Shut Up, and Call Me in the Morning

It's as American as apple pie: the right to complain about poor service. But beware, you may have to give up that right if you want your doctor to continue treating you.

"Doctors across the country are forcing their patients to sign waivers giving up their right to post comments and reviews about them online."

Of course, just because you sign something doesn't automatically mean that you're bound by it. But there are usually consequences for ignoring the rules, especially ones to which you've explicitly agreed. In this case, the consequence is a boot out the door - of the doc's office, that is.

According to Laurence McCullough, a professor of medical ethics at Baylor College of Medicine, "(t)his is just the guild trying to protect itself from accountability to those it serves. That's not professional behavior — this is self-interested behavior." Of course, the medical profession has been under fire of late for other potential lapses in ethics, so this isn't necessarily breaking new ground.

But it is troubling:

Dr. Wendy Mariner, a law professor and director of the Patients' Rights Program at Boston University, opines that "the waivers create an adversarial relationship between doctors and patients, and could possibly limit options for patients seeking care. If this kind of thing gains any traction, medical licensing boards will, and I think should, prohibit it."

On the other hand, the reviews in question are often, well, questionable themselves. After all, how is one to know if the person posting an online complaint against Dr Smith was actually a patient of his, or simply a disgruntled employee, for example? Absent some kind of monitoring, who's to know. But that, of course, begs the question: who does the vetting? There doesn't seem to be any reasonable answer to that one.

And there's this:

"Under the terms of the agreements, patients promise they "will not denigrate, defame, disparage or cast aspersions upon" their doctors or post comments to any Web pages by name or anonymously."

Of course, if it's anonymous, how would the doc know whom to "fire?"

For now, both sides seem to be finding their way around these questions. It may be a while before we see any substantive answers.

Cavalcade of Risk #72: Submissions Due

Next week's edition is hosted by Russell Hutchinson. Submissions are due by Monday, the 23rd, and should include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

And 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.

COBRA Subsidy? Maybe Not . . .

[BUMPED TO TOP: This is just too important. I highly recommend reading the comments for even more details. HGS]

Washington works in strange ways, if you can say it works at all. One part of the recent legislation, which no one read before voting on, provides subsidies for COBRA.

Or does it?

We found several resources that have their take on the subsidy. Of course, like anything else having to do with new rules, the devil is in the details.

Problem is, we don't have any details yet.

But here goes.

The folks at Fox Rothchild, Attorney's at law, offered this perspective.

the American Recovery and Reinvestment Act signed into law today. It is going to create some change to COBRA administration that require some attention very soon. It provides for a 65% employer paid subsidy for COBRA premiums for 9 months.

An employer paid subsidy. That's an interesting wrinkle, especially since the ex-employee normally makes the election and is responsible for paying the premium.

The subsidy applies to those who suffered an involuntary loss of coverage between September 1, 2008, through December 31, 2009. But the Act does not specify what it will consider an involuntary loss, and it also provides that all qualified beneficiaries, regardless of the reason for their qualifying event, must get the notice. Employers and plan sponsors should go back to September 1, 2008, and review records to determine everyone (including dependents) who had a qualifying event and confirm that these individuals will get notice. This can be for voluntary or involuntary termination or reduction of hours, but it also applies to those made eligible as a result of divorce, death or aging out of coverage. They may not get the subsidy, but you must be prepared to send them the notice.

This is like watching sausage being made.

You not only don't know what is going in, but what is coming out either.

The Act includes a retroactive provision that allows those who were eligible for COBRA and did not elect. It creates a window for them to now elect continuation coverage retroactive back to the first date of the qualifying event subsequent to September 1, 2008.

So what if someone bought coverage other than COBRA? Can they drop it and pick up COBRA going forward?

Or say they did nothing, but had a major claim in the interim. Can they elect COBRA retroactively and expect COBRA (and the taxpayer subsidy of course) to cover the claim?

Recognizing that now there is an added cost to reductions in force that equates to paying 65% of COBRA premiums, employers must consider this added expense when considering the cost benefit of a reduction in payroll. Not all eligible employees will elect COBRA because of the subsidy, but it can reasonably be anticipated that more will than would without the subsidy. If you are in the process of reducing the workforce, affected employees should be advised that the subsidy is available, but application of the subsidy will not be finalized until the close of the transition period.

