Beneficiary? Don't Fuggedaboutit!

Although we blogged on the subject some time ago, our favorite Tax Blogger, Joe Kristan, has a timely reminder on why it's so important to periodically check - and, if necessary, update - the beneficiaries of your life insurance policies.

You do own some life insurance, right?

Philly Cheese Exchange

Pat and Geno probably won't be fighting over this one:

"After months of study ... [Pennsylvania is] moving forward with a key - and widely supported - option offered by the federal health-care overhaul: a state-run insurance exchange."

Of course, the authors of this piece offer no evidence demonstrating anything like "wide support" for the Exchanges (possibly because none such exists), but no sense letting a few facts get in the way of a good story, right?

The silliness doesn't end there, of course:

"Besides being a one-stop shop for health insurance, the exchange will be the only place where many of the people who will be newly eligible for insurance under the law ... can apply for the tax credits that are intended to make coverage affordable."

Well, sort of: it's true that, as this is a state-run Exchange, Keystone State citizens would be eligible for whatever tax "credits" may be available, and for as long as they're available. But since we know that ObamneyCare© will quickly generate huge deficits, it's a sure bet that this won't be for long. Especially since tax payers in states with federally-run Exchanges won't be eligible for these same credits.

What could possibly go wrong?

In the event, the Pennsylvania-run Exchange is scheduled to go on-line (literally) in 2014, and is expected to draw some 2 million people. How many of those will be eligible for tax credits is not mentioned, but one presumes that it will be a majority of participants.

Which leads to even greater deficits, and thus higher premiums.

More cheese!

Cavalcade of Risk #145: Insurance Fest edition

David Williams hosts this week's excellent round-up of risk-related posts, with an emphasis on insurance as risk management tool. Do check it out.

Also, we really need a host for the February 22nd Cav...Drop us a line for details.

Barney, Fannie, Freddie and Death Panels

In his role as Congressional "Rabbi" for Freddie Mac and Fannie Mae, Barney Frank has been credited/blamed for many of our current fiscal problems. His recent announcement that he wouldn't be seeking a 17th term may be surprising, but it's his take on ObamneyCare© Death Panels that really hits home:

"Massachusetts Democratic Rep. Barney Frank announced on Tuesday his support for the repeal of the Independent Payment Advisory Board [aka Death Panels] ... became the 12th Democrat, and the 212th member of the House, to co-sponsor ... Rep. Phil Roe’s bill aimed at repealing the [them]."

While much of the focus has been on the (Evil) Mandate, the IPAB/Death Panel has managed to fly somewhat under the radar. Without it, though, there are few (if any) provisions in ObamneyCare© that directly address the cost of health care, not just the availability of health insurance.

Good times, good times.

Food Pyramid Update: Fat's Back!

According to a new study by universities in the Netherlands, the "dietary intake of saturated fatty acids (SAFA) is associated with a modest increase in serum total cholesterol, but not with cardiovascular disease."

Translated, that seems to be a green light for more saturated fats in our diet. The bad news is that we'll most likely need to hold off on carbs, especially those with "a high glycaemic index."

In other words, look for foods that haven't been processed so much (whole grain or sourdough breads are good choices), cut back on the taters, stock up on quinoa (which, by the way, is generally considered Kosher for Passover).

Yum!

[Hat Tip: Hunter-Gatherer]

Turning up the Heat on Allianz

Last week, we updated our readers on the efforts of Florida Congresswoman Ileana Ros-Lehtinen to resolve a decades-old dispute over life insurance proceeds due the families of those killed in the Holocaust.

Turns out, she's turning up the heat. To broil:

"[Congresswoman Ros-Lehtinen] is pressuring National Public Radio stations ... CNBC and others to stop airing sponsorships and advertising by a giant German insurer that collaborated with the Nazis ... has launched a letter-writing campaign aimed at blocking [Allianz] from advertising with any U.S. media until it pays off all Holocaust survivors' life insurance claims."

That's gonna leave a mark.

And in the "Adding Insult to Injury" Department, it turns out that in addition to insuring the lives of Holocaust victims, Allianz insured the means of their deaths, as well: "Allianz insured concentration camp facilities."

Full disclosure: I do not represent Allianz.

On Phones, Cars and Health Care

The Law of Unintended Consequences is cruel, and unforgiving: “every undertaking, however well-intentioned, is generally accompanied by unforeseen repercussions that can overshadow
the principal endeavor.”

We saw this with Cash4Clunkers. and are still reaping those consequences (don't believe me? Try finding a good deal on a used car). But there is, perhaps, an even better model: cell phones.

Ok Henry, now you've just gone off the deep end. What the heck do cell phones have to do with health care, or health insurance?

Just everything:

"Over 26,000 Ohioans abusing free cell phone plan ... Companies are flooding low-income households with free cell phones and minutes under a plan overseen by the federal government."

Let's tweak that a bit:

"Over 26,000 Ohioans abusing free or low-cost health insurance ... Carriers are flooding low-income households with free cell or almost-free health insurance phones, with immediate coverage for pre-exisitng conditions, under a plan overseen by the federal government."

