Mini-Meds under fire?

According to USA Today, police officers should stop trying to catch bank robbers, airlines should ground their fleets, and doctors should desist from operating on seriously ill patients.

Oh, and we Americans are too stupid to be allowed to buy (or refrain from buying) our own health insurance.

Think I'm kidding?

Well, that's the logic behind this article, which starts out by painting its putative hero as an idiot:

"Then the Michigan couple began getting bills from doctors and the hospital, for more than $8,000. To his surprise, Camilleri's insurance didn't cover any of it because his wife had surpassed a $2,500-a-person annual limit on what the policy would pay."

"To his surprise." Translation: they bought an insurance product and never bothered to read what it did, and did not, cover. Now, I know that no one reads all the mice-type, but surely folks should at least familiarize themselves with obvious limitations, which annual limits like this would certainly comprise.

"Limited benefit medical plans" (or "mini-meds," about which we've written before) are not new, but they've been revitalized as folks look for cheaper ways to purchase insurance. There's nothing inherently wrong with looking for a bargain (hey, if there was, then so long Ebay); but that shopping must be tempered with the axiom that "you get what you pay for." That is, if a product is markedly less expensive than comparable plans, then there's probably a very good reason, and that very good reason is not going to redound to your benefit.

Does that mean that mini-meds are inferior? Not necessarily, but the key word in "limited benefits" is limited.

But wait, it gets better (or worse, depending on one's perspective). According to Citizens for Economic Opportunity's Beverley Brakeman, when they purchase a mini-med plan "people think they have insurance, get sick and find out that they don't." Um, no: when they purchase a lesser product (such as a mini-med) and pay a lower rate because of its limitations, they've bought insurance. It's like saying "people that rented a small apartment instead of buying a big house are homeless."

It's quite the conundrum: at a given moment, we have "x" number of folks who are, either by choice or happenstance, without insurance. The industry, under seige for not adequately addressing the issue, rebrands and remarkets a scaled-back benefit plan that enables almost a million people to purchase at least some form of coverage. And the response? "Not good enough."

So, why the hysterical comments in the first sentence? Well, let's think about it: insurers market a product with a lower price tag (and lower benefits and caps) and manage to insure a non-trivial number of people. Not every uninsured person, but a decent chunk. And the response from the sidelines: "Not good enough." That's exactly like saying that since the cops can't catch every burglar, they should stop trying to catch any burglars. And since the airlines can't guarantee that every flight will arrive safely and on time, they should stop flying altogether.

Well, you get the point.

ADDENDUM: I just re-read Bob's post on how Massachusetts' foray into state-sponsored health insurance has left a lot of young folks with stupendous uncovered (and unpaid) expenses. The plans are problematic "because of annual limits and caps on outpatient care and surgeons' fees."

"Annual limits?" "Caps on...care?" Sound familiar?

So how come when the insurance industry pushes these it's a nightmare, but when the gummint implements them it's "progress?"

Cavalcade of Risk: 1st Anniversary Edition

As our good friend Julie pointed out a few weeks ago, the 26th bi-weekly edition could have been considered our anniversary issue, as well. But I tend to look at these things in terms of time passing, and it was a year ago this week that we published the first Cav.

We've come a long way since then, with lots of great hosts, and I want to thank each of you for your help and support, and your willingness to help out. I'm really looking forward to this coming year, as well, as more folks jump on our mailing and hosting lists.

As CoR hosts know, I spend the weekend before each Cav "hunting" for interesting/unusual risk-related posts from around the blogosphere. These are often included along with those submitted by our "regulars." Since this is our anniversary edition, though, I'm sticking exclusively with posts submitted by you.

Thank you for a great year!

And now, the 1st Anniversary Cavalcade of Risk:

■ The title of this post alone earned it top billing here. My Wealth Builder's "Super Saver" explains how asset allocation techniques can help take some of the risk out of retirement planning.

■ Over at the New York Personal Injury Law Blog, Eric Turkewitz tells the tale of an insurance company that wants to settle, and a doctor that doesn’t. The insurer settles anyway. The doctor sues.

■ Hurricane Katrina continues to cause risky ripples. Dr J C, at GNIF Brain Blogger, explores a unique and unusual case involving the failure to evacuate a patient. Was it malpractice, or good medicine?

■ Leon Gettler, blogging at Sox First, says that cross-border fraud is now one of the top 10 business risks, but according to a new study, most companies are not prepared to deal with it.

■ With a subject close to my own heart, Charles H. Green (Trust Matters) avers that systemic insurance fraud won't stop until we make it stop.

■ Bryan Moore, The Financial Whiz, writes about a risk-management approach to investing, using "Hedge Fund" Mutual Funds that are currently available to the small retail investor.

■ Over at the Boston Erisa blog, Stephen Rosenberg examines the roles of risk, liability, and (of all things) climate change. You'd be surprised.

■ HWR regular Jason Shafrin asks "How does insurance company physician reimbursement restrictions affect the cost of influenza vaccinations?" He calls on Adam Smith and Jonas Salk for answers.

■ The Health Business Blog's David Williams has a question, too: Did you know that collaborating with a cardiologist can be like collaborating with a rattlesnake? That's what some radiologists seem to think.

■ Chocolate or vanilla? Ginger or MaryAnne? Stockmarket or Real Estate? In his favorite risk post from the past year, our friend The Silicon Valley Blogger attempts to discern which investment strategy is the better risk. Click to find out.

■ The Cato Institute's always provocative, always interesting, Michael Cannon shares his thoughts on how HSA's (Health Savings Accounts) can be used to help reduce folks' health risks.

■ Julie Ferguson of Workers' Comp Insider takes the industry's pulse to see what lies ahead for employers and insurers. In her post, Julie observes that the worker’s comp market continues to be robust, but there’s still some risky waters ahead.

■ Meanwhile, in her favorite risk post since we started the Cav, Susan Mangiero of Pension Risk Matters highlights a survey indicating that risk still worries some institutional investors.

■ And Jay Norris, over at Colorado Health Insurance Insider, discusses the recent passage of (CO) House Bill 1330, the "second parent adoption bill", the steps Colorado is making to rise above bigotry in the health insurance industry, and what still needs to be done.

■ And finally, here at IB, our own Bob Vineyard has some thoughts on Atlanta’s least favorite lawyer, Andrew Speaker, the erstwhile globe-trotting TB carrier. Bob explores some of the risks Mr S took, as well as those he forced on his fellow passengers.