OK, so the employer is laying off employees to save money. After the RIF, say half decide to opt for COBRA. Since this is an employer subsidy, the employer must pay their share, collect the balance from the ex-employee, and then ask the government for a refund of their share.

Or something like that.

Regardless of the mechanics, the RIF was to save money, but the COBRA SNAFU might create cash flow issues for the employer, leading to more lay offs, creating more COBRA elections, which creates more cash flow issues, leading to more . . . .

Confused?

I know I am.

UPDATE (HGS): New details on this issue have come to light, including news that this may apply to smaller groups, as well. Click here.

Health Wonk Review: The Anti-Spam Edition

In honor of all the "spamblog" submissions I received for this outing, I thought it appropriate to include some useful spam tidbits. And so, each post this week is accompanied by a relevant, and yet tasty, Spam© concoction.

Enjoy!

(Oh, and if that doesn't work, try this)

■ We start off with a Singapore Salad, in honor of Pizaazz blogger Glenn Laffel's post reminding us that not all talk of health care reform is taking place here in the US: China's system is undergoing some changes, as well.

Careful though, about an hour after you read this post, you'll want to re-read it.

■ Moving on to the appetizer course, Sarah Axeen of the New Health Dialogue blog argues that we can both save the economy and reform our health care system, all in one fell swoop.

■ For those interested in lighter fare, we present Fiona Gathright's post at the Employee Wellness blog. She contends that folks are more likely to lose weight if they are paid for it, and that this weight loss would then translate to lower health care costs.

■ Sometimes, Puffs are a great idea. But David Williams, proprietor of the Health Business Blog, warns that looking for bargains in healthcare can lead to puffed up claims, particularly for uninsured and underinsured patients.

■ In a nod to our new president's heritage, we have a Hawaiian Spamburger, courtesy of Musings of a Distractible Mind's Dr Rob Lamberts.

The good doctor is thoroughly unimpressed with the state of Medicare, and in an Open Letter to the President, he explains why.

■ For a south of the border taste, we look to Nursing Degree blog. Looking to mix travel with surgery? Erika Collins has an indispensible guide to what she considers the Top 50 (and then some!) resources for Medical Tourism.

■ Interested in something that may sound good on paper, but might just be overreaching? Our own Bill Halper gives us his take on the "Stimulus" package (known around these parts as "The Spendulus"). Bill takes a look at all the health care provisions, and worries about their impact.

■ Like this recipe for incomparable corn chowder pot pies, Health Care Renewal guru Roy Poses has his own take on the comparative effectiveness research imperative in the recently passed "Stimulus" bill: if done right, he's all for it.

■ Sometimes, it's important to remember the basics, like a classic baked Spam loaf. Jason Shafrin, the Healthcare Economist, reviews some important healthcare statistics. These are classic, too, like health care spending that is expected to grow to almost 20% of GDP in 2017.

■ Remember when Egg McMuffins were first introduced, and folks wondered what they were? Well, just what is the Certification Commission for Healthcare Information Technology, and why should we care? Healthcare journalist Neil Versel explains both, including what they have in common with Bernie Madoff.

■ Is the Kaiser Family Foundation's recent report a bit cheesy? Disease Management blogger Jaan Sidorov thinks so, and gives the KFF a thorough fisking for its disingenuous criticism of insurance coverage for cancer patients. The good news, Jaan assures us, is that his own "pic is Obama-esque."

■ When grilling kabobs, managing heat is critical. So, too, is managing patient care, as Dr Rich reminds us in this "meditation" on why patients who receive stents are so poorly informed, and how policy decisions (i.e, how doctors are "managed") may play a role.

■ Talk about heartburn in a bowl: Blogger Merrill Goozner takes aim at the Atlantic Magazine's apparent misrepresentation of comparative effectiveness. Ouch!

■ This Mexican Extravaganza is sure to cause some gastric pain. And while we're thinking of it, does the level of pain you experience while recovering from surgery have any relationship to the type of coverage you have? Jon Coppelman of Workers' Comp Insider makes the case that it sometimes does.

