Alphabet Soup News: "Reform" Edition

As regular readers know, we're big fans of consumer-centric health insurance (e.g. HSA's). These kinds of plans have demonstrated a unique ability to actually impact the cost of health care. It's a shame, then, that one of the results of current "reform" efforts will be to eliminate them from the marketplace. The withdrawal won't be immediate, but gradual, through attrition.

We can see this occurring in real-time, as ObamaCare immediately imposes a 40% rate increase on the cost of certain medications. This will disproportionally affect those least able to cope with it, since OTC (over the counter) med's are usually much less expensive than comparable prescription-only versions:

"[I]f you pay for any of these items with money in your flexible spending account (FSA) or health savings account (HSA) ... you will face an effective tax increase of up to 40 percent on these items in the health care bill..."

The current "reform" legislation removes non-prescription medications from the "approved" list for plans subject to 213d requirements. This has the immediate effect of increasing their net cost, and thus discouraging their use. It's hard to reconcile that result with the purported goal of reining in the cost of health care. Indeed, it's obviously going to have the opposite effect.

But it's merely the first step in excising the one piece of Kennedy-Kassebaum that has continued to irritate the nanny-staters: tax-qualified health savings accounts. Once the "Exchanges" are up and running, the underlying high deductible products that drive HSA will be outlawed; FSA's will continue, since they encourage spending, which is apparently the (counter-intuitive) goal of ObamaCare.

Cavalcade of Risk #95: Decade's End Edition

Jaan Sidorov presents the last Cavalcade of Risk (for this decade). Remarkably, this also marks the 2 year anniversary of Jaan's outstanding Disease Management Care Blog.

Mazel Tov, Jaan, and keep on posting!

We're scheduling for early 2010 - please drop us a line if you'd like to host.

Careful What You Wish For: Breast cancer Edition

Earlier this year, my better half's mammogram showed an irregularity. Because we've been spared, thus far, from having to live under ObamaCare, she's had relatively easy access to this critical care, and was quickly referred to a specialist who determined that all was fine.

Of course, we were greatly relieved to learn that there was no problem, after all, but how would that have played out under ObamaCare?

Fortunately (for us), we can see quite clearly how she most likely would have fared:

"Women are still waiting months to find out whether they have breast cancer, the Government figure in charge of tackling the disease admitted ... any woman with signs of breast cancer would be seen by a specialist within two weeks by 2008.

The deadline was later extended to the end of 2009 but the cancer czar has admitted the NHS will still fail to hit the target."

Since the MVNHS© represents a model upon which our glorious new system would be built, such a dire shortage of care should send shivers up and down the spines of women (and those who love them). Early detection is key to successful treatment of theis terrible disease, which kills some 40,000 women here each year. And that's with our current regimen - how many more will die if we go the route of our Cousins Across the Pond?

Well, we can get at least a partial answer to that, one which also puts the lie to those who think nationalized health care systems are superior to our own:

"Around 45,000 women develop breast cancer every single year, and survival rates are lower than in comparable Western European countries - largely because the UK is so bad at spotting signs of cancer early."

'Nuff said?

Grand Rounds: Final '09 Edition

Jessica Otte presents the last of this year's Grand Rounds. This one reflects on the year just past, and looks forward to new beginnings.

Carnival of Personal Finance: Year End Edition

Mike at Gather Little by Little presents 2009's final Carnival of Personal Finance. As usual, it's a fun way to see what's out there on the finance front.

Raucus Baucus

One of ReidCare's (a subsidiary of ObamaCare, LLC) primary architects is unhappy with his political foes; as this clip demonstrates, his articulation of this displeasure is a model of decorum and sobriety:

Cavalcade of Risk #95: Call for submissions

Jaan Sidorov hosts next week's Cavalcade of Risk. Submissions are due this Monday (December 28th); please include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

Clueless in Nebraska

Cornhusker State Senator Ben "Clueless" Nelson is hoping that his fellow citizens are as dense as he is. Continuing to tout a popular (if discredited) meme that mandating health insurance is no different that mandating auto insurance, he demonstrates a depth of ignorance that's hard to understand. After all, one would think that a Senator (of all people) would grasp the difference between a function reserved to the states (Hello, 10th Amendment!) and an unprecedented grab for citizens' rights.

To wit:

"Sen. Ben Nelson (D-Neb.) said Wednesday that Congress is given the constitutional authority to mandate that individuals buy health insurance in "probably the same place” that states get the power to mandate that people purchase auto insurance."

There is so much wrong here that it's hard to know where to begin.

First, states only mandate auto insurance for those who choose to operate a motor vehicle on public roads. Own a farm? Don't need insurance for that combine (unless, of course, you're taking it to the drive-in on Saturday night). Don't own a car? No insurance required to ride the bus or subway, or take a cab.

Or ride a bike, for that matter.

That is a far, far different animal than requiring citizens to buy a product simply by being alive.

Second, as noted above, states' rights are not the same as the Fed's. Just because a state is legally allowed to do something does not automatically confer that same right on the federal government.

The 10th Amendment reserves to the states rights and privileges not set forth in the Constitution. Licensing automobiles, for example, is done at the state level, not the federal.

Third, this whole idea that auto insurance and health insurance are the same thing is utterly absurd. Yes, they are both predicated on the principle of "indemnification," but then so are disability and homeowners insurance. But no knowledgeable person conflates those two. If you really want to illustrate auto and health insurance as identical, then why isn't there legislation to outlaw underwriting in for the former as well as the latter? Why should folks with multiple DUI's pay any more than those with nary a speeding ticket? And why should folks who drive late model SUV's pay any more than those happily chugging along in their '76 Gremlins?

And, of course, why doesn't auto insurance pay for windshield wipers and a new set of tires? Or oil changes?

One reason, of course, is that mandating these kinds of changes would render auto insurance unaffordable.

I'm confident that our readers can connect the dots from there (even if erstwhile Sen Nelson, et al, can't).

Un(?)Intended Consequences

I forwarded the link to this article to my co-bloggers, with the tongue-in-cheek heading of "Looks like I picked the wrong week to quit selling life insurance." My point was that the "Exchanges" threaten to put health agents out of business:

"Consumers must buy policies from their employers or through the exchanges--but, either way, their choice of coverage is limited to one of four basic insurance plans that the government sanctions."

The whole article is a must-read, but as an agent, I meant that under such a scheme, I'd have to concentrate more on non-health insurance sales. In his reply, my co-blogger Bill made an excellent point:

"Tell your clients to buy it now. Life insurance will only get more expensive as ObamaCare cost controls kick in."

