Cavalcade of Risk #79 (3rd Anniversary Edition): Call For Submissions

For our 3rd Anniversary, we're back here, where we started. Please submit your recent risk-related post by Mondy (June 1). And remember 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.

NOTE: Due to the massive amount of spam we've been getting, we're working with the hosts of the Health Wonk Review to find an alternative to Blog Carnival. Any suggestions are most welcome (as are offers to design/implement an alternative submission widget).

Health Wonk Review: Now with more "Chowdah!"

Boston Health News hosts this week's roundup of wonky posts. Be sure to stop by for seafood, baseball and thought-provoking insights.

Healthy Living and Insurance: By the Numbers

When it comes to the relationship between healthy lifestyles and insurance costs, we tend towards ambivalence: on the one hand, there's no question that choosing healthy foods and habits is a good thing; on the other, there's scant evidence that this will dramatically reduce insurance premiums.

So of course we'll muddy the waters a bit more, with some news from United HealthCare. UHC recently emailed agents some information on the (potential) relationship of healthy choices and lower premiums. Based in part on the 2009 Employer Survey on Purchasing Value in Health Care (by Watson Wyatt), we learn that two thirds of those surveyed claim their employees' poor health choices are the "biggest challenge to maintaining affordable health care coverage."

Left unremarked in the UHC email was this little tidbit:

"51 percent of companies have a CDHP in place — nearly a 9 percent increase over last year. Enrollment rates in CDHPs are also increasing at a pace of two percentage points per year, rising to 12 percent in 2008."

That's great news for those of us who think that encouraging insureds to be more proactive, and to take a greater role in their health care and insurance, is a good idea.

Another survey, this one by Buck Consultants, found that over half of the surveyed employers intended to "actively pursue a culture of health for the future." It's not clear what that means; one presumes this would include stop-smoking programs, some kind of regular excercise incentive, that kind of thing.

The carrier even included a handy flyer that can be printed out (and distributed) which recaps some of the findings and offers helpful suggestions.

Kudos to UHC for making this information available.

MassHealth: Proving Us Right

We've maintained all along that health insurance "solutions" do nothing to resolve the underlying problem of constantly increasing health care costs. And we've spent the past several years chronicling Massachusetts' (failing) efforts at forcing a government-backed plan on an unsuspecting populace.

But what do we know?

A good bit, as it turns out:

"Massachusetts took a stab at universal care by requiring every resident to buy health insurance, with the state subsidizing the premiums. The annual cost of Commonwealth Care, originally pegged at $245 million, will be $1.3 billion this year. Consequently, the state's health-care costs have spiked 42 percent in three years, and today, health- care spending is 33 percent above the national average." [ed: emphasis added]

And that's just the intro.

It's not just about increasing costs, either: even though The Bay State has more docs (per capita) than any of the other 56, average wait times have burgeoned, and it's become more and more difficult to even see certain specialists (like OB-GYN's, for example). This is apparently due in large part to so many "newly insured" (on the public's dime, of course) suddenly seeking health care. It's a major "be careful what you wish for" moment, of course: when something's free (or nearly so), demand skyrockets (cf: breakfast at Denny's).

And that's the dilemna, really: when the "solution" merely addresses the symptom (cost and availability of health insurance) without regard for the underlying problem (cost and availability of health care), then there is no real solution at all.

UPDATE: On the other hand, perhaps this idea has merit.

COBRA Made Simple

[Welcome Industry Radar readers!]

In addition to Bob's excellent one-stop-COBRA-shop and our own efforts here at IB, Humana's released a helpful video on the subject:

Public Plan or Public Enemy?

One of the favored buzz words in the current debate of health care and how to fund it is the "Public Plan." Simply stated, this would be a gummint-run, alternative system to private insurers, much like some states already use for their employees. On its face, it seems beign enough: offering a government-sponsored plan in competition with "regular" insurers would force the latter toward ever more competitive price points, while maintaining our choice of physicians and level of care.

I recently had the pleasure of "sitting in" (virtually, of course) on a panel discussion of this topic sponsored by the Heritage and New America Foundations and the Lewin Group. The panelists included representatives from all three "think tanks:" Stuart Butler (Heritage's VP of Domestic & Economic Policies), Len Nichols (New America's Director of Health Policy) and Lewin's John Sheils (Senior VP). Julie Appleby, Senior Correspondent for Kaiser Health News, moderated.

In this first of a two-part post, I'll recap some of the points made by the various panelists; in Part 2, we'll take a look "under the hood" to see what this plan is really all about.

John Sheils took point, explaining that the whole Public Plan (PP) idea is modeled on Medicare [ed: which is itself set to implode in less than 10 years.] The plan sets payment rates for providers much as Medicare does. Mr Sheils believes that Medicare currently pays about 68% of what private insurers pay for hospital expenses, and about 81% of private insurance rates for physicians.

