From the Mailbag: Muddy P&C

Last week, FoIB Jeff M and I were chatting and the subject of the (horrific and now deadly) California mudslides came up. We wondered if (and/or how) one would be covered if one's house (literally) went downhill.

Eventually, we turned to Co-blogger Bob, who's a regular participant in an agents' forum, and asked him to research there for this on our behalf.

We were not disappointed.

The two most helpful replies:

"Most HO policies exclude flood and earth movement. The NFIP forms define what "mudflow" is. DIC policies may cover mudslides and earth movement, but if it's in an area blighted by wildfire, availability and affordability could be an issue for a DIC policy."

And:

"Hello! Here's what I heard back from our underwriter @ Safeco... I am based at CA.

'No coverage for mudslide, only possibly covered under Flood coverage depending on the % of water in it (a mudflow). There is no coverage for hotel/food etc. under the home policy either if evacuated due to the mudslide. Mudslide is covered under EQ if a result of an earthquake.'"

Thanks, Bob (and IF folks)!

WooHoo - New Wonk Review!

Health Wonk Review co-founder (and all-around mensch) Joe Paduda gets the first 'Review of 2018 and hits it out of the park.

From  rx cost sharing in Germany to expanded association plans to industry corruption, and lots more. Enjoy!

Breaking: Goodbye Good Sam

It's been just a couple of weeks since we learned that Premier Health and United Healthcare had buried the proverbial hatchet; now we learn that the former is cutting loose what seems to have become quite the financial albatross:

"Good Samaritan Hospital, the fourth-largest hospital in the Dayton region, will close."

Premier Health appears to be streamlining its facility offerings, in line with its self-proclaimed "2020 strategic plan." The company says that Good Sam's services will still be available, just moved over to Miami Valley Hospital (about 5 miles, or 14 minutes, away). How that will work out is, of course, anyone's guess.

Stay tuned...

[Hat Tip: FoIB Debbie C]

Can’t say I’m surprised. You?

According to Gallup, “After four years of Affordable Care Act implementation, the percentage of adults with no health care insurance has hit 12.2 percent”

So is that an increase or a reduction? The linked article continues:

“In the last quarter of 2016, the percentage of uninsured hit a record low of 10.9 percent. A year later, in the last quarter of 2017, the percentage of uninsured increased by 1.3 points—the largest single-year increase Gallup has seen since it began tracking the measure in 2008.”

Based on US population of approximately 320 million, each 1-percentage point increase to the uninsured rate is about 3.2 million people. Do the math.  The number of uninsured Americans increased by more than 4 million just at one enrollment - 2017!  (For any progressives who may struggle with math, 3.2 x 1.3  = 4.1). Don't forget the premiums for 2017 were set B.T. - Before Trump.  

Also note that after 4 years of Obamacare, and despite the “mandate”, Americans age 26-34 have the highest  uninsured rate = 20.1%.   Can’t say that’s a surprise either.

Data, Data, Who owns the data? Part #3,624

So here's an interesting (if tragic) scenario:

"An Afghan refugee named Hussein Khavari is being accused of raping and murdering 19-year-old medical student Maria Ladenburger, disposing of her body in a river."

He has since confessed to the crime, but is disputing some of the details that were obtained once the police were able to access his iPhone's health/activity data for the date of the crime. It seemed to confirm his guilt, but has raised some interesting questions (some of which we've seen echoed here: the Sam Bernadino tragedy comes to mind):

"Sean O’Brien, a researcher at Yale Privacy Lab [believes that it] would be much better... not to collect such surveillance data at all. Such data is best kept locally on devices whenever possible. If it is collected, those who handle it have a deep responsibility to defend the privacy of their users.”

It seems to me that there are (at least) two issues in play here:

First, as we've asked more than a few times before, who actually owns your data? It's not as clear-cut as one might think:

"Hugo Campos has [an ICD] buried in his chest to help keep him alive. But he has no idea what it says about his faulty heart."

The information the device accumulates is stored in a proprietary format, inaccessible to Hugo (or anyone else, for that matter). The iPhone data is also, after a fashion: the owner must either give up the password or the authorities must (try to) use brute force to unlock it themselves. And of course here there are significant 4th Amendment issues at play here (not so much in Germany).

On the other hand, the data can be prove useful in other ways, (alleged) crime-wise:

"Further investigating – including a review of a Fitbit activity tracker – showed the scene was staged and 43-year-old Jeannine Risley knowingly filed a false report."

Two steps forward....

This Sceptered Isle - Part MMXVIII

Britain’s NHS is seeking to charge co-pays for certain patients.  Up to now, NHS has always claimed to be “free” for everyone . . . Free at the point of service, anyway. (I suggest you read the entire linked article.  Its headline is a bit misleading.)

While charging of co-pays would be a departure, it should come as no great surprise.  In the first place, NHS financial problems have been public for quite a while.  And, after all, NHS is just another insurance company - albeit a giant, national monopoly. Aside from the political control of its management and budgets, NHS behaves very much like private insurance companies around the world. Specifically, NHS has a large bureaucracy that determines what medical services are reimbursed, and under what terms.  Also, NHS is financed by premiums that must must cover its costs - although NHS “premiums” are disguised as taxes.

