Life Insurance ON Sale

Yep, you read that right: seems that life insurance (in all its various flavors) is not just FOR sale, it’s ON sale.

Okay, Henry, what the heck are you talking about?

Well, the Insurance Information Institute (I.I.I.) just released a study showing that premiums for folks buying life insurance for themselves have been steadily decreasing. In fact, over the past ten years, they’ve been averaging a 9% decline. Dr. Steven Weisbart (who authored the study) says that:

“Life insurance rates are dropping because death rates for the 25-44 age group—the primary age range for purchasing life insurance—have decreased significantly over the past 10 years.”

He went on to explain that rates for term insurance have been dropping for decades. That makes sense, especially in light of life expectancy data from the published by the National Center for Health Statistics:

That doesn’t mean, of course, that you’re automatically going to see your own premiums drop: we’re talking averages on new business here, not what folks who already own their policies pay. Since an individual’s rates are determined in part on age, smoking and health status, even hobbies, not everyone will benefit from these declines.

Still, if you have a policy that’s more than a few years old (and particularly if it’s term), it may be worthwhile to review your coverage with your agent.

You DID use an agent, right?

TMJ coverage...

Over the years, I've paid an amazing amount for TMJ treatment for various members of my family. No medical carrier has ever given me a logical answer as to why a jaw joint is excluded from coverage. Why is it treated differently than, say, a knee? Admittedly TMJ can be caused by dental problems, but it can also arise from a host of other things...like the time my son ran into somebody's elbow while running on the beach.

Anybody have any thoughts?

A Simpler Way...

We get letters. Today I received an email alerting me to this post at Think Progress:

“Our health care system has gravitated toward quick fixes rather than the persistent actions with lifetime rewards. Proven clinical and community preventive services go unused. Two out of three adults fail to get a flu vaccine or recommended colorectal screening. Millions of lives are lost needlessly. Aliens are on the way to probe our bodies.”

Okay, I made that last part up, but it’s of a piece with the general tone of the post. There’s little doubt that, as a society, we’re too fat, smoke and drink too much, and don’t take care of ourselves as best we can.

And this is news, how?

The fact is, we are living longer (I’ll take the actuaries’ analysis over the nannies at NIH any day; the actuaries are playing with REAL money), and new treatment protocols are being introduced every day.

Now, do I agree that we should take better care of ourselves? Of course, but I don’t think we need another gummint program to do so. Fact is, there are several easy, low-tech, low-cost ways to accomplish this, if we really want to.

That’s the crux, by the way: each person is, ultimately, responsible for his own health and well-being. So forcing folks to take their flu shots is really no different than forcing them to…well, you fill in the blank. The point is, folks that want to improve their health will do so. I blogged recently on my ambivalence regarding health insurance covering preventive care. I’m starting to lean towards that, but it’s really up to the markets to dictate how that plays out.

Seems to me that the carrier(s) which figure out how to profitably cover such expenses will be the big winners (as will their insureds, of course). If it’s what we really want, more carriers will follow (cf: HSA, transparency, etc). The last thing we really need, though, is another tax-payer funded debacle (e.g.: Medicare Part D).

See, it really is that simple.

UPDATE: Vis flu shots and other vaccines, it appears that at least some congress-critters have cast doubts on the CDC's assessment of such preventive med's. According to this article, the agency "the agency is tainted by conflicts of interest because it is also the chief promoter for vaccinations."

And the Survey Says...

When we discuss "benefits" here at IB, we most commonly refer to insurance products (group health and life, HSA's, etc). Occasionally, we discuss non-traditional benefits (e.g. Sabbaticals and QTEPS), as well.

Recently, though, the Bureau of Labor Statistics polled both private- and public-sector employers to determine which kinds of benefits are most "popular." Perhaps unsurprisingly, vacations and holidays topped the list:

Interesting, no?

Cavalcade #10 is up!

Wenchypoo has done a terrific job, and invites you to come see her efforts.

Each post is categorized, and includes helpful commentary. Kudos!

Bob Sargent, blogging at Specialty Insurance, asks if their clients want insurance agents to be in the insurance business or the risk management business. The answer is: yes.

FYI, we'd love to have YOU host an upcoming edition, just drop us an email.

Grand Rounds...

You can read up on the best of the medblogosphere at Unbounded Medicine. Host Jon Mikel Iñarritu presents an attractive and easy to navigate GR, with 30 entries. It's laid out as medical journal's Table of Contents, and each post has its own summary.

As longtime IB readers know, I'm a stickler for proper terminology (e.g. HIPAA vs HIPPA), and it looks like I'm not alone: seems that Bob Coffield (the Health Care Law Blog) shares my AR tendencies.

Legal Heavyweights

We’ve blogged before about lifestyle choices and insurance. But a 30 year old Michigan law may add some heft to the argument:

“Although little-used since it was enacted in 1977, Michigan's unique protection [the Elliott-Larsen Civil Rights Act] is expected to grow in ever more conflict with employer crackdowns on unhealthy behaviors.”

Apparently, some Michigan employers are being sued for terminating obese employees. The rationale is that such folks are at far greater risk for heart attacks (and, one supposes, more sick time), which may not be too far off the mark:

“A 2003 report by the U.S. Department of Health and Human Services estimated the cost of obesity to U.S. companies at $13 billion per year, based on $8 billion in health care costs, $2.4 billion in paid sick leave, $1.8 billion in life insurance and $1 billion in disability insurance.” (ibid)

That’s a lot of claims paid on behalf of one subset of employees. Michigan’s law is unique: federal law doesn’t really address the issue. The much-vaunted ADA (Americans with Disabilities Act) only comes into play if the affected employee suffers a disability as a result of his condition. If an employer terminates an employee before a disability occurs, he stands a pretty good chance of making it stick.

One of the benefits of group insurance is that it is “guaranteed issue;” that is, a carrier can’t decline a group because of health conditions. But the other side of that coin is that the insurer can (and do) charge a hefty premium for unhealthy groups, and a company with a lot of overweight employees certainly fits the bill. Another facet of group cover is that a carrier can’t decline a particular person, or charge one employee more than the others. The whole group subsidizes the unhealthy (e.g. obese) worker. Such is the nature of the product, and thus employers looking to trim their health insurance costs are tempted to dismiss high risk folks.

Is this a slippery slope? You bet: smokers fit this criteria, as do alcoholics and folks with high cholesterol. I suspect we’ll see more of this type of activity in the future.

Take Two Aspirins, and Email me in the Morning...

