Wednesday LinkFest: Dead Parrots and Deer Strikes

Assurant's Jeremy Fink tips us to the latest news from the Council for Disability Awareness (CDA), which recently released the results of its annual Long-Term Disability Claims Review. The review includes data from 17 member companies which participated in the 2011 survey. It's important to note that these 17 carriers represent about 75% of the private DI industry (giving cred to the results).

Some nuggets:

■ As a group, the carriers paid out over $9 billion in long-term disability claims (about 2% more than in 2010)

■ Over 95% of the claims were *not* work-related

■ This is troubling: for the third straight year, the number of covered lives decreased by a half of a percent, meaning fewer people were insured. I'm sure double-digit unemployment had nothing to do with that, of course.

You can read the whole report here.

FoIB Michael Cannon (who's also the Cato Institute's Director of Health Care Policy) continues his beat-down of the ObamaTax Exchanges, pointing out what he considers a fatal flaw:

"[T]he Democrats had no choice but to accept the Senate version. And that version is structured in such a way that individual states can decide to opt out of those state health insurance exchanges that are central to Obamacare."

And what's so insidious about that? For one thing, think of a dead parrot. And more taxes.

Finally, the Insurance Information Institute (III) reports that deer-vehicle mash-ups are increasing:

"An increase in urban sprawl and more roads being built through wildlife habitats have displaced deer from their natural habitat, leading to a rise in deer-vehicle collisions ... An estimated 1.23 million deer-vehicle collisions occurred in the U.S. between July 1, 2011 and June 30, 2012, costing more than $4 billion in vehicle damage"

And it's not just cars that get wrecked - these can be extremely dangerous for drivers and passengers, as well, killing some 200 people every year. So watch out for Bambi.

Open wide and say....

'Twas nice while it lasted.

I'm no fan of dental plans in general, so this news isn't exactly heart-breaking for me, personally. Still, it's one more nail in the "pro-choice" coffin:

"The [ObamaTax] could create a new divide between consumers who have high-end dental coverage and consumers who have bare-bones dental coverage, or no dental coverage at all."

That's according to a new study from the National Association of Dental Plans (kind of AHIP for the toothy crowd). The study claims that 60% of consumers surveyed had some sort of dental plan. Frankly, I find that number dubious, at best. On the other hand, it also claims that 53% of respondents had visited the dentist in the past 6 months. Maybe.

The issue at hand is that, since the ObamaTax essentially kills the employer-based health insurance market, it will wreak ancillary havoc on the dental one. This makes some sense: dental plans per se aren't directly affected by the train wreck, but that nasty Law of Unintended consequences can be a real toothache.

How much time do we have? Well, the Medicare Trust Fund Disappears in just 3 presidential terms

The 2012 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds was submitted April 23, 2012 to John Boehner and Joseph Biden, Speaker of the House and President of the Senate, respectively.  That report states (at page 6 et seq)

"The estimated exhaustion date for the HI trust fund remains at 2024, the same year shown in last year's report."  and

"HI expenditures have exceeded income annually since 2008, and projected amounts continue doing so through the short-range period until the fund becomes exhausted in 2024."

2024 may sound like a long way off in the future but it's only 12 years - 3 presidential terms.  That is not much time.

This is important stuff.  But if you prefer not to wade thru the Trustees Report, then please at least read this opinion piece in Sunday's Washington Examiner.

Here are two key paragraphs (but read the whole thing):

"Under Romney's plan, Medicare would not change for anyone who is currently 55 years of age or older. For those who are not yet 55, Romney has proposed a premium support program that puts the choice of health care coverage in the hands of seniors, not the government. If Medicare is the best option, future seniors will still have access to the program, but if there is a more affordable or higher quality plan in the private sector, older Americans will have the choice to leave traditional Medicare and pocket any savings.

"Whereas President Obama's top-down approach only lowers the amount the federal government will pay for services, Romney's proposal introduces competition into Medicare in order to drive down the cost of health insurance and provide an incentive to improve and innovate current plans for seniors."

I would only add that enabling private insurance competition for Medicare will be a good thing, but that is still nibbling around the edges of the more fundamental problem - the cost of delivering medical care in the U.S.  

Until that more fundamental problem is acknowledged and faced honestly, there is no real hope for a solution that works any better than the failed "solutions" of the past 45 years.  Those failed "solutions" have now brought us to within 3 presidential terms of a Medicare whose trust fund is exhausted and whose annual costs will continue to run far in excess of annual income.  In the private sector, that would be called "broke" if not "bankrupt".  In government work, it's called something else.  

But it walks like a duck and quacks like a duck . . .  So if this is not a crisis what is?  If now is not the time to tackle it, when will be?  If Americans will not devise a solution for ourselves, who do we think will come along and impose one on us?

Racking them up on the MVNHS©

As we've been documenting for many years (most recently, here), the Much Vaunted National Health System© is very good at one thing: killing off its victims patients. In fact, the "system" is pretty efficient at doing so:

"Patients having major surgery in [MVNHS©] hospitals face a much higher risk of dying than those in America ... seriously ill NHS patients were seven times more likely to die than their American counterparts."

W already knew that our cancer survival rates were many times better than the Brits', but this metric goes even further. It appears that a primary driver in this case is a shortage of specialists (which we're already seeing here as a result of the ObamaTax) and post-op facilities. This is rationing without rationale.