And now - co-pays?

What next?  Refusal to cover services of non-approved physicians and hospitals?

Will NHS end up a British HMO?

And The HIT Just Keeps on Coming

Obamacare imposes a "fee on insurance companies" for fully insured plans that is referred to as the HIT (Health Insurance Tax). Last year this tax was in a one year moratorium thanks to Congressional relief. But this year it is back in full effect.

The tax on health insurers is non-deductible, meaning for every $1.00 in taxes the insurer will need to take in $1.54 (assumes 35% corporate tax rate). For 2018, the amount this tax must generate is $14.3 billion - meaning insurers must generate $22 billion of additional premiums to pay for it. Insurers have to pay their portion based off of market share so the larger presence they have the greater the amount they have to charge. This also makes it a moving target from year to year.

The tax applies to all fully insured coverage including:

• Individual On Exchange
• Individual Off Exchange
• Small Group Fully Insured - Both ACA and Pre ACA
• Large Group Fully Insured - Both ACA and Pre ACA
• Medicare Advantage
• Medicare Part D
• Medicaid Managed Care

To offer transparency, many insurers are breaking out these taxes on renewals for consumers to see. But, for most employer plans - where a large amount of this revenue is generated - this tax isn't transparent to employees.

Employers offer a total compensation package to employees. Wages and benefits are the biggest drivers of what makes up an employee's compensation. The HIT hurts employee wages and benefits while providing zero value to the business.

How bad does the HIT hurt employers? For my clients it's extremely painful. Reviewing my January 2018 renewals I found the average cost per employee is $356.50. That doesn't seem like much right?Until we do the math and show that this tax averages a cost of $0.17 per hour.

This puts an employer in a tough position. Do they give a $0.25 an hour raise but increase premium contributions by $0.17 an hour? Do they cut benefits by $0.17 an hour? Or, do they decline to expand, cut overtime, or reduce staff to pay the tax? These are tough decisions employers have to make that are all done behind the scenes.

Employees see these decisions to increase the amount deducted from their paychecks, higher deductibles, higher copays, more restrictive provider networks, and higher prescription costs as if the employer or the insurer is screwing them.

The reality is Obamacare's HIT is causing the problem. It's been screwing employees since 2014 and every year it will get worse.

The next time someone says Obamacare doesn't impact employer sponsored insurance remember the HIT. It's the sucker punch that keeps on coming.

Sharing, Caring and Talking

So Politico's Paul Demko reached out to me yesterday to ask about Health Care Sharing Ministries (HCSM), and specifically about whether or not I'd decided whether or not to market them. He was also interested in connecting with any (former?) clients who'd made the leap from Major Med to HCSM.

I was intrigued, and we agreed to speak this morning. In the meantime, I contacted several folks I knew who'd gone that route, especially hopeful that one in particular will respond.

Why her?

Well, because she was actually referred to me by a mutual friend at our synagogue. We had looked into ACA major med plans for her, but she ultimately chose a Ministry. Since these tend to be church-based I was intrigued, and Paul thought that would be really interesting to hear more about, as well.

Ultimately, we had a very nice conversation, and I told him that I'd let him know if I was able to connect with any of these folks so that I could send them his way (if they agreed that would be a good idea).

I don't know when (or even if) this article will be published, but will post a link to it here once it is.

Interesting Carrier News

■ Good news:

"Aflac is doubling its 401(k) match and adding additional employer-sponsored benefits as part of what the company says will be a $250 million investment initiative over the next three to five years."

The company says that these are a direct result of the recent tax bill.

Nice.

■ Interesting news:

"Gladys is apprehensive about getting her blood drawn ... With Legacy Optimizer Indexed Universal Life insurance. Gladys can apply without needing to provide blood work or visiting a doctor"

This from the folks at North American, for folks who need the protection (and the potential for cash value growth) but have trypanophobia.

■ Financial news:

"Low 2016 Individual Health Margins Trimmed Insurers' Rebate Bills"

As expected, MLR itself put the squeeze on carrier profitability (and notice that as MLR has increased, agent comp has declined, even though there should be no direct correlation).

And there's this:

"[F]ewer insurers earned enough to owe rebates to the enrollees."

Thus offering even more proof (as if it was needed) that the ObamaCare's end-goal has always been Single Payer.

Always.

Companion Life takes a hit

From co-blogger Bob V:

"When Beau Heimer crashed his dirt bike while drunk, incurring nearly $200,000 in medical costs, his insurance company denied benefits ... U.S. District Judge Janet Neff said those key words - "illegal use of alcohol" - didn't absolve Companion Life Insurance Co. of responsibility for the medical bills."

Read the whole thing (it's pretty short and to the point), and then I have a question:

Related: About 20 or so years ago I had a similar situation with a client. Small group health plan with $15,000 life and AD&D ("Accidental Death and Dismemberment);" the idea was that the death benefit doubled if one died from an accident (as opposed to illness). One of the employees, a young man (of course), decided to play chicken with a Ford Explorer (he was riding a motorcycle).

