ObamneyCare© vs The Constitution

While (almost) all eyes have been on the constitutionality of the (Evil) Individual mandate, another constitutional issue is hitting the radar, and it's pretty powerful:

"Nonprofit employers who, based on religious beliefs, do not currently provide contraceptive coverage in their insurance plan, will be provided an additional year, until August 1, 2013, to comply with the new law."

Seems pretty benign and banal, no?

It is anything but:

"Dear Brothers and Sisters in Christ:

I write to you concerning an alarming and serious matter that negatively impacts the Church in the United States directly, and that strikes at the fundamental right to religious liberty for all citizens of any faith. The federal government, which claims to be “of, by, and for the people,” has just been dealt a heavy blow to almost a quarter of those people — the Catholic population — and to the millions more who are served by the Catholic faithful."

At issue is the requirement, about which we wrote this past fall, that health insurance plans pay for abortions and birth control, with no deductibles or co-pays.

There are several issues at play here. We've already debunked the idea that this coverage is "free." But that's not even the worst of it. Catholics are not the only constituency that forbids artificial birth control: approximately 845,000 Orthodox Jews would be affected by this trampling of the First Amendment, as well. As for abortion, well, that's against Catholic doctrine, and not a few Christian denominations, as well.

And according to at least one source, abortion is also forbidden by Islam.

Which begs the question: ACLU, where art thou?

Walgreens Makes a Funny

Last time we looked, Walgreens was in the process of slitting its own wrist. The good news is, we recently received snail-mail [copy available here] from them detailing how we can help them retain their customer base.

The bad news is, of course, that I don't work for Walgreens.

In a particularly tone-deaf plea for assistance, we're told that "[o]pportunity for selling Small Group plans with an integrated pharmacy benefit can ensure your clients access to Walgreen's in 2012" [underline in original]

First, no employer really cares which pharmacies are included in any particular plan. They are concerned primarily with the prohibitively high cost of small group plans, and are looking for ways to reduce them. They're further challenged by the fact that small group plans are "off the rack;" that is, there is precious little customization available, and no carrier (to our knowledge) offers multiple pharmacy provider options. You get what's packaged.

But never fear, "Walgreen's has put together a comprehensive education program to reach patients who may be expressing concerns to their employers." Which is nice, but employers have also rolled out a comprehensive education program to reach their employees with such concerns: "this is our group plan. Feel free to sign this waiver if you don't like it."

Walgreeen CCO (Chief Client Officer) Joe Terrion provides us with handy "Talking points for Health Insurance Brokers;" these include the statement that "pharmacy access is an important consideration for small group." Um, not so much, Joe.

But -- and here's where I literally laughed out loud -- (Slow) Joe continues, groups "can easily switch to competitively priced health plans that provide access to a broad network of pharmacies, including Walgreens."

Uh-hunh.

Here's a question, Mr T: what color is the sun in the sky above your planet? Because here, medical underwriting has tightened up, premiums have sharply increased while choices have sharply decreased, and employers are looking for ways to minimize the damage. I have yet to have any employer ask me about what pharmacies are included in any particular carrier's offerings.

No one but Walgreens cares, and as I pointed out at the beginning, I don't get paid to shill for them.

Open wide and say....ObamneyCare©

Writing in this month's issue of Health Insurance Underwriter magazine (not the swimsuit issue), Ameritas Sr VP Karen Gustin opines about how dental plans will fare under ObamneyCare©. We've addressed this issue before, when we took to task Companion Life's cave-in on "young adult" coverage. At the time, we pointed out that dental plans are specifically excluded from this requirement.

In fairness, what the law (purportedly) says and how it's implemented by HHS Secretary Shecantbeserious are often at odds, so it may not have been completely unreasonable for Companion to have acted pro-actively at the time.

Still, that was then, this is now, and Ms Gustin previews the year ahead as regards dental coverage under the current regime:

■ Dental care for children: as with the medical parts of ObamneyCare©, there will be a core "essential" benefits component, the make-up of which is still being considered.

■ Dependent tracking: this one's disturbing. New requirements will be rolled out detailing employers' responsibilities to track their employees' dependents and how (or even if) they're covered. This is part of new compliance requirements that, frankly, sound even worse than the Individual Mandate (who even thought that was possible?).

■ Fee integration: aka new taxes. 'Nuff said.

■ Employee education: aka Brainwashing. Ms Gustin's point is that the law (ostensibly) requires only juvenile coverage and there's concern that as they age off these plans, folks will forgo needed care. Or, as we call it, personal responsibility.

There's more, and the article is definitely worth the read. Maybe in the dentist's office?

[Hat Tip: SoIB Gail S]

SOTU: ObamneyCare© MIA

Careful listeners might be forgiven if they missed the 44 words covering his signature legislative "victory" in President Obama's most recent State of the Union address. That's correct, 44 words in a speech which, oddly enough, barely qualified as Smarter than an 8th Grader.

