MVNHS©: "We don't play favorites"

That is, doesn't matter if you're a factory worker or an elected government official, your life (or that of your loved one) really doesn't count for much in Jolly Old:

"Ann Clwyd broke down as she spoke about the final moments of Owen Roberts, who contracted pneumonia after being admitted [to a hospital]. They had been married nearly 50 years."

But these things happen, right?

I mean, there's no evidence that the "caregivers" of the Much Vaunted National Health Service© mistreat or abuse their wards, right?

Um:

"[H]er husband was squashed against the side of his bed, his lips dry, and cold from a fan that had been turned on for a patient in an adjacent bay."

The Goddess of Irony does her best Cheshire Cat here:

"Ms Clwyd, the Labour MP for Cynon Valley since 1984 and Tony Blair’s former human rights envoy to Iraq" [emphasis added]

Through the looking glass, indeed.

But hey, don't just take my word for it:

ObamaTax cuts the Cheese(cake Factory)

Ah, the wonderful world of the ObamaTax:

"Cheesecake Factory CEO David Overton spotlighted the looming economic impact of [the ObamaTax] implementation, especially on small enterprises: "For those businesses that don't cover their employees, they'll be in for a very expensive situation." Overton also warned that the cost of the law would be passed on to customers."

No kidding.

Bon appetit!

LinkFest Tuesday

■ FoIB Michael Cannon reports that support for "universal coverage" is way down; in fact, he says, the majority of Americans now oppose it:

■ Seth Menacker tips us to this Wall Street Journal item on the intersection of plastic surgery, health insurance, and the holidays:

"After many cosmetic procedures patients want to go underground during the days-long recovery period, which might involve swelling, bruising and oozing ... This year, with Christmas and New Year's both falling on weekends, a patient can be under the knife or laser beams early in the week and still be presentable by the time the parties start."

Dr Adam Schaffner, a noted New York plastic surgeon, says that he's long noted "a dramatic increase in demand for procedures around the holidays. This could be due to the extra down time, or perhaps people meeting their annual insurance deductible.”

■ And because DC wouldn't be DC without spewing forth hundreds of pages of regulations every day, we have crap results like this:

"The Centers for Medicare & Medicaid Services (CMS) has proposed 373 pages of regulations that could affect how health plans fund and draw from new, multi-billion-dollar risk-management programs."

These kinds of regs, which are all a result of the ObamaTax, are a big reason why businesses are reluctant to grow and to hire: after all, they never know from day to day what new burdens they'll be forced to shoulder.

■ And speaking of which, the ObamaTax is taking a major toll on those it was ostensibly meant to help the most:

"About 100 servers, line cooks and dishwashers working at the Charleston Crab House don’t have health insurance ... they will either receive coverage or face financial penalties."

Because no one really knows for sure how all of the mandates and fines penalties taxes will ultimately play out, businesses have no way to know what they should (or should not) be doing. All they really know is that costs are going up and revenues going down.

Countdown to Exchange

The gauntlet has been thrown:

"Gary Cohen, director of the Center for Consumer Information and Insurance Oversight (CCIIO), told a panel of state insurance regulators that the U.S. Department of Health and Human Services (HHS) "will be able to open our doors" on Oct. 1, 2013."

Color me skeptical.

But hey, he's from the government, and DC folks never lie, so we'll take him at his word. Because we're so impressed with the job that Mme Shecantbeserious has done thus far, we've added a new feature in the sidebar: a Countdown to Coverage Clock.

We await with bated breath.

Health Wonk Review Comin' Up - Another Nudge

We'll be hosting this week's Health Wonk Review, and (as usual) the emphasis will be on "health policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends."

You can submit your wonky post here, and be sure to include:

■ Your name
■ Your blog's name
■ Your post's link
■ A brief summary of the post

Submissions are due by this Wednesday (the 5th),  but early birds get better seats at the table (hmmm, bit of a mixed metaphor, that). And speaking of seats at the table, make sure to bring some apple sauce and sour cream (and maybe some peanut M&M's).

And matches. Definitely matches. Or a lighter.

Avik's Apothecary

FoIB Avik Roy's Weekly Digest is a must read for serious health care policy wonks. His insights and analysis are at once easily understood and remarkably thorough. Here's this week's edition - and we recommend signing up for his email distro list so you don't miss out.

Tiers in my eyes

No, that's not a typo, but the latest strategy by Big Insurance to find creative ways to rein in costs, of both health care and health insurance It's actually a pretty cool idea.

FoIB Jeff M recently attended a Lunch-And-Learn put on by Blue Cross/Shield of North Carolina (pizza, natch). The purpose was to roll-out the next generation of group insurance products, and some of the new strategies being built into them in anticipation of the full implementation of the ObamaTax in a little over a year.

