Movin' on up!

Those folks who pay attention to these things may have noticed that we've been in the Top 20 at Wikio (Health) for quite some time, most recently at #16. I just received confirmation from the Wikio folks that that's about to change:

"I am contacting you about the new Wikio ranking for July. Your blog InsureBlog moved from 16 to 11 this month."

Awesome!

While I'm still relatively clueless about how those rankings are determined, it stands to reason that readership plays at least some part, and so I'd like to thank our loyal (and brilliant, of course) readers.

UPDATE: I've just received a follow-up email confirming that we're #10.

Another Ethical Conundrum: Little Hailey

When is someone too sick to be helped?

"Two airlines this weekend declined to fly Miranda Goranflo and her daughter Hailey to Beijing, where the 5-year-old was to receive stem-cell treatments for a rare fatal disease."

Little Hailey (and her baby brother) suffers from Late Infantile Batten Disease, which causes loss of muscle co-ordination and seizures that do not respond to anticonvulsant drugs. It is (apparently) always fatal. Other than this new, experimental treatment, there is no cure; a patient's life expectancy is about age 12.

Once Hailey (and her mother) had reached Vancouver, Air Canada insisted on making their own determination as to whether or not she was fit to fly. Unfortunately, during the wait for the Air China flight, Hailey's health went from bad to worse, and she was admitted to Vancouver's Children's Hospital. When it was apparent that her health hadn't improved enough to make the flight to China, she was flown home, by air ambulance, to Kentucky.

It now appears that she will be unable to take advantage of the stem-cell treatment that may have extended her life expectancy.

This is just sad, on so many levels.

As a parent, I can certainly respect and empathize with her folks' desire to exhaust every single avenue, no matter the cost or the effort. But I can also see the airlines' perspective: if her health had deteriorated that fast just waiting for the next flight, how well would things have gone once they were in the air and over the Pacific*? And what liability would the airline face in the event that she suffered even more? And finally, what about the safety of the other passengers?

There's also the question of "what now?" Hailey's family is exploring the possibility of a direct commercial flight to China, or even ponying up the $125,000 cost of an air ambulance there. Since this is an experimental treatment, it's unlikely any insurance carrier would agree to foot that bill.

I'm curious about our readers' take on this.

UPDATE: Thanks and a Tip o' the Hat to commenter Foilwoman for catching my geographical faux pas.

Carnival of Personal Finance is up

This week's edition is overflowing with helpful finance tips and info. Host Greener Pastures presents his CoPF with a "green" theme, which is interesting.

Check it out!

Paging Dr Willy Wonka: Chocolate Update

Over the years, we've touted the benefits of chocolate-based health care: whether you're pregnant, overweight, or just suffering from high blood pressure, chocolate seems to be the "go to" dietary hero (well, maybe next to tomatoes). It's not enough, apparently, for scientists merely to acknowledge cocoa's seminal role in the health care arena; now they want to map the delicious pod's genome:

"Government scientists are launching a five-year project Thursday aimed at safeguarding the world's chocolate supply by dissecting the genome of the cocoa bean."

It seems that there are a host of challenges that affect cocoa crops, from fungi to droughts, and researchers believe that they can learn more (and better) techniques for protecting the world cocoa bean supply by more completely understanding what makes it "tick."

It's actually a pretty interesting venture, with leading edge genetic research which promises to have positive, real-world impact.

Nationalized Health Care: Ruh Ro!

"(T)he chairman of a government committee reviewing...health care this year...concluded that the system is in "crisis."

For example:

"Sylvia de Vires....afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care."

And she's far from the only one:

"At some hospitals, seriously ill patients are kept in ambulances for hours so as not to run afoul of the regulation."

Wow, sure sounds like we need to switch to a Canadian-style, nationalized health care system, and right away!

Or maybe not: "the chairman" cited above is actually considered the "the father of Quebec medicare," the system on which Canadian health care is based. And he made those remarks recently, adding "(w)e thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," and proposing a much greater role for private health care for our Neighbors to the North©. In fact, he's "proposing to give a greater role to the private sector so that people can exercise freedom of choice."

And poor Mrs de Vires? Well, she's from Ontario, and because the Canadian system wouldn't approve treatment for her, she took a little trip down to Michigan. There, a surgeon successfully removed her tumor, and none too soon: the surgeon estimated that "she could not have lived longer than a few weeks more."

And you may be wondering about the folks being "stored" in ambulances. In Britain, it has become commonplace for acute care patients to have long waits before being seen, much less treated. So the Ministry of Health promulgated a new rule requiring that those in need of emergency care receive it inside four hours. All well and good in theory, but the Law of Unintended Consequences trumps a mere gummint regulation, and so hospitals refused to allow the patients inside; that four hour meter didn't start ticking until they hit the actual door.

I'll give "the father of Quebec medicare" the last word on this:

"We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

[Hat Tip: RWN]

Cavalcade of Risk #55: Submissions Due

Our friend Jay Norris hosts next week's Independence Day edition of the Cavalcade of Risk. Submissions are due by next Monday (June 30th), and Jay requests that you 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 your post via Blog Carnival or email.

We're scheduling late summer, so please drop us a line to reserve your Cav.

UHC in the (Bad) News

[Welcome Industry Radar readers!]

Well, it must have seemed like a good idea at the time:

"Weeks before the deal was signed, UnitedHealthcare sent 176,000 letters to customers. Many of the letters incorrectly warned people that their doctors would be out of network."

Ooops.

At the time, UHC was in the midst of negotiations with super-sized health care provider OhioHealth. Since doc's like nothing more than to field calls from irate patients, the thinking must have been along the lines of "hey, let's rile up our customer-base, and point them at their own doctors and hospitals." It was probably considered to be a no-lose situation: "hey, we're just the poor ol' insurance company, looking to save our policyholders a few bucks. What y'all do with this information is strictly up to you."

Unfortunately (for UHC, at least), it didn't work out quite that way:

"The investigation was sparked by those complaints and media attention, as well as the fact that UnitedHealthcare is one of the health plans offered to state employees."

