Twitter Insurance?

Our Cousins Across the Pond© seem to have an affinity of late for interesting insurance concepts:

"Users of social networking websites could face higher insurance premiums because burglars are using them to 'shop' for victims' personal details."

Although approximately 40% of all Tweets (?) are "pointless babble," at least one UK insurer, Legal and General, is contemplating a Twitter surcharge as a result of increased claims that they believe are exacerbated by folks announcing to God and country that they're "on holiday" (BritSpeak for "on vacation").

Actually, this isn't so far out:

"A burglar might look out for alarms or security lighting on any pictures of the home, as well as any photos of pet dogs who might be guarding it."

If we're talking risk management - and we are - then it seems to me that L&G has a legitimate concern. The problem, though, is exactly how do they underwrite for this? Simply relying on folks to volunteer that they're on Twitter, or Facebook or some other social networking site doesn't seem particularly reliable to me. And there's this:

"Just because someone is burgled, you can't prove that it's down to details posted on Facebook."

Indeed.

[Hat Tip: Neal Boortz]

Myths & Facts: Which is What?

Writing in today's Wall Street Journal, Jerome Groopman And Pamela Hartzband proceed to fact-check The Won's claims about where we stand and where he'd like us to go regarding health care. The article is chock full of great information; here's a sample:

• Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not ... The statistic comes from a flawed study published in 2003 by the Rand Corporation."

• The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate ... The World Health Organization ranks the U.S. No. 1 among all countries in "responsiveness."

• No government bureaucrat will come between you and your doctor. If doctors and hospitals are rewarded for complying with government mandated treatment measures or penalized if they do not comply, clearly federal bureaucrats are directing health decisions.

You'll definitely want to Read The Whole Thing™.

[Hat Tip: FoIB Dr Stuart Fickler]

About those "Exchanges"

As we noted regarding abortion coverage, sometimes what isn't said in a particular bill is as important (and perhaps even more so) as what is stated. Which brings us to whether or not illegal aliens would be covered under the America’s Affordable Health Choices Act [ed: nice segue!].

Turns out, not only would they be covered, but they'd be required to buy their insurance from the Exchange mechanism put forth in the bill.

But don't take my word for it; let's see what the non-partisan Congressional Research Service has to say:

"Under H.R. 3200, a 'Health Insurance Exchange' would begin operation in 2013 and would offer private plans alongside a public option…H.R. 3200 does not contain any restrictions on noncitzens — whether legally or illegally present, or in the United States temporarily or permanently—participating in the Exchange.

CRS also notes that the bill has no provision for requiring those seeking coverage or services to provide proof of citizenship. So, absent some major amendments to the legislation and a credible, concrete enforcement effort in action, looks like the myth on this issue is the one being spread by Obama, Reid, Pelosi, et. al."

On the one hand, this would definitely solve much of the problem of the "uninsured:" since illegals comprise some 20% of that group, forcing them to buy coverage through the taxpayer-subsidized Exchange would ameliorate that problem. On the other hand, of course, forcing them to buy coverage through the taxpayer-subsidized Exchange will further drive costs skyward.

As Bob is fond of asking, doesn't anybody in Obamington think these things through?

Carnival of Personal Finance

This week's edition of The Carnival of Personal Finance is now up at Stretchy Dollar.

More Questions than Answers from the Dayton Daily News

Our local paper has a front-page story today on health care "reform," part of which recounts the sad tale of a family which faces some major medical bills as the result of some poor decisions. Ron and Mindibeth chose not to use an in-network provider when the latter's ear was severed in a Jet Ski incident. Instead of requesting an in-network plastic surgeon, they settled for one who was out-of-network, because, as Ron puts it "(t)he last thing on my mind was insurance.”

Really?!

Isn't one of the very first questions one is asked upon admittance to a hospital (or pretty much any other provider) "who's your insurance carrier?" You're already looking at the card (for policy numbers, etc), and it's not as if "network provider" is a new term or concept.

As a result of this decision, "the couple said they had $267,000 in uninsured medical bills that year." It's not clear, by the way, how much of that total was for the surgeon's services and other expenses related to the accident; for all we know, the family just kept on choosing to use out-of-network providers for other services, as well.

How, exactly, is that a breakdown in "the system?" Or is personal responsibility completely irrelevant now?

As the result of another poor decision, their daughter, Amanda, "racked up $1.7 million in bills for medical care." For whatever reason, she chose not to be insured, and unfortunately developed cancer. Obviously, this made it impossible for her to obtain insurance through "normal" means, although the article also fails to mention whether she was eligible for, or even tried to find, alternate means (such as a HIPAA plan or any of the myriad government-sponsored programs).

Again, how is this an indictment of our health care financing system? Shouldn't she have purchased insurance before a problem developed? Health insurance for a young woman in reasonably good health is not terribly expensive, and if she was old enough to join the Air Force (as the story mentions), then she was old enough to take on that relatively modest expense.

That's the problem, really, with so many of these heart-string-pullers: they paint a very sad picture, neglecting to point out that there were (and are) many ways to avoid this kind of outcome, but which require a modicum of personal responsibility. Perhaps there were other reasons why the young lady didn't have insurance, but the article fails to mention them; and, of course, the reporter couldn't be bothered to ask "why didn't she have insurance in the first place?" because that wouldn't fit the meme.

But it's valid nonetheless.

Perhaps the saddest part is that Ron still doesn't get it; he says he's "disappointed in the systems that have put us there.”

No, Ron, you put you there.

Harrison Bergeron

This story by Kurt Vonnegut is a miniature classic.

It is relevant to everything we talk about at InsureBlog.

Please read and discuss if you like.

You'll be glad you did.

Thanks.

No Tedicare. All is lost?

Fortunately, there is a way to increase insurance company competition in the individual market without a public option. In fact, this can be done by removing some existing government interference.

Individual medical insurance premiums vary a lot by state. They vary by more than per capita medical costs vary by state. This added variation in insurance premiums occurs because of differences in "mandated" benefits enacted by the state legislatures.

But – state legislatures also prohibit insurance companies from selling policies that are not “issued” in their state – that is, policies which do not include all of that state’s legislated benefit mandates. As a result, individuals who live in one state cannot buy a policy issued in another state, even if – and especially if – the premiums in the other state are less. These “state of issue” laws prevent people from shopping for the best deal. These laws restrict competition among insurance companies. Eliminating these laws would allow people to shop in other states where insurance might be much less expensive. That would force more competition on insurers.