That about wraps up our First Anniversary Edition. Please join Julie, at Workers Comp Insider, on the 20th for the next star-studded issue.

CATO on HSA's: Bigger = Better

The Cato Institute (yes, we're familiar with it), a well-known libertarian think-tank, has proposed some sweeping changes to Health Savings Accounts.

And we do mean "sweeping;" frequent Cavalcade of Risk and Health Wonk Review contributor Michael Canon suggests:

■Increasing the allowable HSA contribution limits dramatically, to $8000 for individuals and $16,000 for families. That's about triple current levels.

■ Removing the requirement that HSA holders be required to own HDHP's (High Deductible Health Plans); anyone could own an HSA, regardless of coverage configuration.

■ Allowing HSA holders to purchase health insurance of any type from any source, tax-free with HSA funds. This is a dramatic change: currently, only long term care (and COBRA) premiums can be paid tax-free from HSA accounts.

These are some aggressive changes, not all (or maybe any) of which will be welcome by the pundit and political classes. Frankly, I'm not sure that the first one is really necessary: there are precious few plans even available with such high deductibles; how many folks are going to be opting for those? Right or wrong, that's bound to upset the class-warriors.

The second one is intriguing: my first reaction was negative, but I couldn't figure out why. It occurred to me that it was visceral: I've been promoting and defending HDHP's for so long, I think I took that personally. Bad idea.

The final suggestion seems pretty innocuous: what harm could that do? So many folks are already moving to "higher" deductible plans (e.g. $1,000/person) that this would seem to be pretty easy to justify.

Michael is always forward-thinking, and he may be on to something here.

Grand Rounds is up...

Dr Lisa Marcucci presents over 30 interesting posts from around the medblogosphere (yeah, I really like that term). Each one has a succinct "thumbnail" for context (I like that, too), and the posts are neatly categorized for easy perusal.

Our friend Jay Norris, blogging at Colorado Health Insurance Insider, tells us about his own less than satisfactory experience with transparency in medical care pricing. Enthususiastic as I am about consumer empowerment, this post really points out that we still have a way to go.

Zero Premium Life: Update the 2nd

As the continuing saga of ZPL, um, continues, we find the ever-vigilent Peach State Department of Insurance following the leads of North Carolina, Iowa and others:

"The Department has received a number of inquiries from Georgia resident licensed agents who have been solicited through e-mail and facsimile transmitted advertisements to sell Zero Cost, No Cost, No Premium, Zero Premium or Zero Payment insurance coverage to their clientele...[and] has opened an investigation to ascertain whether, and the extent to which, these solicitations directly violate any Georgia Statutes and Regulations applicable to the sale of universal or whole life insurance products."

The Department also strongly urges agents to "refrain from entering into any agreement or arrangement to market or sell" these products. Contrary to the implications of the marketers' emails, these products have not been approved for sale in Georgia (or anywhere else, as far as we can determine).

A few weeks ago, the Kentucky DOI also joined the fray, advising agents in the Bluegrass State that the agency is "currently investigating the sales material and the practice in general to determine if there are any violations of Kentucky’s insurance law." They're also requesting that agents forward any relevant sales and/or marketing materials to the department. I like that: it's proactive, and it empowers agents to help their own cause.

Meanwhile, back here in the Buckeye State, the never-vigilant Ohio Department of Insurance continues to ignore the whole brouhaha. Rarely have I been so proud.

Carnival of Personal Finance: Ambitious Edition

Jack Bauer, er, uh, I mean Clever Dude, presents a clever, well-designed, really fun Carnival this week. Based on the hit TV show "24," CD (or is that CTU?) uses the ticking clock metaphor to present over 5 dozen entries. And each one explains the post in the context of the show.

Absolutely amazing (and some great visuals, to boot!). Do check it out.

Do you know the difference between "frugal" and "cheap?" You might be surprised: The Frugalist explains that being economical doesn't necessarily mean being stingy.

Hoax or Outrage?

By now, most folks are probably aware of the recent Dutch "game show" wherein ESRD patients vied for new kidneys from a terminally ill donor. The idea was that, by presenting themselves as the "most worthy" (or whatever), one lucky contestant would win a new set of kidneys, and thus a new lease on life.

As it turns out, the show was actually an elaborate hoax, designed to point out some of the shortfalls of the Dutch organ donor system. The "terminally ill donor" was, in fact, an actress; the patients, though, really were transplant candidates, who agreed to debase themselves for the sake of ratings (and, perhaps, a few Euros). The fact that this was staged, however, only exacerbates the moral issues at play.

In Holland, as here, organ transplants are tightly regulated, with the added complication of relevant EU regulations thrown in. The show points up some pretty significant ethical problems, and a few insurance ones, as well:

For one thing, there is the tension of the greater good versus the wellbeing of the individual. As we saw with the Zero Premium Life kerfluffle, there is a very real danger of "non-voluntary donors." The urban legend about waking up in a hotel room sans kidneys may be merely a myth now, but absent rigorous safeguards, is it all that unlikely?

From an insurance standpoint, most major medical plans cover transplants (often restricted to "Centers of Excellence") which pay both the donor's and recipient's medical costs (although the donor also incurs additional, unreimbursed expenses, as well). But such procedures are done under strict guidelines, and carriers generally have special claims units specifically for these types of claims.

Still, there is no question that there are a lot of folks who need kidneys, hearts, livers, corneas...the list goes on. So why don't more folks donate their organs (either while they're alive, or arranged for posthumous harvesting)? Well, some may pass for religious reasons, others may never have even considered it. And, as with life insurance and wills, there are a certain number of folks who just don't want to even think about their own mortality, and thus choose to ignore the issue altogether.

Which brings us back to the little Dutch "stunt." The producers claim that its real purpose was to increase awareness of the need for more donors. Based on the public outcry the show elicited, I'd say they made their point. The question is, however, whether more people were convinced, or turned off.

On Being Dumb...

Over the past few months, a number of high-profile "medbloggers" (we'll come back to that) have left the building. About a month ago, I observed that "doc's often use their blogs as sounding-boards, and this can be a problem;" privacy issues, of course, were paramount, but there are others.

It never occurred to me that a fellow medblogger could have his own posts almost literally bite him in the tush. The term "medblogger," by the way, refers to physicians, of course, but also nurses, folks in health IT positions, consultants, even those who write about health care financing (such as, oh, say, insurance).

