Autism & Death: Euthenasia in the spotlight

What with the measles news out of North Carolina (and Israel), vaccines and the folks on the anti-vaxx bandwagon are at one another (again). We tend to side with the folks who think protecting our children (and hence our communities) seems like a no-brainer, but the anti-vaxx folks contend that the medicine leads directly (and inexorably) to autism.

Okay, so what's your point, Henry?

Well, it seems that the folks who run nationalized health care schemes have their own vendetta out for the autistic among us:

"The euthanasia of Nancy Fitzmaurice, a severely disabled child who was not dying, has made international waves ... Nancy’s mother had requested that her daughter be killed and was granted approval by the British legal system."

But that was then, and this is, well:

Is autism a valid reason for euthanasia? Belgium opens criminal investigation into doctors who euthanized a 38-year-old woman. https://t.co/tBmKn9i4sN

— AP Europe (@AP_Europe) November 27, 2018

As we've long noted, the challenge with state-run health "care" schemes is that it is, ultimately,the state that gets to make real life-and-death decisions. And, of course, the culture itself plays an important role: why else would this doc think helping a young woman kill herself was acceptable?

Oy Canada: Make mine a double

Shot (courtesy Surgery Center of OK, about which we've posted):

"Family frustrated with lack of bed at Halifax hospital for mother with cancer"

One of the major problems with nationalized health care schemes is that the law of supply and demand is immutable. That is, there will always be a (growing) demand for health care, but there is also a limited (or at least finite) supply. We've seen what happens when you make health care a "right," and it's not pretty:

"Vowing to maintain public dental services in the province, Quebec’s health minister said Thursday he would sign a ministerial decree to block dentists from withdrawing from the public health system." The case at hand, though, is far more serious, since it involves a potentially life-threatening condition, and the patient suffering even more damage as a direct result of the system.

But then, these systems are also capable of turning out world class meds, which brings us to...

Chaser (via Ace of Spades):

"It is one of this country's great scientific achievements. The first drug ever approved that can fix a faulty gene ... But most Canadians have never heard of it."

Yup, that's right: Canadian researchers at the prestigious University of British Columbia "spent decades developing the treatment for people born with a genetic mutation that causes lipoprotein lipase disorder."

Decades, and tonnes of dollars loonies.

The condition, more commonly known as LPLD, is the result of a genetic mutation, and causes ones blood to thicken with potentially deadly results. It also renders females who suffer from it barren (due to the high risk of miscarriage).

The med, called Glybera, promises to fix all that. The problem is that it was just too expensive, and thus was allowed to whither away on the vine.

To be fair, this isn't the fault of Canada's health care system, but one of simple economics:

"Van Deventer says the company never considered lowering the price ... Why would we? Pricing shouldn't be a political decision. It should be a rational decision based on merits and values.'

Which is contra what a lot of folks here say about "Big Pharma."

Interesting dilemma, no?

Bonus:

Canadian Hospital Urgent Care Waiting Room To Patients: Kill Yourself https://t.co/Q9lwPzlPVS from The Political Hat Blog

— Political Hat Blog (@PoliticHatBlog) November 27, 2018

Vets & DPC

No, not that kind of vet, this kind.

Our youngest is the proud mother of two cute cats and, as a graduate student, has a limited budget for feline-related medical expenses. She uses the services of a national chain called Banfield Pet Hospitals, which offers a unique (AFAIK) and interesting option that looks a lot like the Direct Primary Care model (for people) about which we've written so often:

"We focus on preventive veterinary care to promote and improve overall pet health. Routine check-ups allow us to diagnose, treat and protect your pet from contracting serious, costly and sometimes fatal diseases."

These services include vaccinations and dental care, complete exams, even nutritional counseling. That last, by the way, may be something that our own DPC providers may not routinely offer (but which might be a great idea).

The basic Banfield plan looks to be about $30 a month or so (depending on services, breed and age), which seems pretty reasonable. There's a modest one-time sign-up fee, as well; I've also seen these with DPC practices.