And herein lies the problem: radio waves are essentially free, and limitless. Not so doctors, hospitals and medications. If the government can't keep a handle on handsets, how will it rein in the cost of hand surgeries?

But the cell phones are free, so what's the big deal?

Nothing is free:

"The program is paid for with fees mandated by the government and tacked onto most cellphone and home phone bills."

Again, a little plastic surgery (so to speak):

"The program is paid for with fees mandated by the government and tacked onto most insurance premiums and hospital bills."

'Nuff said?

Dumping on MassCare

In the world of investing, the term pump-and-dump refers to a "scheme that attempts to boost the price of a stock through recommendations based on false ... statements. The perpetrators of this scheme ... sell their positions after the hype has led to a higher share price."

Put more simply, they get in, "use" the system, and get out, generally at a profit. This costs the company, and it costs the other shareholders.

But what, you may ask, does this have to do with health insurance?

Well, before there was ObamneyCare©, there was MassCare. And an integral part of MassCare has been Guaranteed Issue, coupled with immediate coverage for pre-existing conditions. Or, as the Boston Herald's Frank Quaratiello reports:

"A gaping loophole in state insurance rules that lets freeloaders pick up coverage to pay for expensive surgeries — and then dump it once they’re treated — has cost taxpayers as much as $37 million a year"

There's even a term for this: "jumpers and dumpers.” Jump and dump, pump and dump; tomato, tomahto.

But that's just a Bay State problem, right?

Not so much, "according to a study that warns the same wrinkle in Obamacare could add a staggering $2 billion a year to the deficit-wracked federal budget ... similar provisions in the nation’s new health care plan could cost the government at least $1.9 billion a year starting in 2014 when Obamacare kicks in."

Ooops.

Glad we passed the bill to learn what's in it.

I been workin' on the railroad (I mean for SEIU)

"If you're a parent who accepts Medicaid payments from the State of Michigan to help support your mentally-disabled adult children, you qualify as a state employee for the purposes of the Service Employees International Union (SEIU). They can now claim and receive a portion of your Medicaid in the form of union dues."

These deadbeat scab parents gotta be stopped. And our government is just the one to stop them.

Cavalcade of Risk #145: Call for submissions

David Williams hosts next week's CavRisk, and wants your risk-related post. Entries are due by Monday (the 28th).

NB: We're now using this submission tool: The BC WorkAround

Once there, you'll be asked to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")

At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.

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

BTW: We REALLY need a host for January 25...

Thanks!

What ICD-10?

I love it when the government supports my theory. The theory in this case is that we will go metric before we go ICD -10. Towards that end the government announced on Thursday, November 17, 2011 that that first piece of moving towards ICD-10 has been delayed.

All physicians were to begin electronically billing using the new updated form, version 5010. That was to begin in Jan. 2012. It has been moved to March 2012.

As easy as running a four minute mile (no I do not know the metric equivalent, America never went metric).

Captain Kirk vs Tom Turkey

If you've never had the pleasure of tasting deep-fried turkey, you're missing a real treat. But unlike conventionally-cooked birds, preparing one of these can be both daunting, and dangerous:



Be careful, and have a GREAT Thanksgiving!

[Courtesy of our friends at State Farm]

Wal-Marting of Health Care in America Continued

In 2009 I wrote a paper titled “The Wal-Mart”ing of Health Care in America”. The premise of the paper was that consumer driven healthcare was paving the way for clinics in places like Wal-Mart. Over the past several years mini-clinics have been popping up in grocery stores and strip malls across the country. In March of that year, an article announced that “Wal-Mart will partner with its Sams Club division with Dell and eClinicalWorks to begin offering low-cost electronic health record systems to physicians”. Well Wal-Mart did not go forward with the EMR, but instead is going straight to the mini med clinic with the headline: “Wal-Mart wants to be your MD: Retailer seeks to use medical services to lure shoppers, boost traffic."

In that 2009 paper I observed that “America has been facing a crisis in a shortage of primary care physicians. For the past few decades the number of graduating medical students going into family and general practice has been steadily declining. According to a study published by the American Osteopathic Association, in 1984 56.4% of all graduating D.O.’s chose family practice. That number has dropped to 42.6% while general internal medicine has significantly jumped from 4.7% to 9.5%. It seems that Wal-Mart “now wants to dominate a growing part of the health care market, offering a range of medical services from basic prevention to management of chronic conditions like diabetes and heart disease, according to a document obtained by NPR and Kaiser Health News.” First, general practice is not a growing part of health care, thus there is no domination. Wal-Mart “intends to build a national, integrated, low-cost primary care healthcare platform.” Isn’t this what Obamacare is all about? So what's wrong with Wal-Mart doing it sooner and cheaper?