It's spot-on because, given the Death Panels and inevitable rationing, not to mention the death of new medical innovations, we can expect two things:

■ Increased mortality, and

■ Decreased life expectancies

The former means that carriers will need to drastically increase their "reserves" (funds set aside, by law, to fund future expected claims); the latter means that actuaries will have to dramatically reevaluate risk. Both of these will lead to increased premiums for life insurance policies, and, perhaps, fewer choices for those making long-range plans.

Bugs and features.

Look, Overhead!

If you own a small business, you've probably purchased coverage for your office equipment, maybe a truck or three, and of course your business liability insurance. But have you considered what would happen if you were to become disabled for any length of time? Hopefully, you've already purchased disability income insurance on yourself (and, perhaps, some key people), which will help keep food on your family's dinner table.

But what about keeping your company's doors open?

One of the most often overlooked types of coverage is Business Overhead insurance (BOi). This valuable coverage can help pay for everyday, on-going expenses like the phone and electric, rent, even some salaries. Unlike "regular" disability insurance, these plans are written for a short time horizon; they typically pay out for only one or two years. That's because they're designed to help keep the business afloat if one recovers quickly, or to buy one time to sell the business if not.

Also unlike personal disability policies, the premiums for these plans are generally tax deductible business expenses, which helps lower their net cost. And since they're written with relatively short benefit periods, the gross premiums aren't too hateful, either.

That's very interesting and helpful, Henry, but where do I go to buy BOi?

As with any type of disability (or life, or health) plan, your best bet is your local professional, independent agent. He (or she) will know which carriers have the right plan (or plans) for your type of business model, and can help coordinate your various other coverages with it.

Grand Rounds: Coming Together edition

Nancy Brown hosts this festive round-up of medblog posts, celebrating holidays from Christmas to Eggnog Day. Think of it as holiday treats for your mind.

Cost vs Care: An Osteo-Conundrum

As we've frequently stated here at IB, health care costs drive health insurance costs; and we've chronicled various examples of how this plays out in the real world. Sometimes, the lessons are readily observable, but sometimes, the conclusions aren't so obvious.

Case in point: Fosomax and Osteoporosis/penia. Does increasing consumers' awareness of a potential problem lead to unreasonably expensive, and perhaps unnecessary, treatment? Does Big Pharma wear a white hat or a black one? Is there necessarily a conflict between ethics and profit motive?

NPR has a fascinating look at how a well-known, and frequently prescribed, medication came to be ubiquitous, and offers insights into how DTC (direct to consumer) advertising can run up demand. It's a little disturbing but, I think, not entirely unfair to either side of the debate (such as it is).

I'd be very interested in our readers' take on this.

Gift of ObamaCare: A Taxing Experience

FoIB and gifted tax-blogger Joe Kristan reports on a timely idea for your last minute shopping list.

How much? For a WHAT??

Tom Harkin, Democrat Senator from Iowa said this last week - look at the clip below, about 15 seconds in:

"What we’re building here is not a mansion – it’s a starter home."

Who else but one of Reid’s Racketeers (or one of Pelosi’s Plunderers) could POSSIBLY look at a $900 BILLION house and call it a starter home?

UPDATE [HGS]: Here's the vid to which Mike referred:

Carnival of Personal Finance

Mighty Bargain Hunter hosts this week's collection of finance-related posts. Do check it out.

Deny, deny, deny

OK, we’ve seen this kind of thing before.

Believe it or not, the DENIAL problem is worse than you think.

It occurred to me today whilst buying gas, that when I pre-pay my $30 the pump always shuts off at exactly $30 – even if my tank isn’t full yet!

Exxon-Mobil DENIES me gas!

I’m telling you, this is how gas stations in Connecticut and all over America ROUTINELY DENY gas to motorists!

What’s worse, we are DENIED gas WHEN WE NEED IT MOST!

Righteous indignation! Outrage!! Snippiness!!!

This widespread DENIAL of gas shows that the country must have a public gasoline option.

This means GOVERNMENT-SUBSIDIZED gas stations where everyone is always GUARANTEED a FULL TANK for a FIXED PRICE.

The public-option gas stations will give the oil companies some COMPETITION - for a change.

Oh, I know, some crackpots will claim competition from a public option will be unfair and will drive the private gas stations and oil companies out of business.

But they're just crackpots. Besides, who needs the gasoline companies, anyway?

Don't believe those crackpots. Let your Congressional representative and your Senators know that you DEMAND a PUBLIC GASOLINE OPTION.

Health Care "Reform:" Content Warning Version

This is awkward. On the one hand, as a "family friendly" site, we attempt to keep things as clean as possible. Certainly, we don't allow obscenities in our comments, nor do we avail ourselves of them in our posts. And when we do "push the envelope," it's done with a sense of humor and decorum.

So I'm ambivalent about the video below [ed: I've decided to "pull" the embedded version - the video can be viewed here]: it is unquestionably in poor taste, bordering on the obscene. But it is also an outstanding insight into the minds of at least some of those pushing for "reform." In the end, I'll leave it to our readers' judgment as to whether or not they wish to view the video, and I'll take full responsibility for inclusion at IB.:

Not a Prayer?

The Law of Unintended Consequences can be a, well, bear. Take, for example, the so-called "individual mandate" (Please!). One of the problems is that, as we've pointed out, some faiths have rather unusual definitions of "health care," which could lead to folks being forced (on pain of jail time) to buy coverage which don't serve their needs, or even go against their beliefs. One such group is Christian Scientists, and they have an issue with that mandate:

"Christian Scientists are lobbying lawmakers to include a provision that would ban discrimination against "religious and spiritual" health care and encourage private insurers to cover prayer as medical treatment."

This leads of course, directly to another Constitutional problem: the First Amendment. Certain folks are quite invested in the concept of "separation of church and state," so would likely take issue with paying for such treatments. But those who practice faith-based health care deserve their rights, as well. Of course, the Christian Scientists lack the resources and troops lined up on both sides of the public-funding-for-abortion debate; still, are their voices no less important?

COBRA/ARRA Update: Pre-Christmas Edition

Lost amid the ruckus that is health care "reform" is news is that the House has passed an extension for the so-called COBRA subsidy, from the original 9 months to 15. In typical, unfathomable congresscritter fashion, this change was actually part of the Defense Appropriations bill.

Go figure.

The measure now goes to the upper chamber, where one presumes it will pass (seeing as how our troops, if not the funemployed, are counting on it), and then on to the president for signing.

