Don't get sick on the MVNHS©

One of the more odious aspects of rationed care is that, just like at the deli, waiting on line until one's number is called can be tedious. Unlike the line at the deli, of course, is what's at stake while you're tapping your feet:

"The most seriously ill patients in the NHS have become the victims of “neglect” as surgeons are forced to focus on hitting waiting list targets for pre-planned operations ... while the NHS has succeeded in reducing waiting times for pre-planned operations ... this has come “at the cost of relative neglect of the needs of the patients admitted as emergencies.”

Translated, this means that the concept of "triage" is taking a back seat to expediency. When the government runs health care, it's the bean counters - not the caregivers - that set the priorities, often to the detriment to those whose very lives are at risk.

It's simple supply and demand, really: when the government promises "free" health care to everyone, then everyone wants their piece of the pie. Of course, the supply of those able to actually deliver that care is finite, and so waiting lists become the de facto order of the day. What happens if you're in dire straits but have a high number? Well, the odds are you're not going to get the best of (or perhaps any) care.

This is, of course, a direct consequence of the nature of the Brits' system, and soon to be of ours. Not to be a tease, but our Resident MOM (Medical Office Manager) will have some words on this as regards the new ACO's (Accountable Care Organizations) shortly.

Stay tuned....

How to say ObamaCare© in Klingon

No idea how I missed this before, but in correspondence from February, United Healthcare (UHC) advised its group clients that effective this July, "[ObamaCare©] requires that group health plans make certain member notices available [in] non-English languages when specific group thresholds have been met."

According to the memo, if there are a number of folks who are literate only in some language other than the erstwhile official tongue of the land, then UHC has to offer those folks EOB's and other routine notices in their native language.

Gee, that's not going to add to the cost of health insurance.

Group admin's are then told to log onto a dedicated UHC website to complete a survey which will determine whether or not they're affected. But of course, everyone's affected by this silliness, since it increases the cost to handle day-to-day transactions, and for which everyone's rates will have to be increased.

The silliest part?

This:

"If you do not [take the survey], we will assume that your group does not meet the threshold."

Just another Stupid Government Trick©.

Medicare and Claims: The Search is on...

The Senate is considering a bill that would create a "searchable Medicare claims database that the public can access at no cost."

On the one hand, Ms Shecantbeserious and her minions would be responsible for building and maintaining the database, which aims to provide more transparency in how and where Medicare expenses are paid.

On the other hand, Ms Shecantbeserius and her minions would be responsible for building and maintaining the database, which means that exemptions from participation will no doubt be available for unions and providers who make the appropriate, um, contributions.

Who's in?

Reining in costs: Networking revisited

As agents, we often tout a carrier's broad network of providers as a selling point. The idea is that switching insurers doesn't have to mean finding a new primary care doc, or leaving one's favorite cardiologist. It's always been a case of "bigger is better."

But is it?

Sometimes, as in the case of Sutter Health, one provider network can drive costs up while simultaneously reducing choice. But hospital chains such as Sutter's aren't the only model:

"Thousands of employers ... are opting for 'narrow network' HMOs, which offer notable savings on insurance premiums but also offer fewer medical providers."

In this case, by reducing access, it's hoped that insurance claims costs (and hence, premiums) can also be reduced. This makes a lot of sense: choice costs. That is, more flexibility means more admin costs, which are in turn passed on to the insured.

One key question left unanswered here, of course, is whether reducing "choice" also reduces "quality." One supposes that time will tell.

MVNHS©: The Hits Just Keep on Comin'

Fresh on the heels of yesterday's expose, our own Bob V tipped me to this debacle:

"Surgeons say patients in some parts of England have spent months waiting in pain because of delayed operations or new restrictions on who qualifies for treatment."

We know from recent experience that even (former) MVNHS© Directors are not immune to the vagaries of the government-run health care scheme, but at least that case had certain complications involved. What's now coming to light is that the same kinds of problems affect even routine procedures.

The driving force?

The MVNHS© needs to slash more than $32 Billion over the next four years.

Ouch!

And what kinds of surgeries are at the top of the list?

Glad you asked:

"[H]ip and knee replacements are being targeted as a way of finding savings."

And just which demographic does one suppose is most affected?

It's not immediately clear why the rocket surgeons at the top of that food chain believe that simply delaying these procedures will save money, but in a classic example of British understatement, Peter Kay, the president of the British Orthopaedic Association, avers "that simply delaying surgery by one means or another does not improve the outcome for patients as their condition can deteriorate."

Ya think?

Of course, this is one of the the systems on which ObamaCare© is modeled, so better drink your milk and watch where you're walking.

Cavalcade of Risk #128 now live (and kickin'!)

Russell at the Chatswood Moneyblog hosts what may be the best Cavalcade of Risk yet. Chock full of great posts, with new features (including Oddball posts and great quotes), you won't want to miss it.

On Band-Aids and Severed Limbs

When I was in college, the university medical service (known affectionately, if pejoratively, as the "Quack Shack") had a reputation for diagnosing pretty much every illness and injury as "mono." Didn't seem to matter what the actual symptoms were, "it's mono" was the canned response.

I was reminded of this by today's news that one of the least important parts of the ObamaCare© train-wreck has been set aside:

"The Senate voted 87 to 12 to repeal the [1099] filing requirement, which would have forced millions of businesses to file tax forms for every vendor selling them more than $600 in goods each year"

So. What?

This is putting a band-aid on a severed limb. Either repeal the whole mess or go home.

Tales of the MVNHS©: Robots and Wheelchairs

As we move inexorably towards government-run health"care," it's instructive to see what lies ahead for those among us facing life-altering and/or -threatening conditions. Championed by erstwhile CMMS Honcho "Sir" Donald Berwick, the Much Vaunted National Health System© provides stark examples of the path on which we find ourselves.

For example, what would you think of a government program that dumped millions of dollars (well, pounds) into research and development of cutting edge robotic surgery, only to deny its lifesaving services to those most in need of it?

Sound farfetched?

Not so:

"Lesley Whiting ... was selected for the procedure because after treatment for advanced breast cancer, three tumours were found in her skull. Without the radiosurgery, she would have around 18 months to live ... But NHS bureaucrats refused to fund the treatment ... despite the fact almost £9 million has been spent buying the robotic technology for three NHS hospitals."