Well, health care transparency isn't the only thing that Minnesota BX is up to:

"Some of Minnesota's largest health care providers, including HealthPartners and Blue Cross and Blue Shield, are beginning to cover e-visits between doctors and patients, an unusual step nationally and an attempt in part to contain exploding health care costs."

A patient simply emails his questions (or concerns) to the doc, who then responds via email. This cuts down on wait times for appointments, and the patient gets a quicker response. Folks who are out of town (on business or vacation, for example) can still "consult" with their preferred doctor, and not have to sit on hold or play phone tag.

That's the good news. The bad news (if it can really be classified as such) is that only about 25% of doc's have bought into this concept, and consumers aren't exactly knocking down the (virtual) door to participate, either. Part of the problem was that physicians couldn't charge for their email consults, which would tend to discourage widespread adoption of the practice. Once carriers start reimbursing for them, that should change (eventually).

This seems to me to be tailor-made for CDHP (Consumer Driven Health Plans): after all, the idea is to empower the patient to make informed decisions about his health care. What better way than electronic communication?

Very cool.

Money Monday: Carnival Time!

The Business Pundit hosts this week's special 3rd Anniversary Edition of the Carnival of the Capitalists. Boasting over 40 posts, categorized, summarized and organized, Rob's done a terrific job!

I've battled the late vs punctual demon all my life, and have (gradually) gotten better about being on time. Barry Welford, blogging at BPWrap, posits that being late is not just inconsiderate, but bad for business.

The Carnival of Personal Finance is hosted at its home page, and presented by its founder, Flexo. With over 50 interesting posts, each with a summary, it's a potpourri of possibilities.

Joe at Roth & Co tells us about an interesting, if a bit offbeat, IRS auction. Who knew an accountant's post could be (almost) NSFW?

Insurance Dispatch

In this week's column, now up at The Medical Blog Network, we revisit (and update) Qualified Transportation Expense Plans. Want a tax break for your commuting expenses? This little gem could be just the ticket.

DIY (NG)

Perhaps the greatest compliment an agent can receive is a referral; they are the lifeblood of any professional who intends to stay in this business. And the most valuable of these is when a client recommends an agent to relatives. After all, you may only see friends from time to time, but you’ve got to deal with your brother-in-law every Thanksgiving.

Today I was paid one of the latter: one of my clients referred her sister to me, telling her that I had been helpful in securing medical cover for her family. The sister – we’ll call her Denise – lives in another city, about an hour away. Her husband, who owned his own business for a number of years, has sold it, and now needs to replace his “lost” coverage. Since the group plan had been through the local Blue Cross (BX), they thought it would be a good idea to just call up said BX and apply for coverage. They applied for a generic co-pay plan, complete with drug card.

Pretty cut-and-dry, at least so far. So why was she calling me? She’d already made application, and received an offer; what role could I possibly play?

Turns out, Denise was diagnosed some 10 years ago with fibromyalgia, for which she takes a particular medication. The problem is that this is one of those conditions (and meds) that insurers intensely dislike, a fact which an agent would have known, and who could have helped avoid the ugly result:

While her husband and daughter were approved for the co-pay/rx plan, she was offered a “stripped down” version at a greatly inflated price. As long-time IB readers know, having been declined or rated for health insurance once, obtaining coverage later becomes problematic. She is appealing the decision, and called me to see if I could offer a better alternative.

Knowing that her existing cover would go away at the end of this month, I advised her that she should accept the offer, while continuing the appeal. Better to have expensive, less efficient cover than none at all. I also told her that I’d see what my other carriers could do.

And then I started asking a lot of questions. After dispensing with the “normal” ones (height, weight, other meds, etc), I asked if she had ever heard of an HSA. She had, and they had actually discussed this. In fact, she asked me if it would help her appeal if she were to go that route. Sadly, it probably won’t: carriers don’t really care which configuration one chooses when they are underwriting (that’s another post). On the other hand, she should: I helped her work through the math, and see that by going with the HSA plan, they could almost completely fund the loss account, and still save money. I suggested that she call up the home office, and tell them that she wanted the HDHP (high deductible, HSA compliant plan). She’ll still be able to appeal the rate-up (good luck with that), but even if that failed, the family would be money ahead.

Needless to say, she was grateful for the time I took to help her noodle this through, and I took the opportunity to tell her that, next time, she’d be far better off working with an agent (preferably me, of course) rather than buying directly from a carrier.

Why? Well, a number of reasons. First, the folks at the home office are order takers, not professionals, and aren’t trained to offer this kind of advice (such as the HDHP/HSA idea) to prospective insureds. Second, since they work for the carrier, they're not going to be eager to help one pursue underwriting appeals.

Third, and perhaps most important, an independent pro would know which carriers to look at in the first place, and may have helped her avoid the problem (or at least minimize it). For whatever reason, folks believe that buying directly from the carrier (or from an internet service) will save them money, whether it’s life or health insurance, coverage for their cars and houses, or even their business liability cover. These people are sadly misinformed, and end up paying for an agent (an advocate) without actually getting one. That is, the commission is already built into the price, so someone is getting it, just not someone who’s accountable to you.

Logic and the Madness of Crowds...

A couple of months ago, I made a presentation to the employees of a mid-sized client. The employer's renewal premiums were being increased by 15%+ and, in response, we were moving the plan down one notch in benefits...overall, it was still a pretty rich benefit schedule. Also, the company was adding another plan choice for the employees...an HSA with a $2400 deductible. As an incentive for employees to switch into the HSA, the employer was going to contribute a substantial portion of the premium savings into the employee HSA accounts. It worked out to a contribution of $1700 for employees and $3400 for employees with additional dependents.

From my perspective, this was a terrific deal. If somebody had no medical claims (admittedly an unlikely situation), he or she would end up with a slug of money in the bank. In a worst case scenario, with a large claim, the employee's out of pocket cost would be offset by the employer's contribution to the HSA account...the net savings to the employee would be thousands of dollars versus remaining in the PPO plan. As a practical matter, most people would end up somewhere in-between. On top of all that, the employee's share of the premium would be decreased to reflect the lower rates the employer would pay. It was a true win-win situation.

Out of 35 employees, guess how many switched to the HSA? Exactly one. The reason most people cited for not changing? They liked the fixed doctor's office copayments in the PPO. Sigh.

Introducing...

Bob and I would like to welcome the newest member of TeamIB: William (Bill) Halper.

Bill is a regular commenter here at IB, and we think he'll be a valuable contributor. We hope you will, too.

Bill's been active in the insurance industry since 1986 [ed: newbie!]. As president of Halper Storz Insurance Services, Inc (an independent insurance agency providing consultation in the dual fields of employee benefits and financial planning for business owners), his clients range in size from companies with hundreds of employees and multi-state operations down to local two-person businesses.