Now why would the President elide over his stellar accomplishment?

Well, the fact that 44% of the public disapproves of it (versus 37% who think it's just Jim Dandy). The most hated part? Well, that remains the (Evil) Individual Mandate, which 54% believe (correctly) is unconstitutional.

Which is not to say that the Republicans should rest easy, either. In his rebuttal, Hoosier Gov Mitch Daniels gave the subject short shrift, as well. As Bob pointed out yesterday, the Republicans' plan is not exactly a barn-burner, either.

Still, one is left to wonder why the President was so uncharacteristically modest about the bill we had to pass to learn what's in it.

$howing us the money

Take a gander at this:

Put together by the folks at research biggie RAND Corporation, it "provides a graphical look at how accelerating health care costs have gobbled up the income gains made by American families over the past decade."

There's no question that the cost of health care, both its delivery and the financing thereof, has become an ever-increasing burden on the consumer. Although it's not the primary cause of the problem, ObamneyCare© has certainly exacerbated it, by decreasing consumers' "skin in the game" and choices, and increasing the cost of both health care (scarcity) and health insurance.

Americans are not stupid: they can see the disconnect every time they look at their pay stub or pay their insurance bill, or write a check at the doctor's office. Would that Washington actually understood this.

And couple that with this little tidbit:

"Just 1% of Americans accounted for 22% of health care costs in 2009"

Make of that what you will...

[Hat Tip: Warren Robak]

Small Biz: RIP

As we've previously noted, one of the major victims of ObamneyCare© is "small business." Aside from affordability issues, there's the very real problem of uncertainty. That is, if would-be employers can't make at least an educated guess about the future of their business, they're going to be very reluctant to even consider new hires.

But don't just take our word for it:

"A new poll from the U.S. Chamber of Commerce reveals an increasingly frustrated small business community worried about the impact [ObamneyCare©] may have on their bottom line.

Nearly three-quarters ... say the new law is causing an impediment to job creation."

But why is that?

It's pretty simple, really:

"[Owners of small businesses] look at this bill as more of a tax bill wrapped up and packaged as a health care reform bill ...It really puts most of the cost and burden on small business owners."

Indeed.

La plus ca change...

Thanks to FoIB Holly R, we learn that the bill we had to pass to learn what's in it has accomplished, well, see for yourself:

In point of fact, the overall rate of uninsured has been increasing despite [ed: more likely, because of] ObamneyCare©.

Feel better now?

Cavalcade of Risk #149: You'll need a #2 pencil...

Nothwithstanding offers a unique, indeed unprecedented, version of the Cavalcade of Risk: a test. For each entry, you'll be asked a question, and offered a set of possible answers. Go ahead, give it a go!

[High scores win a coveted one-year subscription to the CoR Newsletter. If and/or when we ever decide to do one]

GrandRounds Today

Grand Rounds makes its MSM debut today, as FoIB Dr Val Jones hosts the premier roundup of medblog posts at USAToday. It's an ambitious project: dozens of entries in 4 separate posts.

Whew!

Kudos to Dr Val for putting this together, and for the opportunity to reach a larger audience.

High and Dry with the MVNHS©

Hungry? Thirsty? Best not count on the Much Vaunted National Health System to bail you out:

"Four patients are dying hungry and thirsty on hospital wards every day ... 1,316 deaths were linked to or directly caused by dehydration and malnutrition in 2010."

This is of a piece with a post Bob wrote earlier this month:

"We need to get the basics right. Patients need to get the food and drink they need."

The scariest part of this is that the Brits' health system is one of the primary models on which our own ObamneyCare© is based. Why is this scary?

Well, let's let the chief executive of the Patients Association, Katherine Murphy, explain:

"These figures are a terrible indictment of our precious National Health Service."

Coming soon to a hospital near you...

Slippery Slope?

Building on Bob's post from yesterday, reporting that health insurance policies will now have to offer first-dollar coverage for birth control, we learn that the MVNHS© (upon which Obamneycare© is based), has a glimpse of the next step:

"Six children in Britain will be given jabs to delay the puberty on the NHS because they are convinced they were born the wrong sex... It will also make any sex-change operation far easier should they decide to permanently swap gender."

This will come as no surprise to regular IB readers:

"The number of sex change operations carried out on the NHS has almost tripled in the last eight years."

As with IVF, neither birth control nor sex-change procedures are medically necessary, but (as we've pointed out again and again), all of these mandated "benefits" add to the cost of health insurance.

But hey, they're "free," right?

Can you hear the risk?

Not being much of a music lover myself (although I was saddened by this news), I don't own a Sony Walkman MP3 music player, and my car's satellite radio is generally tuned to a comedy channel. But my better half and daughters are avid audiophiles, so I'm pretty familiar with the little (annoying) earbuds.