Mrs Whiting, an otherwise sprightly 56 year old mum of two, faced certain, painful death, but she's far from alone:

"In total, fewer than 30 of 150 PCTs have now funded the radical treatment, with just 26 patients receiving Cyberknife at an NHS hospital."

Small wonder our own cancer survival rates are so much higher than theirs.

The good news, such as it is, is that the Sussex resident received the cybersurgery at a private clinic with help from a local charity. How many others, though, are left to twist in the wind?

Of course, Mrs Whiting is far from the only victim of the MVNHS©:

"A wheelchair-bound patient fed up with being in hospital was found by police on a motorway trying to hitch-hike the 80-mile journey home."

The 42 year old was scheduled for same-day surgery at one of the ironically named "Trusts" (a misnomer if there ever was one), but was kept there, a virtual prisoner, for a fortnight-and-a-half. There's some dispute as to why they wouldn't let him go:

"He says he has been given numerous reasons ... These include a lack of hospital beds at Lincoln and disputes over arranging an ambulance to transport him."

Ah, yes, the (in)famous British "ambulance dance."

And as to the actual "care" which one can expect from these facilities, well, it's not exactly up to our standards:

"And he says he cannot eat the hospital meals - especially as he says four of his teeth have fallen out since he was admitted."

Remember, though, that this is the kind of system touted by those who demanded that we pass the bill to learn what's in it.

RomneyCare© Death Panels

It's conventional wisdom that ObamaCare© is, in general, a nationalized version of Massachusetts' state-run health insurance scheme. Most of the focus on the Bay State's program has been on the mandates and unexpected cost-overruns, but something that seems to have flown under the radar is RomneyCare©'s Death Panel.

Of course it's not called that. Known in the parlance as "the Expert Panel on End of Life Care," this unelected commission is charged with determining appropriate funding for that purpose. The problem, of course, is that it's never really that simple:

"(W)hen the Panelists insist that keeping us out of the ICU and sending us either home or to a hospice is not about the money but rather is about giving us what we really want, they are engaging in willful institutional deceit."

Which is not to say that they're motivated by malevolence, but if the mission is to save money (and it is), then what better way to do so? And how do we know this? Well, that requires digging a little deeper:

"(T)he Experts recommend that "any Commonwealth payment reform initiative should be designed to ensure that, for all patients with serious advancing illness...payment for medical services requires adequate documentation that they are based on the well-informed wishes of patients (or appropriate surrogates), including understanding of life-prolonging and palliative care or hospice alternatives."

On its face, that doesn't seem so foreboding. But then there's that tricky little "adequate documentation." What, exactly, does that mean? Harvard nanotechnologist Michael Stopa thinks he knows:

"(I)ntroductory courses like Greeting the Grim Reaper; practical offerings like Mummies for Dummies: Embalming Made Easy; or maybe business-related electives like Buying the Perfect Farm."

Although he offers this tongue-in-cheek, it's not exactly far-fetched. While making an informed decision is a good thing, having to essentially pass a government-mandated test on determining one's own end (or that of a loved one) seems, well, overly intrusive. Balanced against that, of course, is the fact that the state is, in fact, paying the bill (or at least the lion's share). The bigger concern is that these folks are unelected (and unaccountable - sound familiar?); who's watching them?

Grand Rounds: Not just for the birds

Nurse Kim presents this weeks almost overwhelming edition of Grand Rounds. Come for the Angry Birds, stay for the Green Pigs.

Before I forget: Alzheimer's news

If knowledge is power, then some recent news on the Alzheimer's front is a real shot in the arm:

"In the biggest such study to date, research institutions including the University of Miami have identified four genes implicated in causing Alzheimer's disease."

Unfortunately, there are believed to be "as many as 100 genes linked to Alzheimer's;" still, scientists involved in the study believe that they're well on the way to identifying the rest within the next few years. Of course, that doesn't guarantee that there is a cure, or that we'll find it if there is. On the other hand, the more we learn, the more likely it becomes that we'll at least begin to understand the mechanism. And this, in turn, could "help pharmaceutical companies create drugs aimed specifically at the faulty genes," as well as helping identify folks with an increased risk of contracting the dread disease.

In addition to the human cost, there's big bucks involved, as well: "Alzheimer's today afflicts 3 to 5 million Americans and costs $24.6 billion a year for healthcare."

Let's keep our fingers crossed.

Waivers in the air

"Hallelujah, come on, get waivers!" is apparently the newest hit tune in DC-land. Last time we checked, the count was up to 1,040. But that's so yesterday. For those keeping score at home, the total has now climbed to 1,168 waivers, up 128 (or over 10%). At this rate, of course, by the time 2014 rolls around, only suckers will be required to play by ObamaCare© rules.

Don't worry, though, there's still time to get your own ObamaWaiver©.

A Billion here, a Billion there, pretty soon...

Last fall, we posted an email conversation with one of our readers, the subject of which was the fact that retiree health plans are "exempt from certain PPACA requirements."

Turns out, that word "exempt" is only a part of the story:

"Investigators ... have discovered that a little-known provision in [ObamaCare©] has allowed the federal government to pay nearly $2 billion to unions, state public employee systems, and big corporations to subsidize health coverage costs for early retirees."

Ahem.

About that "little-known provision;" some of us not only knew about it, but actually reported on it over half a year ago:

"The folks in Washington that gave us the "bridge to nowhere" have done it again, this time with health insurance ... (Early Retirement Reinsurance Program) as announced by HHS is supposed to make it easier for employers to provide health insurance to early retirees. Congress authorized $5 billion of money they did not have to fund this program until 2014."

So, according to the Examiner, 40% of the funding for this program has already been paid out, with 3 years worth of retirees still in the wings. At this rate, the program will be bust in about half that time.

What then?

MVNHS©: Suckers!

In a cruel April Fool's Day prank, Englishfolks suffering under the Much Vaunted National Health System© will now be subsidizing their Scottish brethrens' prescription costs:

"All prescription charges have been abolished in Scotland, leaving England the last part of the UK still charging for some prescriptions."

Nice!

The folks who bring us Glenfiddich join those responsible for Guinness and rarebit in passing off the cost of their meds to the producers of Bangers and Mash.

Tapadh leibh!

Hey, Where's MY ObamaWaiver©?

