A Capital Carnival

The Carnival of the Capitalists is up, hosted by CotC co-founder Rob (who has sold his blog for an undisclosed price. Sweet!). He presents this week's edition in the now-traditional "Fav's at the Top" format, and includes the other submissions below that list.

With both parents now living in a nursing home, I'm particularly sensitive to those who would prey on the elderly. Matthew Paulson at Finance is Personal shares that concern, noting "you need to make sure that you keep a close eye on your senior parent’s finances and make sure that they don’t get scammed." Kudos, Matthew!

Not to Brag, but...

Bob's recent post on the SCHIP program was featured today on National Review Online's The Corner, linked to by none other than Mark Steyn himself.

Wow, and Mazel Tov, Bob!

(Hat Tip: Joe Kristan)

UPDATE: And now we're linked at The Weekly Standard, as well. But don't worry, we won't forget "the little people" who made it all possible.

Saturday Miscellany

■ I hope that Bob doesn't mind me traipsing in his territory, but this story caught my eye. Several months ago, he wrote about folks heading to the border for dental care "on the cheap." Apparently, someone in the Turkish press was impressed with his style, because they've picked up on the issue:

"With aching teeth and a need to cut expenses, throngs of Americans are marching into neighboring Mexico for dental care, and saving hundreds to thousands of dollars in the bargain."

So, Mexican dentists are able to treat a variety of oral ailments less expensively than their colleagues stateside, and that includes procedures such as root canals and fillings.

Of course, this article on "dental tourism" just had to reference that number of uninsured (debunked here, for one), which seems to have grown to include those who have no dental coverage.

So how come there's no great hue and cry for nationalized dental care?

■ On the tech front, Dr Bill Gates and company are working to bring the tech and health care worlds closer together:

"Microsoft executives have long talked about their plans to push technology further into the health-care field...HealthVault, as the company is branding this effort, allows users to create an account online that will store data such as medical history, health-plan information, prescriptions, images, cholesterol and blood-pressure readings."

The idea is that consumers can store and track their health care histories on-line, making it even easier to fill out health insurance applications.

Um, no:

The idea is to empower [ed: you just love that word, don't you?] consumers to be more proactive in tracking their own care, and can even be used to text oneself reminders about appointments based on that information.

Gotta love the tech.

Cavalcade of Risk #36: Submissions Due

Just a reminder that submissions for next week's CoR are due this Monday (the 8th). Our host, Bob Laszewski, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

Don't forget: we still have hosting slots available. Please drop us a line to reserve yours.

Polling Update

As you may have noticed, the poll at the top of the sidebar is closed. In all, we had a total of 10 votes, which was a bit disappointing, considering that we get hundreds of folks through here every day.

Given such a low "turnout," I'm reluctant to draw any conclusions from the results (even though I agree with them). Perhaps the most interesting thing about this little experiment was something of which I had been unaware: that particular polling tool [ed: say THAT 10 times fast!] includes a map of the locations of those who voted:

In the event, we'll consider whether or not to do weekly polls. Your feedback is welcome (indeed, encouraged) on that.

Health Wonk Review: SCHIP Edition

Health Affairs blog's Jane Hiebert-White presents a fascinating HWR, with a special emphasis on the recently vetoed SCHIP legislation. There's also a good mix of other topics, making this a well-rounded Review.

"Welcome to (Doctor) WalMart!" may be what you hear next time you stop in for your kids' school supplies or that new chair. FoIB Joe Paduda, proprietor of Managed Care Matters, reports that the retail giant is truly driving at least some health care costs down.

Making the Top 10

Over at the (new to us) Nursing Online Education Database, host Jimmy Atkinson has compiled a Top 100 Health and Wellness Blogs, and we're in the Top 10 (at #6, to be exact).

Thank you to Jimmy, and the NOEDb, for taking the time to review our blog, and for recognizing our efforts.

...a failure to communicate (Conclusion)

[In Part 1, we learned that some simple things can get complicated pretty darned fast. Here's how they can get untangled. ]

I finally connected with the lady at the top of that particular heap, who went back to the carrier to see about a resolution. We went back and forth for a number of days (I took pains to keep my client - the law firm - in the loop all the while).

Finally, the carrier agreed to make an exception, based on the understanding that I would obtain the outstanding forms when I delivered the policy. In the meantime, they would overnight a check to the annuitant within 24 hours. Of course, it was now the first week in September, so we were already behind, but it seemed like an appropriate compromise. I agreed to it, and hoped for the best.

Several days later, I was informed that the check had arrived (Yippee!), but that it was post-dated for September 17th (take back the Yippee). This was not in keeping with our agreement, and so I informed the nice lady at XYZ. I further informed her that I would not be forwarding the additonal paperwork, since the carrier had breached our agreement. She asked if she could forward that to the carrier, and I of course said "sure!"

The folks at the carrier were not happy. You see, they now had a major problem: if they were ever audited, and the auditors saw this case, the carrier would have insufficent paperwork to justify having sent any money. This would be a bad thing for them.

On the other hand, I had all the documentation I needed (copies of the emails, the FedEx forms, etc), and so had no such problem. They needed the paperwork, and I needed an explanation for the post-dating, and for the fact that we never received the August payment (or so I understood), and that August payment itself.

Again, a flurry of emails, and then the carrier called me, demanding that I pony up the forms. The not-so-nice lady from the carrier explained in detail why they needed them, and how she would never have made the exception if she'd not had my assurance that I would comply.

I listened politely, and when she was finished replied "I understand everything you've said, but I don't care." I wasn't being snide [ed: yes, you were], but honest: the only leverage I had was that paperwork. Without it, they were up a creek, and they had no leverage with which to pry it from me*.