Some features of the extension include eligibility for folks who exhausted their original 9 months of the subsidy, as well as expanding eligibility to those whose involuntary employment terminations take place on (or before) February 28th of next year.

[Hat Tip: Ceridian Benefits]

Friday (Not So) Funny

Courtesy of FoIB Dr Val Jones:

Helpful iCarrier Trick

Nationwide Insurance has joined the ranks of carriers embracing smartphone tech. Specifically, they've developed a new iPhone app to help folks out car-shopping (and there are, apparently, a few doing just that). According to an email we received, the carrier has rolled out "Cartopia, a free new app for iPhone that will make shopping for a car easier." It includes "a wide variety of 3rd party info about cars they are considering - right there on the dealer's lot."

One of the features looks like "CarFax" (and maybe it is), because it allows a potential customer to find out if that shiny little convertible rode out Katrina in downtown NoLo. Perhaps best of all, the app is free (and available here). Currently, it's for the iPhone (and iTouch); BlackBerry and Treo users should probably the Ohio-based insurance behemoth a note requesting that it be ported to these devices, as well.

Mindless eDrivel

[Welcome Industry Radar readers!]

One of the problems with online quoting services like local, professional agent, one deals with a faceless, unaccountable person (whom one presumes is at least licensed in the state in which one resides) who answers questions from a script, and is ill-prepared to deal with folks who present unique or challenging problems.

Nevertheless, a lot of folks mistakenly believe that buying health insurance is really no different than buying a new computer monitor, book or slippers. So they fire up their PC's (or Macs), and head out onto the information superhighway looking for "a deal." Never mind that they are just as likely to get stuck as strike gold, and that they're unlikely (to put it charitably) to ever speak again with that anonymous agent at the other end of the intertubes.

So, Henry, why the diatribe?

Well, we recently received email from an outfit called "GoHealth," which had spent (one presumes) a pretty penny on a study which purported to show how consumers' health insurance choices were influencing, and influenced by, e-shopping for health insurance. The report (available here), is very pretty, and equally vacuous. As Bob responded when I asked for his opinion, "What are they smoking?" Mike was a bit more ascerbic: "It's not a glaring problem. It's a blessed solution. High deductible HSA plans begone! Hello, low premium, low deductible plans!"

The problem, of course, is that by focusing almost entirely on cost, rather than value, the conclusions are, well, absurd. And the fact that there are several logical inconsistencies does nothing to vindicate them.

Take, for example, the non-sequitor on the very first page: "In this current employer-based model, consumers do not actively participate in the research or shopping process ... That’s why millions who are now looking for health insurance turn to the Internet."

Hunh? If one obtains coverage through one's work, and it's subsidized by one's employer [ed: yes, we know that's not really the case, but that's another post], then by definition one is not out shopping for coverage. And if one is out shopping, it means that, for some reason, that relationship has ended.

And we're told that "[t]ypically, the employee is limited to a choice between a PPO and an HMO." Um, no. As we've pointed out, employers are looking more and more at consumer-centric health plans, such as HSA's and HRA's.

At the bottom of that first page, we're told that this report "reveals a surprising new trend."

One breathlessly awaits the details of that surprise, but to no avail. The only thing surprising in the mix of pretty pictures and meaningless jargon is that someone apparently paid good money to have this report published.

The report ostensibly details the buying process, but there's very little reality to be found therein. For example: "Consumers considered to be in the “purchase” stage include policyholders who fully submit an application and are accepted into coverage."

While that would be nice, there’s this process called ‘underwriting,’ which can create speed bumps along the way to that new policy. So one is left wondering about those who aren’t just “accepted into coverage,” but are offered a modified plan or premium, or perhaps declined. A knowledgeable, professional agent knows which carriers are more likely to accept a given risk, and which ones are more likely to offer favorable terms. Since this would be "off-script" for e-agents, it's no wonder that this important issue is completely sublimated.

In an effort to glom onto the current debate, the study hijacks the term "Insurance Exchange." One is tempted to admonish these folks to be careful what they wish for: under ObamaCare, they would be toast, as well. Still, it offers an interesting insight into the mindset of those behind this report: they're so impressed with themselves for cleverly turning that phrase that they fail to understand its significance.

Since I don't want to be accused of running up the score, I'll conclude with one last bit of fisking: this obsession with prices and how much less the consumer ends up spending than at the outset of the transaction. This way lies madness: as any experienced agent can tell you, you get what you pay for. Saving a few dollars in premium, but ultimately paying more than necessary for the coverage one really needs is no bargain. That local professional will help you understand why keeping the co-pay plan and raising its underlying deductible to save a few bucks is likely to end up costing you more than simply buying an HSA-compliant high deductible plan in the first place.

Bob explains this more succinctly: "Focusing on cost leads to poor plan choice by consumers. Carriers aren't dumb; every one of them have products that have been gutted to look good (from a price standpoint) on a spreadsheet. These so-called "best buys" are full of holes that can bankrupt you if something major happens." His point is neatly summed up thusly: "there is nothing wrong with those plans as long as you don't get sick."

But, of course, that wouldn't be in the script.

US Healthcare vs Canada's and the MVNHS©: The Truth Hurts [UPDATED & BUMPED]

As we noted earlier this week, there's an email floating around purporting to show how much better our system is than, say the MVNHS© or that of our Neighbors to the North. It references an Investor's Business Daily report, but doesn't include a link, or even a date. Since we pride ourselves on doing everything we can to vet such information, I spent time at the IBD site trying to find the source. Coming up empty, I dropped them an email, to which IBD's Kerry Jackson kindly (and promptly!) responded.

The information in the email is apparently distilled from a May, 2009 IBD article which itself is based on information from Rep Mark Kirk (R-IL), which his office compiled from a variety of valid sources.

It is a devastating rebuttal to those who believe that our system is inferior to, and needs to be made more like, nationalized systems:

■ "In the U.S., only 26 percent of sick adults waited more than four weeks to see a specialist. In Canada and the UK, more than twice as many citizens wait longer than a month to receive the care they need."

■ "In America, doctors use 27 MRI machines per million people. In Canada and Britain, it is less than a fifth of that at approximately five MRI machines per million people."

■ "American women’s survival rate is 61 percent, compared to 58 percent in Canada. American men’s survival rate is 57 percent, and 53 percent in Canada."

The IBD article has more:

[Graph courtesy Kerry Jackson, IBD. No direct link available yet]

Why would we purposefully jettison the clearly superior level of health care available to our citizens?

