Cavalcade of Risk #87: Call for submissions

Andrew at the Oz Risk blog hosts next week's Cavalcade of Risk. Submissions are due Monday (the 7th). Andrew asks that you please include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

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.

BLEG: We're scheduling fall Cav's now, please let me know if you'd like to host one.

Biting the Hand (Well, Finger, Really)...

Is it just me, or are the Obamabots getting a bit, um, thin-skinned? First, they call those of us opposed to gutting our health care system "the villains in this debate." Then, we became "domestic terrorists." Now, it's escalated to actually biting off someone's finger:

" (A)bout 100 people demonstrating in favor of health care reforms rallied Wednesday night on a street corner. One protester walked across the street to confront about 25 counter-demonstrators.

O'Hanlon says the man got into an argument and fist fight, during which he bit off the left pinky of a 65-year-old man who opposed health care reform."

One wonders if Medicare covers digit re-attachment, or if that's an elective procedure that can be denied. Of course, one also wonders whether Obamacare would simply dictate that the now pollex-challenged senior should just take a pill and move on.

Article I, Section 8

"The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States ..."

In all, the Constitution sets forth some 20 duties and powers incumbent upon Congress.

Thus far, all the discussions of "health care reform" have been around "how much, how far." But this young man, a vet, raises an interesting point:

Well?

Yikes!

What else is there to say?

Sentenced to death on the NHS

Excerpts below - but please read the whole linked article:

Patients with terminal illnesses are being made to die prematurely under an NHS scheme to help end their lives, leading doctors warn today.

Under NHS guidance introduced across England to help doctors and medical staff deal with dying patients, they can then have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.

Patients are being diagnosed as being close to death “without regard to the fact that the diagnosis could be wrong."

“As a result a national wave of discontent is building up, as family and friends witness the denial of fluids and food to patients."

The warning comes just a week after a report by the Patients Association estimated that up to one million patients had received poor or cruel care on the NHS.

Thanx to Mark Steyn and National Review Online for the link above.

Health Wonk Review is up...

And it's far from ludicrous, although this week's round-up of wonky posts is hosted at the Lucidicus Project.

Civil Debate: So Now We're Terrorists?!

Oy!Bama's perpetual campaign acolytes seem to have outdone themselves:

"All 50 States are coordinating in this – as we fight back against our own Right-Wing Domestic Terrorists who are subverting the American Democratic Process, whipped to a frenzy by their Fox Propaganda Network ceaselessly re-seizing power for their treacherous leaders.”

Froth at the mouth much?

To its credit, the Oy!Bama-linked "Organizing for America" has since pulled the (no doubt unintentionally) revealing post; to its discredit, the "grassroots" organization felt it appropriate to run it in the first place.

I'm ambivalent on this: on the one hand, being labeled a "Right Wing Domestic Terrorist" is somewhat off-putting; on the other, it would definitely make a great name for a band (with apologies to Dave Barry).

One of the problems, of course, is that it's very difficult to convince someone of the value of your position while you're engaged in vile name-calling. And since an overwhelming majority of Americans are dead-set against ObamaCare, it seems to me that OFA (et al) would do well to remember that old adage about flies and honey.

Hope and Change: Presidential Vision Edition

And so The Won has (finally!) decided to share with us, the unwashed masses [ed: hey, speak for yourself! I took a shower this week] his grand vision for health care (and/or insurance) "reform." Which is nice, after all, since he's spent the past 9 months deferring the design of this "plan" to his congressional colleagues.

Who, despite a clear majority in the House and a fillibuster-proof Senate for most of that time, still couldn't manage to solve this particular "crisis." But I digress.

Since congressional rocket surgeons couldn't agree on a plan, it finally devolved to our President to pause from voting "present" long enough to put down in writing what he has envisioned. The problem, of course, is that he has a nearly insurmaountable obstacle: he promised a plan that would cut costs, increase both efficiency and choice, and which would not break the budget.

I'm reminded of an old axiom: "You can have it fast, you can have it cheap, you can have it good. Pick any two." And it appears that he's decided that the one to be left out is the so-called Public Option:

"(A)lthough House leaders have said their members will demand the inclusion of a public insurance option, Obama has no plans to insist on it himself, the officials said."

Of course, just because The Won doesn't "insist" on this boondoggle doesn't mean that it's dead in the water. In fact, the Congress could (and probably would) simply add it back in during the "reconciliation" process (where the House and Senate versions are stitched together to make one law). The point, though, is that our Health Care Czar-in-Chief is finally deigning to share with us what he'd like to see. How that will go is anybody's guess, but at least we'll have a better idea of how far he's willing to go to cripple our health care system.

UPDATE, OTB Edition: The Politico article mentions that The Won will be giving "a major speech as soon as next week;" perhaps, as so often with this administration, a prime-time version (which costs the networks revenue and turns away viewers). In anticipation of that event, here's a little poll:

pollcode.com free polls

Since the President has already thrown tonsillectomies and ampututations under the bus, which medical procedure do you think he'll call out next?

Hip replacement Botoxification Heart cath Dialysis Lasik

Gruel: It's What's for Dinner (Courtesy of the MVNHS©)

If you're a hungry Englishman, it appears that you'll eat far better as a criminal than a patient:

"Patients in Health Service hospitals are far more likely to go hungry than criminals in jail."

So say a group of British scientists at the Bournemouth University. According to a new study undertaken by the university, " (j)ail diets are "better than most civilians have ... But people on NHS wards do not get the same standard and staff do not check if the food is eaten."

According to Dr John Edwards [ed: no, not that John Edwards], the problems include:

■ patients aren't eating enough (and the staff aren't paying attention to that)

■ because services are so fragmented, there is little (if any) follow-up by medical staff

■ "trays are removed by cleaning staff so doctors do not know how much was eaten"

In short, it appears that these facilities just don't seem to care how well (or poorly) their patients are eating, leading to malnourishment and hindering recovery.

So, health care is free under the MVNHS©, but apparently health isn't.

