InsureBlog on the Road

InsureBlog posts are often found in the MOST interesting places. Here are two this week - -

1. Carnival of Personal Finance, hosted by Wide Open Wallet, features a classic post from InsureBlog’s own Bob Vineyard. How would feel about a $1 surcharge to your bill to help your waiter buy health insurance?

Find Bob by scrolling down to Budgeting and Saving - and while you're there, read the whole thing.

2. Grand Rounds is hosted by Running a Hospital - this one is grand and it’s certainly round – as in fully-packed. The theme: transparency in the delivery of clinical care. It is a looong and thought-provoking Grand Rounds and once again InsureBlog is a contributor:

InsureBlog's Henry Stern tells the true story of the Italian doc whose dedication to his patient overrode his own immediate health crisis.

Scroll down to Hank’s entry and, as above, enjoy your read along the way.

Off Topic: Another Ethics Question

No, "ethics" isn't OT here at IB, but the specific subject of this conundrum is:

"In a cash-strapped Idaho high school where signs taped near every light switch remind the staff to save electricity, an enterprising teacher has struck a sponsorship deal with a local pizza shop: Every test, handout and worksheet he passes out to his students reads MOLTO'S PIZZA 14" 1 TOPPING JUST $5 in bright red, inch-high letters printed along the bottom of every page."

As in many places, the economy has taken a toll on Pocatello High School. Teachers still need to teach, of course, and many (most?) are willing to dig into their own pockets to fund special projects. Still, when even paper for tests and handouts is in short supply, creative, out-of-the-box thinking is called for.

Or is it?

"It crosses a line," said Susan Linn, a Harvard psychologist and director of the Campaign for a Commercial-Free Childhood. "When teachers start becoming pitchmen for products, children suffer and their education suffers as well."

Do they?

I'd like to know what our readers think of this novel approach to education.

Medicare vs Social Security: The Untold Story

[InsureBlog Exclusive!]

[Welcome YahooNews readers!]

As noted recently, the unlikely (but unfortunately true) story of how opting out of Medicare can adversely affect one's Social Security payments is heating up (for background, click here and here). Briefly, a group of fellow citizens has filed suit against the Fed's because Social Security officials claim that folks must forfeit their Social Security benefits if they withdraw from (or choose not to enroll in) Medicare. This seemed like a fairly important story, yet seems to have flown completely under the MSM radar.

Which is where we come in:

I had a very helpful conversation the other day with lead attorney Kent Brown. Mr Brown's been practicing law for some 35 years, focusing primarily on fighting government meddling in the health care industry. Not coincidentally, he was also the lead attorney in the case to force open then-First Lady Hillary Clinton's closed-door health care task force.

I asked Mr Brown how he came to be associated with this case, and he told me that he was initially contacted by Brian Hall, a gentleman who chose to opt out of Medicare coverage once he became eligible. Mr Hall was told that he could, of course, choose to do so, but at the cost of his Social Security benefits. This didn't seem fair, and so he approached Mr Brown to see if there was any legal recourse. The case has snowballed, and there are now five plaintiffs (including Former House Majority Leader Dick Armey).

Why, though, would someone choose to forgo health coverage for which one has already paid? Opting out of Medicare may be legal, but is it smart? Mr Brown explained that there are many reasons why someone might choose to decline it, including the desire to make one's own health care decisions without government intervention. Folks see what's happening in England, for example, and want no part of that.

Basically, it comes down to choices: some (many?) folks want no part of a system that allows the government to dictate their health care alternatives. Then, too, there's the matter of privacy, which is also a concern for many of these folks.

So why was the Social Security Administration telling Mr Hall that it was all or nothing? Is there something in the original Medicare legislation that dictated this? Surprisingly, the answer is no. Social Security states that one who is 62 years old and otherwise eligible "shall be entitled to" Medicare [ed: this was obviously added after the initial legislation, which of course predates Medicare]. Nothing in the Social Security or Medicare statutes state that one must take Medicare in order to receive Social Security payments (or vice versa). There are explicit conditions set forth under which one might lose Social Security benefits, but lack of a Medicare card isn't among them.

So how did this come about? Well, according to Mr Brown, there are three provisions in the Social Security Program operating manual that bear on this subject; it's important to note, though, that these are not laws or even regulations. This came about not by statute, but by bureaucratic fiat. The first two of these provisions were inserted in August of 1993 [ed: interesting timing, no?], and the last one in 2002.

The case is moving along; the most recent development is the one which caught my eye earlier this week: the government has filed a routine motion to dismiss, and Mr Brown has countered with one for summary judgment. The judge has set a May 22nd date to hear arguments regarding the motion to dismiss; if that motion is quashed, the government will be given time to respond to the motion for summary judgment. That will probably be in late summer.

I had to ask, and so I did: what happens if the judge grants the government's motion to dismiss? Mr Brown quickly replied that they'd go right to the Appeals Court; the plaintiffs are totally committed to this fight. He also noted that the judge is quite well versed in the subject area, and has her own wry sense of humor (and irony). We agreed that a quote from her would be just the thing with which to conclude this post:

"It is passing strange that the Social Security Administration would insist on individuals being forced to enroll in one bankrupt program in order to be in another one that overruns its budget."

Oy Canada?

Did Canada's National Healthcare System "kill" Natasha Richardson?

That's the question raised by the New York Post. For the record, let us note that we are truly sorry for her family's loss, and wish to score no "points" from this tragedy. Still, it may be worth examining the premise of the allegations to see if those who advocate that we should adopt such a system are justified.

First, Canada's gummint-run system isn't too keen on high tech health care:

"About three hours after the accident, the actress was taken to Centre Hospitalier Laurentien, in Sainte-Agathe-des-Monts, 25 miles from the resort ... But Sainte-Agathe-des-Monts is a town of 9,000 people. Its hospital doesn't have specialized neurology or trauma services. It hasn't been reported whether the hospital has a CT scanner, but CT scanners are less common in Canada [than in the US]."

I read some years ago that there were more MRI machines in Ohio than in all of Canada; I don't know whether that's still the case. But a system that relies on government largesse is unlikely to be profligate with "the tech."

And there's this:

"Quebec has no helicopter services to trauma centers in Montreal. Richardson was transferred by ambulance to Hospital du Sacre-Coeur, a trauma center 50 miles away in Montreal -- a further delay of over an hour."