Gotta love that last: given that at least a few of their policyholders would almost have to be DOI employees, one would have thought that UHC might have been more, um, circumspect about the whole thing.

The issue will boil down to whether or not any laws or regulations were broken by this perhaps ill-advised venture; it calls to mind the Anthem vs Premier kerfluffle a couple of summers back. Regardless, "investigating" doesn't mean "found guilty." It may well be (and I suspect that it will be) that nothing will come of this.

We'll keep you posted.

[Hat Tip: IB reader Jeff Milne]

Patient Care: Something New Under the Sun?

Consumer-centric health care begins with (what else?) the consumer. On an obvious level, this means choosing the right health insurance plan, knowing its benefits and limitations, and being aware of how it works best. It also means keeping the line of communication between yourself and your providers (doctors, pharmacists, specialists, etc) open, and not being afraid to ask a lot of questions.

But sometimes, the world of health care can be a frustrating set of numbers, codes and phone numbers (and even, sometimes, actual human beings). Wouldn't it be nice to have someone on your side who knows how to navigate the maze that is health care?

That's the premise behind Assurant's new initiative: Patient Care. Well, actually, it's not Assurant's initiative per se: they're making available a "new" service called Patient Care. The company itself was started in 2001, and bills itself as "an independent advocacy company whose sole purpose is to resolve a healthcare problem or assist a member with health insurance and benefit issues." One can avail oneself of PC's services for the (ahem) "modest" fee of $1,000 (or up to $3,000 for a family).

Or, one could simply purchase a new Assurant major med plan, and it's a freebie. Not a bad deal.

This is the latest in what appears to be a wave of new "value added" services that carriers are pushing to help differentiate themselves (and their products) in an increasingly homogenous-looking market. We saw it recently in Companion Life's new "medical tourism" benefit, and I'm sure we'll see it in other forms, from other carriers, in the near future.

While I still maintain that choosing the right product design in the first place is more important than these little "gimmies," they do help with brand identification and, perhaps, as an added incentive to purchase.

Health Wonk Review is up

HWR is one one my favorite "carnivals:" it appeals to my "inner geek," and I almost always discover a new (to me) health blog. This week's 'Review is particularly well done: host Jaan Sidorov adds his own "take" on most of the entries, which spices things up even more.

Some 10 years ago, when HIPAA was a newborn, my CE partner and I did the unthinkable: we actually read the whole thing (200+ pages), and developed what became our most popular class. Ray found a little nugget called the "National Provider Number" (NPI). Sounds innocuous enough, but as Dr Zagreus Ammon explains, there's a lot more than meets the eye.

Business Insurance vs the IRS

Don't know how I missed this, but tax-blogger extraordinaire Joe Kristan has a compelling post about the tax implications of a business insurance claim. Joe explains, in easy to follow terms, why a "no brainer" may have some drastic consequences.

If you own a business, you need to read this.

Much Ado About, Well, Not Much

Back in the day, now-ubiquitous TV pitch man Billy Mays introduced us to the wonders of OxyClean. I must admit, it's one of my favorite products: it's reasonably priced, and it really works. The question is, does that kind of success transfer to less tangible products, such as health insurance?

Recently, the bearded wonder became the official spokeman for something called "iCan Benefit," a website that purports to offer great deals on health insurance. They actually offer two "flavors:" a guaranteed issue, limited benefit (mini-med) plan and a "regular" (i.e. underwritten) major medical plan.

Neither is particularly special; the mini-med plan seems to have pretty much all the features of any of its ilk, and is priced accordingly. That is, it's competitive but not particularly so.

The major med plan is underwritten by Assurant, which is a very decent carrier, with good service and decent products. I haven't been especially impressed with their underwriting or pricing (although they do at least try to offer less generic products). Keep in mind, though, that this is not a group plan, which means that full underwriting applies.

What does that mean, exactly?

Simply this: you'll still need to complete a full application, disclosing your medical history, current problems and any med's you're on (or have been on recently). And Assurant can exclude conditions or med's, or even turn you down altogether. Of course, that's typical of the individual major med market, but it's important to remember that joining iCan doesn't buy you an underwriting (or pricing) break.

It does mean that you'll pay an extra association fee, though.

iCan suggests that "You can think of us like a close friend who knows all about health insurance." Not a bad pitch: after all, we often suggest that you ask friends, neighbors, and the like for a referral to a good agent. But that doesn't mean that these folks are ipso facto experts on insurance; merely that they've had good experience with a particular agent or carrier.

Bottom line: seek out a professional, independent agent with at least 5 years of relevant experience, and who represents more than just the one company.

You'll be glad you did, and it'll give you time to check out Billy's other fine products.

CDC: Sealing the Deal

Red Green touts duct tape as "The Handyman's Secret Weapon." Little does he know that the brilliant scientists of the Centers for Disease Control in Atlanta have their own take on the ubiquitous adhesive:

"The Centers for Disease Control and Prevention has revealed a unique, high-tech use of its own – sealing off potentially fatal bioterror bacteria."

The brainiacs at the Center's Emerging Infectious Diseases Laboratory, which cost over $200 million dollars (or in gummint-speak, "chump change"), have been using roll after roll of the silver stuff trying to prevent the escape of the potentially fatal "airborne Q fever."

In their defense, the scientists claim that the duct tape is merely an "enhancement;" insurance (if you will) added to bolster the containment systems already in place. Of course, we've all heard that before.

I sure hope Bob's got a roll of his own.

Oh Yeah, It CAN Happen here

Over the years, we've chronicled the reckless, often deadly exploits of the MVNHS© (Britain's Much Vaunted National Health System©). Indeed, only a few weeks ago, we reported on the tragic case of an English grandmum who was denied potentially life-saving treatment. There are those who think that such things could never happen here; we know how to balance the good of the many with the needs of the few.

Think again:

"State officials have offered a lung cancer patient the option of having the Oregon Health Plan, set up in 1994 to ration health care, pay for an assisted suicide but not for the chemotherapy prescribed by her physician."