There was a pause (no wonder), and she then repeated her little shpiel. I listened attentively, and replied again "I understand, but I don't care. You agreed to make timely payment, and a check post-dated for 10 days isn't timely. You breached the agreement, and the only leverage I have is this paperwork. You need it, and I have it, and my client has her check. Where shall we go from here?"

She was so flustered by this that she said "you know what? Have a nice day" and hung up on me. I, of course, burst out laughing: she had called me, and then hung up on me. Droll, and yet humorous.

I called my client to apprise them of the latest developments (such as they were), and then called the nice lady at XYZ to discuss the latest round. She had just gotten off the phone with the carrier, and was motivated to get this resolved (after all, this was 100% her company's fault: neither I nor the carrier had really done anything wrong).

So, we set up a conference call between her, the carrier (represented by the lady with the less-than-stellar phone manners and her assistant) and my own charming self. We went back and forth, until finally we had a breakthrough: turns out, aside from the paperwork issue, the real sticking point was that they couldn't honor a 31st-of-the-month payment date: it had to be no later than the 30th. Well, this was the first I (or XYZ) had heard of this, and it helped to clarify the timing problem. The post-dated check, it turns out, was the August payment, and she would be receiving her September payment at the end of this month (and so on). We had understood, incorrectly, that the post-dated check was for September, and were holding out for the August payment. Had they bothered to explain this in the first place, we would have avoided some blood pressure issues.

In the event, all's well that ends; I sent the requisite paperwork up last week, and everyone's satisfied (if not happy). Just goes to show that a little communication can help one avoid a lot of complication.

*[It may have occured to IB readers that the carrier did, in fact, have one piece of leverage. Fortunately, they apparently weren't sharp enough to see or use it. I'll leave what it was as an excercise for the reader]

Ethics and Fraud

I fired a client today.

Well, to be more precise, I refused to help a potential client commit insurance fraud. The lady in question has had auto and home insurance with us, and inquired about health insurance. She was referred to me (d'uh), and I proceeded to ask her the usual litany of questions (height and weight, smoker or non, medications, etc). She claimed to be in good health, and I started to fire up the quoting engines.

My first set of numbers met with some surprise, until I realized that she was really looking for a short term medical plan. These plans are convenient, because they require minimal underwriting and are designed to be issued quickly. They are also of limited benefit, since they don't cover any pre-existing conditions.

Pre-ex; aye, thar's the rub!

Turns out, she had a specific gastro-intestinal condition in the recent past, and was also due for a specific medical procedure in the near future. She has not had health insurance for quite some time (well past the "magic 63 days," which would not have helped her, anyway), but she wanted the coverage so that XYZ Mutual would pay the lion's share of the upcoming procedure.

When I explained to her how pre-ex works, she immediately replied that she was fine, and had no health problems. I was understandably (and uncharacteristically) silent for a moment, and then explained that whether I knew that not to be the case wasn't really at issue here; what was important is that she knew that. As I explained to her, if I sold her the plan, at least one of two things would occur come claim time: the policy would be rescinded, and/or she would face charges of insurance fraud. She was non-plussed.

At that point, it became clear that I could not sell her a policy. Still, she was a client of the agency, to which I also owe a duty. That I would not sell her a policy was not at issue, but how I handled it may have been. I put her on hold for a moment, and went in to briefly discuss what I was about to do with the agency principal. Of course, I knew that he would have no problem with my decision, but I did owe it to him to put him in the loop. Once that was accomplished, I headed back to the phone.

I explained that I could not [ed: don't you mean would not?] sell her a policy, but that I could get her the numbers for HMO's in the area (these plans often have open enrollment periods for folks in exactly this lady's position). She wasn't interested, and we concluded our conversation.

Fortunately, this kind of thing doesn't happen to me very often (I like to believe that it's because most people are basically honest, but then I've also been told that I've led a sheltered life), but I did know exactly how to handle it. It's very simple really: always do the right thing. It's not because I'm particularly devout or arrogant enough to think that this makes me "better" than others; it's just that it makes life a lot easier if I don't have to keep track of lies (even with my Palm Pilot, that would be an arduous task).

Do I feel "good" about this? Not really: I hate to tell folks that I can't help them. In this case, though, she was the one who created that dilemna: I can usually help honest folks find at least some kind of cover.

As they say, all's well that ends.

Zounds, It's Rounds! (Grand Rounds, that is)

Host Dr Rob Lamberts shows his creative side, will a rollicking 'Rounds featuring (among others) The Cat in the Hat, and a myriad of great posts. It's actually fun to read, and there are some fascinating posts.

Does acupuncture really work? A recent news story claimed that it does, and Dr Anonymous reports that so does "fake" acupuncture. Who knew?!

Monday Lagniappe

■ We've been told for some time that women are the nurturers, and that men are less "sensitive." So it's somewhat surprising that, according to a recent survey of small employers (less than 200 employees), more y-chromosome business owners than double-x'ers believe that offering health insurance is important.

The survey, conducted by American Express (available here, and please see update below) found that "67% of men vs. 59% of women feel such coverage is important." The company gleaned the information from over 600 owners of small businesses.

USA Today also notes that, according to The Kaiser Foundation, fewer small companies are offering group medical plans to their employees. The KFF report itself also notes that more covered employees are being asked to shoulder a greater share of the cost of these plans, either by increased premium contributions or higher deductibles (or both).

No real surprise there.

■ More disheartening news for those who think that a national health care system will control costs: at a time when commercial rate increases are declining, Medicare costs are on the upswing.

On the one hand, monthly Medicare premiums are expected to increase by 3.1% next year (to $96.40), which represents the lowest such increase in a half dozen years.

