Movin' on up (Again)!

When last we mentioned it, InsureBlog was ranked 10th out of all the health-related blogs tracked by Wikio. Last month, we had moved into the #5 spot, and Wikio Community Executive Nicolas Boiteux informed us today that the September rankings have us in the #3 slot. In an email, Nicolas told me that they "create a 'top 500' for the different categories" (e.g. health).

Wow!

I was also pleased to see that we're ranked #1122 out of all the blogs that Wikio tracks this way (some 37,000 web logs); this puts us in the top 3%. Thanks to all of our readers, who make this effort worthwhile, and to my co-bloggers for their much appreciated contributions.

Told Ya So!

Thanks to regular reader (and commenter) Scuzz, we learn of a horrendous example of one of our favorite memes here ("health care costs drive health insurance costs"):

"Several months after back surgery, Linda Burdick sat holding a hospital bill for almost $60,000. ... Burdick hired two billing investigators. After demanding an itemized accounting, health care navigators Lin Osborn and Beth Morgan believe Burdick was overcharged by $40,000."

That's a lot of overcharge. For example, she was charged over $1,700 (each!) for a half dozen surgical screws [ed: don't you dare - this is a family blog!]. The moral of the story is to be proactive; just because a provider says you owe additional money doesn't make it so.

And beware of balance billing: if you're in network, it's strictly forbidden. It's always a good idea to check your EOB's (Explanation of Benefits); these are the forms that your carrier will send you to let you know what charges have been paid and why.

And, of course, for more egregious cases, there are a number of claims services that can help you get to the truth. These usually involve a fee, but can literally pay for themselves with one mistaken claim.

[Hat Tip: Scuzz]

UPDATE: In the comments, Lisa Emmrich has links to another story of provider gouging.

The Feds, Health Care, and Illegals

Although we're known more for championing transparency in health care and rallying against socialized medicine, I hadn't realized that we've also written quite a bit about illegal immigration's drain on our health care system:

Some are contractors who sue the citizen who hired them.

Some are quadriplegics left unattended and unwanted, with little hope and no resources.

Some are cancer patients who cost Texas taxpayers some $12 million.

Regardless, we all pay for them via increased taxes and higher insurance premiums. And the tab keeps getting higher. In fact, in the story referneced directly above, we learned that at least one Texas hospital planned to curtail cancer treatments to illegal immigrants.

In nearby Arizona, "Tucson-area hospitals estimate that providing emergency care for illegal immigrants has cost them more than $66 million since 2005;" The good news (such as it is) is that the Federal government (you know, thee and me) repaid them about a quarter of that. Since 2005, Medicare has been matching a certain percentage of expenses that hospitals incur under EMTALA, in order to offset those costs.

But that gravy train appears to have come to a grinding halt:

"(O)n Oct. 1, the beginning of the federal 2009 fiscal year...the reimbursement program ends."

Even under the reimbursement program, "local hospitals try to send illegal immigrants who need expensive or long-term care back to their country of origin." Not a bad idea (cf: "Schengen Convention"), but it doesn't always work: if we don't know who someone really is, how do we know their country of origin? And of course, there are those who are too ill to be transported. But health care costs money, which has to come from somewhere. Unsurprisingly, you and I foot a lot of that bill:

"Under Section 1011 of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, the government designated $250 million a year to be divided among the 50 states for emergency care of illegal immigrants. Arizona received $44.5 million in fiscal year 2007."

On the one hand, that's a lot (our) money; on the other, it gets spent awfully fast. And, as previously noted, that program goes away in another month or so, leaving hospitals scrambling to figure out their next move. Of course, a new congress could renew (or reinstate) the program, letting the hospitals off the hook for at least some expenses, for a while. The question, of course, is how much money we're willing to throw at the problem.

Time will tell.

Cavalcade of Risk #59 is up

Host John Leppard has this week's edition of risk-related posts from around the blogosphere. Take a chance and stop on by.

You, too, can host a Cav. We've got openings available for Late Fall, so drop us a line to grab yours.

Beating the Revenooers...

First, a little background: life insurance companies come in (essentially) two flavors, stock and mutual. Stock companies are owned by (wait for it...) stockholders, who may or may not own policies issued by a given carrier. Any dividends accruing from the stock are distributed to the folks who own shares.

Mutual companies are owned (primarily) by their policyholders; buying a policy automatically makes you a part owner. Dividends from these companies generally flow back to their insureds. Dividends on these policies can be used to pay premiums, or provide additional insurance, or paid directly in cash. As with any such arrangement, dividends are not guaranteed.

