Saturday, March 06, 2010

About "Reconciliation" and The Ides of March (+3)

Not. Gonna. Happen.

I'll make this quick [ed: Thank You!]:

On March 18th, the House is scheduled to vote on the Senate's verion of ObamaCare. If that vote passes, then it will go to President Obama for signing, and become the law of the land.

All of the posturing, all of the "oh, we'll fix it in reconciliation" are moot points: once ReidCare is passed in the House, it's "game over, man."

That's why, if you care about the destruction of the world's best health care system, you ought to be making your voice heard now.

Loudly.

Friday, March 05, 2010

Cavalcade of Risk #100 (Yay!): Call for submissions

Russell Hutchinson hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 8th). Russell would like to remind you 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.

We still have April 21st open - would really love a volunteer.

Thursday, March 04, 2010

Your Healthcare is in the mail...

[Welcome Industry Radar readers!]

Let's play a word game:


"The [Federal Healthcare Service] is inching closer to doing something it's discussed for years -- ending Saturday [health care] delivery."

The Post Office is a quasi-government service tasked with delivering the mail, and "[n]either snow nor rain nor heat nor gloom of night stays these couriers from the swift completion of their appointed rounds." Except, of course, if it means going even further into the red. Thus, the current discussion about cutting its actual delivery service by 16%.

[ed: This represents 1/6 of their promised delivery service, just as health care represents 1/6 of the economy. Coincidence?]

What does this have to do with ObamaCare© v?.0? Well, what happens when the shiny new gummint-run health care system isn't so shiny or new anymore, and demand begins to outstrip supply? Simple: just cut out 1/6 of its promised delivery service.

On the one hand, I'm not sure I'd miss the bills and junk mail on my weekends, but that's really not the issue. The real problem is that, by law, only the USPS is allowed to offer daily mail delivery (FedEx, et al can only deliver "packages"). So if I wanted to have mail delivered on Saturday, I couldn't contract with another carrier for that service. I'm just outta luck.

Now, substitute "Marcus Welby" for "Cliff Clavin" and you begin to understand the real problem.

Wednesday, March 03, 2010

Judging Transparency

Here at IB, we think of the term "transparency" as one of personal empowerment: knowing ahead of time how much a medical treatment or procedure will cost. For the Advocate-in-Chief of ObamaCare© v?.0 however, being transparent is about political empowerment, as in:

"The White House just sent out a press release announcing that today President Obama nominated Matheson's brother Scott M. Matheson, Jr. to the United States Court of Appeals for the Tenth Circuit."

And who, you may be wondering, is the antecedent Matheson? Well, that would be Rep Jim Matheson (D-UT), whose previous votes against a government takeover of the world's best health care system President Obama seeks to change. At least Senators Nelson and Landrieu got swag for their states; this is a far more personal form of bribery.

But no less transparent.

That was then, this is...Shut Up! They explained

Back in the day, say 4 or 5 years ago, then-Senator Obama had this to say about the so-called "Reconciliation" track:


[Video courtesy Naked Emporer News]

Fast forward, say 4 or 5 years, and President Obama is singing a different tune:

"White House officials ... suggest that if it is necessary, Democrats will use the controversial "reconciliation" rules requiring only 51 Senate votes to pass the "fix" to the Senate bill, as opposed to the 60 votes to stop a filibuster and proceed to a vote on a bill."

Thanks for clearing that up.

And an Old Dominion Mandate Update, As Well

It seems that the folks in Virginia are embracing "the tech:"

"By a unanimous vote, the Virginia State Legislature yesterday approved SB 675 mandating that health insurers pay for telemedicine services."

Currently, health insurance plans aren't required to cover these kinds of services, even though they may well reduce the cost of health care delivery. It's also a convenience for consumers, since it means one less trip to the doc (and perhaps one less co-pay). While I'm generally not a fan of benefits mandates, this one seems pretty benign and, unlike most (all?) others, could actually reduce health care costs.

This brings to an even dozen the number of states which have adopted this kind of coverage mandate.

Kind of adds a whole new dimension to "take two aspirin and call me in the morning."

[Hat Tip: Alice Watland]

Buckeye Updates: COBRA and CE

Good news for folks on "mini-COBRA" plans: Gov Strickland has signed a bill extending coverage eligibility for an additional 3 months (from 12 to 15).

Meanwhile, licensed agents got some welcome news: our mandatory CE requirements have increased only 17% (to 24 hours every 2 years). And, we now have an Ethics Requirement (previously, Ohio agents were considered so above reproach that this was deemed unncessary). The new regs require three hours of ethics education; there's also a new, mandatory federal background check for new licensees.

[Hat Tip: FoIB Nelson C]

Tuesday, March 02, 2010

Something Different: Job Opportunity (Wonks Only?)

FoIB Julie Ferguson dropped us a note the other day that may be helpful to (at least) one IB reader:

"[W]e’ve been notified of a promising job opening that sounds perfect for one of our health wonks – or for someone you may know in the health policy wonkosphere – check it out:

The University of Pennsylvania’s Leonard Davis Institute for Health Economics (LDI) is seeking an individual who can combine an enthusiasm for the internet’s ability to convey information and guide national discourse with a demonstrated understanding of the nation’s trillion dollar health care system to create and guide a new issues-oriented, web-based environment reflecting the relevance, rigor, and vitality of LDI and its faculty.

The successful candidate will work closely with LDI’s Executive Director and senior members of its faculty to design, implement and develop its web-based product that will attract and inform LDI’s many constituencies including policymakers, thought leaders, the media, health care economists, and other stakeholders. In addition to developing content based on his or her original ideas, this individual will draw upon the work and shape the voices of LDI’s interdisciplinary faculty, as well as include experts outside the University of Pennsylvania to create a lively, informative, and highly-valued web-based periodical.

Bachelor’s degree required and 5+ years experience as a healthcare/health policy communications/marketing with a proven ability to develop and execute web-based projects. The successful candidate will have superior writing, editing, and verbal communication skills, as well as teamwork and project management experience.

For more information, see [CLICK HERE FOR APP] or contact Daniel Polsky."

Grand Rounds is up!

Fellow Buckeye Dr Anonymous presents this week's roundup of great medblog posts. And he's doing it from the home of co-blogger Bob Vineyard (well, not his actual house).

Monday, March 01, 2010

HSA = Hoosier Savings Account?