What I was not familiar with, however, is this:

"The number of serious and fatal injuries involving pedestrians wearing headphones has tripled since 2004"

Sounds pretty scary, right?

As so much with the media these days, the hype seems - what's the word? oh, yeah - hyped:

"According to Lichenstein’s study, 116 people have been injured while walking with their headphones on since 2004, with most of them being injured in the last few years. According to his study, 16 people were injured while walking and wearing headphones in 2004. By last year, that number increased to 81."

Okay, lessee now, 116 injuries over 7 years (it's only January, so I'll give them the benefit of the doubt) comes to, um, about 17 injuries per year.

But each year, 40 people are killed by lightning (what, they didn't hear the flash over their Gaga?), 823 folks drown in their tubs, and over 320 people die in bus crashes every year (although there's no word on whether or not the drivers were listening to tunes at the time).

So tell me, why is this even news?

A Very "D'unh!" Moment

Over at The Conversable Economist, Timothy Taylor (no, not that Tim Taylor) makes a very simple, but very powerful point:

"[W]hen you see comments about how pay hasn't gone up much in recent years, one big reason is that health care costs are swallowing the gains."

And he's got the chart to prove it:

You really should read the whole thing.

And if you'd like a more detailed explication of how employers don't actually pay for any of your health insurance, click here.

[Hat Tip: FoIB Holly R]

Cavalcade of Risk #149: Call for submissions

The NotWithStanding blog hosts next week's CavRisk. Entries are due by Monday (the 23rd).

Just click here to submit your post.

You'll need to provide:

* Your post's url and title
* Your blog's url and name
* Your name and email
* A (brief) summary of the post

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

Cannon Fodder/LinkFest

FoIB Michael Cannon, the Cato Institute's director of health policy studies, has a trio of interesting, provocative and insightful posts up:

■ Oops, Maybe ObamaCare’s Cost Controls Won’t Work after All wherein MC reports that the Congressional Budget Office just revealed they aren’t very successful, after all:

"In nearly every program, spending was either unchanged or increased relative to the spending that would have occurred in the absence of the program"

Ooops indeed.

■ *Will the Feds Be Ready With the Fallback Insurance Exchanges by October 2013? As we've repeatedly pointed out here at InsureBlog, the Exchanges aren't really the panacea they're being touted as. The reality is that less than half of the 58 states are actually on-track with having their Exchanges "ready to go" on schedule.

Quelle surprise.

■ Wisconsin Stiff-Arms ObamaCare Seems that Badger State Gov Scott Walker has told the Feds "thanks, but no thanks," and has ""announced Wisconsin will return the $37 million “Early Innovator Grant” it received from the Obama administration under the health care law."

Not just no, but Hell No.

MVNHS© Docs: Strike One!

The so-called Doc-Fix is (once again) on hiatus; Congress keeps kicking this particular can down the road, in a (no doubt futile) attempt to make it go away all by itself. But as we continue hurtling toward full implementation of ObamneyCare©, it's worth noting that the system upon which it's modeled seems to be hitting a breaking point.

To wit:

"The British Medical Association ... said two thirds of its members support industrial action which could cripple hospitals and GP surgeries throughout the country."

That amounts to about 87,000 docs and med students.

The "industrial action" to which the BMA is referring is a threatened strike by doctors over planned cuts to their pension plans. It seems that the Much Vaunted National Health System© isn't any better (and is, in fact, arguably worse) at reining in costs than their former colonists.

By the way, the Telegraph claims that the average value of a doc's pension is over $2.6 million.

Not too shabby.

But I'm sure that has no effect on the budget shortfalls.

Health Wonk Review: Future Shock/Beer Month edition

HWR co-founder Julie Ferguson hosts this week's collection of noteworthy (and wonkish) posts, featuring a peek into the future of health care polity and policy.

Amelia's Story

Over the years, we've posed several Ethical Conundrums, most recently here. This one's difficult: Amelia is retarded (aka developmentally delayed) and has poor kidney function.

She is, in all probability, dying.

And she is a toddler.

Here's the problem:

"Did you just say that Amelia shouldn’t have the transplant done because she is mentally retarded ... This phrase. This word. This is why she can’t have the transplant done?

Yes."

So, is this a Death Panel?

Read the whole thing, and then feel free to share your thoughts in the comments here.

[Hat Tip: Ace of Spades]

Southern Belle Tolls

True story: a few years back, my better half and I were watching Paula's Kitchen on the Food Network, when we heard a distinct - and unmistakeable - sound. We turned to each other and asked, "did they just bleep Paula Deen?!"

Indeed they had. First, last and only time we'd ever heard a bleep on Food Network.

I was reminded of that experience when this appeared on the radar:

"Drug giant Novo Nordisk has nabbed Paula Deen ... as a new spokeswoman to help raise awareness about type 2 diabetes – which she has."

Well, that last is no real surprise, but what is news here is that "Deen had profited from making herself and others diabetic, and that now she would make more money selling drugs to make those same people better."