That hour might have been key: after a certain interval, it seems that a less-than-optimal outcome is essentially inevitable. According to the Post, she didn't receive necessary care until some six hours after the incident, which drastically reduced her chances of survival.

For once, though, I'm willing to cut "CanCare" a break: it appears that, immediately following the initial incident, she was conscious and ambulatory, and appeared to be okay. I'm told that this is fairly common with this kind of head trauma (it helps to have a surgeon in the family). Obviously, just appearing to be okay was deceiving, but what else were those on the scene to do? She was a grown woman, not a child, and presumably able to make decisions regarding her own care.

Hard to believe, but I'm going to give Our Neighbors to the North© a pass on this [ed: how noble of you].

Shattering Myths (Again)

We've busted the "Myth of the 46 Million" (or 47 million, or, well, pick a number) many times here at IB, but we're always happy to keep kicking that particular canard as many times as necessary. In 2007, according to the Census Bureau, there were some 46 million folks here in the States without health insurance. Of course, as we've also pointed out countless times, being without health insurance does not mean being without access to health care.

But I digress.

The problem with that number is that it's meaningless: for one thing, almost 10 million of those folks (over 20%) aren't even citizens. That leaves something like 36 million Americans who are uninsured.

Or does it?

An even closer look reveals some amazing perfidy:

"As even the authors of the Census Bureau report themselves acknowledge, "health insurance coverage is likely to be underreported" in the Current Population Survey from which the health insurance data is derived."

That is, the survey takes place in February, and has no way to adjust for the fact that many (most?) of these folks will have coverage in place sometime in the next 10 months. Or, they might reply that, although they're currently covered, they were uninsured at least part of the previous year and, voila, they're "uninsured."

And of course there's the issue of why they're uninsured. Many folks believe, erroneously, that they can't afford even catastrophic health coverage. And finally, there are those folks who qualify for government coverage (Medicare/Medicaid) who for whatever reason opt out (or are unaware of the availability).

But wait, there's more good news:

According to CNN (not exactly rightwing shills), most insured Americans (80% of them!) are actually satisfied with their health care, and about 75% are happy with their insurance coverage, as well.

They're also less than thrilled with the cost of health care, which continues to escalate (but that's another post).

[Hat Tip: American Spectator]

GPMS

That's an amalgam of two seemingly disparate acronyms; this bleeding edge technology is designed to help those of the "Y Chromosome" set more effectively and pleasantly interact with those who sport the "Double X." Specifically:

"PMSbuddy.com, a free Internet-based service that tracks the monthly cycles of a subscriber's significant other and offers e-mail reminders about the impending deadlines."

Modeled after other social networking sites (e.g. Twitter, FaceBook, etc), this may be the ultimate expression of MySpace. And it's certainly swelling: enrollment topped 150,000 last month, of which almost 15,000 are of the aforementioned "Double X" persuasion (although those numbers may be padded).

Although the service started off using email technology, founder Jordan Eisenberg has upped the ante by introducing a phone-based PMSsaging system, as well. The purported demographic for the site is men aged 20 to 40. But as mentioned above, a lot of females are using it, too; Eisenberg warns, though, that this method isn't for tracking fertility.

Cavalcade of Risk #74 now online

Wenchy hosts this week's roundup of all things risk. And to show our gratitude, we'll pass along her bleg for swag (you'll have to click over to her Cav to get that).

On a personal note, this may be the best Cav yet: Wenchy's obviously read each post, and she offers her own insights into them, as well. Kudos!

Italian Medico: True Dedication

Sometimes, it's the little things that mean a lot.

Take, for example, Naples-based neurosurgeon [ed: a real brain surgeon, not a "rocket surgeon?" Yes.] was performing a delicate operation to remove a tumor, when he had his own little medical problem.

Well, not so little, after all:

"An Italian surgeon had a heart attack while performing a brain cancer operation but carried on until he had removed the patient's tumour."

Now, an ordinary surgeon might have stepped aside, and tended to his own immediate medical needs. Not Dr Claudio Vitale (no apparent relation):

"I couldn't leave him at such a delicate moment ...I'm not a hero, I only did my duty."

I think most of us would beg to differ. There's a big difference between a headache and a heart attack, and one could easily be forgiven for immediately addressing the latter. Dr Vitale, though, was having none of that:

"Vitale suffered chest pains while he was halfway through the brain op but refused his team's efforts to persuade him to get emergency treatment."

The good news is that both the surgeon and his patient are "already on the mend."

AIG Update: Vindication [UPDATED]

Last week, I noted that the the punitive-tax bill targeting bonus-receiving AIG execs was "clearly unconstitutional." At least one commenter took exception to that; at the time, Rick had an ally in left-leaning Harvard (Constitutional) Law Professor Lawrence Tribe. Professor Tribe opined that "the goal is not to punish corporate executives generally, but is simply to ensure the appropriate use of government funds," and thus was not a Bill of Attainder.

But that was then, and this is now:

"Harvard professor Laurence Tribe, who advised Obama during the campaign ... says he’s leaning towards seeing the new House bill to tax back all the AIG bonuses as unconstitutional."

Score one for IB (et al).

I also made the point that were such a bill to become law, it would be challenging (to put it mildly) to find competent executives to help right the listing ship of industry; after all, "who wants to take that job for free?"

Lo and behold, no less than the administration itself "has concluded that it needs the private sector to play a central role in fixing the economy. So over the weekend, the White House worked to tone down its Wall Street bashing and to win support from top bankers for the bailout plan."

Score 2 for the good guys.

Okay, enough with the "atta boy's." Back to work.

UPDATE - And thus it begins: I suspect that this is merely the first in what will be a litany of (now former) AIG execs who have "had enough:"

"It is with deep regret that I submit my notice of resignation from A.I.G. Financial Products...Most of those responsible [for the CDS's at the root of the meltdown] have left the company and have conspicuously escaped the public outrage...Many of the employees have, in the past six months, turned down job offers from more stable employers, based on A.I.G.’s assurances that the contracts would be honored."

Read the whole thing.

And remember it when the gummint has a hard time finding competent folks to rebuild the devastated companies; you own more than one.