He went on to explain that, unlike commercial insurance plans, Medicare doesn't require pre-certification for various procedures. He also stated that private insurers' admin expenses currently top out at about 13.4% [ed: we've long since debunked this particular canard, but the nature of the call was such that I could only listen, not respond]. Mr Sheils than talked about projected pricing levels for the PP.

Mr Sheils then explained that there are really two scenarios of how a PP could be implemented: a) for individuals (including the self-employed) and small firms or b) for all employers. He then went on to explain how each of these might work out for providers, but never really addressed the conundrum of "price" vs "cost (a consistent IB theme).

We then heard from Len Nichols, who opened by expressing concern over imposing Medicare pricing on all providers and care. The fundamental problem, he said, was that Medicare generally pays below cost [ed: no kidding?!]. He then blurted out that "people don't trust private insurance," but failed to provide any evidence for this assertion. Mr Nichols then picked up on the various states' plans, which are based on ERISA, which allegedly provide a "level playing field" because they must compete based on payment. Unfortunately, he failed to address the underlying problem of cost control, but we'll discuss this in Part 2.

Finally, we heard from Stuart Butler, who began by asking how each model would likely play out over time. He was particularly concerned over what he called "the down the road,"and wondered if government should manage health care. He said that the PPO option supposedly leveled the playing field, but that it is inherently unstable.

Mr Butler then turned to what he felt was a classic case of "bait-and-switch:" the Feds "wall of separation between the market and the Public Option couldn't hold," that Congress would eventually intervene [ed: cf: mortgages, cars], and that there's an inherent and insurmountable conflict of interest because, as he put it, "the government assumes the roles of both umpire and team manager."

He expressed further concern that what the electorate heard wasn't really what was said: that if one is already insured, for example, that wouldn't change. Of course that's not true, but we often hear what we want to hear. He also said that cost-shifting would increase the costs of private insurance [ed: something we've documented here at IB as regards Medicare]. He feared that the government would "cheat" later, and asked if the public was ready for a health system run by the same folks who brought us the Post Office, the DMV and the IRS. His greatest concern was that once we open the doors to congressional "oversight" there would be no "level playing field" as they required more and more benefits at lower and lower costs. He also dismissed the notion that one could argue that state and federal are comparable: no states are as powerful as the Feds. He argued that the Public Plan would control costs by controlling how much is paid.

In Part 2, we dissect what was said, and explain why the PP option isn't really about choice at all, but simply another name for government-run health care.

[Hat Tip: Elizabeth Carpenter]

Grand Rounds is up

Hosted this week at See it First, don't miss this great collection of posts focusing on the realities of health care.

Memorial Day, 2009

In Flanders Fields

By: Lieutenant Colonel John McCrae, MD (1872-1918)

Canadian Army

In Flanders Fields the poppies blow

Between the crosses row on row,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below.

We are the Dead. Short days ago

We lived, felt dawn, saw sunset glow,

Loved and were loved, and now we lie

In Flanders fields.

Take up our quarrel with the foe:

To you from failing hands we throw

The torch; be yours to hold it high.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields.

We remember.

Carnival of Personal Finance - Memorial Day Edition

Lisa at Greener Pastures hosts this week's roundup of all things financial.

More on BlogSwag

As we've noted before, we don't "do" paid advertising here at IB. This was a conscious decision I made when we began: I believed then, as I believe now, that having paid ("click through") advertising would present potential conflicts of interest, and I really had no stomach for that. Over the years, we've received several offers of products or services for review, and have taken advantage of exactly one (our one and only book review). I also received an (unsolicited) package from the Minnesota Blue Cross touting their (then new) transparency efforts.

Of course, there have been other offers, but we've shied away from them. Even my review of iTraige was based on my having paid full retail (almost $2!) for the privilege.

So what's my point? Well, BlogSwag is about to come under a rather significant microcope, "under a coming set of Federal Trade Commission guidelines designed to clarify how companies can court bloggers to write about their products."

On the one hand, I'm skeptical that the FTC has the manpower to actually police, let alone enforce, any such "guidelines." And I'm not really sure that they have the authority to do so (although I'd welcome any light that may be shed on that by our more legally astute readers). On the other, I certainly think that, as readers and consumers, we're entitled to know whether or not a given blogger has a vested interest in "pushing" a particular product or service. I don't have any particular issue with bloggers posting glowing reviews, but if credibility is our sole asset, it seems to me that how we obtained that which is being reviewed is relevant.

Credit, Taxes and (the new) Law of the Land

With the blitz of radio and TV plugs for debt relief, and the new credit reg's recently passed in DC, folks may be engaging in some premature celebration.

As Taxblogger Extraordinaire Joe Kristan points out, "Angela Bibb-Merritt ran up over $112,000 in credit card debt ... hired a debt-relief outfit and got $10,888 of the balance forgiven ..." and thus may owe some major taxes.

Read the whole thing.

What's EMTALA? A Chevrolet?

The doc at M.D.O.D. had a pretty good response for Hugh Hewitt, and he almost convinces me – but no.