To my surprise, they actually care-flighted him to the hospital (to no avail, of course).

We submitted the death claim, which was approved for the underlying amount, but the AD&D portion were denied because the wording (more explicit than was the case here) said no "double indemnity" if alcohol was involved.

I had a few questions about that wording, too, but never had the opportunity to raise them.

Top 30, Baby!

The folks at Feedspot have graciously named us as one of the Top 30 Health Insurance blogs.

Blogs are ranked based on:

• Google reputation and Google search ranking

• Influence and popularity on Facebook, twitter and other social media sites
 
• Quality and consistency of posts.
 
• Feedspot’s editorial team and expert review

We're in pretty august company, too, including 404Care.gov's blog, Blue Cross and Aetna blogs, and our friend David Fluker's, too.

Another day, another MVNHS© shanda [UPDATED]

The Much Vaunted National Health System© strikes again:

I have unwell patients begging me not to send them into hospital. This is what ‘we’have become. The state of the NHS is shameful. My condolences - feel so upset for you and very angry on your behalf that this could have been avoided.

— universalhealthcare (@Protectthenhs) January 6, 2018

[Hat Tip: FoIB Holly R]

UPDATE: Oh, and this, via FoIB Michael Cannon:

"Every hospital in the country has been ordered to cancel all non-urgent surgery until at least February in an unprecedented step by NHS officials."

Also courtesy of the MVNHS©, natch.

Compare & Contrast: CanuckCare vs MVNHS©

Our Neighbors to the North©'s latest offering:

As of today, prescription medication for anyone under 25 in Ontario is free.

Parents living in poverty can already take their kids to the doctor for free. Now they can get their kids’ medicine for free, too.

Makes me proud to pay my taxes. And proud to be 🇨🇦.

— Jessica Langer, PhD (@DrJessicaLanger) January 2, 2018

Interesting self-correction by Dr Langer:

"Yes, it’s not ‘free’, it’s no-cost at purchase. People like me pay for it through our taxes. As it should be" [emphasis added]

To which the only rational response is: Why?

But it gets better (for certain values of "better"):

"N.H.S. Overwhelmed in Britain, Leaving Patients to Wait ... At some U.K. emergency wards, patients are waiting more than 12 hours to be cared for."

Again free health "care." But as we keep asking, what good is "free" health care if one can't actually, you know, receive it?

We already see that happening here as a result of ObamaCare's narrow networks and sky-high out-of-pocket costs (even leaving premiums aside).

/sigh

[Hat Tip: FoIB Holly R]

Two steps forward, one back

So in December, we began moving several small groups to Anthem (mostly from United Healthcare)(Heh). But we weren't alone, and they are severely backlogged.

How backlogged? Well, my rep told me that groups approved on December 21st are still not all keyed in. Which is a problem for groups approved late last month or even earlier this week.

Here's why that can be an issue: in the early morning hours of January 1st, one of my client's daughters suffered severe frostbite (long story). In fact, she had to spend time in the burn ward, and we're still not sure whether they'll be able to save her feet. As one can imagine, there's a heck of an ER and burn unit bill, and surgery is likely.

I've been on the phone with the hospital about this numerous times over the past few days; she'll be covered, but the billing situation is a mess (fortunately, this just happened so nothing's actually been billed yet).

She also mentioned that there seemed to be (at least) two factors involved here: first, of course, is the aforementioned exodus from UHC. But a close second is, interestingly, the implosion of the individual market, especially here in southwest Ohio: a lot of smaller employers who had been on the fence about installing a group plan took the plunge as a result of that implosion.

So, not a bad problem to be sure (hey, lots of new business means lots of new premium dollars), but a service mess for at least a while.

[Hat Tip: FoIB Liz M]

Breaking: UHC and Premier Kiss, Make up

After spending most of the year on the outs, health insurance behemoth United Healthcare and big-time medical care provider Premier Health have reached "a new, multi-year relationship ... the agreement ensures access to Premier Health’s physicians and facilities for Medicare Advantage plans and restores access for commercial plans effective Jan. 1, 2018."

This was a major stumbling block for most of 2017, and one wonders just how badly the disagreement hit UHC's bottom line (I know of more than a few groups who bailed solely because of this issue).

Will be interesting to see who's next....

[Hat Tip: FoIB Amanda A]

Medical Migration? Medical Tourism? Medical Exile? Whaaaaaa?

Three random topics.    Or    so    I    thought.

1. Medical Migration?  A former employee of the Johns Hopkins Health System has accused the System of violating state and federal regulation by admitting out-of-state patients in preference to Maryland residents.  In other words, the Hospital is “migrating” out-of-state patients into Maryland.

Maryland sets an annual global budget for each of its hospitals.  The federal government also participates in the regulations, by requiring that the hospitals comply with the state-set budgets.  I suppose the feds’ interest is that they finance Medicare and share in the financing of Medicaid.  But the global budgets apply only to residents of Maryland.  Hospital revenues from out-of-state patients – “medical migrants” - are outside the global budgets and thus produce unregulated additional revenues for the hospitals. 