Sort of a "Backdraft" moment, no?

So the question becomes: is this a conflict of interest? After all, one could argue that she encouraged eating behaviors that could easily lead to developing diabetes, a risk that could have been avoided by pushing healthier recipes.

I don't think it's that simple: for one thing, these kinds of shows are as much entertainment as educational. And let's face it, no one's forcing you to make deep-fried butter-balls topped with chocolate syrup and sprinkles.

(Although that sounds delicious!)

And certainly more than a few of her fellow diabetes patients see her "as a fellow traveler, different from the doctors and health nuts who are lecturing them about what they eat." In fact, she may actually have more credibility, given her own food proclivities and history.

Which brings us to this obesity-related item sent in by FoIB Holly R:

"As one of the many outgrowths of [ObamneyCare©], health insurers and employers must now pay the cost of screening children for obesity and providing them with appropriate counseling."

Of course, insurers and employers don't actually pay for any of this: their insureds and employees do, in the form of higher premiums.

On the one hand, it's in the bill we had to pass to learn what was in it. On the other hand, well, the Law of Unintended Consequences is a brutal mistress:

"Other than intensive hospital-based programs, few proven models exist for helping children and adolescents achieve and maintain a healthier weight, and researchers do not even fully understand the factors that contributed to the rapid rise in childhood obesity in recent years."

We don't know what causes this, but the answer is obvious: Quick, throw more money at it!

Why not just block Paula's Kitchen?

On Buggy Whips and Slide Rules

Ironman at Political Calculations (host of the most recent Cavalcade of Risk), has a thought-provoking - and inspiring - post on tech obsolescence:

"Think of things like buggy whips, or Commodore 64 computers, or newspapers, or DVDs."

These have all gone away (buggy whips) or evolved into something new (DVD's). But Ironman points to one example that "would be instantly recognizable to a time traveler from the past for what it is."

Can you guess what that is?

The answer may surprise you, as may the tech that just might supplant it.

Price Check, Please!

As we've discussed on numerous prior occasions, one of the positive consequences of consumer-centric health care has been increased price-awareness on the part of consumers. Of course, this had led to an increased demand for that most vital necessity: information. My favorite metaphor is McDonald's, where a quick glance at "the board" reveals the going rates for Big Macs and fries salads and Diet Cokes.

So why isn't this the case for health care?

Well, that's changing, as we noted long ago regarding Aetna's Navigator tool. And now, Assurant Health has entered the fray with its take, called "Price Check." This online portal enables Assurant insureds to determine ahead of time the price of a given office visit or procedure:

"With Assurant Price Check, ... clients can find guaranteed costs for common medical services and doctor visits ... Assurant Health Access customers will be reimbursed by Assurant Health for costs exceeding the quoted price range," subject to some fairly reasonable conditions.

Once at the site (currently available only to Assurant's clients and agents), you put in your zip code, select a category (office visit, lab, etc),and a provider (optional). I plugged in a simple flu shot, and got prices ranging from $15 to $18 (excluding the cost of the office visit). Nothing fancy, but pretty cool.

Just for kicks, I also asked about a CT scan of my head/brain [ed: bet the results showed nothing!], and learned that these run from $216 to $238. Such a bargain!

It's heartening to see these kinds of tools becoming more widely available; hopefully, they'll empower consumers to be more cost-conscious.

Oh, Those Invincible Yutes

In Colonial America, "full majority was reached at the age of 21." Folks who attained that age could "Buy or sell land without restriction ... Vote or hold public office ... [even] Act as a guardian."

Oh, how far we've come:

"Seventeen million young Americans would lose promised access to health insurance if the Supreme Court strikes down [ObamneyCare©]"

And how, pray tell, does "consumer advocacy group Young Invincibles" define a "young adult?"

Why, that would be folks "between the ages of 18 and 34."

Could we cast a wider net?

Didn't think so.

And of course, these Young "Invincibles" [ed: now there's an oxymoron!] continue the grand tradition of conflating health care with health insurance .

And then there's this little legerdemain:

"The law has already allowed 2.5 million young people to gain coverage thanks to a provision that requires health plans to allow them to remain on their parents' family plans through age 25"

So which is it? Age 26, or age 34? Or some other (arbitrary) number?

And in case you think that this doesn't affect you, because you're a 35-year old fogey, think again:

"When [ObamneyCare© kicks] in in 2014, about 8 million young adults will qualify for Medicaid and another 9 million will become eligible for federal subsidies to buy private insurance"

Translation: you'll be on the hook for health insurance for another 17 million "young people."

Finally, gotta love this howler:

"The group's amicus brief argues that the requirement that everyone have insurance ... "does not impose a significant burden on young adults."

Well first, no one seriously argues that this is a question of finances. It's about the government forcing us to buy something we may not want or need. And second, if it's not a "significant burden," then what's their beef in the first place?