On the other, rates for Medicare drug plans are on course for a whopping 8.7% increase, to an average $40 per month. Ouch!

According to Dan Mendelson, president of Avalere Health (a private outfit that studies, among other things, Medicare efficiencies), "Plans that are popular are raising prices because they understand that seniors are not interested in switching (carriers)."

D'uh.

■ In the "Not Sure What to Make of This" Dept: So far this year, folks covered under individual HDHP/HSA plans are one and a half times more likely to pull money from their accounts as those covered under a group plan. And, those covered under a group plan made over three times the number of contributions to their HSA's as did those with individual plans.

Be interesting to know the "root cause" of this dichotomy.

UPDATE: A very special Thank You to Rosa Alfonso at American Express for providing us with the report on small business owners.

Carnival of Personal Finance is up

This week's Carnival is literally bursting at the seams with interesting and helpful posts. They're categorized, and most have helpful commentary. Our host at My Retirement Blog picked out his fav's, listing them at the top, and then included the rest, which were, to put it mildly, numerous.

One of my absolute favorite bloggers is Jason Shafrin, aka the Healthcare Economist. In this week's Carnival post, he reviews a fascinating book called A Random Walk Down Wall Street. According to Jason, this 30-something book still has relevance today.

(S)CHIP's Ahoy!

We haven't spent much time on the latest version of the State Children's Health Insurance Program (SCHIP) here at IB. No, there's no "agenda" in our having skipped it; generally, we write about those things which interest us. Quite frankly, there've been more than enough blogworthy items of late, and so SCHIP has managed to stay under our radar.

Until now:

For those who may have missed it, the SCHIP was set up in 1997, during the Clinton administration. The then-First Lady (and current Junior Senator from the Empire State) had failed in her bid to nationalize some 15% of our economy, and this program probably seemed a way to address at least some of her concerns (although I'd add that this was not necessarily what she had in mind, nor was she in a position to dictate its terms).

Very briefly, the purpose of the program was to "insure" kids in low (read: Medicaid-eligible) families in order that they might receive more affordable health care. As with many (most?) such programs, its original intentions became blurred, until now a lot of folks one would consider "middle class" are now eligible (or at least their kids are).

This presents a problem: expanding the program garners votes, but it also requires spending more money. And since, as we've pointed out many times here, the gummint has no money of its own, the taxpayer is left to pick up the (ever increasing) tab.

The program is due to expire soon, and so the Legislative and Executive branches are looking for ways to breathe new life into it. The President would like to increase its funding by some $5 billion (yes, that's billion, with a "b"), while the Congress is thinking a bit more "generously," to the tune of some $35 billion (yes, yes, billion with a "b"). Yikes!

As the esteemed Heritage Foundation has learned, however, there's a catch (well, actually, there are a lot of "catches," but we'll focus on this one): Instead of limiting the program to the truly needy, Congress wants to expand eligibility to folks who can well afford to purchase their own health insurance, and therein lies the conundrum:

"While expanding SCHIP eligibility would, to some extent, reduce the ranks of uninsured children, these gains would be significantly offset—or even outpaced—by losses in private insurance. As the safety net is cast further up the income ladder, instead of complementing private coverage and reducing the ranks of the uninsured, SCHIP would increasingly become a substitute for it."

Ooops!

Talk about "unintended consequences." If indeed they are "unintended."

The bottom line is, why would someone making, say, $50,000 or even $75,000 choose to pay hundreds of dollars a month for insurance, if similar coverage was available "free?" The net result is that even more folks end up on the gummint plan (and the taxpayers' dime), which then drives costs up even further...can you say "vicious circle?"

Indeed, the Congressional Budget Office estimates that "one quarter to one half of newly enrolled children would have otherwise had private coverage." That's a lot of folks to cover, and it's not free.

Well, at least not for thee and me.

A Positive Tax Development

If you haven't already, do check out FoIB Joe Kristan's recently updated and beautified Tax Updates blog.

As always, there's great (and interesting) content, now with new features (including Ol' Joe's picture).

For cutting edge info on the tax scene, check out the (new and improved) Tax Updates blog.

A Difficult Situation

I received a phone call last week from a young man with a difficult problem. I’m wondering if one of the IB readers can think of a solution.

He was working for a 50+ person company that had a self-funded plan through a large carrier. The company was having financial problems and had notified the employees that the plan would terminate as of July 31, 2007. Because of this, he enrolled on his wife’s medical plan effective August 1. On July 14, the employee was involved in a serious bicycle accident, spent five days in the hospital and incurred in medical expenses in excess of $100K.

In early August, a bank seized the assets of the company…they were obviously in default on some agreement…and sold them to a third party. This has left no money to pay the medical bills.

Who’s going to pay the hospital and the doctors? There's nothing left of the company to pay anything. The health insurance carrier? They issued the Certificate off Credible Coverage showing a July 31 date termination date. It's not unreasonable to assume that a document showing a July 31 coverage end date actually means that the coverage is in effect through July 31. The company's General Liability policy? Assuming, that is, that it had employee benefit coverage. If not, would their P/C broker's E&O policy come into play? How about the Directors and Officers insurance policy? A strong argument could be made that a self-funded plan is unsuitable for a financially troubled company. The corporate officers must have known the company’s financial position...especially if the company was in (or close to) a default position on a loan. And lastly, what about the health insurance broker’s E&O policy? If the broker was aware of the company financial position and failed to recommend a change to a fully insured plan, does he (or she) share responsibility?

Beats me…I referred him to a good plaintiff attorney who works in this area. All I know for sure is that a client’s friend is lying sleepless at night, worried he’s going to lose his house.

