No Tickee, No Chemo…

The Grand Canyon State has a nifty idea: a $1 million jackpot to one lucky voter. That’s right, “(i)f Arizona voters pass the Voter Reward Act in November... one lucky voter [will win] $1 million just for casting a ballot."

So what does that have to do with health care?

Turns out that the Sceptre'd Isle* has its own little lotto going on:

“Because I was articulate and well-informed and also, I suspect, because I had connections with the Department of Health, I got the right to my treatment...

(B)rachytherapy, which carries fewer side effects than a surgical operation and is less invasive than the alternative, a radical prostatectomy” is being made available to a select few Englishmen. It’s a little complicated, but apparently the NHS (Britain’s National Health Service) will approve only a select few to receive this potentially life-saving treatment.

As one can imagine, this has resulted in quite the hew (or "hue") and cry:

“Thousands of prostate cancer sufferers in Scotland are facing a "postcode lottery" over a new treatment for the disease.

The drug Zometa, has not been approved for use in Scotland, despite being available in England and other EU countries.”

The lesson here is that, while a nationalized health care system may seem like a good idea, remember the old saw:

You can have it cheap, you can have it fast, you can have it good. Pick any two.

* Thanks, Matthew!

Lagniappe

It's kinda nice, being out here ahead of the curve. Sometimes, though, it's helpful to catch up on unfinished business.

To wit:

■ We've blogged (extensively) on the implications of Maryland's recent "Wal-Mart Bill." But is it DOA? Apparently so (H/T: John F).
[NOTE: Judge Motz based his decision on elements of ERISA, which implies that such a law would be equally invalid in any other state]

■ Earlier this year, we noted the difficulty some folks were having in obtaining life insurance, in anticipation of a trip overseas. Well, some of there problems may well be solved by the legislature. Bob tells us that:

As a result of legislation and regulatory declarations, Banner Life will not factor past or future foreign travel into the risk selection process on applications signed in California, Colorado, Florida, Georgia or Washington state.

Banner will also not factor in past foreign travel, but will consider planned future foreign travel on applications signed in Illinois and Maryland.

Foreign travel risks on applications signed in other states will be priced in accordance with Banner's normal underwriting practices.

The legislative atmosphere remains fluid. Several other states are considering legislation that could have further impact on the above lists.

■ And finally, we've discussed the role of genetics in insurance and healthcare before. A new company, GenoMed, aims to use " medical genomics to keep people healthier." Interested? Check out their press release. (H/T: Bob)

Cavalcade of Risk (4th Edition)

Our wandering host, Chris of MedBill Manager, has done a great job, with 20 submissions (our biggest yet!). Better still, most have running commentary from Chris, building on the post itself.

Bravo!

I especially liked Brad's post, over at The Unrepentant Individual, about putting risk, and risky behavior, in context.

Chronic 'Rounds

ChronicBabe hosts this week's edition of Grand Rounds. She's collected 40 posts, all with the (general) theme of women in medicine. Even better, they're sorted into categories and each post includes a (sometimes snarky, sometimes silly, always helpful) summary.

Pardon the preaching, but I think that this post, about new recommendations about heart attack screening, is important. Jake Young at Pure Pedantry has the scoop.

Not Really Sure What This Means...

From the FWIW (For What It's Worth) Department:

EMR (Electronic Medical Records) is a hot topic these days. HIPAA has some EMR mandates that are coming on-line [ed: ugh! now that's a bad pun], and, of course, there are economic benefits, as well.

Dr Rob Lambert has more on this over at The Medical Blog Network. As a practicing physician himself, he has a unique - and helpful - perspective on the issue.

Monday Money

The Carnival of the Capitalists is up, presented by AnyLetter. Our intrepid host, Andrew, fought a bout with bronchitis to bring it to us...now that's dedication.

This post, at Mine That Data, has an interesting tool that one can use to prove that old adage that it's cheaper to keep a current customer than procure a new one.

And this week's Carnival of Personal Finance is up at Just Another Money Blog. With over 40 posts, you're sure to find (at least) one to like.

For example: My Financial Awareness examines how the ancient concept of tithing works in our "modern world."

Insurance Dispatch

The latest column is up at The Medical Blog Network. This week, we begin our examination of price transparency in health care.

Come on by.

Cavalcade of Risk (#4) - Submissions Due

Next week, the C of R will be at MedBill Manager. Chris is looking for a few (okay, many) good posts. You can submit yours (or someone else's):

■ Via email,

■ At the Blog Carnival, or

■ At Ferdy's

Remember, entries are due by next Monday (the 17th)

Health Wonk Review: Mid-July Edition

The Health Care Economist hosts the newest edition of the HWR. Jason has an interesting take on HWR: he's essentially made the compendium of posts a sort of debate about health care costs versus health care quality. It's really unique, and thought-provoking.

Joe Paduda (the "father" of HWR) takes a look at how hospitals are rated, and whether rankings are really such a good idea, after all.