Hopkins’ former employee alleges Hospital management pressured staff to migrate out-of-state patients into Hopkins Hospital, taking beds that might otherwise have been available to Maryland residents, and generating revenues that Maryland residents would not have generated.  Hopkins has responded that “Our census shows that the majority of our patients are from Maryland and that the number has steadily increased over the past several years” - which is fine as far as it goes, but does not directly or fully answer the issue.  A judge will have to sort all this out.

2.  Medical Tourism?  This term describes a growing international trend among patients seeking medical care outside their own country. It has been a recurring topic at InsureBlog over the past few years - here is an old post from 2007; there are many others. 

Medical migration is similar to medical tourism because both have similar motivations and similar ends:  the unbreakable linkage between money and medical care, and access to medical care that may not be locally available. The Johns Hopkins situation is not exactly medical tourism because it involves movement between states in the same country, not between two different countries. Yet it may be evidence that U.S. patients are becoming more willing to travel for their medical care.   And, of course, it’s also evidence of hospitals’ continuing creative efforts to improve their revenues.  

3.  Medical Exile?  On December 30, British media source The Telegraph reported that “SNP [Scottish National Party] ministers are under pressure over their ‘mismanagement’ ofScotland’s NHS after it emerged the number of patients being sent to otherparts of the UK for specialist treatment has increased by almost 50 per cent.”

 What’s that?  Scotland is “exiling” certain patients to other countries in the U.K. for medical treatment? 

It’s complicated.  It seems Scotland has allowed at least 460 NHS specialist positions (plus an additional unspecified number of nurse positions) to go unstaffed.  As a result, a growing number of Scottish patients face unexpected travel for specialist or routine nursing care.  NHS Scotland is sending these patients to England, Wales, or Northern Ireland.  NHS actually anticipated this as an infrequent contingency, so there are funding and administrative means in place to handle referrals.  But the recent, sharply increasing volume of such referrals was not anticipated.  Scotland has apparently been managing – or mismanaging - its understaffing problem by “exiling” patients to obtain care outside their own country, rather than filling the vacant specialist positions inside Scotland.  

The available information is hard to interpret.  For example, how does Scotland reimburse other U.K. specialists?  How does the sum of those reimbursements compare to the sum of the salaries and other employment costs for the 460 specialists the Scots would otherwise employ?  I can’t help but suspect one of those numbers is a fair bit larger than the other.

So why tie these three phenomena together?  Movement. 

Specifically, the movement of a growing number of patients willing - or obliged - to travel far from where they live, in order to access medical care.  Movement of patients within the U.S. to access medical care has been a  slow-growing thing for some years.  But in other parts of the world, such patient movement seems to be growing faster, and is more common across national borders.  And the worldwide phenomenon is not exclusively physician- or patient-driven. Governments are facilitating and, in some cases (i.e. Scotland), are requiring such travel. 

Is patient movement likely to improve care? Will it improve access? Balance patient loads? Result in better match of patient needs with services across local, national, and international medical care delivery systems?  Or will it be not so beneficial?  Will these trends instead end up exposing a world delivery system largely unprepared to meet the rising demand for medical care? Is this the start of some classic B-movie, in which a flooding river causes the dam to spring small leaks, as rising waters spill around and over the dam, and no one is listening to the few townspeople who notice what is happening?

Time will tell.  Meanwhile these phenomena are related, and do bear watching.

A Carrier's Economist's take on ObamaCare

[Whew - That title really rolls off the tongue. FoIB and Blue Cross economist Michael Bertaut recently tweeted a series of posts explaining what has gone off the rails, and why. He's graciously granted us permission to post it here as a service to out readers]

As an economist for a Blue Plan, I can help; here are some of the impacts of the ACA on our organization and products since passage on 3/23/2010:

As an FYI, I've been in my role at at BCBSLA since 2004. Between 2010 and the actual ACA launch, we spent over $100,000,000 in new spending just on compliance work and building the systems to allow us to participate. This is money that could have bought actual health care. Pre-ACA we served an individual market with the following characteristics:

125,000 people

Average age 36 years

51% female

Average duration of 47 months [ed: how long folks kept their plans]

Average rate of $274/month

Average annual deductible $750

PPO broad network

Application rejection rate of 0.4% [ed: oh, the uninsurability cirsis!]

Fast forward to 2017:

165,000 people

Average age 46 years old [ed: 30% increase; older ~ sicker]

58% female [ed: more expensive claims]

Average duration 11 months [ed: one can see where this is heading...]

Average rate $725/month [ed: looks like Michael misspelled 3000% decrease]

Average deductible $3,500

Standard plans cover 40% of Medical providers (down from 95%) [ed: hello narrow networks!]

Rejection rate 0%

Only 40% of policyholders keep their plan for 12 premium payments in a row. [ed: let *that* sink in]

Despite huge rate increases and tight MLR restrictions our Individual block went from slightly profitable to -$250 million since 2014.

Oh, and now 52% of our individual customers qualify for $0 ATC/CSR. If there is a better way to wreck a market than the ACA, I haven’t found it yet.