The “Ethics” of Obamacare

Dr Stuart Fickler, a retired physicist (who hasn't lost his phys!) currently serves as Scientist-in-Residence at the Chabad Learning Center of Greater Dayton (OH). He is a close friend and mentor who recently shared his perspective on Obamacare with me. I felt that it would make a helpful Guest Post:

"I am outraged by the cavalier attitude of our current government toward human life. I refer to the evidence inferred from Dr. Ezekiel Emanuel’s articles related to the “Complete Life System” (Journal of the American Medical Association and Lancet), and the Veteran’s Administration’s publication “Your Life Your Choices”. Dr. Emanuel is Head of the Department of Bioethics at the Clinical Center of the National Institutes of Health and a top advisor to President Obama on health care. The principal author of “Your Life Your Choices” is Dr. Robert A. Pearlman, Chief, Ethics Evaluation of the VA’s National Center for Ethics in Health Care. It is fair to presume that both of these men will have significant influence on the implementation of any law pertaining to national health care. Both of these men base their arguments on what they call ethical considerations.

I am Jewish and I am prepared to argue that their so called “ethical considerations” are an affront to the ethics of Judaism. An essential principle of Judaism is “choose life” (Deut. 30:19). All of the commandments and practices of Judaism are centered on that statement. Any discussion of end of life MUST start with that as the primary operating imperative. The ethical and practical considerations may become complex, but “choose life” must remain the guiding principle. As a scientist with experience with statistical process control, I am convinced that it is indeed possible to develop a heath care system that is effective, economically sound and preserves the ethical imperative: sustain life.

From their writings, it appears that Drs. Emanuel and Pearlman base their “ethical considerations” on a social resource allocation model which reduces the human being to a commodity. Like a commodity a human life will have a price put on it relative to its value to the consumer (the government). That will determine the level of care to be provided to an individual. That is an obscenity! It is an abomination to God, to creation and to humanity! It reduces human life to something that is bought and sold in the marketplace.

In closing, I would like to add one more thought. In one of his writings Dr. Emanuel states "Unlike allocation by sex or race, allocation by age is not invidious discrimination; …”. This is either naïve or insidious. Once the principle of a resource allocation model is accepted, there is nothing to stop an authority from extending it to any other segment of the society."

Thank you, Dr Fickler, for your insights and analysis.

Through the L. Glass

I received a letter from my Congressman last week. The letter is dated August 21, 2009. I want to share this sentence from it:

"The Congressional Budget Office (CBO) has indicated that the House Bill would not increase the federal deficit"

Elsewhere in his letter, the Congressman, the Honorable Mr L., states clearly he is referring to HR3200, America's Affordable Health Choices Act.

Anyone have any response to the sentence I quoted? Anyone?

I'm going to his town hall meeting tomorrow afternoon. I'd be very happy to carry with me a comment or two of yours.

Thanks.

Paging Dr John Galt

Unless you're a senior, you may not be aware that many providers don't accept Medicare; this means that, perhaps by design, the Medicare (MC) provider "network" is limited. This can be an issue if, when you turn 65, your family doc for the past 20 years is no longer (easily) accessible.

"So what's new, Henry," you may ask, "why bring that up now?"

Because one of the "solutions" currently on the table is the so-called Public Option, and a lot of providers are beginning to say that they're not going to accept PO patients, either. Dr. Alfred Bonati, who heads up the American Society of Medical Doctors, says:

"(A) nationwide, nonpartisan poll of physicians this month found that a full 70 percent oppose the health care reform proposals under consideration by Congress. Sixty-six percent feel that a government-run health insurance plan would restrict doctors' ability to give the best advice and offer the best care possible to their patients. Perhaps most importantly, 60 percent said they would not accept new patients covered by a government insurance plan ." [ed: emphasis added]

That's a lot of doc's who'll be refusing new patients. It may also throw cold water on the gummint's projected numbers regarding how many folks will actually sign up for such plans.

Of course, the fed's could just pass a law that requires doc's to take on PO patients. Think it can't happen? Of course it can. After all, is it such a great leap from requiring health insurers to take on anyone and everyone that applies, regardless of health, to mandating that physician's treat whomever shows up on their practice's doorstep?

Of course it's not.

Now why would these doc's dig in their (collective) heels on this issue? It's simple, really:

"Hundreds of auto dealers in the New York area have withdrawn from the government's Cash for Clunkers program, citing delays in getting reimbursed by the government, a dealership group said Wednesday ... they cannot afford to offer more rebates. They're also worried about getting repaid."

Just sub in "doctor" for auto dealer, and you begin to get the picture.

If enough physicians (and, of course, other providers) publicly state from the outset that they're not signing on, what do you think happens to the PO? And if the PO is an integral part of the "reform" (which, who knows, it may or may not actually be), then how's that Hope and Change going to work out?

Grand Rounds

Medical safety and technology is the theme of this week's Grand Rounds, hosted by Dr Joseph Kim. Do stop by.

Twitter Insurance?

Our Cousins Across the Pond© seem to have an affinity of late for interesting insurance concepts:

"Users of social networking websites could face higher insurance premiums because burglars are using them to 'shop' for victims' personal details."

Although approximately 40% of all Tweets (?) are "pointless babble," at least one UK insurer, Legal and General, is contemplating a Twitter surcharge as a result of increased claims that they believe are exacerbated by folks announcing to God and country that they're "on holiday" (BritSpeak for "on vacation").

Actually, this isn't so far out:

"A burglar might look out for alarms or security lighting on any pictures of the home, as well as any photos of pet dogs who might be guarding it."

If we're talking risk management - and we are - then it seems to me that L&G has a legitimate concern. The problem, though, is exactly how do they underwrite for this? Simply relying on folks to volunteer that they're on Twitter, or Facebook or some other social networking site doesn't seem particularly reliable to me. And there's this:

"Just because someone is burgled, you can't prove that it's down to details posted on Facebook."

Indeed.

[Hat Tip: Neal Boortz]

Myths & Facts: Which is What?

Writing in today's Wall Street Journal, Jerome Groopman And Pamela Hartzband proceed to fact-check The Won's claims about where we stand and where he'd like us to go regarding health care. The article is chock full of great information; here's a sample:

• Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not ... The statistic comes from a flawed study published in 2003 by the Rand Corporation."

• The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate ... The World Health Organization ranks the U.S. No. 1 among all countries in "responsiveness."

• No government bureaucrat will come between you and your doctor. If doctors and hospitals are rewarded for complying with government mandated treatment measures or penalized if they do not comply, clearly federal bureaucrats are directing health decisions.

You'll definitely want to Read The Whole Thing™.

