Life's Disappointments

[Welcome Industry Radar readers!]

Life insurance, that is.

Although I've never formally quantified it, life insurance comprises about 40% of my practice. Two recent experiences with this fairly simple product have left me disappointed and angry.

First, in some 25 years "in the biz," I've helped many clients file death claims on loved ones. For the most part, it's a pretty simple process: call the carrier to report the death, confirm mailing information, wait a couple days for the forms to arrive, and on from there.

After my mother died a few weeks ago, it took a while for me to feel up to starting the claims process. A week, in fact. So last Wednesday, I called the three carriers with whom Mom was insured, and asked them to send the paperwork. We confirmed mailing info, and that was that. Two days later, I received the package from Western-Southern Life.

I'm still waiting, a week later, for the forms from General American and TransAmerica.

This is not a complicated process: once the carrier's confirmed the mailing address, they drop the forms in the mail. It doesn't take a week for the envelope to arrive; in fact, I received the W-S one in two days.

Life insurance is a promise to pay, and we trust the carriers to at least get the easy parts right. Neither General American nor TransAmerica seem capable of doing so, and I won't take the chance that they'll disappoint my clients, so I will no longer be selling their products.

At the other end of the life insurance process, I'm beginning to change my mind about how I handle applications. I always have the client fill out the app itself, with guidance from me so that they know which parts to answer and which to skip. One question that has always bothered me, and which I now find completely unacceptable, is the one regarding family history. It's not that the information is irrelevant (it may well be), but it is a fundamentally unfair and flawed underwriting tool.

How so?

If I'm adopted, then I have no idea whether my father died at age 47 of acute liver failure, or remains a robust 97 year old golfer. And if I happen to know that my mother died of leukemia at age 37, there's absolutely no way the underwriter (or claims person) could ever know this. While I will never suggest that a client lie on an application, I think that I will now point out this problem to my clients, and suggest that they answer however they deem appropriate, keeping in mind that, unlike the medical questions which can be checked, the family history is completely unavailable to the insurer.

'Nuff said.

ADDENDUM: Although I've blogged on this subject before, I think it takes on new relevance in light of the recently passed legislation regarding "genetics discrimination." Although that bill seems to focus only on health insurance, it doesn't seem to me to be much of a stretch to apply it to the life side.

So not only is it a fundamentally stupid question, it may well now be illegal.

Viva MedTourism!

We've covered the subject of medical tourism pretty heavily over the years; folks from the US take advantage of it, of course, but so do folks from countries with "universal care," believe it or not.

One downside has been the cost: although many procedures are less expensive overseas (even factoring in travel and lodging costs), many folks aren't really able to pre-figure the total expense, or know how to coordinate all the many facets. And insurance companies haven't exactly been lining up to help their insured with these arrangements.

That may be changing:

"Members now have the ability to receive high-quality medical care overseas at a fraction of the U.S. cost! If you need a hip replacement, knee replacement, arterial bypass or other procedure, Companion Global Healthcare will assist you."

[ed: There's no link to the quote because it's from an email I received from the carrier, not copied from a website]

Folks who are insured with Companion Life will now have access to coordinated care, including surgical services, travel arrangements, transfer services from airports to hospital, even passports and visas, as well as scheduling of the care itself. While this certainly isn't an insured expense, it marks the first time I've seen such an effort by a US insurer. If there's a downside to the plan, it's that the carrier offers only limited benefit (not major medical) plans.

Still, it's a start.

Budgets vs. Healthcare

From the Daily Telegraph:

Operations are being cancelled because of dirty or broken instruments sent back by private companies employed to clean them, the Royal College of Surgeons (RCS) said yesterday.

Hospitals used to sterilise their operating instruments on site but are being encouraged by the Department of Health to put the job out to private companies.

A survey of surgeons found that equipment was often unfit for use, damaged, or late - meaning that operations were cancelled at the last minute, often when patients were already anaesthetised.

There's nothing inherently wrong with using outside contractors, but there's always the assumption that the job will be done correctly. From cleaning the hospitals to sterilizing their instruments, it's bizarre how many times the UK health system messes up. Is there a cultural lack of personal responsibility?  It's like the Chinese manufacturers that put antifreeze in toothpaste to save a buck.  It's just stupid.

Can you imagine the lawsuits that would result if this happened here?