Before getting into insurance, Bill worked for ten years in the high-tech sector. He graduated from Stanford with a Masters Degree in Electrical Engineering.

Bill lives in Saratoga, California and is married with five children, a golden retriever, and an ever-changing number of tropical fish.

(I think Bob's secretly jealous of the fish, myself)

Welcome aboard, Bill!

And today's trophy goes to...

Medscape Medical News, for the article "Chronic Illness in Children may cause Chronic Partial Sleep Deprivation in Mothers"...

As my Grandmother would say..."And for this you went to Medical School???"

You may have to register if you want to read the original article, but the headline really says it all.

Health Wonk Review is online...

HWR founder Joe Paduda hosts this week's edition (which he's dubbed "Harvest Moon"), and does a terrific job. With 15 entries, each with Joe's trademark "take no prisoners" commentary, you can't go wrong.

I have mixed feelings about coverage for preventive services. On the one hand, we don't expect our auto insurance to pay for rust-proofing or oil changes. On the other hand, though, catching heart disease or cancer early on could save an insurer a lot of money in future claims. Louise at Colorado Health Insurance Insider discusses this in more detail. Thought-provoking.

Package Deal, Part 2

In Part 1, we met MaryAnn Stump, RN, Senior Vice President and Chief Innovation Officer of Blue Cross and Blue Shield of Minnesota. She’s the brains behind the company’s foray into the world of transparency. This time out, we’ll learn how the program evolved, and how it’s designed to work.

Once again, I’d like to thank IB reader John Fembup for his time and expertise in helping to craft the questions for this interview.

I asked MaryAnn to describe the role of Chief Innovation Officer, and what that has to do with transparency. She explained that, when she first came to BX (some 16 years ago), she began to look for what she calls “shared quality measurement” that is, how to accurately gauge how health care is delivered and received. She eventually became the person responsible for MN BX’s own employee benefit plan, which gave her a unique perspective, and opportunity. Now she could see the employer’s (customer’s) side of the equation, not just the insurer’s. She wanted to know what other customers were saying, and how they perceived the job BX (and other carriers) was doing.

“Listening to the purchaser.” Now there’s a nifty idea. Ms Stump began to look for appropriate tools that would solve what she saw as unmet needs: employers want to know what goes on in their plans besides just premiums and benefits, but don’t know what questions need to be asked. Not being a “fan of report cards,” MaryAnn began to look around for ways to answer those questions without having to be asked. Pieces like end of life needs, for example, which employers rarely consider, but of course impact claims, and thus premiums. Pain management is another area where HealthcareFacts offers helpful information.

But how did she come up with such a unique – and useful – format? As with so many new ideas, this one was an accident: she was eating a candy bar one day (a $100,000 Bar?), and the answer “stared (her) in the face.” The Nutrition Facts info on the wrapper told her all she needed to know about the benefits (heh) of the product, how many calories, and the like. Why couldn’t health care offer that kind of information, in a timely and easily understood format?

MaryAn told me that she considers her first “success metric” to have been the fact that so many providers signed onto the program. For example, the world-famous Mayo Clinic has never participated in any transparency effort, but they signed off on HealthcareFacts. Similar facilities in West Virginia and Louisiana have also joined in. They’re just now starting to track hits on the HF website, so it’s not clear what kind of consumer response they’re getting at this point. The other challenge, of course, is getting the message itself out; marketing efforts (such as contacting blogs) seems to me a step in the right direction. And making the folks behind the curtain accessible goes a long way toward developing and reinforcing credibility.

A few final thoughts in Part 3 (coming soon).

Grand Rounds: 3rd Anniversary Edition

Dr Aleksandr Kavokin, who blogs at RDoctor, hosts this week's very special Grand Rounds. With over 45 submissions, I was flattered to have our post (the first part of our interview with MN BX's MaryAnn Stump, RN) named as one of his two Top Picks.

In the event, all the entries are categorized and include helpful summaries.

I may have to update my (in)famous food pyramid: this post at A Hearty Life informs us that the Brits are looking to ban their ubiquitous "crisps."

Carnival Time!

Since I was offline yesterday observing Yom Kippur, I didn't have a chance to do the "carnival link thingie." So, a day late (but hopefully no dollars short), here ya go:

Frugal at My 1st Million (at 33!) hosts this week's Carnival of the Capitalists. He presents almost 30 posts, complete with commentary.

Michael Wade, posting at Execupundit, examines how and why we take criticism of our personal decisions so, well, personally.

Insurance Dispatch

In this week's column, available at The Medical Blog Network, we examine the results of a new survey which casts a light on how employers perceive how they pay for health insurance.

Hope you like it.

The 4th Commandment

Okay, so what does keeping the Sabbath have to do with insurance? Well, it’s not so much “the Sabbath,” per se, but taking a sabbatical. Many not-for-profit organizations (NFP’s) offer periodic sabbaticals to their employees, in order to help them refresh and renew their commitments. Unfortunately, such practices may be unlawful under the little-known legal principle of “personal inurement.”

In law, “compensation based on skill, effort and time expended, remunerated by salary or fee, does not constitute personal inurement.” So the challenge is in determining the monetary value of a sabbatical. Common sense [ed: quite the oxymoron, no?] would seem to equate a sabbatical to “unpaid leave;” the only real “value” is that one is assured of having a job to come back to. So what is the value of that certainty, and how would it apply to, say, a minister taking a year off to “find himself?”

Peter Marathas, a benefits attorney, warns that “(n)onprofit employers have to be sensitive about setting compensation. And when they're considering all parts of compensation, they shouldn't ignore sabbaticals." In other words, if the sabbatical has a value, then it has to be included with the rest of said minister’s benefits package. This hasn’t, apparently, been a big deal until recently, when the Infernal Revenue Service (at the urging of Congress) decided to start “cracking down” on NFP’s which offered such benefits as part of their employees’ compensation arrangements.

There are some pretty hefty fines that can be levied against folks who run afoul of these reg’s: starting with a 25% individual tax penalty. And the fines go up from there. And the NFP itself can face substantial whacks, as well: such as a $10,000 penalty on each of their trustees. Ouch!

We tend to think of benefits in terms of health and life insurance, flex plans and vacation days. We’ve discussed transportation reimbursement, of course, as an unusual type of benefit. But I’ve never really thought about sabbaticals as such, and this is a heck of an intro, to boot.

Transparency Uber Alles...