Let’s start by asking: was this doc engaged in health care policy leadership during the 40 years that preceded EMTALA? I'd guess not. Were most other physicians engaged? No.

I believe that physicians, by their failure to effectively assert leadership in health care policy, allowed what this doc calls “professional arguers” to gain control of it. I also believe that, up to just a few years ago, physicians were mostly content with this arrangement because they were left alone to charge fee-for-service based on U & C.

Let’s now ask whether the government suddenly overthrew private medicine? Or did the government come in on little cats' feet, step by step, year by year, always with a promise of doing something good for the people? Yeah, you know the answer. And so gradually government insurance types - and private insurance types for that matter – filled the vacuum of health care policy and administrative control that was being ignored by physicians. Nature truly does abhor a vacuum.

And there are consequences for inaction.

Physicians find they don’t like taking policy direction from the administrators who filled the vacuum that physicians largely created.

So yes, I think it’s an excuse - not to mention a fig leaf over the past - for this doc now to suggest that he and other physicians were simply swept along as passive victims of professional arguers, until one day they were ambushed by EMTALA - the final outrage. And after wandering around in their wilderness of inaction for 40 years, this doc now suggests that physicians believe it’s too late for action. Too late! Resistance is futile! So the better course is to “muddle through to the inevitable” which I gather means toss in the sponge and take the John Galt exit off the Hippocratic Highway. Yeah, sounds like a pity-party to me.

I have hoped and advocated for years for physician leadership in health care policy. I still think that is what the country needs. I hope for it – but encountering continual physician excuses for physician inaction makes me doubt it will ever happen.

And so we will get our government health care controlled by politicians and so docs will slowly turn into government drones and so the government will declare a great victory for the people. And the people will rejoice. Remember that, in the end, Winston Smith decided that he loved Big Brother.

Oh yeah, and there will be political patronage jobs in health care until the end of time.

So let it be written, so let it be done.

I can scarcely contain my enthusiasm.

Maybe Doctor's AREN'T So Stupid...

A few months ago, we raised eyebrows (and hackles) with our assertion that physicians are, as a group, stupid. Thanks to Blogfather Hugh Hewitt, I found this post, by a "semi-young, semi-burned out Emergency Physician," that lays the blame squarely on EMTALA:

"I believe that after EMTALA was crammed down our throats in 1986 we all saw the writing on the wall and have simply been trying to muddle through to the inevitable."

While the post runs a bit long, it's worth every minute.

UPDATE: Mike has a very different take on the good doctor's diatribe. Upon further reflection, I think his is much more defensible.

Cavalcade of Risk #78 is up!

Richard Eskow hosts this week's edition, dodging a myriad of "spamvertisements" to bring us a well-focused collection of risky posts.

Thanks, Richard!

Sen Kennedy: Good News and Bad News

First the good news: Sen Kennedy's brain cancer appears to be in remission. Regardless of how one views his politics (let alone lifestyle), it's always a blessing when folks are able to beat back their illness.

Now the bad: Under the health care plan that Sen Kennedy and his colleagues would impose on us, such an outcome would be unlikely. That's because the centerpiece of their party's plan is the use of cost/benefit analyses, which bodes ill for the sickest among us.

As we've seen time and again, those most at risk in such a system are the ones least likely to be approved for treatment. Of course, if the idea is to ration health care, this makes sense; if you're dying, there's probably no real incentive to bother getting out to vote.

Something to consider if you're leaning toward supporting such a scheme.

[Hat Tip: RedState]

HSA News: "When and How Much" edition

Nothing dramatic, but two recent items may be useful for readers. The first, for those who reside in the Beehive State, clarifies that the “establishment date” of an HSA (the "account" portion of a Health Savings Account plan) is the "first day that an account holder is covered by a high-deductible health plan (HDHP). Previously, an HSA wasn’t considered established until the account was both open and funded." In other words, one had to actually "activate" the account (by depositing money into it) before it was considered "live."

This was a problem for folks who use their accounts on a "revolving door" method (waiting for an actual expense before funding the account). That dilemna is now resolved, at least for those in Utah.

The second item is news that 2010 will see increases in both the amount one may contribute to the HSA and the minimum deductible required for a plan to be HSA-compliant. For singles, the max contribution will go to $3050 (an increase of $50, or about 2%); for families, it'll be $6150 (up $200, or a bit over 3%).

On the other hand, the minimum deductible for single cover increases from $1150 to $1200 for singles (over 4%), while the minimum family deductible goes to $2400 (also about 4%). While these numbers aren't large, they are significant: the percentage increase in minimum deductibles is almost twice that for tax-advantaged contributions to help pay them. That's disturbing.

Grand Rounds: Special Edition

Health Care Technology News hosts this week's edition of health care posts, with a special emphasis on Health Care Reform.

Carnival of Personal Finance is up

Debbie Dragon hosts this week's roundup of finance-related posts, with a "Pay it Forward" theme.

Ve haf vays . . .

[Welcome Industry Radar readers!]