The study also posits that the long wait for treatment means less chance of a positive outcome, which drives up the mortality rates even more. Oh, you want to know how we stack up? No problem:

"The results showed that just under ten per cent of British patients died in hospital afterwards compared to 2.5 per cent in America. Among the most seriously ill cases there was a seven-fold difference in the death rates." (emphasis added)

Not for long.

[Hat Tip: Daniel Mitchell]

ObamaTax vs RomneyCare

Mike gave us a very cogent analysis of the actual, as-implemented MassCare plan, which was, in fact, much different than the original program set forth by Gov Romney. LifeHealthPro's Allison Bell offers her take on key differences between the two Presidential contenders' visions.

Here are a few examples; I really recommend that you read the whole thing:

"2. Women’s health and abortion"

Contrary to the spin, the ObamaTax does, in fact, include coverage for abortion [ed: please note that this is my take, not Ms Bell's]. And, of course, there's the whole convenience item birth control mandate.

Romney's plan doesn't (seem to) address either issue.

"5. Tort reform"

There's no mention of this in the ObamaTax, which doesn't preclude HHS Secretary Shecantbeserious from requiring it.

Romney proposes caps on "non-economic damages in medical malpractice lawsuits."

"6. Health accounts"

Regular readers know we're big fans of consumer-driven health care, which the ObamaTax effectively guts ("essential benefits," slashing of HSA's and FSA's, etc).

It's probably no surprise that Romney supports expanding these types of plans.

Ms Bell does a great job of thumb-nailing some of the key differences, including treatment of Medicare and Medicaid. Definitely worth clicking through.

Liverpool not just for Beatles

We've discussed the Liverpool Death March Pathway before; in brief, the program's "being used to cut costs instead of as simply a more humane mode of care ... allows medical staff to withhold fluid and drugs in a patient’s final days."

Turns out, even this draconian  measure's not enough for the Much Vaunted National Health Service©:

"Thousands of patients have already been placed on 'death registers' which single them out to be allowed to die in comfort rather than be given life-saving treatment in hospital."

Some 3,000 health care "providers" enthusiastically participate in this (un)official death panel, which targets those victims patients who are expected to die within the year. Of course, one wonders whether there's a sort of synergy inherent in that process...

The program even has a very benign sounding title, "End of Life Care Registers," as if one were engaged or expecting a baby. Perhaps Harrods even has a department just for these folks, where one can pre-order coffins and the like for those "lucky" enough to make the list.

Not that the victims patients themselves would even know of it:

"Although more than 7,000 patients nationwide have already been put on the list, there appears to be no obligation for doctors to inform them."

Which I'm sure they're getting right onto.

What's so scary about this is the banality of the term "Register;" sounds ever so much more pleasant than Death Panel, don't you agree?

Checking up on Check ups

Are those "free" routine physicals over-priced? The WSJ's Shirley Wang reports that they may, in fact, be less helpful than one might believe:

"General medical checkups for healthy adults may not be as beneficial as people tend to think ... raising questions about whether spending on preventive services should be more focused on tests shown to be effective."

This doesn't mean, of course, that they're bad things, or will contribute to an early demise. But it appears that their actual effectiveness may be over-hyped.

One of the primary challenges is that we do love our "freebies," and any threats to curtail them are met with, well, certainly not enthusiasm. But the ObamaTax requires that they be covered in full, so of course there'll be a lot more of them (to the delight of Big Laboratory, one supposes).

Great.

[Hat Tip: FoIB Holly R]

Under the ObamaTax Hood

Behemoth tax and accounting firm Ernst & Young has put out a comprehensive study of exactly how the new ObamaTax fees penalties taxes will impact business (and anyone employed by a business). And it ain't pretty:

"[T]he employer community has reacted with concern to ...  the [ObamaTax's] Medicaid provisions, allowing states to decide whether to comply with the Medicaid expansion provisions without risk of losing existing federal funding ... In states that do not expand Medicaid, employers could face greater exposure to taxes for lower-wage employees who otherwise would have been eligible for Medicaid and may now be entitled to tax credits for Exchange coverage if their employer coverage is not affordable."

Onerous.

But it gets worse: new definitions of "large" versus "small" employers, seasonal versus part time or temporary employees, the employer mandate. All of these create uncertainty and, of course, higher costs of doing business (hiring and training HR personnel or conmsultants, increased tax planning, the list goes on).

But wait, it gets still worse:

"The law states that a plan shall not meet the minimum value determination if “the plan’s share of the total allowed costs of benefits provided under that plan is less than 60% of such costs.” How minimum value is determined will have a tremendous impact on the affordability and administration of employee benefit plans and is intricately intertwined with the other employer provisions."

Follow that?

Don't feel bad, it's going to be a bonanza for the CPA's and JD's.

Oh, one last bit:

"Even among employers who for decades have voluntarily offered health benefits to their employees, a driving force in [ObamaTax] compliance efforts is the avoidance of unanticipated tax liabilities and controlling administrative costs. As such, employers must take a holistic view ... to assess and valuate their risk for increased tax liabilities under the law."

Shorter version: bye bye group health plans.

Told ya so.