In my opinion, Wal-Mart will succeed because Medicine is a business. Back in 2009, I wrote that “physicians, like all technicians, understand the art of medicine, that is their training, and they are effective in their art. However, medical schools do not teach physicians how to relate to the enterprise of medicine or to the business of medicine.” Wal-Mart will succeed because they appreciate the patient and they can offer low prices; prices lower, in fact, than the standard family practice physician. Physicians become their own worst enemies by constantly micro managing their practices and their staff; as a result, they will be unable to compete with Wal-Mart.

"Maybe Walmart can deliver a lot of this stuff more cheaply because it is an expert at doing this with other types of widgets, but health care is not a widget and managing individual human beings is not nearly as simple as selling commercial products to consumers," says Ann O'Malley, a physician and senior health researcher at the Center for Studying Health System Change, a nonpartisan Washington think tank.” Unfortunately, this is incorrect: in a recent post, I noted that medicine has already moved to a standardized format and consumers want simple medicine.

Health care leaders will need to deal with many issues if they want to maintain supremacy (or at least market share) in Health Care in America over Wal-Mart. There are many barriers standing in their way to achieve the change necessary to stay viable. One is the culture of the current state of how medicine is managed here. If physicians are making the decisions without input from the administrative people and medical ancillary personnel working in the health care field, then there is a 50-80 percent chance of failure. Norma Hagenow, President of CEO Genesys Health System Source stated that “Culture eats strategy every day of the week. Culture is people. You can set up the best strategies in the world, but if you do not have the hearts and souls of the people behind that enterprise, it’s nothing.”

Back in 2009, these were my concluding thoughts: “The Health Care perfect storm has been brewing for several decades, since the failures of HMO’s in the 1970’s, Phil Donahue lambasting against health care in the 1980’s, the Clinton initiative in the 1990’s and now Wal-Mart has entered the picture. At each time of conflict the physicians clung to their culture and refused to work towards change. As a result, change will come to them in the form of Wal-Mart clinics, consumer driven healthcare and electronic records. Based on all evidence, physicians will not address the changes and as all failed organizational structures, the current physician driven medical system will fade into oblivion.”

It seems the future is now.

The MVNHS© Gets Down

Down Syndrome, that is.

So what is Down Syndrome?

It's a "set of mental and physical symptoms that result from having an extra copy of Chromosome 21 ... Usually, mental development and physical development are slower in people with Down syndrome than in those without the condition."

Although DS isn't curable (yet), those afflicted with it can, with training and time, "live productive lives well into adulthood."

Well, maybe just folks who aren't subject to the Much Vaunted National Health System©:

"A man with Down’s syndrome was locked in a one-bedroom flat and deprived of his basic human rights for ten months until his death ... Detained against his will by health and council officials ... David Parsons was denied regular contact with his wife and family and ‘abandoned’ by those caring for him."

At age 53, he had plenty of life left, time he could have spent with his wife and other family members. A few years ago, MVNHS© physicians declared that he "had developed dementia and epilepsy," but Mr Parsons' family disputes this. Regardless, he and Mrs Parsons (who apparently has similar developmental issues) were locked away in a "residential care home for the elderly."

Well, there ya go: "Out of sight, out of mind, we're the MVNHS©"

No, they're not

Of all the stupid things I've read recently about SCOTUS and ObamneyCare©, this takes the cake:

"The insurance industry is terrified that the Supreme Court will strike down the individual mandate to buy insurance next year while leaving the rest of the healthcare reform law intact."

The truth is, carriers know that ObamneyCare© is simply the next step towards a nationalized system, and every one of the major players wants to be the one (or among the ones) who actually administers that system.

Afraid of it?

Heck no, they're rooting for it.

Great News, LexisNexis edition: Tax Update blog named to Top 20!

FoIB and All-Around Good Guy Joe Kristan has been named one of the Top 20 Tax Bloggers of 2011.

Which is great in and of itself, but there's more: the Update's also in the running for Top Tax Law blog. And no one deserves it more than Joe - the Update is consistently interesting and entertaining, informative and snarky. That's no mean feat for a blog about taxes.

So, click here to vote for the Tax Update Blog for LexisNexis Top Tax Law blog, 2011 edition [NB: Make sure you vote for "Roth Tax Update Blog"].

Selfless vs Selfish

Last night I happened to catch the premiere of a new game show with a pretty cool premise: all the winnings would go to the contestant's best friend "Because She Deserved It." To introduce the deserving single mother of three, we were treated to a quick bio, which included the fact that her late husband was selfish and irresponsible.

Of course, they didn't couch it this way, but consider the facts: he (apparently) had no life insurance, and decided to go scuba diving alone - at night - leaving a young widow and three fatherless daughters. Mom struggles to pay the bills, and lives in constant fear that she or her daughters will become ill. Why is that? Because he also didn't arrange for them to have health insurance.

Having had enough of that, I hit the remote and was treated to this outstanding commercial from State farm:



Yes, it's funny, but it's also illustrative of a father who does care about his family. That's how responsible dads operate.

Frustrating Carrier Tricks: Medicare vs Group

Basic rule: your group is under 20 lives, Medicare is "primary."

But what does that mean?

