Doctors are Stupid (Updated)

[Welcome Industry Radar readers!]

[ed: File this under "great" (?) minds think alike - before I had the chance to push the "Go!" button on this post, my colleague Bill Halper had his take on the Spendulus Package. Please be sure to read it. And it appears that Bob will also be sharing his thoughts on it a bit later.]

Yup, that's what I said: as a group, doctors are stupid.

That bears repeating: as a group, physicians are stupid.

And on what do I base this?

Well, let's look at the headlines on the front page of the AMA website:

■ AMA Cheers New Law to Get Kids Health Coverage

■ AMA Wins Legal Victory for Physicians in Privacy Court Case

■ AMA Wins Victory with Record-Breaking Settlement in case against insurer

Not one word on the Spendulus package, which contains even more pieces of a nationalized health care system As Bloomberg News' Betsy McCaughey reports:

"The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system."

And:

"One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective."

So let's review those AMA headlines in this new context, shall we:

■ AMA Wins Legal Victory for Physicians in Privacy Court Case. Nope, you can kiss that privacy goodbye. After all, the gummint's proven so adept at keeping private information private.

■AMA Wins Victory with Record-Breaking Settlement in case against insurer. And that goes the way of the dodo, as well: can't sue the gummint. So when the bureaucrats in Washington say "jump," the doc's only response will be "how high, boss?"

These are folks who willingly gave up major chunks of their lives to study, work, even brreathe medicine. many of whom make (very) nice wages for these efforts. Yet they willingly risk throwing all of that away to make, what, a political point?

Okay, that's certainly their right and prerogative.

But it's also proof of my original thesis.

And there's this: If you're a "seasoned citizen," be aware (and beware) that this bill dramatically reduces your choices (and chances), as well:
"In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye."

[ed: as we reported last summer]

According to Ms McCaughey, "seniors in the U.S. will face similar rationing." Talk about an uncertain future.

Carnival, anyone?

Oh, and for Economies With "Performance Issues," there's this:

[Hat Tip: Joe Kristan]

You Want Stimulus? I'll give you stimulus...and everything but the kitchen sink...

I hate to be negative about the Stimulus Bill and the myriad of provisions which will affect all of us, but please read:

Ruin Your Health With the Obama Stimulus Plan

If the Bill passes with the provisions relating to health care still in it, you need to think about how it will affect you. As the article says:

"The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors." (ed. And how often have you had duplicate tests???)

"But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Read the comments about his book. Daschle will not be a cabinet member, but no doubt a similar thinking individual will be.

Next time your doctor says he can't prescribe what he wants or treat you the way he wants because the government deems the treatment or medicine not cost effective (even if you want to pay for it) you can blame the Stimulus Bill. If you don't have blinders on, you might even blame Sen Reid, Speaker Pelosi, and oh, yes - President Obama.

You might ask what such provisions have to do with stimulating the economy, but don't. Those questions aren't allowed. If the law isn't passed, it will be a catastrophe. Just ask the President.

Gardisil in the Crosshairs (Again)

From the Told Ya So Department:

"There are new concerns about Gardasil, the vaccine that prevents a virus that caused cervical cancer. It's approved for girls as young as nine ... The FDA and its maker insist it's safe. But CBS News investigative correspondent Sharyl Attkisson has exclusive information on some very serious side effects."

Ooops.

Turns out, this questionable med - which costs $120 a pop - is not only unproven, but potentially quite unsafe:

"The National Vaccine Information Center [NVIC], a private vaccine-safety group, compared Gardasil adverse events to another vaccine, one also given to young people, but for meningitis. Gardasil had three times the number of Emergency Room visits ... Reports of side effects were up to 30 times higher with Gardasil."

Major oops.

In fact, the NVIC notes that "there are more reactions and deaths associated with Gardasil than with another vaccine given in the same age group."

And yet, proponents of the vaccine continue to promote its use; in fact, they're also pushing to have it administered to boys who, as I understand it, have a very low incidence of cervixes (cervixi?).

Oh frabjous day!

On The Other Hand: Turns out that the doc who connected the dots between the MMR vaccine and childhood autism may have significantly fudged his numbers:

"The doctor who sparked the scare over the safety of the MMR vaccine for children changed and misreported results in his research, creating the appearance of a possible link with autism, a Sunday Times investigation has found."

One of the hallmarks of good science is replicability; that is, that results can be replicated in subsequent studies. When one deliberately misreports the actual test results, and also refuses to divulge how they were obtained, it renders those results unuseable.

Or at least it should.

Shame on "Dr" Wakefield, and further shame on The Lancet for even accepting the report in the first place.

The Carnival of Personal Finance now up

Follow the yellow brick road to this week's edition of the Carnival of Personal Finance. Host Brooke of Dollar Frugal has a Wizard of Oz theme that works quite nicely.

Wasteful Government Tricks

No, not that wasteful government trick.

You just can not make this up:

"As he tells it, Randall Hinton is paid $93,803 a year to do nothing...His work agenda involves placing his feet up on his desk, staring out his office window and counting cars on the New York State Thruway. He arrives at 7:30 a.m., leaves at 3:30 p.m., sees no one and talks to no one."

And just what is his (ostensible) job?

Why, he's the "director of investigations for the Insurance Fund." To hear Mr H tell it, he's not allowed to actually investigate anything, though, because he had sued the state for discrimination. Although that suit has long-since been settled, this Investigator-without-Portfolio has been idled, forced to spend long, lonely days staring out the window, perhaps contemplating life "on the outside."

By my reckoning, that amounts to over $50 an hour to twiddle his thumbs, all on the taxpayer's dime. Nice work if you can get it.

And just what is the State Insurance Fund actually for? Glad you asked:

"It exists to provide workers' compensation and disability policies as an insurer of last resort to 190,000 employers statewide."

Hmm. I wonder if Julie knows about this.