This is a clear case where government regulation is driving up costs (mandates), and is also preventing people from shopping in less-costly states (choice restricted to state of issue). So why keep it?

Public Optiony Number 1

No private company "wants" competition. But the public should want companies to compete, because that forces them to innovate and to bring us more useful products at the least possible cost. If a company is not competitive it must improve, or go out of business. That is how competition among private companies serves the entire public. And that is why it is sound public policy to oblige companies to compete.

But it’s not sound public policy for the government to compete directly with private companies. Private companies cannot "compete" with government because government sets the rules that private companies must follow. Governments tend to “compete” by setting rules that drive its competitors out of business – and governments do not have to “improve” to do this. That leaves the entire public with a static, government standard of service rather than the constant improvements brought by competitive private companies. So in this game, the government “wins” even when providing poor service, and the public loses. Imagine the KC Royals vs. the Yankees - and all the umpires and league officials play for the Royals. Not hard to figure out that even the Royals with lesser talent, win most of the time in that game.

Besides, whether some alleged lack of competition among insurance companies is the primary reason for high medical premiums is not at all clear. If the companies are the source of high premiums, why have life insurance premiums dropped so much over the past 20 years? Answer: insurance companies are not the reason medical premiums are high. Medical premiums are high – and rising – because medical cost is high – and rising. Medical cost, not insurance companies, is the problem.

For these reasons, I think the public option promises what it cannot deliver – improvements to the insurance markets through federal "competition". And it does not get at the more fundamental reason insurance is expensive in the first place – that being the cost of medical care.

A conversation with Senator Boxer

Last week, Senator Boxer was on KGO, the largest AM station in the San Francisco area. While disparaging the system, she displayed a remarkable ignorance about California’s health insurance laws and all of the protections that they provide. Since she's one of our two Senators, I felt compelled to call and correct some of her errors…

Misstatement #1: Insurance companies cancel coverage when people get sick
My response: This is flat-out illegal in California. Carriers can only cancel for non-payment of premium

Misstatement #2: Insurance companies raise rates when people get sick
My response: This is also illegal in California. Carriers can only raise premiums based on claims over a large geographic region. Individual claims simply do not count except in a statistical sense.

Misstatement #3: Insurance companies may not cancel policies outright, but effectively do so by raising people’s rates.
My response: Senator, this is illegal in California!

Misstatement #4: Then enforcement must be pretty lax.

Unfortunately, my on-air time ran out at that point. I’m not sure that the carriers that have been fined millions of dollars and been forced to reinstate rescinded policies would agree with her last point.

It was interesting to be referred to at the show wrap-up as a “representative of the insurance industry.”

I do need to clarify a few items…1. I’m really not an industry representative. I’m just a broker helping clients navigate a confusing system and 2. I never said these things “never happen.” I did say that they were illegal.

I certainly don’t expect a Senator to know the nuances of the California Insurance Code. But these aren’t subtle details. They’re part of her key arguments for health insurance reform. And they’re just wrong.

Incidentally Senator, the next time someone calls into a radio station and tells you that they have breast cancer, their COBRA is ending and they’re scared, you might tell them about the guaranteed issue policies mandated under HIPAA. It’s a FEDERAL law that you voted for...

Who's Afraid of the Truth?

Well, ABC for one:

"The ABC Television Network has a long-standing policy that we do not sell time for advertising that presents a partisan position on a controversial public issue."

Which may well be true.

Giving it away, however, poses no problem.

Not that there was anything "partisan" there.

So what, exactly, is ABC so afraid of?

Judge for yourself:

Nothing there we haven't already covered here at IB:

Medicare cuts? Check [ed: updated link].

MVNHS© on the ropes? Check [ed: updated link].

Rationing in Canada? Check.

So it appears that, by ABC's (Guiding) Lights, it's only "partisan" if the truth hurts ObamaCare.

Check.

The Ultimate Tax Authority

I believe that creating a government mechanism that has the legal power to deem people not fit to receive medical care, is a very dangerous business. And that is what rationing would be – a legal means to withhold medical care from some, so others can have it. The ultimate tax authority, one might say.

Isn’t it ironic that people agonize over the death penalty for even the most heinous criminal, yet many advocates for a single-payer medical system seem enthusiastic about institutionalizing another sort of death penalty for ordinary citizens simply because they need medical care?

Discussions of rationing medical care can sound repellent, even if presented as a purely academic exercise. Example: some of Dr Ezekiel Emanuel's work.

Describing his "complete lives" theory of allocating medical resources, Dr. Emanuel wrote that it:

"empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible."

He correctly identifies the nasty part of rationing - who can be allowed into the lifeboat, who will be pushed back into the ocean?

If I and I alone were empowered to make these decisions, I would agree that Emanuel's system is fair. See, I trust myself - but I don't trust all you others. I expect everyone else feels the same way about me, making decisions about whether to save you or your relative. So that presents a practical problem - who will run this thing? Emanuel only says "us." Questions I have for the good doctor are - who do you mean by "us" exactly? And who will appoint "us" to this job? And who defines or limits the power that "us" will have? What assurance can there be that the powers of "us" won't be expanded ad infinitum? And who decides if "us" made a fair decision? And what happens if someone disagrees with "us"? There are many more such Q's, but you get the idea. O brave new world that hath such people in it as "us".

Emanuel also wrote that his system

"prioritizes younger people who have not yet lived a complete life - and also incorporates prognosis, save the most lives, lottery, and institutional value principles".

Well, that's nice. No one could possibly object to a system that is fair and saves the most lives. Oh, well, maybe you would, if you're not invited.

And what's that part about a lottery? Emanuel explains that

"lotteries could be used when making choices between roughly equal recipients."

Heads or tails, ma?

But it's NOT KennedyCare...

The good Senator would have never have been on this plan. Like all of the other Senators, he was and would have continued to be covered by the Federal health care system.

The marketing geniuses in Washington strike again.


(Just wondering...are cost-benefit and treatment efficacy considered factors for approval in the Federal system? And how would aggressive brain cancer in a 77 year-old be treated under ObamaPelosiWaxmanBoxerEtcCare?)

iTriage App: Update

This past Spring, we interviewed iTriage CMO Dr Wayne Guerra, who explained what the SmartPhone application does and how it works. The new features include "zip code and GPS search capabilities, enhanced navigation and user interface, distances to facilities, integrated mapping within the application, landscape view, the addition of more diseases and symptoms, “Tell a friend” feature to share iTriage information with your contacts, and further integration with HealthGrades® quality information for purchasing reports, reviewing physicians, and accessing provider profiles within the application."