One of the fundamental problems with the current crop of health care "reform" (including the Wyden-Bennett "Healthy Americans Act") is that they do little or nothing to stem the cost of health care. This is something that's often overlooked as CongressCritters jockey for position (and headlines), and explicitly underscored by Rep Ryan at last week's Noh Theatre Production...er "Summit."

We've chronicled how consumer-centric (aka High Deductible, HSA-compliant) plans can actually reduce the cost of health care, while helping to rein in rising health insurance rates. In a Wall Street Journal article, Indiana Governor (and 2012 dark horse) Mitch Daniels reports on his own state's experience with these plans:

"When I was elected governor of Indiana five years ago, I asked that a consumer-directed health insurance option, or Health Savings Account (HSA), be added to the conventional plans then available to state employees ... What we ... have found is that individually owned and directed health-care coverage has a startlingly positive effect on costs for both employees and the state."

For one thing, there's been an immediate savings of some $8 million for employees who opted for the HSA (into which, by the way, the state plops almost $3000 per participating employee!); as Gov Daniels points out (and as we've noted here at IB), even folks with large claims see a net savings versus "phantom" plans.

Perhaps more importantly, because participants have "skin in the game," they're more likely to take better care of themselves, which is perhaps why "Indiana will save at least $20 million in 2010 because of our high HSA enrollment." The folks at Mercer Consulting (an independent health care and financial services research firm) confirm these tremendous savings, and the positive impact they've had on the cost of both health care and health insurance.

It's gratifying to see yet another example of how these lower cost, higher value health insurance plans may hold the key to solving at least part of the health care equation. Which leaves us wondering why ObamaCare© v?.0 seeks to do away with them.

As FoIB Brian D points out, there's a bigger issue here: if one indeed has a "right" to health care, then one has a corresponding responsibility to pay for it. What's happened with health care "reform" is that the first part of that equation has become a "right to have health care paid for by someone else." That's one of the primary appeals of products like HSA's: one is empowered both financially and morally to pay for one's own care.

Imagine that.

Carnival of Personal Finance is up!

Dan Ray presents this week's roundup of helpful and interesting finance-related posts.

Saturday, February 27, 2010

Lies, Damn Lies, and Health Insurance

So, does lack of health insurance really increase the risk of premature death?

In a word: Nope.

As we've seen, there's no convincing evidence that lack of health insurance correlates to lack of effective care; in fact, certain kinds of health insurance will actually lead to a decreased life expectancy.

Studies which purport to correlate death with lack of health insurance have been routinely debunked, but that hasn't stopped the uber-liberal Urban Institute from continuing to peddle its faux-science:

"[A] new report warned that without comprehensive legislation, more than 275,000 adults nationwide will die over the next decade because of a lack of health insurance. Nearly 14,000 of those deaths would occur in New York State."

Of course, these numbers are based on a previously published (and debunked) study, so there's really no new ground here.

Or is there?

Fellow medblogger Megan McArdle, herself considered "uninsurable" [ed: bet she hasn't asked Bob or Bill for help], questions not just the numbers, but the underlying assumption that lack of health insurance necessarily means lack of health care:

" [W]hen you probe that claim, its accuracy is open to question. Even a rough approximation of how many people die because of lack of health insurance is hard to reach. Quite possibly, lack of health insurance has no more impact on your health than lack of flood insurance."

She points to increased risk factors of those who are uninsured, including smoking and obesity, that could also account for increased mortality independent of insurance status. She also cites research that seems to support the opposite view: that lack of health insurance has no bearing on mortality.

Controversial? Of course, but the numbers support this contention, as well.

Recommended reading.

Friday, February 26, 2010

Fox Alert!

No, not that Fox:

"(CMS) today directed Fox Insurance Company of New York to immediately suspend marketing and enrollment of new members in the organization’s Medicare Part D prescription drug plans."

Seems that the carrier, which markets Part D prescription drug plans, hasn't been playing by the rules.

While I'm not a fan of Part D plans, it's important to recognize that a lot of folks depend on them to help pay for needed medications. If you're a Fox insured, you may want to talk with your local, independent agent about alternatives.

[Hat Tip: CMS Guy Jack Cheevers]

Summing up the "Summit:" Shut up, they explained.

If this weren't so serious, it'd be funny. After all the hype and all the hope, yesterday's advanced bipartisan workshop has yielded this:

"Obama listened politely for six hours, with occasional flashes of temper, but in the end, the message was clear: It’s over. We’re moving forward without Republicans."

Hope they had a nice lunch for a change.

Thursday, February 25, 2010

Live* from the "Summit"

Is Rep Paul Ryan (R-WI) a closet IB reader?

For years, we've been making the case that health care costs drive health insurance costs; in this clip from today's theatrical performance at Blair House, he explains why the President's "plan" does nothing to curb the former (while increasing the latter:




*Well, almost live.

About that "Summit" (ObamaCare© v?.0) ...

The current meme is that this morning's production will be more Kabuki theatre than substance. Personally, I think that's wrong: it's likely to be much more Noh than Kabuki.

In the event, for those of us who work for a living and find ourselves unable to break away, Dr. Robert Goldberg, President of the Center for Medicine in the Public Interest Advance, will be "live-tweeting" the goings on (so you don't have to).

His TwitterPage is here.

Have fun!

[Hat Tip: FoIB Lyndsi Thomas]

Wednesday, February 24, 2010

The Gipper on ObamaCare© v?.0

Someone once noted that the 10 most dangerous words in the English language are:

"I'm from the government, and I'm here to help you."

That would have been Ronald Reagan, who was a staunch supporter of personal responsibility. He was also no fan of gummint run health care:

Cavalcade of Risk #99: Safe Water Edition

Health Business Blog's David Williams interrupts a business trip to bring us this week's roundup of risky posts. From sex to insurance, you're sure to find something interesting.

A Lesson From Japan (via Fresno)

I don't profess to be a mechanical engineer (nor do I play one on TV), but it seems to me that there's a bigger issue in ToyotaGate than may seem obvious to the casual observer: when Transportation Secretary LaHood opined that one should completely avoid driving one's Toyota, sending an alarming signal to Wall Street and Main Street, he did it as one who has a vested interest in harming that automaker. After all, Toyota is a direct competitor of government-owned GM and Chrysler, who consistently rank behind Toyota in the sales department.