But the focus here really isn't on dividends, but ownership itself. What does that really mean? It's not as if the president of the company calls up each policyholder for suggestions or ideas. From a practical standpoint, there are really only two benefits: one is, of course, the aforementioned dividends. The other is the potential for a nice settlement if (when?) a mutual company "demutualizes." That's not as scary as it sounds; it just means the carrier decides it doesn't want to be a mutual company anymore, and goes through a (lengthy) process to convert itself into a stock company.

That's all well and good, but let's remember that the "owners" are the policyholders, and they're entitled to "a piece of the action." So when a company demutualizes, it essentially "cashes out" the policyholders' ownership, and sends everyone a check representing their fair share. This can amount to a nice little windfall, but it can also mean tax problems. After all, what's the basis for the value? Is this a capital gains situation? Ordinary income? Or something else entirely?

For a long, long time, the IRS has taken the position that policyholders "hadn't paid anything for the shares and owed taxes on the full amount when the shares were sold. Cash distributions also were fully taxable."

Yikes!

Could that be right?

Well, for the past 7 years, Minnesota-based accountant Charles Ulrich has said "no." His thinking is that folks "had paid for their ownership rights through their premiums so the distributions should have been tax-free." In other words, he took the underlying insurance principle and applied it to the tax law. Pretty cool.

And now, pretty successful:

"A federal court recently agreed with his interpretation."

And this is no small victory: Ulrich thinks that there are some 30 million policyholders who've received such distributions. MetLife alone settled with 11 million insureds back in 2000, to the tune of $7 billion. That's a lot of dec pages.

Of course, the IRS wasn't exactly a big fan of Ulrich's efforts, and accused him of "promoting abusive tax shelters." They even demanded his client list, which he refused to turn over. Eventually, the Feds gave up on that tack.

Of course, the IRS has virtually unlimited funds and resources, and could appeal this decision. They could also fight future such claims, hoping for a different result. So the story's not completely over.

But it sure has a happy ending for Mr Ulrich, his clients, and a host of folks who may get a nice refund check from the Feds.

Promising Diabetes News...

The Lone Star State is in the forefront of research into this dread disease, and a Dallas-based researcher "says he's pulled off a medical first: successfully treating mice and rats dying of insulin-dependent diabetes without using insulin."

Dr Roger Unger thinks this has great potential, but actual human testing (and treatment) is a few years away. The key to the process is fat cells; actually, a "protein hormone that plays a key role in regulating energy intake and energy expenditure" called leptin.

Using Leptin-based treatments could help with several facets of diabetes, including "rapid weight loss and altered blood chemistry that make the untreated disease fatal." And of course, one supposes most folks would be pleased to be "off the needle" (not to mention the cost savings accruing from no longer having to buy insulin).

A lot of questions remain, of course. For one thing, there's concern that the effect may be short-term. For another, there's no guarantee that success in rodents will translate to curing people. Still, one hopes that this will indeed be the case.

Good for science!

Piling On Socialized Health Care...

At the risk of striking a metabolically-challenged equine, I'd like to share with you something I received in a recent email:

"Government-controlled health care systems promote longer wait times, reduced quality of care and denials of coverage. Learn first-hand from patients, health care workers and thought leaders from health care systems abroad to learn more about potential costs and consequences of government-run health care systems."

While the idea of a nationalized system sounds good, we've seen that there's scant evidence that it's superior to our own. And because statistics themselves tell only a part of the story, it may be intructive to hear what actually happens to real people, folks just like you and me, who are forced to deal with such systems.

It's not a pretty sight.

[Hat Tip: Elizabeth Terrell]

Atta Boy, Gov!

This would be filed under "Intelligent Government Tricks," if we had such a category. Still, given our enthusiasm for pointing out the dumb things gummint does, it seems only fair to celebrate rational decisions made by the state.

There's been a push in Ohio to make paid sick leave mandatory. This is commonly called a "stealth tax," (or "unfunded mandate") because it would force employers to pay extra wages, with no reimbursement from the state. These extra costs would be passed on to consumers, in a state economy that's already in the doldrums.

Fortunately, Democrat Governor Ted Strickland understands the economics of these kids of tactics, and has come out against the ballot issue that would enable them (Issue 4). He and Lt Governor Lee Fisher have said that the mandate would be "unworkable, unwieldy and would be detrimental to Ohio's economy."

Hear, Hear!

[Hat Tip: Ohio PIA]

It's the Outcomes, Silly

Well-meaning but ignorant folks from the AMA to AARP [ed: sorry, couldn't find any Z org's that fit the bill] have long touted gummint-run healthcare, a la Medicare, as the ideal solution to a system they consider "broken." Nationalized health care, they argue, provides the most fair and efficient means of delivery.