For those who don’t like the free health care that is already, er, freely available, you will really not love the health care planned for delivery to you by crusaders such as the new head of the CDC, Thomas Frieden:

. . . an infectious disease specialist who is known mainly as an enthusiastic advocate of New York's strict smoking ban, heavy cigarette taxes, trans fat ban, and mandatory calorie counts on restaurant menu boards . . .

It's true that unhealthy behaviors affect the government's cost e.g. Medicaid; CHIP; benefits for employees of the City of NY; etc. That means these behaviors raise the tax burden. Hmmm, so as long as we're raising taxes, the thinking goes, why not instead raise taxes to finance "programs" designed to eliminate these behaviors? This motive is couched in benevolence - after all, it's "for your own good," is it not?

And when the government is financing all of "health care", just imagine all your behaviors it can think of to regulate, to save taxpayer money, "for your own good."

The entire linked article is worth thinking about. Thanks be to Jacob Sullum at Reason Hit & Run.

If this topic piques your interest I also highly recommend this short story - if you can find it. Hint: it seems like SF, but is actually a parable of a possible future. Certain characters in this story are truly trying to bring “wellness” to humankind. Their mission is benevolent and they carry it out out with integrity. Yet the result is . . . well, you read it. Worth your time - if you can find it.

Wellness = Health Care

ABC Widgets doesn't just watch all its employees toddle off to its competitors. It also hires new employees.

If "wellness" were more prevalent, those new employees would bring with them whatever health improvements were gained from their previous employer's "wellness program". So ABC Widgets, by offering a wellness program to its employees, would not necessarily be improving its competitor's bottom line. If, that is, "wellness" were more prevalent.

Well then, why isn't "wellness" more prevalent?

And must "wellness" be a "program" that you pay someone to "provide" for you?

I think wellness is health care. The so-called health care debate is not really about health care, it is about medical care. That may be a fine point, and so long as the discussion is really about medical care, perhaps no harm is done. But I think when the attention turns to wellness the distinction must be drawn between health care and medical care. And that is when the similarity (I would say equivalence) of health care and wellness becomes apparent.

Whichever you prefer to call it, the terms wellness and health care include what we can do for ourselves, to keep ourselves . . . healthy.

We can exercise (free). We can get adequate sleep (free). We can steer clear of substance abuse of all kinds (free). We can keep a reasonable diet (free). We can always wash our hands (free). We can hold it down to 85 on the Interstate (free). We can stop smoking or never start (better than free). To a great extent we already have free health care in the U.S.

Why, I wonder, aren’t more people taking advantage of free health care? Free is affordable. What's the problem?

Maybe we're just too busy to do these free things for ourselves. Maybe we're too occupied debating the need for someone to bring us a "program" to "deliver" a lot of "health care" from "providers" who supply it at "affordable" cost. Sounds to me like the present debate.

And, maybe, we are distracted because the present debate is being conducted in terms that are unclear, inconsistent and confusing. Examples? (1) Health care and medical care are the same; (2) “affordable coverage” can somehow reduce the cost of medical care instead of the other way around; (3) wellness is a program that should be included in an insurance plan. There are other examples.

He Said, They Said

Earlier this week, both Bob and I weighed in on the president's proposed health care "plans" (such as they are), with particular emphasis on how the health care and health insurance industries reacted to his initiatives.

Unfortunately, The O-man (to borrow a phrase from Bob), may have significantly overstated his case:

"Hospitals and insurance companies said Thursday that President Obama had substantially overstated their promise earlier this week to reduce the growth of health spending."

Ooops.

Readers may recall that the health care industry had (allegedly) promised some $2 trillion in cuts over the next decade; according to The Gray Lady, "Health care leaders ... say they agreed to slow health spending in a more gradual way and did not pledge specific year-by-year cuts."

As the song goes, "You say tomato, I say hippopotamus."

In point of fact, the American Hospital Association (about whose gloom-and-doom outlook we reported earlier this month) specifically contradicted the administration, adding that the organization "did not commit to support the ‘Obama health plan’ or budget. No such reform plan exists at this time.”

Is this train wreck being derailed?

On the health care financing side of the equation, a spokescritter for America’s Health Insurance Plans (an organization which itself is not exactly the brightest light in the harbor) clarified that "savings would “ramp up” gradually as the growth of health spending slowed." Now where have we heard that tune before? Oh yeah, right here at IB.

Meanwhile, our esteemed legislators are busy hunting for "savings that could be certified by the Congressional Budget Office, the official scorekeeper, so the money could be used to pay for coverage of the uninsured."

Interesting metaphor: is this all just a game to them?

If it is, health care providers aren't in the mood to play: "Mr. Pollack [AHA's Executive VP] assured hospital executives that the promised savings “are not subject to rigid ‘scoring’ rules used by the Congressional Budget Office.”

How reassuring.

Cavalcade of Risk #78: Call for Submissions

Richard Eskow hosts next week's Cavalcade of Risk. Submissions are due by Monday the 18th, and the Cav goes live on the 20th. 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.