It's a great little app; I just wish someone would buy me an iPhone so I could use the GPS function.

Your tax $$ @ Work

Are there no depths to which President Oy!Bama won't sink?

"I was invited by the National Endowment for the Arts (NEA) to take part in a conference call that invited a group of rising artist and art community luminaries “to help lay a new foundation for growth, focusing on core areas of the recovery agenda - health care, energy and environment, safety and security, education, community renewal.”

And to what, exactly, is our correspondent referring? Well to this, silly:

"Backed by the full weight of President Barack Obama’s call to service and the institutional weight of the NEA [National Endowment for the Arts] ... to push an agenda other than the one for which it was created ... to initiate, organize, and tap into the art community to help bring awareness to health care."

That's right: PresBo has decided it's appropriate to use our tax dollars to advertise his legislative agenda. I found the NEA's mission statement at its website, and it says that the agency is "dedicated to supporting excellence in the arts, both new and established; bringing the arts to all Americans; and providing leadership in arts education."

See anything about health care in there?

Nope?

Me, either.

A Trip with Mr Peabody and Teddy

As fellow connoisseurs of 60's Saturday morning television may recall, Mr Peabody was the canine-genius behind the WayBack Machine. Along with his trusted (if dim) sidekick Sherman, he would gallivant back in time to keep us on the straight-and-narrow.

Imagine, if you will, Mr P setting the dial to 1971. Still in his first term, President Richard Nixon proposes sweeping health care reforms, including "a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income."

Mr P and his pal look on in shock as a young Senator Ted Kennedy, all dried off now, moves to block that legislation, which could have helped us avoid many, if not most, of the health care problems we face today.

Troubled and confused, the intrepid pair flash forward almost 40 years, popping directly into the Senate Visitor's Gallery, where they are stunned to see that same Nor'eastern Senator pushing passionately for... wait for it ... employer mandates and increased government spending to insure more people.

Finally regaining his voice (if not his credulity), the determined doggy whispers "it's deja vu all over again!"

Playing Chicken with Health Insurance

Health insurance policies have "grace periods" to accomodate for late-payers. Generally, these are 30 days; that is, one has 30 days to get the premium in to the carrier in order to keep coverage in force. If there's a claim during that time, it's put "in limbo" until that premium's received.

I'm not a big fan of playing chicken with them, but occasionally there's a good reason to take a bit of a chance. For example, if one is switching carriers, and the new plan isn't through underwriting yet, sometimes I'll recommend holding off payment for a few days to avoid double-coverage or waiting for a refund. I'm a bit leery of this, but for a few days, I haven't found it to be a big deal.

But that is quite different than what one client is proposing:

John and his family are clients, and I have them with an individual plan with XYZ Mutual. John's wife has started a new job which includes group coverage for the family; that coverage is set to "go live" on October 1. John is considering not paying the September premium (recall that September has 30 days), and taking his (and his family's) chances that no claims will arise. If they do, he figures, he can always send in the September payment, and everything will be hunky-dory.

As an aside, HIPAA requires that there be no break in coverage longer than 63 days, so the 30 days "bare" isn't likely to be an issue on that score.

In the event, I have strongly recommended against this strategy. Why, you ask?

Simply this: let's say that everybody's fine all the way to the end of the month, and on September 29th, John has a massive heart attack. There is simply no way for them to get the premium into XYZ Mutual before the GP is up, and so he's completely uninsured for that claim (and if the wife's not actively at work come October 1, it's likely that the group plan won't go into effect then, either). So he's completely on his own with regard to all the ER and ICU services, any ambulance and/or EMT services, nursing care, the whole nine yards. And since he's uninsured, he's not eligible for the insurance company's negotiated (discounted) rates, either, which means he pays full retail for everything.

There is no "up" side to this, save for the comparatively few dollars the September premium represents. I've explained all these issues, so it's out of my hands. Obviously, it's more likely that they'll be fine than not, but why take that chance? After all, isn't that what insurance is for?

Cavalcade of Risk #86: Rate-This-Post edition

Political Calculations' Ironman reprises his patented "Contributed Blog Post Rating System" for this no-holds-barred edition of the Cavalcade of Risk.

It's interesting, fun and interactive - what more can you ask for?

BTW, we're scheduling Fall editions, please drop us a line if you'd like to host.

Mandates: Busted! [UPDATED & BUMPED]

[Update below vid]

Ever wonder how much those state mandated benefits add to your premium, and why they even exist? Well, wonder no more:

UPDATE: In the comments, reader Andrew Garland tips us to this video on how "government healthcare and sausages are being made:"

Alphabet Soup Under the Bus?

In our coverage of the swine flu vaccine, we mentioned in passing that it may be eligible for reimbursement under what we call "flex ben" plans (HSA's, HRA's and FSA's). In researching that post, my "guru" for all things flex mused about the fate of what he calls "the alphabet soup" under "health care reform." There seems to be a lot of speculation, but not much hard evidence regarding how these plans will fare.

So, of course, we'll add to that speculation:

First, I could find no mention of any of these plans in the "American Health Choices Act." The only item that remotely touches on them is the requirement that new plans must be "qualified," and I doubt very much that an HSA plan would, um, qualify. Of course, "absence of evidence is not evidence of absence," so it may well be that some enterprising bureaucrat, tasked with actually implementing the bill, would see fit to throw flex plans out under one or more such criteria.

So-called "cafeteria plans" are one benefit of group based coverage; this is a system where a (usually larger) employer offers an array of products from which the employee can choose. Since one of the funding mechanisms for "reform" is a tax on "richer" plans, we may well see those go away, reducing choices and, perhaps, availability of cafeteria plans altogether.

One thing that appears certain is that reimbursement for over-the-counter med's will go away; that is, they will no longer be considered an eligible expense. I'm not convinced that this is a horrible thing: it's a relatively new benefit to begin with, and it's unclear how many people even know about it, much less take advantage of it.