[Hat Tip: FoIB Dr Stuart Fickler]

About those "Exchanges"

As we noted regarding abortion coverage, sometimes what isn't said in a particular bill is as important (and perhaps even more so) as what is stated. Which brings us to whether or not illegal aliens would be covered under the America’s Affordable Health Choices Act [ed: nice segue!].

Turns out, not only would they be covered, but they'd be required to buy their insurance from the Exchange mechanism put forth in the bill.

But don't take my word for it; let's see what the non-partisan Congressional Research Service has to say:

"Under H.R. 3200, a 'Health Insurance Exchange' would begin operation in 2013 and would offer private plans alongside a public option…H.R. 3200 does not contain any restrictions on noncitzens — whether legally or illegally present, or in the United States temporarily or permanently—participating in the Exchange.

CRS also notes that the bill has no provision for requiring those seeking coverage or services to provide proof of citizenship. So, absent some major amendments to the legislation and a credible, concrete enforcement effort in action, looks like the myth on this issue is the one being spread by Obama, Reid, Pelosi, et. al."

On the one hand, this would definitely solve much of the problem of the "uninsured:" since illegals comprise some 20% of that group, forcing them to buy coverage through the taxpayer-subsidized Exchange would ameliorate that problem. On the other hand, of course, forcing them to buy coverage through the taxpayer-subsidized Exchange will further drive costs skyward.

As Bob is fond of asking, doesn't anybody in Obamington think these things through?

Carnival of Personal Finance

This week's edition of The Carnival of Personal Finance is now up at Stretchy Dollar.

More Questions than Answers from the Dayton Daily News

Our local paper has a front-page story today on health care "reform," part of which recounts the sad tale of a family which faces some major medical bills as the result of some poor decisions. Ron and Mindibeth chose not to use an in-network provider when the latter's ear was severed in a Jet Ski incident. Instead of requesting an in-network plastic surgeon, they settled for one who was out-of-network, because, as Ron puts it "(t)he last thing on my mind was insurance.”

Really?!

Isn't one of the very first questions one is asked upon admittance to a hospital (or pretty much any other provider) "who's your insurance carrier?" You're already looking at the card (for policy numbers, etc), and it's not as if "network provider" is a new term or concept.

As a result of this decision, "the couple said they had $267,000 in uninsured medical bills that year." It's not clear, by the way, how much of that total was for the surgeon's services and other expenses related to the accident; for all we know, the family just kept on choosing to use out-of-network providers for other services, as well.

How, exactly, is that a breakdown in "the system?" Or is personal responsibility completely irrelevant now?

As the result of another poor decision, their daughter, Amanda, "racked up $1.7 million in bills for medical care." For whatever reason, she chose not to be insured, and unfortunately developed cancer. Obviously, this made it impossible for her to obtain insurance through "normal" means, although the article also fails to mention whether she was eligible for, or even tried to find, alternate means (such as a HIPAA plan or any of the myriad government-sponsored programs).

Again, how is this an indictment of our health care financing system? Shouldn't she have purchased insurance before a problem developed? Health insurance for a young woman in reasonably good health is not terribly expensive, and if she was old enough to join the Air Force (as the story mentions), then she was old enough to take on that relatively modest expense.

That's the problem, really, with so many of these heart-string-pullers: they paint a very sad picture, neglecting to point out that there were (and are) many ways to avoid this kind of outcome, but which require a modicum of personal responsibility. Perhaps there were other reasons why the young lady didn't have insurance, but the article fails to mention them; and, of course, the reporter couldn't be bothered to ask "why didn't she have insurance in the first place?" because that wouldn't fit the meme.

But it's valid nonetheless.

Perhaps the saddest part is that Ron still doesn't get it; he says he's "disappointed in the systems that have put us there.”

No, Ron, you put you there.

Harrison Bergeron

This story by Kurt Vonnegut is a miniature classic.

It is relevant to everything we talk about at InsureBlog.

Please read and discuss if you like.

You'll be glad you did.

Thanks.

No Tedicare. All is lost?

Fortunately, there is a way to increase insurance company competition in the individual market without a public option. In fact, this can be done by removing some existing government interference.

Individual medical insurance premiums vary a lot by state. They vary by more than per capita medical costs vary by state. This added variation in insurance premiums occurs because of differences in "mandated" benefits enacted by the state legislatures.

But – state legislatures also prohibit insurance companies from selling policies that are not “issued” in their state – that is, policies which do not include all of that state’s legislated benefit mandates. As a result, individuals who live in one state cannot buy a policy issued in another state, even if – and especially if – the premiums in the other state are less. These “state of issue” laws prevent people from shopping for the best deal. These laws restrict competition among insurance companies. Eliminating these laws would allow people to shop in other states where insurance might be much less expensive. That would force more competition on insurers.

This is a clear case where government regulation is driving up costs (mandates), and is also preventing people from shopping in less-costly states (choice restricted to state of issue). So why keep it?

Public Optiony Number 1

No private company "wants" competition. But the public should want companies to compete, because that forces them to innovate and to bring us more useful products at the least possible cost. If a company is not competitive it must improve, or go out of business. That is how competition among private companies serves the entire public. And that is why it is sound public policy to oblige companies to compete.

But it’s not sound public policy for the government to compete directly with private companies. Private companies cannot "compete" with government because government sets the rules that private companies must follow. Governments tend to “compete” by setting rules that drive its competitors out of business – and governments do not have to “improve” to do this. That leaves the entire public with a static, government standard of service rather than the constant improvements brought by competitive private companies. So in this game, the government “wins” even when providing poor service, and the public loses. Imagine the KC Royals vs. the Yankees - and all the umpires and league officials play for the Royals. Not hard to figure out that even the Royals with lesser talent, win most of the time in that game.

Besides, whether some alleged lack of competition among insurance companies is the primary reason for high medical premiums is not at all clear. If the companies are the source of high premiums, why have life insurance premiums dropped so much over the past 20 years? Answer: insurance companies are not the reason medical premiums are high. Medical premiums are high – and rising – because medical cost is high – and rising. Medical cost, not insurance companies, is the problem.

For these reasons, I think the public option promises what it cannot deliver – improvements to the insurance markets through federal "competition". And it does not get at the more fundamental reason insurance is expensive in the first place – that being the cost of medical care.