What better way to make a dramatic and immediate dent in the Japanese car company than to declare its vehicles unsafe, regardless of the truth (whatever that may be). If a financial advisor recommends a particular stock, for example, he's required to unambiguously disclose the fact that he owns part of the company issuing it. Why isn't someone in LaHood's position required to make the same "full disclosure?"

What does this have to do with insurance?

When the government runs both parts of the health care system - delivery and financing - then it has a vested interest in doing away with its competition. That's especially critical to the financing (insurance) side: as we've pointed out on numerous occasions, one cannot compete with the government.

We already see this in HHS Secretary Shecantbeserious' call for investigating Anthem's rate increases recently in the news. She (or her successor) will be in charge of all such approvals under the president's "plan." And of course many of us remember the joys of price controls.

If (when?) a version of the so-called "Public Option" is implemented, how can carriers hope to compete when the government is the final arbiter?

Scary.

Oy Canada!: Premier Update

Earlier this month, we reported on the Canadian Premier [ed: comparable to our "Governor"] who chose to ignore his country's fine - and FREE! - health care system in favor of one of those evil, greedy American providers. This blatant and unmitigated attack on socialized medicine came at a time when our own country is considering such a system, and undermines our efforts to nationalize our own broken and inadequate health care system.

Even more appalling is the reason this ungrateful pol gave for his decision:

"An unapologetic Danny Williams says he was aware his trip to the United States for heart surgery earlier this month would spark outcry, but he concluded his personal health trumped any public fallout over the controversial decision."

How dare he?!

Impugning the superior - and FREE! - Canadian system just because he wanted effective health care. And it gets worse:

"[H]e went to Miami to have a "minimally invasive" surgery..."

So one can't count on the outstanding - and FREE! - Candian system for even minor ailments?

Please remind me why this would be worth emulating.

Tuesday, February 23, 2010

Obamacare© v?.0: A Quick Update

■ It appears that the president's "plan" does, in fact, include federal funding for abortions.

■ The so-called "grandfather" provision, which was purported to allow one to keep one's current plan, is, in fact, no such thing: the requirements for such plans would render them unaffordable.

■ We haven't really discussed the issue of price controls in the "plan.' While one might consider this a bit odd given our history and theme, it's really not: there's no way to implement it without running up against the brick wall that is McCarran-Ferguson.

Is it dead? Well, we've discussed ZombieCare© before, but I wouldn't be betting the house (or the House) on its passage.

Grand Rounds: It's Alimentary!

Dr Michael Kirsch presents this week's collection of the best medblog posts. It's a lot to digest, but quite satisfying.

Monday, February 22, 2010

Obamacare© v?.0: Um, About Those Taxes....

Remember when Candidate Obama promised that no one who makes under $250k a year would see their taxes increase?

Well, promises were made to be broken:

"The president’s proposal would result in higher implicit tax rates on low-wage workers than the House and Senate bills.

The president’s proposal would result in greater incentives for higher-income workers to drop coverage than under the House and Senate bills. That would cause insurance markets to unravel even faster."

That's the word from FoIB Mike Cannon, Director of Health Policy Studies for the Cato Institute.

For more, click here for a livestream of a new forum detailing Obamacare© v?.0.

CBO Blog: ObamaCare© v?.0

So how much, exactly, is Obamacare© v?.0 going to cost us? The current figure being tossed around is "$950 billion over 10 years," which is some $75 billion over the Senate's Christmas Eve version.

But how accurate is that, really?

Turns out, not so much:

"Therefore, CBO cannot provide a cost estimate for the proposal without additional detail."

Ooops.

Tell me again about that "most transparent administration, evah!"

First Impressions: Much ado...

[NB: Bob’s take is here]

At first glance, the president's "new" health care "reform" proposal is just smoke. We'll address key points in a moment, but first, a question:


Where was this 7 months ago?

Were I a Congresscritter, having just spent the past many months fending off disgruntled constituents and jockeying for position amongst my peers, I'd be mighty steamed about now.

Fortunately, I'm not.

Several things immediately jump out:

■ No mention of federal funds for abortions, pro or con. The House's "Stupak Amendment" is nowhere to be seen, which will make it difficult for pro-life legislators to sign on. On the other hand, neither is such funding explicitly mandated, which will upset pro-abortion backers.

■ The evil and unconstitutional "individual mandate" is, however, present.

The CornHustler deal is officially off the table. No word yet on the "Louisiana Purchase."

■ The so-called "Cadillac Tax" is still there, punishing folks who have no control over the cost of their policies.

■ Finally, please explain to me why we need a massive new entitlement program to "to fight fraud, waste, and abuse in Medicare and Medicaid." Isn't that something we should be doing anyway?

If there's any "good news," it's that the so-called "Public Option" (the not-so-stealthy means to gummint-run health care) is nowhere to be seen.


More later.

[Hat Tip: RedState]

Friday, February 19, 2010

McCarran-Ferguson vs Sebelius

Once again, our dim-bulb Secretary of Health and Human Services has failed her civics test:

"Over the last year, America's largest insurance companies haverequested premium increases of 56 percent in Michigan, 24 percent inConnecticut, 23 percent in Maine, 20 percent in Oregon, and 16 percentin Rhode Island, to name just a few states."

So what?

That's a problem, obviously, for insured folks in those states; who are, fortunately, protected by their states' department of insurance. And that's the beauty of the system: if you don't like how that department's working (or not working), then you vote the suckers out. At some level, they're accountable to the electorate.

Furthermore, she can huff and puff all she wants but, at the end of the day, she has exactly as much authority over the carriers as they're willing to cede to her. It astounds me that their CEO's don't just tell her (and her congressional enablers) that they have zero authority to regulate at this level.

Of course, I'm just an insurance industry shill (but not a shameless one!), so I'm merely touting the company line, right?

Not at all:

"This spat deserves more attention, because its real lesson is what will happen to health insurance costs around the country if ObamaCare passes." [emphasis in original]

Really? How's that?

"Wellpoint's rate hikes are the direct result of the Golden State's insurance regulations—the kind that Democrats want to impose on all 50 states."

Case in point: COBRA subsidies (about which we've written extensively). Prior to ARRA, few people elected COBRA, most opting for individually underwritten (and usually much cheaper) health plans. ARRA essentially paid folks to keep their insurance, and run up claims. This had two major, negative effects: it increased carriers' loss ratios (thereby driving up health insurance costs) and accelerated health care spending (thereby driving up health care costs, which in turn increased health insurance costs). Wow, a two-fer.