The crux of the matter seems to be that Mr Hinton believes that he's being discriminated against for having had the gall to sue a GOP-led administration. This falls apart, of course, since Democratic Governor and Man-About-Town Eliot Spitzer elected to continue the charade.

Meantime, New York taxpayers continue to fork over almost $8,000 a month for this gentleman to, well, you know.

Cavalcade of Risk #71: Submissions Due

Julie Ferguson, proprietor of Workers Comp Insider blog, hosts next week's Cavalcade of Risk. Submissions are due by Monday (the 9th). Please be sure to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

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And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

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It's really easy to host, and a nice bump in traffic. Just drop us a line to reserve yours.

Hiding in Plain Site

The nationalized health care folks have found renewed energy and legitimacy in the latest iteration of the Trojan Horse known as SCHIP:

"A new report, Maximizing Kids’ Enrollment in Medicaid and SCHIP: What Works in Reaching, Enrolling and Retaining Eligible Children, suggests strategies states can use to increase enrollment in Medicaid and the State Children’s Health Insurance Program (SCHIP) based on tested ideas for reaching, enrolling and retaining children who are eligible for public health insurance."

Of course, this is merely the logical result of an effort to push more folks out of the private sector and into the gummint trough. There are a myriad of commercial alternatives for children (very few of whom are uninsurable), but that just won't do. Rather, the NatHealth folks see an historic opportunity to expand gummint-sponsored and -run health care schemes, forcing our children into substandard care.

Of course, our friends at the Robert Wood Johnson Foundation are all for it; after all, it serves to legitimize their own view of health care finance and delivery. And of further course, the National Academy of State Health Policy (whose board consists primarily of beareaucrats and educators, with no evidence of input from the private sector, let alone the insurance industry) is all for this, since it represents more money for state governments.

What's so appalling to me is that we've come to a point where the NatHealth folks aren't even trying to hide or disguise their agenda.

Early February Health Wonk Review now online

David Williams, fresh off of hosting last week's Cavalcade of Risk, once again dons the mantle of Carnival Master, presenting a terrific Health Wonk Review. From primary care to Big Pharma, this one's got it all.

Do stop by.

And by the way, InsureBlog hosts the next edition, slated for the 19th.

Treat-worthy Carrier Tricks

Over the years, we've chronicled numerous examples of carriers' less-than-stellar performances. Sometimes, though, they do the right thing, and we try to document those times, as well.

This is one such time.

Recently, we reported on Anthem's apparently lackadaisical approach to changing policy effective dates. In this particular instance, my client learned that she could retroactively cancel her previous coverage back to January 1, and receive a full refund from the prior carrier. But we'd already nagged Anthem to move the effective date forward, to February 1.

Could we get them to rescind this change, and regain the original (January 1) effective date? I set out to try.

The bad news is that it took two days, several hours on the phone, and numerous blind alleys to get to the person empowered to make the change. I eventually got to the right department, but was told in no uncertain terms that the company will allow only one such change per policy. The lady with whom I was speaking made it clear that she was not empowered to make an exception.

So, of course, I asked to speak to the person who was so empowered.

The good news is that I did connect with that person, a supervisor (of course!), who listened politely to my plea and rationale, asked a few questions, and agreed to make the non-change. I'm sure it helped that I had also asked my client whether they'd had any claims since January 1 (which they hadn't), and if they understood that they'd still have to pay Anthem's January premium (which they did).

So, kudos to Anthem for making things right, and for being flexible enough to understand why they should.

Insurance and the Hive(mind)

According to the American Family Association, our esteemed political class has apparently invented a whole new kind of insurance: catastrophic Apis mellifera cover.

For those without a Latin-English dictionary, that would be bee insurance:

"Pg. 102 of Senate Appropriations Committee report: "The Secretary shall use up to $ 50,000,000 per year, and $150,000,000 in the case of 2009, from the Trust Fund to provide emergency relief to eligible producers of livestock, honey bees, and farm-raised fish to aid in the reduction of losses due to disease, adverse weather, or other conditions, such as blizzards and wildfires, as determined by the Secretary")"

That buzzing sound you hear may be a previously uninsured hive stopping by to bind coverage. Or it could just be the innocent taxpayer getting stung again.

Knockin' Wood

The Robert Wood Johnson Foundation, that is. As is typical of such endeavors, when the facts don't support one's preconceived conclusion, just change the subject.

In this case, the Urban Institute doesn't much like free market solutions to health care and/or health insurance issues, so they decided to pick on the one product that is generally perceived to be the most useful in both reining in costs and insuring more people: consumer driven health care plans.

Here's how they characterize consumer-centric health care:

"This RWJF-supported study by the Urban Institute indicates that HSA and HDHPs are likely to be attractive to people with high incomes and those with expected low use of health care services, but they are unlikely to decrease significantly the number of uninsured."

As we've already demonstrated here at IB, none of these conclusions are valid.

Let's take them one at a time:

Fallacy #1: "attractive to people with high incomes." While this may be true (certainly folks with money are likely to want to keep more of it), it implies that folks with lower incomes don't find these plans attractive. As we've previously noted, "75% of its HSA enrollees have an income of $50,000 or less, with 27% reporting a net worth of less than $25,000.” Those folks aren't exactly "high rollers."

Fallacy #2: "those with expected low use of health care services" Again, it's obvious that those who have few health care needs have little use for needlessly expensive health insurance, so of course they'd find HDHP's attractive. But as Bob has repeatedly pointed out, those who have moderate to even heavy use of health care also benefit from plans which eschew costly "extras."

Fallacy #3: "unlikely to decrease significantly the number of uninsured" Of course, this one's the silliest of all, since high deductible plans have lower premiums than their expensive co-pay counterparts, so are more affordable to those who are uninsured, and since the plans have higher deductibles, it seems more likely that those with more health problems (up to a point, of course) will be more likely to make it through underwriting.