Oh! Those who wish to "read the whole thing" can download it here.

[Hat Tip: FoIB Jeff M]

Outliving Your Insurance

While it may seem counter intuitive, it is possible to outlive your life insurance policy. A lot of folks buy term plans with premiums that are level for 10, 20, even 30 years. But when that lock-in period expires, rates go through the roof. Often, we're much older and not necessarily in great health, making it more difficult - and expensive - to buy a new plan.

No problem, Henry, by that time my mortgage will be paid off, kids will be out on their own, and my 401k will be bursting with cash. I'll no longer need any life insurance.

Maybe, maybe not.

But as FoIB Jeff M tips us, you may be in for an unpleasant surprise:

"It is a fact that when the price guarantee ends on a level term insurance policy, the premiums skyrocket ... the only people who continue the policy beyond the price guarantee period are those who can't qualify for a new level [plan]."

Which isn't to say that term plans are bad: just that you need to know the pitfalls. And many (most?) plans are "convertable," meaning that you can trade them in for a permanent plan with premiums that never go up, even if your health has declined.

Nice to know.

Cavalcade of Risk #168: Come and get it!

Jacob Irwin presents this week's round-up of interesting risk-related posts, including his Top 3 picks.

The AMA, Medicare and PR

The "PR" in this case being Paul Ryan. We've been pretty rough on the AMA (whose membership, IB readers may recall, "represents only 17% of the doctors in the U.S."). But fair's fair, and one of that organization's committees has come out with a plan that looks just like...well, let's FoIB Avik Roy set the stage:

"[T]his past weekend, the AMA’s key policy committee, the Council on Medical Service, voted to endorse a Medicare reform plan that shares key traits with the ones put forth by Mitt Romney and Paul Ryan."

As Avik points out, the AMA-endorsed plan is heavy on choice and the defined-contribution model, just like Ryan's. And there's more, but you'll need to see Avik's post for that.

Tuesday Afternoon LinkFest

In no particular order:

■ As we've noted, the "Essential Benefits" facet of the ObamaTax continues to be up in the air. Those states that have gone "all in" on the train wreck have been sending out a flurry of info:

"More states have been posting essential health benefits (EHB) announcements on the Web ... [HHS Secretary Shecantbeserious' minions] are letting states express their EHB preferences."

Yeah, that'll end well.

■ Guardian Life has been looking at the extent to which employees actually value their employer-sponsored benefits. They've even come up with a unique "measure of perceived value" metric.

The study is available here.

■ From the Big Picture Department:

"Dr. John Butterly recently urged insurance regulators in New Hampshire to recognize the importance of reducing the entire cost of care for an entire patient and an entire population of patients."

Rather than addressing pieces of health care, he urges lawmakers and insurers to take the long view, including the difficult to ascertain costs of total care.

■ And finally, the Peach State thinks it can step on the Feds:

"Can Georgia control how quickly self-funded employer health plans pay doctors in the state?"

The US Department of Labor is the agency tasked with overseeing ERISA plans, which would seem like an insurmountable obstacle. The state law requires carriers to "pay claims in a timely manner" (whatever that means), but ERISA (self-funded) plans have typically been understood to be immune.

America's Health Insurance Plans (AHIP) has joined the fray, filing a suit in federal court seeking to block Georgia's insurance commish from enforcing the statute.

Sounds like fun.

Reason and IB

FoIB Holly R tips us to a terrific item at the Reason online site. It's a major fisking of a New York Times diatribe that tries (unsuccessfully) to argue that the ObamaTax is long overdue, and in fact could have saved lives. Well, one life in particular:

"Kristof tells the story of a college pal ... who has Stage 4 prostate cancer and would have been better off ... had [the ObamaTax] been around a decade or so sooner."

As Reason's Ed Gillespie notes, however, Kristof's story is "equal parts wilfully stupid decisions on the part of [his friend] and ... health care costs being driven up by precisely the sort of regulations and bureaucracy that [the ObamaTax] will put on a heavy dose of steroids."

Along the way, he touches on themes quite familiar to InsureBlog readers: personal responsibility (or lack thereof), the fact that the ObamaTax is already leading to a shortage of providers, and the loss of personal freedom (ie choice).

It's a great take-down - read the whole thing.

AG 38 and You

Back in the day, we did a two-part series on Universal Life (UL) insurance policies, pointing out some of the pitfalls inherent in those plans. Since then, there've been some terrific advances, industry-wide, addressing these shortcomings. Called Guaranteed Death Benefit UL, they promised to keep the policy in-force regardless of whether or not there was sufficient (or any) cash value.

In a sense, these are term-to-age-100 (or even 120!) policies, since they're heavy on death benefit guarantees and pretty light on cash values. But for long term planning, they're difficult to beat.

So of course the National Association of Insurance Commissioners felt the need to step in and meddle:

"The [NAIC] adopted revisions to a controversially applied actuarial guideline that governs reserves for universal life products with secondary guarantees after almost a year of intense debate among regulators on all levels and the industry."

So what, you ask?

Here's what:

"For example, for certain policies, companies must “perform a good faith high-level analytical review of the product design with respect to the premium payment patterns to be expected with respect to that design.”

In short, look for premiums on newly written plans to be substantially higher than existing ones. And don't even think about messing around with your in-force policy (if you have one).