Sheesh.

Grand Rounds is up

Intensive Care nurse Gina hosts this week's curated edition of interesting medblog posts.

OmniCare (Back) in the News

When last we visited OmniCare (in passing, some three-and-a-half years ago), they were accused of so-called "pill-flipping;" that is, surreptitiously dispensing more expensive forms of the drug to unsuspecting customers, at the expense of both them and us (as taxpayers).

Fast forward a bit, and we see "the more things change, the more they stay the same" in action:

"Omnicare Inc. faces a lawsuit from a former employee who claims the Covington-based company overcharged Illinois and the federal government for medications ... He alleges that as a result of the actions, the governments possibly incurred millions of dollars of damages."

Now, this could be a big deal, if what they were doing was, in fact, illegal (as it appears to be, inasmuch as the whistleblower claims that "he was compelled by Omnicare to enter false billing information").

Sounds like OmniCare wasn't exactly OmniScient.

[Hat Tip: FoIB Holly R]

The Big, Fat MVNHS© Gets Creative

In what can only be called a very big deal, the Much Vaunted National Health Service© has come up with a really clever way to handle morbidly obese Brits who need CT scans:

"NHS hospitals have resorted to asking zoos and vets to scan patients who are too obese to fit into hospital scanners."

To be fair, this actually makes sense: rather than deny these folks any diagnostic options, this at least gives them some hope.

And, of course, room.

And from the Learn Something New Every Day© Dept:

"The practice of referring patients to zoos is commonplace in America where obesity has reached epidemic levels."

"Commonplace." Uh-hunh.

'Cept for one small problem: No, it isn't.

Alphabet Soup Update: 2012 Edition, Part 1

As ObamneyCare© continues its inexorable march towards full implementation, consumers need to be thinking at least 2 or 3 steps ahead. Case in point: Flexible Spending Accounts (FSAs).

As of next year (yeah, I know, '12 just got underway) there's a new $2500 cap on FSA contributions. So what, you say, it's only 2012.

The problem is that time passes rather quickly, and plans that currently max out at greater than the $2500 limit need to be amended sooner, rather than later. This is as much a timing issue as a wording one, because some plans are calendar-centric and some aren't; that is, some plans track from January 1, while others may run from (for example) April or June.

If you're wise enough to have availed yourself of expert local talent, you may already know about these changes. If not, it may be worthwhile to check in with your FSA admin folks to see what they recommend.

[Hat Tip: United HealthCare]

HHS Sec'y Shecantbeserious Hits Bottom, Keeps Digging

Because pandering to the LBGTBLT Community apparently wasn't enough, Ms Shecantbeserious has decided to throw caution (not to mention common sense) to the wind with this howler:

"‘Of all the forms of inequality,’ Dr. King said, ‘injustice in health care is the most shocking and inhumane"

Um, Kathy? That "Dr" part is of Theology, not Medicine.

Back under your rock, please.

Pancreatic Cancer and the NHS

The BBC published a video interview with two pancreatic cancer patients and their doctor. One person is inoperable and is terminal; the other is alive four years post-diagnosis.

The underlying message was that NHS budgets are delaying diagnostic work and that private insurance allowed one person to get treated early enough to survive.

Welcome to our future. It's worth a look.

http://www.bbc.co.uk/news/health-15672653

What's the 419?

Section 419 of the Internal Revenue Code outlines the steps necessary for companies to deduct various insurance premiums from their taxes. The first (and, as it turns out, last) time we discussed these was about 4 years ago, when we noted FoIB Joe Kristan's interesting post on 419's apparent demise.

Fast forward 4+ years, and Joe's at it again:

"A defense industry consultant signed on the Millenium Plan, set up as a section 419A(f)(6) welfare benefit plan to provide death, medical and involuntary severance benefits to employee participants. The IRS decided that the plan looked too much like a tax-free piggybank for the consultant and assessed over $5.5 million in taxes to the contractor and his corporation."

Ouch!

Definitely check out the rest of the story.

TNR Swings....and misses

Reality is hard for progressives:

"[T]rue competition can't exist without regulation."

This is of a piece with Sen Reid's recent proclamation that "[m]illionaire job creators are like unicorns. They are impossible to find and don’t exist.”

Tell that to, say, the late Steve Jobs or the very much alive Noah Glass, or even Messrs Ben and Jerry. But the bigger picture is that it is the over-regulation of insurance that has led us to where we are.

Mr Cohn cites his colleague Aaron Carroll, who continues to believe, despite overwhelming evidence to the contrary, that MassCare works (and thus ObamneyCare© is destined to, as well). Mr Carroll's argument hinges on the fact that the individual medical insurance market uses actuarially sound underwriting, which results in folks who develop significant health problems being locked into existing coverage, with no hope of changing for the better.