A conversation with Senator Boxer

Last week, Senator Boxer was on KGO, the largest AM station in the San Francisco area. While disparaging the system, she displayed a remarkable ignorance about California’s health insurance laws and all of the protections that they provide. Since she's one of our two Senators, I felt compelled to call and correct some of her errors…

Misstatement #1: Insurance companies cancel coverage when people get sick
My response: This is flat-out illegal in California. Carriers can only cancel for non-payment of premium

Misstatement #2: Insurance companies raise rates when people get sick
My response: This is also illegal in California. Carriers can only raise premiums based on claims over a large geographic region. Individual claims simply do not count except in a statistical sense.

Misstatement #3: Insurance companies may not cancel policies outright, but effectively do so by raising people’s rates.
My response: Senator, this is illegal in California!

Misstatement #4: Then enforcement must be pretty lax.

Unfortunately, my on-air time ran out at that point. I’m not sure that the carriers that have been fined millions of dollars and been forced to reinstate rescinded policies would agree with her last point.

It was interesting to be referred to at the show wrap-up as a “representative of the insurance industry.”

I do need to clarify a few items…1. I’m really not an industry representative. I’m just a broker helping clients navigate a confusing system and 2. I never said these things “never happen.” I did say that they were illegal.

I certainly don’t expect a Senator to know the nuances of the California Insurance Code. But these aren’t subtle details. They’re part of her key arguments for health insurance reform. And they’re just wrong.

Incidentally Senator, the next time someone calls into a radio station and tells you that they have breast cancer, their COBRA is ending and they’re scared, you might tell them about the guaranteed issue policies mandated under HIPAA. It’s a FEDERAL law that you voted for...

Who's Afraid of the Truth?

Well, ABC for one:

"The ABC Television Network has a long-standing policy that we do not sell time for advertising that presents a partisan position on a controversial public issue."

Which may well be true.

Giving it away, however, poses no problem.

Not that there was anything "partisan" there.

So what, exactly, is ABC so afraid of?

Judge for yourself:

Nothing there we haven't already covered here at IB:

Medicare cuts? Check [ed: updated link].

MVNHS© on the ropes? Check [ed: updated link].

Rationing in Canada? Check.

So it appears that, by ABC's (Guiding) Lights, it's only "partisan" if the truth hurts ObamaCare.

Check.

The Ultimate Tax Authority

I believe that creating a government mechanism that has the legal power to deem people not fit to receive medical care, is a very dangerous business. And that is what rationing would be – a legal means to withhold medical care from some, so others can have it. The ultimate tax authority, one might say.

Isn’t it ironic that people agonize over the death penalty for even the most heinous criminal, yet many advocates for a single-payer medical system seem enthusiastic about institutionalizing another sort of death penalty for ordinary citizens simply because they need medical care?

Discussions of rationing medical care can sound repellent, even if presented as a purely academic exercise. Example: some of Dr Ezekiel Emanuel's work.

Describing his "complete lives" theory of allocating medical resources, Dr. Emanuel wrote that it:

"empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible."

He correctly identifies the nasty part of rationing - who can be allowed into the lifeboat, who will be pushed back into the ocean?

If I and I alone were empowered to make these decisions, I would agree that Emanuel's system is fair. See, I trust myself - but I don't trust all you others. I expect everyone else feels the same way about me, making decisions about whether to save you or your relative. So that presents a practical problem - who will run this thing? Emanuel only says "us." Questions I have for the good doctor are - who do you mean by "us" exactly? And who will appoint "us" to this job? And who defines or limits the power that "us" will have? What assurance can there be that the powers of "us" won't be expanded ad infinitum? And who decides if "us" made a fair decision? And what happens if someone disagrees with "us"? There are many more such Q's, but you get the idea. O brave new world that hath such people in it as "us".

Emanuel also wrote that his system

"prioritizes younger people who have not yet lived a complete life - and also incorporates prognosis, save the most lives, lottery, and institutional value principles".

Well, that's nice. No one could possibly object to a system that is fair and saves the most lives. Oh, well, maybe you would, if you're not invited.

And what's that part about a lottery? Emanuel explains that

"lotteries could be used when making choices between roughly equal recipients."

Heads or tails, ma?

But it's NOT KennedyCare...

The good Senator would have never have been on this plan. Like all of the other Senators, he was and would have continued to be covered by the Federal health care system.

The marketing geniuses in Washington strike again.


(Just wondering...are cost-benefit and treatment efficacy considered factors for approval in the Federal system? And how would aggressive brain cancer in a 77 year-old be treated under ObamaPelosiWaxmanBoxerEtcCare?)

iTriage App: Update

This past Spring, we interviewed iTriage CMO Dr Wayne Guerra, who explained what the SmartPhone application does and how it works. The new features include "zip code and GPS search capabilities, enhanced navigation and user interface, distances to facilities, integrated mapping within the application, landscape view, the addition of more diseases and symptoms, “Tell a friend” feature to share iTriage information with your contacts, and further integration with HealthGrades® quality information for purchasing reports, reviewing physicians, and accessing provider profiles within the application."

It's a great little app; I just wish someone would buy me an iPhone so I could use the GPS function.

Your tax $$ @ Work

Are there no depths to which President Oy!Bama won't sink?

"I was invited by the National Endowment for the Arts (NEA) to take part in a conference call that invited a group of rising artist and art community luminaries “to help lay a new foundation for growth, focusing on core areas of the recovery agenda - health care, energy and environment, safety and security, education, community renewal.”

And to what, exactly, is our correspondent referring? Well to this, silly:

"Backed by the full weight of President Barack Obama’s call to service and the institutional weight of the NEA [National Endowment for the Arts] ... to push an agenda other than the one for which it was created ... to initiate, organize, and tap into the art community to help bring awareness to health care."

That's right: PresBo has decided it's appropriate to use our tax dollars to advertise his legislative agenda. I found the NEA's mission statement at its website, and it says that the agency is "dedicated to supporting excellence in the arts, both new and established; bringing the arts to all Americans; and providing leadership in arts education."

See anything about health care in there?

Nope?

Me, either.

A Trip with Mr Peabody and Teddy

As fellow connoisseurs of 60's Saturday morning television may recall, Mr Peabody was the canine-genius behind the WayBack Machine. Along with his trusted (if dim) sidekick Sherman, he would gallivant back in time to keep us on the straight-and-narrow.