Wondering why this happened? It’s actually 3 really bad policy decisions that have led us here:

■ The politically-determined (NOT economically-determined) age rating policy

■ The “federalization” of plan design which assumes states with $80,000 average annual household income will have same opportunity as states with $40,000.

■ And the real tragedy, repairing and creating stable insurance markets is hampered by lying politicians

Thanks, Michael!

Open Enrollment v5.0: ObamaCare #Winning

Ooops:

ACA Sign-Ups Fell by 4% This Year https://t.co/mQ2fAz1wG3

— Brit Hume (@brithume) December 23, 2017

In Memoriam: My Red-Headed Spitfire

I have been fortunate in my career to have some (very) longstanding clients. One of my very favorites, Pat B, passed way Christmas day at age 90. She'd been suffering from dementia for a while now, but was otherwise in (relatively) good health until very recently.

After over 30 years together, I miss her already.

When the girls were born, she knitted them the cutest little booties. She and Ernie were honored guests at our 10th anniversary party (also a long time ago).

I don't know many other agents who can brag that they actually insure every other member of a client's family, but I do. And can name them all (well, on a good day).

There was never a time that I didn't welcome seeing her bright red head passing by the window by our office's front door. She was strong-willed, and brightly-spirited. And she never missed calling me to wish me a happy birthday (we're both Libra's, so...).

Rest easy and well, dear Pat. You are missed.

Dayan Ha-Emet.

Efficient Use of Government Funds

For most, Open Enrollment 5.0 (OE5) in the Federal Marketplace is officially over. Trump's "sabotage" of the insurance market was a rousing success. In an all out assault on Obamacare they successfully cut the following funding:

• Outreach and Marketing from $100,000,000 to $10,000,000
• Unlicensed Assistance Programs from $63,000,000 to $37,000,000
• They also saved by reducing the amount of time people had for OE5 from 90 days to 45. This shortened window also saves on costs to pay government employees who work directly with enrollment assistance.
• Eliminated payments for Cost Sharing Reductions of over $7 Billion.

So what were Trump's sales results? Over 8.8 million people selected a plan. Down a paltry 4% from last year's enrollment of 9.2 million.

Exactly as every Obamacare supporter predicted.

STM takes a HIT

Our friends at Pivot Health, purveyors of Short Term Medical plans, alert us to the latest taxing information regarding these plans:

"In order to comply with section 9010 of the Affordable Care Act (ACA) insurance companies are subject to a new Health Insurance Tax, often referred to as HIT, of 3.5% that will be added to the cost of certain health insurance plans, including short term medical. 

The tax of 3.5% will be added to the Pivot Health Short Term Medical insurance premiums on policies with January 1, 2018 effective dates or later.  This would apply to clients that have started a 4 x 3 short term medical plan in 2017 or have a policy term starting in 2018.  Your client's health insurance premium will include this tax on all January 1, 2018 billing dates and beyond. 

This tax on health insurance premiums is a tax required by federal law."

The good news, if one can call it such, is that these plans are relatively inexpensive, so the nominal increase should be, well, nominal.

Still, it's another ObamaTax eating up value (and your health insurance dollars).

Life Insurance Poser: An Update

So, a few weeks ago I met with the widow of a client to complete the paperwork for filing a death claim. Complicating things was the fact that he died during the contestability period, which meant added scrutiny.

We quickly hit a bottleneck in the form of Matt's urologist, whose assistant wasn't particularly helpful, and so Amy asked me for help. Time was, I could easily make the phone call, but because of various privacy laws, doc's won't even acknowledge to me that a given person is even a patient. Still I offered to try, on the theory that perhaps Matt's privacy concerns died with him.

I never did hear back from the doc, but Amy called me a couple of days later to thank me; he'd completed and returned the form within a day of my call.

Heh.

About a week later, I received the check and let Amy know that it had arrived. And here's one of the two points I'd like to make:

It's still surprising to me that the current default in these circumstances is for the carrier to send the check directly to the beneficiary, and that this is at the agents' request. Unless said beneficiary is a plane-ride away, I just don't 'get' it: this is the most important part of the entire life insurance transaction. I made a promise to Matt that I would be there for Amy; how do I honor that promise by having the anonymous corporation entrust that check to Cliff Clavin for delivery (and maybe some practical advice)?

Which brings me to the second (albeit seriously intertwined) point: seeing the smile of gratitude on Amy's face reinforced just how important, and valuable, my job really is. I can stand tall knowing that I've helped to make it possible for her to continue her current standard of living for (at least) the foreseeable future.

What could possibly be better than that?

Pink Cadillac (Tax)

It's been a while since we last visited the Cadillac Tax:

"By postponing the Cadillac Tax from 2018 to 2020 ...  the federal government is reducing revenues to fund Obamacare"

And by the way, how'd that work out?

In the event, FoIB Rich W recently pointed out that:

"The ACA Cadillac Tax is still around, just not yet implemented. If employers do not crapify plans by pushing toward lower premium, higher out of pocket, over 50% of plans will be impacted w/in 5 years."

[click to embiggen]

On Single Payer: This will end well

A good friend, who actually lived through the experience, notes that the VA is, in fact, socialized medicine, with all the rights and privileges thereunto appertaining.