That's right, Barbara Wagner's been offered an admittedly effective (if draconian) treatment alternative: death. Granted, this would end her suffering and save untold thousands of taxpayer-provided dollars. But does anyone else think that this might be, um, drastic?

The good news, such as it is, is that nasty ol' Big Pharma has stepped up to the plate:

"(A) drug manufacturer that it will provide the expensive medication, estimated to cost $4,000 a month, for the first year and then allow her to apply for further treatment."

And yet we're constantly told that private sector-based health care is bad, while gummint-provided care is good. Maybe in Bizarro World, but apparently not in The Beaver State.

To add insult to (grevious) injury, Dr. John Sattenspiel (senior medical director of the company that runs Oregon's health plan) averred that there was "no intent to upset her, but we do need to point out the options available to her under the Oregon Health Plan."

Gee, I feel better already.

Grand Rounds: Hold the Phone edition

The fine folks at Shrink Rap answered the call to host this week's roundup of the best med-posts.

Literally.

This is truly a "grand" 'Rounds, built around the recent introduction of the new iPhone. It's really fun, and each entry relates in some way to the new gizmo. Kudos!

Here's something new: "mystery patients." We've all heard of "mystery shoppers" who help retail stores keep sales staff on their toes. The Samurai Radiologist reports that it's happening in health care, too.

George Carlin: An Insurance Connection

Over 25 years ago, my first job in the insurance biz was as an agent with one of the few remaining "debit" companies.

[ed: many years ago, a lot of companies sold (relatively small) policies with premiums collected weekly. Agents were assigned a territory, or "debit," from which to collect and, hopefully, make new sales. I'm not aware of any carriers which still do this, although one might argue that payroll deduction, or "worksite marketing," plans are the natural evolution of this market]

My debit included a relatively affluent area, and a high-rise apartment building wherein lived a number of retirees. One evening, as I sat in the apartment of one such couple, they asked me if I enjoyed stand-up comedy. I replied that I did, and they told me that their daughter was married to a stand-up comedian, and perhaps I'd heard of him. At the time, HBO had a series of "specials" highlighting new talent, and I thought that maybe they'd mention one that I'd seen. So I innocently asked "which one?" The lady of the house replied almost apologetically (perhaps thinking that I'd never heard of her son-in-law), "well, our daughter is married to a comic named George Carlin. Have you ever heard of him?"

Of course, my jaw nearly broke as it hit the floor. Had I ever heard of George Carlin?! I'd basically grown up (so to speak) on his humor. I had had no idea that there was a hometown connection, let alone that I'd be sitting in his in-laws' living room. Mrs Hosbrook asked if I'd like one of his albums (they had "a few" laying around), and I said "oh, sure!" It turned out to be an autographed copy of (if I recall correctly) "Class Clown." What a treasure!

I left that carrier some 24 years ago, and lost touch with the delightful couple. But I never parted with the album (although I currently have no turntable on which to play it), and always felt a connection (feeble though it may have been) with the comic legend.

G'bye, Al Sleet and company!

Carnival of Personal Finance is up!

This week's collection of all things finance is hosted by Mrs Micah. Mrs M presents a veritable smorgasbord of interesting posts, all with helpful context.

Check it out.

IRS and HSA: Good News Update

[Welcome Kaiser Network readers!]

According to the NAABC, the Internal Revenue Service recently issued two positive items on HSAs:

First, many people aren't aware that you can fund your HSA (Health Savings Account) with money you have socked away in an IRA (regular and/or decaf, er, Roth). This is a one time deal, not something you can do on a regular basis. According to the Service, if you decide to make the transfer, it won't be subject to the normal 10% penalty s a "distribution." This method is typically used to "seed" the account at start-up.

Good deal.

And it gets better:

The Health Opportunity Patient Empowerment Act of 2006 clarified (among other things) how one calculates one's maximum HSA contribution in a given year. Basically, it affirms that the amount you can contribute isn't necessarily limited to your deductible. Even if your plan's deductible is less than the max, you can contribute the maximum.

Sweet.

And finally, for those who actually received their "Stimulus" checks (and you know who you are), even more good news:

If your check was deposited directly into your HSA, you can safely withdraw it. This would apply to folks who had their regular tax rebates deposited directly to their HSAs.

As always, check with your own tax advisor to see whether (and how) this would affect you.

Interesting Cancer News

What if you had the power to cure cancer, your own cancer, already inside you? That's the promise of a new treatment protocol recently unveiled Across the Pond:

"A cancer patient has made a full recovery after being injected with billions of his own immune cells in the first case of its kind, doctors have disclosed."

Regular IB readers may be wondering if this could possibly be the work of the MVNHS©. Sadly, no:

"Ed Yong, health information manager at Cancer Research UK, said: "It's very exciting to see a cancer patient being successfully treated using immune cells cloned from his own body."

The bad news is that, at this early stage, the treatment is quite expensive, and is likely to remain so for a while. This makes sense: new tech R&D is generally expensive. As it becomes more widespread and economies of scale come into play, costs tend to decline.

The major difference between this technique and earlier regemins is that it shows that "simply growing vast numbers of the few immune cells in the body to attack a cancer can be safe and effective."

Sounds promising.

Is This Really Necessary?

It's bad enough that the science is still out on the value (let alone safety) of the HPV vaccine for young ladies. So what are we to make of this:

"Now researchers are looking into whether the vaccine should be given to boys as well, both to prevent the transmission of HPV, and to prevent the rarer, but no less deadly, cancers that can occur in men from the virus."

Give. Me. A. Break.

As we've noted before, "vaccinated boys were 2.5 times more likely to have neurological disorders (such as autism) than those who had not "had all their shots." So would increasing the number of vaccines reduce cancer risks? We really don't know.

We do know that "it's not been tested for effectiveness in younger girls, and administering the vaccine to girls as young as 9 may not even protect them at all." So why would we take this chance with boys, as well?