So why the rather blunt title of this post?

Earlier this year, Dr Flea (an anonymous blogger whose dayjob was pediatrician) won the coveted "Best New Medical Blog" award. A few weeks ago, his blog went, well, blank. There was some speculation as to why that occurred; he was in the middle of "some litigation," and it was posited that he shut himself down. Which, as it turns out, he apparently did.

For a very good reason (h/t Hugh "Blogfather" Hewitt):

" As Ivy League-educated pediatrician Robert P. Lindeman sat on the stand in Suffolk Superior Court this month, defending himself in a malpractice suit involving the death of a 12-year-old patient, the opposing counsel startled him with a question.

Was Lindeman Flea? "

Turns out, he was. And he wasn't doing himself (or his cause) any favors blogging on his own trial:

"In his blog, Flea had ridiculed the plaintiff's case and the plaintiff's lawyer. He had revealed the defense strategy. He had accused members of the jury of dozing."

Ooops.

There are times when, having written a particularly passionate (or critical, or snarky) post, I'll hit the "Save" button, instead of "Publish." A post that's never, um, posted isn't cached in 'Wayback, and can't come back to bite me. But once I hit that publish button, all bets are off.

Now, that isn't to say that I always go back and delete those posts (d'uh! Just do a search here for Stoopid Client or Carrier Tricks). And, as I mentioned in that previous post, very little of what we write actually names names (and when we do, there's a very good, and documentable, reason for it). But as this wonderful world of blogs continues to evolve, we may see a creeping reticence emerge.

Maybe that's a good thing.

Last Minute Nudge

I received some interesting, and helpful, info today from Phil Montgomery, of the LIFE Foundation, a non-profit focused on increasing public awareness of life and health insurance issues. As we noted a few weeks ago, May is (was?) Disability Insurance Awareness Month. Phil asked me to pass along some final thoughts: It is estimated that one out of every three workers will suffer a disability lasting three months or more at some point in their career, yet studies show that most Americans couldn't afford to live without their paycheck for even one month before financial struggles would start to mount.

There's even a helpful video available.

We write a lot about medical insurance, which essentially pays the doctors' bills. But it's important to remember that, if you have a serious illness or injury, you still have mortgage and car payments, light and telephone bills, and all those other monthly expenses to pay. No major medical plan pays those, so do yourself a favor and ask your agent about disability insurance. You'll be glad you did.

Cavalcade of Risk: Special Anniversary Edition

Next week's CoR marks the 1rst Anniversary (by date). So, I'd like to encourage folks to submit their favorite risk-related posts from the past year (if you've already submitted a post, but would rather enter a "fav," just let me know).

Submissions are due this coming Monday (the 4th):

■ Blog Carnival

or

■ Email

We've still got some hot summer hosting slots available, so please sign up soon.

Health Wonk Review is up!

The estimable Richard Eskow, blogging at The Sentinel Effect, hosts this week's outstanding edition of the Health Wonk Review. He presents 20 posts, all with helpful context, and an intuitive flow.

Although we here at IB are unashamedly enthusiastic about consumer driven health care, we also know that it's not without its faults. Our good friend Joe Paduda, of Managed Care Matters, presents what he's coined as a "pre-lash" against some aspects of this phenomenon. As usual, it's timely and insightful.

MassHealth, or MassMess?

We've discussed the new Massachusetts health plan before, pointing out the ginormous cost of the program (exceeding even its critics' worst fears), so it's no real surprise that the Bay State gummint has decided to increase the plans' load: consultant Alan Raymond was contracted to evaluate the program 1 year in, and he finds some disheartening trends:

In theory, Mass Health was supposed to lower the ranks of the uninsured by increased enrollment in Medicaid for those in the lowest income levels, while "encouraging" (requiring, really) all others to obtain insurance through their employers or individual plans.

In reality, according to Dr Raymond, enrollment in Massachusetts' Medicaid program has increased by over 50,000 since last summer. That means that about 54,000 low income folks who had been previously counted as uninsured are now covered. And why not, since the Bay State itself (or, rather, its taxpaying citizens) foot 100% of the tab.

What to do, what to do?

How about a new, even more encompassing state-run plan: Commonwealth Care. This program debuted in January, for folks who make 200% to 300% of the federal poverty level. Now, these folks have to ante up a bit to participate. It doesn't take a Carnac to divine what's happened with this plan: less than 20% of those eligible have opted in.

Quelle surprise!

Now, what could top both of those? You guessed it: The Commonwealth Choice program, set for a July rollout, will purportedly help "higher-income" residents buy "unsubsidized" (i.e. non-taxpayer-funded) private coverage.

Any guesses on how that'll turn out?

Capital!

For the first time in some months, one of our posts is featured in the Carnival of the Capitalists (Yay!). The uniquely named Marketing Whore (sorry) hosts this week's star-studded edition, with 16 entries, almost all with helpful (indeed, copious) context.

In the insurance biz, trust is a precious and jealously-guarded commodity. Charles Green, blogging at Trusted Advisor, explains why trust is so important, and so easily abused.

Carnival Time!

Ben at Money Smart Life hosts the 102nd edition of the Carnival of Personal Finance. Replete with interesting (if sometimes obscure) musical references, this compendium of almost 70 posts is music to the eyes. I have but two quibbles: only a few posts had any kind of context, and some links didn't work at all.

Still, I did find the Silicon Valley Blogger's post on valuing Moms (both Stay at Home and otherwise) to be pretty darned insightful (and it's not just because my better half sometimes drops by here). Recommended.

We Get Mail!

We do, indeed, get quite a bit of email here at IB; some's good, some's interesting, some's spam (or worse). We endeavor to answer all our (legit) email promptly, especially when it comes to claims or coverage issues.

Recently, we received this from one of our readers:

"I have always had a horrible fear of the dentist. I am 46 years old and though it is a tad better, I still tolerate long appointments better with nitrous. At my age, evidently I am all into the "crown stage"...either that or I am paying up someone's college fund.

My insurance will not pay one dime towards nitrous. Why? Medically unnecessary? They'll pay for one or two little pills if the dentist chose to try one of the anti-anxiety drugs (they don't work)."