Lost in all the publicity-mongering in DC is the fundamental disconnect the policitcal class has with even basic level economics: profits aren't profit margins, and it's the latter that truly count. Does this mean that carriers can't work harder to avoid dramatic premium increases? Of course not, but as long as the public demands first dollar coverage for strep tests and bruised knees, instead of considering high deductible plans, there's not a lot of wiggle room.

As Bob often points out, we don't expect our car insurance to pay for wiper blades and oil changes; just imagine how expensive it would be if it did. I would add only that one needn't imagine the result, one need only look at the current state of health insurance.

Cavalcade of Risk #99: Call for submissions

The Health Business Blog's David Williams hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 22nd). David 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.

BTW, we still have an open hosting slot for April 21st - just
drop us a line to claim it.

Thursday, February 18, 2010

Volunteering for Long Term Care insurance

Although we've discussed LTCi before, it's always been about individuals buying these plans on their own. But that's not the only way one can buy a plan:

"According to Top Trends in Voluntary Benefits, a study conducted in 2009 ... revealed that 84% of employer-respondents indicated that they offer voluntary benefits ... Long-term care insurance placed third in the survey, with 51% of participating companies offering the coverage."

The idea is that one can purchase a policy on a perhaps more favorable basis this way (carriers often relax underwriting rules and offer discounted premiums for worksite products). There's also the perceived advantage of payroll deduction for your premiums, so you that don't have to write another check each month (or year).

The downside to these kinds of plans is that they offer a limited choice of benefits, and not all of these plans may be "portable" (that is, that one can keep the plan if one leaves that employer). Another thing to check when considering a worksite type plan is whether or no it's Partnership Compliant, which I believe will become more and more important as time goes on.

Still, it's certainly a viable option, and one to at least consider.

[Hat Tip: John Hancock Life]

Once Again, Facts Trump (DC) Fantasy

Consider this graph:


Again, the light blue line represents what the gummint told us would happen if we didn't hurry up and pass the Spendulus; the dark blue represents how well the Spendulus was supposed to work, and the red line shows what really happened. Not a pretty picture.

And these folks want to run our health care system?

Somebody definitely inhaled.

Health Wonk Review: Relationships edition

Where can you find Kermit the Frog and Phil the Doctor discussing health care wonkery? At Brady Augustine's place, there's where!

Wednesday, February 17, 2010

Estate Tax, Estate Tax, Wherefore Art Thou?

Used to be, when one died with more than a few dollars in the bank, there would be an estate tax payable to Uncle Sam. Calculating in advance what that would be was, in fact, more art than science, but was an integral part of the estate planning process. Often, if an estate was sizeable enough, some form of life insurance would become part of the overall plan, since it would provide immediate and inexpensive dollars to pay the taxes due.

This year, there is no estate tax in place - at least not yet. The previous legislation expired, and Congress has yet to get around to replacing it (a sure bet, since dead folks don't complain). The problem is, no one knows if or when such legislation will be enacted, and whether or not it will be retroactive back to the first of this year [ed: I have a bridge in Brooklyn to sell to anyone betting against it]. In the face of uncertainty, then, what's one to do?

According to U S News and World Report, this failure to act "has moved from an oversight and embarrassment to a growing real-world problem. To recap: the estate tax was reduced over the past decade in a 2001 law that said estate taxes would disappear totally in 2010, and then return in 2011 in a very punitive form."

So is it a good idea to die in 2010?

Probably not (at least not any better than any other year): there's a little known but potentially devastating twist that seems to have gone under a lot of folks' radars: previously, beneficiaries ("heirs") were able to declare the value of that which they received on a "stepped up basis." That is, they would receive, say, a piece of land that was worth $1 million when their benefactor died, and their ownership would begin at that $1 million mark, not the $35,000 grandpa had paid for it:

"But as part of the end of the estate tax this year, this treatment of assets also was ended. Now, the value of the estate is subject to tax on the difference between its current market value and the value when it was originally obtained by the estate holder."

Ouch!

So absent either clear guidance on how estate taxes (if any) will be calculated, and absent this rather valuable treatment of proceeds received from someone's estate, a number of new issues arise: namely, how does one even begin to calculate how much to set aside (or insure) for potential estate taxes? And another, less obvious question, brought to my attention from the Director of Advanced Sales from a well-respected life insurer:

"No one knows what to advise a client to do. I've read several articles that advise anyone appointed executor of an estate to decline it. Then the court would have to appoint someone ... and then if that person declines [what then]? Don't know what would happen if the court couldn't find anyone to accept the job and the personal liability that goes with it."

Indeed.

[Hat Tip: FoIB Brian D]

Headache AND Breast Cancer Relief

Is there anything that aspirin can't do?

"Breast cancer survivors who take aspirin regularly may be less likely to die or have their cancer return, U.S. researchers reported Tuesday."

I think the first part of that sentence is incorrect: after all, isn't everyone's chance of dying 100%? Still, it's good to know that, in addition to staving off strokes and heart attacks, the lowly and inexpensive acetylsalicylic acid can help extend the lives of breast cancer patients and survivors.

Shame on the MVNHS©!

It's been a while since we've mentioned the failing (failed?) Much Vaunted National Health System:

"Information released by the ­Department of Health after a freedom of information request showed that hospitals were not complying with safety alerts issued by the National Patient Safety Agency (NPSA)."

The problem is that, while the British health system may talk a good game, implementing even such basic level services as patient safety seems beyond their ken. In this case, over 100 hospitals and other health care providers have yet to show that they've complied with a 2007 alert mandating them to make sure that injectables would be used safely.

But that's not all: over two dozen providers haven't confirmed their compliance with a directive "designed to reduce the risk of patients ­falling out of bed." And over 80 hospitals and providers had failed to take "required actions" outlined in patient safety alerts covering opioid (painkilling) medicines."

And even that's not all: some 50 hospitals haven't even figured out that keeping providers' hands clean reduces the number of patient infections.

Louis Pasteur is whirling dervishly in his grave.

Tuesday, February 16, 2010

What's the Billing Code for "Red Hot Lover?"

It's one thing for a physician to carry on an illicit love affair with a patient. While unethical and potentially dangerous, it's at least possible to understand the motivation. But in a case that redefines the term "chutzpah:"

"Dr. Daniel R. Lerom is listed in documents as having a long-standing sexual relationship with his Lakeland patient ... Each time the two had sex ... the doctor would bill her Blue Cross Blue Shield Insurance for their "sessions."