In simple terms, it means that if you're on Medicare, but still actively at work and on the group insurance there, your group plan becomes a sort of supplement to Medicare. Not so difficult in theory, but in practice, well, sometimes carriers make it too hard.

Take, for example, Anthem (please!).

One of my small groups has a simple plan: $30 office visit co-pays, a $5,000 deductible and some co-insurance for big-ticket items, and a prescription drug benefit. Next March, their employee Mary will turn 65, and Medicare will become the primary health insurance on her claims.

Mary's employer asked me how that would work, and requested that information in writing from Anthem. Seems pretty simple to me. Anthem knows how Medicare works, they know that it's primary for this group, and they know this group's benefits structure.

Piece of cake, right?

Well, no.

After repeated phone calls and emails, further and further up the Anthem food chain, this is what I got in email today:

"... I did hear back from customer service who confirmed we do not have something like this. You are correct that there would be too many variances with how the claims will process. We will need to see the Medicare EOB & then determine which policy is the primary. The claims area will then key the claim into the system ... they will input the information from Medicare. All of this information is taken into account, while viewing the members benefits. I hope this helps."

No, Tracy, it does not help. This is very simple: Anthem insures the group, and knows exactly how and what it will pay. This should not be a deep, dark state secret.

Cough. It. Up.

Grand Rounds: In Gratitude edition

FoIB Amy T hosts a Thanksgiving-themed collection of medblog posts, and we're grateful to have been included.

And awaaaaay we go !

Secretary of Health and Human Services Kathleen Sebelius is urging Pennsylvania-based Everence Insurance to abandon its plan to raise rates by an average of 11.6 percent in the small-group market.

And will this be more entertaining than Jackie Gleason?

Well, probably not.

But still good.

Holocaust insurance settlement: Update

It's been over 4 years since we've had any news about efforts by survivors in their efforts to collect on Holocaust-era life insurance benefits. At the time, Florida Congresswoman Ileana Ros-Lehtinen had introduced legislation to help move those efforts along.

Skip ahead 4 years, and Ms Ileana Ros-Lehtinen is holding hearings in Congress aimed at enabling survivors and their families to "sue European companies such as Allianz AG, a German insurance giant, in state courts for unpaid life insurance policies sold before World War II."

The seemingly insurmountable problem, of course, is that life insurance companies require death certificates in order to adjudicate claims. Obviously, these are not going to be forthcoming in the cases of those massacred in the Holocaust. As Congresswoman Ros-Lehtinen asks, "[c]an you imagine anything more outrageous than asking for a death certificate for someone murdered in Auschwitz?"

Indeed.

Of course, there's a twist here:

"[T]he American Jewish Committee, the Anti-Defamation League, B'nai B'rith and the World Jewish Congress ... argued at a 2010 congressional hearing that the International Commission on Holocaust Era Insurance Claims was created to address worldwide claims, and that re-engaging in court could unrealistically raise the expectations of survivors."

I'm reminded of that classic punchline: "what could it hurt?"

Lamenting the Demise of Medicine in America

Two physicians from Beth Israel Deaconess Medical Center, Pamela Hartzband, MD and Jerome Groopman MD, write in the Oct. 13 edition of the New England Journal of Medicine that medicine has become industrialized. In their view, the medical exam given by a doctor to his patient has become an encounter between a provider and a consumer. Their lament is correct but a little late in coming. When I was working on my MBA, I researched the business of medicine and discovered that the process that these physicians lament has occurred over the past 6 decades. The insurance structure that exists today came about as a result of wage freezes during World War II.

As employer-sponsored health insurance become more popular, the revenue cycle of medical care changed. Instead of the patient paying for the entire service at the time of treatment, the patient would pay a small amount of the medical bill and the insurance would pay the rest.

And then:

“…insured patients began to request that the [medical offices] bill their health insurance before making payments on their accounts. [The patient] agreed to pay the balance due after the carriers determined the insurance portion of the claim. Each insurance company had a unique set of billing requirements. The complexity of the new billing procedures greatly increased paperwork and practices had to, therefore, increase the size of their billing staff [or add a billing staff which had heretofore never existed in the medical practice]”

These changes dramatically affected how Americans viewed health care. First, by not paying the premium, they no longer had the knowledge of the true cost of those premiums. Secondly, by not paying for the medical care at the time of service, they no longer had the knowledge of the true cost of health care. The organizational culture of healthcare changed and the organizational memory has been lost by the American populace.

The Deaconness folks weigh in:

“We are in the midst of an economic crisis and efforts to reform the health care system have centered on controlling spiraling costs. To that end, many economists and policy makers have proposed that patient care should be industrialized and standardized.”

Patient care became standardized when insurance companies began telling physicians how much their services are worth. No longer is a physician paid based on the financial needs of the physician’s business, but instead on a government produced fee schedule based on a formula called RVU’s. Physicians have not had a raise in their fee schedule from Medicare in over a decade, and the docs are so appreciative that each year the fee is not cut that they don't realize that they did not receive any increase.