On the one hand, it's claimed that "(t)he vaccine, Gardasil, is proven to prevent infection from four particularly dangerous strains of HPV in women." That would seem to be a "slam dunk" insofar as vaccine's effectiveness is concerned.

And yet:

"HPV prevalence is thought to be high in men as well, but none were studied."

So what's the rush?

Chaperone Insurance

Time once again for a brief walk on the P&C side of the insurance biz. As one who's shuttled kids back and forth to various afterschool activities, dances, practices and the like, I'm always mindful of the potential for a mishap. Thank goodness (and my personal liability unbrella) it's never been a problem for me, but that doesn't mean it can't be:

"A nearly $700,000 verdict against a chaperone of a cheerleading trip to Hawaii is enough to give a chaperone pause."

Seven hundred thousand dollars?!

For what?!

Turns out, Susanne Sadler (a New Jersey resident) offered to chaperone a cheerleaders' trip to Hawaii, where they were to perform in the Hula Bowl. Prior to that exciting opportunity, though, one of the students apparently decided it'd be a good idea to have a drink or two. She subsequently fell off a balcony and died. Ms Sadler isn't accused of giving or getting her the drink; nonetheless, she was sued and found to be at least partially responsible for the tragedy.

And now must cough up almost $700,000.

Which raises a number of questions:

Would your homeowner's liability policy cover you? What if it's over a few hundred thousand dollars?

Do you have an umbrella policy? Would it cover this kind of thing?

It's something I would never have thought to ask my co-worker (who's also my P&C agent). Until now. (For the record, he said "coverage? I've never seen you before in my life." So I've got that going for me) Seriously, ask your agent. Do it soon.

Something else to consider is whether or not the organization which sponsors such a trip has a liability policy. And it's not just an expense issue, either. According to the president of a school booster club:

"If we decided not to have any insurance, at some point a year or two from now, some parents might say they can't take the risks."

Good point.

Cavalcade of Risk #54 now available

Jim at Bargaineering presents this week's collection of risk-related items from all over the blogosphere. Do check it out.

And don't be shy: drop us a line to reserve your edition.

Paging Dr Bernanke!

Today's McPaper has an interesting report on what the Fed's Chairman, Ben Bernanke, thinks about the state of health care and the economy. According to Dr Ben, "(S)pending on health care is the single-largest component of overall consumer spending — larger than spending on either housing or food."

Bravo!

IB regulars are familiar with our anthem: Health insurance costs increase primarily because health care costs increase. To hear the Chairman of the Federal Reserve esentially endorse that position is indeed wonderful, but we won't let it get to our heads.

That increase is driven primarily by heavy and growing demand, and the rather counter-intuitive notion that increasing tech doesn't drive down the cost of health care.

[ed: To understand why that's counterintuitive, consider PC's. As they've gotten more powerful, with more features, they've actually gone down in price. Not so with health care]

And that increase shows no sign of slowing down. According to Dr Ben, "(t)o buffer the effects of rising health-care costs on household budgets, the government may have to absorb an increasingly large share of the bill for those costs." Hunh? The government may have to absorb these costs? Um, no: we will absorb them: the gummint has no money. It must confiscate...er, uh, tax us to aquire it.

And gummint spending in the health care sector is a major driver of these increasing costs: "Medicare for retirees and Medicaid for low-income people — takes up 23% of federal spending that is not for interest payments." Ouch!

Food for thought.

A Tropical Grand Rounds...

David Khorram hosts this week's Grand Rounds from the South Pacific at Marianas Eye. Its calming illustrations belie the frenzy of interesting posts.

As the grandson of (legal) immigrants, I've occasionally wondered whether any of them came through Ellis Island. Annie, at Home of the Brave, has discovered that the medical records of everyone treated at the Island's hospital have gone missing. I do love a mystery.

Date Tree Update

Some two and a half years ago, we brought you the story of an ancient plant sprouting new hope.

That was then, this is now:

"A Judean date palm, long extinct, has been "brought back to life" by scientists who unearthed a 2,000 year-old seed of the plant and germinated it. A healthy 4-foot-tall seedling, named Methuselah after the oldest living man in the Bible, now holds the record for the oldest germinated seed."

Aside from the historical significance of the oldest young tree, it's hoped that it may also yield information to be used as alternative medicines.

A veritable Tree of Knowledge.

Carnival of Personal Finance: 3rd Anniversary Edition

Flexo at Consumerism Commentary hosts the 3rd Anniversary edition of the venerable Carnival of Personal Finance. There are an almost overwhelming number of posts, many with helpful context.

Congratulations, CoPF!

Naughty Pharma Tricks

[Welcome Industry Radar readers!]

Your tax dollars at work:

"Walgreens figured it could pocket millions by switching patients from tablets to capsules."

At first glance, this seems harmless enough: swapping one pill-form for another, assuming the formulations were equivalent. But it doesn't take a rocket surgeon to see that the whole point of the swap was to generate megabucks for the provider, at the expense of the taxpayer (i.e. you and me). And how much, exactly, did this little switcheroo cost us?

How about over a million dollars, in one year, just in Florida.

That's a lot of little pills...er, capsules. And it wasn't just for Zantac, either (although this story sure is giving me a heartburn): "generic Prozac (fluoxetine) for depression, and generic Eldepryl (selegiline) for Parkinson's," all were part of this little money-maker.

Of course, Walgreen's denies they did anything untoward (and they're apparently not the only big pharmacy chain with their hand in the cookie jar:

"CVS and Omnicare quietly settled similar cases coughing up $86 million more."

That's a lot of pills. Capsules. Whatever.

(Urgent) Product Bleg

Bottom line: I need a catastrophic major medical plan with a $100,000 deductible, no per-claim or annual caps, and at least a $1 million lifetime maximum (more would be better).