A Heavyweight Grand Rounds

Doc Gurley (no "gurley-man," he) presents a WWE-themed 'Rounds, complete with pictures and a dash of humor.

Ever heard of "orphan drugs?" No, not Lil' Annie's lipitor, but specially-designated meds that David Williams, host of the Health Business Blog, believes are being abused by Big Pharma.

Carnival of Personal Finance is up!

Lazy Man and Money blog hosts this week's edition. Following the "Best of...and then the rest" model, LM&M presents a slew of timely and informative finance-related posts.

One of my favorite moneybloggers is The Digerati Life. This week, SVB has an interesting post detailing ways to both earn and save more.

Consoles vs Components: A Healthcare Perspective

[Welcome Industry Radar readers!]

Back in the day, home stereos came in huge wooden cabinets, as much furniture as sound system. Their appeal was obvious: rich sound without dangling wires, all neatly packaged together. The downside wasn't so obvious until the tuner knob or turntable arm broke: the whole thing went to the shop for repairs, leaving only the sounds of silence.

Then came components: speakers, turntables, tuners and tape decks all separate, easily upgradeable and if the speaker blew, it was a simple matter to swap in a new one.

If that sounds weird coming to you from a medblogger, consider this:

"This commuter suburb near Washington, D.C., boasts new homes, shopping centers, plenty of traffic — and a state-of the-art 21-room emergency department tucked into an office complex."

Several months ago, when I had my little lesson in the effects of ice and gravity, the provider I chose was such a facility: a dozen or so state-of-the-art exam cubicles, but no hospital rooms. For a relatively minor injury such as mine, this was ideal: there was little chance I'd need overnight accomodations.

We've talked before about minute-clinics and surgi-centers, and how many urban hospitals are cutting back on services, and I think I see a trend: much as stereo cabinets gave way to hi-fi components, it seems to me that previously hospital-based care is moving more and more to out-patient facilities unconnected to the sprawling complexes we've come to know as "hospitals."

Is this a "good thing?"

Only time will tell, of course, but I think the trend is encouraging. Specialty facilities can offer more expert care more quickly, and (perhaps) more cost-efficiently than traditional hospitals. They lack, of course, extended stay options; when my mother was recently hospitalized, she was taken first to the same facility as I had been, but had to be transported later that day to a "regular" hospital. Still, we couldn't have known that at the time, and it seemed a reasonable choice.

Something to keep an eye on.

Genetic Testing Update

Late last summer, we reported on a new genetics discrimination bill in Congress. HR 493 was designed to prohibit health plans from adjusting premiums for a group on the basis of genetic information. Along with "Dr No" (Oklahoma Senator Tom Coburn), we dismissed this bill as both redundant and unhelpful.

Alas, word's out that the Senate is likely to pass the bill this afternoon, and it's anticipated that President Bush will sign off on it, as well.

We'll have more on this as the full effects become apparent.

A Belated Thank You

I want to thank everyone who left comments at Bob's posts, wishing my family well and offering good thoughts and then condolences. They all meant a lot to me; I was pretty much offline for almost two weeks, and I didn't want anyone to think that these were being ignored. Rather, they were much appreciated.

Cavalcade of Risk #50 is up!

Julie Ferguson hosts this week's Cav at Workers' Comp Insider. It's an oustanding edition, and all the more impressive because I was unavailable to lend even a small hand. Thank you, Julie, for a great Cav and all the hard work you put into it.

Finally: Transparency = Cash

[Welcome Industry Radar readers!]

Long-time IB readers know that I have a keen interest in (obsession with?) transparency in health care. That is, I think that pricing and outcomes should more closely follow the McDonald's model than the airlines'. Except for emergency situations, where speed is perhaps the most important criteria, consumers should be able to compare the costs and likely results of procedures and treatments before having to make a decision.

It never occurred to me that one could also make a buck off of this:

"Alliance Community Hospital wants to pay you $100 or more to find out how much your health insurer paid for care you received at rival hospitals."

I have mixed feeling about this: on the one hand, it seems to me a good thing that they're taking this effort so seriously. On the other, wouldn't handing out $100 bills affect their own pricing, forcing them to increase costs?

There's no doubting their commitment to transparency itself, though: they even have a page which lists their charges for a variety of procedures, as well as how those charges stack up against the competition.