■ If you're on a budget, these BLT Bites might be just the ticket. But, as Medicaid Front Page's Brady Augustine reports, the new SCHIP legislation may leave states scrambling to stay within their own budgets.

■ Bet you never expected to see the words 'Spam' and 'cupcake' together, did you? Canadian Medicine blog's Sam Solomon reports on a similar surprise: the Canadian Medical Association is lobbying to reform the country's healthcare system to make it look more like one of the mixed public-private European systems.

■ These Tuscan Spam Bites aren't the only things with (metaphorical) fangs; Anthony Wright opines that the benefits of COBRA shows the complete disaster that is the individual insurance market.

■ Just as this Seven Layer Dip has many levels, Louise at Colorado Health Insurance Insider reports that the Stimulus Package [ed: referred to as "The Spendulus" here at IB] includes some not so obvious ingredients, including some that she hopes will help to ameliorate the problem of so many uninsured.

■ And for dessert, something both sweet and tart. THCB's Brian Klepper reports on a recent appeals court decision that held against the advocacy organization Consumers' Checkbook, and with the AMA and HHS. The latter two are looking to keep Medicare physician data secret, but this may conflict with increased efforts at transparency in health care.

Be sure to check out the comments for some great fireworks, um, debate.

Thanks for stopping by; be sure to catch the next edition when Brady Augustine hosts at MedicaidFrontPage.

Taxes and Top 10 Lists

Our good friend Joe Kristan has been named one of the Top 10 Tax Bloggers.

Congratulations, Joe!!

Medical Transparency Update

Boy, do we get results!

Regular readers may recall that we recently reported on regulations regarding physician rewards for recommending certain regimens [ed: okay, enough already with the alliteration!]. Specifically, "the pharmaceutical industry has agreed to a voluntary moratorium on the kind of branded goodies...that were meant to foster good will and, some would say, encourage doctors to prescribe more of the drugs."

First out of the box, it would appear, is Big Pharma Behemoth Pfizer, which has just announced that "will begin disclosing all sizable payments it makes to doctors, including those who test experimental drugs in people, a first for the industry." Now, that's not quite the same as, you know, actually ending said payments, but it certainly adds an element of transparency to a hitherto murky underworld of quid-pro-quo.

As Pfizer's Chief Executive Jeffrey Kindler noted, "It's very important that we earn the trust of patients and the public."

No kidding.

And it looks like Pfizer's move has sparked an interest in others, as well: "A handful of drugmakers, including Merck & Co. and Eli Lilly & Co., have recently announced plans to disclose payments for consulting, giving speeches and the like."

Another "freebie" sore point has gone unremarked; the underwriting of CME (Continuing Medical Education) credits by Big Pharma isn't mentioned. It would appear that this potentially valuable "gimme" will remain untouched by these new efforts. Actually, that doesn't really bother me: presuming that CME courses undergo at least as much scrutiny as insurance ones do, I don't think there's much danger of "contamination."

Word Problems

No, not that kind of word problems. More like this kind:

When is a rate reduction not a rate reduction?

When it's tied to buying another product. As in this lovely little offer that I recently received from our UHC service rep: "My UW [ed: underwriter] has provided 3% rate relief, off your groups medical rates, if you add any of our ancillary lines...dental...vision...or life."

A few simple words, and I blew my stack.

Why is that, you ask? Let's rephrase this, and perhaps it will become more apparent:

"We're offering a one-time, multi-policy discount on your group health rates if you also purchase dental, vision or life coverage. In fact, this discount could pay for itself."

(NB: I had to add the "one-time" bit because they already offer an on-going "package" discount)

So why would one phrase give me the warm fuzzies, and a simple re-wording send me through the roof?

Call me old-school, but when a carrier rep says "underwriter" and "rate relief" in the same sentence, it implies a whole series of specific processes and decisions, the results of which should be completely independent of whether or not we buy an additional line of coverage.

In fact, wording it in such a way strikes me as just shy of extortion ("(t)aking money by force, threats or deception or by excessive overcharging"). After all, if we're healthy, why not just offer the lower rates? In fact, if the underwriter has determined that we qualify for lower rates, isn't the carrier obligated to just put them in place?

Why not?