The Health Wonk Review is up!

For all of you that have been waiting...This week's Health Wonk Review is at The Workers Comp Insider.

Does Wellness Work?

Got an email the other day from the General Agency through which I write most of my group business. They have an electronic "newsletter" with various announcements from the carriers with which they work. One of these, Medical Mutual of Ohio, recently completed a study with the University of Michigan's Health Management Research Center; the study concerned MMO's own employees' experience with company-sponsored wellness programs.

I would prefer to have a link to the study for our readers to check the results against the conclusions, but have been unable to find one. I did contact the media folks at MMO, who directed me to the Research Center's Dr Dee Eddington. I emailed Dr E requesting either a link or a copy of the findings, but he has not yet responded. I'll update this post if/when I receive a reply.

According to the newsletter, MMo has been tracking certain employee health metrics, beginning in 2003. These include "employee health and fitness. Wellness for Life programs include the Rewards Program, the Health Risk Assessment, on-site health screenings, participation in Weight Watchers and online Healthy Living Programs."

In 2008, they turned their data over to Dr E and his team for analysis. The findings seem pretty optimistic:

■ The number of employees at high and medium risk of developing chronic disease decreased, while the number of employees at low risk increased by fi ve percent. Lowering the number of risk factors that lead to disease means employees are getting healthier.

■ The number of employees at high risk for chronic disease associated with a low level of physical activity decreased by seven percent. In fact, in 2008 over half of MMO’s employees made use of the Wellness Center or their own community fitness center.

■ Medical costs increased less year-over-year for employees who participated in Wellness for Life activities compared to non-participants. The increase in medical costs was $268 less for employees who participated in wellness programs versus those who did not.

Now, I'm generally reluctant to even write about these kinds of things because they lack corroboration. But I think the subject's important enough to at least report, and will leave its credibility to the judgment of our readers. If true, this may indicate that such programs, if properly implemented and incentivized, show promise in reducing health care utilization. Larger groups, which are more likely to be self-funded, may even see some health insurance savings.

From a broader perspective, this could have positive effects on insurance rates in general (although they'll likely be subtle and broad-based): if it's true that health care costs drive health insurance costs (and we've demonstrated that they do), then lowering the cost of care should have some mitigating effect on rates.

Time will tell.

Exit question: were stop-smoking prescription meds included in any of the "Wellness for Life" programs and, if so, were they helpful? Further question: if they were included, and helpful, will they be added to the covered rx list?

Robbing Peter, Paul

If we posit that an "overhaul" of how we deliver and pay for health care is going to cost some major moola (and it will), then the question "from whence will it come" becomes terribly important. As we recently noted, one proposal puts the onus on providers, in an effort (however misguided) to put the brakes on the cost of delivering health care.

Now comes word that part of how we'll pay for that care is going to come from increased taxes on life insurers [ed: But of course!]. According to Morningstar (a financial news service), "The budget also seeks to take away some tax breaks for the life insurance industry, raising $12.7 billion over 10 years, according to the White House estimate." Recently, of course, most WH "estimates" have turned out to be "epic fails." This one strikes me as following in that vein.

The Morningstar piece reports that carriers use "special rules when determining how much to deduct for dividends received on investments in common stock. The White House is proposing to further restrict those deductions." So restricting deductions is supposed to generate income? Ooookay. The reality, of course, is that the affected carriers' increased cost of doing business will simply be passed along to the consumer. Great idea in a tanking economy.

The article goes on to say that the O-Man is looking to do away with "some interest expense related to life insurance [that] companies take out on "key personnel," which under current rules may be deducted." It's not clear where that comes from: so-called "key man policies" aren't generally deductible, and we've already witnessed the demise of COLI.

In a move that could appeal only to uber-wonks, the administration is also targeting "the pro-rata interest expense disallowance rule for contracts covering a business’s employees, officers or directors." [ed: Are there closed captions for any of this?] Apparently, the idea is to stop certain businesses from deducting what had been deductible interest expenses based on the value of life insurance policies. The O-man "estimates" that this will generate an additional $8 billion or so over the next 10 years. Sure.

Here's the thing: for most people, the nature of these proposals might seem, well, unimportant. But they'll have a very real impact on the cost of insurance, and on most other industries' bottom lines and, hence, our pocketbooks.

[Hat Tip: FoIB Jeff Milne]

Health Care for Dead People?

[ed: Ah, the dangers of waiting. I actually wrote this post yesterday (Tuesday) but decided to "sandbag" it for today (Wednesday). In case you missed it, however, Bob has an excellent take on the same story, with a bit of a different spin.]

Not an unlikely consequence if the Universal Care folks get their way. After all, it's likely that the same (kind of) folks who administer Social Security would be in charge of our health care:

"Millions of Americans on Social Security are receiving $250 checks as part of the president’s stimulus plan — including an Anne Arundel woman who’s dead."

Of course, there's a perfectly valid and reasonable explanation:

"Social Security representatives said ... Of the about 52 million checks that have been mailed out, about 10,000 of those have been sent to people who are deceased."