Such as this (via Stephen Miller) from McPaper:

"VA knowingly hires doctors with past malpractice claims, discipline for poor care ... [Schneider]  was forthright in his application about the license revocation and other malpractice troubles.But the VA hired him anyway."

Yay team!

But wait, it gets better (for certain values of "better"):

"A VA hospital in Oklahoma knowingly hired a psychiatrist previously sanctioned for sexual misconduct who went on to sleep with a VA patient"

Talk about a purple heart.

But yeah, Single Payer (the explicit end-goal of ObamaCare) is gonna be great.

Oy, Canada! Part 6,437

Our friend Rich W alerts us to the latest CanuckCare news, and it's not pretty:

"Waiting for treatment has become a defining characteristic of Canadian health care ... waiting times for medically necessary treatment have in-creased since last year."

That last part is important because, unlike elective procedures, medically necessary treatment indicates a certain sense of urgency. And in the case of our Neighbors to the North, there are really two distinct factors at work:

First, "[fr]rom referral by a general practitioner to consultation with a specialist. The waiting time in this segment increased from 9.4 weeks in 2016 to 10.2 weeks this year." This could be potentially life-threatening; what if that referral was to an oncologist?

And second, "[f]rom the consultation with a specialist to the point at which the patient receives treatment. " Again, if chemo and/or radiation is called for, this could mean the difference between a few days versus years of life.

And, of course, the same would hold true for someone with, for example, an acute heart condition.

And it's not just treatment that's getting backburnered:

"Patients also experience significant waiting times for various diagnostic technologies."

These include what we'd consider fairly routine things like CT scans and MRI's, as well as ultrasounds, which could help detect potential issues in the baby.

The point, of course, is that single-payer medicine (the stated end-goal of ObamaCare) isn't the panacea its proponents tout it to be.

Always look on the Briteside of life

It was bound to happen:



And yes, the commercial is a parody of Big Pharma ads, but the service is legit (for certain values of "legit").

[Hat Tip: FoIB Holly R]

MVNHS©: The Gift that keeps on taking

Britain's Much Vaunted National Health System© has long been touted as the quintessential model of government-run, single-payer health "care." Today we offer two more shining examples of how that's working out.

First up, via FoIB Dr Gerard G, a lesson in how the MVNHS© manages to rein in run-away health care costs:

"Now NHS prepares to ration painkillers and routine operations: Bosses drawn guidelines after getting only a third of the money they asked for in the Budget"

That's really the fundamental problem with this kind of system: there's only so much supply to meet pent-up demand. As co-blogger Bob noted some time ago:

"The economics of goods and services can be reduced to simple demand and supply. Health care is no different ... Health care is also inelastic."

That is, one could substitute tea for coffee (for example), but there really isn't a substitute for health care. Sure, one could probably make do with an extra ibuprofen versus that codeine, but what's the stand-in for hip replacement?

Our second lesson comes courtesy of FoIB Rich W, who found this tragedy:

"Hospital apologises after pregnant teenager was turned away from hospital by midwife who blasted her for using an ambulance as ‘a taxi’ – just hours before her baby died."

Talk about compassionate care.

Fortunately, the hospital "was forced to apologise;" I'm sure that went a long way toward helping the young couple's healing process.

Good thing she didn't need that epidural.

Such a deal!

#ACAWinning!

[click to embiggen] 

For perspective, that translates to over $21,000 before the plan pays anything (well, except for free birth control and such). So again, going bare is no longer such an irrational response.

It's a Holly, Jolly Health Wonk Review

Our favorite elf (and HWR co-founder), Julie Ferguson, hosts this week's holiday-themed roundup of health care wonkery and policy.

Enjoy!

From the P&C Files: Winter is here!

Our friend Emily J at PuroClean ("The Paramedics of Property Damage") has some timely suggestions for IB readers:

The Complete Guide to Winterizing your Home

Now is the perfect time to prepare your home for the colder weather. Winterizing your home with the tips below are simple and easy. The longer you wait the more damage could possibly erupt with old man winter cold air rolls in.