As the highly-regarded Heritage Foundation puts it, "(m)ore than 6 million Americans are enrolled in HSA-eligible health plans. And the popularity of these plans is growing, in no small part because patients can determine how much of their money to spend today, or save for tomorrow, for health-care expenses. In short, HSAs allow patients to make prudent decisions for themselves."

Catch that? "HSA's allow patients to make prudent decisions for themselves." That's the whole crux of the matter: the liberal vision assumes that the gummint is best suited to make those decisions for us. The pragmatic, sensible vision is that we are the ones best suited to make them for ourselves.

We Get Results

First there was this: "Mr. Daschle, meet Dartmouth"

Then there was this: "(T)he gentleman in question isn't known for thinking things through"

And now we have this: "Tom Daschle has withdrawn his nomination for health and human services secretary"

Coincidence?

I think not.

Grand Rounds is up

The Samurai Radiologist marks his first blogiversary by hosting this week's Grand Rounds, and does a fine job of it.

Do check it out.

Outrageously Stupid Carrier Tricks: AA Edition

It's difficult, really, to decide which carrier is more incompetent. I'll lay out the facts, and encourage readers to draw their own conclusion.

First up, we have the curious case of Aetna, which doesn't seem to know how to actually underwrite individual medical insurance. I only recently began writing business with them; until a short time ago, their individual policies had a "poison pill" which made them unacceptable. They did away with the offending verbiage, and I was pleased to see what appeared to be well-designed plans with reasonable rates.

Unfortunately, the "2 out of 3 rule" came into play: alas, they have no clue how to underwrite plans. Case in point: a client who completed an online application in early January, requesting a mid-month effective date. This client had some very minor health issues, but that didn't stop Aetna from dragging its feet.

They conduct "phone interviews" with prospective clients; unfortunately, they kept calling mine at his home. During business hours. When I called them to point this out, I was told he could call it in himself. So I passed along the contact number, and he did, in fact, call in. They requested additional information, which he promptly got from his physician. We actually sent this twice, since Aetna couldn't be bothered to keep track of it.

I was told by Aetna that this was all that was needed, so I presumed that all would be fine. What they neglected to inform either myself or my client was that apparently this fax, from the physician, wasn't enough - they needed to talk with him again. Again unfortunately, they neglected to communicate this to either my client or myself, with the result being that they've now closed the case.

This will become a major component of at least one future Continuing Education class.

Anthem doesn't fare much better: on another recent case, they took so long to underwrite and issue that the effective date came and went. Ordinarily, this wouldn't be a major problem, but in this case, the client had paid a semi-annual premium to his current carrier, and we couldn't get a partial refund. So, we asked to move the effective date forward one month.

No big deal, right?

Not so fast: it took well over two weeks, numerous phone calls and emails, and I finally received word that the date had been changed to February 1.

I got that information today: February 2.

We may be able to resolve this with the current carrier, but why should it take so long to make a very simple change? It isn't as if we're asking them to retroactively issue a policy so as to cover a new condition. Actually, they're off the hook by one month, which would be a reason for them to honor the request quickly. There just isn't any acceptable reason to put my client through this aggrevation and stress.

So there you have it.

UPDATE: Poll's closed, here are the results:

Firing a Cannon at SCHIP

FoIB and Cato Institute wonk Michel Cannon has a fascinating and insightful article in the latest edition of the National Review Online. In it, he argues pursuasively that although the program has enjoyed modest success, it has done so at an unjustifiable price.

Here's a taste:

"It’s not even clear that SCHIP’s method for improving children's health—expanding insurance coverage—is the right one. The New England Journal of Medicine reports large gaps between the quality of care children receive and what they should receive, even if the children have insurance. That study’s authors conclude, “Expansion of access to care through insurance coverage, which is the focus of national health care policy related to children, will not, by itself, eliminate the deficits in the quality of care.”

Note well that last caveat about "quality of care." How come *that's* never addressed by those who favor socialized medicine?

As they say, read the whole thing.

Fixing Gender Discrimination in California

Great Scott! In California (of ALL places) there is a state law that would “force women to pay more than men” for individual health insurance. Who knew??

California already has a law forbidding gender-rating of group insurance. Somehow, the legislature forgot about individual policies, and the City Attorney of San Francisco has filed suit to remedy that error.

He will probably succeed. Remember, this is California.

The inconvenient truth remains that insurance premiums reflect the underlying cost of the insured liability. In this case, health insurance premiums for women are greater than for men, because the cost of health care for women is greater than the cost of health care for men.

But never mind that! Because this is another wonderful opportunity for California politicians and other self-serving “public” servants to grab publicity for some self-serving comments about some alleged discrimination against women.

And the consequence of their political showboating? Why, mainly that women will pay less than their cost, while men will be required to pay more than their cost to make up the difference. But will anyone pay attention? I expect not. Not in San Francisco or Sacramento, anyway.

Oh, and one more thing. The fact that insurance prices reflect the underlying cost of the insured liability also explains why life insurance rates for women are significantly LESS than for men.

But life insurance premiums never seem to result in any gender-discrimination lawsuits or grandstanding by these very same politicians and public servants.

Funny, that.

Deeper and Deeper: Too MUCH Transparency?

File this under things I probably didn't want to know [ed: take deep breaths, Henry]:

"Tom Daschle, tapped to be President Obama's health czar, was paid more than $200,000 by the health-care industry in the past two years."

As Bob previously noted, the gentleman in question isn't known for thinking things through, but is that really a good qualification for this job? After all, he's now going to be responsible (at least in part) for much of our nation's health care system. Does the term "conflict of interest" ring any bells?

We've noted before the inherent problem of folks who accept "gifts" from those whose products and services they're responsible for recommending; how bad is it when the gummint's health care czar-to-be accepted, in just two short years, almost a quarter of a million dollars from the folks he's charged with regulating?

Hope and change, indeed.

WHAT Right to Privacy?