[As an aside, he's absolutely correct that this is a problem, one exacerbated, rather than solved, by ObamneyCare©s stupid PCIP rules]

But Mr Carroll (and thus Mr Cohn) double down on the fail:

"[S]ince the law [then-Gov Romney] signed in Massachusetts did exactly that. It organized the individual market, so all that people buying on their own can choose from among a variety of plans that they know will provide basic coverage and will always be there for them when they need it."

It's always the half-truths with folks like this. Yes, MassCare "organized" the individual market, if by "organize" one means forcing insurers to flee the state (resulting in less - not more - competition); increasing premiums, elevating the Bay State to the top tier of state debt, and encouraging folks to game the system for (essentially) free health care.

All that, and they still end up reducing choices in health care.

That is the result of "regulating competition."

But of course there's a silver lining here, right?

Not so much:

"The Affordable Care Act does the same thing"

Boy, howdy.

The TNR Boys conveniently neglect to mention, of course, that regulation in the form of mandates continue to drive up health insurance costs. And, of course, ObamneyCare© essentially outlaws consumer-centric health plans (eg HSA's), further decreasing choice and increasing expense.

Good thing we passed it to learn what was in it.

[Hat Tip: FoIB Holly R]

To boldly go where no patient has gone before

Here is a previously-unreported flavor of the “medical tourism” phenomenon.

InsureBlog has occasionally reported on medical tourism over the past several years.

The new flavor is "circumvention medical tourism" - - medical tourism for services that are illegal in the patient's home country but legal in the destination country.

The author of the linked circumvention article further believes that the “home” country should criminalize this behavior – which I suppose means that when the tourist comes home, she would be subject to prosecution.

I disagree, because I think there are practical as well as legal problems. However the suggestion does reminds me of a baseball story. A batter called out on strikes hurls his bat into the air. The umpire watches the bat spin upwards, then tells the player, “son if that bat comes down, you’re out of the game!”

Inside Baseball: ObamneyCare© and SCOTUS [UPDATED!]

[Poll added - see below. HGS]

NFIB's Karen R. Harned has tipped us to the (revised) schedule for ObamneyCare©'s day in (Supreme) Court. On the one hand, this is kind of dry, but on the other, folks are interested in observing this sausage-making process play out.

So, here's an abbreviated list of key dates; folks interested in the full schedule can drop me an email and I'll happily oblige:

■ January 13: Amici supporting Government on Mandate; Amicus supporting court-appointed amicus on Anti-Injunction Act

■ January 27: Government files Severability Brief; Amicus Briefs supporting Government on Severability due

■ February 6: NFIB/States Briefs Replying on Mandate; NFIB/States/Government Respond on Anti-Injunction Act

■ February 17: Court-appointed amicus on Severability; Amici supporting Government on Medicaid; Amici supporting court-appointed amicus on Severability (i.e., only mandate falls)

■ March 7: Government Replies on mandate

■ March 13: NFIB/States/Government Reply on Severability

■ March 27: 10:00 a.m.-noon Oral argument on individual mandate

■ March 28: 10-11:30 a.m. Oral argument on severability; 1:00-2:00 p.m. Oral argument on Medicaid

Cavalcade of Risk #148: Anti-Obsolescence edition

IronMan does an outstanding job with this week's round-up of risk-related posts. In what has become a tradition for him, IM has assigned value ratings for each post, as well as helpful summaries of their contents.

Do stop by, you'll be glad you did.

Tuesday Afternoon LinkFest

■ First up, American Thinker's Mike Stopa has interesting analysis about what we fear most about ObamneyCare©, and the historical ramifications of such a transformational change:

"They fear that they won't be able to continue to go to the doctor whom they trust. They fear that once a single consumer -- the government -- replaces 300 million consumers of drugs and medical technology and then begins to regulate costs ... But perhaps Americans' greatest fear of all is that Obamacare is a one-way door".

■ Next, a breast implant registry? Well, maybe:

"American health officials were urged to set up efficient mandatory registry to track breast implant patients ... When an implant deflates or things go wrong, it's very important to have because these are not life-long devices"

Who knew?

■ FoIB Jeff M tips us that "[d]octors in America are harboring an embarrassing secret: Many of them are going broke." Seems that "shrinking insurance reimbursements, changing regulations, rising business and drug costs" all conspire to bring them down.

Or maybe not so much:

"[S]ome experts counter that doctors' lack of business acumen is also to blame."

Heh.

■ Do economic factors influence health care spending? Perhaps:

"The growth of health-care spending was near a historic low at 3.9% in 2010 as the weak economy prompted people to cut back on medical care"

And yet:

"Health spending accounted for 17.9% of gross domestic product in 2010, the same as the previous year."

Imagine that.

Health Insurers making out fine, thank you

Before it flip-flopped on ObamneyCare©, the Association of Health Insurance Plans (AHIP - an industry lobbying group) was "all in" on nationalizing health care. Eventually, its members appeared to "see the light," and backed off its blatant support.