Aside from price, another aspect of transparency is a sharing of outcomes and satisfaction levels. In this area, too, Alliance Community seems to have fully embraced the concept: on still another page, they provide a "report card" on their level of care.

And as if that weren't enough, the hospital's CEO, Stan Jonas, runs a blog with insights and information. He even has a comments section, which provides a level of executive transparency, as well.

Kudos!

Regarding Angels

I've never given a great deal of thought to angels. It's not a religious thing; it's just that the subject wasn't really on my radar.

Until recently.

These past few weeks have been the most difficult of my life. As one can imagine, blogging (while an important and rewarding part of my life) has not been a priority to me the past several weeks. So I was touched and honored to read, when I did manage to get some "online time," Bob's updates and final tribute. He is indeed a friend, and a mensch.

Oh, that's right, angels; I have recognized quite a few over the past few weeks. Some are unlikely (gruff bearded ones here in Dayton, krusty bearded ones further south). Others were more obvious: the incredibly sensitive and compassionate folks at Hospice of Dayton, about whom I can never say enough good things. Some were physicians: my mother's long-time internist, who loved my mom almost as much as we did; the doctors and nurses at Kettering Medical Center, with whom I shared a rocky start, but grew to trust and appreciate.

Some I've know all my life: friends of my parents for over 50 years. When Uncle Milt and Aunt Honeylou enter the room, it's as if the sun has literally just burst forth. I don't think I've ever known anyone with such a love for life.

My mother's beloved sister, who begged her own mother for a baby sister (and finally got her way), is another one. Even when Mom was in Hospice (maybe especially then), she called every day, asking me to hold the phone to mom's ear so she could tell her baby sister how much she was loved.

My second father is an angel, too: although he's not in perfect health, he would not leave her side in those final days and hours. Sharing her final moments with him was a sacred thing.

My wife is, perhaps, the most likely angel. I always used to tease her that she was Mom's favorite, and there was more than a hint of truth in that. Even though she, too, was hurting and grieving, she was my rock and my anchor, and made absolutely sure that Mom was comfortable and knew that she was surrounded with love.

I suspect some folks are wondering why I'm sharing all of this in such a public forum. It is, after all, personal and painful and seems to have nothing to do with the issues we generally address here. But I was touched by some virtual angels, too: emails of love and support, the comments many have left in Bob's recent posts, all show just how many angels there are among us, even if we can't see them. I am so deeply grateful for all the love, sympathy and support from my "cyber family."

Just knowing that there are so many angels in my life is a perfect blessing.

Chag Pesach Sameach!

Cavalcade #49 is up!

This week's edition is available at Early Retirement. Blogger Jacob has done a great job, so please stop by.

We have slots available for June and July, so PLEASE drop us a line to reserve yours.

Grand Rounds is up...

Ably hosted by Dr Wes, there are 3 dozen interesting posts, including pieces on "legal thuggery" to pap smears on a man.

Do check it out.

HSA's in Jeopardy?

As a member of the National Assocation of Alternative Benefits Counselors, I receive periodic updates on legislation, pending and otherwise, regarding HSA's, HRA's, etc. Mostly, it's routine stuff, and merely confirms information I've already received from other sources.

Today, though, I learned for the first time about a move in Congress to further complicate HSA (Health Savings Account) distribution requirements. Although the email did not mention the name, number or sponsor of the bill (nor, indeed, much of anything else), a quick search of Thomas.gov gave me the information necessary to write an informed post about it.

[PARA REDACTED: Thanks to a tip from a detail-oriented reader, I've been reliably informed (and confirmed) that the bill originally referenced here is NOT ABOUT HSA's, substantiated or otherwise. This makes it even more frustrating, since the NAABC "alert" made no mention of which bill is involved. I'll keep digging, and update as necessary. My apologies to Congressman McNerney. HGS]

Let's take a step back and talk about a detail of HSA's which we don't much discuss here. When one makes a withdrawal (or "distribution") from almost any "qualified" (i.e. tax-favored) account, there are certain rules and requirements. With Health Reimbursement Arrangements (HRA's) and Flexible Spending Accounts (FSA's), one is required to "substantiate" or prove that the expense is eligible for that favorable treatment. This is really a pretty simple hoop through which to jump: the receipt is going to say "allergy med" (so it's okay) or "Snicker's bar" (which is not) [ed: Dang! Are you sure about that?]. Under Section 105 of the Internal Revenue Code, only folks participating in HRA's and FSA's are required to provide that proof; HSA participants are pretty much "on their own." That is, unless and until one is audited.