Um, no:

"More than 825,000 Canadian citizens are currently on waiting lists for surgery and other necessary treatments...Canada also limits access to common medical technologies."

But wait, the MVNHS© has it right!

Um, no (again):

"In Britain, more than 1 million sick citizens are currently waiting for hospital admission...Britain even has a government agency explicitly tasked with limiting people’s access to prescription drugs."

We've mentioned these problems numerous times here at IB (for example, our Oy Canada and MVNHS© series). The problem, of course, isn't the cost or availability of health insurance, it's the cost of health care. And if a system can't control that (as no socialized scheme has ever managed to do), then one is left with rationing and substandard care.

As Sally Pipes, president and CEO of the Pacific Research Institute, notes, the pundits and pols love the sound bites, but not the facts. They're quick to cite the recent World Health Organization's ranking of various countries' health care systems (which we also posted on) which placed the US near the bottom of the top 20%, behind countries like Morocco and even Costa Rica. But they looked at only two of the important factors that contribute to a nation's true health care picture: a modified definition of mortality and "fairness" (whatever that means). What the study failed to consider are much more important factors, such as cancer and cardiac care.

The truth is, our system is actually superior to socialized schemes when it comes to saving, and prolonging, lives. Why is it, for example, that Italian Prime Minister Silvio Berlusconi chose the Cleveland Clinic, over his own country's "free" medical care, when he needed heart surgery a couple of years ago? I doubt it was just for a trip to Corky and Lenny's.

And what about that "free" health care? Surely a gummint-run system guarantees better cost efficiency?

Sadly, no:

"The United States produces over half of the $175 billion in health care technology products purchased globally. In 2004, the federal government funded medical research to the tune of $18.4 billion. By contrast, the European Union — which has a significantly larger population than the United States — allocated funds equal to just $3.7 billion for medical research."

You get what you pay for.

The bottom line is that there is no "universal" health care scheme that can control costs, guarantee access and deliver consistently superior outcomes. Does this mean that our system is perfect? Of course not. But market-driven changes beat central planning committee ones every time.

[Hat Tip: Power Line]

A Latesummer's Day Grand Rounds

Dr Theresa Chan, hostess of Rural Doctoring, is a small town doc and a scholar of The Bard. She presents this week's Grand Rounds in true Shakespearean style. Unlike some of Willy's works, however, this collection is easy to follow, and full of useful info.

Go forth!

Carnival of Personal Finance

This week's roundup of all things financial is hosted by the Broke Grad Student. Featuring an Olympics theme, it's a champion effort.

Cavalcade of Risk #59: Submissions Due

Next week's Cavalcade of Risk is hosted by John Leppard.

John's eagerly awaiting your risk-related submission, and requests 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 your post via Blog Carnival or email.

We're scheduling mid-Fall, so please drop us a line to reserve your Cav.

Happy Wonkday!

Julie Ferguson hosts this week's edition of the Health Wonk Review. It's chock full of interesting posts featuring the best of health care policy and polity.

Check it out.

Stupid Admin Tricks

Once again, we're delighted to present a post from our favorite anonymous guest blogger (whose most recent work, on Florida's newest health care initiative, can be found here and here). Our anonymous friend is well placed enough in the industry to offer us some unique insights.

In this post, AGB laments the games that are played by some of those who administer ERISA (aka "self-insured") plans:

Here is something to consider. We have seen a rash of material misrepresentation and “gamesmanship” lately resulting in substantial claims costs. In three cases, the administrator filled out all the individual apps (not disclosing any medical information) and just had the employees sign. In another, an app was sent in three days after an incident of care but was dated on the date of the incident. Of course 1 day after the same incident of care, they requested a change in waiting period, thus making this person eligible for benefits.

The question arises: what do we do with clients that are bad actors in these cases. The standard carrier here would adjust the rates to what they should have been underwritten at and make them retroactive, while continuing the policy. Is it time for carriers to start pursuing cases as worst case rather than best case? What is the disincentive for groups to do the same thing with the next carrier if the worst that will happen is that they have to pay what they should have paid in the first place? This affects premiums for all groups in the pool, thus negatively impacting other businesses that applied in good faith.

Ultimately it is the carrier’s decision, but is it time to start moving away from the slap on the wrist and start pursuing options that would be more punitive? Is it worth it or not? Any agent or broker that did this would have their appointment terminated and possibly reported to the department of insurance. What would be the next step for these administrators?

Yay Canada!