Back in the day, a controversial Supreme Court decision turned on the (presumed) Constitutional Right to Privacy. Apparently, someone forgot to inform the new administration of this Right (irony notwithstanding), because buried in the new Stimulus Package is this little gem:

"(E)very American [must] submit to a government program for electronic medical records without a choice to opt out."

Wow.

Privacy experts are a bit miffed at this (no surprise) because, in addition to the "normal" aches and pains, these records will include "documentation on abortions, mental health problems, impotence, being labeled as a non-compliant patient, lawsuits against doctors and sexual problems."

We've discussed the viability and advisability of electronic medical record keeping before, but always from the provider's standpoint, and always with an eye toward respecting and protecting the patient's privacy and integrity. This seems to be a giant leap beyond all that; given the gummint's less than stellar record regarding safe-keeping, I think this is -- at best -- worrisome.

Party on, Gramps!

Alzheimers and dementia are no laughing matter, but in addition to other non-intuitive treatments, this unusual advice may be just the ticket:

"Keeping a full social calendar may help protect you from dementia...Socially active people who were not easily stressed had a 50 percent lower risk of developing dementia compared with [those] who were isolated and prone to distress."

This is from a new report in the medical journal Neurology, which tracked some 500 senior Swedes, none of whom had been previously diagnosed with dementia. The study lasted six years; by the end, about a third had developed dementia. What was (perhaps) surprising was that folks with more active social lives were about 50% less likely to develop those symptoms.

It appears likely, based on this study, that there are some significant environmental and lifestyle factors that play roles in dementia; that's good news, since these are things we can (at least to an extent) control.

Health News Mini-Roundup

■ Looks like Galinda was right: it's good to be popular. But she may have been wrong, as well; some folks may just be born that way:

"Researchers at Harvard and the University of California, San Diego report that popularity seems to have an inherited component."

Here at IB, we've looked at the Alzheimer's gene, the breast cancer gene, even the Down Syndrome gene. But one that could predispose someone to be more popular? Who knew?

Researchers from Harvard and the University of California (San Diego) studied over a thousand teen-aged twins, and found that identical twins seemed to share the same social position than fraternal ones, which the researchers believe suggests a genetic component to social status (aka popularity).

■ Prince Charming may be wearing a wedding ring:

"(A) 34-year-old from the U.K. suffered a heart attack nearly two weeks after giving birth to her son and failed to regain consciousness.

Her husband, Andrew, spent two weeks by her bedside waiting for her to wake up from a coma – but her condition did not improve until he leaned over and asked her for a kiss..."

The comatose woman turned her head toward her husband, pursing her lips and kissing him.

This apparently happened two years ago; she's had a rough time, including some short term memory loss, additional brain surgery, and therapy. But she's coming along well, and seems to be on the road to recovery.

■ MVNHS©: Where's the Beef?

In yet another whimsical, and yet silly, move, Britain's health service has decided to limit its patients' carbon footprint (feetprint? footprints?). First up, taking a page from Domino's, the Service recommends that Brits call it in rather that dropping by:

"Patients should phone their GP rather than drive in for a visit...Ministers want family doctors to hold more 'phone-in' surgeries to help the environment by cutting carbon emissions from cars."

[ed: Don't be alarmed; "surgeries" in this case means doc visits, not procedures]

Actually, that may not be such a bad idea: there's certainly a justification for using the phone or email for simple, non-emergency consultations.

It's not exactly clear how this will help reduce so-called Global Warming:

"They also want hospitals to achieve their green targets by reducing the amount of meat they serve to patients in wards."

After all, it's well-established that bovine emissions increase greenhouse gases; wouldn't it make more sense to encourage eating beef?

This observation certainly rings true:

"(T)he NHS is responsible for a quarter of all the carbon dioxide emissions produced by the public sector."

That's a lot of gas.

Cavalcade of Risk #70 now online

Health Business Blog's David Williams hosts this week's collection of risk-themed posts. Take a chance and stop on by.

And consider hosting your own Cav - just drop us a line.

UHC vs Diabetes: The Interview

Last week, we noted that United HealthCare has introduced a new program to help insured diabetics (and "pre-diabetics") cope with and finance their expensive health care. In a followup, I asked to speak with someone from the program's development team in order to help our readers understand how it came about, and how it's intended to work.

Alex Nelson, their PR contact, graciously arranged for me to interview Tom Beauregard, the CEO of UHC's R&D arm, United Essentials [ed: oddly, and after much searching, I could find no link to that entity]. Mr Beauregard and I spoke for some time, and we're delighted to present the fruits of that discussion:

So, who is Tom Beauregard?

Mr Beauregard runs the Research and Product Development arm of UHC. He's been with them for about 3 years; the previous 20 were spent consulting in this area.

What prompted this new effort?

Demand from employers, primarily. They want to move away from cost-shifting toward more "Value Based Insurance." The goal is to target communications to modify behaviors.

Some employers have begun encouraging voluntary efforts in this regard, and UHC decided to set up its own program to augment these, starting with diabetes and weight management.

How is this program different from previous endeavors?

The goal is to offer incentives based on compliance with ADA (American Diabetes Association) standards. It's both a carrot and stick approach: folks who continue to comply with the stated objectives receive extra benefits, at no cost, while those that "fall off the wagon" are directed back to the basic insurance plan.

[ed: Some might view this as somewhat "Big Brotherish;" I think it's good business sense - up to a point. More on that later]

I can see how this could help those currently suffering from diabetes, but what, exactly, is a "pre-diabetic?"

According to UHC and the ADA, these are folks with elevated levels of HBIC and cholesterol, who haven't - yet - developed full-blown diabetes, but are at increased risk of doing so. The standards, set forth by the ADA, aren't arbitrary; they estimate that up to 26% of adult Americans are "pre-diabetic."