Imagine, if you will, Mr P setting the dial to 1971. Still in his first term, President Richard Nixon proposes sweeping health care reforms, including "a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income."

Mr P and his pal look on in shock as a young Senator Ted Kennedy, all dried off now, moves to block that legislation, which could have helped us avoid many, if not most, of the health care problems we face today.

Troubled and confused, the intrepid pair flash forward almost 40 years, popping directly into the Senate Visitor's Gallery, where they are stunned to see that same Nor'eastern Senator pushing passionately for... wait for it ... employer mandates and increased government spending to insure more people.

Finally regaining his voice (if not his credulity), the determined doggy whispers "it's deja vu all over again!"

Playing Chicken with Health Insurance

Health insurance policies have "grace periods" to accomodate for late-payers. Generally, these are 30 days; that is, one has 30 days to get the premium in to the carrier in order to keep coverage in force. If there's a claim during that time, it's put "in limbo" until that premium's received.

I'm not a big fan of playing chicken with them, but occasionally there's a good reason to take a bit of a chance. For example, if one is switching carriers, and the new plan isn't through underwriting yet, sometimes I'll recommend holding off payment for a few days to avoid double-coverage or waiting for a refund. I'm a bit leery of this, but for a few days, I haven't found it to be a big deal.

But that is quite different than what one client is proposing:

John and his family are clients, and I have them with an individual plan with XYZ Mutual. John's wife has started a new job which includes group coverage for the family; that coverage is set to "go live" on October 1. John is considering not paying the September premium (recall that September has 30 days), and taking his (and his family's) chances that no claims will arise. If they do, he figures, he can always send in the September payment, and everything will be hunky-dory.

As an aside, HIPAA requires that there be no break in coverage longer than 63 days, so the 30 days "bare" isn't likely to be an issue on that score.

In the event, I have strongly recommended against this strategy. Why, you ask?

Simply this: let's say that everybody's fine all the way to the end of the month, and on September 29th, John has a massive heart attack. There is simply no way for them to get the premium into XYZ Mutual before the GP is up, and so he's completely uninsured for that claim (and if the wife's not actively at work come October 1, it's likely that the group plan won't go into effect then, either). So he's completely on his own with regard to all the ER and ICU services, any ambulance and/or EMT services, nursing care, the whole nine yards. And since he's uninsured, he's not eligible for the insurance company's negotiated (discounted) rates, either, which means he pays full retail for everything.

There is no "up" side to this, save for the comparatively few dollars the September premium represents. I've explained all these issues, so it's out of my hands. Obviously, it's more likely that they'll be fine than not, but why take that chance? After all, isn't that what insurance is for?

Cavalcade of Risk #86: Rate-This-Post edition

Political Calculations' Ironman reprises his patented "Contributed Blog Post Rating System" for this no-holds-barred edition of the Cavalcade of Risk.

It's interesting, fun and interactive - what more can you ask for?

BTW, we're scheduling Fall editions, please drop us a line if you'd like to host.

Mandates: Busted! [UPDATED & BUMPED]

[Update below vid]

Ever wonder how much those state mandated benefits add to your premium, and why they even exist? Well, wonder no more:

UPDATE: In the comments, reader Andrew Garland tips us to this video on how "government healthcare and sausages are being made:"

Alphabet Soup Under the Bus?

In our coverage of the swine flu vaccine, we mentioned in passing that it may be eligible for reimbursement under what we call "flex ben" plans (HSA's, HRA's and FSA's). In researching that post, my "guru" for all things flex mused about the fate of what he calls "the alphabet soup" under "health care reform." There seems to be a lot of speculation, but not much hard evidence regarding how these plans will fare.

So, of course, we'll add to that speculation:

First, I could find no mention of any of these plans in the "American Health Choices Act." The only item that remotely touches on them is the requirement that new plans must be "qualified," and I doubt very much that an HSA plan would, um, qualify. Of course, "absence of evidence is not evidence of absence," so it may well be that some enterprising bureaucrat, tasked with actually implementing the bill, would see fit to throw flex plans out under one or more such criteria.

So-called "cafeteria plans" are one benefit of group based coverage; this is a system where a (usually larger) employer offers an array of products from which the employee can choose. Since one of the funding mechanisms for "reform" is a tax on "richer" plans, we may well see those go away, reducing choices and, perhaps, availability of cafeteria plans altogether.

One thing that appears certain is that reimbursement for over-the-counter med's will go away; that is, they will no longer be considered an eligible expense. I'm not convinced that this is a horrible thing: it's a relatively new benefit to begin with, and it's unclear how many people even know about it, much less take advantage of it.

Since one of the primary stumbling blocks facing "reformers" is how to pay for their plans, a number of insurance products are in the crosshairs (e.g. Medicare Advantage); it seems reasonable to presume that doing away with tax advantaged programs like HRA's and FSA's would be a quick and easy way to raise funds. Since these aren't insurance products in and of themselves, getting rid of them may be an easier sell to the public, most of whom don't utilize them anyway.

It's difficult to find credible information about the fate of these benefits, so we'll keep looking, and update as appropriate.

Old School Grand Rounds

Dr Charles hosts this week's edition of Grand Rounds. Head over for a nostalgic look at the far away world of 2004.

Results Matter: "I Drank What" Update

Does the WH read IB? Who knows, but apparently those of us who sounded the alarm about the Obamistration's decision to renew shilling for veteran's to fall on their swords has struck a nerve:

"The debate over what Towey calls the "Death Book" bodes so poorly for the president's position in the health care debate that, after two segments on Fox News discussing the pamphlet this morning, the Department of Veterans' Affairs has apparently pulled the booklet from one part of its website."

Unfortunately, this simply means they've pulled in their horns a bit, since we also learn that "(t)he document still exists in another spot on the site." Still, one small victory at a time.

Laudable Carrier Trick, Swine Flu Edition

"Even a blind squirrel finds a nut now and then" goes the adage, and once again, we have a case of a carrier "doing the right thing." From email:

"UnitedHealthcare will provide coverage for the administration of the H1N1 (swine flu) vaccine for all members covered by its fully insured plans.