MS (Cure) in a Bottle?

Potentially great news for folks suffering from MS:

"A trial has shown [that Gilenya]  not only cuts the risk of an MS attack, it can also slow brain shrinkage, which otherwise can occur in patients at three times the normal rate."

Gilenya, aka fingolimod, is already in use to help both treat (and sometmes prevent) symptoms, and to slow down the damage that MS can cause. This new study "showed the drug cut the risk of an attack by up to 60 per cent and brain shrinkage by 35 to 39 per cent."

That's a significant reduction in both areas, and provides fresh hope in the fight against this ravaging disease.

Growing Old with the MVNHS©

Or maybe not. A new report from those on the front line of British medical "care" paints an  unflattering picture, with "damning evidence of variations in surgical care based on patients' ages, with the chances of being operated on peaking in middle age and plummeting for those in their 60s, 70s and 80s."

It's not just life or death issues, either:

"[T]hose needing new hips and knees are missing out on treatment routinely offered to younger patients even though they could benefit."

This isn't really news to IB readers, of course; we've long documented the shoddy care provided, or rather rationed, by the Much Vaunted National Health Service©. What continues to be most frightening, though, is that this is the future of health care under the ObamaTax.

Bullying Insurer Trick?

Maybe, maybe not. That question mark's there because it's not entirely clear that Fortune 500 company Western & Southern Life is really in the wrong here:

"Western & Southern .... has been trying for several years to buy or force the Anna Louise out of the Lytle Park Historic District, the beautiful and serene neighborhood they share, and turn it into a boutique hotel."

The current owner is Cincinnati Union Bethel, a non-profit that runs the facility, which "provides safe and affordable housing for women so they can live independently and within their means."

On the other hand, the folks at Western & Southern aren't necessarily bad guys just because they disagree with the Bethel folks:

"Our proposal for Anna Louise Inn, its owner Cincinnati Union Bethel and Lytle Park is a win-win for every stakeholder involved. It will cost taxpayers less; provide a new, improved facility for the residents of the Anna Louise; create economic opportunity for the city; and preserve the building and its historical significance."

In fact, there may be no "good" or "bad" guy here: sometimes organizations (and the people who support them) can have fundamental disagreements. From this vantage point, at least, I think both sides present compelling arguments; which one ultimately prevails is a matter for the courts.

MVNHS©: Just ignore it and she'll go away

The Much Vaunted National Health System© keeps finding new ways to kill off its victims "beneficiaries:"

"Mother-of-four Jeannine Harvey died after doctors missed her advanced cervical cancer 30 times ... By the time Harvey's cervical cancer was treated, the tumor had become infected and shattered her pelvic bone. She died shortly afterwards."

It's difficult to imagine a more painful way to go (although I'm sure the MVNHS© will keep looking). And it's not like the signs weren't there all along. But under government run health "care" schemes (like, for example, the ObamaTax plan), the incentive is on saving costs, not lives.

But I'm sure that there are some in the Obamastration that think this is pretty funny.

Minimum, Shminimum

Ohio has joined the list of states thumbing their noses at HHS Secretary Shecantbeserious:

"Gov. John Kasich’s administration won’t meet this week’s deadline for establishing the minimum benefits Ohioans will be entitled to in 2014 under the [ObamaTax]."

As we've noted, it's not so much a refusal to cooperate as it is pointing out Madame Secretary's dereliction of her own duties:

"Lt. Gov. [and Insurance Commissioner] Mary Taylor ... cited a lack of information and guidance for Ohio’s failure to submit its list of “essential health benefits.”

After all, absent these guidelines - which the ObamaTax itself requires to be made available in a timely fashion - there's no way for any state to legitimately comply.

Oh bother.

And by the way, 19 of the 58 states have thus far avoided that deadline:

"10 of the states that have not recommended EHB benchmark plans have taken steps such as analyzing existing state benefit mandates and assessing benchmark plan options. Nine states ...  have taken no formal steps toward recommending benchmark plans."

Small wonder, since Madam Secretary still can't be bothered to publish the guidelines. I'm sure Kathy finds it all very amusing.

Cavalcade of Risk #168: Call for submissions

Jacob Irwin hosts next week's Cavalcade of Risk - Entries are due by Monday (the 15th).

To submit your risk-related post, just click here to email it.

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). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Thanks!

Long Term Care and Life Insurance

Recently the Wall Street Journal had a "Family Value" item on policies combining life and long term care insurance. Often referred to as "hybrids," the premise is that one can avoid future rate increases, and guarantee that someone gets some money out of the insurance company.

The article bothered me, and I couldn't quite put my finger on why that was the case, so I turned to our on-call Long Term Care insurance (LTCi) guru Herman Bruns:

The writer is somewhat confused in her terminology: when the term "hybrid" was coined for LTCi plans, it was more for permanent life plans that would triple, quadruple, etc the death benefit if you ever needed LTC, and give you all your money back if you changed your mind. She does not appear to refer to these at all.

Eventually, some carriers got smart and took the accelerated death benefit feature that has long been around, and tweaked it into a LTC rider that allowed you to accelerate the death benefit if a long term care need developed. This seems to be more what she is referring to. The insurance company is just potentially paying out a death claim early at a predetermined payment schedule.