Hey boys and girls, do you know what Anthony Weiner, the State of Maine, and a bunch of unions all have in common? That's right, they're getting ObamaWaiver©s, and you can, too. It's fun, easy and best of all, it's free*.

[*Well, except for the cost of donations to the Democrat party, of course]

"How do I get my waiver" you ask?

Couldn't be simpler!

Just click here, fill out the request form, and Bob's your uncle!

Isn't ObamaCare© great?!

Cavalcade of Risk #128: Call for submissions

Russell at Chatswood Consulting hosts next week's Cavalcade of Risk. Submissions are due this Monday (the 4th), and Russell asks that you include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

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

You can submit your post via Blog Carnival.

Carefree Lifestyle? ObamaCare© to the Rescue!

You'll have to watch the PSA to learn what's in it:

Picking and Choosing: The Makena Saga continues...

Does the FDA have the right to selectively enforce its own reg's? Reason I ask is this:

"Responding to the public and political pressure, the FDA said it had no intention of blocking pharmacies from selling their own versions of Makena."

By way of background, Bob reported several weeks ago that the price of Makena (a progesterone synthetic) was set to go from $20 a shot to $1500 a pop. Talk about a rate increase! As usual, though, there was more to the story than first met the eye:

"That's because the drug, a form of progesterone given as a weekly shot, has been made cheaply for years, mixed in special pharmacies that custom-compound treatments that are not federally approved."

Since it didn't need FDA approval, the exorbitant costs associated with gaining that approval didn't apply. Pretty much everything the gummint touches, however, begins to cost more gold, and the price of course skyrocketed.

Now, the technology to actually produce the medication didn't disappear overnight from the local apothecary; it was just that the heavy hand of the government had come down upon it, in the form of a letter from the manufacturer to said pharmacists, "warning them of possible FDA enforcement action if they kept compounding the drug."

This is as much a protection for the consumer as the manufacturer, of course, but fine-wary druggists were understandably concerned that they'd be fried under a Federal microscope.

Never fear, however, because the FDA itself has now publicly folded their hand, announcing that they have "no intention of blocking pharmacies from selling their own versions of Makena."

That's correct: they're going to preemptively cede control to the private sector, and abrogate their legal duty to enforce regulations.

This is unconscionable: once the agency stops enforcing one such regulation, how can they enforce others? Obviously, the neighborhood pharmacy just got an FDAWaiver©.

Quelle surprise.

AARP vs Seniors: The $Billion Story

We've wondered before why AARP would be so willing to throw its membership under the bus. After all, one of the cornerstones of ObamaCare© is draconian cuts in Medicare. On its face, this would seem contra the interests of the folks which AARP ostensibly represents.

Not surprisingly, it's all about the green (and I don't mean windmills or solar panels):

"AARP stands to reap an extra billion dollars in profits from ObamaCare ... Worse, this extra profit is largely BECAUSE of the Medicare cuts."

That bears repeating: due entirely to reductions in Medicare, at the express expense of its members, the "leadership" at the American Association of Retired Peons, er, Persons stands to reap a fortune.

Remind me again, why would anyone voluntarily join this disgraceful organization?

MVNHS© Hates Atheists

Well, how else to explain this:

"Former NHS director dies after operation is cancelled four times at her own hospital"

Seems to me, this is God's way of proving that he exists, and has a wicked sense of humor.

If there's any silver lining to this, of course, it's that the Brits' system is at least "fair:" no waivers for previous Directors.

The truly sad part is that the poor woman was hospitalized for quite some time before her family finally decided to bring her home, concerned that she was becoming "institutionalised" from the extended stay. One wonders, given previous examples of poorly equipped and run "trusts" (the MVNHS© name for "hospitals"), whether the family was also concerned about additional health risks, given her condition.

But remember: the MVNHS© (and its ilk) is so much more efficient than our system (for now).

Health Wonk Review: It's Opening Day!

Jason Shafrin hosts this week's all-star line-up of great health care policy and polity posts. As usual, he hits a homerun.

LTCi in Perspective

As we've mentioned over the years, Bob and I frequently contribute to an online forum answering various insurance questions. Along the way, we met Herman Bruns, a Long Term Care insurance specialist with vast knowledge and a big heart. A while back, Herman graciously provided us with a guest post on when it's appropriate to consider purchasing LTCi.

Now, he's added a tremendous, intuitive way to quantify that decision. It's really just a simple test:

How long can you afford to pay $150-200+/day for your care?

How long can you afford to pay $5/day for your care?

As he explains, "if the answer to the first question is "not very long", but the answer to the second is "forever"....then you have just answered your own question. $5/day will buy many people lots of LTC insurance that pays the $150+/day if you need care. (age/health/benefit dependent of course)."

Thanks again, Herman!

Are you ready for some *Real* Death Panels?

Much has been made of the Death Panels enabled by ObamaCare©; last we looked, they had morphed into “end of life counseling” programs. Or so we thought.

Unfortunately, there's new news on this front:

"(T)he Independent Payment Advisory Board (IPAB), will face heat in the coming months from Congress and from the courts ... the IPAB is the “real death panel” in the health care law."

Quite so.

For those who may not be aware, the IPAB is an unelected, unaccountable panel whose job it is to dole out (ie "ration") health care dollars to Medicare beneficiaries. One can see, by the way, why there are those who would wish to opt out of such a system. The board's criteria is based not on need or efficacy, but cost alone.

And here's where it gets really scary: this process is every bit as transparent as the ObamaWaiver©'s. That is, unelected officials will be in charge, with no oversight, determining who lives and who dies, potentially based on political affiliation and support.

What could possibly go wrong?

But hey, it's only money!

Remember how the bill we had to pass to learn what's in it was going to save us boatloads of dollars?

Turns out, not so much:

"In particular, the provisions related to expanding health insurance coverage were projected to increase the deficit between 2012 and 2021 by $1.04 trillion ... they are now projected to increase the deficit by $1.13 trillion over that period."

That's an 8% increase in one fell swoop. And that's only the beginning:

"The estimated cost of the coverage provisions ... is a good deal larger over the 2012-2021 period than over the 2010-2019 period."

Why is that, do you suppose?

Well, it's really by design (such as it is): by "frontloading" the costs and then tacking on the "benefits" down the road, the actual impact on the deficit is delayed, but not gone.