We intend to process all self-funded member claims as a covered service unless clients explicitly direct us otherwise. If your client's plan does not currently cover the administration of the vaccine, and you notify us of your client's intent not to cover the vaccine in the future, UnitedHealthcare will reimburse the cost of the administration of the vaccine. The federal government has said that the vaccine will be provided at no cost to health care providers."

The note goes on to say that UHC will be working with appropriate authorities to make sure as many folks as possible have access to the vaccine.

The reference to self-funded (aka ERISA) plans is interesting, as well. Most folks don't know this, but ERISA plans are pretty much free to cover and exclude benefits as they see fit. So if a plan either doesn't specifically cover, or if it specifically excludes, the cost of these vaccines, the carrier (UHC in this case) really has no justification for paying or reimbursing for that expense. If you work for a company which has such a plan, it'd be worth your while to check with HR about how (or even if) the vaccine is a covered expense.

Whether or not it is, if you have an HSA, FSA or HRA plan, my Flexible Benefits Guru Pete Deist says that the cost is "probably" reimburseable under that, so your own out-of-pocket may be reduced. The reason for that qualifier, by the way, is that it's not specifically mentioned as either eligible or ineligible, so we really don't know for sure.

Singin' the Arizona Blues

Several weeks ago, we brought you the odd tale of how an Arizona woman, having survived breast cancer, was rebuffed by Anthem when seeking a simple blood test. Throughout her initial ordeal, Anthem seemed to have no problem covering expensive and ultimately successful treatments, but in its aftermath deemed some inexpensive blood work unnecessary.

After exhausting the carrier's appeals process, Heather Toplak turned to TV reporter Carey Peña for help. Ms Peña went to bat for Heather, and they successfully lobbied Anthem to both cover the lab work, and to change how they would deal with this issue in similar cases going forward.

Good news.

The initial post raised some additional questions, however, and Ms Peña graciously agreed to forward my request for further information on to Ms Toplak; she has replied to my request, and given me permission to post this interesting (and hopefully useful) information. She writes:

"As of today, I have a clean bill of health. I still have a panic attack every three months before my check-ups, but I guess it can be expected.

I honestly think there are many more people with the same plan dealing with the same issue. Before my first chemo treatment last year, my oncologist ordered the standard bloodwork to be taken. A few weeks later, I received an invoice from [the lab] stating there was a balance due of $77 dollars for a CEA test. I checked my explanation of benefits statement...and there it was...denied. As so the saga began.

Hours on the phone with BC/BS, numerous letters from myself and from my doctor and three levels of the appeals process...once again left me with "denied."

What amazed me the most was that, during my conference call with the Appeals Board, my doctor told them this test is recognized by Medicare as being the standard for testing during breast cancer treatment. Their comment was it was a "gray area". The doctor said "There is no gray area...this is the standard for breast cancer treatment under national guidelines."

That is when I took the story to Channel 3. It was not a dollar factor. I felt they were denying preventative care.

Many oncologists insist on PET scans, ports, etc. These generate extremely high costs to the insurance companies. I have great veins, so no port was needed and my doctor felt a PET scan at that time was not necessary. They can have too many false positives. Great!! One less surgery and one less bill to the insurance company. I was approved to have a PET scan if needed. My course of preventative care is blood work every three months.

When you look at most insurance policies, they have a cap at about two million dollars. Two million dollars seems like a large amount to most Americans, but if you need re-occuring treatment, it adds up fast.

In comparative speaking....Lets buy the 3 million dollar plane, new condo and a few vacations and then ask for the bailout plan!"

I'll just add a few thoughts. Ms Toplak refers to the policy maximums, and she is quite correct (although many plans now have a $5 million limit). This is an issue with which most folks aren't familiar, but each time one has a covered expense under a given policy, the amount paid for it is deducted from that policy's lifetime max. Obviously, a few doc visits and flu shots aren't going to make much of a dent in that amount, but chemo, radiation and the like definitely will. Just something to keep in the back of our minds.

I'd like to thank Heather Toplak for sharing her story, and Carey Peña for covering it, and wish Heather continued good health.

Death Panels Made Simple

Not to (you should pardon the expression) beat a dead horse, but one of the reasons that "Death Panels" struck such a resounding chord is because of CARS.

Hunh?

We've all watched the past few weeks while the gummint's ill-advised (and even more poorly implemented) program to turn perfectly serviceable older vehicles into new car sales has itself been traded in. Of course, no one called the program by it's actual name: the Consumer Assistance to Recycle and Save Act of 2009 (CARS). No, we immediately glommed onto the completely unauthorized and unofficial term "cash for clunkers." I defy any reader to find that term in the enabling legislation.

I'll save you some time: it ain't in there.

But that didn't make the program any less well-known or "successful." The reason it became such a joke is precisely because that new title became an unstoppable meme, with the added bonus that it happened to be spot-on accurate.

And that is exactly why "Death Panel" was effective: it accurately summarized the insidious nature of the bill, its intent and implementation, in a way that was instantly understandable and recognizable to the citizenry. They saw how the government viewed serviceable vehicles creeping past their prime, listened to Ezekiel Emanuel (Rahmbo's brother, and an advisor to the president) when he wrote that "health care should be rationed in a way that “promot[es] and reward[s] social usefulness,” [<- 6/30/10: new, working link] and that age could play a factor in determining who can and cannot access health-care resources."

It's really a very small and valid leap from there to "Death Panels."

Of course the term itself never shows up in the bill; what boots it? There were no shadowy, hooded figures coming out to announce "sorry, Mr Smith, you're denied." Such verbiage was unnecessary: all that was necessary was to pass the concept (just as the term "cash for clunkers" is nowhere to be found in HR1550).

And just how has C4C worked out? Well, it's run out of money (even with an extension) and is due to be shut down in a few days. In the meantime, it's left in its brief wake thousands of now useless vehicles (which can't even be scavenged for parts or donated to charity), thousand of dealers who have no idea when (or, perhaps, even if) they'll be paid, and a public which sees first-hand how ObamaCare can be expected to perform.

Not a pretty picture.

Knee deep? Waist deep? Neck Deep?

The cost of medical care in the U.S. is the real reason medical insurance costs so much.

Because the care is expensive and its cost is growing, the insurance is expensive and its cost is growing. As a result, there are more and more Americans whose access to medical care is limited because they are uninsured.