Medical Tourism (with a twist)

Medical tourism (that is, traveling outside the country for medical care) has been a recurring theme here at IB. The rationale for this phenomenon has been almost exclusively for price; quality of care has been, if considered at all, an afterthought.

But what if that quality of care was the primary reason to travel outside one's native land for needed health care?

"[Canadian] Liberal MP Belinda Stronach, who is battling breast cancer, travelled to California last June for an operation that was recommended as part of her treatment."

And just why did the Hon Ms Stronach make the trip? For treatment of a "later-stage" operation in the U.S. after a Toronto doctor referred her.

But hold on there, pardner. I thought that the "free" Canadian health care system was far superior to our own "broken" one. Why would a leading Canadian pol make the trip stateside if that were true?

Well, one might suppose that since it was her very life on the line, she knew that she could trust good old American know-how over her fellow countrymen's less effective level of care.

Granted, Ms Stronach has some political "issues" of her own (as chronicled by the indefatigable Cap'n Ed), but she apparently knows a good thing when she sees it:

"MacEachern said the decision was made because the U.S. hospital was the best place to have it done due to the type of surgery required."

"The best place."

Hmmm...

Mixed Messages

Quick: What's the American Cancer Society's number one issue?

Most (if not all) of us probably answered "well, cancer, of course." And we would be wrong:

"The American Cancer Society on Monday began a $15 million advertising campaign that seeks to make expansion of health insurance a top priority for presidential candidates ... The ads, which feature two cancer patients, will air about nine times weekly and will target politically active viewers."

So the ACS has decided to give up on its ads about the dangers of smoking and other risky behaviors in which we're prone to indulge, nor will it tout the importance of potentially life-saving cancer screenings. In their place, we'll see a year-long series of advocacy pieces about the wonders of "universal health care." Ironically, they won't mention that such systems themselves do a pretty poor job of fighting the disease.

Instead of focusing on (and funding) research to actually cure a deadly disease, the ACS is choosing to play politics, with money it ostensibly raised for that aforementioned research. I can hardly wait for next year, when they decide that global warming causes cancer, and start running ads about that.

The reality is that this is purely politics, with no scientific basis, and a deliberate sidetracking of funds for that purpose. How many patients will now die because the ACS has lied about the uses for which its fundraising was driven?

My suggestion: find another outlet for your charitable contributions and fundraising efforts (such as this one).

Starting now.

UPDATE: If you're in southwestern Ohio, this is a worthy cause, too:

Something New

As we're dragged, kicking and screaming, into the 21st century, we're trying some new "blog tech" (well, new to us old fogeys). So, Bob did our first YouTube embed, and he and I are taking a swing at online polling. If it goes over well, we may add it as a weekly feature (with new questions each week, of course).

Our first one may be found near the top of the righthand sidebar. We're still looking for a tool to allow us to embed it in a given post.Have fun!

Cavalcade of Risk #35 is up!

A little late, but well worth the wait, Justin at the Investments & Loans blog has an outstanding Cav. Fighting an ever increasing load of spam submissions (and calling folks on it, as he should), Justin has an eclectic collection of risk-related posts.

Do check it out.

And don't forget, you can host one, too. Just drop us a line.

Tech Bleg (Polling Widget)

Okay, we'd like to post an online poll, but do not want to "upgrade" our Blogger setup. I've tried a bunch of different "free poll" tools, all of which give me html code, and none of which work. I get all kinds of "can't open tag" kinds of error messages, etc. It would be nice if we could "embed" a poll in a post, as opposed to on the sidebar.

Any suggestions?

(Already tried vizu, freepoll, adpoll, and several others)

Is More Better?

A while back, we looked at whether the HPV vaccine was a good idea or a Big Pharma profit center. This morning's McPaper brings us a full page ad from Generation Rescue, an autism advocacy group (no, they don't advocate for autism, but on behalf of folks afflicted with it). It's their contention that the increasing number of vaccinations "recommended" by the CDC may be responsible for an increase in the number of children diagnosed with autoism.

Obviously, correlation does not mean causation, but it doesn't preclude it, either.

So the group commissioned an in-depth study of chillun on the west coast (some 17,000 of them), to see if there was any overlap between those who'd been vaccinated and those with autism. The results are here.

It's kind of interesting, and scary. Turns out, of those surveyed, vaccinated boys were 2.5 times more likely to have neurological disorders (such as autism) than those who had not "had all their shots." Interestingly, GenRes isn't calling for a boycott or moratorium, but rather more study of the issue. As one who supports consumer empowerment and transparency in health care, I certainly applaud and support that.

Which isn't to say that the GenRes study was without flaws. As they themselves ask: "Are parent responses a reliable indicator of a child's diagnostic status?" Well maybe, and maybe not. But that just underscores the need to ask more questions. As I opined in that HPV vaccination post, "the risks here are great, and the downside is particularly troublesome."

Medical Care Disconnect

According to the L A Times "(n)early two dozen private hospitals in Los Angeles and Orange counties, accounting for up to 15% of beds in the region, are in dire financial straits and in danger of bankruptcy or closure, according to hospital administrators, industry experts and state data."

This is not the first time we've talked about the dire financial straits in which hospitals have found themselves, sometimes justifiably.

But it underscores a critical problem: how to balance the public good (adequate access to necessary health care services) with the funding necessary to pay for it. One way, of course, is to increase reimbursement rates. This may be difficult, however, given Medicare's notorious (and ever increasing) tight-fistedness [ed: you just made up that word!]. Insurers follow suit, of course, when they can, but lack the purchasing power of the gummint-run health care program.