The latter choice (with the rider), which I do *not* call a hybrid, still gives you a reasonably cost-effective permanent life insurance policy....as opposed to an overpriced life policy in the case of a true hybrid. The hybrids want the big up front, single premium payment, whereas the life plans with the riders can be paid just like any other life plan: as you go.

The general problem with life insurance policies as a LTC solution is that you have to buy two polices to protect a couple; that is, there is no such thing as a "shared" life plan. I have seen no second to die plans that come with LTC riders so far. You have to qualify for the life insurance medically, so sometimes you can get LTC and not life, and vice versa.

Bottom line is that there is a place for all these products.

Thanks, Herman!

Health Wonk Review: Surprise, it's October!

FoIB David Williams presents this week's collection of wonky posts, heavily influenced by the recent Presidential debate. If that's not your thing, though, don't fret - there's lots of other interesting info, as well.

Unfortunate Agent Tricks

And yeah, that "tricks" is a double entendre. From upscale Kennebunk, Maine:

"[A] local fitness instructor who's been charged with running a prostitution business out of her Zumba dance studio and secretly videotaping her encounters ... her business partner, 57-year-old Mark Strong Sr., pleaded not guilty to 59 counts of promotion of prostitution and violation of privacy."



And what does this have to do with insurance? Well, "[t]he Strong Agency is an automobile, home and commercial insurance business located in Thomaston" whose owner (the aforementioned Mr Strong) has "pleaded not guilty to 59 counts of promotion of prostitution and violation of privacy."

One wonders if his E&O (Errors and Omissions) policy covers that.

Medicare :: ObamaTax

One of the major problems with government-run healthcare schemes (such as, say, Medicare or the ObamaTax) is that the bureauweenies running them have so little accountability or motivation to ensure that things run fairly and effectively.

Last week, for example, almost 100 people were arrested and charged in one of the biggest Medicare fraud cases to date. Attorney General Steadman and HHS Secretary Shecantbeserious were quick to pounce on this major bust as a turning point. But it's the culture of the system itself which encourages - nay, facilitates - these kinds of crimes.

And it's not just erstwhile providers on the line:

"More than a quarter-million Medicare beneficiaries are potential victims of identity theft and hampered in getting health care benefits because the government won't issue new IDs"

Medicare officials' excuse will surprise exactly no one who's been paying attention: "it's too expensive and too many agencies are involved to reissue" the cards and numbers. So all those "potential victims" are outta luck. Sure, they can call Medicare's equivalent of 9-1-1, but instead of a dispatcher sending a squad car, Ms Kathy will send a "so sorry" letter (at best). This is the perfect illustration of why government-run health care provides neither health nor care.

And it's this system writ large which is responsible for implementing much of the ObamaTax. Which means that it's not just those poor 284,000 medicare beneficiaries at risk, but you, too.

Death Panels take Cannon Fire

As in Cato's Michael Cannon, who heads up a special Cato forum at noon tomorrow (Thursday). Michael is joined by Len Nichols, the Center for Health Policy Research and Ethic's Director (whom we've met before), and a few other "friends."

The forum will discuss the ObamaTax's Independent Payment Advisory Board (IPAB) Death Panels, and takes place at the Institute. For those of us who can't be there in person (and thus will also miss out on lunch), the event is being livestreamed, as well.

Stupid Government Tricks

The latest nail in the coffin of personal responsibility (and common sense) just got pounded in:

"Unclaimed property probes by states have escalated to now include mid-sized insurance companies ... The cost of these settlements are not insignificant."

This past Spring, for example, MetLife paid off settled with regulators in 22 of the 58 states, to the tune of $40 million. And for what? Allegedly, they used different methods to track down annuitants than life insurance beneficiaries.

Here's a clue, "insurance regulators:" of course they used different methods, they're different kinds of policies which promise different things.

Presumably, one buys a life insurance policy to help defray funeral costs, pay off a mortgage, help one's progeny through college, whatever. But if it was important enough to motivate one to buy the insurance, doesn't it stand to reason that it's also incumbent upon one to let people know you bought it in the first place?

Sheesh.

There are really two questions here: is it really the insurer's responsibility to track down its dead policyholders? And exactly how are they supposed to do this? As to the first question, do we really want to give insurers access to our every movement? Because that's the only way they can track us. No one has a problem with that?

As to the second, even the government admits its own record-keeping of deceased citizens is damaged goods.

By the way, MetLife didn't pay that $40 million: its policy- and share-holders did. But does anyone really expect government bureauweenies to "get" that?

The ObamaTax vs The Economy

A year and a half ago, we noted that the ObamaTax specifically encouraged employers to find ways to discontinue (or avoid offering) group health insurance plans. At the time, we predicted a "preference cascade" among employers; that is, once one large company started down that road, others would soon follow.

Are we beginning to see this in action?

You tell me:

"Orlando-based Darden Restaurants has stopped offering full-time schedules to many hourly workers in at least a few Olive Gardens, Red Lobsters and LongHorn Steakhouses ... one of the many things we are evaluating to help us address the cost implications health care reform will have on our business."

The company is quick to point out that there's been "no decision made about expanding" the program, but really, what else can they say at this point?

Something about unringing a bell?