Very high quality medical care is delivered in Western Europe and in places all over the world, at much less cost vs. the U.S. Why can’t that be done here? That is the key question – and please note this is a medical cost question, not an insurance cost question.

Achieving real economies in medical cost should be a central objective of reform. But the administration doesn't seem to be looking there.

In fact, the administration can't seem to explain in straightforward terms, what it is trying to accomplish and why. First we were told it was health care reform. Now they say it's health insurance reform. First the motivation was to help the uninsured – plus or minus 15% of the population. Now we see Congress intends to control 100%. First we’re told we can keep the coverage we have. Now it appears we cannot. First we have Section 1233 of HR3200 that no Congressman or Senator or administration official could explain. Now the administration promises to pull Section 1233 from the Bill (as if that will change anything). First Obama told us his proposals were necessary to save the economy. Now CBO has shown that all the bills currently being discussed will increase the deficit. So now the economic argument for reform is set aside in favor of a moral and ethical imperative. First Obama demanded a bill be passed by August - a deadline that foreclosed meaningful Congressional debate. Now we are told that the public is obstructing debate in the Town Hall meetings - as though the administration suddenly decided on July 31 that debate is worthwhile. And of course this administration assured us from the beginning that it will unite us around hope and change we can believe in. Now we see the leaders in this administration descending into ugly name-calling and vilification of ordinary citizens for exercising their right to speak up and speak out.

What do you see? I see an administration and Congress who have failed to figure out what they want, or to to explain to us what they are trying to do in any but highly generalized and uninformative terms. Nevertheless, the administration and Congress seem less interested in listening to the public, and more determined to discredit public opinion, while they doggedly forge ahead with their plans anyway.

“We’re knee-deep in the big muddy but the big fool said to push on.”

Why we need real physician leadership

Physicians for a National Health Program, or PNHP, is self-described as “a non-profit research and education organization of 17,000 physicians, medical students and health professionals who support single-payer national health insurance”.

I recently went to the PNHP site. I read their mission statement. Now I feel sick.

In their mission statement, here's what PNHP says guides them:

“The U.S. spends twice as much as other industrialized nations on health care”

Yes, the problem is medical care spending. The high cost of medical care is why medical insurance is expensive – but don’t expect PNHP to tell you that.

“Yet our system performs poorly in comparison”

And that, too, is a medical problem. Question: who is responsible for medical care in your home town?

“and still leaves 45.7 million without health coverage”

Kaiser Family Foundation released a study a couple years ago that revealed 65% of the uninsured have incomes below 2X’s the Federal Poverty Limit.

Why has Medicaid failed to protect the poor? Medicaid is the government program expressly established to provide adequate medical insurance for the poor. Why is it not doing so? Why has our government left so many of the poor without access to medical insurance? I think that is a scandal. PNHP won’t tell you this, because PNHP advocates government-controlled medical care for EVERYONE, not just the poor.

Medicaid’s failure is not speculation, it's real. What is speculative is to believe, despite the evident Medicaid failure, that the government would truly manage a universal, single-payer public plan as its advocates promise.

“This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar.”

One of my former jobs was chief of benefits for a very large employer. If I mentioned the name, everyone would instantly recognize it. We worked with Aetna and Blue Cross. Their administrative overheads amounted to about 5% of our annual claim volume. Why is this relevant? Because the 31% number that organizations like PNHP like to throw around is a cherry-picked number – and PNHP presents it dishonestly. It may be the right number for individual insurance. But in my experience it is clearly not the right number for group plans – where most insured Americans are covered. and besides, it defies logic for PNHP to blame the problem of high medical costs on insurance. In fact, the reverse is true.

“Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

Think carefully about this statement. PNHP is not saying any “savings” would be returned to the public. PNHP is saying that such "savings" would be paid to physicians. Aside from increasing physician incomes, this means that the public would pay even more for the expensive medical care we now have.

So PNHP presents nothing that will help solve our principal problem - the high cost of medical care. The public has every right to expect physicians to help solve that problem, not simply to demand more money from us. Sadly, PNHP barely acknowledges that problem, and offers no solution – just more spending.

And this is why we need real physician leadership on health policy.

Two-wheeled Risk (You Want Fries With That?)

[Welcome Industry Radar readers!]

While not strictly an insurance issue, this story does pose some interesting risk-management questions:

"Sarah Gilbert stepped off her bicycle long enough to send one angry tweet via Twitter — and it's changed the way one fast-growing burger chain treats bike riders ... after biking last week into the drive-through of the local Burgerville — an eco-conscious burger chain that even recycles its used cooking oil into biodiesel — she tried to order four cheeseburgers ... She was refused service at the drive-through for, of all things, ordering from a bike."

[ed: we'll table the discussion about the seeming contradiction between eschewing a car for a bike but ordering a cheeseburger instead of a salad]

The gist of the story is that this particular chain, known for its "green policies," banned bike riders from using the drive-through, citing safety concerns. Other national chains also do this, but Burgerville has decided, as a result of Ms Gilbert's experience and response, to delete (or at least modify) that policy. One supposes that's good news, at least for the bicyclists.

But is it sound risk management?

Here's why I ask: if you're on a bike going through the drive-through, aren't you at greater risk of being run-over than if you simply parked the bike out front and walked on in? I don't know the answer to that, and I spent quite some time Googling around trying to find stats to prove the case either way.

No luck; perhaps one of our resourceful readers has access to this info and would be willing to share it?

Of course, this same principle would apply to drive-up ATM's [ed: and BTW, what is it with braille markings on drive-up ATM's? Isn't that oxymoronic?], and I didn't see any stats on that either.

While I understand how riders must feel when they find themselves barred from the drive-up, how big is that lawsuit going to be the first time one gets creamed by a Caddy? Which also begs the question: is this policy driven by insurance company rules as much as common sense?

It's funny how things snowball: when I began to write this post, I had two questions that were still unanswered: one, stats on bikes and drive-throughs and two, whether or not insurance carriers played a role in the "no bike" rule. Since this falls under the general aegis of "P&C," I called on my colleagues in that field. There seems to be a mixed bag of answers: it doesn't appear to be a general industry rule that Wendy's et al post and enforce a "no bikes" rule. There may well be carriers which include that verbiage, but it doesn't seem to be a standard policy clause.