[ed: And here's where I have to draw a line. I take issue with UHC's apparently uncritical acceptance of this whole "pre-diabetes" phenom. The ADA claims that "(p)re-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes."

And just where does that 57 million come from? The ADA doesn't say, and, at something like 20% of the population, it doesn't pass the smell test. I think that this whole idea of alarming the public over obviously inflated numbers does more to harm a cause than to help it. The other "23.6 million" is similarly suspect. If you're wondering why the ADA would be okay with these inflated, perhaps spurious numbers, remember that many organizations rely on public perception for fundraising purposes]

One very simple way to decrease this risk is through weight loss, so the program includes numerous tools to help facilitate this.

Sounds like a plan. But why only self-insured groups? Is there a plan to expand it to fully insured plans?

UHC decided to focus on SI groups first, to get a feel for how many people would both sign up, and subsequently stay with it. It's easy for folks to say "sure, I'd be interested in such a plan," but the real test comes when it's actually offered to them, and they have to make the conscious decision to participate. And once they're on the plan, how many will stick with it? That can only be determined by trying it out in a controlled setting.

If the metrics bear out, then the company will consider expanding the program (in one form or another) to their fully insured groups.

We truly appreciate Mr Beauregard's time and candor, and will keep an eye on the plan's progress. He also indicated that he'd be happy to answer any other questions we might have, so readers are invited to suggest them in the comments.

Not Just for the Ladies: Grand Rounds at Chronic Babe

Jenni Prokopy, the hostess with the mostest, presents this week's roundup of the best medblog posts.

We're tickled pink to be included.

Humana Network Fallout

Fresh on the heels of Humana's recent faux pas, FoIB Rick Byrne alerts us to this important change to the way Ohio DOI handles network changes. Effective (apprently) immediately, health insurers must now report "significant changes to their medical provider networks to the Ohio Department of Insurance." They'll also have to tell the Department just how they intend to communicate these changes to their insureds.

What's more, they have to notify the state at least 15 days before they contact their insureds. One supposes this is to enable the Department to oversee the transition, and (perhaps) protect policyholders from the potential for significant reductions in how their claims are covered.

I'm pretty sure that this is a "good thing."

[Hat Tip: Rick Byrne]

Cavalcade of Risk #70: Submissions Due

Health Business Blog's David Williams hosts next week's Cavalcade of Risk. David asks you to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

Thanks!

It's fun and easy to host - just drop us a line to find out how.

Lights out for CFL?

Insurance, which is the primary theme of this blog, is about identifying and managing risk. But it's not the only risk-related subject; sometimes risk is simply about assessing whether or not it's safe to change a lightbulb.

Hunh?

Anyone who's had to change a light bulb recently [ed: quick - how many insurance agents does it take to change a lightbulb? Answer: no one knows, we don't mind being kept in the dark] has seen those nifty new "twisty-bulbs," aka Compact Fluorescent Lights (CFL). Touted as a substantial energy savers, they're now actively creeping into widespread use.

Of course, our nanny-state gummint-class has mandated that these little marvels must soon replace the familiar "regular" bulb (notwithstanding their potential danger). But are they good for our health?

In addition to toxic mercury, our Neighbors to the North are becoming increasingly concerned that they may also be giving off "potentially harmful ultraviolet radiation." Health Canada (the "department responsible for helping Canadians maintain and improve their health") recently studied CFL's to determine whether they pose a radiation risk. Oddly, I couldn't find any mention of this study on the HC website; perhaps it's too new.

But it's not just Canadian authorities in a dither:

"The United Kingdom's Health Protection Agency said in October that open, or "single envelope," bulbs — which have a corkscrew-like or tube-like design — can emit ultraviolet radiation at levels that can result in exposures to UV radiation similar to exposing bare skin to direct sunlight."

It's so bad, in fact, that the Brits are recommending that folks spend no more than an hour a day in their immediate vicinity (the bulb's vicinity, not the Brit's). There's also concern that these little wonders may negatively impact those with lupus.

Stranger still, our own Consumer Product Safety Commission is completely silent on the subject.

Why is that?

Post-Inaugural Health Wonk Review

Jaan Siderow hosts this week's roundup of interesting and provocative health care policy posts. It's a true rock concert of a 'Review.

Admirable Carrier Tricks: Good News for Diabetics

United HealthCare's Stacy Cohen just alerted us to that carrier's new health care plan "designed to help the rapidly growing numbers of diabetics and pre-diabetics manage their conditions more effectively while controlling employers' escalating costs of insuring them."

Currently, the program is available only to self-insured groups, and is available for both diabetics and what UHC calls "pre-diabetics." One supposes that these are folks who, because of genetics and/or lifestyle choices, are more at-risk of developing the disease.

Folks participating in the Diabetes Health Plan receive on-line monitoring and special disease-related educational tools and training. They also receive some diabetes-related meds, including not just insulin but even anti-depressants.

I've asked Stacy about interviewing someone from the plan's development team, and hope to have that set up and posted in the near future. I'd also like to know if there's any chance of porting this program to fully-insured groups down the road; given UHC's stated concern about the "rapidly growing numbers of diabetics and pre-diabetics," one would think that this is on someone's drawing board.

In the meantime, here's a quick video with some background, and an explanation of how the program works:

Healthcare Stakeholders: A Perspective

We're delighted to welcome guest-blogger Deron Schriver, blogmeister of Healthcare Rx. Deron recently proposed a post about physician/insurer relations, and we're happy to oblige. He's worked in the health care field for for ten years, with the last three spent as a medical group administrator for a large OB/GYN practice. Deron tells me that his "daily interactions with the various healthcare system stakeholders have enlightened me and sparked my interest in system reform, which has lead to my other life as a rookie healthcare blogger."

Deron believes that there is a tremendous amount of room for improvement in that area. Given today's political climate, this seems like a capital idea, and we are pleased to present his take on where we "go from here:"

The high per capita spending of the U.S. healthcare system has been widely published. As a result, we have seen a renewed interest in system reform. Despite the large number of people and organizations developing and proposing reform strategies, no single strategy has emerged as the best solution.