Monday Morning LinkFest

Have you ever driven by a car wreck just as it's happening? Time seems to slow down, everyone and everything appears to be moving in slow motion. Well, that seems to be happening with the ObamaTax. FoIB Elena Marie notes this little gem:

"Five insurers, including two of the nation’s largest, already decided to stop selling health insurance in Indiana, mainly because of the [ObamaTax] edict ... And the American Enterprise Group, citing the medical loss ratio and other regulatory burdens, will stop offering individual insurance in more than 20 states, causing 35,000 people to lose their coverage and create a less competitive insurance market."

But remember, "if you like your health plan..."

Meanwhile, in our nation's capital, the local politicos think they've stumbled on the health insurance panacea:

"A board has required D.C. small businesses and individual buyers to purchase health insurance through the newly minted health exchange."

There's some question as to that Board's authority to enforce the new regs, but it's interesting to note that its chairman, Dr. Mohammad Akhter (doctor of what is left unspecified) opines that "[i]f you have a business license here in the District of Columbia, then you participate through the exchange."

Looks like some folks have a problem grasping that whole "pro-choice" concept.

On the other hand, it looks like actual health care providers are none too pleased with the ObamaTax:

"A new survey shows Mitt Romney with a commanding lead over President Barack Obama among doctors, with Obamacare helping to sway their votes."

Well over half of the doctors surveyed say they favor repeal of the train wreck.

Our last item this morning also comes to us courtesy of Elena Marie.

Seems that the Much Vaunted National Health System© is continuing its crackdown on folks who want to, you know, stay alive:

"Forty-three hospital patients starved to death last year and 111 died of thirst while being treated on wards ... There were 558 cases last year where doctors recorded that a patient had died in a state of severe dehydration in hospitals."

Remember, this is the model for the ObamaTax that we'll soon be living dying under.

UPDATE: Looks like the ObamaTax may have another potentially damaging challenge:

"Tucked inside the Supreme Court's lengthy list of orders ... was an indication that the fight over President Obama's health care law soon could be back before the high court ... Liberty University, a Christian college in Virginia, has been fighting the employer mandate since the law was enacted ...  the Supreme Court ruled that the Anti-Injunction Act did not serve as a barrier to lawsuits challenging the health care law."

Earlier, the 4th Circuit had turned down the case as "premature" since no one had yet been penalized for not paying the Employer Mandate fine tax. The Supremes, though, have just re-opened the door for Liberty to re-file.

We've written before about the ill-conceived Employer Mandate; this seems to indicate that it'll be back on the radar soon.

Shecantbeserious Flails

Well, continues to flail is probably more accurate.

She and her minions still haven't found time to delineate specifics for the "Essential Health Benefits" portion of the ObamaTax. This is a set of core "benefits" that must be included in health insurance plans that want to participate in the Exchanges (yeah, we know) come 2014.

Badger State insurance commissioner Theodore Nickel "now has written to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius to say that the state needs at least 60 days after HHS issues the final PPACA essential health benefits (EHB) regulations."

While she's dragging her feet on actually doing her job, Ms Shecantbeserious has found time to spread government largesse (ca$h) around to her buddies in the private sector, inking a "deal worth more than $3 million to promote [ObamaTax] “exchanges.” And yes, these are the same Exchanges that she can't be bothered to actually, you know, provide guidance for.

By the way, this is the second such deal for her friends at PR firm Weber Shandwick; back in 2010 they scored a cool $3.4 million contract ostensibly for promotion of Medicare fraud prevention and reporting.

Nice gig if you can get it, right Kathy?

Um, about that 3000% Premium Decrease (Redux)

As we've pointed out before (most recently here), the mythical decrease in health insurance premiums was always a fantasy, concocted by those who pushed to pass the ObamaTax (in order, of course, to find out what was in it). Now, FoIB Holly R tips us to the latest from my own neck o' the woods:

"Workers in Greater Cincinnati and Northern Kentucky will pay an average $4,775 out of their own pockets for health care in 2013, about $400 more than this year and nearly $2,000 more than 2007."

Ooops.

I can't help but notice that Mr Peale joins his journalistic brethren in continuing to conflate health care with health insurance. On the other hand, he at least tries to differentiate between them by noting that "payments include health care premiums through their employer, plus office co-pays and deductibles."

I give it a B-.

A star is born!

Our very own Kelley Beloff was part of an NPR roundtable last night, watching and commenting on the debate:

"Kelley Beloff, who works in the health care industry and leans right, says tax rates are impacting her vote, "I am totally middle class...and the big thing for me was hearing Mr. Romney talk about bringing down our taxes. My husband owns his own business, and we pay those individual taxes, and it is very difficult at times to make those tax payments."

Here's audio:

Musings: An Interview with Dr Rob

Dr Rob Lamberts, one of my very favorite med-bloggers, is making a major career change. He'll still be doctorin', of course, but in a new practice, based on a cutting-edge model of health care delivery. If you've never read any of his work, I heartily recommend that you do so.

After his residency at Indiana University in 1994, Dr Rob went into private practice with another physician (who subsequently went to Africa to do missions work). Their practice was initially owned by a hospital, but by 1996 they'd decided that it was better to leave and do "their own thing."

InsureBlog: What made you decide to chuck it all and re-boot?