Well, well, well...Here at IB, we've been blogging on healthcare transparency for almost two years. And, as noted, we get results. So far, that's two BX's, an Aetna and a QwikHealth. And now, we have United Healthcare, from whom I've just received this email:

"We are proud to announce an exciting new consumer resource: the UnitedHealth PremiumSM hospital comparison program. Beginning February 2007, all UnitedHealthcare members will have access to the UnitedHealth Premium hospital comparison directory on myuhc.com®.

The UnitedHealth Premium hospital comparison program will provide consumers valuable comparison information so they are better able to make informed decisions about where to seek care. More specifically, the directory will offer condition/procedure level quality, and cost information, on approximately 80 inpatient and outpatient procedures in more than 140 markets."

Looks like someone took our challenge seriously because, unlike Anthem's anemic effort, this one looks to rival Minnesota Blues' efforts.

Of course, it's still vaporware, but we'll keep our eye on it, and offer an analysis when we're able.

Cavalcade of Risk #9 Has Rolled on in...

Joe Kristan, who runs the Roth & Co Tax Update blog, has a witty and pretty CoR for us. With some 20 entries, it's the biggest edition yet. Posts are grouped by subject (more or less), and each post is accompanied by a little blurb (and sometimes a barb).

Former CoR host LA Money Guy warns us about a new(?) scam involving jury duty and phishing. Definitely worth a click.

Mea Culpa...

The most recent edition of the Health Wonk Review slipped under my (slightly overworked) radar last week. Leif W Haase, of The Century Foundation's blog, presents over a dozen interesting and enlightening posts.

I hated statistics when I took that course in college, but David Williams, host of the Health Business Blog, writes that physicians may well benefit from a better understanding of them.

A Delectable Grand Rounds

Dr Enoch Choi, host of Tech Medicine blog, presents a delicious 'Rounds this week. He's catered to our every medblog whim, with a generous buffet of posts, each garnished with a soupcon of commentary.

When my better half and I were younger, we absolutely loved to watch the back-to-back shows Hill Street Blues and St. Elsewhere (who else remembers the episode featuring a dour Howie Mandel, the police chief from Newhart and a paper bag?). Well, HIStalk blog reports that St E's season 1 is due out at Thanksgiving. WooHoo!

We Get Results...

Much like Bob’s hard-hitting analysis got Wellpoint to “roll” on its policy rescission, um, policy, my own relentless push for transparency, including in-depth interviews with folks In The Know, has yielded similar results:

“More than 300,000 Miami Valley residents will be able to compare ballpark prices in advance for certain medical procedures by using an online database that Anthem Blue Cross and Blue Shield is launching for its enrollees today.”

Much like Aetna’s pilot program, Anthem has chosen a relatively modest roll-out, with the estimated costs of a few procedures available on-line. As the program develops, I would anticipate that more types of information will become available, along with more detailed financial information.

It strikes me as significant that the Gem City is home to the “national” roll-out of “CompareCare.” Last year, Aetna introduced its pilot program down the road, in Cincinnati. Is there something in the air or water that make the Cin-Day corridor so attractive to carriers looking to break the mold? More likely, it’s the confluence of industry, agriculture and technology that offers a unique incubator for such endeavors.

I think it's wise that Anthem is starting small, with only a few procedures and limited cost information. Having spoken with the folks at corporate cousin Minnesota BX, I know that it takes a lot of effort to put these plans together.

It would be to Anthem’s benefit to expand this effort as quickly as possible. As we’ve noted often here at IB, transparency is coming sooner, rather than later. As more carriers introduce their own implementations, the pressure will be on to offer more information, with more detail, more quickly.

We applaud Anthem for seeing the light, and look forward to a more integrated and comprehensive program.

Carnival Time!

The epynomously-named Canadian Capitalist hosts this week's Carnival of Personal Finance. We're treated to over 50 great entries, each with a helpful blurb about the subject matter.

What do Richard Dean Anderson and Red Green have in common? Why, duct tape, of course! And this post, at 2 Million Blog, binds them cleverly together. Recommended for those who need a smile.

After last week's abortive attempt, this week's Carnival of the Capitalists is a breath of fresh air. Our hostess, Evelyn Rodriguez of Crossroads Dispatches, brings us over 40 posts, in useful categories and with thoughful commentary. Thanks, Evelyn!

For those of us who abhor change, David St Lawrence offers wisdom and inspiration. Check out his post on how to move past your personal bubble.

Insurance Dispatch

This week's edition, available at the Medical Blog Network, is a reprise of my Rosh HaShannah post here at InsureBlog. Look for a small twist, though, about how long our New Year's celebration lasts.

Cavalcade #9 - Submissions Due

Just a reminder that submissions for next week's C of R are due Monday (the 25th). Joe at Roth & Co would love to see your work. You can submit entries:

■ via email

or

■ at Blog Carnival

[Note: Ferdy's has suspended their submission engine]

PS: We're still looking for hosts. If you'd like to host a future edition, just drop us an email.

Good (?) News...

Apparently, the ban on meds imported from our Neighbor To The North may be eased:

"House Republicans tentatively agreed Thursday to relax a ban on importing prescription drugs from Canada."

The move would allow Americans to bring home (up to) a three month supply of medicine, with the potential for even more flexibility in the future.

L’Shannah Tova

Tonight, those of us who practice Judaism, the oldest of the “Abrahamic faiths,” will begin to usher in our New Year.

Unlike December 31st, though, there will be no “Dick Clark’s Rocking Rosh HaShannah Eve,” no champagne corks flying, and no confetti streaming from the rafters.

In Judaism, Rosh HaShannah, while a joyous and festive occasion, is part of a ten day cycle called The Days of Awe, which begin tonight, and continue until we break our day-long fast at the end of Yom Kippur. It is a time of intense self-examination, as we try to identify and atone for, the wrongs we’ve done to others in the past year, and to find a way to return to a more spiritually productive path.

So what does that have to do with insurance? Well, truthfully, not much. But how we sell insurance, and how we treat our clients and carriers, have a lot to do with it. In my faith, we believe that, when we die, we will be judged first and foremost on how we conducted our business. How we treat those with whom we conduct commerce, the thinking goes, says a lot about how we treat all the people in our lives.

And I believe that.

It’s why I conduct my practice the way I do. It’s why I choose to blog with someone who shares my values (if not all of my opinions). It’s why, when I teach insurance to other agents, I always stress the importance of doing the right thing. Always.

Part of our process of atonement is to ask forgiveness from those whom we’ve hurt, by word or deed. On the one hand, I’m proud that, in the almost 2 years that I’ve been blogging, InsureBlog has had over 56,000 visitors. On the other hand, I’m sure that I’ve managed to hurt or offend at least a few of them. And so, if you’re one of the latter, I ask your forgiveness, and pledge to do better in the coming year.