Oh, goody.

I can't wait for gummint run health care.

Another "D'OH!" Moment, Rx-Style

If your employer paid for your groceries, wouldn't you eat a lot more steak (vegetarians excepted, of course)?

What if the guy down the street offered to make your car payments? You'd be at the Beemer dealer ASAP, right?

And what if your cousin offered to buy you a boat? You'd probably opt for the yacht over the canoe, wouldn't you?

So why is this a shocker?

"Many more Americans have been using prescription drugs to treat mental illness since 1996, in part because of expanded insurance coverage and greater familiarity with the drugs among primary care doctors."

Wow, never saw that one coming, did we?

That's part of the problem with how we currently finance health care: there are so many (expensive) mandated insurance benefits that it's almost a challenge to spend them all. Mental health parity mandates make such meds more accessible and affordable. Now, I'm all for affordability - to a point. That point is where folks take a look at the low cost of care (since someone else is ostensibly paying for it), and that leads to over-utilization and hence, higher rates.

This part's scary:

"[Researchers] said 73 percent more adults and 50 percent more children are using drugs to treat mental illness than in 1996."

Are there really half again as many pyschotic/neurotic kids now than a scant 13 years ago? Should so many of our progeny be on potentially dangerous mood-altering drugs? I don't know (I'm not a doc), but that's certainly a valid - and important - question.

So why aren't we asking it?

The adult side of the equation isn't much better: "Among adults over 65, use of so-called psychotropic drugs — which include antidepressants, antipsychotics and Alzheimer's medicines — doubled between 1996 and 2006."

I can see where the new Alzheimer's meds are critical (regular readers know why), but are there really that many depressed seniors? Maybe, but then oughtn't we be asking why?

Of course, when all you have is a hammer, a lot of medical problems look like nails:

"... expanded drug coverage under Medicare, the federal insurance program for the elderly, and the State Children's Health Insurance Program for poor children, helped make such drugs more affordable."

Is that a feature or a bug?

[Hat Tip: Holly Robinson]

Blawg Review (new for us)

Fellow wonk David Harlow is hosting this week's edition of the Blawg (law blog) Review, featuring a roundup of posts about the President's first 100 days in office. Lots to read, and lots of food for thought (although some may give you indigestion).

Recommended.

The Lady with the Lamp (and Grand Rounds)

The folks at Health Blogs Observatory host this week's Grand Rounds, celebrating the birthday of Florence Nightingale. It's a big 'un, too, so head on over!

Oh, Sure: NOW They Get It!

[Welcome Industry Radar readers!]

For some 4 and a half years, IB's most significant and oft-repeated message has been that health care costs drive health insurance costs. Finally, it appears that someone has listened, but whether or not it's too little or too late remains to be seen:

"Leaders of the health care industry have offered $2 trillion in spending reductions over 10 years. The goal is to make insurance more affordable so the government does not create a system to enroll middle-class workers and their families that directly competes with the health care industry."

That translates to an average of $200 billion per year, which is a non-trivial amount. Is it enough? Good question. A better one would be: and from where would these cuts come? Providers are already screaming about reduced reimbursements from both Medicare and insurers. The reality is that this seems both irresponsible and unlikely.

How's that, you ask?

Well, let's deal with the latter:

"The groups concede that their prices are not going down, they are merely slowing the rate of growth. But economists say the move would create breathing room to help provide health insurance to an estimated 50 million Americans who now go without it. "

Kudos to the economists who seem to "get" that health insurance costs are driven, to a large extent, by health care costs. Raspberries, however, to the folks who think that merely slowing the rate of growth (by how much is left unspecified) will significantly impact the problem. Yes, it's a step in the right direction, but until there's a push for more personal responsibility (and accountability) in both the delivery and financing of health care, we're merely slowing down, not changing direction.

The irresponsible part is neatly summed up about halfway through the Fox piece:

"There's no detail on how the savings pledge would be enforced. And, critically, the promised savings in private health care costs would accrue to society as a whole, not just the federal government. That's a crucial distinction because specific federal savings are needed to help pay for the cost of expanding coverage."

This is a policy statement, not a plan of action (which seems to be the MO of our current political class). Just how does one go about implementing these lofty goals? An email I (perhaps not coincidentally) received this morning reported that "UnitedHealth Group Executive Vice President Simon Stevens spoke about how health care coverage for all Americans is attainable and can be funded by slowing the growth in health care spending in the United States." He made this statement late last month while addressing the Illinois Chamber of Commerce Employer Health Care Conference in Chicago.

If we posit that health care spending will slow, generating enough funds to attain "universal coverage," who's responsible for the "universal" part? It certainly implies that there will be some kind of mandate requiring everyone to buy insurance, whether they want to or not. Does this mean that carriers will be forced to issue coverage on everyone? We've seen how well that works: in every instance, the cost of health insurance skyrocketed. Where are the (alleged) savings then?