Oy.

Talk about overutilization!

No word yet from our Guru on whether this would qualify for reimbursement under an HSA or Flex Plan.

[Hat Tip: Ace of Spades]

A Good Deal, or Another Unethical Scam?

We've written before about both variable annuities and stranger-owned life insurance (SOLI), but some enterprising (?) investor types have figured out a new twist that combines these seemingly disparate vehicles:

"Terminal Illness? $2,000 in CASH, Immediately Available." ... "He recruited dozens of terminally ill people to, in effect, serve as paid fronts for purchases of the product, variable annuities."

Here's how it (allegedly) works:

The concept behind SOLI was relatively simple: offer to buy, and pay the premiums for, someone's life insurance policy. The insured reaped a quick and easy profit, and the buyer reaped one later (when the insured died). This perhaps typifies the concept of "moral hazard," but that's another post.

In the case of variable annuities, many (most?) such contracts contain a guarantee that one (or one's beneficiaries) will receive at least the amount originally invested. While this sounds a lot like life insurance, it's really not, because - in theory - there's no underwriting.

That is, the basic qualifications are a pulse and a checkbook. And the former need not be as strong as the latter:

"Because the products are sold primarily as investments, insurers generally don't ask about the health of the "annuitant," the person whose death triggers the death benefit."

Adding insult to injury (metaphorically speaking, of course), "some don't seek information about the buyer's relationship to this annuitant."

Since it's not technically an insurance policy (although it is an insurance product), the principle of "insured interest" doesn't seem to apply.

Generally, these products are bought as long term "investments," allowing the carrier to recoup potential losses. But if the buyer is, um, not long for this world, it could mean a very short term contract. And it's essentially no-lose for the "investor": if the underlying "investment" tanks, there's the death benefit guarantee. And if it does well, well...

And of course the agent (literally) who arranged the sale makes a nice commission (7.5% or more).

What makes this even more ghoulish is that the folks pushing the idea often promote it as endorsed by a particular faith. For example, one participant (it's really difficult to call her a "victim," since she profited, as well) was dying from stomach cancer when she "saw a flier from what appeared to be a Catholic charity, says her husband, Dan. Mr. Bulpitt says the family of four was on food stamps after he quit his auto-dealership job to care for his wife." She and her family received some $8,000 for her participation.

After the annuity was issued, someone (it's not clear whom, but obviously it wasn't the Bulpitt's) dropped a cool $1 million into it. When Mrs B died a few months later, the stock market had taken a tumble, and the value of her annuity was shy $13,000, which the carrier had to pony up. The only real "loser" here, of course, was the carrier; the Bulpitt's, the agent and the mysterious buyer all made out just fine.

To some extent, this is a function of how annuities have traditionally been built. The other side of the coin is that these same carriers routinely double-dip themselves: they price their life products to penalize smokers, but don't offer their smoker annuitants extra vig for a shorter expected lifespan.

One supposes that the ones with the most to lose in this equation are the stockholders of the carriers who've been targeted.

In the event, the The National Conference of Insurance Legislators is set to discuss this latest "twist" at their upcoming confab. It will be interesting to see what, if anything, they're prepared to do about it.

Or can.

Grand Rounds: The Hospital Edition

The ACP Hospitalist blog presents this week's collection of great medblog posts.

Monday, February 15, 2010

Carnival of Personal Finance: Fiscally Faulty Famous Families edition

Len Penzo presents this week's roundup of financial responsibility (and irresponsibility) posts, featuring (among others) Mike Brady and Carrie Bradshaw.

Sunday, February 14, 2010

Health Insurance Costs Increase: One More Reason

"Lost the remote control and can't be bothered to get up to change the channel on the TV? Don't worry, you're not lazy, you simply have sluggish cognitive tempo disorder."

Yup, you're not a "couch potato," you're a "low energy reclining unit."

The American Psychological Association, which compiles and publishes the "Diagnostics and Statistical Manual of Mental Disorders," even thinks that incessant whining is a mental disorder, worthy of therapy and treatment.

As opposed to just, you know, "dealing with it."

Of course, now that everyday travails merit diagnosis of mental illness, more meds will be dispensed - paid for by your insurance company, increasing utilization and, of course, rates.

Just how valuable are these new diagnoses?

"Richard Bentall, professor of clinical psychology at Bangor University, said: 'Most of these diagnoses are meaningless and have no basis in science.

'But the more disorders there are, the more private business psychiatrists get.'"

Give the man a cheroot.

[Hat Tip: Ace of Spades]

Saturday, February 13, 2010

Genetics and ESRD: An Israeli Breakthrough?

End Stage Renal Disease (ESRD) afflicts some 40 million Americans; of thse, some half million are considered terminal. Interestingly, "African and Hispanic Americans [are at] a double-to-quadruple risk for the disease, compared to Caucasians of European ancestry."

But that may all change:

"An Israeli research team ... has discovered new genetic data on a DNA region that could predict who will develop end-stage kidney disease."

Knowing what causes the dread disease is a first step towards developing a treatment protocol for it, and (perhaps) a cure.

Good news.

Friday, February 12, 2010

How Much Do You (Really) Need?

Recently a client asked me about increasing his life insurance coverage. As a retiree, his former employer had offered him the opportunity to purchase additional group term life coverage. I have some reservations about Group Term Life (GTL) in general, but that's another post. Suffice it to say that it offers a seemingly inexpensive way to buy more life insurance, which is a good thing.

Or is it?

Let's step back and look at what this offer really means.

First, some facts about the GTL plan offered to - let's call him Sam. Sam's in his early 60's, quite healthy and active. The plan he was offered was for $50,000 of group term insurance on a guaranteed issue basis (i.e. no medical questions, he can't be turned down). The initial rate would increase by about 50% per thousand dollars of coverage once he hit age 65. Sam asked if I could offer something comparable.

I replied that I would be happy to look around for him, but that I wasn't aware of any carrier that would offer him a guaranteed issue plan such as this one on an individual basis. At the very least, there would be some health questions. I also pointed out that the flip side of this is that, since the GTL plan takes everyone, regardless of their health, it should be easy to find a less expensive alternative; certainly one that didn't double its rates in less than five years.

Sam responded by telling me that the GTL rates increase again at age 70 by about two and a half times, while the benefit itself decreased by half. Ouch! As he pointed out, "so $50,000 of coverage costs 2.5 times as much at age 70 and results in only $25,000 of coverage. Not a great deal!"