Since one of the primary stumbling blocks facing "reformers" is how to pay for their plans, a number of insurance products are in the crosshairs (e.g. Medicare Advantage); it seems reasonable to presume that doing away with tax advantaged programs like HRA's and FSA's would be a quick and easy way to raise funds. Since these aren't insurance products in and of themselves, getting rid of them may be an easier sell to the public, most of whom don't utilize them anyway.

It's difficult to find credible information about the fate of these benefits, so we'll keep looking, and update as appropriate.

Old School Grand Rounds

Dr Charles hosts this week's edition of Grand Rounds. Head over for a nostalgic look at the far away world of 2004.

Results Matter: "I Drank What" Update

Does the WH read IB? Who knows, but apparently those of us who sounded the alarm about the Obamistration's decision to renew shilling for veteran's to fall on their swords has struck a nerve:

"The debate over what Towey calls the "Death Book" bodes so poorly for the president's position in the health care debate that, after two segments on Fox News discussing the pamphlet this morning, the Department of Veterans' Affairs has apparently pulled the booklet from one part of its website."

Unfortunately, this simply means they've pulled in their horns a bit, since we also learn that "(t)he document still exists in another spot on the site." Still, one small victory at a time.

Laudable Carrier Trick, Swine Flu Edition

"Even a blind squirrel finds a nut now and then" goes the adage, and once again, we have a case of a carrier "doing the right thing." From email:

"UnitedHealthcare will provide coverage for the administration of the H1N1 (swine flu) vaccine for all members covered by its fully insured plans.

We intend to process all self-funded member claims as a covered service unless clients explicitly direct us otherwise. If your client's plan does not currently cover the administration of the vaccine, and you notify us of your client's intent not to cover the vaccine in the future, UnitedHealthcare will reimburse the cost of the administration of the vaccine. The federal government has said that the vaccine will be provided at no cost to health care providers."

The note goes on to say that UHC will be working with appropriate authorities to make sure as many folks as possible have access to the vaccine.

The reference to self-funded (aka ERISA) plans is interesting, as well. Most folks don't know this, but ERISA plans are pretty much free to cover and exclude benefits as they see fit. So if a plan either doesn't specifically cover, or if it specifically excludes, the cost of these vaccines, the carrier (UHC in this case) really has no justification for paying or reimbursing for that expense. If you work for a company which has such a plan, it'd be worth your while to check with HR about how (or even if) the vaccine is a covered expense.

Whether or not it is, if you have an HSA, FSA or HRA plan, my Flexible Benefits Guru Pete Deist says that the cost is "probably" reimburseable under that, so your own out-of-pocket may be reduced. The reason for that qualifier, by the way, is that it's not specifically mentioned as either eligible or ineligible, so we really don't know for sure.

Singin' the Arizona Blues

Several weeks ago, we brought you the odd tale of how an Arizona woman, having survived breast cancer, was rebuffed by Anthem when seeking a simple blood test. Throughout her initial ordeal, Anthem seemed to have no problem covering expensive and ultimately successful treatments, but in its aftermath deemed some inexpensive blood work unnecessary.

After exhausting the carrier's appeals process, Heather Toplak turned to TV reporter Carey Peña for help. Ms Peña went to bat for Heather, and they successfully lobbied Anthem to both cover the lab work, and to change how they would deal with this issue in similar cases going forward.

Good news.

The initial post raised some additional questions, however, and Ms Peña graciously agreed to forward my request for further information on to Ms Toplak; she has replied to my request, and given me permission to post this interesting (and hopefully useful) information. She writes:

"As of today, I have a clean bill of health. I still have a panic attack every three months before my check-ups, but I guess it can be expected.

I honestly think there are many more people with the same plan dealing with the same issue. Before my first chemo treatment last year, my oncologist ordered the standard bloodwork to be taken. A few weeks later, I received an invoice from [the lab] stating there was a balance due of $77 dollars for a CEA test. I checked my explanation of benefits statement...and there it was...denied. As so the saga began.

Hours on the phone with BC/BS, numerous letters from myself and from my doctor and three levels of the appeals process...once again left me with "denied."

What amazed me the most was that, during my conference call with the Appeals Board, my doctor told them this test is recognized by Medicare as being the standard for testing during breast cancer treatment. Their comment was it was a "gray area". The doctor said "There is no gray area...this is the standard for breast cancer treatment under national guidelines."

That is when I took the story to Channel 3. It was not a dollar factor. I felt they were denying preventative care.

Many oncologists insist on PET scans, ports, etc. These generate extremely high costs to the insurance companies. I have great veins, so no port was needed and my doctor felt a PET scan at that time was not necessary. They can have too many false positives. Great!! One less surgery and one less bill to the insurance company. I was approved to have a PET scan if needed. My course of preventative care is blood work every three months.

When you look at most insurance policies, they have a cap at about two million dollars. Two million dollars seems like a large amount to most Americans, but if you need re-occuring treatment, it adds up fast.

In comparative speaking....Lets buy the 3 million dollar plane, new condo and a few vacations and then ask for the bailout plan!"

I'll just add a few thoughts. Ms Toplak refers to the policy maximums, and she is quite correct (although many plans now have a $5 million limit). This is an issue with which most folks aren't familiar, but each time one has a covered expense under a given policy, the amount paid for it is deducted from that policy's lifetime max. Obviously, a few doc visits and flu shots aren't going to make much of a dent in that amount, but chemo, radiation and the like definitely will. Just something to keep in the back of our minds.

I'd like to thank Heather Toplak for sharing her story, and Carey Peña for covering it, and wish Heather continued good health.

Death Panels Made Simple

Not to (you should pardon the expression) beat a dead horse, but one of the reasons that "Death Panels" struck such a resounding chord is because of CARS.

Hunh?

We've all watched the past few weeks while the gummint's ill-advised (and even more poorly implemented) program to turn perfectly serviceable older vehicles into new car sales has itself been traded in. Of course, no one called the program by it's actual name: the Consumer Assistance to Recycle and Save Act of 2009 (CARS). No, we immediately glommed onto the completely unauthorized and unofficial term "cash for clunkers." I defy any reader to find that term in the enabling legislation.

I'll save you some time: it ain't in there.

But that didn't make the program any less well-known or "successful." The reason it became such a joke is precisely because that new title became an unstoppable meme, with the added bonus that it happened to be spot-on accurate.