First off, I am not a big proponent of (individual) dental "insurance:" in almost every circumstance, one is, at best, trading dollars with the insurance company. Think I'm off base? Do the math: waiting periods for anything more involved than a simple cleaning (and sometimes those, too!), deductibles and co-insurance for "major" claims, and an annual cap in the low $1,000's. Insurance companies miss very few tricks. Group dental is also a dollar-trading affair, but may make sense if some/most/all of those dollars are your employer's (if you buy into the theory that employers actually pay for insurance).

Be that as it may, our correspondent raises an interesting question: why is N2O not considered an eligible expense in this scenario? After all, novacaine is okay when you're having a tooth filled, and nitrous is approved for extractions, so why not here?

The easy answer is: because dental insurance is regulated very differently than medical coverage, and carriers can exclude a whole lot more in the former than the latter. Since a benefit that's excluded doesn't cost the carrier anything, there's an incentive to keep as much as possible off the "covered" list.

The more accurate answer is, as the email mentioned, "medical necessity." That is, "treatment which is required to treat or care for symptoms of an illness or injury or to diagnose an illness or condition that is harmful to life or health.” I might add that the industry has often expanded this definition, to include certain obvious comfort-making processes (i.e. anaesthesia for surgery, etc). One can readily see that, although our correspondent may well experience heightened anxiety when visiting her dental practitioner, this does not in and of itself constitute medical necessity.

One possible alternative for folks contemplating dental coverage is to look into an HSA compliant medical plan, and funding dental (and a host of other eligible) expenses through the tax-advantaged Health Savings Account. In this way, Uncle Sam is helping to subsidize your out of pocket, including the aforementioned N2O. And if you're able to shed some anxiety, the money then stays in your account, instead of going to the insurer.

A rather toothsome win-win.

Grand Rounds!

With over 4 dozen interesting posts, the 2nd year medical student who blogs at (of course) From Med Skool hosts this week's Grand Rounds. It's easy on the eyes, and easy to follow, as well, with helpful context and useful categories.

In a rare case iof synchronicity, David Williams (of the Health Business Blog) discusses medical tourism with the author of a new book on the subject. A very interesting read.

A Safe & Enjoyable Memorial Day Weekend

Bob, Bill, Mike and I would like to wish all of our readers a wonderful weekend. Please find the time to thank a vet or active duty military person for their service to our country. It's their efforts that enable us to remain " the land of the free and the home of the brave. "

And if you're planning a big cookout on Monday, stick with the steak and veggies:"The FDA issued a warning Thursday that some imported monkfish may actually be puffer fish, which contains a toxin called tetrodotoxin than can cause serious illness or death."

Talk about putting a damper on the festivities.

Girls & Boys...

One of the conditions that give insurance underwriters much trouble is diabetes. This is due, in part, to the "elastic" nature of the condition: adult vs juvenile onset, insulin vs diet control, "stick" vs oral, and now (apparently), boy vs girl:

[Graphic courtesy of Employee Benefit News]

According to Medco Health, "(n)ew research suggests that adolescent girls may be at increasing risk for several physical and psychological health problems." They seem to have found a a link between diabetes meds and sleeping aids, antipsychotics, and treatment for ADD/ADHD. This "linkage" is much more pronounced in young ladies than gentlemen.

One phenomenon which may be driving this disparity is the finding that so many young women are taking anti-psychotic meds: over the past 5 years, the number of girls 10-19 years old who are on these meds has grown by almost 120%, while young mens' usage has gone up just over 70%. That's a pretty wide gulf. Also disturbing is the use of sleeping aids; 80% more young girls use them now than just 5 years ago. I'd sure like to know why; seems to me that adolescence has always been a pretty stressful time, perhaps especially for girls. Couple that with the growing number of that demographic who are now on ADD/ADHD meds (up almost 75% for the girls), and it's not a recipe for positive long term results. Granted, more boys are on these meds than girls, but the gap is apparently shrinking.

One bright spot: "The slowing of growth in pediatric utilization of ADHD drugs, antipsychotics, and sleep medications from 2005 to 2006 may be a reflection of the concerns raised by reports such as (this)."

Gee, I would hope so!

Transparency Growing Up

When we discuss transparency in health care (and/or health insurance), we often focus exclusively on the costs (in dollars) of a given procedure or treatment. Sometimes, as with HealthcareFacts, other information (such as outcomes, complications, etc) are available. The challenge is finding non-insurance sources for this information.

Why?

Well, for one thing, a lot of folks are (understandably) reluctant to trust health insurance companies when it comes to their health care. For another, a lot of these are proprietary systems, so they may be of lesser value to those not insured by a given carrier.

The good news, according to USA Today, is that more and more providers are now making more and more information available.

What kinds of information?

"Click on the "Quality Reports" tab at the top of the virtual file drawer and look up coronary artery bypass graft surgery. You'll learn that the hospital's death rate is 2.3%, a shade below the national average of 2.5%. The length of stay is 7.2 days, a tenth of a day longer than the national average, and the charges will total about $75,000, roughly $49,000 for the hospital and $26,000 for doctors."

And that's just for one hospital!

And various states are getting into the act, as well; California's HealthCare Foundation (in partnership with a number of related entities) has a web portal one can use to rate a given hospital's quality of care. The Ohio Hospital Association maintains a website where one can search for specific facilities, or by geographic area, for outcomes and charges. Even Georgia's hospital association has a web presence, where one can compare facilities, costs and quality.

The Fed's have also been busy in this arena: Medicare's website boasts a number of search tools, among which is "Hospital Compare," which enables beneficiaries to identify how well a given hospital is performing. Costs and quality measurements are both available, and one can even print off a handy hospital check list of questions to ask before care is rendered.

It's encouraging to see these tools becoming more sophisticated and available to us consumers. As consumercentric health insurance plans continue to evolve, these kinds of tools are becoming more critical. Timing is everything.

Cavalcade of Risk #26 - Now Up!

You'll find this week's Cavalcade over at Colorado Health Insurance Insider. Jay's done an outstanding job, pulling together almost 2 dozen relevant and timely posts.Thanx, Jay!

Jay will tell you that hosting's fun, fairly easy, and highly rewarding. Why not give it a try yourself?

Insurance going to the dogs (and cats)?

It's been a while since we visited the world of Pet Insurance, and after the recent pet food scare it seems timely to revisit the subject.