Considering the magnitude of the problem, we would be best served if we could identify synergistic reform opportunities. I would like to suggest one very important opportunity that could produce significant benefits: a focused effort to improve and enhance the relationship between physicians/hospitals and health insurers/managed care organizations (MCOs), with a goal of improving quality and reducing cost.

In a well-functioning healthcare system, providers and payers would partner in the name of improving the health status of their mutual customers: the patients/covered members. However, patient-centeredness has taken a back seat in the current environment. Factors such as market share and leverage have played a big role in fee schedule negotiations and provider network development and maintenance. Instead of identifying common goals and opportunities to work together, the two sides have been guided by short-term financially-motivated thinking.

So where do we start with an initiative like this? My suggestion is that we get the two factions to sit down and discuss 1) the measures they can take to improve the health status of their mutual customers and 2) the steps they can take to reduce waste and complexity in their relationship.

The two must identify key indicators to help guide their efforts. Clinical measures such as average spending per condition, hospital infection rates, and screening rates (mammograms, cholesterol checks, bone density tests, etc.) should be routinely analyzed and acted upon when necessary. Administrative measures such as claim denial rates, phone hold time, and consistency of policies with national standards (ex. CCI) should also be considered.

As someone who sees this relationship play out on a daily basis, I can tell you that there is tremendous room for improvement. Turf protecting is a big problem within the U.S. healthcare system, and all stakeholders, particularly the two mentioned, engage in it routinely. If it’s done right, reform does not have to mean that insurance companies, physicians, or any other stakeholder needs to take a big financial hit. Reductions in revenue will be offset, to at least some extent, by corresponding reductions in cost. When the focus is where it needs to be, waste will be eliminated and everyone will come out stronger. This is a best-case scenario, but I can’t imagine striving for anything but the best.

Many, many Thanks, Deron! It's obvious that there's a lot more to the challenge of health care delivery and financing than meets the eye, and that a good place to start is by opening up these lines of communication between providers and insurers.

Moronic Carrier Tricks: The Aetna Story

I tend to write a fair amount of individual medical. For one thing, a lot of agents in my area have given up on this market; for another, I actually enjoy the one-on-one nature of this type of business (as opposed to group).

There are a number of carriers available, but of course the market is dominated by one or two. As a firm believer in competition, I'm always on the lookout for alternatives. Recently, I've started using Humana and Aetna in an effort to broaden the marketplace. Unfortunately, I've had to (at least temporarily) curtail placing business with Humana, so I had high hopes for Aetna.

Which have been dashed to little, teensy weensy pieces:

First, despite their insistence on how well they do online applications, I can rarely get their link to work. I have clients sitting in front of their monitors, waiting patiently for the page to load, only to see the page time out. And time out. And time out.

So back to paper apps, which are cumbersome and add even more processing time. Not to mention additional, stupid procedures. Recently, two brothers and a sister applied for major medical this way. We tried, in vain, to get the online app to work. When that proved futile, we switched to paper. I had their father (who's initially paying the premium) write one check for all three, hoping to at least save some effort.

This is what I received:

"We will need once [sic] check for each applicant because technically each application is it's [sic] own separate policy, and will have it's [sic] own ID #"

To which I reply:

So. Freakin'. What?!

What possible difference does it make that there's one check for each application, when the only thing that matters is that they got the money?

In another case, we were finally (and after much technical support) able to get the online application to work. The underwriter then decided that he (she? it?) needed additional info, and tried to call my client. Unfortunately, they were calling his home number during business hours; when I called to suggest that they use his business number (which was on the application), they countered that he should call them back at their special, super duper toll free hotline. Here's how that worked out:

"Boy have I been having a hard time with Aetna. They do not answer or return calls. But finally, I got through. They want stuff faxed from [my] doctor--last three ... and last ... reading. The doctor is faxing it to them."

Why would a carrier offer a "streamlined" service which was itself so difficult?

Oh, I know: because they're...well, see the title of this post.

Needless to say, I won't be writing any more Aetna individual plans.

Inauguration Day Grand Rounds

FoIB Val Jones presents an inspiring and thoughtful Grand Rounds, including eye-catching pics and thought-provoking posts.

Do check it out.

Back in the Pool

Last fall, we took a look at the North Carolina high-risk insurance pool. And tomorrow, of course, heralds a new day in Washington, where health care delivery and financing will take on new urgency.

So it seems rather timely that the National Association of State High Risk Insurance Pools (NASCHIP) has released their comprehensive report on state high risk insurance pools, and how these mechanisms may play a vital role in both state and federal reform efforts.

The report itself is available here.

According to Noah Rouen, Vice President for Accounts, "(t)he paper is particularly timely as Congress and the Obama administration seek to add coverage for millions of Americans. You may recall that Sen. McCain had proposed expansion of state high risk insurance pools as a cornerstone of his reform proposal."

Of course, we had our own take on Senator McCain's dubious proposal.

Nevertheless, the NASHIP report makes compelling reading, and underscores how important it is to address the problems facing our health care system on a state-by-state basis before overhauling it on a national level.

A Classic Carnival of Personal Finance

Penelope Pince, blogging at Pecuniarities, hosts this week's Jane Austen-themed Carnival of Personal Finance. If you're a fan of the classics - literature or finances - this one's for you.

Food Pyramid Update: Good News, Java-style

Turns out that El Grande double-mocha-frappa-latte espresso may help decrease your chances of developing Alzheimer's:

"Middle-aged people who consume modest amounts of coffee can significantly lower their risk of developing Alzheimer's disease, according to a new study by Finnish and Swedish researchers released on Thursday."