Folks who've been following our Oy Canada!© series know that we're not enamored of our neighbors' health care system (such as it is). Now comes word of an opportunity for young people to help chart a new direction for Canadian health care:

"The Fraser Institute is hosting a new Student Video Contest and students are eligible to win $10,000 in cash and electronics prizes. The topic is: Incentives Matter - Fixing Health Care in Canada."

According to email I received today from Director of Student Programs Vanessa Schneider, students who submit a short concept paper by the end of September (and post their videos by the end of October) are eligible to compete for the cash (no word yet on whether that's Canadian or real money). For details, click here.

IB In The News (Again)

One of the neat fringe benefits of blogging is the opportunity for even greater exposure (no, not that kind). Mike's been on TV, and both Bob and I've been interviewed by various trade and news magazines. As a result of a post I did back in June, I was contacted by Private Payment Watch, a monthly newsletter that "reports on private payer fee schedules, reimbursement strategies on out-of-network payments, out-of-state claims, contract negotiating strategies, credentialing and more." They were interested in how providers could encourage their patients to more effectively use their HSA's.

On the basis of that post (and some helpful comments from reader Robin Fisk), I was recently interviewed by PPW for their August issue:

There's actually a bit more, and I'd recommend this newsletter to folks in the business of handling providers' accounts receiveable.

Transparency: Dead On

[Welcome Kaiser Network readers!]

Transparency in health care is a recurring theme here at IB, usually with an emphasis on costs. But in the long run, buying the cheapest item isn't always (or even usually) the least expensive route. So we also urge carriers and providers to be more proactive in discussing how well they do, not just what they charge for doing it.

In today's McPaper, Steve Sternberg and Anthony DeBarros provide us with some encouraging news on that front:

"Until today, hospital death rates were closely guarded secrets, discussed in board rooms but beyond the reach of patients whose lives are on the line. That changed this morning when USA TODAY posted on its website the government's best estimates of heart attack, heart failure and pneumonia death rates for every U.S. hospital for two years."

And they're not kidding; click here for an interactive map for hospital mortality rates in three key categories. Very cool.

As more and more of us become "connected," tools like this will become more readily used. With so many phones and PDA's now internet-capable, I can certainly see a time in the near future where most people will have ready access to this kind of information.

As with any new tech, there will be naysayers. One of the objections we hear a lot is that tools like this are nice in the abstract, but who's going to tell the ambulance driver what hospital to race for, sirens and lights blaring? And there's some validity to this: after all, if you're coding, where you go may be important, but how quickly you get there most likely takes precedence, and that generally means which facility's closest.

Still, it's a step in the right direction. The results are helpful for the consumer, of course, but for the provider as well:

"When last summer's CMS report came out, one of the 11 hospitals in the Dallas-based system, Baylor All-Saints Medical Center in Fort Worth, was found to have a heart failure death rate of 14.6%, higher than the 11.1% average.

What leapt out of a review of the patients' records was that just 10 of 31 deaths occurred in the hospital, suggesting that some deaths were due to follow-up care by local doctors and nursing homes, says Paul Convery, Baylor's chief medical officer. "This was a signal that we have to be responsible for patients after they've left our halls."

By pinpointing problem areas, hospitals can address problems that they may not have been aware of. Armed with that kind of information, appropriate changes can be instituted, thus saving even more lives.

And that's a good thing.

Social (In)Security and Disability

Recently, Bob wrote about the claims problems plaguing the Social Security Disability system. In Georgia alone, three quarters of those applying for benefits are initially rejected. Some will probably, ultimately, prevail, yet many will be shut out.

But that may not be the worst of it:

"...the Social Security Disability portion of the Old Age Security (OAS) “DI” trust fund is now in the RED on what would be defined as a “real world” cash flow basis. And, the shortfall must be borrowed by the Treasury in the credit markets as part of the growing budget deficit."

Ooops!

And the problem's growing. According to economic consultant Keith Forrest, over a million and a half folks have been added to the already burgeoning number of SSDI beneficiaries. That's an annual growth rate of about 4% per cent. Ouch!

The problem is the payroll tax for the benefit is less than 1%, and doesn't look to be growing by leaps and bounds. Now that's a recipe for disaster. But neither presidential candidate seems to be addressing this looming catastrophe.

Something to think about.

[Hat Tip: Unum]

ENnie Awards: Awesome Update

Earlier this month, FoIB Tom Tullis was up for a prestigous (and highly sought-after) industry award. This made it two years in a row for Tom's company to be in the running, which was virtually unprecedented. Online voting ended less than two weeks ago, and the results are in:

Best Miniature Product - Silver ENnie: Dragon Tiles: Forest Adventures, Fat Dragon Games

WooHoo! Congratulations, Tom, on a win well-deserved. And Thank You, InsureBlog readers, for helping to put him over the top.