Not much one can add to that.

But that still wasn't the most important point Sam made. In the very next sentence, he hit the nail squarely on the head: "You know the real question is how much coverage do you need? If I were to pass away today, the coverage we have is adequate to cover all of our debt. That would leave [my wife] with her current income, her pension when she retires, my social security survivor benefits, her social security, my pension survivor benefits ... and our savings/investments."

And that's the $64,000 question: How much life insurance does one need?

It's often considered blasphemy to state that a client (or potential client) has "enough life insurance," but I think that, rare as it may be, some folks do, in fact, have "enough." As agents, we're always tempted to suggest more, but the reality is that there really is a point at which it's just not necessary. For my more mature (isn't that so much nicer than "older?") clients, I suggest looking at all the things Sam mentioned, plus whatever final expenses might be, and whether or not there's a need to cover estate planning issues. And take a look at your current policies to see if they're sufficient - they may well be.

Of course, the other side of that coin is that I've never had someone reject a claim check because his/her spouse had "too much insurance, and I really don't need or want any more money."

In the event, Sam's still trying to decide whether or not he needs additional coverage. Whatever the outcome, he's done himself (and perhaps others) a real service by asking that most important question.

Thursday, February 11, 2010

And *Another* PSA: Preventable Infections

One of the primary reasons that health insurance costs rise is because health care costs do. And one way to reduce the cost of health care (and thus health insurance) is to stay healthy. As I was reminded by Barbara Dunn of Kimberly-Clark-sponsored HAI Watch. Barbara tells us that their "goal is to eliminate these preventable illnesses and their often tragic consequences."

Learn more about how you can help prevent the spread of potentially deadly infections by clicking over to HAI Watch now.

Special Announcement: TeamUSA @ The Olympics

Got this in email from TeamUSA's Liza Peiffer:

"This Friday February 12, the world will gather to watch top athletes from around the globe compete in the Winter Olympic Games in Vancouver. Our athletes from Team USA ... will take the stage to represent our country. I'm hoping that you could share the news about Team USA with the readers of Insure Blog to get some excitement going.

Anyone who registers on Teamusa.org will have access to the latest info and will receive exclusive updates throughout the games. I've put all that information including some Team USA widgets and banners into this social media news release
."

Let's support our great athletes. Thanks!

Is "Heavy" the "New Normal?"

[Welcome Industry Radar readers!]

Last fall, Mike reported that the MVNHS© really doesn't like moms (new or otherwise) with a little meat on them. In fact, the compassionate folks who run Britain's national health care system actually removed children from the home of one zaftig mamma.

Did they go overboard?

Well, according to researchers Down Under, "an average 140-pound woman gained 20 pounds across 10 years if she had a baby and a partner; 15 pounds if she had a partner but no baby; and 11 pounds if she were childless and without a partner."

In other words, it's apparently perfectly normal for mom's (married or otherwise) to gain a few pounds. Whether that's by design or happenstance, it's potentially good news for a lot of folks.

Wednesday, February 10, 2010

We'll Take a Pass: Piling on

Last week, we reported that both Louisiana and Virginia are planning to opt themselves out of ObamaCare©.

Well, you can now add The Gem State to the (growing) list:

"The "Health Freedom Act" ... would require Idaho to sue the federal government over any health insurance mandates."

It's passed the Idaho House, and now heads for that state's Senate. We'll keep you posted.

When is a Death Benefit (not) a Death Benefit?

Most life insurance policies pay a death benefit when one dies, regardless of cause (absent fraud, of course). Some plans include an "accidental death" rider, which doubles the amount paid in the event of death due to an accidental injury.

[ed: I've never understood the appeal of such a rider: how likely is it that a surviving spouse needs twice as much money if one's hit by a bus instead of dying slowly of cancer?]

And there are some policies which only pay if one dies an accidental death: called "accident plans," these are usually inexpensive (for good reason) because they don't have to pay out after, say, a long and expensive illness. Again, I fail to see the value in such plans, but folks do buy them.

Which brings us to the topic at hand: what, exactly, defines an "accidental death?"

"Your spouse goes into the hospital for surgery and winds up dead ... Are you entitled to collect?"

According to a judge in New York, "yes." In this case, a woman went in for surgery, the gas-passer screwed up, and she died of complications. The judge determined that this met the definition of "accidental death."

His is not the last word: other jurisdictions have ruled the opposite.

What do you think?



(Poll open until 2/28/10)

[Hat Tip: FoIB Fred W]

Cavalcade of Risk #98 is up!

Tuesday, February 09, 2010

Early February NewsLinx

Patrick Paule sent us this link to an interesting - if infuriating - story on how the Obamastration has decided, against all precedent, to ignore the recommendations of Medicare Trustees.

Why should you care?

Well, the Trustees' projections regarding the long-term growth of health care costs underpins its own projections, and ignoring it in the budget is a recipe for potential disaster.

■ Over the weekend, the Wall Street Journal had an interview with WellPoint CEO Angela Braly. WP is currently the "largest U.S. commercial health insurer by membership ... [its] affiliated health plans in 14 states cover 34 million people—or roughly one out of nine Americans."

They also contract with some 8 in 10 of our country's primary care doc's, as well as more than 9 in 10 of its hospitals. That's a lot of providers. By contrast, Medicare can boast of only about 75% of physicians.

Ms Braly must be a closet IB reader, as she concludes (quite correctly) that "[h]ealth-care reform" soon became "health-insurance reform" exclusively. It was a pivot that was—unfortunate ... because it is not going to solve the longer-term problem."

Indeed.

■ Late last week, we received an "embargoed" news item from CMS (the gummint agency responsible for Medicare and other programs). We honored their request, and held off reporting this rather startling news:

"Growth in national health expenditures (NHE) in the United States is expected to have increased faster than the growth in the Gross Domestic Product (GDP) last year."

On the other hand:

"The projected acceleration in growth for 2009 was due in part to faster spending growth for the Medicaid program ... reflecting increasing growth in enrollment associated with the recession. Also contributing to the acceleration was faster growth in the use of a variety of health care services as many sought treatment for the H1N1 virus and an expected increase in the take-up rate for coverage provided through ... (COBRA) in response to the government's subsidization of COBRA premiums."

So let's get this straight: health care costs rose because more people sought treatment, and health expenditures rose because more people lost their jobs and looked to the (few?) remaining taxpayers to subsidize their health insurance costs?