Of course, the "Hospital" in the name also means that they also offer more robust services, but I like the preventive care idea, and wonder if we'll start seeing similar collaborations with the DPC community/model.

Meow!

That was then...

Regular readers may recall our piece on Direct Primary Care "wrap" policies from a few years back:

"Pan-American VP Carlo Mulvenna was kind enough to walk me through the basic idea behind the plan's design, as well as share product details."

Recently, a reader emailed asking about the status of this plan:

"Have you seen any new major medical/catastrophic wraps for DPC since the article was written in 2015?"

So, I reached back out to Carlo Mulvenna (subject of the interview) who, as it turns out, is still with Pan American Life, and who graciously responded with an update:

"Henry,

Good to hear from you.

The MedLion relationship remains though they are focused on a new segment of Virtual Primary Care. For our traditional relationships of employers with large populations of hourly workers we have added a new relationship with HealthCare2U. I've attached a copy of our promotional/info piece."

Regards,

Carlo"

Very nice.

The brochure explains that the program is designed to offer "Affordable, Convenient Access To Healthcare" by packaging online tools and "unlimited same-day/next-day doctor appointments for acute issues at $10 a visit and around-the-clock telemedicine for no out-of-pocket cost."

There are also tools and services available to help manage chronic diseases, which could be very handy.

The "bad" news, of course, is that we still don't have a workable DPC "wrap" plan for catastrophic situations. Oh, well.

Thanks Carlo and Jeremy!

Medical Tourism: An Ugly Turn

Back in October, a realtor from Dallas took a trip south of the border for some body work (rhinoplasty and a breast enhancement tune-up). What seems like fairly routine procedures led to some pretty serious complications, and ultimately took her life.

But there's a larger lesson in this, one having to do with getting what one pays for, at least according to her attorney:

"So that her death is not in vain, people should think of Laura before they look for cross border discount surgery ... Always LOOK before you leap!"

Always sage advice, and it appears that Ms Avila had done her homework:

"Laura's fiance Enrique Cruz said he had researched the clinic and found positive reviews online."

Which may or may not be worth the pixels they're printed with.

I don't really think that one can generalize from this that medical tourism is inherently more dangerous than care we receive here, but it's worth noting that it's not necessarily worth the savings, either.

Caveat emptor, indeed.

[Hat Tpi: FoIB Holly R]

A Blessed Thanksgiving

There's a theory that the original Thanksgiving celebration, and the holiday itself, is modeled on the Jewish Festival of Sukkoth (Tabernacles). The idea is that they're both harvest festivals that take place in the Fall, and that the Pilgrims, as religious folks, would have looked to the Bible for inspiration.

The reality is that it's highly unlikely to be true, but it's always fun to speculate on these kinds of connections.

A joyous and blessed Thanksgiving to all of our readers!

Pre-65 Medicare Health Insurance

It's currently Open Enrollment season for both ObamaPlans and Medicare Supplements. The former has been a bit frustrating (the only non-Medicaid carrier available in this market has a *very* narrow network) and I've been referring the latter out for many years.

But it got me to thinking that perhaps it's time to reprise another of my former Answers.com gig's posts:

For millions of younger Americans with health problems, Medicare may be available to cover medical expenses. This would include those with long-term disabilities or who have been diagnosed with specific diseases or health conditions, such as amyotrophic lateral sclerosis (ALS) or end-stage renal disease. As with those who qualify due to their age, though, Medicare itself doesn't cover everything, and some form of supplemental coverage may be desirable.

What's the problem?

During surgery, a client's adult daughter was deprived of oxygen for many minutes, resulting in brain damage that left he unable to support herself. She was eligible for Social Security Disability, and thus for pre-65 Medicare health coverage. The challenge is that there are deductibles and co-payments that add to her out-of-pocket costs. A Medicare Supplement policy might be able to pay for most of them. Unfortunately, many people don't know that these plans exist.

What's available?

In some states, one can purchase a standardized Medicare Supplement policy from a licensed carrier. These plans, which are usually available only to those 65 and older, are made available to those who qualify for pre-65 Medicare. They can be expensive, but in many cases the coverage they provide far exceeds the monthly premium.