Dr Lamberts: I had been frustrated as the other doctors in the practice grew more and more resistant to change. The more partners we had, the more inertia we gained. Since I am not a person to sit still when I think there are solutions to problems, I found it increasingly difficult to stay put because of others' personalities. This created conflict, which led to me looking at my options. Going solo in a practice that dealt with the insurance game and had the same limitations as the old practice was not a good solution for me, so when I found the Direct Primary Care (DPC) model it really appealed to me. In the end, my (now former) partners and I saw this as an irreparable split between us and the decision to split was mutual. They have worked it out so I don't have to draw a paycheck for up to 6 months, which gives me time to build my new practice right. They also gave me access to my patients to tell them about the new practice, which is a really generous thing on their part.

IB: You've mentioned that you may have patients that can't (or won't) follow you to your new practice, can you expand on that?

RL: The DPC model is one in which the patient pays the doctor directly for their care, usually in the form of a monthly "subscription," plus or minus a fee for visits. DPC usually limits the size of the patient pool as well, so I will only be able to take 1/3 of my total patient population even if all wanted to come (I had between 3 and 4 thousand patients in my old practice and will limit it to around 1000). Plus there is the fact that some patients are not going to be willing to pay what they see as an extra fee for care they already could get. Since nobody else in the area is doing this, the only way I can show that the value of the service will be worth the cost is to make it work. Some people will trust me in this, while others won't.

IB: I know a lot of practices are being gobbled up by hospitals eager to grow their ACO's [ed: Accountable Care Organizations]. Was this ever an option for you?

RL: Not really. If we were able to work out our differences in the old practice I would have been part of a primary care ACO that is being formed by a local IPA (group of independent primary care physicians who have allied together to do this). Primary care is quite independent in Augusta, and has recently done quite well in organizing and working together for their best interest (without risking collusion, despite what the hospitals may say). I could be part of an ACO in that setting if I wanted. In truth, however, I have grown less and less enamored with these models, as they are more driven by data and processes built around meeting care standards than they are built around good patient care.

We had been working on "Patient Centered Medical Home" in our practice, and I found that it was anything but patient-centered; it was data-centered, and took my attention away from the patients. Finally, I simply don't think the hospitals are the means to truly affect meaningful change in health care. They are the businesses that have been built on over-spending on health care, on unnecessary procedures, and on consumption of medical resources. The goal of most hospitals for my patients is 180 degrees from mine: their financial gain is built on people getting procedures, going to the ER, and being hospitalized, while mine is to help them avoid all of the above. [Continued below the fold]

Quote of the Day

"Fathom the hypocrisy of a government that requires every citizen to prove they are insured... but not everyone must prove they are a citizen."

Now add this, "Many of those who refuse, or are unable, to prove they are citizens will receive free insurance paid for by those who are forced to buy insurance because they are citizens."

[ed: incorrectly attributed to the great Ben Stein - but spot on nonetheless]

[Hat Tip: FoIB Debbie C]

Cavalcade of Risk #167: Now online!

Russell Hutchinson presents this week's Cavalcade of Risk and, as usual, does an outstanding job. As he notes, "whatever the conditions, I usually find at least one writer in each Cavalcade offers something interesting that is written well."

Take his advice and check it out.

Alzheimer's News

It's been a little while since we've written about Alzheimer's; two recent news items on the subject caught my attention.

First, it appears that researchers at the "Barcelona Biomedical Research Institute have hailed a natural hormone linked to the sleep cycle as an important new weapon in the fight against" Alzheimer's. Combined with an active lifestyle (exercise), melatonin seems to be effective in slowing deterioration of the brain.

Nothing conclusive yet, but it seems promising.

The second item relates more to those providing care to folks already suffering from the disease. As we've noted, a major problem for family members as caregivers is that they can "cost themselves major chunks of their own nest-eggs; giving up their ability to contribute to 401(k)'s and the like means that there's less available to them when they need it."

That's the financial side, which is pretty important, No less important, though, is the physical toll this can have on these selfless folks. And that's where "the Hebrew Home at Riverdale's ... ElderServe at Night" comes in. The program offers "a structured series of singalongs, crafts and therapy sessions that lasts until dawn." and is available to folks suffering from dementia. That's the good news.

Here's the bad:

"While many nursing homes offer temporary "respite care" so caregivers can catch up on sleep or go on vacation, the overnight-only program at the Hebrew Home fills a niche. But costs are high, and such programs are rare. An official at the Alzheimer's Association said she knew of no other."

Here's hoping that the phenomenon takes off.

ObamaDentalTax

Dr Kim Henry is a dentist (and friend of Bob's) who practices in Hapeville, Georgia. He's also a veteran (Navy) who served alongside Marines in Lebanon in 1983. Having been in practice for over 3 decades, he's seen a lot of changes in health care. Recently, he penned this post for his own FaceBook page, and has graciously allowed us to re-post it here:

"We were told by the former House speaker that we should “Pass the health care bill so we could find out what is in it.” Slowly we are finding out what is in it, and much of it really stinks.

Beginning January 1, 2013, a new 2.3% federal excise tax will be added to all dental lab work- crowns, dentures, bridges, everything. Bet you thought something called the “Affordable Care Act” was supposed to make health care cheaper, not more expensive, right? Well, I am sure it’s not the first time you have been lied to by politicians.