Never let it be said, though, that the CBO lacks a sense of humor:

"As we have noted repeatedly, our projections of the budgetary impact of last year’s major health legislation are quite uncertain because assessing the effects of making broad changes in the nation’s health care and health insurance systems requires assumptions about a broad array of technical, behavioral, and economic factors."

More succinctly: "we have met the enemy, and he is us."

[Hat Tip: Bob Vineyard, CLU]

Grand Rounds is up

Family doc Mike Sevilla (formerly known as Doctor Anonymous) hosts this week's great collection of interesting medblog posts. Do check it out.

Use it vs Lose it

The major benefit of Flexible Spending Accounts (FSAs) is that contributions go in pre-tax, and eligible withdrawals come out tax-free. The major downside is that money left in the account at the end of the year is forfeit, which can discourage folks from participating in them.

A new bill, HR 1004, seeks to ameliorate this problem by allowing folks with unused balances to "cash out" at the end of the year (albeit with some tax penalties, which is fair).

Since ObamaCare© caps the amount at risk (ie the maximum contribution) at $2500, the sponsors of the bill believe that more folks will be willing to take a chance, driving up participation levels.

What say you?

[Hat Tip: National Underwriter]

Goodwin's Law Prevails

No, not Godwin's Law, Goodwin's, as in Wayne Goodwin, the Tar Heel State's Insurance Commissioner. In some ways, it's old news:

"The settlement arose out of a routine Department of Insurance, DOI, market exam of the company that began in 2005 and looked at the years 2002-04."

Settlement? What settlement?

This one:

"Cigna Healthcare of North Carolina will pay a $600,000 fine and customer refunds and credits totalling $637,974.98"

That's north of $1 million in fines and restitution, all because of sloppy record keeping and premium calculations, not to mention a consistent failure to process "claims in a timely fashion and ... failing to send acknowledgment letters within three business days for member grievances."

The aforementioned refunds were actually paid out late last summer, but the fines are due now. Incidentally, said fines will be "distributed to the state public school system."

Talk about lessons learned.

[Hat Tip: FoIB Jeff M]

POMS and ObamaCare© [UPDATED]

All those naysayers who pooh-pooh the idea that ObamaCare© will deprive Americans of the basic freedom to choose appropriate health care certainly got an eye-opener this week:

"Judge Rosemary Collyer has ruled that Americans have a legal obligation to accept subpar government health benefits."

But surely, Henry, you must be quoting selectively; there's no way a Federal Judge can force people into such a system.

Actually, I'm being kind, and to understand why, it's necessary to rewind a bit, back to October of 2009:

"Under existing rules, if one elects not to be covered by Medicare, one is also ineligible for Social Security benefits ... The judge went further than just denying the feds' request, though: she explains that these POM's are not supported by the statute. In short, they're making their own law (which is a no-no)."

[ed: POMS are Program Operations Manuals used by the Social Security Administration]

In effect, Judge Collyer said that the POM's were clearly extralegal, and allowed the plaintiffs to proceed against the Feds.

But that was then, and this is now:

"The Medicare Act is very clear that persons entitled to Social Security retirement benefits, i.e., of an age and work history and application therefore, are immediately and automatically entitled to Medicare Part A benefits upon their 65th birthdays"

She goes on to note that the plaintiffs are "trapped in a government program intended for their benefit... and wish to escape."

Seems reasonable enough.

But then, she turns this completely on its ear by ruling that there's "no loophole or requirement that the secretary provide such a pathway."

So what caused this 180-degree shift into bizarro-world?

We went back to the source, Kent Masterson Brown, the plaintiffs' attorney who's been leading the charge. Mr Brown (whom we'd interviewed several times a few years back), graciously shared his time and observations with us, Since his appeal is currently pending, he was constrained in what he could tell us, but he was equally stunned that Judge Collyer could do such an about-face with no new facts presented.

In effect, he told us, her 2009 ruling that the POM's were out of bounds has become a confirmation that the agencies can, in fact, deny his clients basic freedom of choice. Somehow, as he understands the ruling, the idea that one is entitled to a benefit now means one must accept it, regardless of one's wishes.

And he draws a straight line directly to ObamaCare©: the same (kinds of) folks who wrote the POM's will be writing these new reg's. Why would anyone believe these will be any less onerous?

The case now heads to the Appeals Court, where, in effect, Judge Collyer will be arguing with herself. Should be interesting, to say the least.

[A Special InsureBlog Thank You to Mr Brown for his time and expertise]

UPDATE: Mr Brown has written a piece for today's Washington Post, in which he warns that the decision "would allow the "health reform" law to become even more Orwellian than it already is, without any action from Congress ... More immediately, whether they want it or not, seniors will now be forced into Medicare, a program that even Judge Collyer asserts "may bankrupt all of us."

Definitely read it all.

ObamaFail©

So the bill we had to pass to see what's in it, touted as the solution to the critical problem of the uninsured, turns out to be a colossal failure?

No kidding:

"(T)he percentage of U.S. residents under age 65 who were uninsured increased to 16.3%, from 15.4%."

I'm shocked, shocked I tell you!

Midweek Link-Fest

For your edification and edutainment pleasure:

First up, it's the one year ObamaVersary©, and the Pioneer Institute hosted a debate on the financial impact of this train-wreck. Courtesy of Josh Archambault, the Institute's Director of Health Care Policy, here's the highlight reel:

2011 Hewitt Health Care Lecture from Mike Dean on Vimeo.

The full debate's available here.

Next, Jane Sanders has put together a pretty alarming graphic about the specific costs of obesity. Here's an excerpt:

Get the rest of the big picture here.

And finally, FoIB Jeff M reports that public employee benefits-cut fever has arrived in North Carolina, where state workers "would pay more for health insurance but get fewer benefits" under a new budget proposal. On the one hand, the proposed changes "scrap a provision that pushed cigarette smokers and those who were very obese into less-generous coverage until they quit puffing or lost weight" (see item above).

On the other hand, the proposal would impose onerous new contribution requirements on said employees, forcing "all active state employees and those retirees in a more-generous plan to pay monthly premiums of between $11 and $22 a month." [emphasis added]

Oh, the humanity!

Hackles and Meds

In recent posts, we've explored the rising costs and potential supply problems of "specialty meds" such as Makena and immune deficiency therapies. Fellow medblogger Lisa Emrich is deeply concerned about the increasing volatility of MS (Multiple Sclerosis) medications:

"It is expected that Gilenya will net more than $3 billion in annual sales. When the pricing of Gilenya was announced in September, members of the MS community were outraged. I was disappointed to say the least. $4000 per month for any medication is outrageous."