Medicare Advantage Plans may also be an option, depending on one's residence.

How does Medicare Advantage work for pre-65 beneficiaries?

There are several benefits to an Advantage Plan. First, it caps one's maximum out-of-pocket in case there are a lot of claims (or one very big one). Second, many plans are available at little or no cost to the consumer. This can save thousands of dollars a year in premiums over a standardized Medicare Supplement policy.

The downside to Advantage plans is that one is limited to certain providers for health care, and not all of one's medications may be covered.

What about Open Enrollment?

One challenge with switching to a Medicare Advantage plan is that this can generally only be done during Open Enrollment. Fortunately, my client's daughter was also participating in Social Security's "Extra Help" program. Extra Help enables qualifying Medicare beneficiaries to purchase their meds at greatly reduced prices, with the government picking up the cost. According to the Social Security Administration (which oversees the program), Extra Help "[is estimated to be worth about $4,000 per year]( ttp://www.ssa.gov/prescriptionhelp/)." 

What about an Exchange Plan?

One of the alternatives we explored was whether or not an ACA-compliant Exchange plan would be appropriate. This was quickly discarded because, according to the Centers for Medicare and Medicaid, "it’s against the law for someone who knows that you have Medicare to sell you a Marketplace plan".

And people who do choose to reject Medicare and end up buying a plan from the Exchange are ineligible to receive any subsidy.

And so?

Americans who are on Medicare due to serious health conditions have limited health insurance choices. For many, a Medicare Advantage plan may be the most efficient means to supplement their Medicare coverage.

MVNHS© hates women, too

We've long known that the Much Vaunted National Health Service© really doesn't like kids:

"[I]t's actually cost the MVNHS© more money to fight his being flown elsewhere for treatment at his parents' expense."

Turns out, the health "care" scheme doesn't much like their mom's, either:

"Error means 48,000 women have not received cervical cancer screening information"

To be fair, this mistake was made by an MVNHS© vendor, not the service itself. Still, the buck pound sterling has to stop somewhere.

And hey: Free!

[Hat Tip: FoIB Dutch R]

CanuckCare© Gone ... Wrong?

Earlier this month, we reported on a service available to our Neighbors to the North© that helps them obtain health care while they can still use it:

"Check out Timely Medical Alternatives in Canada, which specializes in helping Canadians find affordable care (for cash payment) instead of waiting in the queue."

Well apparently that isn't sitting too well with the rocket surgeons who run the country's free health "care" system:

Canadian Hospital Waiting Room Promotes Euthanasia https://t.co/w4CSAcaXg2

— Þe Political Hat with "Ralph" The Wonder Llama (@ThePoliticalHat) November 14, 2018

Ooops.

Medicare - New rates for 2019, some history too.

About one month ago (October 12) CMS announced the Medicare cost-sharing factors for 2019. The table below compares 2019 with 2018, together with a couple of historical years. 

                                                                                                                                  2019                     2018    

Part A Deductible per hospital admission                                             $1,364.00           $1,340.00

Part A full buy-in premium                                                                         $   437.00           $   422.00

Part B annual deductible                                                                            $    185.00             $   183.00

Part B standard monthly participant premium                                   $     135.50            $   134.00

Part B full buy-in premium                                                                        $     542.00            $    536.00

                                                                                                                                  2000   .

Part A Deductible per hospital admission                                              $   776.00

Part A full buy-in premium                                                                          $   301.00 

Part B annual deductible                                                                            $    100.00

Part B standard monthly participant premium                                   $       45.50

Part B full buy-in premium                                                                        $    182.00

                                                                                                                                  1980      .    

Part A Deductible per hospital admission                                            $    180.00

Part A full buy-in premium                                                                       $       78.00 

Part B annual deductible                                                                           $       60.00

Part B standard monthly participant premium                                  $         9.60

Part B full buy-in premium                                                                       $       38.40

Notes to the Table

1.  The good news is that the increase to participant cost for 2019 is very small.  This reflects continued moderation in the rate of increase of medical costs that began in roughly 2003.  Costs rose faster prior to 2003 and less so afterward.  Looking back over the 39 years 1980-2019, the Part B premiums rose by more than 14 Xs, the average annual increase was 7%. 