BX introduced two new plans for 2013: "Blue Value" for groups of 1-50 1-48 (what rational employer wants to butt up against the mandate?) and "Blue Select" for groups of 51 and up.

They share a common goal: to reduce rates by anywhere from 2-12 percent over existing plans.

And how, exactly, do they intend to accomplish this?

Common sense. That is, under the ObamaTax, there's a practical limit of how much you can tweak the internal plan design. Ratings structures will be closely monitored by Mmme Secretary Shecantbeserious, and the Medical Loss Ratios will continue to exert downward (or is that upward?) pressure. Carriers have already "adjusted" how prescription drugs are covered, what with separate deductibles, tiered co-pays and cost-sharing, formulary changes, and the like. There's not a lot of wiggle room left on those.

But the concept of "tiers" doesn't have to apply only to meds. What if you could unbundle your provider network, and steer your insureds to cheaper/more efficient docs and hospitals? Might not that improve the bottom line? Of course it would, but how to get that to happen?

Well, you bake it into the cake policy.

Take a look at the different plan designs (generously provided by Jeff M and available here). The change is clearest with the Blue Select plans, where there's a 20% out-of-pocket differential between Tier 1 and Tier 2 providers. That's a heck of an incentive to go online to confirm that your doc (or hospital) is in the "right" Tier.

It has an additional effect, as well: when you reward something, you get more of it. By incenting insureds to patronize Tier 1 providers, BX is rewarding both the consumer (who pays less) and the provider (who, presumably, enjoys a bump in patient count). And Tier 2 providers will get this message, one way or the other.

Very interesting - Thanks, Jeff!

From the P&C Files: Marathon Insurance

No, not that Marathon, this one:

"The New York Roadrunners Club and its insurers have been waging a pitched battle the past four weeks over how much money race organizers will be able to reclaim in the wake of last month's canceled New York City Marathon."

When Mayor Bloomberg cancelled the annual event (in the wake of Hurricane Sandy), it seemed like the right thing to do. After all, tens (if not hundreds) of thousands of area residents were still without power, and relief efforts were (at best) haphazard. Add in the fact that area hotels were at capacity with displaced storm survivors, and there seemed no reasonable way to actually hold the run.

Now, in addition to all the other financial headaches, there's the matter of the non-refundable entry fees prospective participants had to pony up for a chance at glory, and the millions more would-be spectators had plunked down for tickets.

Hard to believe but we first covered the concept of "Special Event" insurance over 6 years ago:

"Special Event insurance is just that: coverage to protect one from a sudden loss during some unusual activity or promotion. Think "$1 million Hole In One Contest."

Well, the New York City marathon is indeed a "special event," and had (propitiously) obtained coverage through a Lloyd's of London syndicate. Of course, these things are never as simple as they might at first appear:

"A person familiar with the Lloyd's deliberations said the company already has authorized a "large payment," a sign that it has acknowledged liability, even though the running club actually decided on its own to cancel the race. The person said Lloyd's is still working with NYRR officials regarding the size of the payment, and a significant disagreement remains."

Of course, of course.

The "disagreement" stems from the fact that the event organizers don't "have enough money to refund all the investments made in the race by runners, sponsors, broadcasters and the travel partners who arranged trips for foreign participants."

On the other hand, "the marathon has a clear no-refund policy, even if severe weather forces organizers to cancel the race." So it's unclear (at least to me) why there's a problem: doesn't "no" mean "no?"

Beats me.

Nurse: 50cc's Johny Walker, Stat!

Gotta love the Kiwi's:

"The 65-year-old Taranaki man suddenly went blind when vodka he had been drinking reacted with his diabetes medication. He regained his sight only after hospital staff administered expensive whisky."

Seems that the gentleman, a catering tutor, was celebrating his parents' 50th wedding anniversary (yeah, I didn't get the math there, either) with hooch his students had gifted him. When he found himself unable to see, he made haste to the nearest hospital. As surgeons cut him open, they got a string whiff of "nail polish remover" and believed they'd found formaldehyde poisoning. The standard treatment is to administer ethanol, which tends to counteract the methanol (a component of formaldehyde):

"Auckland City Hospital intensive care medicine specialist Tony Smith said administering ethanol was a well-established treatment for methanol poisoning.

It worked because the ethanol competed with the methanol and prevented it from being metabolised into harmful formaldehyde, which can cause blindness."

So what was this magic potion?

"Johnnie Walker Black Label. It was good whisky, yeah."

L'chaim!

Don't Ask, Don't Tell: MVNHS©-style

So, what do (sickly) grandparents and their (sickly) grandchildren have in common?