The Deaconness Duo adds:

“The problem ... is that the special knowledge that doctors and nurses possess and use to help patients understand the reason for and remedies to their illness get lost in a system that values prepackaged, off-the-shelf solutions that substitute "evidence-based practice" for "clinical judgment."

What Hartzband and Groopman do not understand is that the patient does not want to pay for the physician to develop an evidence-based plan of care. Today’s exam averages 15 minutes. A physician cannot do the type of work that Hartzband and Groopman want in 15 minutes. That is the reason that more and more medicine is pre-packaged, and it works for the majority of the population. For the minority of patients that need the more protracted appointment and care, there is resentment that they should have to pay more for their care than someone else.

More from Boston:

“Even more troubling ... is the impact of the new vocabulary on future doctors, nurses, therapists and social workers who care for patients. Recasting their roles as providers who merely implement prefabricated practices diminishes their professionalism.

Reconfiguring medicine in economic and industrial terms is unlikely to attract creative and independent thinkers with not only expertise in science and biology but also an authentic focus on humanism and caring.”

Here, Hartzband and Groopman are correct: individuals who desire to make a contribution to society, and to be rewarded for this contribution financially, will steer away from medicine. Since insurance companies pay the inadequate physician the exact same as the extraordinary physician, what is the incentive to become a physician?

While I applaud Doctors Hartzband and Groopman for their impassioned plea to return to medicine of old, that ship has sailed. Modern medicine is dictated by a labyrinth of regulations, economics, and government oversight that has forever changed medicine in America.

Puzzling Carrier/Government Tricks

Last week, I had the pleasure of once again hosting the Health Wonk Review, which included a post from our very good blog-friend Louise Norris that really piqued my interest:

"For the last several months, individual health insurance applications in Colorado have included a new set of questions to determine whether an applicant’s premiums are going to be paid or reimbursed by an employer."

For as long as I can remember, carriers here in Ohio have forbidden employers from directly subsidizing premiums for individually-owned plans. Although this applied across the board, it was specifically aimed at those small companies that offered to payroll deduct individuals' premiums and then send them in to the insurance company (often called "list billing").

Let's take an example:

Sam works for ABC Widgets, which does not offer group health insurance. But Sam, Joe and Sally each own individual plans from (for example) Anthem. Their boss offers to set up a list billing arrangement, whereby he deducts the appropriate amounts from their paychecks each week, and then sends that all in to Anthem at the end of the month. In this case, he's just acting as a conduit, providing nothing more than a convenience.

But if the boss were to go a step further, and offer to kick in, say, $25 a week towards each of their plans, this could create a major problem: it could very easily be argued that he now has a group health plan, and the Anthem could potentially be on the hook for expenses not contractually covered under the individual plans.

So carriers forbid this practice, and life goes on.

But that's Ohio, and as Louise points out in her post, Colorado had no such moratorium.

Until now.

I've asked Louise to explain in more detail for InsureBlog readers:

In Colorado, it has also been illegal for many years for employers to an employee's individual health insurance policy. It was illegal for brokers to even discuss individual plans with an employee at their place of work - everything about individual policies, from the application to the billing, had to be done outside of work. But then federally legal HRAs came on the scene and started to muddy the waters a bit. Some HRA companies were actively soliciting brokers to get them to encourage employers to switch from a group plan to an HRA and have the employees seek out individual health insurance policies that the employer could reimburse via the HRA. The big problem with that tactic is that some employees won't be able to qualify for medically underwritten coverage in the individual market and are left with no option other than CoverColorado, the state's high risk pool. A flood of employees into CoverColorado threatened to destabilize the risk pool.

Earlier this year, the Colorado legislature passed Senate Bill 19, which changed the rules considerably regarding the legality of employer funding of individual health insurance* Employers can now fund individual health insurance premiums for their employees via an HRA or wage adjustments - as long as the employer has not had a group health plan in place in the past 12 months. Senate Bill 19 has resulted in a new section on individual health insurance applications in Colorado wherein the applicant has to state whether or not an employer will be reimbursing any portion of the premium, and if so, whether or not the employer has had a group policy in place in the last 12 months. If yes to both, the application will be declined (unless the employee agrees to pay all of the premiums without any assistance from the employer).

Senate Bill 19 was a big change to the legal landscape of individual health insurance in Colorado. It's not a perfect system by any means, but it does allow employers - who wouldn't otherwise be able to afford group insurance - to kick in at least a small amount of money towards their employees' health insurance premiums. The provision requiring 12 months between coverage under a group plan and reimbursement for employees' individual policies will hopefully help to prevent employers from dropping group plans just to send their employees into the individual market and CoverColorado. This should help to prevent destabilization in both the small group market and CoverColorado. But it's also causing some employees to be declined for coverage when they may not have any other option at all (assuming their employer has already dropped the group plan and isn't going to reinstate it, and assuming that they were relying on the contribution from the employer to be able to afford a new individual policy.)

Starting in 2014, this shouldn't be an issue anymore, as all policies are slated to be guaranteed issue by then. But for the next couple of years, it's likely to cause some headaches.