Interior

• Furnace: When it comes to your heating system take the time to do a test run to make sure everything is working properly set to 80 degrees, listen for the furnace to turn on and wait for the warm air to blow. If it isn’t running properly, contact your local qualified service technician.
• Furnace Filters: Dirty filters can restrict airflow and boost energy demand. To extend the life of your furnace and keep costs low change furnace filters monthly.
• Preventing Freezing Pipes: Drain water from swimming pools and water sprinklers. Replace exterior faucets with freeze-proof faucets. Look for pipes that are vulnerable for freezing, pipes located by cracks or openings in walls, floors and ceilings. For pipes at risk for freezing consider installing specific products made to insulate water pipes like a "pipe sleeve" or installing UL-listed "heat tape," "heat cable," or similar materials on exposed water pipes. Keep the faucet on a trickle, cabinets open for warm air to circulate and if there are water supply lines in the garage keep the garage closed.  
• Thawing Pipes: Keep the faucet open for water to trickle out as you treat the frozen pipes, apply heat to the section of pipe using a electric heating pad, hair dryer or a space heater. Apply heat until the water pressure is fully restored, if you can not find the frozen section call a licensed plumber. If a pipe bursts or a water leak occurs, turn off your water shut-off valve and call your local service contractor..
• Air Ducts: Debris in air ducts can cause heating bills to rise. Get air ducts professionally cleaned by your local service contrator.
• Water Heater: Consider having your water heater flushed once a year.   
• Sump Pump: Test your sump pump to make sure it’s working properly.
• Home Detectors: Replace the batteries and test your smoke and carbon monoxide detectors.
• Put up some Plastic: A cheap alternative to prevent old drafty windows is buying a cheap window insulation kit at your local hardware store. This will help keep your home warm and your energy bills low.
• Fire Place: Clean and prepare your fire place and chimney. Make sure the chimney is clear of any nests from birds, squirrels or other animals. Inspect the fire brick in the fireplace, repair any mortar joint, a fire can spread into the stud wall behind the masonry fire brick.

Exterior

• Gutters: Clean gutters and downspouts to make sure both are free of leaves and debris, allowing water to flow properly. Clogged gutters are one of the major causes of ice dams. Replace old or damaged gutters with new ones that have built-in leaf guards.
• Roof: Inspect roof for shingles that are curling, missing, or broken.
• Seal up cracks and gaps: Be sure to caulk or weather strip around windows and door frames to prevent heat from escaping.  “Caulking and sealing openings is one of the least expensive maintenance jobs,” says Michael Hydeck, President of the National Association of the Remodeling Industry (NARI). “Openings in the structure can cause water to get in and freeze, resulting in cracks and mold buildup,” he says.
• Air Conditioner: Cover air conditioning unit outside to prevent debris from entering the system.
• Outdoor Furniture: Cover and store outdoor furniture.
• Yard Equipment: Clean up yard equipment.
• Water Hose: Blow out and store your hoses to prevent damage. Winterize outdoor faucets and spigots to prevent freezing pipes.
• Check for Peeling Paint: Peeling paint is a sign that existing paint is failing and can no longer protect the siding of the building which will deteriorate if not corrected.
• Yard: Rake leaves, trim trees and bushes.

 Always try to buy a snow shovel, salt, extra water, canned goods and other winter supplies before nasty weather hits.

Thanks, Emily!

Top O'The Week Linkfest

■ A few months ago, we noted that, far from elevating health care results among those most needy, "the weight of the scientific evidence is that Medicaid expansion has not saved lives."

Now, FoIB Holly R offers more proof that Medicaid over-promises and under-delivers:

"[F]or patients with other public [i.e., Medicaid] or no insurance, survival was often stubbornly unchanged, or, in some cancers, declining."

Ooops.

■ A slight correction (well, clarification) for our item last week on Wells Fargo's little insurance fraud fiasco. From the original article, we understood this to mean home (and perhaps auto) policies; thanks to FoIB Allison Bell, we learn that at least some of these appear to have been life insurance plans:

"California insurance regulators say problems with unauthorized product sales at Wells Fargo bank branches may have affected some sales of term life insurance."

Yikes.

■ And about that ObamaTax cost curve; back in September we noted that:

"Out-of-pocket costs for specialty drugs under the Affordable Care Act increased 16 percent from 2016 to 2017."

Ouch.

But wait, there's more:

"U.S. health care spending increased to $3.3 trillion in 2016, with out-of-pocket health care costs borne directly by consumers rising 3.9 percent — the fastest rate of growth since 2007."

#ACAWinning!

[Hat Tip: Jason]

ANOTHER Baby Charlie? The MVNHS© Strikes Again

Regular readers may recall the tragic story of Baby Charlie:

"The parents of terminally-ill baby Charlie Gard are 'utterly distraught' and facing fresh heartbreak after losing their final appeal in the European Court of Human Rights."

Well, turns out the caring, compassionate Angels of the Death Mercy at the Much Vaunted National Health Service© apparently haven't met their quota:

"Ader Hey Children’s Hospital has applied to the High Court to switch off life support for a baby in a coma, the ECHO understands. Alfie Evans’s family said they were now in a “living nightmare” after the hospital said they had exhausted all options in trying to diagnose and treat his mystery brain condition."

Get that?

They don't even know what's wrong with the poor boy.

Adding insult to (fatal) injury:

"An Italian children’ hospital has offered to take the child as a patient for further inquiries and treatment. But the UK hospital administration and doctors are not only saying NO, seeks a court order allowing them to withdraw life-sustaining treatment."

But hey: Free health care.

(For certain values of "care")

[Hat Tip: FoIB TPH]

From the P&C Files: Is this big?

Because it seems big:

"The accusation is the result of a department investigation that found that from 2008 to 2016, Wells Fargo customers were issued approximately 1,500 insurance policies and charged premiums without their knowledge or permission."

The result of this investigation  may be the revocation of WF's license to sell insurance in The Golden State.