And that is exactly why "Death Panel" was effective: it accurately summarized the insidious nature of the bill, its intent and implementation, in a way that was instantly understandable and recognizable to the citizenry. They saw how the government viewed serviceable vehicles creeping past their prime, listened to Ezekiel Emanuel (Rahmbo's brother, and an advisor to the president) when he wrote that "health care should be rationed in a way that “promot[es] and reward[s] social usefulness,” [<- 6/30/10: new, working link] and that age could play a factor in determining who can and cannot access health-care resources."

It's really a very small and valid leap from there to "Death Panels."

Of course the term itself never shows up in the bill; what boots it? There were no shadowy, hooded figures coming out to announce "sorry, Mr Smith, you're denied." Such verbiage was unnecessary: all that was necessary was to pass the concept (just as the term "cash for clunkers" is nowhere to be found in HR1550).

And just how has C4C worked out? Well, it's run out of money (even with an extension) and is due to be shut down in a few days. In the meantime, it's left in its brief wake thousands of now useless vehicles (which can't even be scavenged for parts or donated to charity), thousand of dealers who have no idea when (or, perhaps, even if) they'll be paid, and a public which sees first-hand how ObamaCare can be expected to perform.

Not a pretty picture.

Knee deep? Waist deep? Neck Deep?

The cost of medical care in the U.S. is the real reason medical insurance costs so much.

Because the care is expensive and its cost is growing, the insurance is expensive and its cost is growing. As a result, there are more and more Americans whose access to medical care is limited because they are uninsured.

Very high quality medical care is delivered in Western Europe and in places all over the world, at much less cost vs. the U.S. Why can’t that be done here? That is the key question – and please note this is a medical cost question, not an insurance cost question.

Achieving real economies in medical cost should be a central objective of reform. But the administration doesn't seem to be looking there.

In fact, the administration can't seem to explain in straightforward terms, what it is trying to accomplish and why. First we were told it was health care reform. Now they say it's health insurance reform. First the motivation was to help the uninsured – plus or minus 15% of the population. Now we see Congress intends to control 100%. First we’re told we can keep the coverage we have. Now it appears we cannot. First we have Section 1233 of HR3200 that no Congressman or Senator or administration official could explain. Now the administration promises to pull Section 1233 from the Bill (as if that will change anything). First Obama told us his proposals were necessary to save the economy. Now CBO has shown that all the bills currently being discussed will increase the deficit. So now the economic argument for reform is set aside in favor of a moral and ethical imperative. First Obama demanded a bill be passed by August - a deadline that foreclosed meaningful Congressional debate. Now we are told that the public is obstructing debate in the Town Hall meetings - as though the administration suddenly decided on July 31 that debate is worthwhile. And of course this administration assured us from the beginning that it will unite us around hope and change we can believe in. Now we see the leaders in this administration descending into ugly name-calling and vilification of ordinary citizens for exercising their right to speak up and speak out.

What do you see? I see an administration and Congress who have failed to figure out what they want, or to to explain to us what they are trying to do in any but highly generalized and uninformative terms. Nevertheless, the administration and Congress seem less interested in listening to the public, and more determined to discredit public opinion, while they doggedly forge ahead with their plans anyway.

“We’re knee-deep in the big muddy but the big fool said to push on.”

Why we need real physician leadership

Physicians for a National Health Program, or PNHP, is self-described as “a non-profit research and education organization of 17,000 physicians, medical students and health professionals who support single-payer national health insurance”.

I recently went to the PNHP site. I read their mission statement. Now I feel sick.

In their mission statement, here's what PNHP says guides them:

“The U.S. spends twice as much as other industrialized nations on health care”

Yes, the problem is medical care spending. The high cost of medical care is why medical insurance is expensive – but don’t expect PNHP to tell you that.

“Yet our system performs poorly in comparison”

And that, too, is a medical problem. Question: who is responsible for medical care in your home town?

“and still leaves 45.7 million without health coverage”

Kaiser Family Foundation released a study a couple years ago that revealed 65% of the uninsured have incomes below 2X’s the Federal Poverty Limit.

Why has Medicaid failed to protect the poor? Medicaid is the government program expressly established to provide adequate medical insurance for the poor. Why is it not doing so? Why has our government left so many of the poor without access to medical insurance? I think that is a scandal. PNHP won’t tell you this, because PNHP advocates government-controlled medical care for EVERYONE, not just the poor.

Medicaid’s failure is not speculation, it's real. What is speculative is to believe, despite the evident Medicaid failure, that the government would truly manage a universal, single-payer public plan as its advocates promise.

“This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar.”

One of my former jobs was chief of benefits for a very large employer. If I mentioned the name, everyone would instantly recognize it. We worked with Aetna and Blue Cross. Their administrative overheads amounted to about 5% of our annual claim volume. Why is this relevant? Because the 31% number that organizations like PNHP like to throw around is a cherry-picked number – and PNHP presents it dishonestly. It may be the right number for individual insurance. But in my experience it is clearly not the right number for group plans – where most insured Americans are covered. and besides, it defies logic for PNHP to blame the problem of high medical costs on insurance. In fact, the reverse is true.

“Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

Think carefully about this statement. PNHP is not saying any “savings” would be returned to the public. PNHP is saying that such "savings" would be paid to physicians. Aside from increasing physician incomes, this means that the public would pay even more for the expensive medical care we now have.

So PNHP presents nothing that will help solve our principal problem - the high cost of medical care. The public has every right to expect physicians to help solve that problem, not simply to demand more money from us. Sadly, PNHP barely acknowledges that problem, and offers no solution – just more spending.

And this is why we need real physician leadership on health policy.

Two-wheeled Risk (You Want Fries With That?)

[Welcome Industry Radar readers!]

While not strictly an insurance issue, this story does pose some interesting risk-management questions:

"Sarah Gilbert stepped off her bicycle long enough to send one angry tweet via Twitter — and it's changed the way one fast-growing burger chain treats bike riders ... after biking last week into the drive-through of the local Burgerville — an eco-conscious burger chain that even recycles its used cooking oil into biodiesel — she tried to order four cheeseburgers ... She was refused service at the drive-through for, of all things, ordering from a bike."

[ed: we'll table the discussion about the seeming contradiction between eschewing a car for a bike but ordering a cheeseburger instead of a salad]

The gist of the story is that this particular chain, known for its "green policies," banned bike riders from using the drive-through, citing safety concerns. Other national chains also do this, but Burgerville has decided, as a result of Ms Gilbert's experience and response, to delete (or at least modify) that policy. One supposes that's good news, at least for the bicyclists.