But recasting this as a completely separate business decision (which, after speaking with the rep, I came to understand it to be) makes it an attractive offer, not a thinly veiled attempt at squeezing even more premium.

As they say, "words mean things." And sometimes, they mean things we don't intend.

Grand Rounds is up!

Nurse Kim hosts this week's 'Rounds, and it's Dynamite! (Napolean Dynamite, that is). Kim does a great job of weaving together snippets from the film with great medblog posts.

Eraser

"Who are these children and why are they calling me Mom?"

Wouldn't it be nice to be able to forget bad memories? What if there were a pill you could take to wipe out the memory of bad things that happen in your life.

According to my wife, I don't need such a pill. She claims I already have selective memory.

And a hearing problem.

But I digress.

Dutch researchers have discovered that taking a generic beta-blocker "significantly weakened people's fearful memories of spiders."

So much for a fear of spiders, but what about other things?

The findings published in the journal Nature Neuroscience are important because the drug may offer another way to help people suffering from post-traumatic stress disorder and other problems related to bad memories.

That sounds promising.

And here is some good news as well.

Propanolol is not some new miracle drug. It is generic and available for $4 at many pharmacies.

That's cheaper than getting drunk to forget.

Asking the Wrong Questions

If you ask the wrong question, you will never get a right answer.

Roland Burris, newly appointed to the U. S. Senate to fill the vacancy of Barack Obama was repeatedly asked if Governor Rod Blagojevich had solicited donations or any form of remuneration in exchange for the appointment.

According to testimony, and news conferences, the answer was emphatically "no".

Now comes word that, while it is apparently true that Gov. Rod Blagojevich did not ask for money, his brother, Rob Blagojevich DID ask for money in the form of campaign contributions.

So if you ask the wrong questions, you will never get the answer you really want.

Same is true when shopping for insurance.

If you ask the wrong questions, you will never get the right answer.

"Are prescription drugs included in this plan?"

"You will receive a discount on medications equal to the lowest price negotiated by the carrier."

Note: Receiving a discount is not the same as covering the drugs as part of the major medical. Your discounted price for Abilify will be $450 but the carrier will never actually pay for the drug.

"Is my blood pressure medication covered under this plan?"

"There is a rider for blood pressure medication but you may still receive the discounted price"

Note: Many people will dismiss this as insignificant since many BP meds are available in generic form for $4. Most, but not all, riders exclude coverage not only for the named medical condition but anything that could be related to high blood pressure. This means, no coverage for heart attack, stroke, renal failure. However there are some riders that are not as broad and will only restrict coverage to outpatient treatment of the high blood pressure.

"Is maternity covered?"

"Yes."

Note: Most major medical plans issued in Georgia are required to cover complications of maternity but may not cover normal delivery. Most, but not all, plans covering females of child-bearing age require an extra premium to cover normal delivery. Most, but not all plans have waiting periods of up to 12 months before maternity is covered. And just what are complications? It varies by carrier. Even if you have maternity coverage, once the pregnancy becomes "complicated" you start a new deductible and most people do not know that.

Why?

Because they asked the wrong questions.

Shape Up or Pay More

Employees of the city of Kennesaw, Georgia will need to get healthy or pay more for health insurance.

Employees will be asked to pay more for health insurance if they smoke, are overweight or have other "high risk" health factors.


That could double their premiums, which would go from $25 a pay period to $50.

“It’s just a good incentive to help the members and owners of the plan to save money,” Mathews said.

Makes sense to me.

The higher premiums for employees who don’t want to participate in the wellness program were proposed by an employee benefits committee, Mathews said. He said he has not heard from any employees concerned about the proposal.

At least, not yet . . .

BREAKING: ShenLife on the Rocks [Updated]

Just "over the wire:" Shenandoah Life has been placed in receivership. This means that the state of Virgina has taken (at least temporary) custody of the troubled carrier.

The good news is that the system works: already, other carriers have stepped up to the plate, offering safe harbors for ShenLife insureds.

We'll have more on this over the weekend, as details come in.

[Hat Tip: An anonymous FoIB]

MORE: Readers may be wondering just why ShenLife foundered. Apparently, the predicate cause was its substantial position in certain pillars of financial stability:

"Shenandoah Life lost approximately $50 million when the value of its equity position in Fannie Mae and Freddie Mac preferred stock was significantly diminished."