2.  About 92% of Part B participants pay the standard Part B premium. By CMS rules, about 3% pay less, and about 5% pay more.  

3. Deductibles have risen steadily over the years.  The Part A deductible rose about 5% per year on average, the Part B deductible 3%.  Premiums over the years would have risen much higher, if deductibles had not also increased.    

This table does not show one of the most significant facts about Medicare:  its budgeted income has not kept pace with expenditures. As a result, Medicare has run budget deficits for many years.  In fact, its actuaries calculate Medicare has accumulated future unfunded liabilities of well over $40 trillion.  That is 7-8 times total Federal spending anticipated for 2019. Any private insurance company having proportional unfunded liabilities, would be bankrupt. 

4.  The table does show Part A and Part B “full buy-in premiums” even though in the real world, no one pays those premiums.  Those are the premiums Medicare participants would pay – if they paid the full premium to cover Meidcare’s budgeted cost. For example, in 2019, the full buy-in premium for Part A plus Part B is $979, or $11,748 per year – per person.   Just keep in mind even those premiums, as high as they are, are not nearly high enough to cover Medicare expenditures.  

5.  For anyone who might be interested, when Medicare started, January 1, 1966, the Part A deductible was $40, the Part B deductible was $50, and the Part B monthly premium was $3.00.  Those numbers seem impossibly low today.  How times have changed.

Health Care Sharing Ministries in the crosshairs

This just in:

"Nebraska published a consumer alert about health care sharing ministries - consumers should be aware of the significant limitations (like no-legal-responsibility-to-pay-claims-level limitations)"

Why this is just now being treated as "breaking news" is beyond me: we've been pointing out these very real problems for years:

"My claim from October had still not been paid. Yesterday I received a notice dated April 19, 2017 that since I was no longer a paying member my medical claims are no longer eligible for payment!"

Of course, these plans have their good sides, as well: ACA-compliant, relatively inexpensive, often include decent benefits (and omit unnecessary ones that tend to drive up rates). But as I point out to my own clients, they aren't insurance, so there's really no recourse if they decline a claim or simply fold up shop. And, as the report points out, there are often significant limitations in what's covered (and for how much).

Still, they remain a viable ObamaPlan alternative, as long as one joins up with eyes wide open.

[Hat Tip: Rachel Schwab]

Fall Health Wonk Review

Well, we got our first major ice-storm of the season last night (and continuing this morning), so it seems that Fall is, indeed, making itself known. And Lisa Lines is making her presence known, too, as she makes her Health Wonk Review hosting debut over at The Medical Care Blog.

And a right nice job she does of it: with posts ranging from Open Enrollment to Big Pharma Phunnelling Funds, you're sure to find *something* to pique your interest!

A Deadly Conundrum

Here's the (gruesome) headline:

"California dad charged with insurance fraud after he drove off cliff, killing autistic sons"

Now, we've discussed before the fact that one may not profit from a crime:

"In this story ... we learn about Joaquin Shadow Rams, who seems to have a habit of buying, and then collecting on, life insurance policies for his intended victims, including (allegedly) his mother and his girlfriend."

And of course there have been others. In all of the related posts I can find, though, all save one have been about straightforward and underwritten (term, whole or universal life) plans. But this one's different, and I'd like to talk about that difference.

"Regular" (aka "ordinary") life plans like term and whole life are generally underwritten (although there are guaranteed issue versions which impose waiting periods). But "accidental death" plans pay out only if the death is due to an non-purposeful injury (well, almost always). And the key to these plans is that they are generally not underwritten.

[ed: As an aside, one wonders if there was a cultural motive involved here in addition to the financial one]

In the case at hand, the facts seem pretty straightforward as to what happened. What's interesting to me is why the father chose an Accident Only plan instead of a term or even "Jumping Juvenile" one. And it seems to me that the answer is fairly obvious: the lack of underwriting makes it an easier "buy," and the fact that it's Accident only makes it a lot cheaper.