They both get to travel the Liverpool Pathway, and at least half of them aren't even asked about it:

"Almost half of dying patients placed on the controversial Liverpool Care Pathway are never told that life-saving treatment has been withdrawn ... around 57,000 patients a year are dying in [MVNHS©] hospitals without being told that efforts to keep them alive have been stopped."

Well, why should they be?

After all, it's not their money being spent on care. And, of course, there's the remote chance that they (or their parents) might raise nasty, totally unnecessary objections. Of course, this is entirely logical: what sense would there be in disclosing the distasteful fact that while health "care" is free, there's a finite supply of it, and that supply is much more efficiently spent on folks who have some hope of survival, right?

Now, if this sounds familiar, it should: the ObamaTax's IPAB's Death Panels are right around the corner to enforce this course of (non-)treatment on us.

Pleasant dreams!

Health Wonk Review Comin' Up

We'll be hosting next week's Health Wonk Review, and (as usual) the emphasis will be on "health policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends."

You can submit your wonky post here, and be sure to include:

■ Your name
■ Your blog's name
■ Your post's link
■ A brief summary of the post

Submissions are due by next Wednesday (the 5th),  but early birds get better seats at the table (hmmm, bit of a mixed metaphor, that). And speaking of seats at the table, make sure to bring some apple sauce and sour cream (and maybe some peanut M&M's).

And matches. Definitely matches. Or a lighter.

Babies and Gramps: On the road to Death

Well at least they're consistent: The Much Vaunted National Health System© seems hell-bent on applying the same (dubious) health care standards on helpless infants as vulnerable seniors:

"Sick children are being discharged from [MVNHS©] hospitals to die at home or in hospices on controversial ‘death pathways'"

What they're talking about there is the Liverpool Pathway, about which we've written pretty extensively in recent weeks (for example: here and here). Typically, the LP had been used to dispose of decrease treatment for the elderly, since the MVNHS© had already been doing a bang-up job killing off post-birth-aborting children.

One can see their point, of course: much more efficient to combine the two programmes, and the Pathway has already proven quite helpful in reducing health care expenditures (well, health care, anyway) for seniors. We'd best be paying attention to this ourselves, since the ObamaTax is our version of that vaunted system.

Sweet dreams.

PHI and Speed Bumps

Yesterday, Bob posted on the increasingly intrusive role data and its management play in modern health care. But it goes beyond physicians typing in notes on their iPads:

"The small box inside Amanda Hubbard's chest beams all kinds of data about her faulty heart to the company that makes her defibrillator implant."

That data gets shot to her cardiologist, but is essentially inaccessible to Ms Hubbard.

Wait a minute, Henry, haven't we seen this show before?

Indeed we have:

"Hugo Campos has [an ICD] buried in his chest to help keep him alive. But he has no idea what it says about his faulty heart."

All the pertinent data is collected and then sent back to the manufacturer, which then shares some of it with Hugo's doc."

So why the re-run?

Well:

"Medtronic [the device's maufacturer] says federal rules prohibit giving Ms. Hubbard's data to anyone but her doctor and hospital."

But it apparently doesn't prohibit Medtronic from seeking to make a buck off that data. The so-called "money quote," though, is this:

"[B]usiness agreements with doctors and hospitals restrict [Medtronic] to relaying information only to them."

This is reminiscent of the discounted rates insureds pay for in-network covered services, but which are excluded for those that fall outside the plan. That is, these agreements are quite lucrative for the providers (be they hospitals, device manufacturers or doctors), but not so much for the actual patient.

One argument will be that laypeople have no real use for the data because it's incomprehensible to them anyway; we already know from Mr Campos' experience that this isn't necessarily true.

A second argument would be that the law prohibits manufacturers from disclosing that data. Actually, my layperson's read is that since it falls outside the rubric of HIPAA (and/or the ObamaTax), manufacturer's aren't required to disclose it. Not quite the same thing.

So we'll ask again: Who (really) owns the data?

On Death Files, Competence and Confidence

As we noted last Spring, the Social Security Administration's Death Master File (DMF) "is itself rife with potential errors and misinformation." We reported this as part of our report on how life insurers are having an increasingly difficult time tracking down insureds and beneficiaries.

But there's another problem with that DMF, as well.

And this one's not so much about incorrect information as it is missing information.

One of my (very long term) clients lost her daughter 28 years ago, victim of a murder-suicide. Both her daughter and son-in-law have been gone almost 3 decades, but that didn't stop the government from reaching out to the long-dead perpetrator to remind him that he's now eligible for both Social Security and Medicare benefits.

But Henry, you may be asking, why are you even posting this?

Because it's just one more example (as if any were really needed) of how incompetent the Feds are at even the simplest of tasks, and these are the folks now in charge of our health care. In this case, it's simply a minor waste of postage, but what happens when it's your upcoming surgery?