UPDATE: In the comments, Mike makes a vital point:

"In the US where the absence of insurance is usually cited as evidence of the absence of medical care, waiting times are actually less, and for a greater fraction of the people, than in Canada. And in Canada a greater fraction of the people have longer waiting times than in the US.

And yet, supposedly, Canadians all have insurance. So perhaps insurance is not the bogie that popular opinion holds it to be - and that the US Congress cannot seem to see past."

From His Lips to...

There's an old Yiddush expression, "from your lips to G-d's ears." It seems odd that I'd be agreeing with "erstwhile Presidential candidate and spokesdoctor for the DNC" Howard Dean twice in a month's time, much less that I'd be hoping for the same outcome vis: health care "reform," but there ya go:

"Howard Dean bluntly called for the bill to be killed in a pre-recorded interview ... denouncing it as “the collapse of health care reform in the United States Senate.”

From your lips, Doc...

[The full interview is online here]

Cavalcade of Risk #94 now live

This week's Cavalcade of Risk is now up and running at My Wealth Builder. Take a risk and stop by.

Grand Rounds: Charlotte's Web edition

Hosted by Barbara Olson, this week's roundup of medblog posts is woven into the classic children's story. Enjoy!

Politicizing Cancer [UPDATED]

The Susan Koman Foundation is considered one of the premier advocates for breast cancer research. Unfortunately, it's also in danger of becoming known for its political and anti-semitism problems, as well. Recently, the organization sponsored a breast cancer awareness program in Egypt; unfortunately, Israeli survivors and researchers were specifically excluded. While the blame for this is primarily the Egyptian government's, it seems to me that the Foundation, as a matter of principle, should have cancelled the event.

One of its most visible, and effective, spokespeople is Hadassah Lieberman; Mrs Lieberman's husband has gone on record as being opposed to Doc Reid's version of ObamaCare, and so those who advocate the destruction of our current health care system feel it's appropriate to lash out at the senator's better half. Having heard her speak, I have no doubt that she can fend for herself, but will the Komen Foundation toss her under the bus?

One hopes that the Foundation will eschew the rabid demands of a small group of "activists;" if not, it seems to me that there are other, less prejudiced, cancer researchers worthy of our support. After all, nationalized systems are no friends of cancer patients.

UPDATE: The national health care proponents are in full-blown conniption mode, and it's hysterically funny. You cannot make this up:

"The Progressive Blogs, a feared and highly organized hegemonic force, are very upset with Hadassah Lieberman for continuing to raise money for breast cancer research despite being married to her husband, Joe Lieberman..."

Well, actually you can make it up: that's the tongue-in-cheek analysis of Wonkette's Juli Weiner; she goes on to report that, in all seriousness, noted WhackBlogger Jane Hamsher is demanding that "Ellen DeGeneres, Christie Brinkley and other high-profile celebrities who are associated with Komen to demand that no more money raised for cancer treatment be given to Hadassah Lieberman or any other ex-Pharma/Insurance strategists."

Right, because heaven forfend that women at risk for breast cancer should benefit from any of that tainted blood, er, um, Big Pharma research money.

Citation Bleg (IBD) [UPDATED]

There's an email making the rounds which purports to cite statistics in a recent Investor's Business Daily article. If these are accurate, they paint a devastating picture of nationalized health care schemes; thus far, however, I've been unable to confirm their provenance.

I've tried searching the IBD site, to no avail. We'd be most grateful if any of our readers could provide a link to the source (not just another blog or forum posting).

UPDATE: We’ve found a source/cite, and have written a post on this subject. Thanks to our readers for their help!

Saturday, In The Park...

Lookin' like the 4th of July (with aplogies to Chicago). This time, though, it was in a city known for an entirely different kind of wind: New Orleans. Thousands of Big Easy residents (and others) gathered to protest Sen Mary Landrieu's complicity in the potential destruction of our health care system:



[Hat Tip: Lyndsi Thomas]

Something Completely Different (Chanukah edition) [UPDATED]

Although we comprise several different denominations, Jews tend to fall into two distinct physical/cultural branches: Ashkenazic and Sephardic. The former refers to those of us of eastern European descent, the latter Mediterranean. A good friend has loaned me his copy of the latest Bon Apetit, which includes Mexican Chanukah foodways, which fall under the Sephardic rubric.

For many years, I've prepared "latkes" - potato pancakes - according to Ashkenazic tradition: grating potatoes and onions together, adding in some egg, flour and salt, mixing well and frying. I have my own little "secret twist" which yields surprisingly crunchy exteriors with creamy interiors. But they're still a variation of the Ashkenazic tradition.

Tonight, my youngest and I made latkes according to the Mexican (Sephardic) recipe in the BA. These include cilantro in the batter, and and ancho chile (we subbed in chipotles) "sprinkle" and are accompanied by a watercress guacamole:

My usual latkes are about 3 or 4 inches in diameter and about a half inch thick; these are more like "latke bites," but the cilantro really shines through. And the watercress adds a little "bite" that really cuts through the potentially greasy little fritters.

They were gone quickly.

UPDATE: This afternoon (Sunday), Junior and I made our tradition Ashkenazic version. Here's a comparison of the two types:

Chag Chanukah Sameach!

That's Hebrew for Happy Chanukah, the Jewish Festival of Lights. This festive, weeklong celebration of freedom over tyranny begins this evening when we light the first candle in our special menorah (technically, it's a chanukiah, or Chanukah candelabra).

Although it's actually considered somewhat of a minor festival, Chanukah's proximity to Christmas has helped it make "the big time," complete with gifts, cards and public events. Personally, I think it's a wonderful opportunity to acknowledge the powerful help of a much greater authority, who helped inspire and guide us through a time of great adversity.

May your Chanukah be filled with the warmth and love of family, and the joy of good health.

[Thanks to Bob for the cool menorah graphic!]

Cavalcade of Risk #94: Call for submissions

My Wealth Builder hosts next week's Cavalcade of Risk. Submissions are due this Monday (December 14th); please include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

BlogRoll Update

We generally don't update our "Blogs of Interest" very often; when we do add a new link, it's because we see a great "fit." InsWeb is another insurance-related blog with great content, frequently updated and well-written, and we're pleased to add them to our 'Roll.

Food Pyramid Update: Brew vs Cancer

It's been a while since we've discussed important medical breakthroughs provided by everyday consumables. One of our favorites may have just added another notch to its belt (or belch):

"MEN now have another excuse to go down the pub thanks to new research suggesting that a compound in beer may prevent prostate cancer."

Now that is good news. Turns out that xanthohumol, a compound present in that bubbly quaff, acts much the same as drugs that are commonly used to treat prostate cancer. Seems like an easy choice: chemo or Guiness?