I wish all of our readers a joyous, prosperous, and healthy 5767.

Carnival Hero...

The other day, I noted my disappointment with this week's Carnival of the capitalists, wherein the host decided that he couldn't be bothered to put together an actual Carnival.

Well, Execupundit host Michael Wade has stepped up to the plate in a big way: he's gone through all the links that okDORK ignored, and put together a supplemental CotC, complete with commentary. Be sure to check it out:

Part 1
Part 2
Part 3
Part 4

Kudos to the Execupundit!

Feelin’ Blue...

[UPDATE: For more insight, check out Bob's follow-up, and especially these commments from a CA agent]

I am not a shill. My challenge is that, if I’m going to write about health insurance (and I am), I can’t help but discuss Blue Cross (in all its various and sundry forms). It would be like writing about the automotive industry without mentioning GM, or discussing the fast food sector while ignoring McDonald’s.

So why the disclaimer and qualifications? Well, because I’m going to defend BX (of California, of all places). Well, that’s not really accurate: it’s more a matter of explaining how and why insurance works the way it does, and how sometimes folks have to live with the bad decisions they make (or others make on their behalf).

When she was 2 years old, little Selah was found to have a lump on her chin, and a case of the croup. About that time, her parents applied for medical insurance with the aforementioned BX, and neglected to completely, accurately, and honestly answer all the medical questions. About two years later, Selah has been diagnosed with a potentially fatal tumor in her jaw, and BX (having reviewed her application and medical records) has rescinded the policy [rescission is a process whereby the insurer essentially annuls the policy, and returns all the premiums]. They did so because, at the time, their underwriting guidelines apparently required that folks with the croup and/or undiagnosed (but visible and known) lumps be declined.

In fairness, I looked at the current underwriting guidelines for the BX available here, and it is silent as to both. Since I don’t keep outdated guidelines handy, I have no idea what they might have done with this several years ago. Regardless, according to the carrier, they would not have accepted this risk had the conditions been fully disclosed.

Which brings us to the “controversy:” my friend Joe Paduda calls the Blues’ decision “cheap, heartless, and stupid.” Based on the news report he cites, though, it appears to be none of those, but good business sense. Contrary to popular belief, underwriting guidelines are not “fine print” nor are rescissions based on “obscure technicalities.” Rather, the guidelines are based on research and experience, and policy provisions (including the right of rescission) are based contract law. In this case, the insurer was apparently prevented from adequately assessing the risk, and faced the very real possibility that it would harm its other policyholders (as well as stockholders) if they had actually paid such a claim.

That’s right, it’s not just about poor little Selah (although she’s been victimized as a result of her parents’ apparent actions); it’s about treating all insureds fairly and equally. If BX had paid her claims, what about the next insured who “fudged a little” on their application? It’s not a perfect system, of course, but it requires that we all follow the same rules. It appears that Selah’s folks chose not to, and now seek to blame someone else for their own mistake.

Of course, I’m relying on a newspaper article that may (or may not) have all the facts. For example, it appears that the BX in question has a reputation for post-issue underwriting, and rescission. If true, this is no less wrong than what Selah’s parents did; that is, the carrier is obliged to follow the rules, as well. What, if any, consequences ultimately befall the BX remains to be seen. The consequences for Selah appear to be self-evident.

The article doesn’t say whether or not Selah’s parents bought their policy through an agent, nor is it clear that the end result would have been different had they done so. But, having a professional, independent agent at least gives the consumer an advocate, one who knows the system, and can “work it” on their client’s behalf.

Let the firestorm begin…

Grand Rounds

Tundra Medicine Dreams hosts this week's 'Rounds, and does a fine job. In addition to the 47 posts, complete with useful summaries, there are beautiful and serence pictures of the Alaskan landscape.

David Williams, host of the Health Business Blog, has a provocative post on Electonic Medical Records, and especially about some EMR implementations.

Money Monday!

This week's Carnival of Personal Finance is hosted by Flexo at Free Money Finance. He's done a terrific job, organizing almost 50 posts, and included helpful context and comments.

In a rare two-fer, my favorite item also happened to be one of his. We've blogged about outsourcing medical care overseas, and Flexo offers this post about traveling overseas for surgery.

WordNet defines "dork" as "a dull stupid fatuous person," and blogger okDORK certainly lives up to his (her? its?) billing. In a deliberately terse (and sometime obscene) post, okDORK "presents" what may well be the worst Carnival of the Capitalists yet. Instead of actually reading each post, perhaps organizing them, or even including some brief commentary, okDORK takes the easy way out, highlighting a handful of posts he actually deigned to read, and then simply posting links to the rest.

What's so disappointing about this is that okDORK seems proud of his poor work. With less than 30 posts to deal with, one would presume that this did not present an insurmountable challenge.

In any case, I liked this item from Vihar Sheth at Green Rising. Using Chipotle food services as a model, Vihar discusses business growth based on "conscience." Nicely done.

An Apology, and a Thank You...

IB readers may have noticed a dearth of substantive posts by yours truly this past week.

I have been dealing with issues relating to aging parents (to which I allude in this week's Dispatch), and have had scant time to do any "real" blogging. A side-effect has been that I have been experiencing painful "net-withdrawal."

I'd like to take this opportunity to thank my co-blogger, Bob Vineyard, for his yeoman efforts, and his concern on my behalf. We tend to get so wrapped up in the issues of the day (or week) that we forget that the web, and especially the blogosphere, is about people. Those of us who have been in the insurance biz for any length of time recognize that this is a business built on relationships, far more than on product or prices. And so it is with blogging; it is hard to express the relief I found when, on the rare occasions recently that I have been able to log on, I have found interesting, provocative, and helpful posts already up.

Thanks, somarco!

And thank you, InsureBlog readers.

/maudlin off

Insurance Dispatch

In this week's column, now available at The Medical Blog Network, we look at how increased life expectancy also means increased costs. A new study by researchers at Harvard and the University of Michigan shed some interesting light on the subject.

Stop by, won't you?

A Package Deal...

It is my habit to pop home about noon or so, to get some lunch and let the dog out. One day late last month, I did so, and found a package waiting for me. The return address was enigmatic: HealthcareFacts, PO Box so-and-so, Minnesota, featuring an eye-catching, stylized cereal box. More interesting, perhaps, was that it was addressed to me, c/o InsureBlog.

Hmmm.