Or did they?

Well, the various carriers which make up AHIP's membership seem to be doing quite well by ObamneyCare©, even as the agents which represent them take a major haircut. According to the Washington Post:

"[T]he nation’s major health insurers have prospered in large part by expanding their role in government programs such as Medicare and Medicaid ... The share of large insurers’ revenues contributed by their Medicare and Medicaid business has jumped from 36 to 42 percent over the past three years."

That's about a 15% increase. Now, what happened three years ago that might have somehow affected health insurers and how they do business?

'Tis a mystery, that.

Now, I have no particular problem with carriers making hay off their Medicare/Medicaid business (I want them to be around to pay my claims, after all). The problem lies in this little tidbit:

"[T]he private companies are hired to run managed-care plans as an alternative to the traditional fee-for-service plans provided by the two programs ... The practice is attractive to states seeking to curb spending on Medicaid, which is funded with a combination of state and federal dollars"

So we're basically paying taxes and insurance premiums for the same service(s). Does this seem right to you?

[Hat Tip: FoIB Holly R]

Shecantbeserious keeps on over-reaching

To be fair, she just can't help herself. One is reminded of a certain theory, made popular in the late 60's, known as the Peter Principle:

"[I]n a hierarchy every employee tends to rise to his level of incompetence", meaning that employees tend to be promoted until they reach a position at which they cannot work competently."

AKA: HHS Secretary Shecantbeserious.

Because killing the market for child-only health insurance. muddying the waters as to what is and is not a covered preventive care procedure, and killing actual jobs just isn't enough, Ms Kathy has decided that ObamneyCare© needs to "[improve] the health and well-being of lesbian, gay, bisexual and transgender communities [by] training health professionals in "cultural competency"; and developing definitions of sexual orientation and gender identity."

So Christians and Jews are forced to pay for "health care" which is in direct contradiction to their beliefs, while the LBGTBLT Community is given extra consideration.

Isn't that special?

Sexual preferences are personal, private decisions, and we make no judgement calls regarding them. But where in the bill we had to pass to learn what's in it does it require that sexual identity is now a "special class" deserving of "special benefits?"

As with all of these "feel good" insurance mandates, it is the tax- and premium-payer that pays the price, in the form of higher insurance premiums and health care costs.

Sheesh.

Time for a TAA (make that TAAEA) Update

Some two-and-a-half years ago, we reported on the little-known Trade Adjustment Assistance program, started in the early 60's, which "was originally intended to help workers whose jobs were shipped overseas by helping them obtain new jobs at pay similar to their previous employment. It's since been expanded..."

And how.

According to an email from Anthem, "the Trade Adjustment Assistance Extension Act (TAAEA) ... increases the amount of the Health Coverage Tax Credit (HCTC) that is available to certain individuals receiving Trade Adjustment Assistance to 72.5 percent ... In addition, TAAEA provides an extension of COBRA coverage through January 1, 2014 to qualified beneficiaries ..."

Talk about Mission Creep.

That fine print can be a pain in the...

As we've noted, ObamneyCare©'s "free" preventive care benefits aren't actually free. Increased premiums, fewer providers and lower quality health care are the price we pay for these oh-so-generous freebies.

Turns out, though, that even the freebies aren't, well, free:

"[ObamneyCare©] encourages prevention by requiring most insurance plans to pay for preventive care ... But there are confusing exceptions ... colonoscopies can go from free to pricey while the patient is under anesthesia."

The problem is the distinction between "preventative" and "diagnostic." A simple colonoscopy, where the doc is simply "sightseeing" is going to count as the former, and thus "free." Oftentimes, however, he'll spy a (usually benign) polyp; using the 'scope, he'll zap it and continue on his way. It's that "zapping" that changes this from a preventive to a diagnostic - and thus chargeable - procedure. Since one is under anesthesia while all of this is going on, there's no opportunity to say "hold up there doc, just let it be."

Of course, I don't understand the mindset that would allow anyone to actually do that, either, conscious or not.

The problem is further exacerbated by the fact that the entire exercise - not just the "zapping" - becomes diagnostic. It makes much more sense for the additional process to be billed as diagnostic, while leaving the underlying procedure in the preventative (and therefore "free") category.

Some of the players are looking into making these kinds of changes. But of course we had to pass the bill to learn what's in it.

And what's not.

[Hat Tip: FoIB Holly R]

Winter Driving Risk iManagement

This is pretty cool:

"Winter Survival Kit ... is both a primer to help motorists prepare for winter driving and a beacon when things go badly."

The "kit" is a smartphone app that features auto-911 dialing, family notification, even tips on how to keep from suffocating if caught in a bad winter storm.

Developed by two members of the North Dakota State University faculty, it's free and (apparently) pretty intuitive to use.

Think you'll never need it?