Almost $50 thousand a year to treat this condition, most of the cost of which is borne by insurance companies (and thus, thee and me). And even this number is suspect because, as Lisa points out, "you will note that the numbers quoted vary from source to source. Such is the nature of the pharmaceutical business. Patients do not have easy access to information such as wholesale price."

I urge you to read the whole thing for some thought-provoking insights.

Cavalcade of Risk #127 now online

Making his hosting debut, Irwin Jacobs presents this week's Cavalcade of Risk. It's a (not very) dangerous job, but someone's gotta do it.

Birthin' and such

Did you know that we spend over $50 billion a year for child-birth related expenses? I didn't, either, but FoIB Kate H sent us the link to an interesting infographic with all kinds of birth-related info. Some, like the aforementioned costs, are more interesting than others (such as predominant hair colors). The graphic itself was apparently put together by the folks at Ultrasound Technician.

The graphic leans heavily on information gleaned by researchers at "Giving Birth Naturally," which provides more than ample citations to back up its findings.

I also found this statistic rather telling: an "[u]ncomplicated delivery ... costs anywhere from $8,000-$10,000 (which) doubles for a C-section." Group medical plans generally cover both eventualities; individual plans generally cover only unplanned C-sections. Come 2014, of course, all of these expenses will be covered under all (non-waivered) medical plans, so look for premiums to sky-rocket based on that provision alone.

One place the graphic fell short was its claim that "America ranks 29th in the world for its infant mortality rate." We've debunked this canard before, of course, but it never hurts to stress how completely screwy it is. In fact, more recent information skewers this claim even more. For example:

"France, the Netherlands, and other European countries don’t count as live births babies who weigh less than 500 grams or had less than 22 weeks of gestation. They are, instead, counted as stillbirths ... in this country, we actually try to save premature and low-birth-weight babies rather than just chalk them up to stillbirths to make our numbers look good."

Spot on.

Quakes, Tsunamis and Reinsurance

The recent disasters in Japan will likely send financial shockwaves across the P&C side of the insurance industry.

A M Best reports that "Swiss Re is estimating claims costs of about US$1.2 billion, net of retrocession and before tax, from the March 11 earthquake and tsunami in Japan" and that AIG "expects to incur a pretax insurance loss of US$700 million for its nonlife subsidiary Chartis Inc. from the March 11 earthquake and tsunami."

When both the wholesale (Swiss Re) and retail (AIG) markets are reeling, one can expect substantial price increases on related lines of coverage (such as homeowners, business and the like). The basic structure of insurance is, of course. "spreading the risk," which translates to "spreading the cost of the risk based on actual losses."

And so our wallets take another hit.

Baby Joseph Update: Still with us (for a little while)

Reader Patrick P alerts us to this terrific development in the story of Baby Joseph Maraachli:

"Baby Joseph," the dying Canadian infant whose medical care sparked a national controversy, arrived at a St. Louis hospital [last week] night for treatment ... Ontario's London Health Sciences Centre ... said it doesn't perform a tracheostomy for patients who have no hope of recovery."

Which is interesting in and of itself, but becomes even more disturbing with this news:

"Doctors report he is resting comfortably ... His parents will soon be able to take him home, which was their initial wish."

The bottom line remains that Baby Joseph will likely die soon regardless; it's a question of how, not if.

An Emotional Grand Rounds

Dr Val presents this week's collection of medblog posts organized by various emotions. Provocative and effective.

The Good of the Many, The Needs of the Few

Over the years, we've posted numerous entries to our "Stupid Carrier Tricks" series. The common theme is that insurance companies, like any other corporation, have no "ethics." And yet, carriers are made up of people, and people do (or don't).

The other day, I attended a CE (Continuing Education) class on Ethics. My fellow participants couldn't understand why I was giggling about an "Ethics" course given - for free! - to agents who'd received a "goody bag" full of tschochkes (chip clips, staplers, etc). Often there's an obvious "line in the sand" across which we dare not step.

Sometimes, though, it's not so simple.

I recently received an email from the Immune Deficiency Foundation (IDF) about Highmark Blue Cross' newest policy regarding those with immune system disorders. This is serious stuff: folks who suffer from these conditions lack the ability to fight off even simple infections. The cost to treat it can be enormous; as regular readers know, prescription costs are a major driver of insurance rates.

And yet.

The people who have these conditions face potentially life-threatening results if their meds are changed or excluded.

Highmark Blue Cross and Blue Shield recently changed the way they cover medications for this fairly exclusive group. And thus begins our saga. After receiving the IDF email, I replied that I was, in fact, interested in learning more. But I also know, from previous experience, that there are usually (at least) two sides to these kinds of stories, and so I reached out to Highmark, as well.

After speaking with the Highmark rep, and reading his follow-up email, I connected with Larry La Motte, the IDF's Director of Public Policy. Larry very graciously gave me about an hour of his time, and I came away from the experience with quite mixed feelings. What struck me deeply is that, from my perspective, both sides are "right." That is, there's no obvious "bad guy" here. The good news, such as it is, is that the folks from IDF (and other such groups) have obviously swayed the debate: it appears that Highmark's initial position has softened.

So what's the story?

According to Highmark's Aaron Billger, there are about 350 Highmark insureds potentially affected by this policy. To put that into perspective, the carrier insures over 4 million people. By any objective measure, 350 out of 4.something million is less than a rounding error. Of course, the lives of these 350 people are no less (and no more) important than the other 4.something million, but the cost of their meds affect every single one of them. What to do?

Well, one way to handle this would be to exclude all such treatments. That seems draconian (although not something I'd put past "Sir" Donald Berwick), but continuing to pay for all manner of treatment isn't fiscally sound, either. What Highmark plans to do is to change the way it covers these treatments, both for those currently covered and those who come on board beginning next month.

The aforementioned IDF is, understandably, displeased with what they see as a potential death sentence for those insureds affected by the new plan design. Briefly, it is their belief that the status quo ante was sufficient and justifiable, and they'd prefer that no such changes be implemented. The carrier demurs, and thus the impasse.

