Cavalcade of Risk #87: Call for submissions

Andrew at the Oz Risk blog hosts next week's Cavalcade of Risk. Submissions are due Monday (the 7th). Andrew asks that you please 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.

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

Biting the Hand (Well, Finger, Really)...

Is it just me, or are the Obamabots getting a bit, um, thin-skinned? First, they call those of us opposed to gutting our health care system "the villains in this debate." Then, we became "domestic terrorists." Now, it's escalated to actually biting off someone's finger:

" (A)bout 100 people demonstrating in favor of health care reforms rallied Wednesday night on a street corner. One protester walked across the street to confront about 25 counter-demonstrators.

O'Hanlon says the man got into an argument and fist fight, during which he bit off the left pinky of a 65-year-old man who opposed health care reform."

One wonders if Medicare covers digit re-attachment, or if that's an elective procedure that can be denied. Of course, one also wonders whether Obamacare would simply dictate that the now pollex-challenged senior should just take a pill and move on.

Article I, Section 8

"The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States ..."

In all, the Constitution sets forth some 20 duties and powers incumbent upon Congress.

Thus far, all the discussions of "health care reform" have been around "how much, how far." But this young man, a vet, raises an interesting point:

Well?

Yikes!

What else is there to say?

Sentenced to death on the NHS

Excerpts below - but please read the whole linked article:

Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors warn today.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong."

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

Thanx to Mark Steyn and National Review Online for the link above.

Health Wonk Review is up...

And it's far from ludicrous, although this week's round-up of wonky posts is hosted at the Lucidicus Project.

Civil Debate: So Now We're Terrorists?!

Oy!Bama's perpetual campaign acolytes seem to have outdone themselves:

"All 50 States are coordinating in this – as we fight back against our own Right-Wing Domestic Terrorists who are subverting the American Democratic Process, whipped to a frenzy by their Fox Propaganda Network ceaselessly re-seizing power for their treacherous leaders.”

Froth at the mouth much?

To its credit, the Oy!Bama-linked "Organizing for America" has since pulled the (no doubt unintentionally) revealing post; to its discredit, the "grassroots" organization felt it appropriate to run it in the first place.

I'm ambivalent on this: on the one hand, being labeled a "Right Wing Domestic Terrorist" is somewhat off-putting; on the other, it would definitely make a great name for a band (with apologies to Dave Barry).

One of the problems, of course, is that it's very difficult to convince someone of the value of your position while you're engaged in vile name-calling. And since an overwhelming majority of Americans are dead-set against ObamaCare, it seems to me that OFA (et al) would do well to remember that old adage about flies and honey.

Hope and Change: Presidential Vision Edition

And so The Won has (finally!) decided to share with us, the unwashed masses [ed: hey, speak for yourself! I took a shower this week] his grand vision for health care (and/or insurance) "reform." Which is nice, after all, since he's spent the past 9 months deferring the design of this "plan" to his congressional colleagues.

Who, despite a clear majority in the House and a fillibuster-proof Senate for most of that time, still couldn't manage to solve this particular "crisis." But I digress.

Since congressional rocket surgeons couldn't agree on a plan, it finally devolved to our President to pause from voting "present" long enough to put down in writing what he has envisioned. The problem, of course, is that he has a nearly insurmaountable obstacle: he promised a plan that would cut costs, increase both efficiency and choice, and which would not break the budget.

I'm reminded of an old axiom: "You can have it fast, you can have it cheap, you can have it good. Pick any two." And it appears that he's decided that the one to be left out is the so-called Public Option:

"(A)lthough House leaders have said their members will demand the inclusion of a public insurance option, Obama has no plans to insist on it himself, the officials said."

Of course, just because The Won doesn't "insist" on this boondoggle doesn't mean that it's dead in the water. In fact, the Congress could (and probably would) simply add it back in during the "reconciliation" process (where the House and Senate versions are stitched together to make one law). The point, though, is that our Health Care Czar-in-Chief is finally deigning to share with us what he'd like to see. How that will go is anybody's guess, but at least we'll have a better idea of how far he's willing to go to cripple our health care system.

UPDATE, OTB Edition: The Politico article mentions that The Won will be giving "a major speech as soon as next week;" perhaps, as so often with this administration, a prime-time version (which costs the networks revenue and turns away viewers). In anticipation of that event, here's a little poll:

pollcode.com free polls

Since the President has already thrown tonsillectomies and ampututations under the bus, which medical procedure do you think he'll call out next?

Hip replacement Botoxification Heart cath Dialysis Lasik

Gruel: It's What's for Dinner (Courtesy of the MVNHS©)

If you're a hungry Englishman, it appears that you'll eat far better as a criminal than a patient:

"Patients in Health Service hospitals are far more likely to go hungry than criminals in jail."

So say a group of British scientists at the Bournemouth University. According to a new study undertaken by the university, " (j)ail diets are "better than most civilians have ... But people on NHS wards do not get the same standard and staff do not check if the food is eaten."

