward to now, roughly six months later. Average rate increase statewide: 15.4%. Average increase for HSA and HIA plans: 25.4%. Increase for their most popular plan, the Luminos 1500 HSA plan (and the one I'm on!)? A breathtaking 32%.

Thanks guys.

The increase for the Luminos 1500 wasn’t a surprise. The magnitude is. There's a good reason that it’s one of their most popular plans…it’s the best plan for the premium dollar, and with a low out-of-pocket maximum, it’s even a better deal if a serious medical condition is present. That was obvious to anybody who looked at the plan design. But if that was the case, why hold it at ZERO increase in January, and then go up 32% five months later????

What precisely changed? Is the actuarial department that out to lunch? Or are we looking at marketing games?

The same question applies (although not quite as bad) to their traditional PPO and HMO plans. To go from a 5% decrease to a 12% increase is disconcerting. A carrier should be able to forecast better than that. The typical excuses: The aging of the population causes increased utilization. There are increases in the cost of medical technology. Drug prices went up again. All are true. But we’re talking about a five month period here. And how did these last five months differ from the preceding period, where the rates were held stable and/or declined?

Stability and predictability is incredibly important. I have clients who switched to HSA plans that will now have their budgets completely blown….even after I advised to factor in a 12-15% annual increase in benefit expense. Goodwill generated by the rate decrease just vanished in a large cloud of oily smoke. I think I’m going home and work in the garden.

Good News, Bad News, So What?

Full disclosure: my mother has Alzheimer's Disease, which has been growing steadily worse over the past couple of years (no surprise there). As one may imagine, this is a source of both pain and compassion, and has been a difficult journey for those who love her.

And just as folks whose loved ones have succumbed to cancer, there's always the nagging question: am I destined for this, as well? Since no definitive cause has been found, there's not a lot that can be done to head this off, if it's meant to be. Children of alcoholics worry whether they're succeptible to the ravages of that addiction; abstinence is, of course, an easy enough prevention strategy. Unfortunately, when it come to Alzheimer's, from what can one abstain to avoid that? Apparently, not much (yes, there's talk of a link between aluminum and Alzheimer's, but that's far from settled science).

Still, wouldn't it be worthwhile knowing if one might be more sucseptible than one's neighbor?

That's the question that Smart Genetics, a Pennsylvania-based "genetic risk assessment service." The company is set to begin processing "saliva samples for the only known genetic risk factor for late-onset Alzheimer's, which begins after age 65 and represents at least 90% of all cases of the disease." The idea is to see if one has a predisposition toward the disease. One presumes that there are safeguards in place regarding false positives and the like, but that's not the real issue.

Okay, Henry, what is the "real issue?"

Well, when one considers that we don't know what actually causes Alzheimer's, nor is there a "cure" (yet), then what does one do with the information if one "tests positive" (for lack of a better term)?

Professor David Goldstein, who teaches genetics at Duke University, nutshells it thusly:

"It's bad news you can't do anything about."

So the dilemna is really whether or not to send SG a saliva sample and a check for $400. They'll happily and promptly process your DNA, and let you know the results.

The question then becomes: Do I really want to know?

Health Wonk Review is up!

Hosted by Workers Comp Insider's Jon Coppelman (sitting in for the lovely Julie Ferguson), this week's edition features some 16 posts, ranging from "terror pills" to AIDS in Africa. Check it out.

I decided a while back not to sell Medicare D plans, but I've kept my hands in the "regular" MedSupp marketplace. Over at the Health Care Law Blog, David Harlow takes a behind-the-scenes look at Medicare Advantage plans. Interesting reading.

Someone Asked for Change?

The old adage goes "be careful what you wish for (you might get it)."

As we've pointed out before, one of the major cost drivers in health insurance premiums is the burden of gummint mandates (coverage that benefits only a few, but is paid for by all). The Society for Human Resource Management offers even more corroboration for that assertion:

[Graphic courtesy of Employee Benefit News]

That's an almost 20% increase in mandate-driven costs in a year's time. Ouch!

A Very Pink, Very Thorough Grand Rounds...

Jenni the Chronic Babe presents a really stupendous 'Rounds. She chose to highlight posts that discuss "new beginnings" (inspired by her family's recent major home renovation). There are a lot of interesting and inspiring entries, so please drop by.

As agents, we get a lot of, um, interesting requests, but I found Dr Val's compendium of patient excuses topped anything I've ever heard.

Caution: 60 Minutes Rant Ahead

I never really expect the MSM to get things right, but sometimes, as in last night's Scott Pelley piece, they don't even really try. We've debunked the "47 million uninsured" myth countless times here, but of course that tired old horse got trotted out again last night. And they also introduced the new buzzword: "underinsured." So apparently, even if one has insurance, it may not be enough.

We see the term "underinsured" in auto policies, but this was the first time I'd heard the term used in this context. And just what does underinsured mean? Well, according to 60 Minutes, it means a $500 deductible. What?! Heck, I don't even quote such a low deductible anymore. That's translates, by the way, to less than a cup o' joe a day at Louie Latte's place. And that's underinsured? No, that's nuts.

Speaking of nuts, we're introduced to an ex-pat Brit who lives in an abandoned scholhouse, and who spends his weekends setting up free clinics around the US. He bemoans the sorry state of health care here in the 'States. Hey Colonel, take a look further north, or perhaps across the pond, and you'll see LOTS worse.

Somehow, though, these folks -- who couldn't afford $50 for an eye exam -- can suddenly afford to drive 200 miles (at $3 a gallon!) in their new pick-up trucks for "free care."

Yes, I'm sympathetic to the plight of the relative few who are both uninsurable and ineligible for the myriad of government and private programs and resources available. But the folks on last night's show, from the "reporter" to the do-gooder to the participants, all ought to be ashamed of themselves.

Carnival of Personal Finance...

Is up, hosted this week by The Baglady, has a slew of interesting posts on matters of finance, all with helpful context.

The Federal Reserve has always been something of a mystery to me, so I appreciated Megan's report on what it does and how to works.

Good Hands, Meet Your Neighbors...

Our friend Eric "The Lawblogger" Turkewitz has another hot scoop:

"Allstate Insurance was hit late last week with a 78 page racketeering complaint, charging the good hands people with conducting sham medical exams."

They join fellow insurance behemoth State Farm in that rarified environment known as "RICO land." What is it with these folks?

Ah well, at least is takes the heat off Health Net, right?

UPDATE: I did a little research on Dr McGee, the plaintiff in both cases. If I'm correct (which is by no means guaranteed), he is a "Physical Medicine and Rehabilitation Physician" with several offices in New York.

UPDATE II: Eric just emailed me that one of the (other) physicians named in the Dr McGee's lawsuit has responded:

"Part of the problem with McGee's case is that he is under investigation by Allstate, Geico and State Farm for insurance fraud."

Ooops.

Competition vs Costs

One of our mantras here at IB is that health insurance costs continue to rise primarily because health care costs do. And now we have some independent, corroborative evidence of this position:

"Medicare’s studies have shown that patients fare FAR better when they have surgery in the specialty hospitals...But now those specialty hospitals pretty much can’t be built. There are a number of reasons...all of them stemming from stymied competition."

With competition comes choice, which is at the heart of consumer-centric health care, and a driving factor in cost. One of the problems is that urban areas have essentially forced out small, specialty-care facilities in favor of larger, community-based ones. From one perspective, this may be admirable: serving the needs of the many. But it comes at a price: the needs of the (desparately ill) few.

The FoxNews piece referenced above links to some fascinating Forbes articles on this issue, all of which I commend to you for more on this trend.