Okay, now from the top:

A few days ago, I received a phone call from a gentleman asking about medical insurance. He's an engineer (no, not that kind) with a company of about 2 or 3 thousand employees, all of whom are in the same boat: covered by a generic-looking group medical plan (office visit co-pays, a drug card, deductible and 80/20, etc). Oh, and there's a very generous $5 million lifetime maximum. The catch: a $100,000 annual cap on all expenses. So if there's a big claim, once it hits $100 grand, "you're on your own." This has the gentleman (and his coworkers) understandably nervous. I proposed a cat (catastrophic) plan with a $100,000 deductible. This would basically pick up after/when someone hits their $100 thou annual max. He loved that idea: he had apparently been speaking with other agents, and they were all pushing him to look at $3,500 or $5,000 deductible (HDHP) plans.

So I said I'd look into it, and get back to him. I popped over to an "insurance warehouse" I've used before, because I knew they'd have one. And indeed they had (almost) exactly what I was looking for: their plan had a $100,000 deductible, and a $1 or $2 million cap lifetime max. But there were some internal limitations ($400/day for hospitalization, for example) that were bothersome, and the plan seemed kinda pricey: about $70 a month (he's already paying about $160 per month for the underlying group plan).

Presuming that there were other such plans available, I started Googling, and eventually figured out that there ARE other cat plans out there, but they're all "affinity" (one must be a lawyer, or doctor, or engineer, etc). I did find one very decent plan offered through an engineers' association: good benefits, decent rates, a $50,000 deductible (which would mean some double-coverage, but certainly not a deal-killer).

So I sent him the link to the engineers' plan, explained that he would be better off with this than the one that I could sell him, and maybe I can help him with something else? Well, he called me back, absolutely stunned that I'd push something I wouldn't make anything from, and said "look, I'm not the only guy in this boat. You come up with something like this that YOU can sell me, and I'll put you in front of the other 2 or 3 thousand guys."

Ooookay, you have my attention, sir.

The challenge is finding a carrier to place this with. I have a limited timeframe (I don't want to keep my contact "on hold" any longer than absolutely necessary, for obvious reasons). If you have access to an appropriate plan, please drop me an email, and perhaps we can help this gentleman and his coworkers.

Thanks!

Cavalcade of Risk #54: Submissions Due

Hello! Jim at Bargaineering eagerly anticipates your contribution to next week's Cavalcade of Risk. Submissions are due by next Monday (June 18th), and Jim asks that you 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 your post via Blog Carnival or email.

We're scheduling late summer, so please drop us a line to reserve your Cav.

Health Wonk Review: Washington. DC Edition

Jane Hiebert-White, blogging at the Health Affairs Blog, presents a truly policy-based Health Wonk Review (including a "guest" post from Secretary of Health and Human Services Mike Leavitt). Lots of good stuff to check out.

Over at the Medical Humanities Blog, Daniel Goldberg takes the MSM to task for inaccurate reporting of health care issues.

Another Healthy Update

More than once, we've discussed mortality tables, those mysterious numbers on which life insurers base many of their assumptions (and your rates). Well, they've been revised again recently, and the news is encouraging:

"For the first time, U.S. life expectancy has surpassed 78 years, the government reported Wednesday."

Previously, that number was 77.6 years, so this represents a modest improvement. On the other hand, it seems to me that any improvement is a step in the right direction. According to the gummint, this increase is due primarily to "falling mortality rates for nine of the 15 leading causes of death, including heart disease, cancer, accidents and diabetes." Get that? Our health care system is so "broken" that we've actually reduced the number of folks dying from cancer and diabetes (not to mention heart disease).

And speaking of good news, there's more:

"A compound found in dehydrated tomatoes may help quash prostate cancer tumors, new animal research suggests."

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

There's some controversy over the role which lycopene plays in this drama. One study failed to find a correlation between one's level of that substance and the risk of prostate cancer. So it may turn out that there's something else going on with those delicious red (or yellow, or variegated) orbs than the lycopene. Still, something to consider.

No word yet on what role salmonella will play in combatting cancer, though.

Covering Florida (Part 2)

[Welcome Kaiser Network readers!]

In Part 1, we learned about new legislation that looks to help reduce the number of uninsured Floridians. Our guest blogger now looks at the potential downside, and offers some food for thought:

■ The bad

Along with the good provisions of this policy, there are also some challenges. There are challenges for those interested in purchasing the policies, the carriers offering the policies, and the State of Florida.

The biggest issue I see with this offering is the potential for under-insuring. Health care is very complicated and it takes some investment by the individual to become an informed consumer. There is potential for someone who chases the lowest premium to wind up in much the same position they would be in if they were uninsured. This also applies to those that don’t understand pre-existing exclusions, and pursue a course of treatment during their exclusionary period.

While many mandates are based on rare, elective or unproven treatments; others are based on inadequacies of current offerings. Things such as certain transplant benefits, cancer drugs and postnatal care. By removing all mandates, there is further potential for a subscriber to realize a catastrophic loss.

Questions remain as to what the offerings will look like to hit the $150 price point. Carriers that improperly estimate their actuarial exposure could take a loss that would affect their ability to offer competitive products to their other segments. Carriers could also realize a loss based on the fact that many first time insureds or those coming off a period of being uninsured tend to over utilize the first couple of years. This could start the product out with either a bad risk profile or a loss during those first years. There is also the risk associated with brand perception if the under-insuring item does become an issue.

The State of Florida has taken an aggressive action to address the health care concerns in today’s market. There is potential for significant political ramifications if they cannot deliver on this initiative. They have made many promises in this legislation that they will have to rely on outside partners to fulfill. They also walk the line of alienating brokers with the advent of the Florida Health Choices Corporation. The success or failure of this program has already become a point of discussion in the upcoming presidential election. There are many in the universal coverage camp with a vested interest in the failure of this initiative.

■ The unanswered

With any new program, there are always many questions. This initiative is no exception. The basic rules have been laid out, a framework has been envisioned, now we have to look to the market and see what types of offerings will be available. We must also look to the role of the brokerage community in marketing these plans. The final piece that has not been addressed is the medical providers.