Thanks to The Industry Radar, we're now aware of the Top 10 Reasons we take our pets to the vet: Skin allergies and ear infections top the list for our canine friends, while our feline companions' favorite travails are urinary tract infections and upset tummies.

Most folks don't have pet insurance, so the cost to treat these maladies is 100% out of pocket (and after taxes). According to the American Veterinary Medical Association, "only a small percentage of pet owners carry health insurance for their animals." The American Animal Hospital Association reports that about 3% of pet owners have purchased this cover. By contrast, almost 10% of Canadian owners, and about 2% of cat owners, bought this coverage (what, no national pet insurance plan?).

Our cousins across the pond are snarfing it up, though: in the UK, about 12% of cat owners, and an astounding 18% of dog owners, bought pet insurance, according to the latest figures.

Most of the plans available here are based on an indemnity model; that is, reimbursement up to a certain, scheduled amount. They're comparable, for example, to the now ubiquitous mini-meds on the "human" market. And the plans seem to be reasonably priced; I've even seen some offered in corporate cafeteria plans [ed: dog insurance, cafeteria plans; are you sure you're not talking about Korea?].

Just some (dog) food for thought.

Taking Time (Off, that is)

Generally speaking, we use the term "benefits" to describe various things covered by insurance policies. But that's by no means an exhaustive definition; retirement plans, for example, are benefits, and flex-time hours certainly qualify, as well.

Perhaps the newest of these non-traditional "benefits" is "Paid Time Off." According to World At Work "(p)aid time off (PTO) banks help companies increase productivity and lower costs by reducing unscheduled absences." Basically, an employer "deposits" a certain value in an employee's benefit bank, against which the employee can draw; the benefit is that such time off is characterized not as "vacation" or "sick leave," just "time off."

In the event, according to Employee Benefit News, more companies are now installing such banks, and there's an increased interest in implementing them:

[Graphic courtesy of Employee Benefit News]

Who knew a simple day off could become such a big deal?

Carnival Monday

FIRE Finance blog hosts a very cool Carnival of Personal Finance, with eye-catching (and relevant) illustrations, and helpful context for each of the 50+ entries. It's even categorized for readers' convenience.

For a while now, my daughter and I have had a standing (well, sitting, really) date for Friday nights: House (the doc ) on USA Network. It's always a hoot to watch the title character arrogantly bully his way toward a solution (kind of a medical Sherlock Holmes). I had never considered the show as a place for financial advice, though, until Flexo pointed out some interesting lessons to be inferred.

Cavalcade #26: Submissions Due [UPDATED!]

A big round of applause to Colorado Health Insurance Shopper's Jay Norris, who has bravely & graciously stepped in to host this week's Cav. Here's updated submission info (posts due Monday, the 21st). You can submit your (or someone else's!) risk-related post via:

Blog Carnival

or

Email

Please include:

■ Your blog's url

■ Your post's url

■ The trackback url (if applicable)

■ A (brief) summary

PS We're scheduling hosts for Early Summer '07, so don't wait too long to sign up!

ZPL ("Zero Premium Life") Update

As we recently reported, Zero Premium Life is the latest something-for-nothing scheme making the rounds of agents' in-boxes. Today I received this from one of our sources:

The product was supposed to have been approved in six states (CA, GA, NC, SC, PA & VT), but the Departments of Insurance for these states have NOT approved it, and many have posted warnings on their websites:

■ North Carolina

■ Georgia

■ South Carolina

■ Idaho

■ Ohio continues to be asleep at the wheel (as is California, but they have an excuse)

The product's roll-out date was supposed to be May 1st, but has apparently been pushed back a month. FWIW, agents are being charged a $10 contracting fee, yet the names of the carier and the investment group are both being withheld.

NAIFA, ACLI and AALU have published a joint STOLI ALERT [ed: STOLI, or Stranger Owned Life Insurance, was supposed to be dead and buried. Guess not].

We'll keep you posted.

The Golden Years, Redux?

Just a few months ago, we reported that a lot of folks worried that they'd be working even after they'd formally "retired." Turns out, many of them underestimated their own nest eggs.

The survey on which that report was based was conducted by the Pew Research Center; the Employee Benefit Research Institute recently did its own Retirement Confidence Survey, with interesting results:

[Graphic courtesy of Employee Benefit News]

■ Almost 1 in 5 believe they'll retire before they hot 60

■ A few more than 1 in five plan to bail out between 60 and 64

■ And just about a quarter of those surveyed think they'll hang it up at 65

The survey results conclude that employees are still playing catch-up with all the retirement plan options available to them. Perhaps more disturbing: about half of them are pretty skeptical about their company sponsored pension plans, yet they're not really taking advantage of all the personal opportunities now extant (IRA's and Roth IRA's, for example).

In a nod to a recurring theme here at IB, most workers currently approaching retirement are ill-prepared for a long term care claim; a lot of them think they're covered, but most probably aren't.

It's not a pretty picture.

Health Wonk Review is up...

Must be "early bird week," 'cuz Bob Laszewski has this week's terrific HWR already posted. It's got a kind of folksy feel to it, which makes it even more fun to read. And each post benefits from that; it's obvious that Bob read each and every entry carefully.

One of my favorite things about the medblogosphere is how folks can take away something completely different from the same data. Jane Hiebert-White of the Health Affairs blog looks at the same USA Today article as I did, and draws completely different conclusions. Viva la difference!

Hypothetical vs Ethical

This post has nothing to do with insurance, or health care, or risk management. It does have to do with the burgeoning power of the blogosphere [ed: now cut that out!], and where lines can and/or should be drawn.

By way of example: early on in the life of this blog, I was invited by the Oxford University Press to review a new book on health care and health insurance. OUP very kindly sent me a copy of the book (unsigned) to expedite that endeavor. A little later, Blue Cross of Minnesota sent me a nice little package consisting of a pretty brochure and some kind of granola-type bar thingie (as you can see, I'm not exactly a health-food afficionado). Neither the publisher nor the carrier asked me to write glowing reviews; in fact, I was less than kind to Dr Q (but always polite!). Still later, I had the opportunity (along with several other bloggers) to interview a United States Senator.

So what's my point?

The Wall Street Journal recently reported on the newest blog phenom: "blogola." Simply put, it's companies sending nifty free stuff to bloggers (including airline tickets, IPods and other assorted goodies) in order to build "buzz" about a particular service or product. And it appears that this is having its intended effect: "I hope you like it," wrote Ms. Marie in an email to CBS to flag her "Old Christine" posting. "If there's anything you'd like me to add, just tell me and I will." She signed the note, "XOXO."