Of course, California's solution is to require everyone to buy insurance (rotsa ruck with that), and subsidize folks who "can't afford it." And where would that subsidy come from (remember, the gummint has no money, it simply confiscates what it needs from the taxpayer)? Let's see, now: How about we add an additional 4% tax on the already overburdened hospital system? Yeah, that sounds about right.

Not.

...a failure to communicate

There are few (if any) things insurance agents sell that are simpler than fixed annuities, particularly immediate ones. These are instruments that are used to provide an inexhaustible (or nearly so) stream of income to folks who need one.

One of my clients is a law firm which represents a local company which had a defined benefit retirement program for some long-time employees. Such programs are designed to provide a fixed, usually small, retirement income. The company has a number of folks who have reached retirement age (or are approaching it), and wanted to offload the administrative details. A Single Premium Immediate Annuity is an ideal vehicle for this, because it provides a guaranteed income for the retiree, and zero effort (past writing the check) by the company. The law firm wins, because they provide the resource (that would be moi) to handle the transaction, and I win because there's a nice (although not outrageous) commission check for my efforts.

I've done a few of these for the firm, and in July, they asked me to do another one. I use a "wholesaler" that provides me with quotes based on criteria I provide (the monthly benefit amount, age and sex of the annuitant, A M Best rating of the carrier, etc) as well as the paperwork I'll need to write the case. I trust them to get me accurate information and proper forms.

Until now, I've had no complaints.

The wholesaler (whom we'll refer to here as XYZ) gave me the three quotes I requested, and we settled on a carrier. I received the quotes and forms via email (which is very convenient), we completed the paperwork, and I overnighted the completed case to XYZ on August 7. We had requested a payment date of August 31, which I presumed wouldn't be a problem (annuities such as this aren't underwritten like a life or health insurance policy; it's more enrollment than application). Case closed, or so I thought.

Mid-September, I get a call from the law firm, asking where the check was. Turns out, the retiree ("annuitant") hadn't received it. That didn't sound right to me, so I sent off an email to XYZ (the wholesaler) inquiring about it. The answer I received did not bode well: apparently, there were several forms missing, which would have to be completed before any check was cut. The carrier was firm: unless and until they had all the forms, they would put a hold on all funds.

Major oops.

As one can imagine, this didn't sit well with me; after all, I had counted on XYZ to provide me with all the proper documentation, and had in good faith secured the information, signatures and check. It seemed to me that XYZ had an obligation to supply me with all the necessary paperwork, and they had two opportunities to make sure all was in order: once when they emailed the forms to me, and again when they received the FedEx package I had sent back. I had no way of knowing what was missing, because I don't work directly with the carrier. I explained this to a number of folks as I made my way up the corporate ladder, becoming more and more frustrated as I did so.

In Part 2, we discuss how problems like this get resolved.

Cavalcade #35: Submissions Due

Just a reminder that submissions for next week's CoR are due this Monday (the 24th). Our host, Justin Broadbent-Shaw of the Investments and Loans blog, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

NEWS FLASH: The October 10 edition is still available; PLEASE let us know if you'd like to host it.

UPDATE: Hooray for Bob Laszewski, who's taken the 10/10 Cav. Thank you!

Health Wonk Review is up

FoIB Joe Paduda (founder and chief bottle washer of the HWR) hosts this week's "Back to School" edition, with over two dozen of the most interesting and insightful posts on health care policy and polity.

Transparency in health care is a frequent topic here at IB; The Health Care Blog's Brian Klepper is also a proponent, but with an interesting twist: in a "sauce-for-the-gander" post, Brian thinks we should be demanding the same from health plans, not just providers.

Oy Canada (Again)!

From time to time, we like to take a look at our Neighbors to the North(tm), to get a sense of how well their health care system, so often touted here in the 'States as "health care nirvana," is faring.

Alas, not so good.

When even the president of the American Medical Association (AMA) finds major fault lines, it's time to reevaluate how much stock we should put in that kind of system. Less than a month ago, his Canadian counterpart opined that their "system was built to meet the needs of the underprivileged. It is now failing both them and everyone else, because it has not adapted to the times."

Ooops.

What could have gone so drastically wrong?

Well, for starters, Michael Moore's fantasy about the bullet-proof Canadian health care system turns out to have missed the target, by a wide margin:

"Annual survey data for the past four years indicate that these perceived access problems have worsened or remained about the same, with no significant improvement for any single service. Moreover, about half of the respondents believe that health care services will get somewhat worse (34%) or much worse (15%) during the next two to three years."

That doesn't portend well for a system which stateside advocates fervently wish for us to emulate. In fact, the leadership of the Canadian Medical Association is now on record as recommending "that Canadians be entitled to obtain government-funded treatment outside their home jurisdiction or within the private sector," if those who run the system don't find a way to effectively rectify its many failings, including rationing and excessive waiting times for services.

And for those who think that the future of nationalized health care is all sunshine and flowers, consider this:

"Among the 800 physicians participating online, 39% said that Canada's health care system should allow for an increased role for private financing and delivery of health care services. A rather low 63% said they would recommend medicine as a rewarding career to aspiring young people."

That defines a vicious cycle; is that really the kind of system we want here?

Shopping Grand Rounds

Six Until Me's Kerri hosts a clever, entertaining and informative Grand Rounds. Laid out as a story unfolding as she meanders the supermarket, Kerri manages to tie informative but disparate posts together around common themes. Unique and highly readable.

Regular readers know that we're big on consumer empowerment, which means increased consumer knowledge. Walter at Highlight Health cautions us, though, to step back and assess just what it is that we think we know, because it might be wrong.