Who Ya Gonna Call?

Regular reader Holly R tipped me to this interesting factoid:

"The Ohio Department of Insurance says its consumer hot line can help when Ohioans have trouble with their insurance companies...Callers must be fully insured and complaints must involve disputes of at least $500."

So far this year, the hotline has received some 1,500 calls (at $500 a pop, that's over three quarters of a million dollars, at least, so far). And what kinds of complaints does the Hotline typically get?

I called, and spoke with Larry, who was quite helpful. Larry told me that the health side of the business gets the most complaints (no real surprise there, although I had thought it might have been auto). The most frequent complaint? Delay of claims; interestingly, this cut across all lines of business, even life.

Larry wasn't aware of what percentage of reported problems were ultimately resolved, but he did tell me that the number of complaints has gone up each year, as more folks become aware of the service.

So now you know.

This Week's Grand Rounds now available...

For those of us old enough to remember, libraries used to have large cabinets filled with drawers. When one needed to find a specific book, one went hunting through this Card Catalog, which used the Dewey Decimal System. It was painstaking and awkward, and I (for one) am grateful for QuickSearch and a PC.

And so is Kerri, of Six Until Me, who hosts this week's Catalog of the best medblogs, and who's built her effort around that old standby, the Card Catalog. Never fear, though, this collection's easy (and fun) to browse through.

Where Those (Premium) Dollars Go

Regular reader (and frequent commenter) Scott M clued us into a very interesting document he recently received. Like myself, Bob and Bill, Scott is an independent agent with many years of experience in the health insurance field. The missive comes from Aetna, which broke down how premium dollars are actually spent.

This particular piece is about 2 years old; I went poking around the Aetna site for an updated version, to no avail. However, I doubt that the actual numbers have changed that much in the meantime.

There are some interesting factoids here:

■ Almost 80 cents of every premium dollar is paid out to providers

■ About 6% is profits (not too shabby, but certainly not outlandish)

■ Surprisingly, state and federal taxes amount to only about 4%

There's more, and it's available for download right here.

[Hat Tip: Scott M]

No Free Lunches on the MVNHS©

Well, no lunches at all, actually. According to a new poll by the folks at Macmillan Cancer Support:
"...nearly half of cancer patients in England are being forced to cut back on basic necessities in order to pay for their prescriptions."

But how could this be? After all, our Cousins across the Pond enjoy a free health care system that is far superior to our own "broken system," at least according to the folks pushing for us to adopt such a plan. Yet here we have actual cases of folks being forced to choose between food and health care. I thought that only happened here?

Perhaps this is a reason why Britain's cancer survival rate is so much lower than ours.

45 year old Amanda Whetstone is a cancer survivor (so far) whose regular course of chemo has ended. The good news is that it apparently worked, the bad news is that she requires follow-up med's that take a pretty good chunk out of her fixed income (she's on the British equivalent of SSDI). She makes about $700 a month, and her meds take about $90 of that. And because of her limited income, she's putting off trips to the eye doctor and dentist (but I thought these are all free?!).

Gee, why can't we have such a great system here?

Stupid Government Tricks: STOLI

No, not that Stoli; Stranger Owned Life Insurance. We've actually discussed various forms of this concept before, but a quick recap is in order:

To understand STOLI, one must start with the concept of "insurable interest." Briefly, insurable interest means that one may expect to suffer a financial hardship if the insured person dies. An obvious example would be a spouse, or perhaps a key employee. It's important to note that, until now, it has been a given that insurable interest must exist at the time a policy is issued, but that requirement would subsequently go away.

When AIDS became so prevalent, a previously little-known concept, "viaticals," started to take off. Viatical contracts were a way for a dying person to sell their life insurance policy to someone else, generally through a broker, at a discounted rate. For example, one might sell a $100,000 life insurance policy for $45,000 cash. This benefited the insured, who may have had no one to whom he cared to leave the larger amount, and who wanted (or needed) a large sum of ready cash. As one might imagine, such a market was ripe for abuse, and various laws were enacted to limit the damage. Insofar as the primary beneficiaries of these plans were in the midst of a debilitating and fatal illness, this seemed an appropriate response.

Unfortunately, once that camel's nose was under the tent, the original nature of the life insurance contract was violated.