To be sure, not everyone involved "rolls over," but it seems to me that there may come a time where that conflict of interest may become important, maybe even unseemly. Whenever there's a quid-pro-quo, explicit or tacit, then there's the danger of an insurmountable conflict, which erodes the blogger's credibility and influence. And really, isn't that what we're selling: we write posts in the hope that we will sway our readers toward a certain conclusion or opinion. We have no super powers, only words. But words mean things and, if we choose to "sell out," what have we really accomplished?

Realistically, it's not terribly likely that Bob, Bill, Mike or I will ever be offered any items of real value [ed: oh really? Ask Bill about that new Porsche]. But both Bob and I have been interviewed by various trade journals, and Mike's had an interesting media experience recently (I'll let him tell you about it when the time is right), all because of IB. So we're relatively insulated from the problem. Still, it does give one pause: how would we handle real blogola?

Just some food for thought.

Transparency: A Different Take

Our friends at MedBill Manager have taken one of our pet "causes" (health care transparency), and given it a thorough re-working. What they've designed is a system which incorporates pricing information with real-time provider searches and provider coding.

Sounds complicated? It's really not, and Chris at MBM explains it far better than I.

Check it out.

Universally Speaking: A Big Fizzle

On the one hand, I really like the idea that states are trying out different iterations of "universal health care" [ed: a major misnomer, BTW; what they mean is "universal health insurance"]. Constitutionally, it's the only legal way to do this, and it has the benefit of being a smart method, too.

Why's that?

Well, if one state tries a given program, and it's a loser, then only the folks in that state are substantially affected. If one such program turns up a winner, then other states can adapt it to their own population. Kind of a win-win.

Thus far, unfortunately, we haven't seen a successful model, but at least the states are still giving it the old college try. Among the latest is Illinois' plan, which was predicated on a massive tax hike (a $7.6 billion "gross receipts tax" on Prairie State businesses) that was supposed to fund the new program, such as it was.

To get an idea of just how badly this whole campaign went down, one need only consider that the state's House of Representatives (an overwhelmingly Democatic body) buried it with a unanimous (107-0) "no" vote. Yikes!

What went so wrong? Well, consider this little snippet from the WSJ: "Instead of raising individual taxes, he aimed at business and even built in an exemption for smaller firms."

Do you see the problem here?

Of course: businesses (large, small or in-between) don't pay taxes. So the tax hike would have led to major costs being borne by the actual taxpayers, aka consumers. Notice that the article doesn't even really explain the nature of Governor Blagojevich's health care program; it focuses solely on the funding of it. Kinda tells us all we need to know.

What was that about a free lunch?

Busy, Busy Monday (Carnival Time!)

First up, the Carnival of Personal Finance. Madame X (of My Open Wallet) presents the 100th edition of this venerable blog compendium. Keeping with this theme, she hosts 100 entries, in 9 distinct categories, and all with great context.

WenchyPoo has an interesting, counterintuitive take on the relationship between fuel efficiency and taxes. Very interesting.

Daniel Goldberg, a second-year PhD student in medical humanities, is out of the gate a day early with his edition of Grand Rounds. Nothing wrong with that, of course; just took me a bit by surprise. In the event, he's got 30 interesting posts; a good mix with helpful comments.

This one caught my eye, at first for the title, but mostly for its "who knew?" factor (although the blog's name itself should be a clue). Go ahead, click it; you know you want to.

Some More Equal Than Others...

One of the most prolific, and tenacious, canards cited by those who advocate a nationalized health care system here is the (demonstrably) false assertion that such a system saves more lives than ours.

We've gone over this ground before, but there's new proof of just how silly that argument is:

"British cancer patients are substantially more likely to die of the disease than those in other western European countries because of poor access to the latest drugs...While more than half of patients in France, Spain, Germany and Italy have access to new treatments provided since 1985, the proportion in the UK is four out of 10."

Okay, says the skeptic, that just proves that the NHS (and its Continental Cousins) isn't very good at getting new drugs out to patients; doesn't prove that we do any better.

And a fair point that would be.

If it were true:

"The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe."

Thank you very much.

Survey: Disabled

We've blogged before about disability income insurance (here, for example), but the Council for Disability Awareness has released some disturbing new figures, and we thought it'd be a good idea to share them. And since May is National Disability Insurance Awareness Month, that seems quite appropriate. According to the CDA's “2007 Disability Awareness Survey:”

■ Nine out of ten workers underestimate their own chances of becoming disabled.

■ Nearly 60% of workers have not discussed how they would manage an income-limiting disability.

■ Nearly two-thirds of respondents with 401k or IRA plans are unaware of what would happen to their retirement savings should they become unable to earn an income.

■ Female workers, particularly unmarried women, are less likely than males to feel confident that they could pay their living expenses for three months if their wages stopped.

This is not a pretty picture. Working folks are much more likely to suffer a disability than die, yet most of us have at least some group life insurance through our employers. Disability has been called "the living death," because it can quickly reduce one's savings due to lost wages and extra medical and support expenses.

So what can you do about it? Talk with your agent (you do have an agent, right?) about this important coverage. Check at work to see if there's a plan in which you can participate. It's important.

Mini-Rant: Discount Cards

We've written before about health care discount cards, and the generally low esteem in which we hold them. There are times, of course, when they're appropriate, but I find the marketing gimmicks to be (at the very least) misleading: "All health conditions covered," and "no waiting periods," for example. Of course such plans are in effect immediately, for pretty much any condition: they're not insurance, so there's no underwriting.

But the latest iteration really set me off. See if you can spot the offending "benefit:"

Catch that second line? "Any citizenship status accepted" No matter what one's take is on the current state of either health care or health insurance, it boggles the mind that these folks are encouraging people who are here illegally, and misleading them, as well. This is offensive, and yet there's precious little that can be done about it.

Why, you ask?

Because these are not insurance plans, state departments of insurance have little (if any) power to regulate them [ed: not necessarily - see comments], or even hold them accountable.

Sheesh!