Universal Unhealthy Care

The pols are out in force of late: The Junior Senator from New York proposes HillaryCare II, a $110 billion (to start) program to bring about a gummint-run [ed: don't you mean gummint-mandated?] health system. Meanwhile, the non-Senator from North Carolina is waving a big stick, threatening to cut off Congress (and, to be fair, the executive branch, as well) from their cushy health plans if they don't pass "universal care" by mid-ought nine.

If nothing else, these are ambitious folks, so perhaps they're to be forgiven for overlooking the salient fact that these types of plans don't work.

I know, I know, they work great in England, and France, and Canada (or not, as the case may be). But they've proven themselves to be something less than stellar here. No one likes to mention it, but we already have a gummint-run health care system (several, in fact), and the problems become increasingly absurd, and yet painful:

"An obscure provision slipped into a $120 billion Iraq spending bill in May threatens to leave some poor and disabled Medicaid recipients without prescription drugs in October."

Ooops.

Never mind why Medicaid prescription benefits became part of an Iraq war bill (then again, it is a War on Terror, and few things are more terrifying than "I'm from the government, and I'm here to help you").

"In a case of unintended consequences..."

By far the best clause in the whole article, and one which should give any thinking person pause before even contemplating the idea of giving the feds even more control over our health care.

Carnival Time!

The Carnival of Personal Finance is up at Money, Matter, and More Musings blog. Our host has whittled the 100 submissions down to a more manageable (heh!) 88 posts, neatly categorized in helpful little "chunks."

One of our major themes here at IB is personal responsibility. We obviously apply this to insurance and health care decisions but, as the folks at One Million and Beyond point out, it's also critical in how we manage our debts, as well.

Loose Cannon Update

Recently, we noted that FoIB and Cato Institute biggie Michael Cannon had an op-ed in USA Today. Well, building on his new-found celebrity (notoriety?), Michael will be a featured guest on this evening's edition of ABC's 20/20. In fact, the whole show is on the health care delivery and finance debate, facilitated by John Stossel.

As they say: Check your local listings.

US life expectancy rises to an all time high...

There's an interesting article published today on Reuters that says that the US life expectancy continues to rise, following a decades long trend. That's absolutely amazing considering the shoddy level of health care that we enjoy. Oh. Wait. Maybe it's not so shoddy after all...

Just Can't Win

The headline reads "Health Insurance Premiums Vault Past Inflation."

The only reasonable response is "And so?"

In the very same edition of USAToday, we find that housing costs (which include ever-increasing property taxes) easily eclipse even health insurance, while the price of gasoline continues to climb to Olympian levels, as well.

What do these things all have in common (other than the obvious)?

Things cost more to buy.

It's called economics, and it's not that complicated: prices for goods and services rise to meet demand, and some things are more in demand than others.

And so, to borrow a line of thought from Mike, how come we don't see a push for nationalizing mortgage brokers? Or gas stations?

It's kind of frustrating that, according to USAToday, health insurance premiums rose a measly 6.1% last year, but that's not good enough: that increase was higher than the rate of inflation. But that really tells us very little: as noted above, the cost of a lot of things we need and use increased at a higher rate. What's critical, and missing from the article, is the rate of medical inflation. After all, the increasing cost of providing care drives the cost of financing it.

The other salient fact which jumps out in that story is this 'throw away:' a business owner, by simply adding a modest deductible, saw his rates climb a paltry 5%, two years running. That in itself is remarkable, but he also added an HRA (Health Reimbursement Arrangement) to mitigate his employees' increased exposure. The best part? "So far, not very many of his workers have needed to take him up on the offer."

Now what does that tell us?

Well, for one thing, the owner has a wise and competent agent, who helped him to see how a simple rearrangement of benefits could help his own, and his employees', bottom line. But the other, perhaps more important message is that a lot of folks pay for insurance that they don't even use.

Unfortunately, according to the Kaiser Foundation study on which the article's based, the number of insured employees who've enrolled in higher deductible plans hasn't grown much, which is a shame.

Just think how much lower rates would be if they did.

Cavalcade of Risk #34 is up!

Host David Williams, of the Health Business Blog, hosts this week's round up of risky posts from around the blogosphere.

David did an outstanding job, and you can, too: just drop us a line to reserve your Cav.

L'Shannah Tova, 5768!

Our Jewish readers, as well as half the IB team, celebrate our New Year (Rosh HaShannah - the head of the year) beginning this evening. For some, this is a one-day holiday; others celebrate for two. Regardless, it's less a time of champagne and fireworks as for introspection and rededication.

You may be wondering about that photo. Every week, my better half bakes two special loaves of bread, called challah; one for our family, and one for another, older couple who are among our dearest friends. It is traditional to bake a special challah for Rosh HaShannah; it's the same basic recipe, but the bread is braided into round loaves, and topped with a sprinkling of sugar (for a sweet new year).

Those two pictured above came out of our oven just a few minutes ago (and boy, do I wish we had pod-smelling technology!). What a delightful, special, and meaningful way to usher in the New Year.

This season is also a time to thank those who have been helpful, indeed inspirational to us through the past year. And so I especially thank our readers, and my esteemed co-bloggers: Bob Vineyard, Bill Halper and Mike Feehan.

May your New Year be filled with joy, health, prosperity and peace.

Grand Rounds

This week's edition of Grand Rounds is hosted at The Efficient MD. There's a theme with this one: innovations in health care (and new tech). Clocking in at two dozen posts (including several blogs with two each, which I had thought was counter to GR guidelines, but what do I know?), this is one of the smaller 'Rounds I've seen in a while, which is actually quite nice (I'm sort of a quality over quantity kind of guy).