Of course, we've discussed the "nuances" of Swedish scientists before, but teaming with the Finn's may have been a good idea. Those of us in that nebulous demographic called "middle aged" may benefit from a few Cups o' Joe every day, to the tune of as much as a 60% reduction in the risk of Alzheimer's.

There's no word on why coffee has such magic properties; oddly, I couldn't find a report on the study which indicated whether or not decaf obtained similar results. Miia Kivipelto, a professor at the University of Kuopio in Finland and lead researcher on the project, noted that "coffee contains strong antioxidants, which are known to counter Alzheimer's."

MVNHS© Dirty Little Secret

Proponents of nationalized health care systems often tout the benefits of gummint control, with no need for nasty, profit-driven "private insurance." After all, the thinking goes, health care is "free," and "available to all."

As we've repeatedly demonstrated here at IB, this is simply wishful thinking.

But don't just take our word for it:

"Simple and affordable health cover with added peace of mind...Access healthcare when you need it not when you can afford it."

Well, that looks like pretty much every health insurance ad we've seen around here.

Except for one thing:

"New Enquiries: 0800 072 6712"

That, dear readers, is a British phone number. That's right, the "dirty little secret" is that, despite the hoopla, Brits still need that evil insurance. In fact, there are a number of different plan options available, all reasonably priced.

Well, they're in Euros, so who knows, really?

According to Jennie Burraway, Digital Strategy Consultant for HSA Healthplans, the company is looking to expand its marketing efforts, presumably to all those Brits currently enjoying their free health care.

The company even touts its own long history of "helping individuals, families and organisations access affordable healthcare since 1922, a history that pre-dates the NHS."

Hmm.

The truth is, even the Much Vaunted NHS has numerous holes which need to be addressed, and it appears that Brits actually pay for their health insurance twice: through expensive taxes and additional premiums.

Blimey!

Cavalcade of Risk #69 is online

Debbie Dragon hosts an outstanding Cavalcade, the first of the new year. Head on over and check it out!

And please consider hosting your own Cav, just drop us a line.

CDHP Wins Another Round

Consumer Driven Health Plans (e.g. HSA's, etc) continue to help solve one of the underlying, persistent problems facing health care delivery: cost.

As we continue to demonstrate here at IB, health care costs drive health insurance costs. That is, increases in the cost of care directly affect the cost of financing (insuring) that care.

One proven method for reining in that trend is through health plans that empower and involve the consumer. Recently, UnitedHealthcare underwrote another major study of Consumer Driven Plans, and how they have affected costs. They studied their own claims experience for the past 5 years, and found that these plans "consistently delivered lower cost than PPO plans in four of the five years, even after adjusting for differences in health status, demographics and other influencing factors. Importantly, the bulk of the savings are attributable to changes in health utilization, not cost shifting to the employee."

That last part is key: one of the major arguments against consumer-centric plans has been a (false) perception that they come at the expense of the insured. Turns out, not surprisingly, that that's not the case.

The study comprised over 400,000 insureds, which seems like a pretty decent sample size. Folks (and fellow wonks) who'd like more details can access the results by clicking here.

Connecting with Grand Rounds

Hostess Barbara Kivowitz presents a fun and informative 'Rounds, built around the (perhaps non-intuitive) connection between health care and sci-fi. It's worth a read if only for the clever way she brings the two together.

Good stuff.

Not tonight Honey, I have a 339.82

[Welcome LGF readers!]

[Another timely update from our Favorite MOM (Medical Office Manager), Kelley Beloff, MSW, CMM]

I recently attended one of my yearly Medicare updates. This one focused on changes in the coding for medical conditions in the medical field, known as ICD-9s.

Women around the world have now been vindicated by the world’s medical association. There is a new ICD-9 for this year, code 339.82: Headache associated with sexual activity. As a woman -- and for my long suffering sisters -- it is about time that the medical field recognized the condition of how the thought of sexual activity can bring on a headache. So, as a service to the many readers of Insure Blog, I felt it necessary to report this breaking news on the medical front.

Yes, Virginia, the headache is real.

And now for something completely different...

Cox Arboretum is a beautiful, lush learning environment in one of Dayton's southern suburbs. Open year 'round, it offers breathtaking flora and interesting fauna. If you're in the area, it's worth (at least) an afternoon.

But a year?

Actually, that's exactly what a friend of ours did: she devoted a whole year to documenting the seasonal changes that take place at Cox. Shot over 53 weeks, from two specific vantage points, one can almost feel the chill winds, warm rains, even the snwflakes crunching underfoot. And she's even written a book chronicling these changes, complete with gorgeous photos with accompanying journal entries.

Here's a sample:

The book is available here, both for sale in softback and as a downloadable pdf. Enjoy!

But is it Right?

Where do we draw the line between healthy babies and eugenics? Should we even consider drawing it?

I ask these questions because:

"The first baby girl in Britain to have been screened before conception for a genetic form of breast cancer has been born, doctors said on Friday."

The process involved the use of multiple embroyos, which were each screened for the target "breast cancer gene." Note that the selected embroyo itself was not genetically altered, it was enough that it was free of the offending gene. Note, too, that having the gene is not in and of itself a guarantee that one will develop breast cancer; it's believed that absence of the gene effectively eliminates that particular risk.

All well and good, so far.

The dilemna arises out of the potential other uses of this technique: will "designer babies" be screened for the presence (or absence) of the "blue eye" gene? The "freckles" gene? How about the "shortness" gene?
Or perhaps the one which determines whether we're looking at pink or blue blankets?
Or poor report cards?
I'm concerned that this is a slippery slope, and we're not really sure how, or where, it will end. If the genetic marker for Alzheimer's show up, what then?

Brave new world, indeed.

Bitten in the Asp

[Welcome Kaiser Network readers!]

The good thing about COBRA (the Consolidated Omnibus Reconciliation Act of 1986) is that it exists at all.

On the other hand, the bad news about COBRA is that it exists at all.