Among the healthiest people in the world

The May 9th Wall Street Journal [subscription required] features a front-page article that illustrates some of the adverse financial, productivity, and social implications that arise from lax disability certification rules and inadequate standards of approval for disability insurance benefits. The article focuses on Sweden, where benefits for disability are insured by the Swedish government. Sweden is clearly in a corner and must now reduce or withdraw benefits that the people have naturally come to believe they are entitled to have. This won't be easy:

“At a time when low-cost competition from Asia is clobbering Europe’s markets and straining its generous welfare states, governments from Finland to Portugal are trying to cut back and get more people to work.”

Work? B-b-b-b-but isn’t health care a right? Why should Swedes (or anyone else) have to work for their rights? How can anything be a right if you have to work for it? Say it ain’t so, Lars!

Two other statements in the article caught my eye. First this:

“Swedes are among the healthiest in the world, according to the World Health Organization. And yet 13% of working-age Swedes live on some type of disability benefit – the highest proportion on the globe.”

Seems a reassessment is in order. Meanwhile WHO looks ridiculous.

And near the end of the article, where so often one can find the truly interesting facts of a story . . .

“Everyone who said they were sick was getting money. We didn’t demand anything’ said Ingrid Nilsson, the local agency’s director. ‘I guess that was the wrong thing to do."

Gee, ya think?

Anyone remember the Seinfeld episode when George was fired for a certain kind of after-hours misconduct atop his supervisor's desk, and then plaintively asked “Was that wrong? Was that wrong? No one told me that was wrong.”

So yeah, Ingrid, that was the wrong thing to do.

The Journal continues to report facts that individuals committed to the notion of government control of the health care and health insurance systems like to disparage or ignore.

Unfortunately the Journal's reporting reflects reality, which we ignore at our peril.

Cavalcade of Risk #25 - Now Up!

This week's CoR is available at Getting Green. Matthew Paulson (who's frugal, but NOT cheap) has put together a great Cav, with an even dozen interesting posts.

Thanks, Matthew, for a great job!

And as Matthew will attest, hosting a Cavalcade of Risk is easy & inexpensive. Why not give it a whirl yourself?

The Amazing, Self-Fisking Gap Report

According to USA Today, "(t)he uninsured pay nearly three times more for hospital services than health insurers pay, and the gap between what they're charged and what insurers pay has soared since 1984."

Except that they don't, and it hasn't:

"Hospitals rarely recoup the full amount they charge patients."

Nice little sleight-of-hand there, USA Today! Bravo!

Let's take a closer look at how this trick was done:

First, "what hospitals charge" and "what uninsured folks pay" are two entirely separate things. Providers (not just hospitals) enter into agreements with insurers (or MCO's) which set the terms for reimbursement of services. The providers offer to discount what they charge, and the insurer/MCO agrees to pay that full amount in a timely manner, and to "steer" its customers to that provider, thereby increasing its sales volume. It gets even better with Medicare/Medicaid, because the gummint itself sets the price; no negotiations necessary.

Pretty simple, even for a journalist.

An uninsured person has no such agreement, and has little (if any) leverage. Many folks will (attempt to) negotiate with a provider, with limited success. One sees this especially in maternity cases, where the date of future service is pretty easy to define, and prepayment may be an option. It's pretty hard, though, to negotiate with the ER crew while you're having a stroke.

Which is not to say that I'm unsympathetic; it's a matter of economics and contract law. The providers have an agreement with the insurers, and none with those who are uninsured. For their part, they have little leverage with the patient: the law requires that they treat emergency cases regardless of insurance status, but they are restricted in how they can collect if a patient skips out on payment.

Of course, the cost of the skippee's treatment will be passed on to the rest of us, much as the cost of shoplifting is at KMart (or wherever). One can argue about the fundamental "fairness" of such a system, but it's what we have.

The point [ed: Yay! We knew there'd be one!] is that uninsured folks don't actually "pay" 3 or 4 or 5 times what an insured patient does: just because they're charged more, doesn't mean they pay more.

I also loved this: "The gap between what the uninsured and other self-paying patients are charged for hospital care and what Medicare pays has more than doubled in the past 20 years." Um, what hasn't? Again, it's simple economics, this time coupled with everyday politics: pretty much everything costs more (in raw dollars) now than 20 years ago. Of course, we're making more money than we did back then, too. And Medicare reimbursement fees are set by the gummint, and are applicable to Medicare patients, who -- by definition! -- are insured. Nice job of muddying the waters, USA Today!

And finally, there's this gem: "Hospitals provide $25 billion a year in uncompensated care every year." Um, no they don't: they pass along those costs to their insured population. I suspect that Stephanie Armour (the author of the silly piece) also believes that the government subsidizes health care, and employers pay taxes, as well.

Gotta love freedom of the press.

Oh sure, Blame the Meds!

Next time you have a prescription filled, don't be surprised if the warning label cautions against venturing outside:

"A Hampton man told a judge Monday that he dropped his pants and exposed his buttocks to motorists on the Sarah Mildred Long Bridge due to the effects of prescribed medication."

Generally, we're admonished not to operate heavy machinery, consume adult beverages, or beware of constipation. I'm guessing that the little pamphlet inside poor Mr Stretton's prescription of "Baritol" [ed: you're bad!] didn't caution him about that particular side-effect.

I'm not sure that the judge's decision to instruct Mr Stretton to seek medical help was such a good idea: wasn't that the problem in the first place?

A Beautiful Grand Rounds...

The Blog That Ate Manhattan hosts a lovely and large 'Rounds, helpfully categorized and with helpful context for each post. It's obvious that the good doctor has read each and every submission, which must have been no mean feat: there are over 40 of them!

If you've read the book (or seen the movie), then you know the moving story that is "Paying it Forward." Dr Val Jones has an equally moving piece about a young lady who returns her providers' attentions by pursuing a career in nursing.

And we're pleased that our own Bob Vineyard's post on Free Health Care made the cut.

OOPS! Good News/Bad News

In all fairness, parts of this story could have happened here in the 'States; so for once, we're not picking on the NHS:

"A man who spent his life savings after being told he had months to live is seeking compensation after doctors in Britain conceded they had got the diagnosis wrong."

So the good news is that he doesn't have cancer, but the bad news is that he thought he did. Having seen what happens to those unfortunate enough to suffer pancreatic cancer (not to mention those loved ones left behind), this is no laughing matter. But it's also a warning that, when faced with a "fatal diagnosis" (okay, no diagnosis ever killed anyone, but it's a great turn of phrase, no?), a second opinion would seem to be in order, wouldn't it?