Will there be multiple carriers allowed to offer plans within the guidelines ala Medicare Choice? Or will there be a bid process to control and manage the block like some of the state risk pools? It may also be possible to set up a separate subsidy program similar to the “three share” programs being proposed in Texas. Can the benefits hit the price point? Is that price point firm? What are the obligations of the carrier as far as assessing the risk offsets and renewals? Will there be a risk based scale or a COLA adjustment or a combination of the two? Can there be HSA options?

There are also questions from the broker community. Will the state actions push some producers out of the individual market and 2-50 market by establishing direct marketing entities and operating as the broker between proposed plans and the insured? What is the exact role of the Florida Health Choices Corporation? Can the agents help to market these plans and receive compensation?

The question that has only been touched on in the statistics is the medical community. There are provisions to enhance the role of community health providers in the outreach to the uninsured. This is to keep uninsured out of the ER and into community health clinics. The question that comes up is: If they are not paying currently and going to the ER, what is the driver that would encourage them to pay premiums and use the lower cost clinics?

The last question and one that I have yet to see addressed in any commentary or policy paper: Since Health Flex plans were a bust, has Florida learned from their previous mistake?

There is a lot to consider, but it is nice to see a market based solution being proposed. Now it is the market’s turn to see if they can rise to the challenge.

Thank You! We truly appreciate all the effort that went into these posts, and we'll keep our readers updated on how the program fares.

Oy Canada: Yer Outta Here! Edition

Ah, those Compassionate Canucks©. First, they leave patients in gurneys lounging around the hallways for a week at a time. Then, they fast-track Fido for cancer treatments, ahead of his owner. And now, it's so long, don't let the door hit ya...

"A live-in caregiver from the Philippines, the terminally ill cancer patient will be forced to leave when her work permit expires in two months, even though her period of service here as a nanny was supposed to be the gateway to permanent residency."

Seems that Ms Tejada was actually recruited to come to Canada as part of Canada's "federal live-in caregiver program." This is a deal where foreign nationals agree to come live and work in Canada, providing daycare for Junior Canucks. As long as they complete the three year program (and pass some background checks), they're fast-tracked to permanent resident status.

Unless, of course, they get sick. Then the Canadian health system is not so much "compassionate" as "stingy." This is pretty ironic, considering how much money we Americans are willing to spend on illegal immigrants. But our system is somehow "inferior" to theirs?!

Yeah.

Still Another Ethical Conundrum

[Welcome Industry Radar readers!]

Several months ago I blogged on a new test to determine the likelihood that one may be more or less susceptible to having Alzheimer's. At the time, I questioned the usefulness of the test, and asked whether one was better off knowing the results.

The issue there was about personal choice and priority. After all, since we don't know what causes Alzheimer's, there's really nothing one can do (at this point) to either increase or decrease that likelihood. Perhaps I should have asked whether or not we should be requiring our parents to take that test, to see if we in the sandwich generation will face an added burden.

Reason I bring this up is this news article:

"Sequenom, Inc., a leading provider of genetic-analysis solutions, announced positive results from screening studies using the Company’s noninvasive circulating cell-free fetal ... nucleic acid SEQureDx™ Technology, which enables the detection of fetal aneuploidy, including Down syndrome from maternal blood."

In short, they can now (reliably) test for Down's syndrome.

So what?

Well, what happens if one tests positive? And what other "problems" will this testing allow for: diabetes, MS, brown eyes, female? And what does one do with the results?

Tough questions.

[Hat Tip: Hugh Hewitt]

Outstanding 'Rounds on line now...

Dr John Crippen, doc-blogging [ed: you just made that up!] as the NHS Blog Doctor, presents a delightfully whimsical, overtly off-the-wall, totally readable Grand Rounds. It's fun, too, since there's so much to choose from.

I was particularly intrigued by our friend David William's post on Singapore's health care system, which seeks to bridge the gap between public and private sector efforts. Highly recommended.

Idiotic Carrier Tricks

[Welcome Industry Radar readers!]

So you may be asking "Henry, don't you mean Stupid Carrier Tricks?"

Sadly, no.

Regular readers may recall our piece on group insurance audits, wherein employers are required to verify that the folks on the plan are supposed to be, and that everyone that's supposed to be on the plan is [ed: clear as mud]. Early last week, one of my groups received such a request from its carrier, United Healthcare (UHC). They called me, and I helped them fill out the form. Once it was completed, they faxed it to me and I forwarded it on to our service rep. Total time involved: maybe 15 minutes, tops.

Later in the week, I received an email from the service rep: UHC wanted to know what the form was for, and why we'd sent it. Here is my response, copied directly from the "Sent" folder:

"UHC is run by idiots and/or morons. PLEASE feel free to forward that, BTW.

UHC sent this form to my client, who then complied by actually, um, completing and submitting the form as requested by the idiots/morons at UHC home office.

That help?"

My rep assured me that he'd take care of it (and I knew that he would: Don is exceptionally good at this, and really does make my job easier). He also said he'd delete my unsolicited review of UHC personnel (darn!). Well, at least I could put it away and move on.

Sure! This morning, I received a copy of a letter that UHC has sent my client, which starts with "Advanced Notification of Contract Cancellation Due To No Response And/Or Incomplete."

Let me get this straight: we get the form, we complete the form, we return the completed form, we're asked WHY we sent the completed form, and now we're facing cancellation because we didn't return the completed form?

So I called Don, and brought him up to speed. He asked me to email the letter and he'd get this resolved. So I did (and what did I title the pdf file? This: [client]_uhc_morons.pdf).

But you said tricks, Henry. Is there more?

Oh, indeed yes, dear reader:

Sometime around the last week of May, the owner of another of my groups called to tell me he would be turning 65 in June, and needed some advice. His spouse has some health issues, and we really need to keep her on the group, which we have with Anthem. He's continuing to work, so that's not a big problem. I explained to him that, since it's under 20 employees, Medicare is primary and so the group essentially becomes a Medicare Supplement plan.

"That's nice, Henry," he said, "but what's it gonna cost me?" Well, let's look at the renewal, which should have the MedSup rates in it.