According to the IDF's email, there were 4 major sticking points:

"IDF has asked that any Highmark policy should:

• Not determine the specific IgG therapy a patient must use

• Ensure that patients already stabilized on an IgG therapy not be switched to another therapy without medical cause

• Allow physicians an opportunity to prescribe an alternative if they determine it is in the best interest of the patient

• Better inform patients and physicians about its policy plans and gain direct feedback on their recommendations."

It seems to me that the first one is unreasonable: if the carrier is expected to pay for something, then it seems to me that they get to make that call (within reason). The second and third, however, do seem reasonable (the fourth is bluster).

What's heartening is that, in the Mr Billger's email, "a large majority [of the affected insureds] are already on our preferred IG product. They will not be directly impacted by this policy." He also reported that the new policy will now "provide continued coverage for members currently using non-preferred IG products, when clinically appropriate, with no disruption." And finally, the new "policy will cover a non-preferred IG product for someone new to therapy when the prescribing physician documents ... why the preferred product is not suitable."

Seems to me that this has been resolved in a manner that's fair to all involved, and causes the least disruption and potential danger to the affected members. Still, it offers a valuable lesson in how carriers can work with special interest/needs groups to find common cause and solutions.

Kudos to Highmark and the Immune Deficiency Foundation (as well as the other groups involved) for defusing a potentially volatile situation and working towards a resolution that's in everyone's best interest.

The MVNHS© Hates Seniors

Well, what other conclusion can you draw from this:

"Thousands of older cancer patients are being denied potentially life-saving surgery because of ageism in the NHS."

As we've documented countless times before, the Much Vaunted National Health System© consistently looks for ways to ration care to its elderly population. Certainly, this is an easy (if morally bankrupt) way to rein in runaway health care costs, but it should certainly give pause to those proponents of Obamacare© who are themselves reaching maturity.

Or are just closing in on it:

"The chances of being operated on start falling in middle-age and plummet for those in their 70s and older ... They reinforce evidence showing older people still get a raw deal from the ‘institutionally ageist’ NHS[sic]"

And that's not all: in those cases where local expertise is lacking, few elderly patients are being referred to other experts. Recognizing that Brits lag far behind us in cancer survival rates, lead researcher Mick Peake acknowledges that "internationally our biggest gap in terms of survival is in the elderly," adding "if you can give a seventysomething-year-old ten or 15 years of active life, you should certainly offer it to them."

Or not.

At the risk of emulating a broken record, I would remind our readers that this is the system which "Sir" Donald Berwick (current CMMS honcho) advocates and admires.

Close, but no cigar?

I've often wondered why group plans, unlike individual medical, don't differentiate between smokers and non-smokers. It's long been known that tobacco-users have higher frequency of claims, miss more work, and generally drive up the cost of healthcare (and thus, insurance).

Until recently, though, this has not been reflected in group medical plan rates. When requesting group quotes, we typically include sex and age, family status and at least some medical underwriting information, but not tobacco use.

That may be changing, however:

"Some Maricopa County employees are fuming over a new health-plan requirement forcing them to submit saliva for nicotine analysis ... those testing negative for tobacco use are spared a premium that is $480 higher per year."

Covered employees who decline to submit to the testing are automatically assumed to use tobacco, and get hit with that $40 per month surcharge. On the other hand, employees are concerned that the information garnered from these tests may not be limited to tobacco use, but for more invasive purposes.

And then there are those who, on principle alone, refuse to participate, even though they're not tobacco users:

"I'm going to be penalized this year, but I'm still not taking it," he said. "This is a forced penalty and I've never seen anything like this. It's a disgrace."

I have little sympathy for this particular fellow: as a government employee, the taxpayers foot the bulk of his health insurance costs, and have a right to demand value for their taxes. The gentleman (and his cohorts) are free to opt out of the county-provided plan and find their own coverage in the open market, at their own (increased) expense.

The fly in this particular ointment, though, comes from a spokescritter who admits that they "do not keep data on how much tobacco users cost to insure compared with non-tobacco users." It's not enough that they "believe" that tobacco users cost more in claims; facts, not faith, are required here. It doesn't seem to me unreasonable that such data would be easy enough to get from their insurer(s).

The bottom line, of course, is the bottom line:

"I don't like my fluids on record in some file ... I would prefer not doing it, but we have to, to get the $480. That's about what it comes to."

Indeed.

Cavalcade of Risk #127: Call for submissions

Irwin Jacob at My Personal Financial Journey makes his hosting debut next week. Submissions are due this Monday (the 21st), and Irwin asks that you include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

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

You can submit your post via Blog Carnival.

Testing 1, 2, 3....

The folks at the Kaiser Family Foundation (KFF) have introduced an interesting (if flawed) interactive quiz about ObamaCare©. It's 10 simple questions that ostensibly test one's knowledge of that train-wreck, and then offers up your "score."

The problem is that at least two of their "correct' answers are wrong:

2. Will the health reform law allow a government panel to make decisions about end-of-life care for people on Medicare?

KFF claims that "(n)o such panels exist;" we know better.

And:

3. Will the health reform law cut benefits that were previously provided to all people on Medicare?

KFF says "no;" again, IB readers are much better informed.

Since their own answers are only 80% correct, I'll give this one a B-.

Show some CLASS, man!

As we've reported, the Community Living Assistance Services and Supports (CLASS) act, part of ObamaCare©, has some major structural flaws. One of the most critical of these is that it is, to be blunt, unsustainable.

But what does that mean?

The dictionary defines 'unsustainable' as "not able to be maintained or supported in the future," or, as we put it, "a plan that's guaranteed issue, with (ostensibly) no waiting or elimination period and "unlimited" benefits is not exactly a candidate for "most stable rates."

But that's only part of the story.

Today, the House Energy and Commerce Committee will begin its own investigation into the program's long-term viability. On the one hand (and as we noted previously), "for several years, program managers would collect premiums for workers without providing benefits."

[As an aside: that seems to be the hallmark of the whole ObamaCare© "model:" pay now, benefits (maybe) later]

So what happens when the older folks, who haven't paid in all that long, start making claims? Well, premiums rise, resulting in classic adverse selection, and ... well, "(a) resulting series of losses, premium increases and decisions by younger, healthier insureds to drop coverage could lead to a death spiral that would kill the program."

And all those premiums paid in?

Well, you know.

Health Wonk Review: Spring has sprung!

Glenn Laffel hosts this week's round-up of wonky posts, in his own version of spring training.