Why is it that we see no concrete insurance policy criteria? How about we delete some (maybe even most) of the expensive mandated benefits, and increase deductibles? And if we must require certain benefits, how about some that benefit everyone, not just a politically-connected few? Preventive care benefits, for example, can help to cut costs over time.

As we've seen time and again, there seems to be no move to address the underlying premise: when someone else is paying for our care, money and responsibility are no object. How about we take a look in the mirror, instead of at Washington?

Carnival of Personal Finance now online

William at Earn What You Spend blog hosts this week's roundup of finance-related posts. It's chock full of help for the budget-consious.

The REAL Face of Nationalized Health Care

As Mike is fond of saying, "if you think health care's expensive now, just wait 'til it's free." Not much to argue with there, but readers might think he's talking only about money.

Unfortunately, "cost" is about more than just dollars and cents, it's about people's health and even lives. Still dubious?

Truth to power.

[Hat Tip: Michelle Malkin]

Laudable Carrier Tricks

[Welcome Industry Radar readers!]

Sometimes, carriers surprise us by "doing the right thing" without being asked. Case in point: Just received an email from Anthem Blue Cross/Blue Shield outlining their response to the Swine Flu kerfluffle:

· Making changes to our formulary to ensure members with pharmacy benefits are covered for Tamiflu® or Relenza® without the need for prior authorization.

· Complying with state and federal regulatory guidelines for care, including those that override benefit language.

· Providing educational information to our employer groups and members about swine flu.

Of these, the most critical is the change on rx benefit: this saves the client an office visit co-pay, and (more importantly) gets the med to the patient much more quickly.

Kudos!

Do You Know the Way to T-A-A?

FoIB Rick B tips us to a little known, but well-established, Federal program that's been around since the early 60's. The Trade Adjustment Assistance program began in 1962 as part of a major labor law overhaul. It was originally intended to help workers whose jobs were shipped overseas by helping them obtain new jobs at pay similar to their previous employment. It's since been expanded to offer additional benefits.

Unlike "regular" unemployment compensation coverage, TAA funds are accessed by groups of laid-off folks: a group of newly unemployed workers file with the Department of Labor, if that group is approved each person in it can then apply for the services and benefits that he or she needs.The criteria seems to be based on proving that these workers' jobs have been sent outside the country (or they've suffered a significant reduction in hours and income as a result of outsourcing). Rick believes that this program is a major reason why Michigan and Ohio (with relatively high unemployment rates) still sport a lower than average percentage of uninsureds. Part of that reason is that the taxpayer picks up 65% of one's group insurance premium (deja vu all over again) for up to two years, and the new COBRA/ARRA program expanded that rate to 80%.

Interestingly, this newly expanded subsidy comes via a mechanism called the Health Coverage Tax Credit, which is now available to eligible employees retroactively: the newly expanded program provides eligible employees "with retroactive payments to help cover up-front costs of obtaining health coverage prior to the start of HCTC." It also applies, to some extent, to individual states' "mini-COBRA" programs.

Of course, if someone else is picking up 80% of your tab, it's a lot easier to afford to stay on the plan. Rick posits that the TAA was essentially a starting point for COBRA/ARRA: after all, why start from scratch? That makes a lot of sense, since it's an already established program easily adapted to other, similar efforts.

Rx Cyberjacking [UPDATED AND BUMPED: 5/7/09]

[UPDATED - Please scroll down]

[Welcome Industry Radar readers!]

On the one hand, EMR (electronic medical records) promises convenience and efficiency. Having one's records easily accessible by one's provider saves both parties time, and can help avoid potentially dangerous medication interaction problems.

On the other hand, one's data is only as convenient and safe as the holder of that data makes it. In Virginia, for example, the state has set up a website for licensed pharmacists to track potential prescription drug abuse. Unfortunately, the firewall protecting this sensitive information wasn't as effective as they might have believed: hackers broke into the system, deleting "records on more than 8 million patients and replaced the site's homepage with a ransom note demanding $10 million for the return of the records."

The news item is based on a Wikileaks entry that claims to include a copy of the ransom note. It's hard to verify that, since it's just text, not a picture of the note itself. Naturally skeptical, I clicked on over to the Virginia Department of Health's website, hoping to find either confirmation or denial. Unfortunately, this is what I found at the top of the relevant page:

"The Virginia Department of Health Professions is currently experiencing technical difficulties which affect computer and email systems. We apologize for any inconvenience this may cause."

Ooops.

While this kind of news makes interesting, and perhaps important, blog fodder, I can't in good conscience comment as if this is fact. We'll continue to follow this, updating and expanding on this post.

[Hat Tip: Holly Robinson]

5/6/09: New information is coming online about this bizarre situation. According to Fox News:

"An FBI official has confirmed that the FBI, along with state police in Virginia, have launched an investigation into a $10 million ransom demanded by a hacker or hackers who say they have stolen nearly 8.3 million patient records from a Virginia government Web site that tracks prescription-drug abuse."