Let's step back for a moment, and discuss this unlikely sounding concept called STOLI. It refers to the sale of one's life insurance policy to someone who (apparently) has no insurable interest. This is beyond viatical settlements, and has many uses, some benign, some not so much. I've been unable to find any hard numbers regarding how many of these sales have actually taken place, how many insured's and their policies are affected. I daresay that's partly because it's such a miniscule part of the market, and rarely used. But because of a few high-profile cases abusing the idea, we now have the government effectively dictating to you how you may dispose of your own life insurance policy.

Think I'm exaggerating?

Suppose you wanted to sell your home to someone you didn't know, and the government forbade you from doing so? That would seem pretty silly, and beyond the authority of the state. But that's exactly what a life insurance policy really is: a piece of property. Permanent life insurance policies (e.g. whole life, universal life, etc) have "cash values," which are exactly the same as equity in one's home: one may borrow against the policy using its cash value exactly the way you can make a home equity loan (minus the fees, points and credit check, of course). Why would it be any less dangerous for the government to be empowered to dictate to whom we could sell our insurance policy than our home?

And yet, that's precisely the result of new legislation in Ohio. Yes, it seems like a blow against the "forces of evil," but it is in actuality a shrinking of what "private property" is supposed to mean. We've sacrificed a real right on a false premise.

And of course, the National Association of Insurance and Financial Advisors (a true oxymoron) provides the cheerleaders:

"STOLI transactions violate the essential social purpose of life insurance, which is protection...Life insurance was not intended to be used as a vehicle for financial speculation on human life” says NAIFA president Jeffrey Taggart, completely missing the point.

All this does is place an increasing burden on the insured, while relieving that same insured of a fundamental right.

Nice going.

BUSTED! (An MDA Bleg)

Looks like picking on the poor folks at the MVNHS©, bureaucrats in Oregon and misguided policy wonks has caught up with me, and I'm now in the hoosegow. The good news is, it's for a good cause: The Muscular Dystrophy Association's annual fund-raising drive.

Could you help a blogger out (of gaol), and at the same time give new hope to folks who suffer from this terrible disease? Your tax-deductible donation will help families living in our community (and help guarantee me an early release!).

Just click here to make your contribution.

A few years ago, InsureBlog readers helped propel us into the Top 40 (out of 1800) blogs in raising money for our fellow Americans devastated by Hurricane Katrina. I'm hoping that we can make the same kind of difference for Jerry's Kids.

Thank You!

Cavalcade of Risk #58: Now Online!

Joe Paduda hosts this week's Cavalcade of Risk, and it's a doozy! Please stop by and check it out.

We'd love you to host your own Cav, just drop us a line to reserve yours.

Oy Canada, Part #786 (more or less)

One of the problems with gummint-run health care is that it tends to hurt most those whom it was designed to help. Case in point: Edmonton resident Debbie Trelenberg had a rather large tumor growing in her abdomen, to the point that she had difficulty dressing. And worse yet, it was diagnosed as a "high-grade ovarian cancer." With prompt treatment, this particular condition was survivable, but of course health care systems run primarily by government employees aren't really interested in speedy treatment (well, unless you're in Oregon, but that's another story).

So Ms Trelenberg waited, and waited, until she (like so many of her fellow countrymen) headed south, to the "broken system" called American health care. Once in Texas, she spent almost $80,000 of her own money to pay for neeeded surgery and follow-up. The good news is that, thanks to her prompt action (and deep pockets), she has an excellent prognosis. The bad news is that her bank account may have suffered a critical injury: she "has twice been refused reimbursement by the Alberta government, most recently in June, when the Out-of-Country Health Services Appeal Panel said a wait of about four weeks was not found to be unreasonable by the surgeon who initially saw her."

Did you get that last?

"(A) wait of about four weeks was not found to be unreasonable."

That may explain why Canada's cancer survival rate is so much lower than ours, and it certainly explains how such systems actually work. I'm thinking here of the first rule of holes.

Both the surgeon who operated on Ms Trelenberg and her own family physician wrote detailed letters to the gummint bean counters, explaining in detail why speed had been so critical, and asking for them to reconsider their refusal to reimburse her. Regular readers can already guess the response:

“There is no reason that we would send patients out of province just for faster access.”

Well said sir, well said.

Grand Rounds now available

Daniel Goldberg, host of Medical Humanities blog, presents this week's round-up of the best health care posts on the 'net. Each entry has helpful comments.

Do stop by.

USA Still #1 (NOT an Olympics Update)

While folks on both sides of the ideological divide continue to debate the efficacy of gummint-run health care, it may be instructive to see just how ineffective it is when compared to our "broken" system's ability to deal with cancer. For example, folks in Canada have a lower cancer survival rate than we do. And our friends the French, whose system was recently lauded by the World Health Organization as "the best in the world" ranks below even our Neighbors to the North.