The story doesn't elucidate on this point, but it seems to me that, had a second opinion been sought, a whole lotta trouble could have been avoided:

"John Brandrick, 62...decided to spend his remaining time in style, quitting his job and spending his savings on hotels, restaurants and holidays."

Now he's seeking restitution from the medical providers who "done him wrong." Given that this is a government-run operation, however, one has to wonder about his odds:

"I do not want to pay solicitors, I do not want the hospital to pay solicitors because there are people that need that money. But if they have made the wrong decision they should pay me something back."

For its part, the hospital (The Royal Cornwall Hospital's NHS Trust) declaims any negligence. Since I'm neither a Barrister nor a Solicitor, I have no idea whether or not that will prove to be an insurmountable defense. Guess we'll have to wait and see.

Carnival Monday

An outstanding Carnival of Personal Finance is available at The Tao of Making Money. Golbguru (who informs us that golb is "just the word ‘blog’ read from the wrong end") presents 55 interesting posts, in a dozen (clickable) categories.

As a big fan of snopes, I really appreciated Poorer Than You's fisking of the "No Gas Day" pseudo-boycott. Not only does hostess Stephanie debunk the concept, she also suggests potentially viable alternatives. Yay!

Insurance Dispatch...

This week, we look at some new legislation affecting how insurance carriers must deal with genetic testing. Here's a taste:

"Underwriters are prohibited from using test results that indicate possible future treatments, but those which are already underway need to be priced in to the final rates."

On a personal note, this will be my last 'Dispatch (at least for a while): it's been a terrific experience, but it's taking too much of my time of late. Still, I highly recommend that IB readers continue to stop by Trusted.MD for interesting and unusual offerings.

HWR: The Derby Edition

In honor of the 133rd Run for the Roses, we present the Thoroughbreds of Wonk. Thanks to the expert grooming of Joe and Julie, the Health Wonk Review is a blog carnival of a different color. Thanks, too, to all the bloggers who submitted almost 20 posts. In keeping with the spirit of the Review, though, I had to turn some in to the glue factory. What's left are the true champions.

And now, I'll stop horsing around, and it's off to the races:

■ Richard Eskow presents A Brief History of Capitation, From Medieval Days to 21st Century Reform. Richard considers the policy implications of provider capitation with a history lesson that moves through ancient China, the Norman Conquest, the 1980's, and other long-forgotten eras.

■ The GrrlScientist tells us about Chromosomal Chaos and Cancer. She asks whether cancer results from random gene mutations or from severely scrambled chromosomes.

■ Sharp Brains blogger Alvaro Fernandez reports on Healthetc, a day-long health event in San Francisco, which featured a presentation by former President Bill Clinton on health care and wellness.

■ Writing at the Health Business Blog, David Williams tells us about generic biologics. So what's a "biologic," generic or otherwise, and how will they impact medical costs? Well, I'll let David explain.

■ EconBlogger Jason Shafrin asks whether or not patents are needed to spur innovation for new pharmaceuticals. Good question!

■ Michael F. Cannon, posting machine at Cato, fisks an Ezra Klein article on the uninsured. In true wonk fashion, Michael uses Ezra’s own supporting graphic in the process.

■ And Dr Rob Lamberts writes about his experience with the National Governor’s Association regarding privacy in sharing medical records. "I'm from the goverment..."

■ HWR newbie Universal Health writes that only about one third (about 1 million) of registered nurses are educated at the baccalaureate level or above. This could lead to increased morbidity and mortality of hospital inpatients.

■ Rob Cunningham, blogging at Health Affairs, offers a useful primer on the Prescription Drug User Fee Act, currently under debate in Congress.

■ Over at Health Care Renewal, Roy Poses writes about the fall of the Allegheny Health, Education, and Research Foundation. It’s a cautionary tale about what happens when health care entities adopt questionable business practices.

■ Meanwhile, Jon Coppelman of Workers Comp Insider gives OSHA low grades in acting to protect food workers from harmful and potentially fatal exposure to popcorn flavorings, the so-called "popcorn lung." While science points to compelling evidence linking the additive to the illness, OSHA's response has been lackadaisical at best.

■ Next week's host, Bob Laszewski, writes about a scandalous situation going on behind the scenes of Medicare reimbursements. "Your tax dollars at work..."

■ Finally, here at good ol' InsureBlog, you'll find my take on a recent Gartner Group study about the future of health care consumerism. Be warned, I chose the title on purpose.

Well, that's all for this edition of the The Most Exciting Two Minutes in Blogs. Bob Laszewski at Health Care Policy and Marketplace Review hosts the next one, coming up on May 17th. Meantime, relax and enjoy a tall, cool one:

Grand Rounds is up...

Roy at Shrink Rap plays host, and you'd be nuts not to stop by. He's got imaginative categories and great comments for each post. And with 50 to choose from, that's a lot of helpful info.

We often blog on transparency in health care, but how how transparency in health care blogging? Maggies at Liverpool Leftovers reports on a website that offers just that. Interesting and provocative.

More Good (CDHC) News...

Based on data amassed throughout 2004 and 2005, United Health Care recently announced that Consumer Driven Plans don't seem to prevent folks from seeking medical care. According to UHC, those who enroll in these types of plans don't forego needed medical care any more than their opposite numbers who went the "traditional" route.

This puts the lie to the oft-repeated (but rarely supported) contention of CDHP critics that these plans encourage chronically ill members to skimp on needed care, let alone healthy folks to skip out on preventive care opportunities.

I also found the raw numbers interesting, as well: UHC looked at data for a quarter of a million CDHP participants, and compared it to industry-wide numbers (based on a staggaring 10 million folks with PPO co-pay type plans). Compared to the co-pay folks:

■ CDHP members were 16% more likely to have a cervical cancer screening

■ 10% more likely to receive a cholesterol screening

■ 16% more likely to receive a prostate screening

■ 8% more likely to have well- child visits

Oh, they were just as likely to go for colon cancer screenings and mammograms.

Of course, this makes sense: if one has been empowered (through premium and tax savings) to make these choices, it stands to reason that folks who "get" the CDHP concept will take advantage of such benefits. I've also noticed that a number of High Deductible Plans (HDHP's) now include 100% coverage for many preventive services (vaccines, well-child care, mammograms, etc). As this segment of the industry matures, look for more plans to adopt this strategy.

And that would be a good thing.