MVNHS©: Out of this World (And Into the 3rd)

Those that favor a gummint-run health care system, ala the Brits' NHS (known to IB regulars as the MVNHS©) generally gloss over the many failings of such schemes. We've been pointing them out for years, focusing primarily on issues of cost control and rationing of services. There's now growing evidence that, rather than elevating health care, such systems actually demean those who need it:

"Appalling standards of care that may have contributed to the deaths of at least 400 patients at a hospital trust were missed repeatedly by managers and regulators...A report by the Healthcare Commission into death rates at Mid Staffordshire NHS Foundation Trust found that receptionists were given responsibility for carrying out medical checks and patients were left screaming in pain for hours."

Oh yeah, sign me right up!

One shudders to think.

But it actually gets worse:

"Families have described Third World conditions at the trust, with some patients drinking water from vases and others left on trolleys for hours without medication."

This is not the MVNHS© we thought we knew.

Also keep in mind that this hospital was repeatedly cited as a model of health care, lauded for its "elite foundation status and [continuing] to receive positive annual reports." Which begs the question: if this is the expected level of care at an elite facility, what must it be like at "normal" ones?

Tell me again why such a system is preferable to our own?

Grand Rounds is up!

Code Blog hosts this week's collection of medposts, presented as a narrative covering a lot of ground.

Social Security vs Medicare: Update

Previously, we learned that "opting out of Medicare benefits also means opting out of Social Security benefits, as well." Not that this made any sense, but there you go.

Today's email brought an update from the group that's challenging this rather strange legal loophole:

"The plaintiffs ... urged the court late last week to reject government efforts to have the case dismissed ... the plaintiffs asked the court to grant their request for summary judgment and to issue a permanent injunction barring enforcement of the illegal regulations."

So it appears that the lawsuit is still alive, and plodding forward. I've asked the group's contact person if I could interview one of the folks litigating the suit. We'll continue to keep you posted on this unique, and perhaps important, situation.

World Down Syndrome Day

Just wanted to note that today is World Down Syndrome Awareness Day. This date was chosen for its significance:

"On March 21st, 2009, World Down Syndrome Day will mark the 50th anniversary of the publication of Professor Jerome Lejeune's discovery of the extra copy of chromosome 21 which causes Down Syndrome.

Now known as trisomy-21 because of the third copy of the 21st chromosome, Down Syndrome was first described by the English doctor, John Langdon Down, in 1866 but until Professor Lejeune's publication in 1959, the ultimate cause of Down Syndrome was unknown."

The chromosome abnormality that underlies the diagnosis of Down Syndrome is known as trisomy 21 (hence 3/21).

The condition affects some 350,000 people here in the US, many of whom lead meaningful lives, participate in sports (e.g. Special Olympics, bowling) and hold steady jobs.

About Those AIG Bonuses...

The more I read about this, the more convinced I've become that:

1) The bonuses themselves comprise an inconsequential amount of the total AIG bailout (now approaching the $170 Billion mark)

2) They represent a promise to AIG employees to stay on during a time of extreme turbulence, with little hope of career advancement in the firm or elsewhere (indeed, one might be tempted to forgo mentioning one's tenure at AIG altogether). In fact, the affected employees weren't even in the division of AIG that contributed (caused?) the melt-down.

3) Congress knew of these bonuses well in advance (cf: the Dodd Amendment)

Actually, I'm with Sen Dodd (D-CT) on this: these folks should be well compensated for their service.

Now, these same Congresscritters have passed a clearly unconstitutional bill in an effort to clean up a mess of their own making. This is not just bad law, it is bad business practice: why would anyone take such a job, knowing that the compensation promised to them could be revoked at the slightest whim? This is why CEO's insist on, and get, "golden parachutes:" to entice them to come aboard a potentially sinking ship, in order to try to their best to salvage what they can.

Which brings up the next problem: we now own 80% of a failing financial giant, which is in desparate need of competent, expert helmsmanship, and we've just announced that whatever sucker takes the job can't rely on being adequately compensated for it. That's dangerous and stupid.

What happens when the next AIG falls through the floor? Will we bail them out, too? And how are we going to guarantee whomever is tapped to bring them up to snuff that they're not working pro bono?

I'll reiterate that we should never have bailed out AIG in the first place, but essentially shooting the messengers isn't going to get us out of this mess. We now own 80% of the firm, and the government now has a fiduciary responsibility to the shareholders (that's thee and me, fellow taxpayer) to do all in its power to empower AIG to right itself. That's not going to happen if it can't attract, much less retain, the caliber of executive necessary to turn things around.

As I said in a recent comment, "Hypocrisy, thy name is Congress."

Cavalcade of Risk #74: Call for Submissions

Wench Wisdom hosts next week's Cavalcade of Risk, which goes up on the 25th. Submissions are due by this coming Monday (the 23rd). Please be sure to 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.

Health Wonk Review is up

Uber-wonk David Harlow hosts this week's roundup of health care polity and policy.

If you haven't read a 'Review, you're missing a chance to see what other folks are saying, thinking and suggesting.

Update Mania: Things That End With "A"

■ COBRA/ARRA: From the mailbag, we get this inquiry from Pete Peterson:

"Has anyone addressed the Pre-x issue concerning the new law. For example it seems that an employee could be involuntary terminated without paying the premium for 5 months, then come back on the plan by paying 35% of one months premium, have both knees replaced with no pre-x conditions because the creditable coverage period does not apply.

If the participant discontinues coverage after one month the adverse carrier risk is brutal to say the least."

Unfortunately (for the carrier, at least), this is correct. ARRA defines a "late-electing person" as one who had previously been offered, and rejected, COBRA extension, and who subsequently became eligible under the new rules [ed: new "rules?" Are they really "rules" if they can be changed on a whim?]. Such a person could, indeed hop back on the plan by simply paying their portion of one month's premium, have such a procedure, then bail.

As a practical matter, though, I'm not convinced that this will be a common occurrence. For one thing, they'll still have their deductible and co-insurance, and the pre-cert requirements may well take longer than the person would have under this one-month scenario. Also, any such procudure is likely to require follow-up care, not to mention rehab, which would also take at least a few months.

■ Aetna/Humana: FoIB Rick emails that this is more likely to be a distraction than a certainty; it seems that there's more happening under the radar than in plain sight:

"WellPoint ... announced today that it has selected Availity, LLC as a strategic part of its suite of online provider solutions."

Rick explains that "Availity is working towards -- and in testing in selected Florida markets has actually achieved -- real-time claims adjudication, the Holy Grail of claims processing." One of the challenges of Consumer Driven Health Plans (e.g. HSA) is lack of hard data at time of service. Since there's no co-pay, and the provider generally has no real idea of what that claim will really cost (after repricing and depending on deductible and/or co-insurance), most folks leave the office parting with no cash. The doc then has to wait for the claim to be processed for payment to be received, from either the insured or the carrier (or some combination of the two).