According to Dr John Edwards [ed: no, not that John Edwards], the problems include:

■ patients aren't eating enough (and the staff aren't paying attention to that)

■ because services are so fragmented, there is little (if any) follow-up by medical staff

■ "trays are removed by cleaning staff so doctors do not know how much was eaten"

In short, it appears that these facilities just don't seem to care how well (or poorly) their patients are eating, leading to malnourishment and hindering recovery.

So, health care is free under the MVNHS©, but apparently health isn't.

The “Ethics” of Obamacare

Dr Stuart Fickler, a retired physicist (who hasn't lost his phys!) currently serves as Scientist-in-Residence at the Chabad Learning Center of Greater Dayton (OH). He is a close friend and mentor who recently shared his perspective on Obamacare with me. I felt that it would make a helpful Guest Post:

"I am outraged by the cavalier attitude of our current government toward human life. I refer to the evidence inferred from Dr. Ezekiel Emanuel’s articles related to the “Complete Life System” (Journal of the American Medical Association and Lancet), and the Veteran’s Administration’s publication “Your Life Your Choices”. Dr. Emanuel is Head of the Department of Bioethics at the Clinical Center of the National Institutes of Health and a top advisor to President Obama on health care. The principal author of “Your Life Your Choices” is Dr. Robert A. Pearlman, Chief, Ethics Evaluation of the VA’s National Center for Ethics in Health Care. It is fair to presume that both of these men will have significant influence on the implementation of any law pertaining to national health care. Both of these men base their arguments on what they call ethical considerations.

I am Jewish and I am prepared to argue that their so called “ethical considerations” are an affront to the ethics of Judaism. An essential principle of Judaism is “choose life” (Deut. 30:19). All of the commandments and practices of Judaism are centered on that statement. Any discussion of end of life MUST start with that as the primary operating imperative. The ethical and practical considerations may become complex, but “choose life” must remain the guiding principle. As a scientist with experience with statistical process control, I am convinced that it is indeed possible to develop a heath care system that is effective, economically sound and preserves the ethical imperative: sustain life.

From their writings, it appears that Drs. Emanuel and Pearlman base their “ethical considerations” on a social resource allocation model which reduces the human being to a commodity. Like a commodity a human life will have a price put on it relative to its value to the consumer (the government). That will determine the level of care to be provided to an individual. That is an obscenity! It is an abomination to God, to creation and to humanity! It reduces human life to something that is bought and sold in the marketplace.

In closing, I would like to add one more thought. In one of his writings Dr. Emanuel states "Unlike allocation by sex or race, allocation by age is not invidious discrimination; …”. This is either naïve or insidious. Once the principle of a resource allocation model is accepted, there is nothing to stop an authority from extending it to any other segment of the society."

Thank you, Dr Fickler, for your insights and analysis.

Through the L. Glass

I received a letter from my Congressman last week. The letter is dated August 21, 2009. I want to share this sentence from it:

"The Congressional Budget Office (CBO) has indicated that the House Bill would not increase the federal deficit"

Elsewhere in his letter, the Congressman, the Honorable Mr L., states clearly he is referring to HR3200, America's Affordable Health Choices Act.

Anyone have any response to the sentence I quoted? Anyone?

I'm going to his town hall meeting tomorrow afternoon. I'd be very happy to carry with me a comment or two of yours.

Thanks.

Paging Dr John Galt

Unless you're a senior, you may not be aware that many providers don't accept Medicare; this means that, perhaps by design, the Medicare (MC) provider "network" is limited. This can be an issue if, when you turn 65, your family doc for the past 20 years is no longer (easily) accessible.

"So what's new, Henry," you may ask, "why bring that up now?"

Because one of the "solutions" currently on the table is the so-called Public Option, and a lot of providers are beginning to say that they're not going to accept PO patients, either. Dr. Alfred Bonati, who heads up the American Society of Medical Doctors, says:

"(A) nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan ." [ed: emphasis added]

That's a lot of doc's who'll be refusing new patients. It may also throw cold water on the gummint's projected numbers regarding how many folks will actually sign up for such plans.

Of course, the fed's could just pass a law that requires doc's to take on PO patients. Think it can't happen? Of course it can. After all, is it such a great leap from requiring health insurers to take on anyone and everyone that applies, regardless of health, to mandating that physician's treat whomever shows up on their practice's doorstep?

Of course it's not.

Now why would these doc's dig in their (collective) heels on this issue? It's simple, really:

"Hundreds of auto dealers in the New York area have withdrawn from the government's Cash for Clunkers program, citing delays in getting reimbursed by the government, a dealership group said Wednesday ... they cannot afford to offer more rebates. They're also worried about getting repaid."

Just sub in "doctor" for auto dealer, and you begin to get the picture.

If enough physicians (and, of course, other providers) publicly state from the outset that they're not signing on, what do you think happens to the PO? And if the PO is an integral part of the "reform" (which, who knows, it may or may not actually be), then how's that Hope and Change going to work out?

Grand Rounds

Medical safety and technology is the theme of this week's Grand Rounds, hosted by Dr Joseph Kim. Do stop by.

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.