Briefly, and as it pertains to health insurance, COBRA enables an insured to continue his group insurance coverage even if he's no longer an employee of that company. This is both a boon and a bust: the boon is that unhealthy folks, who might otherwise have trouble finding coverage in the individual market, can keep their coverage for up to a year and a half (and sometimes even longer). If one is in the midst of a claim, this can be a lifesaver (literally).

COBRA also dovetails with HIPAA so that, if one continues to have significant health problems, one may transition to a guaranteed issue individual plan with no exclusion for pre-existing conditions (pre-ex). Again, this can be a major benefit.

There are also (at least) two substantial problems with the law: the first is that, contrary to popular myth, belief and advertising, group coverage is almost always more expensive than individual (for a variety of reasons), but this cost is hidden from the employee because most employers subsidize the coverage. That is, most folks think their health insurance costs, say, $50 a week, but aren't aware that the employer is also chipping in at least that amount [ed: as we've noted before, this isn't exactly accurate, but we'll leave it be for this post]. So, the premium that one pays under group is really only a portion of the total, real cost.

When one elects COBRA continuation, one pays "full freight" for the coverage, which includes the amount the employer had been kicking in. This usually results in "sticker shock:"

"The cost of buying health insurance for unemployed Americans who try to purchase coverage through a former employer consumes 30 percent to 84 percent of standard unemployment benefits...

Because few people can afford that, the authors say, the result is a growing number of people being hit with the double whammy of no job and no health coverage."

Well, that's part of the story, anyway.

The truth is that very few people are truly uninsurable, but many (most?) folks don't know this, and so they don't even bother to look for alternatives to COBRA. And there are many such: individually underwritten major medical plans, short term medical, even mini-med plans all fill some (often significant) gap, and are usually less expensive than the COBRA offering.

Of course, with unemployment quickly edging back up (after years of being below historic levels), this is becoming more relevant, and urgent. The challenge is that Congress is going to be pressured into offering even more gummint-styled solutions (which, of course, is exactly what gave us COBRA in the first place), when the individual market is far more capable of crafting and providing more realistic alternatives.

And that begets another problem: how to cut through the political rhetoric to get that message out. If industry trade groups, such as NAHU and AHIP, were truly focused on market solutions (which, of course, they are not), then they would be blitzing the airwaves educating the public about these cost-effective alternatives to COBRA.

I'm not holding my breath.

Cavalcade of Risk #69: Call for submissions

Debbie Dragon hosts next week's edition of the Cav, and she asks that you include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

Thanks!

We have some hosting slots available - just drop us a line to reserve yours.

MVNHS© on a Roll

But not necessarily a good one:

"The number of hospital patients killed by mistakes has risen by 60 per cent in two years, official figures show...Patient groups have warned that the true toll is likely to be higher because some hospitals do not record all incidents."

That last bit is especially frightening: if it's "officially" as bad as 60%, and the "actual" number could be much higher, what does this say about socialized medicine, and the efforts of our own political class to implement a similar scheme here? We're constantly subjected to the (oft-debunked) canard that our health care system is "failing," and "too expensive for the benefits received," ad nauseum.

But here's a real life example of a system which apparently takes killing its "patients" a little too casually (as we've seen before). It's reminiscent of the silly "infant mortality" myth, because we count every live birth, regardless of potential problems, whereas most other countries (and hence health care systems) only count those that survive a specific number of days.

So how many folks has the MVNHS© killed today?

Grand Rounds: First 2009 Edition

Edwin Leap hosts this week's collection of great medblog posts. There are a lot of good items here, and he obviously read them all: each one has a helpful summary.

I must say, though, that I was a bit put off by the rather lengthy intro Edwin wrote; it's his take on the theme ("profit in health care"), which is fine, but it's also nine paragraphs long. I think that's a bit much.

Insurance by the Mile?

On a consumer-oriented online forum at which Bob and I frequently post [full disclosure: we've both received golf shirts for our "services" there], a poster recently brought up the idea of auto insurance based strictly on the number of miles driven. Neither Bob nor I are P&C agents, but we have enough knowledge of insurance principles to know that, when something sounds too good to be true, it often (usually?) is.

Another frequent poster, who happens to be a state insurance regulator, also weighed in with his opinion of the phenom. The three of us concurred that the scheme, while unique and interesting, had a number of flaws.

Briefly put, "insurance by the mile" is designed so that one signs up, and pre-pays for insurance based on the number of miles one anticipates driving for the next six months. These miles are audited, of course, lest one be tempted to "lowball" the company. There is apparently no other underwriting.

I probably wouldn't even blog on this had not alert IB reader Holly R sent me this link this morning:

"Bordoff and Noel have some common-sense proposals for encouraging pay-as-you-go insurance—most notably a tax credit to cover the initial cost to insurance companies of installing remote mileage-monitoring devices in customer's cars or setting up a network of odometer-inspection stations."

In other words, they like the idea, but implicitly question drivers' honesty as regards miles driven.

Hunh.

The TNR article contains another even more serious, if less obvious, error:

"This process, better known as adverse selection, is what causes individually-purchased health insurance to cost a lot more than a comparable employer-provided plan."

Nope.

As we've repeatedly pointed out here at IB, the only advantages to employer-based coverage are guaranteed issue and the "convenience" of payroll deduction. Individually underwritten plans for health folks are always less expensive than group (this may not seem obvious, until one recalls that the employer "subsidizes" the group premium).

Now, I have no horse in this particular race, but I would be very concerned about sharing the road with someone who didn't understand basic risk management, and how carriers determine risk and premium.

Methinks that there's a very good reason that there's only one carrier even testing these waters.

Top 100: Again!

Back in September, we reported that IB had been selected by RN Central as one of their top 100 health care policy blogs.

Quite an honor, and we were grateful for that recognition.

This morning, we received word from the Radiology Technician Schools site that we'd been selected by them as a top 100 Best Health Care Policy blog.

And we're quite honored by that, as well.