But is it sound risk management?

Here's why I ask: if you're on a bike going through the drive-through, aren't you at greater risk of being run-over than if you simply parked the bike out front and walked on in? I don't know the answer to that, and I spent quite some time Googling around trying to find stats to prove the case either way.

No luck; perhaps one of our resourceful readers has access to this info and would be willing to share it?

Of course, this same principle would apply to drive-up ATM's [ed: and BTW, what is it with braille markings on drive-up ATM's? Isn't that oxymoronic?], and I didn't see any stats on that either.

While I understand how riders must feel when they find themselves barred from the drive-up, how big is that lawsuit going to be the first time one gets creamed by a Caddy? Which also begs the question: is this policy driven by insurance company rules as much as common sense?

It's funny how things snowball: when I began to write this post, I had two questions that were still unanswered: one, stats on bikes and drive-throughs and two, whether or not insurance carriers played a role in the "no bike" rule. Since this falls under the general aegis of "P&C," I called on my colleagues in that field. There seems to be a mixed bag of answers: it doesn't appear to be a general industry rule that Wendy's et al post and enforce a "no bikes" rule. There may well be carriers which include that verbiage, but it doesn't seem to be a standard policy clause.

One colleague suggested that it may have to do with the inherent risk of letting people walk up to the window: if they pull a gun and ask for money, they can be gone pretty quickly. If they're in a car, they're likely blocked front and rear (and, of course there's the license plates). There's also a slippery slope here: in my research, I noted that there were at least a few incidents where folks on "Rascals" (motorized wheelchairs) were also turned away, presumably for the same "safety concerns" as the bikers. If Burgerville lets bikers use the drive-through, what can they say to Granny in her Rascal. Or Joe in his "regular" wheelchair?

The other concern regarding safety is this: at drive-through speeds, if my Honda hits your Buick, there are some scrapes and dents, but no one's getting care-flighted. But if my Ford hits you on your Schwinn, there could be some major injuries.

The bottom line, such as one exists here, is that this really isn't as cut-and-dried as it might at first appear. Risk management means taking into account all the variables (or at least as many as possible), and sometimes we don't like the answers.

Cavalcade of Risk #86: Call for submissions

The Political Calculations blog hosts next week's edition. Submissions are due this Monday (the 24th). PC requests that you include:

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

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.

HOSTING: We're scheduling fall Cav's now, please let me know if you'd like to host one.

Late Breaking Wonkery

Health Business Blog's David Williams hosts this week's Health Wonk Review. Today's edition of this bi-weekly compendium of all that's wonky is a bit late out of the gate but well worth the wait.

Do check it out.

ObamaCare 2011

"Hundreds of [physicians] in the New York area have withdrawn from the government’s [Public Option] program, citing delays in getting reimbursed by the government, a [provider's] group said Wednesday.

The Greater New York [Medical] Association, which represents [doctors] in the New York metro area, said about half its 425 members have left the program because they cannot afford to offer more [health care]. They’re also worried about getting repaid."

We now return you to regularly scheduled blogging.

Are You on "God's Team?"

PresBo wants you to be:

"We are God's partners in matters of life and death"

Yes, our Spiritual Leader in Chief© really said that in a conference call with some 1000 Rabbis, as he urged them to supplement his bully bimah with their real ones. As an aside, whatever happened to that much vaunted proscription from the left regarding "separation of church and state?"

Or is that only on the right side of the equation?

This little pep talk was especially inappropriate when one considers the overarching Torah commandment to "choose life." This is, of course, in direct contravention to the proposed cuts in Medicare, the rush to rationing, and the inclusion of abortion coverage in the House bill.

Amen?

I Drank WHAT?!

Such were Socrates' (alleged) last words in the best-forgotten film "Real Genius." Apparently, the prototypical Greek sage was also covered by the VA:

"Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, "Your Life, Your Choices" ... Who is the primary author of this workbook? Dr. Robert Pearlman ... a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing."

President Bush quickly put the kibosh on that little missive, but it has been, um, resurrected by the Obamastration.

The pamphlet "presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political "push poll." For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be "not worth living."

Is this the model upon which ObamaCare will draw? But of course.

Now, what was that railing against those of us opposed to "Death Panels?"

[Hat Tip: NRO]

It's All Fun and Games - Until Somebody Gets Hurt

There's nothing funny or amusing about our rush to socialized medicine, but that doesn't mean the debate has to be dry or humorless. Want to see how a gummint-run health care system would work? Well, here's your chance:

Can You Make It To The Hospital In Time?

[Hat Tip: Lyndsi Thomas]

Grandma's Throwing AARP Under the Bus

Earlier this summer, we reported that AARP seemed to have no qualms about selling out their own membership. Well, to borrow a phrase, it seems those chickens have come home to roost:

"CBS News has learned that up to 60,000 people have cancelled their AARP memberships since July 1, angered over the group's position on health care."

Ooops.

And they're not just leaving AARP (although AARP seems to have left them): a lot of them are voting with their Social Security checks by joining the conservative-leaning American Seniors Association, and a sweet deal it is, too:

"The American Seniors Association (ASA) invites any American Association of Retired Persons member to mail us your torn AARP card and receive a 2 year- for- 1 year membership with ASA."

That's gonna leave a mark.

AARP's losing some veteran members, too:

"Elaine Guardiani has been with AARP for 14 years, and said, "I'm extremely disappointed in AARP."

Retired nurse Dale Anderson has 12 years with AARP and said, "I don't wanna be connected with AARP."

This is more interesting than it might at first appear: presuming that these folks joined up upon becoming eligible, they're just now hitting the "senior circuit," thus robbing AARP of what would presumably be many years of dues.

And unlike AARP's record of flip-flops on ObamaCare, the ASA is unequivocally agin' it:

"The American Seniors Association is flat-out against President Obama's plan, which calls for $313 billion dollars in Medicare cuts over ten years. The AARP is widely viewed as supporting the President."

Doesn't get any clearer than that.

Can you believe it? Another Insurance Horror!

[Welcome Industry Radar readers!]

According to Congressman Joe Sestak, Democrat of Pennsylvania (Sestak is challenging Senator Spectre for his Senate seat in the 2010 election): “ . . . only 2 percent of claims have been paid and that four of every five applications have been rejected for minor oversight.” Horrible, horrible!