[ed: "Significantly diminished" is insure-speak for "flaming burn-out."]

I must admit to having been somewhat flummoxed when I first heard the news this afternoon; it had flown completely under my radar. However, our "Anonymous FoIB" told me that it had caught pretty much everyone by surprise: as late as yesterday, another carrier had been in negotiations to buy ShenLife's entire book of business; that fell through and the Virginia Insurance Department (aka the State Corporation Commission) stepped in to act as safety net.

Just goes to show you, though, how important it is to diversify, and to avoid putting so much money into investments backed by questionable actors.

And You Thought You Had Seen it All . . .

Remember Nadya Suleman? The woman who recently produced a litter of 8 children is not alone.

And neither is her doc.

It seems the good Dr. Kamrava has almost a fetish for assisting in the procreation process. He is already under fire for his handiwork with Ms. Suleman. Now we find out she is not the only woman wanting to create their own population explosion.

The woman, who has three adult children already, is around five months’ pregnant, and has been admitted to hospital where she is expected to remain until the birth, the Los Angeles Times reports. It is understood that Dr Kamrava transferred at least seven embryos, made from donor eggs, into the woman.

Let's parse this out.

The woman is 49 years old, with three adult children.

She had 7 embryos from DONATED eggs. In other words, these are not (genetically speaking) her children.

Dr Kamrava is under investigation by the American Society For Reproductive Medicine (ASRM) and the Medical Board of California after Nadya Suleman, 33, gave birth to octuplets last month . Women Miss Suleman’s age should have a maximum of two embryos implanted in the womb during a single cycle, the ASRM says.

Did the doctor lose count? Or is he just hoping the National Enquirer will come knocking?

The LA Times reports that the 49-year old expectant mother has three adult children, but wanted a baby with her new husband, who is believed to be almost 20 years her junior.

It would seem that a psychiatric evaluation is not required before undergoing this procedure.

According to Federal Records, Dr Kamrava’s West Coast IVF Clinic has one of the worst success rates of any fertility clinic in the country. Of the 61 procedures conducted in 2006, only two resulted in births — one of which was Miss Suleman's twins.

So why does this guy still have a license to practice medicine?

One other interesting tidbit about this new mommy. She was initially admitted to Good Samaritan hospital but then transferred to USC hospital.

Good Sam is a private hospital.

USC is taxpayer funded and treats patients who do not have insurance.

Health Wonk Review Coming Up

We're pleased as punch to host next week's roundup of all that's wonky. If you'd like to participate, please submit your post no later than next Wednesday (the 18th). Please be sure include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

And PLEASE note: Only posts which meet the HWR Guidelines will be included:

"Health policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends re same are all fair game."

You can submit your post via Blog Carnival or by dropping us an email.

On the Radar

If you're in the health care or insurance biz, HR or Project Management; if your job has anything at all to do with risk or benefits, you need to be reading the Industry Radar.

Head Honcho John Nail has grown this aggregator into a powerful tool for anyone who wants (or needs) to know about what's going on in health care financing, risk management, and benefits in general.

Highly recommended.

Are WE Stupid, Too?

[Welcome Industry Radar readers!]

Recently, I noted that doctors demonstrate a remarkable lack of intelligence and sense. But I also wonder why the public at large believes that health care reform included in the Spendulus is going to have a happy ending.

As we've repeatedly noted here at IB, unless we're able to contain health care costs, our likelihood of controlling health insurance costs is a pipe-dream. And we can look at real world examples to ascertain the truth of this.

One such example, often cited as a model of health care efficacy by those in favor of such systems, is Medicare. Unfortunately, it fails miserably on all counts:

"An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn't work, a government-contracted study found."

Got that? A "government-contracted study." Not an insurance company or doctor's association. For many seniors, chronic illness is a way of life; the challenge is to manage it cost-effectively. Unfortunately, this gummint-run system has demonstrated no such ability:

"Most of the patients had serious, but common, age-related illnesses...Programs were set up at 15 centers...Only two cut the number of times these patients were hospitalized...None saved Medicare any money." [emphasis added]

One of the primary problems (and again, one we've mentioned many times) is that many folks have behaviors that can be changed, but too often remain unchecked: weight, excercise, smoking, etc. Without more personal responsibility, there's very little hope of change, the power of the gummint notwithstanding:

"The only way you can really do it is by changing patients' behavior and by changing physicians' behavior, and both things are really hard to do," according to the study's author, Randall Brown.