A system that allows the provider to immediately know how much to collect from a patient, and the patient immediately knows what the service will cost, is a major step towards more transparent health care delivery. This is a good thing.

In related news, however, Rick reports that the aforementioned partnership now adds up to almost 50 million "medical lives, not counting Part D standalone or Med supp members, from the first, fourth, seventh and thirteenth largest insurers in the country. Hmmm. The words "too big to fail" come to mind, and not necessarily in a good way."

A year ago, I would have pooh-poohed such sentiments, but based on the AIG and Big 3 fiascos, I'm not so quick to dismiss this concern. On the other hand, there's not much we can do about it (even if we wanted to) except to hope for the best.

P&C PSA: State Farm Pulls Plush Promos

Back in the day, State Farm agents were famed for handing out free road atlases (atlasi?) to new and prospective insureds. Recently, though, they've done some image modification, and traded in maps for toys.

Unfortunately, the idea seems to have backfired a bit:

"State Farm said on Tuesday that more than 800,000 teddy bears given out in North America as part of a company promotion were being recalled because of a choking hazard."

This is, of course, serious business: if you or a loved one have received one of these, please contact your nearest SF agent for instructions on how to dispose of the dangerous trinket.

Real Life Life-Line?

One of my very favorite sci-fi authors, Robert A Heinlein, wrote a haunting short story about a scientist, Pinero, who discovered a means to literally and accurately determine one's date of death. Called "Life-Line," it was RAH's very first published story.

Today, actuaries and underwriters use "Mortality Tables" to guesstimate how long one might live. These are based not on the length of one's "world line," but the Law of Large Numbers. Obviously, an underwriter has no idea when you are going to die, just the likelihood of it in a certain timeframe.

Now, the folks at The Quiet Company have come up with their own version of Dr Pinero's device. Called the "LifeSpan Calculator," one answers a series of questions, and the LSC calculates how many years one has left on this mortal coil. It even offers suggestions on how to improve that number. It took me only a few moments to calculate my likely lifespan, and the questions were quite user-friendly.

Definitely worth a click.

A Few (More) Words on AIG [UPDATED 3/17/09 AND BUMPED]

[Please scroll down for updates. HGS]

I haven't commented on the recent kerfluffle regarding the massive bonuses planned for the former insurance behemoth's executive squad, primarily because there doesn't seem to be any need to: it's getting quite enough play in the press.

But it seems to me that remaining silent might be construed as condoning the idea, and that, of course, will not do. So, for the record, while I don't believe that these execs should be forced to commit hari kiri, I do think that any bonuses should be remanded forthwith to the federal treasury, and used to help pay off the carrier's massive debt to the citizenry.

On the gripping hand though, there's this:

Current CEO Edward M Liddy avers that he has ""grave concerns" about the impact on the firm's ability to retain talented staff "if employees believe that their compensation is subject to continued and arbitrary adjustment by the U.S. Treasury." And that may well be a valid point: if they can't attract, and retain, top-notch talent, what are the chances that they'll ever be in a position to repay us? Reason #14,287 why we never should have bailed them out in the first place.

UPDATE: In the comments, Bob takes me to task for missing the big picture:

"(T)his is a multi-faceted situation with no simple or direct solutions...The bigger problem with AIG is this. What did they do with the taxpayer money?

Apparently they used it to make several banks "whole". Billions were funneled back to Deutsche Bank, Credit Suisse, Goldman Sachs and others...

Sorry Hank, but targeting the bonuses misses the mark. There are MUCH bigger issues."

Well hey, it wouldn't be any fun if we agreed ALL the time. I think Bob's quite correct that there are other, perhaps larger issues at stake here. But it seems to me that even the appearance of impropriety, especially on such a volatile issue, is cause for a hard look.

UPDATE 2: It seems that not only are there contractual issues (which Rick also mentioned in the comments), there appears to be a specific, legal requirement to fulfill these obligations. Apparently, as the Senate was crafting the Spendulus last month, Sen Christopher Dodd (D-CT) "unexpectedly added an executive-compensation restriction to the bill. That amendment provides an “exception for contractually obligated bonuses agreed on before Feb. 11, 2009,” which exempts the very AIG bonuses Dodd and others are seeking to tax. The amendment is in the final version and is law." [emphasis added]

Although this is probably irrelevant, it should also be noted that Senator Dodd (D-CT) "was AIG’s largest single recipient of campaign donations during the 2008 election cycle with $103,100, according to opensecrets.org."

A lousy $100k? Sheesh, what a bunch of pikers!

Good Health News: Mid March Edition

First up, good news for cancer patients:

"Pfizer ... said (on March 12) that a Phase 3 trial of its Sutent cancer drug has been halted early because the drug showed "significant benefit" in patients with advanced pancreatic islet cell tumors."

And why, you may be asking, is this good news?

Because all of those cancer patients taking part in the trial "will have the option to continue taking Sutent or be switched from placebo to Sutent." One presumes that those on the placebo will opt for the "real thing," but I wonder if any of the patients experienced the "placebo effect."

Next up, good news for those who worry about suffering from Alzheimer's (or are concerned about loved ones who might):

"A new test can accurately detect Alzheimer's disease in its earliest stages, before dementia symptoms surface and widespread damage occurs."

This new test looks at the proteins in one's spinal fluid; these proteins are believed to be an indicator of Alzheimer's. The test itself was shown to be effective in almost 9 cases out of 10, accurately "predicting which patients with early memory problems and other symptoms of cognitive impairment would eventually be diagnosed with Alzheimer's."

Of course, any good news in this area is welcome, but it's important to remember that this is a predictor, not a cure.

Third, FoIB Holly Robinson emailed this link announcing some good news about ovarian cancer screenings. This dread disease is considered quite treatable if caught in the early stages, but only about 25% of these invasive cancers are detected then. A new study seems to show much promise, claiming that "postmenopausal women who are screened for ovarian cancer either by transvaginal ultrasound scan or by a blood test followed by a scan are more likely to have their cancers detected at early stages, with almost half the cancers picked up before they had spread beyond the pelvis."

So, ladies, get those screenings!

Finally, Fox News reports that there's good news for folks suffering from certain food allergies:

Extra! Extra! Read All About Grand Rounds!