Mass Health: Update

A while back, Bob reported on the new Massachusetts health insurance program. Well, some new details have come out, and (as usual) we're on the case:

■ Mass businesses can avoid the $295 fine...er, uh, "fee" if at least 25% of their full-time workers are enrolled in their health plan, or if the company contributes at least 33% of the premium cost. That's actually a lower percentage than what most employers pay now [ed: oops!].

■ On the other hand, employers won't be allowed to count employees receiving health insurance from other sources (e.g. through their spouse's employer or government programs).

■ And, the "fee" requirement applies to businesses with more than 10 full-time workers.

■ Massachusetts' Division of Health Care Finance and Policy is projecting that the "fee" will affect about 8% of the state's 35,000 eligible companies (which represents less than 2% of all Massachusetts' employers). They're hoping to raise about $26 million, which they plan to use to subsidize health insurance for low-income individuals.

Under this new proposal, employers would have to inform the state about whether their workers were offered employer-sponsored health insurance and whether each employee accepted or declined. Workers who decline the employer's offer and don't have alternative coverage will be required to file a form acknowledging responsibility for medical care. It's not clear whether this will relieve the employer of the $295 "fee."

A Very Grand Rounds

TC, host of the provocatively named Donorcycle blog, presents this week's Grand Rounds. Divvied up into interesting and helpful categories, almost every one has notes on context and content.

Medical Connectivity has some real concerns about how more of your private health info is available (and vulnerable?) than you might have thought.

Up, Up & Away!

According to actuarial consultant firm Milliman, average medical expenses for a family of four rose by 9.6% last year. Interestingly, this tracked with average annual increases for the past 4 years, as well. Milliman expects that these rates will stay in the 9 to 10% range for the foreseeable future.

The numbers are based on medical claims, including:

■ office visits (37% of total costs)

■ inpatient hospital services (30%)

■ outpatient expenses (another 15%)

■ and rx (also at 15%, and much lower than I'd have thought)

What surprised me the most (aside from the relatively low rx number), was that the greatest rate of inflation was in- and out-patient expenses. Counterintuitively [ed: ooooh! a $3 word!], the rise in pharma costs slowed significantly.

Bob Cosway, one of Milliman's consulting actuaries, averred that "There have been more and more drugs going off patent, and more therapeutic classes have good generic drugs available. We think many of those market forces will continue for pharmacy."

He also indicated that technology, new drugs and managed care policies have allowed more medical problems to be handled with outpatient services and medications, rather than the more expensive inpatient care.

The report (which you can read here) also shows that the different components are trending at different rates. Rx costs, for example, increased almost 13% between 2004 and 2005, while hospital services (inpatient and outpatient) as well as physician costs grew at rates of about 8%.

Of course, this will have an impact on health insurance costs; it's not just greedy insurance companies looking to increase market share and profitability.

Carnival Time!

First out of the gates this morning is the Carnival of Personal Finance, presented this week by The Real Returns blog. Almost 60 posts grace this week's edition, along with helpful summaries.

We've blogged on Identity Theft before; this post, from Dogberry Patch (another candidate for cool blog name) questions whether it's really such a big deal.

And the Carnival of The Capitalists is now up, hosted by Fat Pitch Financials. Over 50 posts are presented, in a unique (and useful) "table" format, which can be sorted by site, category, and title. Very cool.

Joe Kristan, of Roth & Co fame, posts this infuriating story about the gummint taxing a business...in order to subsidize its primary competitor. Infuriating, but enlightening.

Insurance Dispatch

This week's column is up at The Medical Blog Network. We answer reader mail, and set a commenter straight.

Good times, good times.

Underdog vs Google

As you may recall, FoIB Chris Parks has been working on a powerful, free, useful, no cost to the consumer, innovative and free on-line tool that will help reign in the out-of-pocket cost of healthcare.

Well, it seems that Chris almost had need of some ICU-type healthcare when he read that the 800# gorilla that is Google seemed to be poaching on his territory.

Never fear, though, our intrepid hero eventually came to realize that, rather than competing with his new project, Google was, in fact, reinforcing the need (and desirability) of it.

Bravo!

M.I.B. II

I have received a reply from my correspondent, explaining the circumstances and issues.

 

Turns out, an application for health insurance was recently turned down because of discrepancies between the app and the medical records. Apparently, the applicant’s physician had included several health-related problems in the records, none of which were applicable. Some of these were quite serious (COPD, for example, and hypertension). All told, there were 10 such discrepancies [ed: no wonder the app was declined!].

 

So, after reviewing all the “problems,” my e-friend met with the doctor, discussed all the items, and agreed that they needed to be corrected. Subsequently, the doctor documented this for his patient, and this letter was forwarded to the insurer. At this point, no word has been received from the carrier as to whether or not this will affect its earlier verdict.

 

But that’s not the end of it. My e-friend is concerned that the declination has been reported to the afore-mentioned MIB, and will become a permanent source of problems for future insurance applications. For now, COBRA is in place, so there is at least a safety-net in place during this process.