Yet we have folks who think that having the government actually run the entire health care delivery and financing system would solve the problem?

What's in the water?

COBRA/ARRA Extension Update

We'd be remiss if we failed to remind folks that the famed COBRA/ARRA Subsidy has been extended (along with more and more folks' status as unemployed), The good news for those affected is that "[e]ligibility for the subsidy now runs through Feb. 28 ... and the duration of the subsidy can be up to 15 months. For state continuation, the length of the subsidy period depends on a particular state’s current continuation legislation. "

That last refers to states with so-called "mini-COBRA" regs.

There are, of course, a lot of reasons to stay on COBRA when one's (former) employer is footing most of the bill; still, if one is healthy, it's usually best to get off of such a plan as quickly as possible (again, taking the subsidy into account). It's a shame that there's no mechanism to, well, pay folks to get their own plans.

Unless I'm missing something?

[Hat Tip: UHC]

Grand Rounds: Thoughtful Edition

Dr Edwin Leap jumps into his edition of this weekly roundup of the best medblog posts with enthusiasm and insight. Well done.

Monday, February 08, 2010

Prescient Carrier Tricks

Today's McPaper reports that almost 3 years ago, State Farm warned the Feds that there seemed to be some "sudden acceleration" issues with some Toyota and Lexus models. The Bloomington, Illinois-based insurance behemoth "notified NHTSA in late 2007 that it was seeing an increase in sudden acceleration trends with other" vehicles from the Japanese automaker.

A decade before that, State Farm also led the way in "identifying the increasing trend of tire tread separation" which then plagued Ford and Firestone.

Kudos, Good Neighbor©!

Pre-paid Death Taxes?

One of the varied uses of permanent life insurance is to pay estate taxes at a discount (since insurance dollars never cost as much as "real" ones). FoIB Joe Kristan takes that a step further, reporting on a proposal that would allow non-dead (not to be confused with "The UnDead," or the Grateful Dead) to prepay their estimated "death taxes."

Interesting proposition, and definitely worth reading.

Saturday, February 06, 2010

Ethical Conundrum or Disgusting Scam?

"A Dignitas doctor in Zurich reviewed the Peninous' case and agreed to write a prescription for sodium pentobarbital, the lethal drug typically used for assisted suicides ... They paid Dignitas its fee of ($10,500).

The suicides took place not in a private medical facility, but in an industrial space next to a large brothel ... just two spare rooms without a bathroom. He says two Dignitas volunteers, neither a doctor, helped prepare the couple. There was just one single bed, forcing Mr. Peninou to sit in a chair near his wife when the couple took the lethal dose."

I realize that this is a lot of quoting without much comment (so far), but please bear with me just a bit longer:

"[Ludwig Minelli, founder of Dignitas] argues that anyone—the chronically ill, the mentally ill or those who are simply tired of living—deserves help to end it all."

"Chronically" ill? "Tired of living?" These are legitimate, justifiable reasons to encourage folks to commit suicide?

Or are they, instead, a sales pitch for a few dollars worth of chemicals?

I know what I think.

Tranny Deduction Update

Several summers ago, we wrote about a "57-year-old suburban Boston man [who] underwent a sex-change operation ... wrote off the $25,000 in medical expenses on her [his?] taxes ... But the IRS disallowed the deduction."

Flashing forward [ed: was that really necessary?], we learn that the "U.S. Tax Court ruled Tuesday that a Massachusetts woman should be allowed to deduct the costs of her sex-change operation."

While this may well have "broad implications for transgender people" (and again, do they really need to use the term "broad?"), it has even, um, broader implications for transgender folks who also have an "alternative benefit" plan (HSA, HRA, FSA). The general rule of thumb is that, if its deductable on your taxes, it's eligible for tax-advantaged reimbursement under these plans [ed: the relevant controlling authority is IRS form 213(d), which appears not to have been updated - yet - to reflect this new reality]. If that's the case, then it seems to me that we now have a whole new demographic that should be clamoring against a gummint-run health care system that would do away with many of these benefits.

Friday, February 05, 2010

Cavalcade of Risk #98: Call for submissions

John Leppard, proprietor of Healthcare Manumission, hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 8th).

John 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.

Mortgage Insurance: Old vs New

Back in the day, agents routinely sold "decreasing term life insurance" plans to help their clients' beneficiaries pay off a mortgage. The plan, written to coincide (generally) with the number of years on a given mortgage, had a fixed premium but a declining face amount. The idea was that, as the mortgage balance declined, so would the policy.

The most obvious problem with this approach was that the policy actually became more and more expensive with each passing year, as the same premium pruchased less and less protection. There were other problems with these plans, as well, but they remained a commonly used tool for a long while.

Today, we often use some kind of permanent plan (such as Universal Life) or "regular" term plan to cover mortgages. In fact, we often don't sell separate policies to cover a mortgage, but simply include it as part of a comprehensive package.

The problem with this approach is that it still only covers one risk: death. Of course, some people (but not nearly enough) own disability insurance, which can help pay the mortgage in the event that one becomes disabled. Another approach, which is currently being touted by Assurity Life, is to couple a Critical Illness benefit with a life insurance plan. In a video the carrier recently sent to its agents, Ken Smith (Director of Health Products) explained why this may be a good idea:

[ed: the video was distributed "for agent use only," so I can't embed or link to it here. I'll do my best to pass along Mr Smith's "pitch"]

Something like 25% of folks in the UK own a critical illness policy; of those, over 60% bought their plan as a means of covering their mortgage. After all, what's more likely to happen before one reaches age 65, death or a critical illness? Folks with life insurance protection only could face a very unpleasant surprise if they're diagnosed with cancer or have a stroke. Either of these would mean some major time off work, and an increased risk of losing the house while still very much alive.

According to Mr Smith, the cost of the additional protection is usually "less than the cost of a cup of coffee a day."

It was unclear to me whether Mr Smith was discussing a critical illness policy with a death benefit, or a life insurance policy with a critical illness benefit. I'm not aware of any life insurance plans already in force to which one could add a critical illness rider. Likewise, most CI plans don't have a death benefit. So, what's one to do?

Well, if one currently has neither, then a combination plan may be the best best. If one already owns the "old fashioned" kind of mortgage insurance (e.g. term life), then supplementing that with a separate CI plan may be the best bet. Either way, your first stop should be with a professional, independent agent who can help you sort out your options. It's one more way that insurance can help manage risk.