But this horror is NOT another complaint about private-sector medical insurance companies. It’s about the federal cash-for-clunkers program.

Speaking of federal programs – won’t the federales also manage American medical insurance reimbursements, after Congress votes later this year to take control of them? How smoothly can we expect that to go?

Much popular opinion seems to be that after the federal takeover, medical insurers will be prohibited from ever again refusing coverage to anyone. Also, medical insurers will be prohibited from ever again denying a claim. Yet the cash for clunkers programme denies 80% of applications and 98% of claims. Problem is, neither popular opinion nor the cash-for-clunkers outcome has any truthiness to it.

So who can we believe and what can we expect?

If there were an Obi-Wan Kenobi, he would be our only hope - if there were any hope.

Back to School Grand Rounds

The Invisible Illness Week blog hosts this week's roundup of med-posts. Be sure to attend!

One more on HR3200 Section 1233.

The administration has announced that the Democrat House majority will remove Section 1233 from HR3200 – the House version of Obamacare. This is the so-called death panel provision.

I hope no one who reads this blog is so naive as to believe this settles the matter.

The administration still intends to control medical costs by

(1) reducing fraud and waste
(2) reducing admin cost thru a single payer mechanism and
(3) limiting payments for Americans' medical treatments.

That third objective will not go away. Section 1233 has been put aside for the moment, as a political expedient to induce people who disagree with Obamacare to quiet down and get out of the way.

Meanwhile, anyone remember Barbara Wagner? Her case illustrates exactly what governments do when they are in charge of medical care. This case predicts how the Federal Government will administer a single-payer medical insurance plan.

Wagner is an Oregon woman whose cancer returned from remission in early 2008 [ed: and about whom we blogged here]. Wagner was covered under the Oregon Health Plan (a Medicaid plan). Her doctor prescribed a new cancer drug for her. But the State of Oregon health plan denied payment for the medicine. It wrote Wagner a letter, stating the plan would pay for comfort care, including "physician aid in dying," - - that’s better known in Oregon as assisted suicide.

Wagner appealed the State’s decision twice and the State denied her appeal both times.

But the the state assured Wagner that there was no malice intended:

“Dr. Som Saha, chairman of the commission that sets policy for the Oregon Health Plan, said Wagner is making an "unfortunate interpretation" of the letter and that no one is telling her the health plan will only pay for her to die.

See? No malice. Only an “unfortunate interpretation.” All better now, right?

Technically this story proves the Obama administration is telling the truth.

There may be a commission, but no officials are “telling us” it is a death panel. I mean now really, who would tell us that anyway? Fer cryin out loud, it’s a HEALTH Plan Commission. HEALTH, not death. Don’t you see, health has nothing to do with death? So, everyone can stop worrying. No government official is telling us that there will be death panels. That must mean if you don’t get the care your doctor prescribes, it’s just “unfortunate”. People who say otherwise are uninformed. People who say otherwise are repeating fishy things and should be reported to the authorities.

Oh yeah – Barbara Wagner died. May God bless her.

It is sad that her story has receded from public memory - thanks in no small part to our bumbling media – while buffoons like Nancy Pelosi are given the headlines. But you can be certain that the tactics by which the administration intends to reduce medical care spending will impose limits on government payments. And that will mean fewer treatments available for people who are receiving them now.

Nose + Face (Some Assembly Required)

On the one hand, this would seem to be good news for proponents of the status quo:

"A health care reform plan without government-run insurance is "D.O.A.," says one left-wing grassroots organizer up in arms about the possibility the Obama administration could abandon its efforts to build a "public option."

As we've repeatedly shown, the so-called "Public Option" was never a good or viable idea, although the recent rumors of its demise are, um, exaggerated. Nevertheless, the sooner that monstrosity is off the table, the sooner we can begin to look for meaningful, realistic and sustainable solutions.

Which is why I, for one, am quite puzzled at the left's seeming to throw in the towel on health care reform (or, as it's evolved, health insurance reform). If it's PO or nothing, and PO gets thrown under the bus, then who's going to be supporting a major overhaul? The right? Maybe, but I thought this was supposed to be a bipartisan effort. And if it is defeated, it's obviously not going to be at the hands of the Republicans (the minority party in the House, and facing a filibuster-proof Senate).

We are not proponents of the status quo; the current system needs work, beginning with identifying the real culprits: the cost of health care and so many mandated benefits. If the left is going to pick up its ball and go home to sulk, we're more than up to the challenge of crafting sustainable, reasonable reform.

CDHP News: Lukewarm

Late last year, the Guardian Life Insurance company surveyed 1,000 working folks, specifically looking for their attitudes and opinions about Consumer Driven Health Care. Not surprisingly, the survey found that there's a lot of misinformation about CDHP, and that if we're going to have a meaningful national debate about its role, we need to clear those up.

While "traditional" plans still hold the lion's share of the market, consumer driven products (e.g. HSA's, HRA's, etc) are gaining ground, with some 14% of the market. Still, given that the current version of HSA's has been around for almost half a decade, I found that result disappointing (although not, frankly, surprising). The survey focused on the group market, though, so these numbers may or may not translate to the individual.

Part of the problem with that anemic enrollment is that almost half the respondents (44%) believe that such plans are actually more expensive than PPO's or similar plans, and almost a third (29%) are very concerned about what would happen if there was a catastrophic claim. There are two problems with this, of course:

First, high deductible plans are almost always going to have lower premiums than comparable co-pay plans. This just makes sense: if the carrier is off the risk for the little claims, they can charge less premium. The second problem is that, come a major claim, the high deductible plan will have - at worst - no greater out-of-pocket exposure than the co-pay plan, and often a lower one.

Another interesting find is that " (a) strong majority of consumers (85%) want more control over decisions that affect their health care, and 81% think health care costs should be transparent. Nevertheless, 33% of workers feel overwhelmed by too much information already."

That's really a shame. On the one hand, it illustrates that people do want to have some say in their own care, and a majority (think they) want more transparency in that care. On the other hand, there are still a lot of folks who are saying "TMI!" Still, they represent a minority opinion, and can easily avoid that overload (just swear off WebMD and Google).

Having done a number of employee enrollment meetings over the years, I wasn't the least bit surprised by the finding that over half (53%) of those surveyed listed co-payments for doc and hospital visits, not price, as their number one concern. That's not news to me (nor, I suspect, my colleagues): after carefully explaining how the high deductible plan and accompanying savings account work, the number one question I'm asked is always "okay, Mr Stern, that's really great. But what's my co-pay?" After explaining again how the plan works, and that there are no co-pays, the second question I'm asked is always "oh, that makes sense. So, then, what's my co-pay?"