Ryan DuBosar of ACP Internist blog hosts this week's roundup of top-flight medposts. He's built his edition, appropriately enough, to resemble a newspaper. Very creative, and quite well done.

Humana, Aetna Nuptials?

Doth the lady protest too much? That's the question, and the buzz, in home offices around the country:

"Aetna Inc. and Humana Inc. capped a brisk week of trading Friday when their shares rose as several reports surfaced that one insurer might want to buy the other."

So far there's scant evidence that any of this is true, but that obviously hasn't stopped the speculation [ed: which, of course, we're feeding].

This is developing, so we'll be updating as necessary.

[Hat Tip: Industry Radar]

Update 1: IF this merger takes place, it does make some sense. There's a synergy that the two carriers would offer since, combined, they'd be in pretty much the same league as the Big Boys (WellPoint and UHC). Also, this might help to solve one of Humana's problems (network issues) and, perhaps, some of Aetna's (lack of ability to actually write business). More later.

2.6 Million Served (And Satisfied)

Co-blogger Mike tipped me to this intriguing, and ultimately validating, story on an ambitious study undertaken by Aetna. Indeed, as Mike also pointed out, HR behemoth Mercer is "effectively blessing the Aetna study results." Mercer, by the way, bills itself as "the global leader for trusted HR and related financial advice, products and services."

The comprehensive, 6 year study sought to determine whether any of the charges leveled against Consumer-centric health care were valid. The most oft-cited of these canards include:

"Folks in high deductible plans skimp on preventive care."

"Folks in high deductible plans eschew important health screenings like diabetes and breast and cervical cancer."

"Folks in high deductible plans skip needed meds, especially for chronic conditions."

and

"Folks in high deductible plans don't really use the online resources available to them any more than those with co-pay plans do."

The results of the study shatter every single one of these. It's important to note that the carriers themselves are apt to be quite objective when undertaking these studies. After all, they're not trying to get folks to switch from another carrier, only to determine whether or not their own products are serving the needs of their insureds. This is important in assessing the validity and bias of such studies.

What Aetna found was fascinating, and extremely good news for those of us who advocate more Consumer Driven Health Care (CDHC):

Turns out that insureds in CDH Plans seek out "preventive care more often than the control matched PPO population. Furthermore, Aetna HealthFund members had 10 percent lower primary care physician utilization for non-routine services and 15 percent lower utilization of specialist care" than those in co-pay plans.

Also, these folks "(a)ccess the same or higher levels of screenings for diabetes and breast and cervical cancer, compared to members in traditional PPO products."

And they use "the prescription drugs necessary to treat chronic conditions such as diabetes, congestive heart failure, coronary artery disease and high cholesterol at similar or higher rates than PPO members."

Finally, folks with "skin in the game" utilize those "consumer tools and information ... at twice the rate compared to PPO members."

Game, set and match.

Now, this isn't to say that CDH plans are a panacea, as they clearly are not. But it should lay to rest the most often heard objections to their use. The one issue which the study didn't seem to address was cost-differential with regard to co-pay plans, and between various out-of-pocket levels of HDHP's. I still think that carreirs need to look at these results as indicative of High Deductible Plans' ability to keep costs down and insureds healthy, and thus put some downward pressure on pricing of these plans.

ERISA-roni, that San Francisco treat!

[Welcome Industry Radar and Kaiser Network readers!]

This article from the WSJ Health Blog reports the progress of Golden Gate Restaurant Association v. City of San Francisco. The Supreme Court has now agreed to hear an appeal from the judgment of the Ninth Circuit Court of Appeals, which reversed the original trial court’s decision.

IMO, Golden Gate Restaurant Association wins in the Supreme Court, and the City loses. The Ninth Circuit is frequently reversed.

The WSJ article fails to clarify a frequent misrepresentation in the media about the fundamental legal issue in this case. Specifically, the fundamental issue is regulation of “insurance plans” vs the regulation of "ERISA plans”. This distinction is essential to understand.

An insurance plan operates under a contract of insurance issued by an insurance company. The States are authorized to regulate insurers and the business of insurance. In contrast, an ERISA benefit plan is provided under a contract of administrative services only. In an ERISA plan, there is is no contract of insurance, no insurance company, and no insurance premiums. These plans are called ERISA plans because they are regulated by the Federal law called ERISA.

Most of the largest employers/plan sponsors, nationally and in San Francisco, manage their employee benefits thru ERISA plans. I think the Restaurant Association does the same and therefore the fundamental premise of their objection is that their plan is not subject to regulation by the City or the State. (If otherwise, I doubt the Association would have chosen to incur the expense of a trial and, now, two appeals. I also believe the Supreme Court would not waste its time if this were about an insurance plan – which the States have clear authority to regulate.)

I believe the City attorneys understand the law - but the City went ahead anyway. Why? I think because, if ERISA plans are ruled exempt from the requirements and tax the City wants to impose, then the City’s ability to manage its scheme of insurance for the uninsured would be greatly diminished. I understand the City's motivation. I just think the City is wrong on the law.

Another Treat-Worthy Carrier Trick

[Welcome Industry Radar readers!]

Regular readers are aware of our (ever growing) Stupid Carrier Trick series. Lesser known (and less populated) is our Treat Worthy Carrier series. I'm tickled pink to present our latest addition, Assurity Life Insurance Company.

I use Assurity primarily for blue and gray collar disability income plans. These are typically folks whom the "Big Boys" eschew in favor of doctors, lawyers and politicians. The particular case which has earned Assurity its place in the pantheon of "Good Guys" is somewhat unique:

Mike [ed: not his real name] works for a company which has tasked him with two seemingly unrelated jobs: one is inside sales, with little chance of major injury; the other involves some pretty hefty manual labor "out in the field." One of the primary factors in disability insurance pricing is occupation: more "hands on" jobs generate higher premiums. Because I tend to be fairly conservative in quoting policies, I erred on the side of caution and assigned Mike's case a relatively low occupation class, which resulted in a sizeable (but still reasonable) premium. I submitted his completed application, and waited.

A week or so later, I received an email from Assurity informing me of two things: first, that I had used an outdated app (my fault for not checking the date), which necessitated Mike having to complete a new one (not a huge deal, but my bad).