Perhaps most surprisingly, the MVNHS© ranked fifth (out of five!), with some of the lowest cancer survival rates in the civilized world. Keep that upper lip stiff, old chaps!

And who says so? Why, that venerable (and venerated) medical journal, the Lancet. Kind of difficult to cast them as water carriers for private health insurance.

The Health Care BS blog has a telling graphic that tells the whole story.

[Hat Tip: Elizabeth A. Terrell]

UPDATE: On a related note, many pro-socialized-medicine folks like to pull out that old canard that such systems actually have lower infant mortality rates than ours. Although we've debunked this before, it bears repeating: it's a canard because it's demonstrably untrue.

How's that, you ask?

Simple: we value each and every life, and so we count every live birth regardless of the baby's life expectancy. Under gummint-run systems such as those in Canada and Germany (among many, many others), "(l)ow birth weight infants are not counted against the “live birth” statistics...a premature baby weighing 500g." [ed: 500g is a little over 1 pound]

Here, of course, such preemies are considered worth saving, and we do count them, which tends to skew the stats. Add to that the fact that these systems don't count babies who live less than a day or so, even though they were, in fact, live births. And again, we do, which also throws off the number crunchers.

In fact, those bastions of civilization, the Swedes, don't count babies who are deemed "too short." And once again, we do, and suffer the statistical consequences.

Randy Newman, eat your heart out..

Carnival of Personal Finance, College Football Edition now available

Kevin at No Debt Plan hosts this week's football-themed Carnival of Personal Finance, and it's truly a winner.

Run on over.

401(k) Ooopsie

FoIB Joe Kristan, proprietor of the venerable Tax Update Blog, has a timely warning for folks who borrow (or plan to borrow) from their retirement accounts:

"If you borrow from your 401(k) plan and then lose your job, you can find yourself facing an ugly tax situation."

It's a fascinating -- and scary -- insight into an area of tax law about which most of us know very little, but which could be tremendously helpful.

An InsureBlog First

I'm indeed fortunate to have known Bob for eight years or so (according to my profile at a consumer bulletin board we both visit regularly, and where we "met"). Over the course of those years, we've exchanged countless emails and phone calls. A few months after I set up IB, we became co-bloggers, as well.

Bob was an amazing help to me during the last few months, and especially days, of my mother's life. I knew that I could call him any time I needed to, and he would offer support and much needed perspective.

We've gotten to know each other's families, as well, which has been the source of much fun (and we both hope neither of our spouses read all our emails).

But until Friday evening, we had never physically met each other.

In a sense, that's the wonder and power of the internet: that people can "connect," become good friends, and never be in the same physical location. Last week, my family took a much needed vacation (our first in 2 years!), traveling down to Florida to visit relatives and bask on the beautiful beaches. On our way back, we stopped in The Big Peach, and (finally) met up with Bob and his beautiful, charming and articulate better half. We spent over 4 hours together (perhaps to the consternation of my 17 year old daughter, who accompanied us).

Actually, it was much more of a reunion than a "first date:" we'd all had so much experience talking about each other that it was as if we'd known each other for many, many years. Still, there were new things to be learned, experiences (and wine) to be shared, as we finally broke the distance barrier.
Although I had a wonderful time in Florida, I know that it was our evening with the Vineyard's that became the highlight of our trip. Thanks to both for their warm hospitality and generous spirit.

Surprisingly, until Friday evening, the only co-blogger I'd ever "seen" was Mike Feehan, whose TV debut we featured earlier this year. So for those who've always wondered, be careful what you wish for:

Cavalcade of Risk #58: Submissions Due

Next week's Cavalcade of Risk is hosted by Joe Paduda of Managed Care Matters. Submissions are due this coming Monday (August 11th), and Joe's asked me to remind you to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

Remember, too, that submissions must relate to risk.

You can submit your post via Blog Carnival or email.

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

Health Wonk Review now available...

Major health wonk Bob Laszewski hosts this week's collection of this week's best health policy items. Bob's the proprietor of the highly respected Health Policy and Marketplace blog.

Highly recommended.

Bursting Bubbles

Back in June, we were treated to an insightful two part series on Florida's new Health Care initiative (Part is is here, Part 2 is here), written by an anonymous guest blogger. Recently, I received a tip from another reader, and asked our Anonymous Blogger to once again lend us his expertise.