No kidding.

Stupid Mommy Tricks

Several years ago, we caused a kerfluffle with a series of posts explaining why IVF (In Vitro Fertilization) should not be covered by insurance. At the time, it never occured to us that we should have added "or by the taxpayer."

Ooops:

"A big share of the financial burden of raising Nadya Suleman’s 14 children could fall on the shoulders of California’s taxpayers."

Turns out, the young "lady" (who had already spawned 6 children) has been receiving gummint subsidies, at least in part because she is unemployed. For some reason, this rocket surgeon decided that having a slew of additional mouths to feed would be appropriate, and that it would also be appropriate for thee and me to pay for their care.

Perhaps the hardworking taxpayers of the Golden State (or should that be "Goldbrick" State?) had other plans for those dollars; alas, those tireless workers weren't consulted, only forced to pay up.

But wait, it gets better!

"(T)he hospital where the octuplets are expected to spend seven to 12 weeks has requested reimbursement from Medi-Cal, the state’s Medicaid program, for care of the premature babies, according to the Los Angeles Times. The cost has not been disclosed." [emphasis added]

Oh, great: a blank check!

The good news is that Ms Suleman "doesn’t consider the public assistance she receives to be welfare." Well good on her! After all, it's only important to consider what one calls it, not that one is expected to pay for it.

Surprisingly, "bloggers rained insults on Suleman." Gee, I wonder why?

Cavalcade of Risk #71 Now Up

Once again, Julie Ferguson presents an outstanding edition of the Cavalcade of Risk. From peanut butter to lightbulbs, medical errors to radiation risks, you're sure to find something to interest (or scare) you.

Do check it out.

And consider hosting your own Cav; we're scheduling for Spring '09. Just drop us a line to snag yours.

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.

Good Money in Mental Health

Psst. Want to make a quick buck? Get into drugs.

But not just any drugs.

Mood altering drugs.

As Tommy Chong might say, "this is some good stuff, man."

United States demand for anti-psychotics is a $12 billion dollar market and continues to grow each year.

Top sellers include Zyprexa which runs $400 per month at discounted carrier pricing.

Following close behind is Risperdol at $120 per month, and Seroquel at $120 per month.

But closing in fast with a 54% jump in sales is Abilify. Thanks in part to DTC (direct to consumer) advertising, Abilify is becoming the drug of choice.

At $450 per month is it any wonder that Abilify is the darling of maker Bristol-Myers Squibb?

Abilfy, along with another heavily promoted drug (blood thinner) Plavix, comprise more than a third of B-M S revenue.

Existing patents on these drugs will expire in 2012 so B-M S needs to do what they can to pump up sales and DTC advertising is a proven winner.

And speaking of pumping up, sales of Viagra were $5 billion last year and still growing.

But I digress . . .

Abilify is used to treat depression, bipolar disorder and schizophrenia. Sadly, the latest thing is to diagnose these severe psychotic conditions in children as young as 6 years of age. Such diagnoses are highly controversial in children so young, and to put them on high powered, mood altering drugs so young is equally controversial.

The facts about anti-psychotic drugs don't support the sales figures.

Some studies suggest that newer, more expensive meds are no more effective than older, less expensive drugs.

The analysis found four second-generation drugs, amisulpride (Solian), clozapine (Clozaril), olanzapine (Zyprexa) and risperidone (Risperdal) were more effective than first-generation drugs, with "small to medium effect sizes."

But, other second generation drugs, such as aripiprazole (Abilify), quetiapine (Seroquel), sertindole (Serdolect), ziprasidone (Geodon) and zotepine (Nipolept), were no more effective than first-generation drugs, the researchers reported.

So more expensive, and newer, is not necessarily better for the patient.

only aripiprazole and ziprasidone among the second-generation drugs did not induce more weight gain than the first-generation drug haloperidol (Haldol), the study found.