Thanks, Louise, for helping to put this in perspective!

ObamneyCare© Glitch - IB Ahead of the Curve

Over two months ago, Bob noted that citizens in states that opted out of creating their own Exchanges would be ineligible for premium subsidies. Since so few states have thus far even begun exploring how to set up an Exchange, this has now hit the radar.

As Cato's Michael Cannon writes in today's Wall Street Journal:

"[Obamneycare©] offers "premium assistance"—tax credits and subsidies—to households purchasing coverage through new health-insurance exchanges ... [Obamneycare©] authorizes premium assistance in state-run exchanges (Section 1311) but not federal ones (Section 1321)."

Ooops.

So folks in states utilizing Exchanges run by the Federales will have a choice: buy (and pay for) unaffordable health insurance, or go to jail.

So not only didn't they read it before they passed it, they didn't even debug it.

FoIB Tax Update LexisNexis bleg

Our good friend Joe Kristan, whose outstanding Tax Update blog is always a must-read, is in the running for "LexisNexis Top 20 Tax Law Blogs." As Joe says, there's nothing else quite like the Tax Update: fresh material several times a day, and Joe's unique way of making even the driest of tax-related info interesting and fun.

Voting's easy: just click here, and sign in (you can even use your FaceBook or Twitter ID!).
Vote for Joe - you'll be glad you did.

Cavalcade of Risk #144: Gobble it up now

Nancy Germond hosts this week's Thanksgiving-themed roundup of risky posts, and it's all gravy.

Pull up a chair and enjoy!

Grand Rounds at Sharp Brains

Alvaro Fernandez hosts this week's collection of the best medblog posts. Do check it out.

Mazel Tov to the 2011 Top Insurance Law Bloggers

A heartfelt congratulations to the 2011 Honorees, which include our friends Nina Kallen, David Harlow and Emily Holbrook. Kudos!

And thanks to all of our readers for their support. Yes, we're disappointed to miss out for the first time, but that's life in the blogosphere.

This Sceptered Isle, Part CXLXXIII

Hullo, what's this then? "NHS managers have been banned from rationing treatments while patients wait to die".

I guess that practice was wrong after all - so kindly stop doing it, you NHS Managers.

For some people this little bit of news from the Sceptered Isle may come as a surprise, for others it will simply be a confirmation.

PowerLine Blog puts it this way: Under government medicine, the patient isn’t the customer, the government is. The patient is merely an inconvenience who can make things easier by going away

Sounds right to me.

And meanwhile on these "progressive" western shores of the Atlantic, the U.S. Supreme Court has agreed to hear arguments that Obamacare is brought to us by the federales for our own good.

ObamneyCare© meets SCOTUS

One supposes that we'd be remiss in not remarking on this news:

"The U.S. Supreme Court will hear a challenge to President Obama's signature law on health care ... The challenge in the case, brought by 26 states out of Florida, is based on the constitutionality of the individual mandate in the Patient Accountability and Affordable Care Act, which requires that all Americans purchase health insurance."

The case at hand is the "biggie" comprising 26 of the 58 states, and which argues that the (Evil) Individual Mandate is unconstitutional.

Dunh.

At this point, all we know is that the Supremes have agreed to hear the case, presumably next Spring. Given the Court's current make-up, and recognizing that IANAL, it's anybody's guess how they'll eventually rule.

Shall we set up a pool?

Kiwi HIStorectomy?

One of my favorite fellow health policy wonks, Russell Hutchinson, has a disturbing story from his native New Zealand. As I understand it, the NZ health care system is a combination of government and private enterprise. Many (most?) folks are part of Primary Health Organisations (PHOs), which provide primary care (dunh!) but may not be the perfect choice for more complicated issues.

Then again, maybe they beat the government-run alternative:

"Man told pain due to hysterectomy"

As Russell explains, it's bad enough that the system made this inane call in the first place, but in a fit of bureaucratic pique, they doubled down:

"Mr Kennington's nurse took the matter up with the DHB [District Health Board] but they just sent the same report back. Which means, that even when a nurse said there was something wrong, they didn't even look at it."

And believe it or not, it gets worse.

Go read the whole thing.

Lasers vs Epilepsy

In what could prove to be a watershed moment in treating this dread condition, Golden State doctors have used a special laser-tipped device to zap specific cells in a pre-teen's brain:

"Early Friday afternoon, doctors at Sutter General Hospital slipped a laser-tipped probe into 11-year-old Jack Petersen's brain and turned on the light, sizzling some of Jack's most problematic brain cells in seconds at temperatures near 130 degrees Fahrenheit."

Although it's still considered experimental, this could be a major breakthrough in curing what is an often debilitating illness. Certainly, it could prove much less dangerous than the surgical method that's been the go-to method for many years.

Here's hoping that it works out for Jack P.

Told Ya So: Bye Bye Group Plans

As we've predicted since the very moment of its passage, ObamneyCare© spells the death knell for group insurance.