Until now.

The (as yet unidentified) bill would change that, and require HSA participants to substantiate each of their withdrawals, as well. Is this a big deal? Maybe, maybe not. According to the NAABC email:

"The proposed solution to this undiagnosed problem is to require that expenditures from an HSA be substantiated as a qualified medical expense. This would surely lead to higher administrative costs and more hassles for consumers."

I'm not convinced that that conclusion necessarily obtains. After all, many carriers offer HRA and FSA administration gratis, or for a nominal fee. Admin costs for the HSA loss-funds (the actual "accounts" in "HSA") are already all over the board; as their popularity (and marketshare) continues to grow, more admin's will come into the market, and competition will help to rein in costs. Based on this fact alone, I doubt that substantiation will be much more than a minor nuisance.

UPDATE, NAABC Responds: I sent a link to this post to the NAABC, and Harvey Randecker, its president, sent me this helpful reply:

"My only point in circulating this "Alert" was to indicate exactly how consumer-driven health plans can be destroyed...incrementally.

After The Clinton Reform Plan [ed: "HillaryCare"] was defeated in the early 90's, Bill Clinton was quoted as saying that the lesson they learned was that, in order to get what they wanted, they would need to proceed "incrementally," passing small legislation that will chip away at the system and, gradually, force a more socialized system on the American public.

Now, due to the expansion of HSAs and HRAs, the only way to halt their growth is to make them less desireable to the public. Admittedly, I thought that [the recent Medicare] legislation...made HSA provsions too liberal and that it was bound to incite anti-CDHP legislators, once they assumed control, to do whatever necessary to reverse the trend and, to me, it looks like this is just the first small step.

We are so small staffed at NAABC that all we can do is pass along Alerts like this that we receive that we feel would begin to adversely affect the CDHP market in one way or another. Unfortunately, having a tiny staff means that we really don't have anyone with the time to really digest what we receive. Nevertheless, if we ignored the alarm bells being sent us, we would not be doing a service to our members.

I appreciate your comments."

Thank you, Harvey, we appreciate both your prompt response and your insights. The point about staffing problems is, of course, spot on: it's one of the banes of such associations. It seems to me, however, that this may be one of the key benefits of blogs (such as IB): the ability to do "distributed computing" type analysis on these issues. The appeal of this method would be financial (i.e. free to the organization) as well as comprehensive (i.e. lots of folks working on pieces of the puzzle).

UPDATE 2: I received a phone call from Congressman McNerney's office this afternoon, after I'd already corrected the post. Although I was happy to have given the Congressman free publicity for his bill, I still wanted to know the name and number of the correct bill, since I still couldn't find it at Thomas. So I emailed the NAABC (again) to ask for this information, and their spokescritter had no idea what it was, or any other relevant and important details.

This is outragous: you don't send out an "Alert" about legislation when you don't even know the name or number of the bill. Regardless of the staffing issues, this is just inexcusable. I no longer consider the NAABC as a credible source for legislative information, and won't be troubling our readers with its "Alerts" in the future.

Good News is Bad News? (From the P&C Files)

Only in the world of insurance would we find the following said strictly matter-of-fact, with no laugh track expected or necessary:

"Lloyd's of London warned yesterday that an absence last year of natural disasters or man-made accidents was putting pressure on firms to reduce premiums in 2008."

Because claims have been so low, profits have been good, which means that competition (which is, of course, a good thing) is heating up. But when that happens, folks who underwrite the risks have to slash prices to make themselves more attractive, which then cuts into profits.

This is one of those times where I'm truly grateful to work in a side of the biz that understands market forces and the value of customer satsifaction and open communication.

Oh, Behave: Redux

When last we left our friends at the MVNHS©, we learned that once their "quota" was filled, it was off to the golf course.

But what happens to their patients?

Well, if you've pumped your own gas recently, then you're halfway there:

"A grandmother performed her own tooth extractions in despair after being turned away by 12 dentists.

Elizabeth Green, 76, was in agony with two front teeth and after a fruitless search for an NHS practitioner, resorted to DIY."

Words fail me.