[ed: Which, to be fair, may be to their benefit, based on the fires currently raging out of control]

I reached out to my P&C guru Bill M, who pointed out that:

A) Yes, this certainly appears to be fraud, and

B) In the grand scheme of things, 1500 incidents over 10 years seems more likely the actions of a "rogue" agency than systemic. Doesn't make it right, but probably easier to contain and remediate.

Will be interesting to see which licenses are pulled, and for how long.

[Hat Tip: FoIB PC360]

From the Comments

We're privileged to have some really interesting and informed commenters here, and the discussion can get lively (but always  civil!).

But we also get some .... well, unusual feedback, such as this one from Regina Raymond in reply to our recent MedMutual post:

"My husband of six years left me for another girl because I accused him of seeing another girl and since then I have been trying to get him back but he refused to come back to me, he was not responding to my calls or email and he even unfriended me on face-book and also unfollowed me on IG and he told me that he was done with me and my two kids.

I got really confused, I was searching on the internet for help and I saw a testimony of how a spell caster helped them to get their exes back so I decided to give it a trial, but i was even more confused because of many testimonies that i saw, but my heart told me to go for Dr [REDACTED] because I did many researches on him and I found nothing bad about him, that was how I contacted him and I explain my problem to him and he casted a love spell for me and guaranteed me 7 days that my ex will come back to me and to my greatest surprise the third day a great miracle fell on me and my ex came back to me and he begged for my forgiveness.

Dr [REDACTED] you are just the best, I will continue to publish his name because he is my Savior, we are now one big happy and united family, If you need his help you can Email him Do not loose hope too soon contact him If you need his help you can Email him ...  for easy and fast communication you can also call or add him on whats-app."

Well gosh, thanks so much, Regina, and congratulations!

Pretty sure this isn't considered an EHB, though.

Questionable Client Tricks

Well, not so much "tricks" as judgement:

One of our P&C clients is going through Open Enrollment at work, and the voluntary term life for both himself and his wife is going up pretty dramatically. This happens because most of these plans use age-banding; that is, your premium is (for example) $10/week from age 30 to 34, then $115 from 35 to 39, etc.

So he called to see if buying his own plan might be a better way to go.

It usually is: group term plans are generally guaranteed (or at least simplified) issue, which means little or no underwriting, which means carriers inflate the rates to cover for the unhealthier employees. Healthy ones can almost always do better on their own. The biggest advantage for these plans is that they're payroll-deducted, so a lot more convenient than cutting a check (although most carriers will do auto-withdrawal for monthly premium, which is pretty close).

Anyway, Joe is in good shape, but Kelly's not quite tall enough for her weight, which adversely affects her rate going in. I suggested 20 year term plans, and the numbers looked good for Joe, but they're thinking about going with a 10 year plan for Kelly in the hope that she'll shed a few pounds in the meantime and qualify for lower rates down the road.

I countered thusly:

"If you can swing the 20 year premium-wise, it's a much better idea. For one thing, you can always request a rate review down the road if/when Kelly drops a few pounds. Plus, who knows what rates will be with these companies 10 years down the road or (even more importantly)  whether her medical history would change where she couldn’t even qualify for a plan – regardless of the weight issue.

She would have to lose about 10 pounds and be stable at that weight for at least 1 year to get to get the next better rate class, and down to another 10 or 15 and stable for 1 year for best.  Of course, that’s assuming overall history and findings look good such as lipids, any other significant history, etc.

Your call, and I’m happy to oblige whatever you want – but also want to give the very best advice I can."

We shall see....

Blog Contest Alert

We've been nominated for Healthline's 2017 Most Loved Health Blogs contest (we're a previous award winner).

Voting's now open - We would really appreciate your support.

Thank You!

 
[First posted on 11/26/17] 

Boy Howdy, A Roaring Success

Well, for certain values of "success:"

Q. Obamacare enrollment is strong!

A. See chart. Look at rightmost bar. pic.twitter.com/cobMvFc11M

— Dean Clancy (@DeanClancy) December 3, 2017

[Hat Tip: FoIB Rich W]

From the mailbag: No Choice Health Insurance

So, received this in email this morning:

"Hello, my family and I are looking into health insurance assistance. One of our concerns about it is that we are looking for PPO plan and not HMO. We've been in touch with another agency and was informed that HMO plans were the only thing available. We were given this site to begin Healthsherpa.com and all we can see are HMO plans."

I have no idea who or what a Healthsherpa is, but presume it eventually ends up at the 404Care.gov site. Where, in fact, the only options for our area are Molina, CareSource and Buckeye Health, all of which are HMO's, and all of which are generally known as Medicaid "carriers." And that means even narrower networks (fewer providers).

Oh goody.

But it gets better:

"My wife and I have 4 kids and our ages are 29, 26, 9, 6, 4, and 3. 3 girls and 1 boy.Our household income is 40,000 a year."

I ran that through the handy subsidy calculator, which yielded - not surprisingly - this result:

"Results

You are likely eligible for Medicaid

"Based on the information you provided, you are likely eligible for Medicaid. Medicaid is a health coverage program run by states and the Federal government"

So not subsidy-eligible, either.

There are still choices, of course; we'll see which (if any) they elect.