Here's the latest installment in its demise:

"A new Gallup poll shows ObamaCare is working just as planned: kill the private health insurance industry in order to implement a single-payer government system ... The percentage of American adults who get their health insurance from an employer continues to decline, falling to 44.5%"

The proof, as they say, is in the numbers, and those are stark indeed.

But of course, ObamneyCare©'s good outweighs its bad, right? That is, we've made great strides in reducing the number of uninsured Americans, providing more citizens with health insurance than ever before, right?

Right?

Not so much:

"The percentage of adults with no health insurance has been increasing in 2011"

So much for "if you like your health insurance you can keep your health insurance."

UPDATE [11-12-11]: And it's not just health insurance getting the axe, but actual employees:

"Stryker, the Kalamazoo-based maker of artificial hips and knees, will cut 5% of its global workforce by the end of next year to reduce costs in the face of new fees on device makers required by the U.S. health care law."

This is big news because of our prediction last Spring that this would indeed be the case:

"ObamaCare© mandates a new excise tax on certain classes of medical devices (including certain female-related products). This in turn is creating a chilling effect amongst those companies doing R&D on the next generation of life-saving devices."

Fewer jobs, fewer choices, Papa Washington.

Cavalcade of Risk #144: Call for submissions

Nancy G hosts next week's CavRisk, and wants your risk-related post. Entries are due by Monday (the 14th).

NB: We're now using this submission tool: The BC WorkAround

Once there, you'll be asked to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post ("Remarks")

At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.

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

Thanks!

LabCorp Update

A month or so ago we interviewed the principal litigant (and whistleblower) in a lawsuit targeting alleged Medicare fraud. Today comes word that Mr Baker's efforts have captured the attention of (at least) two high-profile lawmakers:

"Senators Chuck Grassley and Max Baucus are asking the leaders of three major health insurance companies and two leading clinical laboratory testing companies for information about a practice where insurers receive discounted pricing from labs in exchange for referrals ... Grassley and Baucus said they want to “protect the interests of our nation’s Medicare and Medicaid beneficiaries and the federal health care programs.”

One supposes that this is good news (at least for Mr Baker and his supporters), but of course Medicare faces significantly more important and drastic challenges than this.

[Thanks to Ania Kapla for the tip]

Health Wonk Review: Olio Edition

No, not oleo, but olio: "a miscellaneous collection (as of literary or musical selections)." And this week, that means great posts from some of our "regulars," as well as an eclectic selection from folks that are new to the 'Review. Regardless, as always when we host HWR here at IB, we're strict constructionists regarding the Review's Founding Purpose of "policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends."

After hosting countless 'Reviews, I'm going to invoke "Seniority," and lead off with my own blog. I hope to be forgiven, however, since the post in question is the first ever from My Better Half, who proposes a rather unique, if outside-the-box, solution to a vexing health care financing problem.

Something I noticed this time around was a sort of "pattern" to the submissions: half were about, or related to, health care financing (aka health insurance), which isn't all that surprising. But almost as many were about topics I don't recall seeing in previous editions, ranging from teens in trouble (of a sort) to quacks (but not not duck-related). I think you're really going to enjoy this one:

■ Gail Stern is a Project Management Professional with an emphasis on IT Infrastructure [ed: don't feel bad if you don't quite get that - I often need subtitles as she discusses her work at our dinner table]. In her first ever blog post, she turns her (considerable) talents to resolving an expensive government-sponsored health insurance conundrum.

■ In a somewhat related post, Jonena Relth reports on the latest EMR/EHR trends being tracked by the Healthcare Information and Management Systems Society. The challenges facing our health care system and its reliance on information tech are mind-boggling.

■ We here at HWR-HQ have never claimed to be speciest, so we're happy to include Rachel Cleary's thought-provoking post on pet obesity, and how to prevent and/or deal with it. Ruff! Meow!

■ Our first insurance-related item (I'll be sprinkling them throughout this edition) comes from my favorite Health Care Economist, Jason Shafrin. This week, he tackles something currently on the minds of a lot of seniors (and those that care for and about them): how to choose a Part D plan to help pay for meds. Timely and informative.

■ If choosing a plan, or even writing about how to choose one, becomes too stressful, Charles Chua has just the ticket: how about making every day a holiday? No, Jay, he doesn't mean playing hooky, he means adjusting our mindset. And isn't mental health policy just as important as physical?

■ NewsFlash: #OccupyHWR is in effect! Well, in a way: Roy Poses is ticked off at what he considers "crony capitalism" in the health care marketplace. His post is important, because it vividly illustrates that financial issues aren't just about banks and taxes, but pills and x-rays, too.

■ Does your employer help pay for your health insurance? For folks covered by employer-sponsored (aka "group") plans, the answer's yes (sort of, but that's another post). But as Louise Norris points out, it's a whole 'nother matter when you've got an individual plan and your boss wants to help out with the premiums. There's a lot more here than you might think: Federal Law vs State Regulations, for starters.