Comparing first- and second-generation drugs, Davis's team also found that second-generation drugs produced fewer "extra-pyramidal" side effects such as unintentional muscle contractions, Parkinson-like symptoms and restlessness than Haldol.

However, only a few of these second-generation drugs reduced these side effects compared with low-dose Haldol, the researchers noted.

So why is information like this buried in medical and scientific journals and not broadcast in commercials to generate consumer awareness?

That was a rhetorical question. We all know the answer.

Oh, and in case you are wondering, Haldol is $10 per month.

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)

■ A (brief) summary of the post

And 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.

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.

Malaria Awareness Week

First Bill Gates gave us Windows.

Then Windows XP.

Then Vista.

Now he wants to give us malaria.

Well, not really. Just raise our awareness.

Malaria is spread by mosquitoes,’ the Microsoft founder yelled at a well-heeled crowd at a technology conference in California.

’I brought some,’ he added. ‘Here, I’ll let them roam around – there is no reason only poor people should be infected.’

Who does this guy think he is? Moses?

The stunt was an attempt by Gates – who quit Microsoft last year to concentrate on his charity work - to hammer home the importance of malaria prevention.

It's bad enough he gave us Vista with bugs. Now we have real bugs.

The Good SCHIP Lollipop

[Updated and Bumped]

Marching forward with change . . . we find that an expanded SCHIP program was introduced and sent on to the president for signing.

The bill (H.R. 2) was passed by the House this afternoon.

Some key provisions of the bill include expansion of the definition of eligibility to include families with incomes up to 200% of the FPL (federal poverty level) . . . about $36,000 for a family of four.

Of course SCHIP will be set up much like ordering by the numbers in fast food restaurants so our non-English speaking residents can be brought into the fold. Money is available for translation and interpreters for those who do not speak English.

And to make it even easier, proof of U.S. citizenship is not required. SCHIP will work under the honor system. All you need do is declare, presumably through an interpreter, that you are in fact a U.S. citizen. No proof is needed.

As long as you have a Social Security number, no problem. It is then up to the Social Security Administration to verify if the number is actually valid.

But in the meantime . . .

SCHIP is also expanding coverage beyond just medical benefits to include dental coverage as well. It also requires parity with medical & surgical benefits regarding mental health treatment.

The makers of Straterra and Abilify will love that.

(Straterra is around $135 monthly at wholesale while Abilify is closer to $450).

Of course Washington doesn't operate like the rest of the world. They have the ability to write checks even when they don't have money in the bank.

The estimated cost of this expansion is only $31 billion over the next four years.

But never fear. Congress expects a portion of this to be funded by smokers.

So light up for our kids and smoke them if you have them. The good SCHIP lollipop is ready to sail.

UPDATE [HGS]: Not that he needs any help, but I thought that this brief clip from Representative Steve King neatly sums up Bob's points:

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.

Hands Off . . . Maybe

Way back in 2003, men were told they ran an increased risk for prostate cancer if they did not, uh, relieve their tension on a regular basis.

Men could reduce their risk of developing prostate cancer through regular masturbation, researchers suggest.

They say cancer-causing chemicals could build up in the prostate if men do not ejaculate regularly.

So far, so good.

Now comes word this practice may not come with the benefits we were promised in 2003.

A new study finds men who are sexually active in their 20s and 30s are more likely to develop prostate cancer — especially if they masturbate frequently.

Define frequently . . .

The message, perhaps: Hold off until middle age.

It's a little late for some of us.

The study also found that frequent sexual activity in a man's 40s appears to have little effect and even small levels of sexual activity in a man's 50s could offer protection from the disease.

Back to good news, at least for those who have made it to 50.

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.

UHC FUBAR

[Welcome Industry Radar readers!]

Take one claim, file it with a carrier, then wait.

Three months later the claim is processed, and denied.

No problem. It wasn't our claim. It should have been denied.

But wait!

If it wasn't our claim, why did it show up in our file?

Good question.

On 9/4/08 some guy named Edward Vineyard visited Dr. Ohno. (Names changed to protect the innocent).

Dr. Ohno's office filed Edward's claim with United HealthCare.

OK so far, except . . .

We don't know Edward Vineyard, he is not a dependent of ours, and no one in our family have ever seen Dr. Ohno.