Carnival of Personal Finance is up

This week's edition of the venerable Carnival of Personal Finance is now available at MoneyNing. Host David uses the (preferred) Editor's Choice then All the Rest template, with over 100(!) posts to persuse. Have fun!

Cavalcade #49: Submissions Due

Early Retirement blogger Jacob hosts next week's edition of the Cavalcade of Risk. Submissions are due by Monday the 7th, and the Cav will be up and out on the 9th. As always, please make sure to 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 May and June, so PLEASE drop us a line to reserve yours.

The Uplifting Side of Universal Health Care...

Sorry, but I have to blog on this:

"A German woman is suing doctors after she checked in to have wrinkles removed - and woke up with a new pair of breasts."

Now here in the benighted 'States, we'd call that a "two-fer," but the poor woman simply wanted relief from unsightly (and probably uncomfortable) extra skin left after she lost an incredible 224 pounds (Atkins eat your heart out!). The surgeons claimed that adding the implants was the most efficient way to tighten her skin.

I'm thinking Dr Anderson had a hand in this.

On Aging (A Personal Post)

Although our primary focus here is insurance [ed: nice of you to notice], we also discuss more general topics, specifically those that are health-related. I'd like to share some personal experiences and observations, partially out of a need for catharsis, but also in keeping with our underlying mission of education and awareness.

Some 18 months ago, we had to move my mother into a nursing home. She'd been diagnosed with Alzheimer's (and yes, I'm aware that the definitive diagnosis actually takes place at the autopsy, but that seemed so, well, final). She's not completely "gone:" I used to talk about her having "good days" and "bad days," but I've matured a bit, and now discuss it in terms of whether she's in her world or ours.

My beloved stepfather is in the same facility, although they're not currently in the same unit; he's in somewhat better shape, and more able to take care of himself.

The reason for this post, at this time, is to share with our readers the very real, very personal, very painful reality of the dilemna that our "seasoned citizens" - and their progeny - face when things begin to go downhill. So I'm going to take some liberties here, and make some observations and suggestions:

If you're one of "the seniors," begin to downsize now. I mean it: DO NOT BURDEN your children with having to clean out your home of the past 30, 40 or 50 years of accumulated junk (and yes, much of it is junk, not treasure: deal with it). It is okay to donate, burn or otherwise dispose of it; if your kids want any of it, offer it to them, conditioned on them actually removing it in the next two weeks.

If you don't already have it (and are able to do so), buy long term care insurance. Contrary to industry propaganda, it is not a method of insuring or conserving your estate. It is to help you retain something far more important: choice. If you don't understand this, then you need to do some serious research. If the agent uses the terms "liquidity" or "estate" (or some variation thereof), find a new agent. I'm serious.

If you're the son or daughter of a senior, encourage them to downsize. Offer to help box things up, drop them off, or otherwise dispose of them. If you have your eye on a particular item (or items), just remember that, far too quickly, your children will face the same daunting task. Make it easier for them than it was for you.

For my compatriots dealing with the declining health of their parents, know that there are people in your life who do care, and want to help. If I've learned nothing else through this experience, it's how many people truly care, and want to help. Perhaps surprisingly, many (most?) of these folks won't be your "family" (that is, brothers, sisters, etc), but others whose lives you've touched. In my faith, we call this "mishpacha" which means "family," but oh so much more. You have that, too, whether you know it or not; ask for help, I guarantee that you'll get far more than you could ever have imagined.

Finally, a personal note: for those praying for me and my family, I am truly indebted, and hope that I can return the favor (when appropriate). Thank you, too, to everyone who's emailed and/or called. You are part of my "mishpacha," too.

Thank you.

Health Wonk Review is up...

Brian Klepper, proprietor of The Health Care Blog, hosts this week's collection of the best of the medwonkosphere [ed: the whatsis?!]. Brian presents almost 2 dozen intriguing, thought-provoking posts, from age-related diseases (heads up to Bob) to virtual office visits.

Do check it out!

All in a Day's (Week's? Month's?) Work: Part 1

This is the incredible story of persistence, perserverence and perspicacity on behalf of a client. Your intrepid correspondent endured countless weeks of nail-biting tension, seeking to resolve a seemingly insurmountable set of obstacles.

Either that, or it was a dark and stormy night.