■ Did you know that almost 10% of American teenaged girls are moms? Or that we have one of the highest teenage pregnancy rates in the world? Neither did I (and me with two daughters!), which is why this post from the folks at DNA Testing blog was both an eye-opener, and quite relevant.

■ Jaan Siderov has an interesting take on a special kind of health care vendor, and why its roller-coaster stock pricing may be less than meets the eye.

■ Workers Comp Insider's Jon Coppelman fisks the idea that charging higher health insurance premiums for smokers and, um, plus-sized folks will ultimately close the gap between premium income and claims outgo. But he goes further, pointing out that the net effect may be to actually harm those least able to afford it.

■ It's really good to hear from too-long-silent med-school blogger NotWithStanding. NWS poses an interesting conundrum [ed: you really like that word, don't you?]: is it possible to legally ban health care quackery without forever politicizing questions of scientific and medical truth? Careful with your answer: the Law of Unintended Consequences awaits you if you falter.

■ And finally, unlike yours truly, Mark Hall is a fan of the Individual Mandate. In his post at the Health Affairs blog, he sets out to show that keeping the mandate will lead to a more predictable, stable market, and that it's absolutely vital to the success of the new health reform law (what we here at IB call ObamneyCare©)

And that concludes this edition of the Health Wonk Review. Since we're big fans of tryptophan, we'll be skipping the Turkey Day HWR festivities, and reconvening at Brad Wright's place on December 8th.

Thanks as always to Julie Ferguson for helping to make hosting as easy and fun as possible. Speaking of which, she's always on the hunt for new hosts, so why not drop her a line and grab an HWR for yourself. You won't be sorry.

Another 1,000 Words....

[Courtesy of PowerLine]

Are you protected?

Quick, which is more valuable: the Golden Goose or its eggs? Or put another way, your most valuable asset is (most likely) your ability to earn a living.

Unfortunately, Disability Income (aka Income Replacement) insurance is one of the least-bought products in our portfolio. As agents, we're partially to blame for this: how many of us really "push" DI?

And there's this: in most cases, I think individually-owned policies are preferable to those available under an employer-sponsored plan. Still, any coverage is better than none, and group plans are often more affordable than individual ones.

Independent agents (such as yours truly) represent multiple carriers, and there are any number of quality choices available. One such is Unum, which provided this video as a helpful introduction to the topic. It's relatively short (just over 5 minutes), and has a wealth of interesting info:



If your employer offer such a plan, maybe you should look into it. And if he doesn't, well then, maybe you should suggest that he do so.

Because you never know.

Stupid Client Tricks: Cancelled Life Insurance Edition

MarySue is a successful mid-level executive at a fast-growing small business. For a number of years, her employer paid for her $100,000 term life insurance policy, which cost less than $300 a year, and was guaranteed to stay at that rate for a total of 20 years. It was also "convertable," meaning that she could trade up to a permanent plan pretty much any time she wanted, locking in her coverage for the rest of her life.

A few years ago, she developed breast cancer, which was quickly removed with no apparent long-term effects. Still, it meant that her ability to buy life insurance was dramatically reduced for quite some time.

No problem: she still had better than 15 years left on her term policy.

Then, a few years later, her employer decided to discontinue paying her premiums for her. She could have easily taken them over herself, which is what we advised her (rather vehemently, given her recent cancer scare) to do.

But she was having none of that, and so she chose to let it lapse.

Was this a poor choice?

You tell me:

Recently, she called and asked about buying a new policy. I checked with our primary carrier; the underwriter informed me that, based on the facts of the case, MarySue would not be eligible for consideration for a few more years, and that whatever her rate would have been at that time, there will be an additional surcharge on her annual premium.

That means that her policy would start out "in the hole," and that's before the "regular" rate is applied.

Ouch!

Since she wants coverage now, and doesn't want to wait 2 or more years, I contacted our local "problem case" gurus, who told me that, after checking their markets, the best they could offer would be a guaranteed issue, graded benefit plan. These plans have reduced death benefits for the first few years before taking full effect, and are generally quite a bit more expensive than "regular" plans.

Could all of this have been avoided?

Of course: for less than 85 cents a day, she could have kept her perfectly good existing term policy, and even converted it into lifetime coverage with a level premium guaranteed never to increase. We always urge clients not to cancel existing coverage before a new policy is issued, but this goes beyond even that: she cancelled her policy after she already knew she had a major problem.

Life is tough...

[Special Thank You to Bob V]

Still think Long Term Care insurance is a "luxury?"

Well, then, think again:

"Daily private-pay rates for long-term (custodial) nursing home care were obtained for private and semi-private rooms in licensed facilities ... National average rates for a private room increased by ... to $239 daily or $87,235 annually in 2011."

But then, you'll probably prefer home health care instead, right?

Well:

"The 2011 national average private-pay hourly rates for home health aides and homemaker/companion services remain unchanged from 2010 at $21 and $19 respectively."

At, say, six hours per day (let's lowball it), that comes to about $2,600 a month, or over $31,000 a year. Still not convinced?

Fine:

How about now?

[Hat Tip: FoIB Jeff M]