In case there were any doubts...

About the endgame here, noted rightwinger John Conyers thoughtfully explains:



[Hat tip: Hot Air]

Open Mic Night: HHS Secretary Shecantbeserious

They say that when one door closes, another opens. It appears that even as Gilbert "Aflac" Gottfried exited stage left, Cabinet member cum comedienne Shecantbeserious has entered stage right. In her stand-up debut at Politico, she rocked the house with some great one-liners:

"Just 12 months after [ObamaCrap] became law, the American people are enjoying new protections, greater freedoms and lower costs.

Children are now protected from being turned away by insurers because of a pre-existing condition."

Good one, Kathy!

The punchline is spoiled, of course, by the fact that (with few exceptions) there are now no child-only policies available. So the fact that that they can't be declined for pre-existing conditions is scant comfort to those who can't buy it at all.

"Seniors enrolled in Medicare now have the freedom to get preventive care ... for free."

Really? The doc's no longer get paid for their services? Bet that's news to them! Of course, the rest of us do pay for these services, in the form of higher taxes and, of course, less choice.

Here's a howler:

"Early signs show that ... the number of small businesses offering coverage to employees is increasing."

Is that right? One supposes it would be asking too much of Ms Shecantbeserious to offer a cite for this claim; the truth is that, because of the poor economy, more small businesses are failing, and fewer that are left plan to continue offering plans.

And another cute one:

"Perhaps less widely recognized ... has been the way the law is demanding transparency and accountability from the insurance industry to bring down premiums."

It certainly takes a certain chutzpah to rail on the insurance industry about "transparency" given the process by with this train-wreck was forced onto an unwilling citizenry. And premiums going down? That's Lenny Bruce-level funny right there.

But wait, there's more!

"And for the first time, insurers are being held accountable for the way they spend consumer premiums."

That'll come as a surprise to the states that have always required that carriers justify rate increases based on claims and other factors. Had she herself been an insurance commissioner. she might have known that. Oh, wait... Never mind!

The hits, they keep on coming:

"Today, Americans also have a new Web-based tool that allows them to comparison shop for the best insurance options ... Go to www.[obamacrap].gov to check it out."

As Bob's noted, this site is itself quite the joke.

But the lady's on a roll:

"These efforts are helping to make the health care marketplace more competitive"

Excuse me a moment while I catch my breath.

With fewer choices available as carriers exit the market, this one's quite the knee-slapper.

For some reason, she turns serious at the end:

"Ultimately, we know that the biggest factor driving up premiums is the soaring cost of care."

I was unaware that we'd made Ms Shecantbeserious an honorary co-blogger. After all, we've been saying this for years in the (previously) vain hope that someone in DC would listen. Apparently, she's been an avid IB reader all this time. The problem, of course, is that she still misses the mark: "Analysts predict that by 2019, these efforts could save an additional $2,000 for a family policy for employer-based coverage."

The only thing missing is context: what good is that savings if it still means that coverage is unaffordable? How many people seriously say "sure I'd buy that Bugatti if they'd knock $2000 off the list?"

Don't quit the day job, Kathy.

If it walks like a duck...

It's probably not Gilbert Gottfired....er, uh, Gottfried.

Some of the more annoying TV commercials are from the the Aflac folks, known for their worksite marketing of specialty disability, critical illness and other policies. Apparently, the former rocket-surgeon-turned-washed-up comedian thought it would be a good idea to "tweet" a series of tasteless jokes about the earthquake/tsunami and its aftermath.

According to the WSJ, "70% to 75% of Aflac’s earnings come from Japan."

Ooops.

Your Tax Dollars at "Work"

I'm tempted to say that only at an (alleged) institute of higher learning would one expect to find actual money spent on a study titled:

"Use of $4 Drug Programs Could Save Society Billions of Dollars, Says Pitt Graduate School of Public Health Study"

But of course, we've seen plenty of such examples in the halls of government, so I'll just mention that this came in email from the above referenced "elite" institution. The release, which arrived early yesterday afternoon, very explicitly warned "EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, MONDAY, MARCH 14."

We aim to please.

All Ides on Grand Rounds

Amy Tenderich presents an Ides of March themed Grand Rounds. This week's edition is notable not only for its attractive layout, but the helpful context she provides for each entry.

Shecantbeserious talks "Ethics"

The other day, I received an email with the (no doubt unintentionally) humorous title "WellPoint's Standards of Ethical Business Conduct." It seems that the Centers for Medicare and Medicaid Services, currently run by the ethically-challenged "Sir" David Berwick, "requires all Health Plan Sponsors have written standards of conduct that communicate the Plan's commitment to comply with all applicable Federal and State standards."

I'll pause while you wipe your monitor.

Turns out, the folks who actually interact with the public (that would be agents) are subject to a whole host of rules and regs that, apparently, don't apply to the gummint employees in charge of oversight. I find it ironic that the very bureauweenies passing out ObamaWaivers© hither and yon have the temerity to even say the words "Ethical Business Conduct," let alone lecture us on the subject.

This particular missive was directed at those selling Medicare supplement plans, which is even more pathetic, given the fact that Medciare itself is currently circling the drain, due in no small part to the efforts of the folks in charge.

Pot, meet kettle.

ObamaWaivers© for Thee and Me?

Looks like WaiverMania's heating up, but this time it may be good news:

"A House Republican is pushing a new bill that would allow individuals to get a waiver from major provisions of the new healthcare reform law, including the so-called individual mandate."

Hey, it's only fair: unions, restaurants, even states get a waiver, why not those of most likely to be negatively impacted by ObamaCrap?

And in a swell bit of hypocrisy, "the administration says ... that limited insurance is better than no insurance at all."

Really?

So "low value" (meaning, of course, affordable) insurance is okay for now, but we look forward to making health insurance unaffordable in a few years.

Daggum rockit surgeons, I tell ya!

ObamaScrips©

As we reported last summer, those enrolled in tax-advantaged medical accounts (aka FSA/HSA/HRA) got a nasty surprise when we "passed the bill to see what's in it:"

"Health Savings and Flexible Spending Account (HSA and FSA) "funds can no longer be used to purchase OTC drugs and medicines ... unless you have a Note of Medical Necessity (NMN) or a prescription from your doctor."

We wrote at the time that this seemingly simple change "actually increases the cost of health care."