Well, maybe:

The late John Lewis fisks ObamneyCare©

Dr Lewis was a noted Professor at Duke University, who recently succumbed to cancer. Here, he discusses the morality of health care reform versus the cost of it:



[Hat Tip: We Stand Firm blog]

Cavalcade of Risk #148: Call for submissions

Iron Man at Political Calculations hosts next week's CavRisk. Entries are due by Monday (the 9th).

Just click here to submit your post.

You'll need to provide:

* Your post's url and title
* Your blog's url and name
* Your name and email
* A (brief) summary of the post

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

Happy New Year!

Investments vs Insurance

Cash value life insurance plans, including Universal and Whole Life, have a very definite and useful place in many (most?) folks' risk management portfolio. One of the criticisms of both UL and WL, though, is that they're "lousy investments."

Quite so.

In point of fact, life insurance professionals are essentially forbidden to use the terms insurance and investment(s) together. And that's as it should be: life insurance is a risk management tool, not an investment vehicle (although some products have investment-like properties).

I bring this up because of an email that went out to those of us who represent Assurity Life. Assurity offers "regular" life insurance and disability products (they're excellent for blue- and gray-collared clients), and they are serious about policing how their products are sold.

How serious?

This serious:

"If Assurity has knowledge that a variable contract is being replaced by an Assurity product and the producer is not licensed as a variable contract producer, the application and funds will not be accepted."

Apparently, some agents (who should know better) have been touting the guarantees inherent in fixed policies (such as UL and WL) based on the rather anemic growth in some prospects' variable life policies (the ones with investment-like sub-accounts). It is Assurity's stance that even discussing this kind of comparison amounts to offering investment advice, and they want no part of it.

I do see their point, although I think it's a far cry from comparing results with actual investment "advice." Still, it's their party, and they get to set their rules.

The bottom line, of course, is still the "need" for any life insurance. As Bob noted over four-and-a-half years ago: "Most folks don't want insurance. What they want is a way to protect their income and other cash assets."

Health Wonk Review: It's a New Year edition

Jared Rhoads hosts the first HWR of 2012, and it's a great way to kick off the new year.

This is Jared's 4th time hosting, and it shows, with interesting selections and helpful summaries.

Life (Former) Partners

Last Spring, we continued our coverage of Life Partners (LP), a holding company that buys and sells life insurance policies to (unwitting) investors.

Or should we say, sold:

"The SEC announced ... that disclosure and accounting fraud charges will be levied against Life Partners Holdings Inc ... The SEC also alleges that CEO Brain Pardo, general counsel Scott Paden and CFO David Marten misled shareholders ..."

No kidding.

As we noted in late 2010, LP's resident medical risk guru, a certain Dr Donald Cassidy, had a rather unenviable track record for picking, um, winners and losers: over 60% of the insureds had outlived his reported life expectancy, and almost a third had tripled it.

This boded ill for those suckers investors who did business with LP.

And it continues to do so:

"The SEC alleges that during the process of artificially underestimating the life expectancy of policyholders that Pardo and Paden then sold $11.5 million and $300,000 respectively in Life Partners stock at inflated prices."

So, $12 mil and their "clients" didn't even get t-shirts?

ObamaWaiver©s, Shecantbeserious, and Corruption

And yes, I realize that the title is somewhat redundant. According to Judicial Watch, our suspicions that these little party favors were, in fact, Thank You gifts to Obamastration supporters seem pretty well confirmed:

"While it's not possible using this HHS report to pin down the exact share of the $4.5 billion that was paid to plans covering union retirees - it seems very unlikely that share is less than 50%. About 12% of the US workforce is represented by unions."

As Mike recently pointed out, the "HHS report shows that the UAW retiree trust has received over $387 million - which is, all by itself, 8.5% of the total distributed ... Only 3 of these top 17 are corporate plans ... the remaining 14 are either union funds or public employer retiree plans."

And as if this transparently obvious payback wasn't enough, Ms Shecantbeserious also embarked on "on a massive, taxpayer-funded, multimedia campaign designed to promote Obamacare."

But then, IB readers are already familiar with MatlockCare©.

[Hat Tip: Mike F]

MassDunh!

As we've previously remarked, MassCare's health insurance mandate lacks any real teeth. One reason for that is, of course, that the penalty for failing to purchase health insurance is a joke.

So what's the Bay State's answer?

"Massachusetts residents who do not have health insurance would face a higher financial penalty in 2012 ... the maximum penalty ... would be $105 for each month that an individual is not covered by health insurance"

Seriously? A hundred bucks?

Call that one a bargain and move on.

Oh, and how's that whole mandate working out?

Well, there's this:

"[T]he U.S. Census Bureau reported that at 5% ...Massachusetts had the lowest uninsured rate of any U.S. state."

Sounds good, right?

Aye, but here's the rub:

"Doc Shortages and Rising Health Care Costs"

Ooops.

[Hat Tip: FoIB Holly R]