Recently, Business Week offered its take on the problem of the uninsured, and blogger Pam weighed in with her review of the BW piece. Our Anonymous friend offers his perspective:

Some interesting points in the original piece and some inside information of which many industry people are not aware is brought to light. For some that have been on the underwriting side, this is old news, a way to more accurately assess risk. It also catches a lot of medical conditions that someone may have “forgotten,” like the guy who forgot to disclose that he was diabetic until the system showed he had been on Glyburide for the last 5 years. It also allows some companies to apply with a “gatekeeper” application, rather than having their employees fill out lengthy and sometimes confusing forms.

Now, I ask myself: is there a potential for abuse and is it possible that carriers are using this tool too aggressively? Absolutely. In the land of HIPAA will we ever know what happened with the Sheltons? No, but I would bet there was more to the underwriting call than we see in the story, possibly supporting either side of the event.

When an individual signs an application, they are asked to disclose certain medical information, and authorize the insurance company to verify this information. This database is a tool for verification. When an application comes in, they should see the same meds on the app as are on the report, correct? I would think catching the missing info up front and taking action would be much better that going in after the fact and denying all claims retroactively due to material misrepresentation.

Actuaries (you know, glasses and pointy heads,) tend to have projections regarding their membership outlined ahead of time, so I would doubt this information is adjusting the membership. Plus, different companies have different thresholds for acceptable risk. I can not confirm or deny the 30% as put forth by the crack think tank of “industry veterans.”

Now to the next piece:

We see a concern over the potential misuse of information regarding a person’s prescription records. This is a fear we all have, having an unauthorized individual or group obtaining sensitive personal data. But it tends to play in to all the points made above.

“Certain medicines, if you know what to look for, are a clear sign that someone is undergoing treatment for cancer or HIV.”

Exactly.

“And John McCain's health plan would make sure a good many of us get even less -- something he probably knows right down to his $520 Ferragamo loafers, given that his own cancer history (with its attendant prescription history) would probably result a denial of coverage if he were almost anyone else besides Sen. John McCain.”

Now we see the real point of this piece, slam McCain. Nice jab at class warfare there, plus I think if I were in those $520 shoes, I’d be on Medicare, our own wonderful single payer system. Actually, by the time I get there, it will be long gone into insolvency.

"But John McCain would never have to live with the realities of his own radical health plan, which would raise costs by dismantling the employer-based coverage system that insures 60 percent of us, putting us in the same position as the Shelton's; with a medicine cabinet full of prescriptions we need to keep us healthy, that could also get us denied health care coverage because they're instrumental in helping the insurance health industry "identify high-risk, reduce costs, lower loss ratios, and increase revenue."”

Here I kind of agree with our commentator. I don’t think either candidate has an acceptable platform on this issue.

Thanks, Anon, for a well-thought-out and well-written review.

Carnival Tuesday!

The outstanding money-based Carnival of Personal Finance is up at Squawkfox blog. It's chock ful of great advice and interesting stories.

Check it out!

Gamer Awards: One Last Reminder

Today's the last day of voting for the ENnie Awards. If you haven't already done so, please head on over (click here for the backstory).
Voting's simple: First, click here, then scroll down to "Best Miniature Product." Click on "Choice #1" and then click on "Dragon Tiles: Forest Adventures, Fat Dragon Games." Scroll to the bottom, click on "Submit," and Bob's your Uncle [ed: don't ask].

Compassion AND a Bargain

My mother passed away this spring, after a two year battle with Alzheimer's. Her final week was spent in Hospice, a place teeming with angels. As I mentioned before, Hospice caregivers exude compassion and patience, and the folks at ours helped to make one of the most stressful and depressing times in my life manageable.

We were told when we "checked in" that there was no charge for their services, but that was, frankly, far down my list of concerns. After all, Mom had been in the hospital for the previous two weeks, and I had a pretty good idea what those charges were going to be. Still, I heard them say that Medicare would pick up the tab, and mentally filed that information away.

Yesterday's mail brought the EOB (Explanation of Benefits) for Mom's all-too-brief sojourn at Hospice, and I was pleasantly surprised to see that there were, indeed, no charges for this outstanding service:

I also noticed that the charges themselves were quite reasonable, and that (unlike all the other medically-related services) Medicare didn't "re-price" this particular claim. One supposes that there's no "negotiated rate" involved; regardless, the charges amount to less than $800 a day.

I call that a bargain.

Gamer Awards: Reminder

If you haven't had the opportunity to vote for Fat Dragon Games, now's a great time to do so:

Click here, then scroll down to "Best Miniature Product" Click on "Choice #1" and select "Dragon Tiles: Forest Adventures, Fat Dragon Games" Then, scroll down to the bottom and click on "Submit."

Thank you!