As a gadget-lover, I was intrigued by Gene Ostrovsky's report on a new type of wheelchair, one operated by essentially "thinking" at it. Skeptical? So was I, but the video that accompanies the post is compelling.

9/11: 2007

A year ago, we paid tribute to Jerome Robert Lohez, who perished in the flames and destruction of the World Trade Center.

In his memory, and those of his fellow Americans who died on that horrible day, I'm honored (if saddened) to reprise that post:

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.

Carnival Monday!

Kevin, blogging at kmull, hosts this week's Carnival of Personal Finance. There are a lot of entries, some of which include context. He does have things well organized, with posts divvied into helpful categories.

When it was on, I absolutely loved Win Ben Stein's Money. Over at My Retirement Blog, the anonymous blogger reports that Ben's an advocate of variable annuities (tax advantaged savings vehicles with investment components). Who knew?!

And the Carnival of the Capitalists is now up at Entrepreneurs blog. It's chock full of posts. On the one hand, I like that blogger Scott Allen has a "Top 3;" on the other hand, it's obvious that he simply copied/pasted the template from Blog Carnival, with little effort at originality. Very few of the other posts reflect an actual reading of what was submitted.

One obvious and refreshing exception to that was this post by the Silicon Valley Blogger. He has a decalogue of insightful stories on various wealth-building models.

Now THAT'S a Really Bad Idea...

Seems a local couple hasn't really tried shopping for health insurance with a professional, independent agent who specializes in that field:

"The Riverside resident and his wife soon found plans that were affordable but discovered they were wrapped in restrictions, tied to minimum health care services and anchored to premiums that would skyrocket once the couple's health care costs reached a certain threshold."

That doesn't even make sense:

"affordable but...tied to restrictions."

Such as?

Well, the article doesn't say, but one can guess: a limited benefit (mini-med) plan comes to mind, as does any product from Mega Life (et al). Regardless, affordable coverage doesn't have to mean "restricted" coverage - if properly designed.

"tied to minimum health care services"

Again, I have no idea what that is supposed to mean. One might infer that it offers minimal cover for routine items, but so what?

"anchored to premiums that would skyrocket..."

First, individual plan premiums aren't tied directly to individual claims; they're "pooled" with the experience of other plan owners, which helps to levelize premium increases. Since we already know that rates are leveling off, this scenario seems unlikely.

So what do the Whorton's plan to do about this seeming impasse?

Glad you asked:

"Dan and Carly Whorton decided a savings account for their health care costs was the safer bet."

Now that's just brilliant! Why didn't I think of that? Oh, yeah, right: because it's a mindnumbingly dumb idea.

Why's that, you ask?

Simple: insurance companies pay their actuaries handsome salaries to determine the likelihood and severity of future claims. It seems a stretch that Mr Whorton, "a welder by trade," has the expertise to make accurate calculations about his family's medical expenses (not picking on welders: insurance agents, lawyers and burger flippers are equally ill-equipped). What happens, for example, if Mr W has a heart attack? Or Mrs W becomes pregnant? Or little baby W develops respiratory problems? How long will that bank account last?

Had Mr and Mrs W availed themselves of a competent advisor, they would have learned about Health Savings Accounts (for example), which would allow the W's to put money aside for future claims (on a tax advantaged basis, to boot) while enjoying the security of a health insurance plan for catastrophic claims such as noted above.

Hard to believe, but it gets dumber. In addressing the estimated 70,000 local folks (a number which the authors of the article never question, even though it's preposterously large) who are uninsured (at the moment), one local official opined:

"We hope to be able to make sure that everyone in Montgomery County has some type of health care"

Yoohoo, Mrs Lieberman, every single resident already has access to health care. They may or may not be insured, but care is most definitely available.

Of course, our local pols aren't the only ones with tunnel vision:

"I think it unconscionable that the wealthiest country in the world can't provide universal coverage for its citizens."

Thus spake Tom Breitenbach, CEO of Premier Health partners, which has had its own issues with providing health care. Of course, Mr B will be the first to complain about recent cuts in Medicare, touted as a potential "jumping off point" for a nationalized health care financing and delivery system.

And we all know how well that's working out.

Cavalcade #34: Submissions Due

Just a reminder that submissions for next week's Cavalcade of Risk are due this Monday (the 10th). Our host, David Williams of the Health Business Blog, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

The October 10 edition just became available; PLEASE let us know if you'd like to host it.

Health Wonk Review is up!

This week's HWR is now available at Brian Klepper's The Doctor Weighs In blog. Brian apparently received a slew of submissions for this one, and presents over a dozen. They all have great commentary, as well. Well done, Brian!

Regular IB readers know that we are major proponents of transparency in health care. And as we've pointed out, it's not just about cost, but outcomes and satisfaction, as well. Richard Eskow, blogging at The Sentinel Effect, has a disturbing piece on the lengths to which some physicians will go to avoid accountability. Recommended.

"Blaggin'" (Bloggin' and Braggin')

A little over a year ago, our own Bob Vineyard had the story of a "factory worker who claimed his lungs were ruined as a result of mixing flavoring oils used in microwave popcorn," and who subsequently won $20 million in a jury trial.

Skipping ahead a year, we learn that "(a) pulmonary specialist at Denver's National Jewish Medical and Research Center has written to federal agencies to say doctors there believe they have the first case of a consumer who developed lung disease from the fumes of microwaving popcorn several times a day for years."

Coincidence?

I think not.

For those of you who still want to enjoy their nuker-corn, albeit without the potential side effect of dying prematurely, I heartily recommend the AB ("Good eats") method.