The Prescription Monitoring Program discussed in the original post is still offline, which is causing even more speculation, but which may be indicative of a simple server crash. According to the news story, though, a spokescritter with the Virginia Department of Health claims that the "Prescription Monitoring Program Web site is now secure," although there's nothing to corroborate (or refute) her statement.

Since we have only the hacker's word that the data was breached, I'd prefer not to speculate, but we'll keep our readers posted.

5/7/09: It appears that the site is now back online. According to a statement from the Director of the Department of Health Professions, "A criminal investigation is currently underway regarding a potential security breach of the Virginia Department of Health Profession’s (DHP) Prescription Monitoring Program on Thursday, April 30. While DHP cannot comment directly on an ongoing investigation, we can assure the public that all precautions are being taken for DHP operations to continue safely and securely " [emphasis added]

Gee, that must be comforting to those allegedly affected by recent events.

Exciting Science News

Although the primary focus at IB is, of course, insurance (and, to a lesser extent, health issues in general), we sometimes feature non-insurance-related items. FoIB Rick B tips us to this latest news from the world of science, which may have applications and ramifications far beyond the laboratory:

Lawrence Livermore Laboratories has discovered the heaviest element yet known to science. The new element, Governmentium (symbol=Gv), has one neutron, 25 assistant neutrons, 88 deputy neutrons, and 198 assistant deputy neutrons, giving it an atomic mass of 312.

These 312 particles are held together by forces called morons, which are surrounded by vast quantities of lepton-like particles called peons. Since Governmentium has no electrons, it is inert. However, it can be detected, because it impedes every reaction with which it comes into contact.

A tiny amount of Governmentium can cause a reaction that would normally take less than a second, to take from 4 days to 4 years to complete. Governmentium has a normal half-life of 2 to 6 years. It does not decay, but instead undergoes a reorganization in which a portion of the assistant neutrons and deputy neutrons exchange places.

In fact, Governmentium's mass will actually increase over time, since each reorganization will cause more morons to become neutrons, forming isodopes. This characteristic of moron promotion leads some scientists to believe that Governmentium is formed whenever morons reach a critical concentration.

This hypothetical quantity is referred to as critical morass. When catalyzed with money, Governmentium becomes Administratium (symbol=Ad), an element that radiates just as much energy as Governmentium, since it has half as many peons but twice as many morons.

Cavalcade of Risk #77, (literally) Hot off the Presses

Most excellent tax-blogger Joe Kristan braved a fiery inferno to bring us this week's Cavalcade of Risk. It's an excellent journey 'round the risk-related blogosphere.

Do stop by.

Ohio DOI vs The Feds?

In an online forum to which both Bob and I contribute, there's an on-going discussion regarding my post from last month reporting on Ohio's implementation of the new COBRA/ARRA regs. In brief, the new Ohio rules state that "(s)mall employers will not be obligated to pay any portion of the premium. The former employee will pay 35% of the premium and the insurance company will claim the credit from the IRS for the 65% of the premium not paid by the former employee."

All well and good, but for one (ahem) minor detail: as Bob points out, "it does not appear to say how that credit will be achieved. Nor does it indicate the IRS will go along with this scheme."

It's that last bit that's the real poser: how can state insurance law trump federal tax law?

While it's very nice that the Ohio Department of Insurance is willing to give the insurer a break, what makes the DOI think it can offer a federal tax break? This morning, I posed that question to the folks at the Ohio DOI, and was delighted to learn that this has the "blessing" of the IRS:

"For this purpose, payroll taxes are defined as Federal income tax withholding ... The credit is claimed on the person’s payroll tax return ... Under ARRA, the “person to whom premiums are payable” is based on the nature of the plan and which COBRA continuation coverage provisions apply ... For any other group health plan subject to ARRA (generally, fully insured coverage subject to State continuation coverage requirements), the insurer providing coverage under the group health plan is allowed the credit." [emphasis added]

So it appears that the state is simply reiterating what the Feds have already specified. Good news, right?

Grand Rounds is up!

Nurse Ausmed makes his (her?) Grand Rounds debut with a tremendous edition. Lots of interesting pictures and thought-provoking links.

Bravo!

Carnival of Personal Finance now online

The Weakonomics blog hosts this week's link-fest of personal finance-related posts. Lots to see and read, all categorized for your convenience.

Cancer Research Blog Carnival #21 now online

Highlight Health hosts this week's round up of posts on cancer research. This is a new Carnival for us, but we were invited to participate, and our post on a new cervical cancer test was included.

Interesting reading.

The Gloves come off

In case anybody has any doubts about the effect of a public-run option on the private insurance industry, you need to see this video of Rep. Jan Schakowsky (D-IL)at a recent speech...



I need some Tums.

[Hat Tip: Breitbart.TV]

Cavalcade of Risk #77: Call for Submissions

Next week's CoR is hosted by tax-blogger extraordinaire Joe Kristan. Submissions are due by Monday the 4th, and Cav goes live on the 6th. Joe reminds you 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.