I'll drink to that!

[NB: We actually reported on a similar study a few years ago. At that time, the problem was that "Agent X" was present "in such small amounts that a person would have to drink more than 17 beers to benefit." Perhaps the Scottish researchers were more successful than those in Oregon]

Health Wonk Review: Sausage making and Christmas

Workers Comp Insider's Julie Feruson presents this week's round-up of health care policy and polity. Like sausages, Julie's HWR demonstrates why it may be best not to ask for too many details.

Seriously, it's a great way to see what's interesting and of interest in the wonky side of the blogosphere.

More "Fannie Med" Health Insurance Tricks

Earlier this year, Bob introduced us to "Fannie Med" insurance; that is "parallels between the mortgage meltdown and health care reform." It was an apt comparison then, and is even more so now; as Ace o'Spades co-blogger Gabriel Malor points out, this morning's news that Doc Reid's idea to scuttle the so-called "Public Option" is really just a ruse to morph it more quickly into a single-payer scheme. He makes the point that the "massive expansion" of Medicare and Medicaid eligibility is, in fact, the much vaunted (by some) "Medicare Part E" (where "E' means "everyone"). The goal is to end up with a system that, while appearing to be based on private enterprise, is in reality well under government's command and control.

One of his fellow co-bloggers then asks if we know of "any other "tightly regulated nation-wide nonprofits which are technically private-owned, but akin to publicly-regulated utilities?" And, of course, he supplies the answer: Fannie Mae and Freddie Mac. What's so fascinating about this is that it's such a transparent attempt to hijack 1/6 of the economy, putting it under government control. Given that Social Security, another government program to help us take care of ourselves, has just marked half a year in the red, what possible evidence could there be that a national health care scheme would fare any better?

The reality, based on actual experience, is that Mae and Mac, Social Security and Medicare offer ample proof that the government is not the answer; it is, in fact, the biggest part of the problem.

The Onion Meets McPaper

As FoIB Brian D notes, it's easy to confuse today's issue of USAToday with the farcical news "organization." To wit, the "hidden nuggets" that have been added to the underlying bill, many of which leave one quite puzzled:

"Companies with 50 or more employees would have to set aside “reasonable” break times for nursing mothers and create a private space for breastfeeding." While this may sound reasonable, why isn't it simply left to employers to offer on their own? Will mom's be nursing "on the clock" or not? And if they get extra breaks, what about other folks who could use a few additional moments of respite? Talk about a nanny state.

"Nurse midwives would be paid the same as doctors for their services under Medicare." Why?! Do they have the same training? Are they required to carry malpractice insurance? What's the criteria for calling oneself a "midwife" as opposed to "doctor?" Not to mention increasing Medicare's already bloated shortfalls.

"Restaurants with more than 20 locations would be required to post nutritional information." Um, yeah, we all hit Mickey D's for the health benefits. Again, what does it have to do with health care reform?

And my favorite:

"Included in the provision is a requirement that vending machines must include nutrition labels." Right. Because our health is the first thing we consider when we're popping in quarters for a Snicker's bar. Of course, this provision could be for the less mentally competent among us:

"Thomas Martin, a 53-year-old diabetic, said the labeling would help him think twice before buying. “It’d be nice,” he said as he pulled an ice cream sandwich out of a vending machine in Maryland." [emphasis added]

Um, Thomas, why would we take you seriously given the circumstances? Perhaps we should add a Bill Engvall provision for these folks. That would be as relevant to health care "reform" as any of these little gems.

Video: The Medicare Primer

Ever wondered just how Medicare coverage is supposed to work? The latest in Humana's "Now You Know" series [ed: our term for the vids] gives you the basics:

Grand Rounds is up...On Broadway

Jeffrey Seguritan, proprietor of the Nuts for Healthcare blog, presents a Broadway-themed collection of great medblog posts.

I was particularly pleased to see that we comprise the entire category of The Producers, the original of which is one of my three favorite movies.

History to Sen Reid: "Um, no."

For our readers that may not have already seen this, here's Sen Harry Reid (D-BS) opining that Republicans who oppose ObamaCare are akin to folks that opposed an end to slavery, women's right to vote and civil rights legislation [ed: we're just surprised he left out the heartbreak of psoriasis, as well]:



Apparently, Sen Reid failed 7th grade history, else he would have known that Abraham Lincoln was himself a Republican, that it was the Republican party which first pushed for women's suffrage, and it was the GOP which advocated civil rights legislation, despite heavy Democrat opposition.

No gold star for you, Harry.

More (Un?)Intended Consequences

One of the major problems we'll likely face if a national health care scheme is adopted is a shortage of primary care docs. Actually, we already face such a shortage, but ObamaCare threatens to exacerbate and extend it:

"... the bill may exacerbate the difficulty some Americans already have in finding a doctor ... Even without an insurance expansion, the American Medical Association estimates the country will be short 85,000 doctors in primary care, cardiology, oncology and general surgery by 2020."

For right-brainers:


When the demand for services (i.e. tens of millions of newly insured folks, using primarily someone else's money) increases, if the supply (health care providers) doesn't match, then you're going to have shortages. Pretty simple economics.

Wonder if anyone in DC ever studied that?

(Un?)Intended Consequences: More Mammography Monkeyshines

Talk about a roller coaster: first, the Feds decide that mammograms really aren't "all that," then they decide "well, maybe they are." Now the Golden State has decided that those women on the bottom rungs of the economic ladder don't really need them, after all:

"The eligibility age for state-subsidized breast cancer screening has been raised from 40 to 50 by the California Health and Human Services Agency, which will also temporarily stop enrollment in the breast cancer screening program."

This is a state-funded initiative that had previously helped poor women to pay for this important (or not) cancer screening. It's particularly troublesome because "[m]ore than 50 percent of the women we give breast exams and mammograms to are in their 40s ...The majority of our current breast cancer survivors are women in their 40s.”

That's a pretty large swath of females that just got thrown under the health care bus. As we've noted before, while insurers can't arbitrarily decide whether or not to pay for certain procedures (and face sanctions, arbitration or lawsuits if they try), the gummint has the ultimate decision-making power: if they decide you're not going to get needed care, then you're not going to get needed care.

[Hat Tip: Gateway Pundit]

Oy Canada - Early December Edition

One of the most significant problems with gummint-run health care is that, just as with most things the government touches, red tape and stringent rules often lead to broken - or at least in this case damaged - hearts:

"An elderly woman with a cane and a heart condition was told to bring her husband into a Nova Scotia hospital on her own or call 911 after he suffered a heart attack 10 metres [32 feet] from the facility's front door"

Not only did the hospital turn her away, they told her that they'd only treat hubby if he arrived by ambulance, for which she'd be charged. But of course, Canadian health care is free, right?