A Loose Cannon

[UPDATED: Please see below]

Not really, but I couldn't resist the headline. Michael Cannon, Director of Health Policy Studies for the prestigious Cato Institute (and FoIB), has a terrific and timely guest column in todays USA Today. He writes:

"Simply expanding coverage would have little effect on the quality of care, health disparities, or how long we live, nor would it stop free-riders from shifting costs to others. In fact, expanding coverage through government regulation or tax-and-transfer programs would make our problem worse."

Amen.

But that's not all:

"If we want to increase access to health care, our first priority must be to contain costs. Nothing would help more than 200 million cost-conscious consumers."

Which is another way of saying what we've been touting for quite a while: health insurance costs increase because health care costs increase.

He also reminds us that "there are not 47 million U.S. residents who can't get health insurance. According to the Department of Health and Human Services, that Census estimate "appears to overstate the uninsured substantially compared to other surveys."

As they say, read the whole thing.

UPDATE: Commenter Zagreus Ammon has some issues with some of Mr Cannon's conclusions. On his blog, he goes into further depth; he lists 8 areas of contention. This is one of the great boons of the blogosphere: relentless fact-checking and civil disagreement.

Calling Dr Welby (on a cell)

One of the worst parts of the hospital experience is being cut off from one's support system (family and friends). As a society, we've become so reliant on cellphones (including texting and emoticons) for instant communication. When that's denied us, as is usually the case in an ER or a waiting room, it can make the situation feel even worse. Of course, there may be perfectly understandable reasons for banning cell phones in these circumstances, but that doesn't make one feel any better about the sense of enforced isolation.

Well, that may soon be changing:

"(S)ome health care facilities are creating wireless networks to let patients, family members, physicians and staff members use their phones."

There's been a technological basis for the cell phone ban; the devices could interfere with certain medical equipment, for example. On the other hand, enhanced communication between patients (and patients' families) and provider can actually help speed up the healing process. It's an area of transparency, by the way, which we've never really addressed. Add in laptops and Blackberries, and you've got a recipe for either disaster, or better communication and outcomes:

"An increasing number of patients arrive with laptops and other means of communication and are frustrated if they cannot connect with the outside world, says Andrew Cooper, information technology manager at the Zangmeister Center, an oncology and hematology clinic in Columbus, Ohio. It has installed a $70,000 antenna system for better cellphone use."

The clinic recognized that it could use the technology to enhance the treatment process, by encouraging (and enabling) patients and families in its use:

"By putting the antenna inside the medical facility, the phone signals are reduced, and engineers can measure and better control the electromagnetic energy in-house."

Several other area hospitals are apparently following suit, although this is by no means an indication that the practice either is, or soon will be, ubiquitous. Still, competition is a wonderful thing: if enough facilities take the leap, there will be increased pressure on those who've taking a pass.

It's another example, as well, of the private sector seeing a need (and a potential improvement) and acting to "make it so."

Carny Tuesday

Okay, the title's a little strange, but the long weekend pushed our favorite Carnivals back (forward?) to today; it's an embarrasment of riches.

First up, the Carnival of Personal Finance is now available over at the Advanced Personal Finance Blog. It follows the now prevalent paradigm of "editor's favorites," followed by a listing of the other submissions. This week is really jam-packed with interesting posts. I found this post, on attaining a secure retirement over at FIRE Finance, pretty interesting.

Over at Emeritus, Dr Emer hosts this week's Grand Rounds. It's his fourth time as host of this prestigious (and no doubt challenging) carnival. He, too, followed the "Top 10 & The the Rest" model, which is fine. In the "Turnabout is Fair Play Department," Allison at Lemonade Life blogs on the patient's perspective. A lot of us will relate to her phone conversation.

And the Carnival of the Capitalists is now available at Welcome to Help, a new blog from the folks who started the CotC. There are plenty of helpful posts, each with useful context.

And while we've been debunking the "myth of the uninsured" here at IB, Warren Meyer at the Coyote Blog has been looking at the latest numbers on "poverty" to similar effect.

This blessed plot, this earth, this realm, this England - II

A pregnant woman has been told that her baby will be taken from her at birth because she is deemed capable of "emotional abuse" . . . based in part on a letter from a paediatrician she has never met . . . psychiatrists treating her say there is no evidence to suggest that she will harm her child in any way

O brave new world that hath such people in't.

You Can Run (but it ain't free!)

One of the more hare-brained schemes proposed to address our nation's issues with health care funding has been to expand Medicare coverage to folks under age 65. Although many of us have objected to this idea for a variety of reasons, it's kind of nice to have real, unambiguous proof that it would be a poor choice:

"In his drive to kick-start the French economy by creating a culture of hard work, Nicolas Sarkozy believes those who chose to retire early - under 65 - should not benefit from free health care."

Yes, yes, I know: that's France, not us. But a there's a lot of overlap among the folks who push the "Medicare for all" approach and those who advocate a nationalized system of health care. This latter group likes to point to other countries, ones which already have gummint-run health care, as "models" for us to follow (France being one example).

And what has "mes amis" knickers in a bunch? Well, it seems that folks fleeing "the much vaunted NHS" are placing a real drain on the French system [ed: I thought the Brits and the French despised each other?].

Apparently, "thousands of Britons living across France were sent "brutal" letters last week from the department of social security informing them that they would no longer be welcomed as non-paying customers of France's hugely efficient - and traditionally extremely generous - national health service."

Who knew there were so many ex-Britishers living it up in Gay Paree?

According to The Telegraph, "(t)hey will face potentially crippling private health care bills."

But I thought nationalized health care was free?

A pretty man with his own nice hair and other peoples' ideas

TIPTON, Iowa - Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.

Ah’m tebbly, tebbly sorry, suh – but this idea is already taken.