While insurance certainly isn't rocket surgery, there's a reason why folks must endure many hours of training before becoming licensed, and fulfill continuing education requirements once they're officially "in the biz." And this case is illustrative of the role an agent can play in navigating potentially complicated waters. Obviously, I've changed the names of the insureds, but I'm also holding back the name of the insurer. That may change, but for now we'll just call them Thema.

In early February, I was referred to a family with a dilemna: they were on COBRA continuation which would run out at the end of the month, and the Mrs was pregnant, due mid-month. Further complicating matters was that this rendered the rest of the family uninsurable (until after the baby was born), as well. Don't ask me to explain that, by the way; it just is. So we had a definite and urgent need, and few options.

I sat down and wrote out all the the issues. After about an hour and a half (hey, I'm a little slow), I had my strategy: we would write a HIPAA plan (hang on, I'll explain shortly) for March 1, and simultaneously submit an application for a "regular" major med plan for an April 1 effective date. To my relief and pleasure, the clients are big fans of HSA's, so we chose a high deductible policy for the April 1st plan.

COBRA and HIPAA are two ubiquitous and generally misunderstood federal laws that greatly affect our health insurance choices. Under COBRA, one can keep one's existing group coverage for up to 18 months (and yes, there are exceptions) even if one is no longer part of that group. After 18 months, if one is "uninsurable," one can elect a special "HIPAA Plan:" essentially a mediocre and expensive major medical plan, whose primary benefit is to cover pre-existing conditons. In this case, the HIPAA plan was a life-saver: we could have it in place for March 1, giving us about a month and a half from the due date to the HSA's effective date.

So far, so good.

The rub is that I wanted to submit ALL the paperwork at the same time, using the same carrier. My primary reason for this was the KISS principle. I chose Thema because they had the lowest rate for the HIPAA plan (which is, by definition, standardized as to benefits) and because I like their HSA plan (which has first dollar coverage for most routine preventive benefits). And there's this: I also wanted to have all of this done prior to the baby's arrival. The good news was that the clients had a C-section scheduled, so the date was firm. So, we filled out both sets of paperwork, and sent them off to Thema (along with a cover letter I wrote to explain the extentuating circumstances). Now came the hard part: waiting and hoping.

The HIPAA plan was issued pretty quickly (as we knew it would be; generally speaking, it's something you simply sign up for, with no underwriting). The delays came when trying to get PHI (Private Health Information) from the client. PHI is a byproduct of HIPAA privacy concerns, and requires the carrier to go directly to the insured for answers (rather than through an agent). The problem was that the client was difficult to connect with (understandable, since she'd just had a baby). Complicating things further was the fact that the husband had a health history of his own, with quite a few med's.

As the clock ticked, and we got closer and closer to April 1, I became more and more concerned. It also occurred to me that, since we had submitted the applications before the due date, we'd have to add the new baby to the app while still in underwriting.

On the 25th, the client called to let me know that the Thema folks had called to discuss the PHI, and that she was going to call them back. I said "great, and you can tell them to add the new baby to the policy, as well." Progress!

Except not.

Stay tuned for Part 2.

"Strip-ChIP" Update

Several months ago, we reported on a Texas effort to levy a $5 fee on "adult entertainment venue" clients. The proceeds from this seemingly modest tax was purported to be used to help fund health care for the uninsured (among other things).

FoIB Joe Kristan has good news for champions of free speech (and/or lapdances):

"A Texas court has ruled a $5 admittance tax to strip clubs to be a violation of constitional free speech rights."

Hoo-Ah!

HSA M&A

In a recent post, Bob wrote about Health Savings Accounts for "seasoned citizens." As a result, we had a delightful and informative discussion about HSA's in the comments section. Kirsten Trusko, senior manager at BearingPoint and I had a virtual conversation about the future of these plans in general, and she provided some fascinating and helpful links for our readers.

We're pleased to share this podcast from Kirsten, in which she discusses the interaction of HSA's and "mergers and acquisitions." One wouldn't ordinarily link the two, but this is an intriguing insight into how the worlds of (high) finance and health insurance intersect.

Enjoy!

Grand Rounds: April Fool's Edition

This week's 'Rounds, (initially) hosted by Grunt Doc, is a tour de farce of unprecedented quality. Without giving away too much, be prepared for a wild ride through the medblogosphere.

Start here.

You'll be amply rewarded.