In fairness, my experience with American hospitals is that those arriving by ambulance are almost always bumped ahead of those who arrive by private transport; still, requiring such seems a bit Big Brotherish.

Just another example of what we may be in for.

Rocks, Hard Places, The Maverick and The Bus [UPDATED]

One of the ways its proponents plan to fund ObamaCare is by making severe cuts to Medicare [cf: Paying Paul]. The thinking is that, by throwing Grandma (and, of course, Grandpa) under the bus, "we" can better afford to pay for health care for, well, the grandkids.

One Grandpa who objects to this transfer is Sen John McCain (R-Maverick), who has proposed an amendment that would "stave off Medicare cuts and approved safeguards for coverage of mammograms and other preventive tests for women." The amendment was defeated along an almost party-line vote, with two (presumably elderly) Democrats voting with The Mav.

What's ironic is that another long-serving senator recently characterized any cuts to Medicare as "immoral." That would be Doc Harry Reid (D-BS). What a difference 4 years and an election or two makes.

[Hat Tip: PowerLine]

UPDATE: One of the (perhaps) unintended consequences of the ObamaCare cuts to Medicare is the availability of home health care:

"Bertha G. Milliard greeted the nurse who had come to check her condition and review the medications she takes for chronic pain, heart failure, stroke and dementia ... Ms. Milliard, 94, said those visits had been highly effective in keeping her out of the hospital. But the home care she receives could be altered under legislation passed by the House and pending on the Senate floor as Congress returned to work this week."

Ooops.

Turns out, home health care (which is one of the most cost efficient forms of care delivery) takes a "disproportionate" hit under ObamaCare. And since seniors are more likely than younger folks to actually receive care in this manner, it's going to hit them "disproportionately," as well.

Poor Grandma: thrown under the bus, and no home health aide to nurse her back to health.

ForeSee-able Consequences

We've long advocated increased consumer involvement in health care. When folks have "skin in the game," they tend to be more careful and discerning shoppers, which in turn can help drive down costs. A vital part of this "consumer empowerment," though, is the availability of certain tools. And one of the most important, and effective, tools is the internet. Over the past few years, we've seen various players in the health care game make increased use of the 'net, often to great effect.

For example, a lot of (perhaps most) insurance carriers have numerous features on their websites for their insureds to track claims, check availability of providers, get cost estimates, that kind of thing. But how does one measure the effectiveness of these tools?

ForeSee Results (FSR) is a company that measures customer satisfaction with vendors' websites. It publishes the American Customer Satisfaction Index (ACSI), which includes many different companies across many different sectors. Because health care is such a hot topic right now, they thought it would be interesting, and instructive, to see how different segments of the health care sector stack up. For insurers, the picture isn't pretty:

But what does this graph really mean?

To find out, we recently interviewed the president and CEO of FSR, Larry Freed. Mr Freed was kind enough to share with us the results of the survey, as well as some intriguing insights about it.

InsureBlog: Thanks for speaking with us, and for sharing your findings with our readers. What's the point of the ACSI?

Larry Freed: It's a measure of how satisfied customers, users, are of different companies' websites. We look at 700 to 800 different sites across the specturm, from retail sales to government agencies, and then look to see how they compare with others in their sector.

IB: Okay, so what does "customer satisfaction" really mean in this context?

LF: It's about how the customer perceives the company's technology: is it helpful, easy to navigate, is there adequate help available? We believe that a happy customer is a loyal customer, and this helps our clients determine how well they're doing in that regard.

IB: What do the scores in the chart mean?

LF: Well, we consider an 80 to be a very strong (good) score. As an industry, health care averaged 75, which is very good. But that's an aggregate, and you can see that different segments have different scores.

IB: I see that. I notice, too, that the "worst" aggregate position is taken by health insurers; in fact, there's a pretty big gap between that carriers and - most surprising to me - government sites.

LF: That is interesting; in fact, and I can't tell you the names of the carriers involved, but within that cohort the scores ranged from a high of 86 to a low of 42. By way of comparison, Google and Amazon both scored 86 in their categories, so you can get a sense of what those scores can mean.

IB: So (at least) one carrier scored very high, which is good. I'm still somewhat confused, though: my experience with government sites is that they're often very difficult to navigate, heavily cluttered, just not all that use-friendly. It just seems counter-intuitive that they'd score so much higher than carriers. We're certainly no shills for the companies [ed: I mentioned our "Stupid Carrier Tricks" series], but at least in this regard, I've been fairly impressed with their sites.

LF: Well, ease of use, navigability, that kind of thing is important, but it's not the only measurement. There's also what we call the "trust factor" that plays a big part; how much credibility do you give the site, what are your expectations. Often, customers look at, say, the CDC site as very credible, which more than offsets whatever problems that might have with the mechanics of the site itself.

It's really a perception and expectation issue: if the customer goes to a site where their expectations aren't that great, the bar is pretty low so it's easy to jump. Contrasted with another site that may have a great reputation, one's expectations are higher.

IB: Like eating at Frisch's versus Ruth's Chris...

LF: Exactly. You're expecting great service at one, maybe you're pleasantly surprised by the service at the other.

IB: So what does this bode for the carriers? What do they have to do to close that gap? And is it important that they try?

LF: I think it's very important. They're sort of at a crossroads, there's health care reform legislation that's going to directly affect them, they need to be trying to improve their credibility and the value of their online presence.

I'm actually a big fan of the "42" company; they really have nowhere to go but up, and every incentive to make that happen. And these kinds of surveys are helpful in that effort. We believe very strongly that "you cannot change what you do not measure." If you don't know where you are, how do you where to go?

IB: Thanks so much for your time, Larry, and for sharing your insights.

Readers who'd like to know more about ForeSee Results should click over to their site; please feel free to leave your own thoughts and questions in the comments, and I'll forward them on.

[Special Thanks to Brandon Fibbs!]

Call it Macaroni? Er, No, It's Still a Feather.

The Congressional Budget Office issued a report November 30 prepared in conjunction with the Joint Committee on Taxation. Among other things, the report states (bottom of page 4):

"CBO and JCT estimate that the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law."

Got it. That outcome is financially WORSE than doing nothing.