Since I wasn't expecting any packages, I was intrigued, and proceeded to open it up. Inside, I found a cover letter attached to a glossy marketing folder, inside of which was information on a new type of transparency program. There was also a small cereal box, containing a granola bar and some more marketing info (well done, too).

Turns out, Blue Cross Blue Shield (BX) of Minnesota has designed, and now implemented, a different kind of consumer empowerment program, and they wanted me to know about it. I suppose, too, that they hoped that I’d help promote it. Indeed, I was invited to call and interview the woman who had designed it. Very heady stuff, and intriguing, as well.

So, pick up a box of cereal, a package of pasta, or a can of peas, and you’ll find a handy little chart on the side. This is the Nutrition Facts label, which tells us how many calories, which vitamins, how much salt is in that product (among other things).

What if we could get comparable information about that upcoming knee surgery?

That’s the premise behind “HealthcareFacts,” a fairly new, definitely unique effort from the folks at the aforementioned BX.

In the past, I’ve touted the “McDonald’s” metaphor when discussing health care transparency. That is, positing that prices for services be available, in advance, so that consumers know upfront what a given service will cost.

HealthcareFacts goes one (or three) better, by disclosing not just prices, but quality of care, outcomes, and more.

As long-time IB readers know, health care transparency has been sort of my "pet cause" for a long time, and I've interviewed a number of industry folks regarding it. This promised to be interesting as well, and so I began to read through the material. My goal was to formulate the questions which IB readers would like answered, in preparation for the interview. In this regard, I’d like to acknowledge the invaluable assistance of long-time IB reader John Fembup, who graciously took weekend time to help me with those. Thanks, John!

MaryAnn Stump, RN, is the Senior Vice President and Chief Innovation Officer of Blue Cross and Blue Shield of Minnesota. In deciding how I wanted the interview to go, it occurred to me that IB readers would be more interested in how the whole process of rolling out a new service would go - “what were they thinking?” - as opposed to just product information.

So I asked MaryAnn to tell me how she became interested in this concept we call “transparency,” and how she came to the conclusion that bloggers could help get the message out. Her first response surprised me: she likes blogs. And she was well aware of ours in particular, because of our interest in, and frequent articles on, transparency. So it seemed to her kind of a natural avenue to explore. She asked “how else could we be heard, with authentic information and perspective” other than through the blogosphere? One of her primary goals with this program is to “demystify the data;” that is, make the raw information meaningful to the consumer.

This perspective intrigued me. I asked her to tell us a little about herself, and how she came to be the Chief Innovation Officer of a large insurer. Turns out, she started her career as a critical care cardiac nurse and, in fact, continues to work as a “health professional who happens to also be a health provider.” One of her major issues is that of competency: she tries to bring the same skillset that helped her with the “predictable unpredictability of cardiac care" to the field of insurance. She’s been with BX for 16 years, and took over as CIO a couple years ago.

In Part 2 (now posted),we look at how HealthcareFacts is looking to change the way we look at our own care, how it’s funded, and our own role as consumers.

Cavalcade #8 is up...

Jay Norris, of Colorado Health Insurance Insider, hosts this week's edition of the Cavalcade of Risk. He's done a great job of organizing 14 posts, complete with interesting details. Thanks, Jay!!

I especially enjoyed David Williams' post over at the Health Business Blog, in which he examines how our parents managed risk "back in the day," especially since we're inundated with so much emphasis on safety.

EMR = OOPS!

Dr Rob Lamberts, writing at The Medical Blog Network, has some disturbing news about physicians' access to their patients' EMR's (Electronic Medical Records). Apparently, a number of physicians (and, presumably, other providers) electronically offload their patients' medical info to vendors, who then host the files for them.

The benefits of this technique are, presumably, cost- and security-related, which makes it an attractive option for non-geek doc's. If you're not buying, maintaining, and servicing computer hardware, you've got extra money and personnel available for, well, doctoring.

The problem about which the good doctor reports is that some doc's have fallen behind in paying their vendor's bills (or flat-out refuse to do so), and said vendor's are then withholding access to the records. The doc's call that "extortion;" the vendors, presumably, call it good business sense.

Physicians are quite unhappy with this arrangement, but there is precious little they can do about it: it's all perfectly legal. And why not? If I don't pay my insurance premium, I can hardly complain when my claim goes unpaid. Still, this tends to harm the patient as much as (or perhaps more than) the doc; after all, whose health is put at risk?

I suspect that Dr Lambert will be following this story for a while, so we'll keep you posted.

Grand Rounds...

Blogger Amy, over at Diabetes Mine, presents an outstanding and uniquely creative Grand Rounds. In celebration of matriculation, she's fashioned her 'Rounds after a college student's emails home. It's a terrific metaphor, well executed.

I never gave much thought to the role and training of hospital chaplains. I just assumed that one's Minister, or Priest, or Rabbi would drop by to offer spiritual encouragement. But Susan, hostess of Rickety Contrivances of Doing Good blog, reports that there's quite a debate about the subject.

A Quick Blip from the P & C World...

We don't write much about the Property and Casualty side of the insurance business here. But once in a while, it can be pretty interesting (I'm sure there are folks who believe that it's interesting more often than "once in a while," but they can get their own blog).

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." That kind of thing.

Not being much of a football afficianado myself (although all three of my girls were glued to the OSU/Texas game this past weekend), I was unaware that "Da Bears" had shut out the Green Bay Packers in the teams' season opener. As disappointing as this must have been for the "Cheeseheads," it could have been catastrophic for one Chicagoland merchant:

World Furniture Mall "promised that if the Bears shut out the Packers in the season opener at Lambeau Field in Green Bay, Labor Day weekend shoppers would get their furniture free." Which, as mentioned, they did.

Store owner Randy Gonigam stood by his promise, and stood to lose almost $300,000 to boot. Fortunately, he had purchased a Special Events policy "just in case."

Good on him, and Congrats to Da Bears.

Carnival Monday on Tuesday...

Note: Because we chose to honor the victims of 9-11 yesterday, I'm posting this week's financial carnival notices today. Thanks for your understanding.

This week's Carnival of Personal Finance, hosted by No Credit Needed, includes 40 posts. They're all neatly categorized, but - alas! - no helpful 'blurbs.

We've talked about Section 125 plans here at IB; this post, by Daniel at My Money Path, has a consumer-friendly explanation, as well.

BONUS: Although it's not in the Carnival, Joe's post at Roth & Co, on a humorous lesson in time (mis)management, is a must-see.

And the Carnival of the Capitalists is up, as well. Joshua Sharf, blogging at A View From A Height, presents over 50 posts, each with some helpful comments.