In June, our US House of Representatives voted to kill this provision, by 270 to 146. Unfortunately, there is not the interest in the more liberal US Senate to back up the House action.

When government makes operating costs of dentists go up, guess what happens to dental fees? Think they will be more “affordable?”

I could write a whole book on how government raises the cost of health care. Unfortunately, class envy demogogues want you to believe it is greedy health care professionals who are responsible.

There will be more Obamacare surprises to come, I guarantee you."

Thanks, Dr Henry, for sharing your succinct - and spot on - thoughts with our readers.

Will Obamacare figure in the debates that start this week?

I think not much. Why not? 

Obama may not want to bring up this law because, despite the Supreme Court decision, it remains widely unpopular.

Romney may not want to bring it up either.  That’s because the Obama campaign would very likely not respond on the issue, but instead would respond by claiming "Romneycare" in Massachusetts was the model for Obamacare.  That’s false; Romney’s actual proposal was less intrusive and less expensive than the law that was ultimately enacted in Massachusetts.  But, nevertheless:

(1) the explanation is complicated, and would not sway many votes.  That’s because most voters would ignore it just because it’s complex.

(2) Worse, it would be a diversion, taking limited debate time away from focusing on Obama’s main governing failures – his wretched economy and his wretched foreign policy.

For these reasons, neither candidate may see much use in bringing up Obamacare; in fact both candidates may see potential harm in doing so. That’s why I think Obamacare will not figure importantly in the debates.

Additional info is here and here.

Among other things, the first linked article reports

The Romney proposal included an employer mandate that required only catastrophic coverage, not the comprehensive and expensive "Cadillac plan" coverage that was ultimately included in the Massachusetts law, and in ObamaCare. 

So, clearly, the Obama plan did not follow the Romney “model” in this feature – a feature important enough that it was disputed all the way to the Supreme Court.  There's more:

Romney's successor, Governor Deval Patrick, greatly increased the mandated level of coverage while implementing the law

Deval's tinkering resulted in much higher costs not contemplated in the original law, and those costs still adversely affect the state’s finances.  Yet the whole thing is tagged as “Romneycare”.  Go figure.

A further insight, which both the linked articles report:  On the day that Romneycare was signed into law, Romney line-item-vetoed eight elements changed in or added into the final draft of the bill . . .  After the signing ceremony, though, the Democrat legislature returned to the State House and overrode all eight vetoes. (in fact, during 2006 alone, Romney's last year as Governor, Romney issued 250 vetoes, every single one of which was overridden.)

. . .  see how easily an Obamacare discussion leads away from the economy and foreign policy?  My bet -  Romney won't go there - and neither will Obama.

Assinine Industry Tricks

Back in the day (2 months ago), I could get competitive quotes from several carriers using the application of just one. Apparently, the carriers think the new ObamaTax Exchanges are preferable to (icky) agents, though, because that's now a thing of the past.

Professional agents "pre-screen" groups so that the quotes have some basis in reality. If a carrier has no medical (underwriting) information, then they're just going to use their "book" rates without adjusting for folks who are, for example, pregnant or diabetic (or both!). These quotes are worse than useless, because they will never reflect what the actual rate will be. By using one carrier's application to obtain quotes with several carriers, we could provide meaningful quotes to our clients.

Well, that used to be the case.

Now, if I want (need) competitive quotes, I can no longer use just one carrier's application. Sure, some carriers will still accept (for now) another carrier's application for rating purposes, but this number is quickly dwindling.

Of course, I can pay an extra fee to a 3rd party to collect that information for me, which is (one supposes) convenient. But what with MLR and carriers looking to cut costs, this is hardly an economically viable alternative to those of us in the (soon to be gone anyway) small group market.

It's almost as if the carriers want to be marketing through the ObamaTax Exchanges.

Gee, I wonder why?

Sarah P and The MVNHS© [UPDATED]

If you want to see how the system on which the ObamaTax was modeled really works, you have only to pick up a British newspaper:

"Cost-cutting NHS chiefs are routinely assigning just one family doctor to districts that stretch over hundreds of square miles ... Patients are still put at unacceptable risk by apparently negligent practices.’"

As we've pointed out before, such provider shortages are looming on our own horizon, as well. And no wonder: more folks with insurance seeking care from fewer and fewer doctors results in the text-book definition of rationing.

It's ironic that former Vice Presidential candidate Sarah Palin made this call years ago. It's even more ironic that her banner's been picked up by erstwhile auto bailout maven Steven Rattner:

“We need death panels ... unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget."

Gee, ya think?

UPDATE: Turns out, it's not just us laypeople who are worried. The folks on the front lines, who will be called upon to actually render care to all these extra 10's of millions of new "patients" aren't exactly thrilled, either. Dr. Marc Siegel, an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center, weighs in:

"President Obama and Congress should have checked with the country’s physicians before passing a law that relies on our efforts to handle health insurance expansion to more than 30 million more people ... Perhaps most disturbing, more than half of doctors surveyed by The Physicians Foundation revealed that they will cut back on patients (including Medicare) or reduce patient access to their care over the next three years."

So, more demand, fewer resources, what could possibly go wrong?