The second item regarded his occupation class: in reviewing the application, the underwriter noticed the dual jobs, and asked me to confirm with Mike more precisely the division of his labors. The underwriter felt that Mike may well qualify for a lower rate. So while Mike was re-completing the application, I had him be more precise in describing his typical day. We sent that off, and awaited an answer.

When the policy arrived, I was, to put it mildly, pleasantly surprised to see that the premium was reduced by some 40 percent; Mike had indeed qualified for the higher job classification.

This is an example of a carrier not just doing the right thing, but actively engaged in doing so. It is obviously a big part of their corporate culture. I pay little (if any) attention to carriers' "mission statements;" rather, I look at how they do business. It's obvious that Assurity looks for ways to make it easier on their clients (and would-be clients), and for that, they earn an IB Treat.

Kudos, Assurity Life.

[And a Very Special Thank You to Shannon Smith at Assurity]

Europe to MVNHS©: More Rationing, Faster

To be fair, this one isn't entirely the doing of the MVNHS©:

"Patients face a significant increase in waiting times for operations as 'insane' European rules mean doctors' hours are cut so much medics will not be able to cope."

Recently, the British health service has been trying to cut wait times for patients, enjoying modest success in that endeavor. But "two steps forward, one step back" seems to be the order of the day, as new rules will limit "junior doctor's" work week, cutting them by some 15%. These new rules, called the European Working Time Directive [ed: insert punchline here], severely curtail how many hours physicians can work, and thus patients' access is reduced, as well.

Of course, when the gummint runs health care, these are the kinds of things that will happen, regardless of the consequences to the public. One might presume that our own providers would chaff under such a system, but I'm not convinced. In the event, this results in even less health care for our cousins Across the Pond:

"It means patients will have to wait months for routine operations as surgeons prioritise emergencies rather than scheduled cases."

These reductions translate into real lossses, since it's estimated that the average hospital will lose the equivalent of three interns. This is, of course, rationing of health care, which may well be necessary to reduce costs. The question is whether we'd be satisfied wth a system that essentially dictated how many hours a provider could work. That seems to be rather shortsighted.

Survey Says: Cavalcade of Risk!

Jason Shafrin hosts a clever and interesting Cavalcade of Risk. He even includes a Surgeon General's warning, so you know it's risky.

Enjoy!

Ohio & COBRA/ARRA: More Questions than Answers [UPDATED]

[Welcome Industry Radar readers!]

[Please scroll to bottom for update]

In looking through the latest missive from the (Ohio) Department of Insurance, I was drawn to this innocuous-looking requirement:

"Employers are required to send a notice to former employees so that former employees can elect to continue their group coverage and receive the subsidy."

What, exactly, does that mean? As we've discussed before, it's just not cost-effective for a small employer to contract out this kind of administration, but it would be nice to know what, exactly, is going to be required of him in the event a former employee (exployee?) becomes eligible under this new program. Then, too, there are budget considerations regarding how far back the employer will need to pay.

So I poked around the DOI and DOL websites for a bit, but was unable to find anything helpful. The phone seemed to beckon me, and so I called Columbus and ended up speaking with a very nice (if befuddled) gentleman from the DOI. After introducing myself, I explained why I had called, and what had me confused. Then, I asked what it means that an employer is "required to send a notice to former employees?"

The answer was not comforting: "we really don't know yet; the legislature is working on it now." The problems include the fact that Ohio's current coverage continuation law runs for only 6 months, while COBRA/ARRA goes for up to 9. So those two have to be reconciled.

Another problem is that there's never really been any formal notice required on the state level; that is, it was up to the employee to seek out coverage. But the new law has this pesky employer requirement, which begs the question we've already mentioned. It seems to me that, with the clock already ticking, this would have been resolved and implemented. But of course, we don't want to confuse governance with common sense.

A related problem is the next sentence: "Former employees will have from the first day they are eligible until 60 days after receiving the notice to enroll." The way I read that, if one became eligible on, say December 1st, but the notice isn't received until, say April 1st (being generous and/or optimistic), how is this going to help the former employee, who now has to come up with 5 months of premium (well, 35% of premium) when they've potentially been unemployed the whole time? And, of course, the employer's 65% liability is at issue, as well.

I hate to keep saying "we'll keep you posted," but as this continues to evolve, that's the best we can do.

UPDATE: In the comments, FoIB Chad (co-blogger at Tusk and Talon) informs us that:

ARRA does require the employer (whether subject to COBRA or state continuation) to send notices to employees terminated between 9/1/08 and 12/31/09. A model notice is due to be issued by the US DOL on 3/17. For those who did not elect COBRA, coverage would be effective for coverage periods starting 2/17 or after (or 3/1 if coverage is monthly). Unlike normal COBRA, coverage is not retro to the qualifying event, rather only to the 2/17 or 3/1 date. ARRA generally does not modify state law as far as the duration of coverage.

So the coverage elected in OH should still only last for 6 months from the date of the event (e.g., if the event was 5 months ago, the EE would only get 1 month of coverage from 3/1 to 4/1). Employers/Carriers will only be able to claim a subsidy for the 6 months or less of coverage extended under OH's state continuation law. There are lots of other nuances but I'd be surprised if the DOI provides any assistance beyond leaning on your carriers to figure out, and do, whatever it is they are supposed to do.

Thank you, Chad!

Grand Rounds: Live! Edition

Dr. Jan Gurley hosts this week's edition of all that's interesting in the medblogosphere. This one's special, though, because it also includes a "LIve!" version with podcasts.

Please stop by.

Carnival of Personal Finance is up

Stock Trading to Go hosts this week's edition. Do check it out.

About Wellpoint's PBM Auction

So Wellpoint is auctioning off its in-house pharmacy benefits management company. The likely purchaser will be one of the big PBM’s whose larger volume will presumably result in lower pharmacy costs for employer plan sponsors.

This article from WSJ Health Blog quotes Citigroup analyst Charles Boorady who believes that insurers would better manage health costs and quality “if they focused on the 85 percent of health care costs that are doctors and hospitals and leave the 15 percent that’s drugs to companies that are already much better at it.”

Boorady is a very smart guy and I think what he says is true as far as it goes - - but I think he is overlooking or discounting a larger point.

Specifically, is health benefits management more effective when pharmacy data are integrated into the management model along with medical data? There’s growing evidence that the answer is yes. To the extent that’s true, an in-house PBM and an in-house medical management capacity are synergistic and neither is as effective standing alone.