It's also worth noting this little tidbit:

"[T]wo years and 12 days earlier, Elmezayen bought the last of his insurance policies, which were purchased to cover his family in the event any of them accidentally died."

One presumes that this was to avoid triggering the "Contestability Clause," but I'm not seeing where that would apply to an Accident Only plan. After all, that clause is to protect the carrier from misstatements of health, age or sex; I'm not aware of any app that asks "Are you planning to murder your spouse/children any time soon?"

This is obviously a very sad case, but also a very strange one.

Cost transparency: I'll drink to that!

Shot:

"Health care is a service like any other. We ought to expect price transparency for medical goods and services to make informed choices that maximize value."

I, too, have been chasing this wild goose for many, many years. And I still believe that it's a noble goal.

But as long as government and insurance - in other words, 3rd party payers - are in the mix, it's not a viable one.

Chaser:

Are you a Dr. who agrees with this article? Please help us show patients/media/govt that this article is true. Post your cash fees on https://t.co/KruMnPRA4H. Help be the proof-source that affordable medical care is abundant and not limited to a few DPCs and @SurgeryCenterOK

— Alisa LeSueur (@Alisa_LeSueur) November 12, 2018

And why would any physician agree to this? And perhaps more critically, how would they?

Which brings me back to my first point (above): so long as the government (through Medicare and Medicaid reimbursement levels) and insurance (trough multiple provider contracts) distort the price (that is, that which the consumer/patient/insured pays), then there's no practical way for this to occur.

Which of course brings to mind Direct Care (whether Primary or other): when one pays the piper oneself, then it's reasonable (and viable) to pre-determine the cost of various services beforehand [ed: up to a point - what if the knee surgery uncovers something more serious?]. Of course, there's still an affordability challenge (and, often, an accessibility one), which means we still have a long way go.

Which is still another reason I'd love to see true cat plans re-legalized.

Tuesday Potpourri

■ So this past August we posted on the most recent "shiny new thing," Association Health Plans, which allows otherwise disparate groups of folks (employers and individuals) to band together to create larger insurance "pools." Our friends at HAFA (Health Agents for America), tip us that some carriers are beginning to roll out actual plans:

"Land O'Lakes, several Nevada chambers of commerce, and the National Restaurant Association have formed association plans this year ... the Land O'Lakes association plan “will offer another really good choice for individuals who either don't receive a subsidy and cannot afford coverage on the exchange or for some reason prefer not to purchase that coverage.”

Interesting. And we're seeing a lot of activity lately in the group self-funded space. So perhaps the market itself is killing ObamaCare with 1,000 cuts?

We'll see.

■ Thanks to FoIB Dabz, we're treated to this very interesting piece on creative (and viable) ways to deal with the (over-hyped) pre-existing conditions issue. For example:

"... the option of buying coverage at some point in the future—insurance against developing a health condition that makes one uninsurable."

This is not new; a decade ago we noted that (now-defunct) American Community Mutual rolled out "Community Flex," it starts out as an accident policy (major claims are only paid for injury, not illness), with some coverage for doc visits, preventive care, and a drug discount card ...  if you want more coverage, such is available through a "Gold Plan" buy-up."

And of course, "Dave's Plan" takes a similar approach:

"The capper, though, is that the plan has a rider that allows the insured, at their discretion (and with with no additional underwriting) to convert it to a major medical plan."

Which is to say, Chris Jacobs at The Federalist is spot on.

■ As we've long noted (most recently here), The VA is a hot mess. And if you still harbor any doubts, well:

Veterans Day: By the time I saw my VA doctor, he said it was too late...#veterans#healthcare#lessismorehttps://t.co/0BgNyaj8AP pic.twitter.com/dCi4bEsTvd

— Dutch Rojas (@DutchRojas) November 13, 2018

Wonderful Veteran's Day.

Dutch Doc in Dutch

We've written before about Holland's fascination with euthanasia:

"The number of Dutch people killed by medical euthanasia has more than doubled in the 10 years since legislation was changed to permit it, rising 13 per cent last year to 4,188."