Except it doesn't. So I request these rates. Three times in the past two and a half weeks. And until just a few minutes ago, I couldn't get them. The penultimate email read:

"I sincerely apologize for the delay in getting the Medicare rates to you. Enrollment/Billing was not able to pull them for me so I have to go back to underwriting to see if they can provide. I am hoping for a response from the underwriter today. I will let you know as soon as I get something back from her."

I received that about an hour ago, and replied:

"I guess it's comforting to know that UHC isn't the only company run by incomptent morons and idiots. Just not VERY comforting."

Five minutes ago (while I was composing this post), I received this wonderful news:

"The member that is turning 65 would pay the same rate as the active members. The renewal rates are based on the current census and since this member was not on Medicare at the time of the renewal, the Medicare rates will not apply until their next renewal."

Anyone else see the problem with that?

I'll keep you posted.

Ease on Down the Road...

Here's something off the beaten path:

"As gasoline prices continue to rise, more employers are offering additional benefits, such as telecommuting and flexible schedules, to help offset those costs, according to a new survey from the world’s largest human resources association."

Ever prescient, we actually blogged on this subject over two and a half years ago.

The Society for Human Resource Management reports that many employers are choosing to offer increased benefits, rather than pay raises, to offset some of these costs. These range from increasing the gas allowance to performance bonuses in the form of pre-paid gas cards. Some employers are even encouraging (and helping) employees to form car pools.

Keep on truckin'.

[Hat Tip: Employee Benefit News]

Learning the Hard Way

[Welcome Kaiser Network readers!]

Second-tier carrier American Community has learned what other, more experienced companies long ago came to understand: it's mighty difficult to successfully market against agents.

"A health insurance company that began selling coverage online in Texas a year ago has abandoned that effort and switched to using agents."

While online quote engines like eHealth have enjoyed success, it's another thing entirely for a carrier to make a go of selling directly to the consumer. There are a number of reasons for this:

■ Lack of market penetration. Most people still prefer to deal directly with agents, and it's the agent that can "talk up" a particular carrier. Without this direct contact, companies (especially lesser-known ones like AC) can find it difficult to break into the market.

■ Lack of value. Consumers pay the same rate whether buying direct or through an agent. Since there's no financial incentive to avoiding "the middle man," consumers have no real reason to do so.

■ Lack of choice. When dealing directly with the carrier, the consumer is told only that carrier's "story," and given no information about other choices. This is especially problemmatic for consumers with health issues: if AC (for example) can't help them, they have no idea what options may be available in the open market.

■ Lack of relationship. An agent isn't just a salesperson, but an advocate. If (when) there's a claims problem, for example, an independent agent (who works for the client) can help navigate the home office, and is one more voice on the client's behalf. Dealing directly with the carrier means that, should there be a problem, there's no such outside advocate to help out.

Nice that AC saw the light.

[Hat Tips: Industry Radar and Rick Byrne]

Covering Florida

[Welcome Kaiser Network readers!]

From time to time, we present guest posts written by our readers. Recently, a long-time reader tipped us to new legislation in the Sunshine State; its goal is to help decrease the rolls of the uninsured. Since the reader in question is someone with whom we've corresponded for a while, and indeed has helped us in other efforts, we've invited our (herein) anonymous friend to dissect the Cover Florida Health Care Access Program:

■ What is it?

SB2534 was the driving legislation behind this program. The state of Florida has taken on the lofty goal of addressing the issue of the uninsured with a market driven approach. Under this plan, carriers would be allowed to bid on plans to be offered to the individual market. These plans are designed to cater to the uninsured.

There are two types of plans, a catastrophic and a non-catastrophic. Catastrophic would be based on hospital services, urgent care, outpatient surgery. Non-catastrophic would focus on wellness and preventative care, including office visits and office based surgery. These can be offered separately or in combination based on the bid from the carrier, but must include a prescription benefit. These plans are required to be guaranteed issue, but can have pre-existing limitations. The state is looking for them to hit a $150/mo price point.

In order to be eligible to participate, the potential enrollees must be below age 65, have family income below 300% of poverty level, and have been uninsured for at least 6 months. They cannot be eligible for other public health insurance programs. Exceptions are if they lost coverage due to loss of job with health benefits, expiration of COBRA, reaching a limiting age, or loss of benefits due to death or divorce of spouse.

Other provisions establish the Florida Healthy Kids Corporation to administer the Florida Kid Care Program. It removes the 10% cap for families paying the full premium for the Florida Kid Care Program. It adjusts the age of eligible dependents from 25 to 30. House additions include the establishment of the Florida Health Choices Corporation that acts as a clearinghouse for employees of small businesses (under 50) to purchase an array of benefits.

This is what I have gathered by reviewing the text of the bill as well as the official press releases. It's all subject to change based on any further action by the State of Florida or their Department of Insurance.

■ The good

As I see it, the biggest boogeyman of those pushing for universal health care is the issue of the uninsured. We hear the statistic in every argument and news report on the subject. We have disassembled the numbers, but a sound bite often has longer legs then an in depth analysis and is easier to repeat. So let’s go into the good things about this initiative.

It attempts to hit an affordable price point by exempting offerings from state mandated benefits. Often these mandates are placed into effect not by consumer complaints or needs, but by lobbying efforts of an advocacy group or providers of the mandated services. There are often mandates for questionable homeopathic services like acupuncture, and high dollar elective procedures like fertility treatment. These mandates can greatly increase the costs of a policy and put unnecessary claims dollars into the risk pool.

The increase in dependent age to 30 will help cover the young invincible segment. This helps to address those in the 19-30 segment that choose to go without coverage for a variety of reasons. This is the largest segment of the uninsured. Also by bringing those low utilizers into the risk pool, it helps balance the overall risk profile of the employer based segment.

By removing the cap on full pay enrollment in KidCare, it allows parents another option for insuring their kids. The key here is that these parents are paying the full premium cost of the program and creating an economy of scale in the program that would allow it to become less dependent on government subsidies.