Why You Need Disability Insurance

'Nuff said:

Thursday, February 04, 2010

Health Wonk Review is up...

Managed Care Matters' Joe Paduda hosts this week's compendium of all that's wonky in the wild, wild world of health policy and polity. It's a little late, but Joe does a great job of explaining why each post merits inclusion.

Do check it out.

Health News: (Don't) Make a Run for it!

For folks caught up in the fitness craze (and you know who you are!), there's something you should know:

"Researchers have discovered that the health benefits of aerobic exercise are determined by our genes - and can vary substantially between individuals."

Dang!

Turns out that, at least according to English researchers at the Royal Veterinary College [ed: so, are they talking about running dogs or running people?], about 1 in 5 of us get essentially no fitness benefit from excercising regularly. Which is not to say that it's necessarily a waste of time, but it does call into question some assumptions about health insurance programs that incentivize folks to excercise on a regular basis.

Wednesday, February 03, 2010

PSA: Toyota Owners' Alert [UPDATED]

While not strictly insurance related, folks whose Toyotas are affected by the recent recall are being urged not to drive them until they've been corrected:

"Department of Transportation Secretary Ray LaHood told lawmakers Wednesday that Toyota owners should stop driving cars affected by the recall and bring them back to the company."

This seems to me a pretty simple risk:benefit calculation (although it remains unclear how one is supposed to avoid driving a car and yet still deliver it to the dealer for service).

UPDATE (via Michelle Malkin): Secretary LaHood has now "walked back" his previous advice, explaining that "“What I said ... was obviously a misstatement ... My advice is if you have one of these vehicles, if you are in doubt, take it to the dealership today.”

Oh, well, never mind.

Ms Malkin also makes an important point about the inherent conflict of interest between a (largely) successful car company (Toyota) and those which the gummint now owns (GM, Chrysler). In fact, it is to Mr LaHood's advantage that Toyota's current problems may cause a decline in their fortunes; surely GM and Chrysler would benefit from a Toyota sales slump.

Which brings us to the larger point: a private sector company can not compete with the government. This is a lesson that must not be lost on those who continue to believe that a gummint-run health care system can coexist with a private sector one.

Sushi and Insurance

"The country is is straining under the twin burdens of an aging population and rising health care costs. At some point in the next two decades, retirees will outnumber active workers. Medical expenses per person have almost doubled since the 1990s and continue to rise."

Quick, to which country does the above quote refer?

If you guessed the US, you're not wrong, but you're not right, either:

Evan Falchuk, who provided us with the groundbreaking graph on health care costs and coverage around the globe, is referring here to Japan. Seems that this highly homogenous, incredibly ingenious, resolutely resourceful nation has much the same trouble with health care that we do. And even though their system is of the "universal" model, they have had little success is either curbing runaway health care costs or providing appropriate and timely delivery of care.

The whole article is well worth reading, but for me, the takeaway (carryout?) is simply this: "The equitable and affordable distribution of health care services is a problem across the globe."

That is, those who tout "universal" health care systems may think they're promising better, more affordable health care to a greater number of people, but they couldn't be more wrong.

[Hat Tip: Dr Val]

Tuesday, February 02, 2010

Beating a Dead Horse?

[Welcome Kaiser Health News readers!]

I remain unconvinced that the current version of health care "reform" (aka ObamaCare©) is dead. As noted previously, its zombie-like nature almost precludes its actual demise, no matter how bad a beating its proponents seem willing to take to "make it happen."

On the other hand, evidence continues to mount that it may soon find itself "under the bus," as even its most outspoken advocates begin to understand just how politically toxic it's become:

"They were right the first time,” said Lawrence O’Donnell, the Democratic staff director for the Senate Finance Committee during the 1993-94 Clinton health care debate. “There’s no such thing as ‘Let’s take a pause in legislating so that we can gain momentum on it ... Democrats have moved into “full bluff mode.”

Ouch. Them's harsh words, Mister. But is it possible that they're also true?

Time, of course, will tell. And there will be the temptation to continue the shady, backroom shenigans that have become the hallmark of this particular legislative effort. And just as with the zombie menace, it's important to remember that there are only a few ways to be sure that it stays dead.

2009 MedBlog Awards: Finalists Announced [Bumped & Updated]

UPDATE: There's now a direct link for voting. Please click here and cast your vote for the Covert Rationing Blog.

This year's nominees include a number of blogs with which I'm not familiar, and one of which I'm a big fan. The Covert Rationing Blog, penned with delicious snark and good humor by DrRich, is a finalist in the "Best Health Policies/Ethics Weblog." If you vote for no other contender (and I'm not suggesting that you do), please consider casting a vote (or three) for DrRich (and no, that's not a typo).

Still not convinced?

Then read this and then go vote.

Oy Canada! Medical Tourism Part ??

Previously, we reported on Canadian Member of Parliament Belinda Stronach, whose fight with breast cancer led her to California for life-saving surgery.

Now, in a blatant attempt to derail ObamaCare©, Canadian Premier Danny Williams has chosen to circumvent the obviously superior (and free!) Canadian health care system, by flying to the United States for heart surgery, which is widely and freely available in his home country.

Right?

So again we'll ask: Why do President Obama, Sen Harry Reid and Rep Nancy Pelosi hate Canadians?

[Hat Tip: RedState]

Include Me Out...

As we've previously averred, the so-called "Individual mandate" is evil. That is, it flies in the face of well over 200 years of settled Constitutional law, and has no place in any discussion of health care "reform."

And, apparently, the legislatures of (at least) two states agree with us:

"Louisiana State Senator A.G. Crowe (R, Slidell) is introducing a bill for the 2010 legislative session in Baton Rouge that would make Obamacare illegal if it violates state laws, effectively making Obamacare null and void in the Pelican State."

He contends that the law would, in effect, render any such mandate as null and void.

Dead on arrival, if you prefer.

Meanwhile, " the Virginia Senate today passed a Republican measure that says Virginians don't have to buy health insurance."

What's notable here is that, although the bill is touted as a Republican effort, the Old Dominion's state senate is under the (nominal) control of the Democrats. The point is, this is an almost-textbook example of bipartisanship, something that's been sorely lacking in the national "debate" on the issue.

It will be interesting to see how the Supreme Court resolves this obvious conflict between the current administration and the 10th Amendment.