And that was a little over 5 years ago. In the meantime, seems that the situation has deteriorated even further:

GOOD. This case was utterly disgusting. "Hold down the old lady while I shoot her up with death drugs."

Dutch doctor faces first euthanasia prosecution https://t.co/PHuwQXPyLg via @YahooNews

— I'm a woman, and I'm mad as Hell (@nowhere_nh) November 9, 2018

Thing is, it's not really clear to me why this doc has been singled out: it's not as if the underlying culture of enforced expiration is new, or somehow a secret.

Perhaps it's because, according to the linked article, this particular case was "assisted suicide" in much the same way as The Soprano family offered free swimming lessons. So the *true* message is ... a more subtle, refined ... approach.

It will be interesting to see how the case is ultimately resolved. Perhaps it, too, will (not so quietly) "go away."

Stupid, Self-Defeating Carrier Tricks

So, have a (long-time) client that needs a short term medical plan. Decided on one from United Healthcare (don't judge). After choosing deductible and co-insurance options, we started the "Broker Assisted Application" process (which basically means that I fill in his name and date of birth, etc, and checking account info). Once that's done, I press a button that sends him a link, he completes that link with his last name and date of birth, then hits continue to send it back to me for finalization.

Well, that's the way it's supposed to work, anyway.

What happened this morning - repeatedly - was that he would get the link, enter the info, press the magic button, and be told:

"Application not found."

Really, then how the $@()*^ did you know to send him the link in the first place, dummies?

After repeating this another time, with different browsers and same results, I called the ever-helpful people at Home Office. They advised me that he needs to complete this process from Google Chrome. I responded, well then, maybe we'll just use the "via text" option, and was assured that this process will not work for the application portion.

Then why offer it, you dolts??

This person wants to give you money and you're making it difficult for him to to do so?

Wow, just wow.

From the P&C Files: Ooops!

Rx and Profits: A Contrary Perspective

There's no question that the cost of prescription medication is a significant driver of health insurance costs. And there's decent enough evidence that "Big Pharma" plays by ... ummm ... perhaps different rules than most industries, racking up fairly decent profits (NTTAWWT). And we hear from the "health care press" on a daily basis how bad this is for consumers and patients.

But maybe there's a good reason for this: after all, in a (nominally) free enterprise system, greater risk should justify greater return.

Okay, Henry, what the heck are you babbling on about?

Well, this:

"the United States generates more new medicines annually than the rest of the world combined. Specifically, it produces 57 percent of all new drugs each year. Switzerland is second with 13 percent;" https://t.co/QLE2W9hBeo

— Bob Tufts (@TuftsB) November 6, 2018

Keep in mind that it may cost millions of dollars and decades of research to come up with even one new med, which then has to undergo the (presumably) stringent FDA approval process. And, of course, some non-trivial number of these new efforts fail to pay off.

Maybe there's some room for debate here, after all.

Mixing religion and health

I'm not really sure that I find what I'm about to share credible, but it is intriguing, and who knows, maybe there's something to it. In any event, it's something very different.

 Let's start with the Jewish practice of "laying t'fillin:"

The practice comes to us from several sources. The Torah (Jewish Bible) tells us in Deuteronomy and in Exodus to "bind them as a sign upon your hand, and they shall be for frontlets between your eyes." Observant Jews (and Jewish tradition) has interpreted that to mean wrapping one's left arm (near the heart) and one's head with special leather straps (at proscribed times and using a specific ritual and prayers).

But  what the heck does this have to do with insurance or health care, Henry?

Well, FoIB Holly R sent us this rather interesting article connecting them:

"A pilot study led by researchers at the University of Cincinnati (UC) College of Medicine suggests Jewish men who practice wearing tefillin ... may receive cardiovascular health benefits."

To be fair, this is a very limited study, including but a score of Jewish men, some of whom regularly engage in this practice, and some who do not (control group).  And of course, correlation ≠ causation, but still, intriguing findings:

"We found people who wear tefillin in either the short or long term, recorded a measureable positive effect on their blood flow. That has been associated with better outcomes in heart disease."