The claim was processed, under our policy number, by UHC on 12/5/08 and denied. Code R7.

What is R7 you ask?

Code R7: According To Our Records, This Dependent Has Not Been Enrolled For coverage. Therefore, We Are Unable To Provide Benefits.

Other than the mysterious claimant and doc, no problem.

So we called UHC and alerted them to the claim in question.

No problem (we were told). The claim would be investigated and removed from our account.

A month later the claim is still showing, but still denied.

Then . . .

A new claim appears.

Same patient, same doc, new claim. Incurred 1/15/09, processed 1/30/09 and paid.

So . . . we call UHC again.

They have no idea why the old claim is still showing, nor why the new claim was paid.

We are to check back with them in a week.

Today I checked our account.

The claim from 9/4/08, originally processed on 12/5/08 and denied, has been re-processed on 2/2/09 . . . and paid.

So . . . I call UHC and get the run around.

I ask for a supervisor.

None are available.

No problem, I will hold.

You can't do that. We were told yesterday not to put anyone on hold.

Goodbye.

I called back, went through the phone prompts, and spoke to Mary. This time rather than telling my issue, I asked to be connected directly to a supervisor.

Two minutes later I had Hannah, a supervisor.

I explained the situation and then asked why a claim that was challenged two months ago was reprocessed and paid.

Hannah had no answer.

Then I dropped a bomb.

We have talked with Dr. Ohno's office and were told the name of the patient, that he was covered by UHC (but under a different number) AND that Dr. Ohno's office was paid on the 9/4/08 claim before it was processed by UHC under our policy number.

(This is a clear violation of HIPAA by the doctor's office).

The UHC response?

They were quite upset that Dr. Ohno was paid twice. I was told they would contact him and get a refund for overpayment.

Oh, and this.

The supervisor promised to get back to me in 48 hours with an explanation.

This is a minor claim. Less than $1,000. Including the reprocessed claim, UHC has paid around $370 and charged it against our account.

If they can't handle small claims, what happens on a big claim?

FUBAR.

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.

Please, sir, May I have some more?

[Welcome Stumbleupon readers!]

If you feel like you are spending more at the doctors office with each visit, it probably isn't your imagination.

Your wallet really is getting lighter.

A growing number of physician practices are using software programs, some developed by health insurance companies, that can immediately access a patient's insurance information and let the patient and the medical practice know precise co-pay rates, whether a deductible has been paid up and the exact or estimated dollar amount the insurer will pay once the doctor's office submits the bill. Armed with this information, often referred to as "real time claims adjudication," office managers can, and sometimes do, ask patients to pay those costs at the time of service.

Par providers are prohibited by contract from billing and collecting more than the copay for services that are INCLUDED in the copay, but there are no restrictions on collecting for incidentals such as lab fees or non-covered office fee's.

Kati Spencer, 39, a public relations executive in Tempe, Ariz., recently visited a medical center in Scottsdale for a cortisone shot to relieve pain in her hip. The hospital determined that Spencer's $2,600 deductible had not yet been met and asked for full payment of the $2,000 fee for the injection.

Ouch.

This takes wallet biopsy to a new level.

About 13% of physician revenue comes from patients themselves, not insurers, says Mark Rukavina, executive director of the Access Project, a health insurance resource group in Boston. Adds Halley, that's likely to rise as more consumers opt for lower-premium, but higher-deductible insurance plans -- requiring consumers to pay out hundreds to thousands of dollars before insurance kicks in.

Yes, but . . .

The amount consumers pay a par provider, even with a high deductible plan, is less than they would pay absent insurance.

Under the more common practice of contacting insurers first and then billing patients, physicians typically don't send out bills for the patients' share until about 40 days after the visit, Young says -- adding that 30% of those bills go unpaid.

Further, says Dr. Dev GnanaDev, president of the California Medical Assn. and chief of surgery at Arrowhead Regional Medical Center in Colton: "The labor cost for sending out a single bill is $8 to $15, which makes it understandable that a doctor might opt for a more efficient system."

For those of you stiffing your doc for unpaid balances . . . STOP IT.

Some docs are withholding future services until outstanding balances are paid, as well they should. As a result, some consumers go looking for a new doc to stiff.

Bummer.

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.