And who are the people who buy “nongroup policies”? They’re individuals. A great many of these individuals are uninsured. The uninsured are the very people who need the most help. But the Senate Bill will increase the premiums that the uninsured would have to pay to get medical insurance they already can't afford. Does this make sense?

I think even more important, the effect of the Senate Bill on medical insurance premiums tells us that the cost of medical care would also be greater under the proposed law, than under current law. That’s because the cost of insurance is driven by the cost of medical care. In other words, the Senate bill does bend the cost curve. It bends the curve UPWARD.

The November 30 report goes on to say (still on page 4):

"About half of those enrollees would receive government subsidies that would reduce their costs well below the premiums that would be charged for such policies under current law."

The administration and Senate leadership selected this comment for their great “AHA!” on Monday – AHA!! CBO proves us right! The premium per participant will reduce under the Senate Bill!! [they said]

Sure - - after the subsidy.

So you tell me. Will it cost taxpayers more to subsidize the more-expensive medical care caused by bending the curve upward ? Or will it cost taxpayers more to subsidize the less-expensive medical care we have now? C’mon, it’s an easy question.

I’m not saying we should be satisfied with what we’ve got. What we’ve got is far too expensive and it’s far too inefficient. The current “system” not only drives people nuts, it drives doctors nuts and payers such as the government, small employers, and large employers nuts, too. We need to change it. But the Senate Bill will give us no better than we have now, at higher cost.

The Senate leadership wants to stick a feather in its cap, and call it macaroni. But CBO says not so fast. Thanks to CBO, the information before the public is now clear and settled fact. It is wrong to assert that the Senate Bill will save money, or will be “budget neutral”. It will instead cost much more than doing nothing, and will not accomplish the very things we understand are most important.

By the way, remember when candidate Obama promised a health care plan that would save every American family $2,500 a year? I’d like to know, where the heck is THAT plan?

Keeping Abreast of the Mammogram Controversy

A couple of weeks ago, we reported on a federal health panel's new recommendations regarding when and how often women should get mammograms. The panel's findings had ignited a pretty fierce firestorm among women's health advocates, and was widely denounced. Our take was that it didn't portend well for those who think that government-run health care would be such a perky idea.

Now comes news that the panel is softening its approach, opining that "screening women in their 40s should not be automatic, but should not be denied either."

But what struck me as even more disturbing was this admission by one of the panel's esteemed members:

"The recommendation about breast cancer screening for women 40 to 49 did not say what the task force meant to say. The task force communication was poor."

No kidding.

One is tempted to believe, however, that it was merely the fact that they were called out on their recommendations that caused them to backpedal; if the information hadn't been widely disseminated in both the old and new media, how many women would now be facing mammography rationing?

As we noted in our original post, this might have had even farther reaching impact, in that insurance carriers might have been encouraged to approve fewer mammograms. Fortunately, this hasn't turned out to be the case, as we see in an email notice I received yesterday from UHC:

"UnitedHealthcare Mammography/Cervical Screening Guidelines Remain Unchanged ... We consider mammography an important screening procedure, one that has resulted in the ability to detect and treat breast cancer at earlier stages of the disease and save lives."

The release goes on to note that UHC will continue to cover mammograms as recommended by its insureds' physicians, and that employers with self-funded plans may modify their plans to include this coverage if they don't already do so. What's also heartening is that the carrier notes that, "the American College of Obstetricians and Gynecologists (ACOG) recently changed its recommendations for cervical cancer screening, advocating less frequent screening for women in their 20s. However, UnitedHealthcare is not changing its coverage policy on cervical cancer screening."

Kudos to UHC.

Medicare Advantage: What's Up with That?

Inasmuch as Medicare Advantage (MA) plans are firmly in the crosshairs of ObamaCare, this video may soon be rendered moot. But since they're still alive and kicking - so far - this latest video in the Humana "Good to Know" series [ed: that's our name for them] provides a good background on what they are and how they work:

Right-wing Nutjob Casts Aspersions on ObamaCare

This is just beyond the pale. A noted hard-right senator has the temerity to claim that deficit neutrality is not part of the plan:

"Just for a second -- health care reform, whether you use a ten-year number or when you start in 2010 or start in 2014, wherever you start at, so it is still either $1 trillion or it's $2.5 trillion, depending on where you start…"

And how does this arch-conservative justify these outrageous comments?

Well, he points out, without a thought of how unlikely this might be, that all the tax increases start in Year One of "The Plan," but that expenditures don't actually occur until Year 5.

Well, if you're going to use facts and logic...

Shame on you, Senator Max Baucus, shame on you.

MassCare Coming Up Short

Over the years, we've chronicled the various pitfalls of RomneyCare (aka MassCare). Long on promises, short on delivering on those promises, it's a glimpse into the (possible) future of how a national health care system would fare. Now, though, the fit has really hit the shan:

"Six community hospitals, squeezed by the economic downturn and the Massachusetts budget crunch, are set to file a lawsuit in Suffolk Superior Court this morning seeking millions of dollars from the state for unpaid health care services."

Hospitals are generally taking major hits as their reimbursement rates continue to fall. In this case, the Bay State's much-touted health care initiative has left them reeling with lower reimbursements and unpaid bills. Of course, that's a direct result of the program's own struggles to control costs.

Adding fuel to the fire is the fact that the half-dozen plaintiffs are among those truly at the bottom of the rung:

"[H]ealth care providers known as “disproportionate share hospitals,’’ institutions at which at least 63 percent of patients ... are covered by public insurance plans such as Medicaid or Medicare."

That last is important: "covered by public insurance plans." It doesn't seem much of a leap to substitute "public insurance plans" with "Public Option," and a whole new can of worms becomes accessible. Whom do the hospitals sue when it's the Feds?

RELATED: Over at Ace of Spades, an intriguing discussion of health care as "supply side" driven. This insight is worth more than a passing thought:

"In the US system, there is a theoretically unlimited amount of health care available, you just have to be willing to pay for it.

You've just the nailed the fatal flaw of the Democrat's health care reform; it isn't reform at all, it's simply more regulation ... real reform would involved increasing the supply of doctors, medicines, and hospitals. ObamaCare does just the opposite, it focuses entirely on demand." [italics in original]

Definitely food for thought.

HR 3961 - you need to know about it [Bumped to Top]

[Welcome OpenCongress readers!]

[ed: I've bumped this to the top of the page because it's important. To quote P J O'Rourke: "If you think health care's expensive now, just wait 'til it's free."]

H.R. 3961 passed the House last week by a vote of 243-183. This bill was formerly a part of HR 3962 “Obamacare”. Here’s a link to the voting by Yea and Nay, by Democrat and Republican, and by Not Voting.