I'm not trying to make fun of the employees here - after all, we're the ones who've been pushing $10 and $15 co-pays for years - but to illustrate the uphill battle we face if we're going to break through that 14% barrier. In the event, the complete results are here, and I'd recommend reading through it for even more insights.

"Mini-Med" Update: STOP! [UPDATED & BUMPED]

[Please scroll down for update]

Just got this from one of the "mini-med" (limited benefit) companies. Seems that the Empire State has decided to review "all companies that sell Limited Medical Plans in their state for various reasons." As a result, this particular carrier is pre-emptively suspending sales of its products in New York. I'm sure that, as the day goes on, I'll be receiving similar notices from other carriers in that market.

A quick look around the New York DOI site yielded no additional information on this; I've emailed this particular carrier for more details.

We'll keep you posted.

UPDATE: No thanks to the carrier who sent out the original "alert," we've been able to confirm that the New York Department of Insurance is, in fact, "reviewing the sales practices of insurance companies that provide limited benefit health insurance plans." It's also worth noting that, despite the growing number of carriers offering these plans, the email in the original post was the only one I've received on this. Strange.

In the event, Gov David Paterson is concerned that these "plans provide less coverage than what consumers are led to believe."

That's probably correct: unfortunately, sometimes people believe what they want to believe, and agents sometimes feed into that assumption.

In addition to requesting information from the carriers who market these plans, the DOI is planning a series of public hearings on the matter. For more details, here's the press release.

Weird Carrier Tricks [UPDATED & BUMPED]

[Please scroll down for update]

This one would initially seem to fall under our Stupid Carrier Tricks category, but it also seems to have a "happy ending:"

"An Anthem [insured] could not believe it when her insurance company refused to pay for a $77 blood test that would show if her breast cancer was still in remission ... but was willing to pay for a much more expensive pet scan, which costs thousands of dollars."

Hunh?

Apparently, Heather Toplak is a 35 year old breast cancer survivor, who needs annual blood screenings to determine if she's still in remission. Such tests are generally considered "standard of care," meaning that they're usually covered expenses, unlike much more expensive scans. This can save the insurer (and thus, its policyholders) a lot of money, which would seem to be a good thing.

During her battle with the cancer, Anthem apparently had no qualms about paying for various treatments and procedures [ed: Hey, aren't they supposed to fight these types of claim tooth and nail, and then cancel the offending insured's coverage? Looks like someone didn't get the memo!]. The follow-up blood test was denied as "not medically necessary," and recommended that she instead undergo a (much more expensive) Pet Scan. One presumes, given her condition, that she would have already met most (if not all) of her own out-of-pocket maximum, meaning that Anthem would have footed most or all of that bill.

Now, the twist: Mrs Toplak contacted her local TV-news troubleshooter, who in turn contacted the insurer. Anthem has reversed its decision, and "has agreed to pay for the [blood test]. Not only that, they are changing their policy on paying for these blood tests going forward."

Kudos!

The story still left a few unanswered questions:

■ Why was an Arizona woman covered by Anthem (since that state is served by BCBS of Arizona)?

■ What type of policy did she have, a co-pay plan or an HSA?

That second question is important because it's generally presumed that folks with HSA plans are more attuned to these issues.

I've emailed the reporter for clarification. So far, I haven't heard back. We'll let you know if and when we do.

[Hat Tip: FoIB Rick B]

UPDATE: In the comments, reader John H tells us that Mrs Toplak is most likely covered under the "Bluecard" program, which enables folks who live in states served by other "Blues" to have essentially seamless cover.

And we've heard from Carey Peña, the reporter on whose work we based this post. She tells us that she appreciates our "posting the story and hope that it helps advance the conversation."

In response to our question regarding the type of coverage involved, she writes:

"I’m not at liberty to answer your questions due to the privacy that I extend to my interview subjects. However I am more than happy to forward your link and request to Mrs. Toplak and if she wants, she can contact you directly with additional information."

That's an entirely reasonable response; we'll let you know if we hear from Mrs Toplak.

Slashing CEO Comp, Saving Money?

Our own Bob V has made this point before, but it bears repeating, and who better than FoIB Flarin' Karen. She notes that Cigna's CEO reportedly makes some $30 million a year. She further notes that Cigna insures about 11 million people. She then observes:

"If he worked for free then each insured would pay $3 per year less in premiums on a policy that costs about $10,000 or more per year.

If their $1.7 billion operating expenses were reimbursed to the insured, they'd save less than $200 per year.

Savings we can believe in!"

Amen!

Forget Chilling - Try Freezing!

We were perplexed and a bit put out by the Obamistration's Big Brother effort with the tattle-tale email addy.

And were alarmed when this was expanded to an entire website given over to collecting "misinformation."

But this is beyond stunning:

"Since 2000, it has been the policy of the federal government not to use such technology. But the OMB is now seeking to change that policy and is considering the use of cookies for tracking web visitors across multiple sessions and storing their unique preferences and surfing habits."

When one surfs the 'net, one invariably picks up these little info gathering pieces of code, which are used for a variety of purposes (some benign, some not so much). The best definition I could find says that cookies are "a piece of text that a Web server can store on a user's hard disk. Cookies allow a Web site to store information on a user's machine and later retrieve it."

As noted above by the ACLU (not exactly a bastion of right-wing ideology), it has long been our gummint's policy to eschew cookies, encouraging citizen participation.

But that was then, and this is now:

"Without explaining this reversal of policy, the OMB is seeking to allow the mass collection of personal information of every user of a federal government website."

This means, for example, that if you visit that Big Brother site, our most transparent administration ever will be able to see many (perhaps most) of the websites that you've previously visited. And because of in-place regulations, once this data is collected, they are forbidden to destroy it.

Now, one might say that this is no big deal, because there's no way they can match up your "hit" with any personally identifiable information.

And one would be wrong:

How many of us shop online? How many use our real names (or even parts of our real names) in email addresses and when leaving comments? These are easily "picked up" by various cookies, and could potentially become government policy. Before you fit me for a tin-foil hat, do a little research and prove me wrong.

But be convincing.

And, perhaps, be afraid.