I found this post on college tuition to be quite interesting. Boring Made Dull explains what drives the increasing cost of a higher education.

In Memoriam: Jerome Robert Lohez

As regular InsureBlog readers know, my better half has long maintained that “there are no coincidences.” That is, she believes that everything happens for a reason, although we may not be aware just what that reason is.

As for me, I’ve gradually become 90% convinced that she’s right on this (in everything else, of course, she’s 100% right). But one evening, a few weeks ago, that all changed.

I have a confession: My name is Henry, and I’m a news junkie. It is my habit to stay up way too late reading news blogs. Which I was doing several weeks ago, when I came across an item about one man’s extraordinary effort [ed: back online] to harness the power of the blogosphere, in tribute to our fellow Americans who died in The Towers, exactly five years ago today.

The concept was deceptively simple: 2996 victims, 2996 blogs, each one remembering a single person. Bloggers were invited to sign up, and each was assigned – at random – one name.

Stop for a moment, and consider this: one blogger, reading one news item, decides it’s the right thing to do, signs up, and is assigned the name of a person he’s never even heard of, let alone met. We’ll come back to this shortly.

And so I was assigned the name of Jerome Robert Lohez, given a photo of him, and told the briefest of biographical information: age 30, lived in Jersey City, New Jersey.

That was it. A name, a face, a place.

The assignment was simple: On September 11, post his name and picture.

But I’m a news junkie, and that wasn’t good enough. I had to know more about Jerome. So I Googled his name (hey, why not?) and came across a site that CNN put together in December of ’01. It had pictures and names, of course, but I also learned that Jerome, born in France, married Dening Wu some three years before The Towers fell.

One month before The Towers fell, Jerome got his Green Card, and the happy couple flew to Europe to celebrate with his family. When they got back, two days before The Towers fell, Jerome told Dening “Only in New York do we have so much sunshine."

That was Sunday, September 9, 2001.

On Tuesday morning, he left for work. And The Towers fell.

And now we've come full circle: One. Random. Name.

Jerome didn’t just work in The Towers. He worked for Empire Blue Cross and Blue Shield. He worked in the insurance industry.

90% doesn’t cut it anymore.

Thank you, Jerome, for the lives you touched, the joy you brought, your love for New York and America, and for the privilege of paying you tribute.

Au revoir, Monsieur Lohez, au revoir.

Insurance Dispatch

The latest Dispatch is up at The Medical Blog Network. This week, we take a look at two recent surveys - one from Harris/Kronos and the other from Aetna - about how employees view the value (and importance) of their benefits.

Please take a gander.

Programming note: Tomorrow marks the 5th anniversary of 9/11, and we'll have a special post up all day in commemoration.

Shoe, Meet Other Foot...

I’ve had the privilege of interviewing some interesting people here at IB. Recently, though, I was asked to be interviewed, by a very nice fellow with Health-Leaders. Seems they’ve been following our items on some insurance agent shenanigans, which dovetailed with their own investigations of same. The H-L folks got to wondering how the agent community was reacting to the story, and to the ethical ramifications of the situation itself.

Briefly, several agents (and agencies) agreed to help local school districts shop for their group insurance. They were paid a fee by these public entities, and charged with finding the best plans at the most attractive rates. Unbeknownst to the school districts, the agents were also paid commissions (and apparently bonuses) by the carriers, essentially getting paid twice for the same work. When the districts found out, they cried foul, and the agents now face disciplinary action (if not firing squads) by the State of Ohio.

The folks at Health-Leaders have been avidly following the money trail, and the legal one. Apparently, we’re one of a very few blogs that’s been paying much attention to this story, so they thought we’d be a good resource. They wanted to know how the agent community felt about how the Insurance Department handled the disciplinary aspect, and what we thought about the ethical ramifications of the process.

The first question was simple to answer: (sound of crickets chirping). That is, for the most part, this whole sordid mess has been under the radar, and/or ignored. There’s a reason for this: by and large, insurance agents are surprisingly good at avoiding reality, even when said reality threatens to directly impact our own wallets (and this story didn’t meet even that threshold).

The second question gets a little tougher: what, exactly, are the ethical (as opposed to the legal) issues in play here? Not being a lawyer, I’ll pass on the legal aspects; since I teach a Continuing Education course on insurance ethics (not an oxymoron, really!), I believe I’m qualified to weigh in on the ethical ones, at least from the agents’ perspective:

There really aren’t any.

In all of the brouhaha, I have not read that any school district or DOI representative have claimed that the agents did not do their job, or did an inadequate one. In fact, it appears that the districts were quite pleased with the results. Yes, the agents apparently “double-dipped,” which strikes me as incredibly stupid (not to mention, greedy), because it invites close inspection and engenders doubt. But stupid is not the same as unethical, as least insofar as the school districts were concerned.

Now, there is one item that, if true, seems to me to fit the criteria of “unethical:” allegedly, one of the agents demanded extra compensation from the carrier, and requested “that the payments not be called commissions (his contract with the district prohibited commissions) but rather be an "override, or some other form, like consulting." This would be deliberately hiding the fact that he was being paid the additional compensation. Fine line? You bet.

One thing I’d like to make perfectly clear is that I hold no brief for the agents or their actions. Frankly, I find what they appeared to have done to be reprehensible, greedy and obnoxious. It bothers me that we’re even in the same industry. If the facts, once they are exposed in court, corroborate the media accounts, I hope that they are punished to the fullest extent of the law.

But it’s also important for folks to understand that ethics are something not to be taken lightly, nor interpreted “on the fly.” There are specific, identifiable principles at work, and I want to make sure that IB readers understand that most agents do take our positions of trust seriously.

I’ll let you know when the article gets published (forgot this was about my interview, didn’t ya?).

Cavalcade #8 - Submissions Due

Just a reminder that submissions for the next C of R are due on Monday (the 11th). Jay at Insurance Shoppers would love to see your work. You can submit entries:

■ via email

■ at Blog Carnival

or

■ at Ferdy's

PS: We're still looking for hosts. If you'd like to host a future edition, just drop us an email.

Health Wonk Review: 15th Edition

Greetings fellow wonks (and wonkettes), and welcome to InsureBlog. Along with my (thus far) unindicted co-conspirator, Bob Vineyard, we try to make insurance understandable, or at least bearable, to our fellow denizens of these tubes.

Regular readers know of my food fetish; what most folks may not know is that I have my own personal food “guru.” And so, I’ve decided to merge these two seemingly disparate phenom’s into a smorgasbord of possibilities (click the "■" buttons for a treat).