To state another way, a PBM may be able to manage its 15% of total health care costs better than an insurer, but the PBM cannot directly manage the other 85% of total health care costs costs at all. The insurer can manage both - if it operates a PBM. That's a good reason for an insurer to have both medical and pharmacy management capacity.

An example is Aetna, which not only has a subsidiary PBM but also owns ActiveHealth whose business is disease management. ActiveHealth asserts that its medical results are noticeably better when it has immediate access to pharmacy records along with medical records.

Ironically, when ActiveHealth was a start-up it received substantial assistance and direction from Empire Blue Cross (today a component of Wellpoint). In retrospect, I think Empire’s failure to acquire ActiveHealth was a strategic error. Anyway, it appears that Wellpoint’s PBM today has more value to another PBM than to Wellpoint - which is probably one of the reasons it’s being auctioned off.

Cavalcade of Risk #73: Call for Submissions

Healthcare Economist Jason Shafrin hosts next week's Cavalcade of Risk, slated for the 11th. Submissions are due by this coming Monday (the 9th). Please be sure to 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.

Concierge? Mais Non...

Bob's written several posts on the idea of "concierge medicine;" that is, one pays a (flat) fee for unfettered, priority access to one's primary care physician, bypassing the normal appointment issues and, perhaps, first dollar insurance coverage for doc office visits (these plans don't help you with big ticket items like hospitalizations, surgeries, etc). Whether or not they're viable alternatives is, of course, open to debate, but they at least offer one a choice.

Unfortunately, the New York Department of Insurance thinks they run contrary to the Empire State's insurance laws:

"A New York City doctor's flat-fee, $79-a-month medical practice has run afoul of state insurance regulators who have told him to shut it down."

It seems that Dr Muney's plan, which "includes unlimited office visits, some tests and in-office surgeries," looks a bit too much like a pre-paid medical insurance plan, but lacks the requisite capitalization and legal paperwork of an actual carrier. He's currently in talks with the DOI, looking to find some way to keep the plan running without breaking any laws.

I'm actually on Dr Muney's side in this; as an insurance agent, it might seem counterintuitive to be rooting for his success, since it may be perceived as "competition." But I've always felt that competition was a good thing, and I also appreciate that he's looking for ways to help his patients gain quicker access. We'll have to wait and see if he's able to navigate the regulators' waters.

[Hat Tip: FoIB Brad Ford]

New P&C Blog

Thanks to a tip from FoIB Bill Montgomery (who, by the way, is considered the "go to guy" for vacant dwelling cover here in southwest Ohio), we learn of an outstanding blog focusing on the Property/Casualty side of the insurance business. Hosted by Tim Norris, an agent in Cincinnati, the National Real Estate Insurance Group blog offers insights on everything from umbrellas to commercial property coverage, all written in an easy-to-follow format.

Recommended.

Thursday Potpourri

■ Can we actually control cancer? That's the question being discussed by the Global Leadership Forum for Cancer Control. This international, grassroots organization believes that with "existing knowledge, it is possible to prevent at least one-third of the 10 million cases that occur annually. Where sufficient resources are available, current knowledge allows the early detection and treatment of another one-third of cases."

That seems a tall order, but perhaps they're on to something. If you're interested, they're holding their first Global Leadership Forum for Cancer Control in Canada later this year. For more info, check out their website.

■ Regular readers know that we don't do paid advertising here, but we do offer links to a few specialty products, primarily as a convenience for our clients. You may have noticed a new product at the bottom of the sidebar: "HIPAA Compliant Special Risk Medical." We're sort of ambivalent about limited benefit (aka "mini-med") plans: while they can be a terrific safety net for folks with severe, chronic health problems, they're often misused by agents who may not fully appreciate their limitations (or who don't really care about them). Still, they can be helpful because they're (usually) guaranteed issue, and will eventually cover pre-existing conditions.

That "eventually" is really the sticking point: why should one pay premiums for 6 or 12 months even before coverage for pre-existing conditions takes effect? Well, if that's your only choice, then so be it. But this new plan will cover pre-ex immediately (assuming previous coverage), neatly avoiding that problem.

■ Finally, this video from a group called "Conservatives for Patients' Rights." What I found so interesting about this video, which outlines four "pillars" of health care reform, is that it stresses (at least) two IB themes: transparency and personal responsibility. I also appreciated that it takes only about 30 or so seconds to make its point.

Health Wonk Review worth "Watching"

Brady Augustine takes a page from the comics, presenting a rather unique edition of the Health Wonk Review. Based on the new movie "Watchmen," this week's edition is short, sweet, and to the point.

Enjoy!

Windy City Treat: Connecting the Dots

Back in the day (well, a few short months ago, really), the University of Chicago Medical Center undertook to reduce its exposure to the costs associated with treating the uninsured. In particular, the neighborhood in which the Center was located, which boasted a particularly high percentage of these folks. Curiously, they also happened to be predominantly poor. And did I mention, black?

Now, one might suppose that this would have resulted in a hew and cry from that community's leadership, which also happened to share some of those demographics. After all, if you're a hospital turning away black people, one would think there was a problem, no?

As it turns out, one would be wrong:

"Michelle Obama...helped create the program, which aims to find neighborhood doctors for low-income people who were flooding the emergency room for basic treatment."

For those in the dark on this, Ms Obama's other job is currently First Lady. Interesting also is the involvement of David Axelrod, currently serving as Senior Advisor to President Obama. His PR firm was given the task of "selling" the program, dubbed the "Urban Health Initiative" to the public and in particular, the folks who live in the neighborhood surrounding the UCMC.

Does anyone else see a disconnect between the stated goals of the new administration (more access, better care) and a program designed to save a particular hospital money by turning away those most in need?

Maybe it's just me.

More ARRA/COBRA Confusion

[Welcome Industry Radar and Wall Street Journal readers!]

Received in the mail this morning a letter which included the following:

"...small employers that are exempt from COBRA (e.g. employers with less than 20 employees) but subject to state continuation laws [ed: "mini-COBRA] will have to comply with the new subsidy requirements..."

Which we already knew, but:

"The new rules require employers to send out special notices and to allow certain individuals who originally declined coverage a second opportunity to elect to continue coverage." [emphasis added]

Now, this is from a noted expert on COBRA (in fact, he's one of our favorite CE instructors on the subject), so one might presume that this could be taken as "gospel."

Not so fast.