One colleague suggested that it may have to do with the inherent risk of letting people walk up to the window: if they pull a gun and ask for money, they can be gone pretty quickly. If they're in a car, they're likely blocked front and rear (and, of course there's the license plates). There's also a slippery slope here: in my research, I noted that there were at least a few incidents where folks on "Rascals" (motorized wheelchairs) were also turned away, presumably for the same "safety concerns" as the bikers. If Burgerville lets bikers use the drive-through, what can they say to Granny in her Rascal. Or Joe in his "regular" wheelchair?

The other concern regarding safety is this: at drive-through speeds, if my Honda hits your Buick, there are some scrapes and dents, but no one's getting care-flighted. But if my Ford hits you on your Schwinn, there could be some major injuries.

The bottom line, such as one exists here, is that this really isn't as cut-and-dried as it might at first appear. Risk management means taking into account all the variables (or at least as many as possible), and sometimes we don't like the answers.

Cavalcade of Risk #86: Call for submissions

The Political Calculations blog hosts next week's edition. Submissions are due this Monday (the 24th). PC requests that you 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.

HOSTING: We're scheduling fall Cav's now, please let me know if you'd like to host one.

Late Breaking Wonkery

Health Business Blog's David Williams hosts this week's Health Wonk Review. Today's edition of this bi-weekly compendium of all that's wonky is a bit late out of the gate but well worth the wait.

Do check it out.

ObamaCare 2011

"Hundreds of [physicians] in the New York area have withdrawn from the government’s [Public Option] program, citing delays in getting reimbursed by the government, a [provider's] group said Wednesday.

The Greater New York [Medical] Association, which represents [doctors] in the New York metro area, said about half its 425 members have left the program because they cannot afford to offer more [health care]. They’re also worried about getting repaid."

We now return you to regularly scheduled blogging.

Are You on "God's Team?"

PresBo wants you to be:

"We are God's partners in matters of life and death"

Yes, our Spiritual Leader in Chief© really said that in a conference call with some 1000 Rabbis, as he urged them to supplement his bully bimah with their real ones. As an aside, whatever happened to that much vaunted proscription from the left regarding "separation of church and state?"

Or is that only on the right side of the equation?

This little pep talk was especially inappropriate when one considers the overarching Torah commandment to "choose life." This is, of course, in direct contravention to the proposed cuts in Medicare, the rush to rationing, and the inclusion of abortion coverage in the House bill.

Amen?

I Drank WHAT?!

Such were Socrates' (alleged) last words in the best-forgotten film "Real Genius." Apparently, the prototypical Greek sage was also covered by the VA:

"Last year, bureaucrats at the VA's National Center for Ethics in Health Care advocated a 52-page end-of-life planning document, "Your Life, Your Choices" ... Who is the primary author of this workbook? Dr. Robert Pearlman ... a man who in 1996 advocated for physician-assisted suicide in Vacco v. Quill before the U.S. Supreme Court and is known for his support of health-care rationing."

President Bush quickly put the kibosh on that little missive, but it has been, um, resurrected by the Obamastration.

The pamphlet "presents end-of-life choices in a way aimed at steering users toward predetermined conclusions, much like a political "push poll." For example, a worksheet on page 21 lists various scenarios and asks users to then decide whether their own life would be "not worth living."

Is this the model upon which ObamaCare will draw? But of course.

Now, what was that railing against those of us opposed to "Death Panels?"

[Hat Tip: NRO]

It's All Fun and Games - Until Somebody Gets Hurt

There's nothing funny or amusing about our rush to socialized medicine, but that doesn't mean the debate has to be dry or humorless. Want to see how a gummint-run health care system would work? Well, here's your chance:

Can You Make It To The Hospital In Time?

[Hat Tip: Lyndsi Thomas]

Grandma's Throwing AARP Under the Bus

Earlier this summer, we reported that AARP seemed to have no qualms about selling out their own membership. Well, to borrow a phrase, it seems those chickens have come home to roost:

"CBS News has learned that up to 60,000 people have cancelled their AARP memberships since July 1, angered over the group's position on health care."

Ooops.

And they're not just leaving AARP (although AARP seems to have left them): a lot of them are voting with their Social Security checks by joining the conservative-leaning American Seniors Association, and a sweet deal it is, too:

"The American Seniors Association (ASA) invites any American Association of Retired Persons member to mail us your torn AARP card and receive a 2 year- for- 1 year membership with ASA."

That's gonna leave a mark.

AARP's losing some veteran members, too:

"Elaine Guardiani has been with AARP for 14 years, and said, "I'm extremely disappointed in AARP."

Retired nurse Dale Anderson has 12 years with AARP and said, "I don't wanna be connected with AARP."

This is more interesting than it might at first appear: presuming that these folks joined up upon becoming eligible, they're just now hitting the "senior circuit," thus robbing AARP of what would presumably be many years of dues.

And unlike AARP's record of flip-flops on ObamaCare, the ASA is unequivocally agin' it:

"The American Seniors Association is flat-out against President Obama's plan, which calls for $313 billion dollars in Medicare cuts over ten years. The AARP is widely viewed as supporting the President."

Doesn't get any clearer than that.

Can you believe it? Another Insurance Horror!

[Welcome Industry Radar readers!]

According to Congressman Joe Sestak, Democrat of Pennsylvania (Sestak is challenging Senator Spectre for his Senate seat in the 2010 election): “ . . . only 2 percent of claims have been paid and that four of every five applications have been rejected for minor oversight.” Horrible, horrible!

But this horror is NOT another complaint about private-sector medical insurance companies. It’s about the federal cash-for-clunkers program.

Speaking of federal programs – won’t the federales also manage American medical insurance reimbursements, after Congress votes later this year to take control of them? How smoothly can we expect that to go?

Much popular opinion seems to be that after the federal takeover, medical insurers will be prohibited from ever again refusing coverage to anyone. Also, medical insurers will be prohibited from ever again denying a claim. Yet the cash for clunkers programme denies 80% of applications and 98% of claims. Problem is, neither popular opinion nor the cash-for-clunkers outcome has any truthiness to it.

So who can we believe and what can we expect?

If there were an Obi-Wan Kenobi, he would be our only hope - if there were any hope.

Back to School Grand Rounds

The Invisible Illness Week blog hosts this week's roundup of med-posts. Be sure to attend!