HWR is served:

■ ESI at HR Web Café writes that in the anniversary aftermath of the public health debacle that was Katrina, Human Resource managers learned some important disaster planning lessons, including the need to be alert to workers suffering Post Traumatic Stress Disorder.

■ HR heavyweight Peter Rousmaniere, writing at Working Immigrants, discusses how Wal-Mart is becoming the banking intermediary of choice for Mexicans living and working in the U.S. Scary and timely.

■ Over at Worker’s Comp Insider, Jon Coppelman offers some management lessons, Ghengis Khan style. Incredibly, there are lessons to be learned from the man who led the Mongol hordes.

■ Our friend Joe Paduda, posting at Managed Care Matters, questions the criteria used by some industry groups for assessing quality. He notes that doing too many procedures on relatively healthy patients can greatly improve outcomes, resulting in fancy awards and big bucks for the procedure-doers.

■ Associate Professor Dr Roy M. Poses blogs at Health Care Renewal. In a post that seems related to Joe’s, Dr Poses tells us that primary care doctors are now under the gun to submit to various pay for performance programs. Noting that a particular pharma company recently pled guilty to a criminal offense, he asks if the new slogan for our health care system ought to be "pay for malfeasance?"

■ Meanwhile, over at the Health Business Blog, David Williams argues that bias isn’t always a bad thing. Citing a recent article on FDA Advisory Panels, David posits that consumers have a bias toward cost control, and that’s a healthy attitude.

■ InsureBlog’s own Bob Vineyard avers that taxing smokers is one way to help pay for health care, but wonders if that’s a good thing. He asks if targeting one lifestyle choice for special taxation might not lead down a slippery slope.

■ Dr R Craig Lefebvre blogs On Social Marketing and Social Change, which is providential, as he takes a look at mobile technologies, their current use and promise in public health and health behavior change programs.

■ Another PhD, Adam J. Fein, hosts the Drug Channels blog. His post examines the "demand side" problem of drug counterfeiting, asking how we stop pharmacy buyers and consumers from purchasing outside of a theoretically secure supply chain?

■ This post, from Carol Kirshner at Driving In Traffic, discusses recent news that Wellpoint (one of the nation's largest insurers) has announced that they will be providing a wide range of consumer-driven health plans, from the individual to the large corporation.

■ Medblogosphere biggie Matthew Holt, host of The Health Care Blog, alerts us to a recent study by David Cutler, which suggests that increased spending on health care is “reasonable value.” Matthew believes that the report was destined to be used as propaganda, and wonders whether Cutler intended just that.

■ In what may be a harbinger of things to come, we have PhD student Jason Shafrin on board. Jason helms the Healthcare Economist blog, and wonders why some employers hesitate to offer generous health insurance benefits. He hypothesizes that when a firm offers a generous insurance package, it may attract sicker workers, driving up the cost of the firm's health insurance.

■ Last, but certainly not least, Medical Blog Network founder Dmitriy Kruglyak brings us exciting news about a new Medical Blog “Widget” program, and also updates us on the Healthcare Blogger Survey.

I’ve certainly enjoyed hosting duties this time around, and encourage you to catch the next episode, on the 21st, over at The Century Foundation.

B'tayavon!

Going to Pot...

A while back, Bob blogged on The Pill Nazi. Now, we have the Pill Narc:

"(N)o animal or human data supported the safety or efficacy of marijuana for general medical use."

You may recall that there has been a move afoot (primarily in California) to legalize marijuana use fopr certain medical conditions (e.g. cancer pain management). Pot was touted as a potentially helpful alternative to other medications, which have their own negative side effects. Ostensibly, it offered quick and long-lasting pain relief, with minimum problems.

As expected, there has been a lot of smoke blown on both sides of the issue. Not being an afficianado myself, I've stayed out of the fray. But Dr Henry Miller (a physician, and fellow at the Hoover Institution) has an interesting article over at TCS Daily (ibid) which tends to undermine the reliability of medicinal cannabis supporters. He asks "is it 'medicine?'" And then he proceeds to answer the question:

According to Dr Miller, in order to be classified as a medicine, a product must:

■ Be prescribed by a physician (or other appropriate health care provider)
■ It must be standardized by composition, formulation, and dose
■ It must have been tested for a particular medical condition in rigorous trials
■ And it must be administered by means of an appropriate delivery system.

It's Dr Miller's contention that medical marijuana fails most, if not all, of these tests. Some of it's just common sense: since there's no Eli Lily (for example) which is testing, manufacturing nor distributing "joints," there's no standardization. So how can one determine the efficacy of a particular "dose?" And, there are different varieties of the plant, so variations in the chemical composition of these must be taken into account.

There's more, of course, and it's an interesting topic, one which I have not seen discussed much in the medblogosphere.

Until now.

Carnival Update

This week's Carnival of Personal Finance is up, hosted at Aridni. Blogger Todd presents a cool 50 posts, replete with brief summaries of each.

Feeling charitable? Well, Joe Kristan at Roth & Co warns us that tax breaks for charitable donations just got a bit more challenging. Thanks, Uncle Sam!

Grand Rounds...

Clinical cases & Images blog, hosted by Dr Ves Dimov, presents over 40 items in this week's 'Rounds. It's in the style of a medical journal, with posts organized by topic.

I think it's safe to say that many of us have trouble following directions. Aggravated DocSurg writes about his own experiences when he fails to do so, and how he deals with patients who ignore his advice.

Wonk Alert! [BUMPED]

We'll be hosting the Health Wonk Review this week (Thursday the 7th). If you blog on health policy, infrastructure, insurance, or technology (or know someone who does), HWR is the place to be.

You can submit posts:

■ via email (for HWR submissions)

or

■ via TMBN

I don't really have a theme, but I love this place.

The Best Carnival of the Capitalists Yet?

A resounding: Yes!

Our host, Starling Hunter, hosts September's first CotC, and has chosen to present the posts (all 46 of them!) as answers to questions. This is unique, of course, but it is also quite useful: by posing a series of questions, to which Carnival entries serve as the answers, one can decide which posts are of interest. Kudo's!

My teenaged daughter is an avid fan of Project Runway, a show about folks vying to become the next "super model." Well, this post, at My Simple Trading, is about (already) super model Tyra Banks, and has some useful financial answers for "the rest of us."

Insurance Dispatch

This week's column is up at TMBN. In it, we tie together Bob's recent post on British infertitility treatment guidelines and our own insurance system's take on IVF.

Happy Labor Day (I guess)...

Make of this what you will (click to enlarge):

In any case, have a safe and enjoyable holiday weekend.