Let's back up a moment: as we've discussed, the Spendulus included some radical changes to COBRA, one of which extended the "subsidy" to smaller groups. From what we've learned so far, this applied only to the "subsidy" itself, not the notification requirements. Until now, Ohio (for example) had none: it was up to the (former) employee to seek out that coverage continuation. COBRA requirements in that area, however, are onerous, and almost always contracted out by employers. This is cost-effective for a larger group, but prohibitive for smaller ones.

If true, this new notification requirement would be a severe blow to any small employer's budget: under COBRA, the penalties for screwing up notifications are severe and not just applicable to the employer, but to the hapless employee who was assigned the task. So many groups (and most of the smart ones) contract with a COBRA administrator to handle this chore. That's probably not an option for a group of, say 10 or 12 employees, so the temptation to do this in-house will be great.

And unwise.

I'm still not convinced that this is the new law of the land, however. We've been keeping a very close watch on this issue, and haven't seen this particular item come in, except for this letter. So I called the Department of Insurance to see if they knew about it.

They did not.

In fact, their response was to "stay tuned" because the Department of Labor (the federal agency tasked with overseeing COBRA) was still ironing out details. Better yet, I clicked on over to the DOL, and found a brief FAQ about the new rules, none of which addressed the notification issue at the state level. Ditto at the dedicated COBRA site.

So, is this fact or urban legend?

At this point, no one seems to know. We'll keep you posted.

Email of the Day

From FoIB Brian D, comes this breaking news from Washington. We're proud to have scooped the MSM on this important, ground-breaking new program: 

The Americans With No Abilities Act

Washington , DC - (Dateline March 3, 2009) President Barack Obama and the Democrat controlled Congress are considering sweeping legislation that will provide new benefits for many Americans. The Americans With No Abilities Act (AWNAA) is being hailed as a major legislative goal by advocates of the millions of Americans who lack any real skills or ambition.

"Roughly 50 percent of Americans do not possess the competence and drive necessary to carve out a meaningful role for themselves in society," said California Senator Barbara Boxer - Democrat. "We can no longer stand by and allow People of Inability (POI) to be ridiculed and passed over. With this legislation, employers will no longer be able to grant special favors to a small group of workers, simply because they have some idea of what they are doing."

In a Capitol Hill press conference, House Majority Leader Nancy Pelosi – Democrat, and Senate Majority Leader Harry Reid – Democrat - pointed to the success of the U.S. Postal Service, which has a long-standing policy of providing opportunity without regard to performance. Approximately 74 percent of postal employees lack any job skills, making this agency the single largest U.S. employer of Persons of Inability.

Private-sector industries with good records of non-discrimination against the Inept include retail sales (72%), the airline industry (68%), and home improvement warehouse stores (65%). At the state government level, the Department of Motor Vehicles also has an excellent record of hiring Persons of Inability (63%).

Under AWNAA, more than 25 million mid-level positions will be created, with important-sounding titles but little real responsibility, thus providing an illusory sense of purpose and performance.

Mandatory non-performance-based raises and promotions will be given so as to guarantee upward mobility for even the most unremarkable employees.. The legislation provides substantial tax breaks to corporations that promote a significant number of Persons of Inability into middle-management positions, and gives a tax credit to small and medium-sized businesses that agree to hire one clueless worker for every two talented hires.

Finally, the AWNAA contains tough new measures to make it more difficult to discriminate against the non-abled, banning, for example, discriminatory interview questions such as, "Do you have any skills or experience that relate to this job?"

"As a Non-abled person, I can't be expected to keep up with people who have something going for them,"said Mary Lou Gertz, who lost her position as a lug-nut twister at the GM plant in Flint, Michigan, due to her inability to remember rightey tightey, lefty loosey."This new law should be real good for people like me," Gertz added. With the passage of this bill, Gertz and millions of other untalented citizens will finally see a light at the end of the tunnel.

Said Senator Dick Durbin (Democrat-IL), "As a Senator with no abilities, I believe the same privileges that elected officials enjoy ought to be extended to every American with no abilities. It is our duty as lawmakers to provide each and every American citizen, regardless of his or her inadequacy, with some sort of space to take up in this great nation and a good salary for doing so."

Grand Rounds 5:24

FoIB David Williams, proprietor of the Health Business Blog, hosts this week's roundup of great medblog posts. Once again, it's obvious that David's taken the time and trouble to actually read each submission, and it shows in the recaps of each post.

Well done!

AIG: Chutzpah Redefined

Honestly, I had decided not to post yet another diatribe on the travails of disgraced (former) insurance giant AIG. After all, there's an ethical Rubicon that I feared to cross, given that we'd beaten up on the carrier so often of late.

This morning brought news that they were back at the trough, demanding that we taxpayers fork over another $30 Billion.

But that was then, this is now:

"In the midst of its negotiation with the federal government over revised terms of its bailout, American International Group Inc. sued the U.S. on Friday over a disputed $306 million in taxes, interest and penalties."

And guess who pays for that bit of litigation?

Thee and me.

Please remind me again why we threw them a safety net?

Told Ya So...

Earlier this week, referring to the President's "vision" of health care reform, I observed that "(h)istorically, too, such programs inevitably outgrow their initially estimated size (cf: Medicare), and become cures which are worse than the underlying disease. Thus, a big problem becomes an even bigger one, with little hope of slowing down."

Lo and behold:

"Orszag [director of the White House Office of Management and Budget] described the $634 billion the administration built into the new budget over the next 10 years -- as a “down payment” for health reform." [emphasis added]

But of course.

Far-reaching programs such as this always grow, whether by design or implementation.

And of course, no such program would be complete without its backers conflating health care with health insurance: e.g. "(r)educing premiums and other health-care costs."

Sheesh!

As our own Mike Feehan observed in the comments in a recent post:

"The difference between health care and health insurance is not mere semantics and it is not hair splitting. It's a difference that truly makes a difference.

The economic law of demand says that price and demand reach equilibrium at some point.

The more billions the government pours into subsidizing health insurance, the higher health insurance prices can go before reaching equilibrium with demand."

I certainly can't improve on that.

COBRA/Spendulus: Another Update

[Welcome Industry Radar readers!]

Just got another email from our FSA/HRA/HSA Guru, who clarifies that:

"FSAs were specifically excluded from the temporary COBRA subsidy program. There are a couple of links below that speak to the subsidy and note the exclusion of FSAs."

He also sent along this helpful link.

Thanks, Pete!