Hunh.

Tuesday Linkfest

■ For once, the term "shoddy insurance" doesn't apply to an ObamaPlan. Our friend Jeff M tips us to this item:

"Federal authorities have shut down a network of Florida companies that they say used aggressive, deceptive tactics to sell skimpy health insurance products that skirt requirements of the Affordable Care Act and left tens of thousands of people around the country with unpaid medical bills."

And no, these aren't Short Term Medical plans (or at least, not legit ones). First, these rocket surgeons (allegedly) used the logos of actual carriers to lure folks in, then sold them mini-med and discount plans as if they were "comprehensive" CA-sompliant policies.

And, of course, the numbskull "reporter" calls them "short term health insurance plans like those promoted by President Trump as an alternative to the Affordable Care Act."

Y'know, Bob, a simple call to a real agent could've helped you avoid embarrassing yourself.

(Aww, who am I kidding - these "journos" have no shame)

■ We're generally pro-DPC (Direct Primary care), although we've been known to call out some of its more ... enthusiastic ... proponents. Mark Aubry (of Impact Capitalists) alerts us to "The 8 Problems with Direct Care Medicine:"

"[W]e’ve been involved in the direct care “movement” for about 6 years now.  Sometimes we’ve stood on the periphery at events and conferences and sometimes we’ve run direct care clinics ... there is a real difference between hiding prices and using prices as a competitive advantage."

There's more and, while it's not exactly devastating, it does point out some areas of legitimate concern.

■ We've long written about the Much Vaunted National Health Service©'s war on children. Here, for example:

"[I]n this case it's actually cost the MVNHS© more money to fight his being flown elsewhere for treatment at his parents' expense."

And so one might be justified in thinking they'd hit rock bottom.

Justified, but wrong:

Children's operations cancelled by NHS up 58 per cent since austerity began, new figures show @Independent https://t.co/IGOtjbF7zh pic.twitter.com/aliOiyUhfo

— Sally Pipes (@sallypipes) October 29, 2018

But hey, free!

CanuckCare© Gone Private

Regular readers know that Canada's "free" health care system has, well, issues. Some years ago, we noted:

"A group in British Columbia has offered medical waiting-list insurance to members whose government treatment is on hold."

And, of course, it's well-documented that this is a problem for a lot of our Neighbors to the North:

"My father’s first oncologist appointment was scheduled for after he died."

Well, better late than ... Oh.

A half dozen years ago, Bob posted on the Surgery Center of Oklahoma, which "operates on a cash only basis. They do not accept health insurance, Medicare or Medicaid funds."

Turns out, our Neighbors to the North also have their own version:

"Check out Timely Medical Alternatives in Canada, which specializes in helping Canadians find affordable care (for cash payment) instead of waiting in the queue."

And indeed, when one visits the (aptly named) "Timely Medical Alternatives" site, one is greeted with an informative banner that touts their 14 years of experience, 20 facilities in Canada and the US, and (like their Sooner State colleagues) significant discounts. Best of all, they touch on two IB "hot buttons:" speed and transparency.

Speed:

"Recent evidence suggests that Canadians who require surgeries wait on average for approximately 20 weeks to receive the treatment they deserve, more than twice as long as national averages from when data first was collected a little more than 20 years ago"

But hey, free, right?

And transparency: one has only to select from the menu of services provided, and with a click of the mouse receive a free, no obligation quote.

Nice.

[Hat Tip: Twila  Brase]

On Open Enrollment v6.0: Perspective

So as Open Enrollment '19 kicked off yesterday, lots of folks checking out the new plans and (of course) higher rates. Our friend Rich Weinstein offers this helpful factoid that may give us a hint of things to come this time 'round:

Has anyone noticed there's only abt 10m enrolled in exchanges & the (2013) baseline estimate is about triple that?

I know 8m were to be screwed out of ESI & sent to HIX via Cadillac Tax. But that still leaves an additional 10m shortfall.

Obamacare's an epic failure. pic.twitter.com/2Y7NcUllJl

— Rich Weinstein (@phillyrich1) October 31, 2018