And we were right (of course):

"Patients are demanding doctors' orders for over-the-counter products because of a provision in the health-care overhaul that slipped past nearly everyone's radar [ed: not ours!] ... It drives up the cost of health care as opposed to reducing it," says Dr. Chung"

And of course, in classic "Rule of Unintended(?) Consequences" fashion, many physicians are balking at fulfilling these requests, further driving up the cost of health care (and hence, health insurance).

Told ya so.

[Hat Tip: FoIB Elena Marie]

Let More than a Smile be Your Umbrella

FoIB Joe Kristan reports on the tax consequences of failing to ensure that you have proper and adequate auto and home owners insurance. This particular case generated some major pangs of regret.

Takeaway: review and update your coverages regularly.

If you thought that story was sad (on at least a few levels), well "you ain't seen nothin' yet." Bob tipped me to this incredible tale:

"An Ohio insurance company must pay benefits to a Detroit-area woman who suffers from witnessing the death of her son on a motorcycle."

Apparently, Ms Boertmann was in another nearby vehicle when her son was killed; claiming lost wages and out of pocket medical expenses, she sued her own auto insurer for monetary damages. The insurer stupidly and erroneously thought that, just because she and her car had nothing to do with the accident which claimed her son's life, they were off the hook.

The wise risk-management experts posing as Michigan judges demurred, apparently relying on their own rocket-surgery-level understanding of insurance principles to support their decision.

Introducing: BoCare©

About two years ago, Bob (presciently) posted about a New Jersey initiative to push pet insurance. Seems like little Fido's owners weren't being made aware of various insurance alternatives available to them (and hence, money available to Fido's vet).

And I bet you thought that ObamaCrap was just for us silly humans.

Well, guess again. Behold, H R 525:

"To amend the Public Health Service Act to enhance and increase the number of veterinarians trained in veterinary public health."

Briefly, the bill's purpose is to extend federal funding for vet's (as in veterinarians) in order to spend even more money (that we don't have) so that Fido can enjoy the same kind of health care that we enjoy.

Oh, wait:

Did I say "Fido can enjoy?"

I meant: "So that you and I can dig deeper in our pocket to subsidize another sub-group of professionals."

And what, you may ask, does this have to do with ObamaCare©?

Glad you asked.

It seems that, when they were "passing the bill so that they (and we) could see what's in it," they inadvertently forgot to include funding to increase the "Public Health Workforce Loan Repayment Program" (aka Title V of Section 5204) of ObamaCare©.

Do we all get a treat now?

[Hat Tip: RedState]

Updated ObamaCredit© Tool

Late last summer, Bill posted on the new "tax credit" available to some businesses. Today, UHC sent me the link to a new version of their on-line calculator, "with no login or registration required."

It's available here.

I'd encourage readers to take it for a spin, and would certainly appreciate any feedback you might in the comments.

Cavalcade of Risk #126 is up!

Jay Norris at Life Insurance Colorado presents this week's round-up of risky posts. As usual, Jay does an outstanding job of summarizing each entry.

Like Jay, you can also host a Cav: we're scheduling for Spring '11 right now. Just drop us a line to claim your slot.

ObamaCare© Kiddies

As we've previously noted, new "child-only" health insurance plans are a thing of the past. Turns out, they're not even available retroactively.

Hunh?!

One of my clients has a plan covering himself, his wife and their son (who needs some specific counseling and meds). "John" recently took a new job, and is eligible for the company-sponsored group plan. Problem is, it doesn't cover their son's "issues" quite as well as their current plan. John and his wife asked if they could put themselves on the group, and leave their son "behind" on their individual plan.

Seems reasonable enough.

The obvious route would be to file a simple change form, requesting removal of Mom and Dad. I knew that this wouldn't work: Dad's the "primary insured," meaning that removing him would be a substantial change requiring a different process.

So I checked with the service rep, who informed me that it would, in fact, be a big deal. We'd have to submit a new application on the child [ed: hang on, I'm getting there] and the carrier could decline to (re-)write him. Since we know that there are no more new child-only policies, I questioned this and was told that we needed to reference the in-force plan on the new application, and send a cover letter explaining what we were attempting to do.

I'm nothing if not helpful, so I had Mom fill out the new app, and I sent it (along with the requisite cover letter) to the carrier. And then we waited.

And waited.

Today, several weeks later, I received this in email from the service rep:

"[The carrier] has stated that they would not allow this due to it will now be a child only policy."

Okay, then why did we even go through this process in the first place? I could understand if the underwriter declined the child due to some health condition or other, but this answer means that everyone just wasted their time: there was no way they were going to acquiesce in the first place. I don't blame the rep: he was simply passing along the information that Home Office had supplied.

It seems to me that there are, in fact, two "bad actors" here: first, ObamaCare©, which has made it impossible for carriers to offer child-only policies. But I also blame the carrier for not just saying "no can do" in the first place, saving everyone involved time and trouble.

(I'm not naming the carrier because I have no reason to believe that this is company-specific).

Sheesh.

Docs on the Margin

Yesterday, we looked (again) at one relatively new health care growth industry, concierge physician practices. One of the great things about this country is that folks are always coming up with new ways to make "the system" work for them (instead of them working for the system). Today, FoIB Jeff M tips us to another "under the radar" approach some doc's are taking in order to simplify their practices and avoid some of the more egregious impacts of ObamaCare©:

"On a recent Saturday morning Ann Donato and her husband, Frank, popped by the office of Dr. Robert Novich, a primary care physician ... In the last two years Novich, 62, has coaxed a vast majority of his patients into scheduling visits, refilling prescriptions and asking simple questions over the Web"

That's right, the new buzzword isn't "the medical home" but the "medical url." It makes sense: you don't really need skilled (and expensive) support staff to handle routine chores like scrip refills and appointment scheduling. This is also helpful from an insurance standpoint: remember, health care costs drive health insurance costs, so any new process that reduces the former helps the latter.

There's even a new terminology for these brave pioneers: "micropractices." The idea is that general practitioners tend to be "traffic controllers," helping coordinate their patients' various specialists and medication needs, but don't get reimbursed for much of these services. Automating processes and information eases that "traffic flow" and makes it that much more cost-efficient to manage.

Makes sense to me.

Grand Rounds is up

Dr Pullen presents this week's varied and interesting roundup of medblog posts, helpfully scored for writing and content.