This bill would block the 21 percent cut in Medicare reimbursement to physicians, scheduled to take effect in January 2010. The bill would instead increase physician payments in 2010 based on the Medicare economic index, and implement an entirely new formula for 2011 and after. That’s a pretty big swing – minus 21% to plus something. So it has a significant cost. This bill was scored by the Congressional Budget Office as costing about $210 billion when it was part of Obamacare. So the House leadership, bless their hearts, seeking to reduce the cost of Obamacare, just made it go away. Like magic, the cost of Obamacare was reduced by $210 billion. But like reality it's back as HR 3961. I think this illustrates how governments - anyway our government – anyway most of our Representatives - pretend that charging us more is really a savings. It’s also a pretty good insight into how gullible they think we are.

Wait, there’s more.

The bill would entitle physicians to more than a 20% increase in Medicare reimbursements relative to CURRENT LAW.

Why the capital letters? Because, when CMS calculates the Medicare premiums each year, it can take only the CURRENT LAW into account. Based on current law, “the standard Medicare Part B monthly premium will be $110.50 in 2010, which is a 15% increase over the 2009 premium.” 15% is a whopping increase for Medicare Part B.

But if physicians will become entitled to 20% MORE in 2010, the 2010 Part B cost will be higher than CBO projected and that means premiums are too low even after that whopping 15% increase. The Part B premiums for 2010 need to be a lot higher. Would that happen? Heck no, it’s too late in the year to change the premiums. So the government (that means the taxpayers) would eat the entire additional cost. Medicare participants won’t pay higher premiums than already announced. That is, in 2010 they won’t. But come 2011, CMS will again calculate the Part B premiums, taking into account the new physician reimbursements, and Seniors will suffer another whopping increase to their Part B premiums.

Now go back to the link again. See that reference to “pay-as-you-go budget rules” in the top paragraph? That means this bill is not funded. So its cost adds to the US deficit.

Oh yeah, about the voting on HR 3961:

242 of the 243 yea votes were Democrats.

172 of the 183 nay votes were Republicans.

Scroll down, yeah keep on scrolling, keeeeep on, until you reach “Not Voting”

There you find the name of NANCY PELOSI. Third in line for President, exercising her precious right . . . NOT to vote. What th- ??

Please don't you be like Nancy. Stand up for something constructive. Tell your senators what you think of this Bill. Call their offices. They're probably not all that busy this week anyway.

Cavalcade of Risk #93 now available

Insurance Copywriter hosts this week's Cavalcade of Risk. Be sure to stop by for some risk-free info.

MVNHS©: Another Bubble Burst

Here at IB, we refer to the Brits' health care scheme as the Much Vaunted National Health Service (MVNHS©), and for good reason: time and again, our Cousins Across the Pond have demonstrated that their health care delivery and finance system is deeply flawed. Yet, there are folks here in the States that would emulate this disaster, at the expense of our own system. One of the metrics often touted by pro-national health care advocates is how much better care is in, for example, England than here.

Unfortunately (well, for them), this just isn't true. Case in point:

"More than nine out of 10 NHS trusts in England are failing to provide a good standard of cancer care compared with other countries, official figures show."

As we've shown before, our own citizens' cancer survival rates are second to none.

The other problem is that the MVNHS© hasn't been effective in reining in costs, either:

"Since Labour came to power, the NHS budget has tripled"

So they're spending more, and getting less.

Sound familiar?

A Very Seinfeld Grand Rounds

Healthcare Technology News hosts this week's edition of Grand Rounds, liberally sprinkled with clips from the classic TV show. Just watch out for Newman.

Turnabout as Fair Play: Guest Blogging Elsewhere [UPDATED]

Over the years, we've had the privilege of some really terrific guest bloggers. Recently, I was asked by John Power, of the Insurance And Annuities blog, to pen an essay on the recent collapse of Penn-Treaty, and how it affects my fellow Buckeyes.

PT wasn't exactly a major player in the Ohio Long Term Care insurance market, but this case illustrates the value of state guaranty funds. If you're interested, click here to see the post.

UPDATE: Got this in email from the LifeHappens folks:

"Even as the average annual cost of a home health aide now tops more than $40,000 and private nursing home care is approaching an average cost of $75,000 a year, a new survey by the nonprofit LIFE Foundation finds nine out of 10 Americans do not have a realistic plan to pay for these expenses."

Those are some pretty hefty numbers; if you're curious about how much LTC runs in your neck of the woods, you can click here for their cost estimator tool.

Medical Tourism Update: Hold the Plane!

Despite the efforts of some carriers to promote so-called "medical tourism," the floundering economy is taking its toll on the nascent industry. Today's McPaper reports on a study "by the Deloitte Center for Health Solutions, a research center focused on trends in the health care system":

"From 2007 to 2009, the number of Americans traveling abroad for elective medical procedures is expected to have fallen as much as 13.6%"

That's quite a drop in such a short period. Of course, it's kind of a double-bind: folks look to overseas providers in order to save money on health care costs, but find that any savings is offset by incrweased travel costs and decreased assets.

Of course, this may be just a short-term hit; if and/or when the economy rebounds, one would expect that these folks will once again find that traveling abroad for certain procedures is a net savings. Indeed, the Center expects that "the number of American medical tourists will rise by 35% each year through 2012," due to "[p]ent-up demand and improvements in international medical care."

My Magic 8-Ball (on loan from Bob), though, says "Maybe."

Carnival of Personal Finance now online

This week's Carnival of Personal Finance is hosted by Revanche at the Gai Shan Life blog. This edition is chock full of amusing (and on-target) finance-related webcomics.

This Sceptered Isle, Part LXVI

There's been another distressing report from the Telegraph of London regarding hospital trust mismanagement within UK’s National Health System.

As if the news is not bad enough on its face, scroll down to the 13th paragraph to read this:

“Ratings given to hospitals rely on their own assessment of their performance.”

What could POSSIBLY go wrong?

Well, management malfeasance, for one: “At Basildon Hospital, managers gave themselves 13 out of a 14 possible marks for safety and cleanliness. The ratings were published just weeks before the damning inspection report was drawn up.”

Previous reports of problems at Basildon are linked here and here.

However, it is clear that Basildon is not some isolated, one-off failure in a sound system.

The linked articles also report that disclosures such as these are harming the public trust in NHS. Gee, ya think?

These are not simply management failures, but are governance failures within the NHS model. They show NHS is seriously at risk to incompetence, indifference, and lack of public accountability that are so prevalent in government bureaucracies.