Sleep well.

MVNHS©: Cruel and Unusual

When bureauweenies run your "health care" system, this really shouldn't come as a surprise:

"Patients experience “coldness, resentment, indifference" and "even contempt” in some hospitals, the Health Secretary has claimed"

And why not? They're not paying the bills.

And so you get, well, government-run health care:

"[P]atients left to lie in their own excrement in Stafford Hospital, with members of the public taking soiled sheets home to wash ... The man with dementia who was supposed to be monitored every 15 minutes who managed to leave Pontypool Hospital and drown ... residents kicked punched, humiliated, dragged by their hair and forced through cold showers"

And the list goes on...

At the risk of stealing his thunder, Mike's been working on a post detailing a rather interesting and provocative theory of how and why this is the natural result of state-run health care systems (like, for example, the ObamaTax). Suffice it to say, there really is a perfectly good reason why this sort of behavior is becoming "the new normal."

And the fact that the Brits' version of Mme Shecantbeserious is just now lashing out only serves to underscore how putting government agencies between ourselves and health care providers never ends well.

LTCi Gets More Expensive

Kinda wondered when the carriers would get around to this:

"Until now, insurers have charged the same premiums regardless of gender for [Long Term Care insurance] policies ... beginning early next year, Genworth Financial, the country's largest long-term-care insurer, plans to start charging women applying for coverage as much as 40% more than men."

This actually makes sense: women tend to live longer than men, so have an increased chance of needing some kind of assistance. As a result, two thirds of LTCi claims dollars go to the fairer sex. Add in carriers' measly investment income in these low-interest rate times, and there's a recipe for some major problems.

And don't be surprised to see underwriting tighten up, as well, as carriers are starting to better understand long-term trends.

And there's this: just because Genworth's going first doesn't mean that the other carriers won't follow their lead, so look for plan prices to begin jumping pretty soon.

Ouch.

Cracks in the MVNHS©?

Hmm, this sounds familiar:

"The [MVNHS©] can’t go on like this. Patients today – baby boomers, especially – bother the doctor with minor complaints ... and have unrealistic expectations of what the health service can provide. The system is at breaking point ... We are going to have to start paying for some medical services at the point of delivery."

Heh.

So the Much Vaunted National Health System© has been no more successful at reining in costs with "free" health care than our own "dysfunctional" system?

Who'da thunk it?

Oh, yeah.

This diagnosis, by the way, comes from physician (and Tory MP) Phillip Lee, who adds that the system "probably can limp on for the rest of this decade ... but the reality is the pressures coming from the baby boomer generation and their expectations of health care, their perceptions of pain and suffering is profoundly different [than] their stoic parents who survived the war.”

In other words: suck it up, buttercup.

Or it's hit the Pathway for you.

Cavalcade of Risk #171: Up and running

Emily Holbrook hosts this week's episode featuring the best of risk-related posts from around the 'sphere. It's short, sweet and packs a punch (and a mighty hammer, too).

Yeah, about that promise...

You know the one:

"If you like your health insurance you can keep your health insurance."

That sound you hear? It's that promise going under the proverbial bus.

From Medical Mutual of Ohio (email):

"As part of the renewal process for our individual health plans ... we will introduce several key changes starting with January 2013 renewals.

... the Internal Revenue Service (IRS) changed the 2013 key amounts for health savings accounts (HSAs) and HSA-qualified high-deductible health plans.

Due to the revised guidelines, we can no longer offer Wellness HSA 1200 plans to our SuperMed One and Ohio Farm Bureau members. As a result, we will transfer all members enrolled in these plans at their renewal.

SuperMed One members will move to the Wellness HSA 1500 and Ohio Farm Bureau members will move to the Wellness HSA 1750. These members will see an increase in their deductible"

Ch-ch-changes, indeed.

Off the Beaten Path(way)

As we noted late last month, MVNHS© "trusts" (hospitals) that participate in the British Death Panel Liverpool Care Pathway have been handsomely rewarded for their efforts. This makes sense: by scrimping on care they save the system cold hard cash, thereby earning their (not so) little finder's fees.

But all that may be coming to an end:

"Ministers ... ordered an independent inquiry into why hospitals have been paid to hit targets for numbers of patients dying on the Liverpool Care Pathway."

I'm sure this will be welcome news for those currently on the path; for those whose lives bought Angus steak dinners for the bureauweenies, not so much.

I did find this little tidbit darkly humorous:

"Mr Lamb said the inquiry would ‘consider the value of locally set incentives, and whether they are leading to bad decisions or practice’"

Well, that really depends on whether one believes killing off patients is a bug or a feature, doesn't it?