Guarantee issue policies also address the next big issue for universal advocates, the uninsurable. With the guarantee issue provision in this initiative, anyone who fits the market and wants to purchase the coverage can do so. With pre-existing condition limitations allowed, it also allows the carrier to offset some of the excessive risk associated with guarantee issue products.

The last point I will mention in the good category: no Massachusetts-style individual mandate.

Whew! That's a lot to digest, and we're only beginning. In Part 2, our guest blogger has the other side of the coin, as well as some thought-provoking questions.

Biting the Hand That Feeds (An Update)

Just last week, we learned that the MVNHS© had successfully killed off another beneficiary (citizen) via the clever method of denying that "free health care" that we've heard so much about. Never fear though, dear Brits:

"Baroness Ilora Finlay, president of the Royal Society of Medicine, said Labour's policy of denying free care to patients who use their own money to buy the latest drugs went to the heart of the purpose of the health service."

She then asked:

"Can we justify spending billions of pounds on the relief of relatively minor conditions and deny patients with life-threatening disease the support of the NHS when they want to bridge the costs themselves?"

Of course they can, my dear! This is the gummint, after all, of compassion and "the people." And how better to demonstrate that than to teach wayward cancer patients that it's more important to play by the rules than to, you know, get better?

Don't believe me? Well, let's hear it straight from the horse's, er, mouth:

"The Government says allowing cancer suffers to pay for some drugs while receiving others free would create a two-tier health service, with patients on the same ward being given different drugs depending on their ability to pay."

And they don't already? The Baroness observes "private and state-funded care already run side-by-side in many parts of the health service."

And lest one think that this is purely a class-warfare issue, with well-to-do Britishers vying for "special treatment" above the means of the commoners:

"Victims of the co-payment trap include Richard Eckley (CORR), a 68-year-old farmer, whose decision to pay for the kidney cancer drug Sutent is costing him more than £4,000 a month."

That's a lot of courgettes.

We Get (e)Mail!

Recently, reader Brad F wrote to us with a dilemna:

"First of all, I enjoy your site [ed: /blushes].

I think other readers (and employees of your clients) may face the same issue I now face. Later this year, I am getting married. After the wedding, we planned to consolidate our health coverage with her employer. Unfortunately, my HR department just informed me I will face “tax consequences” if I leave my high-deductible plan for her PPO before the end of 2008. Although I can avoid the penalty by staying with my plan for a few extra months, it was a definite unexpected surprise."

In general, if one leaves an HSA/HDHP (Health Savings Account/High Deductible Health Plan) mid-year, one has a number of issues. From a coverage standpoint, there's a new deductible to satisfy. Although it's likely to be (much) lower than the High Deductible plan's, it does start at "$0 met" on the first day of coverage, previous HDHP-covered expenses notwithstanding.

From a tax standpoint, there are also some speedbumps:

1) You can't make any more contributions (dunh!)

2) You may well have overfunded the account. This is kinda screwy: if you start an HSA mid-year, the contributions aren't pro-rated (that is, you can still fund the max, if you want). But it doesn't work in reverse: you'll have to withdraw the excess contributions, and there are some taxes to be paid on those.

Curiously, you can still use the HSA to pay for qualified medical expenses. That is, even though the underlying plan isn't HSA-qualified, you can still use the account itself to pay for most medical expenses, with no tax or other penalties.

But I wasn't the only one who responded to Reader Brad. Co-blogger Mike Feehan offered a different perspective:

I don't see this as a now-or-never choice. (I)t appears to me that the basic amount at stake here is

(a) the difference (presumably a savings) between the payroll deduction in his own plan and the dependent deduction in his new wife's plan vs.

(b) the "tax consequence" (i.e., a cost) for dropping his employer's plan before year end.

So it boils down to the customary question: is the savings bigger than the cost?

First of all, I think the correspondent should ask his employer to tell him, in dollars and cents, exactly what the "tax consequence" will be to him in 2008. He can then judge whether it's better for him to disenroll before year-end and eat the tax consequence, or stay in his own plan until the end of the year and pay his own premium contribution for those few months.

No matter what, he [should] be able to enroll in his new wife's plan effective January 1, if he wants to, during the open enrollment period later this year.

What is the tax consequence anyway? I've understood that IRS allows certain tax advantages in group "cafeteria" plans - - subject to certain conditions, one of which is that there can be only one benefit election or open enrollment for any taxable year. To the insured person, the tax advantage is that premiums are paid or deducted from payroll on a pre-tax basis, which reduces one's taxable income. So from IRS' standpoint, you've agreed to a tax deal when you enroll in a cafeteria plan, and breaking the terms of the tax deal forfeits the tax benefit. You point out that the tax deal includes the employee's own contributions to the HSA (which also reduce one's taxable income) so those contributions would also become subject to tax if one were to drop out mid-year.

An employee who chooses not to enroll during the open enrollment, can enroll later but only under certain circumstances permitted by IRS. An employee who enrolls but then later decides to drop out can do that, too, but in that case the cost is forfeiture of the tax advantages for that taxable year. (The forfeitures don't apply to employees who "drop out" because of retirement, or termination of employment, or death.)

I may not have all the details 100% but I think this is pretty close.

PS - I certainly hope we are not getting to the point where our choice of wedding day is influenced by the tax treatment of our medical insurance premiums!

So there you have it! Thanks to Brad F for the great email, and to Mike for his help in answering it.

Info Bleg...

Welcome to our EG&A visitors!

We're getting a number of visitors from the Eagle, Globe and Anchor message board, and would like to first say, Thank You for your service. We'd also welcome any comments you might have about our site.

Finally, I would love to know which post brought you here.

Have a great weekend!

$100 Million...And Rising

[Welcome Industry Forum and FoxNews readers!]

A fundamental meme here at IB is that health insurance costs increase primarily because health care costs do. We've made the point many, many times, but I think that we've been outdone by someone who lives this every day, whose job it is to deal with this every day.

I give you Carol Plato Nicosia, Director of Corporate Business Services for Martin Memorial Hospital in Florida:

Any questions?
[Hat tip: IB reader Patrick Paule]