 

Okay, so what’s my role in this?

 

Along with Bob, I spend some time each day helping folks at an insurance-related consumer bulletin board. My e-friend read some of my posts, and thought that I might be of help straightening out this mess, or at least supplying helpful directions.

 

Which I have done.

 

I explained that the MIB has an appeals/corrections process, which consists of writing them a letter and waiting for a reply. I suggested that such a letter be sent, along with a notarized list of corrections provided by the doc. I also suggested a follow-up phone call, and posited that this will not be a speedy process. Lastly, I suggested that the whole bundle be sent in such a way that it could be tracked, and with a way to confirm delivery (signature, etc).

 

The next piece of advice was to avoid the initial carrier altogether (for a number of reasons, none of them really relevant here), and to seek the counsel of a professional, independent agent with a minimum of 5 years experience in the health insurance field. Since I have the privilege of knowing quite a few “good guys” all around this great land of ours, I offered to help find one if necessary.

 

Finally, I suggested that it’s not always necessary (or even desirable) to keep an entire family on one’s COBRA. Sometimes, it’s better to “spin off” other family members to a separate policy. Again, a pro will be able to help determine this.

 

At the very least, this is an interesting experience. It’s nice to be able to help out, and it’s also nice to have the opportunity to learn more about agencies like the MIB. In fact, Bob sent me a gaggle of links on this subject, which I’m starting to go through even now.

 

As my correspondent has promised to keep me posted on any progress, I’ll pledge the same to you.

 

UPDATE: Have you ever heard the term "Common Knowledge?" That's where everyone just knows that such-and-such is true, or that so-and-so is a genious, or whatever, but then it turns out not to be true at all?

 

Well, like many of you, I just "knew" that MIB is notified whenever a company turns someone down.

 

Turns out, that's just "CK:"

 

From: MIB Info Line [infoline-at-MIB.com]

To: insureblog-at-hotmail.com

Subject: RE: Declinations

An MIB Report does not indicate the amount of coverage applied for or if a policy was issued, declined or charged an extra premium.

Interesting, no?

Something Different: Carnival Wednesday

Over at Raising 4 Boys, host "Dad" presents this week's Carnival of Personal Finance. Each of the 38 posts is neatly summarized.

I thought this post from Debt Free, on pre-paying one's mortgage, quite interesting.

Dominick at Trader Knowledge has the 3rd Edition of the Cavalcade of Risk. He's done a fine job of organizing the posts, and he's included helpful notes about each one.

As one who's always found the Worker's Compensation system to be mysterious yet unncessarily complicated, I found Jon Coppelman's post on workers comp and the Supreme Court to be quite fascinating.

Independence Day Capitalism

The July 4th edition of the Carnival of The Capitalists is up, hosted by My Money Forest. With over 50 entries, you're sure to find (at least) one that piques your interest.

As one who has always believed in treating my clients the way I'd like to be treated, this post at Trizle really hot the spot.

M.I.B. (NOT Smith & Jones)

Conventional wisdom ("common knowledge") is interesting, fun, and most often, wrong. What prompts me to make this observation is an email I recently received:
 

"I was very surprised with a little known fact concerning the Medical Insurance Board (MIB). Do consumers really understand the ramifications of their medical history in this system?"

Apparently, my correspondent has had some recent troubles obtaining health insurance. I'm still not sure what, exactly, the missive's author wants from me; I replied, of course, and am waiting for more information.

In the meantime, it may be useful to bust a few myths about what the Medical Information Bureau really is, and what it really does:

First, the MIB does not keep a copy of one's medical records. One doesn't really even need to read the FAQ on their website to know this; it just doesn't pass the "smell test." Think about it: even before the draconian privacy measures mandated by HIPAA (which, we'll grant, aren't exactly enthusiatically enforced), how would such an organization go about getting all the files from all the doc's that one has ever seen? And where in the Wide, Wide World of Sports would they keep them?

Second, only folks who have applied for insurance (life or health) from one of the 600 companies who participate are even subject to its "review" (IIRC, there are something like 1,800 such carriers). And of these, the Bureau is informed regarding only those who have been rated or declined. Then, if such a person applies for another policy, with another participating carrier, will it even matter?

Third, these notes are kept for a maximum of seven years, after which they are purged. So it's not "forever," anyway.

It is true that most (if not all) life and health applications (and to be accurate, I'm lumping in Disability and Long Term Care policies under the general heading of Life and Health) include a question regarding previous insurance experiences. That is, they ask if one has ever been rated or declined for insurance. Some carriers give this question (and its implications) greater weight than others; conversely, some carriers are notoriously stringent in their underwriting process, and that has a certain significance, as well.

The primary mission of the M.I.B. is "to detect and deter attempts by applicants of life, health, disability, or long-term insurance who would omit or misrepresent facts." This is actually a powerful tool for us consumers: fraud helps drive up the cost of insurance (as if it needed any help to get more expensive). By working to minimize it, organizations like the M.I.B. help to hold down those increases.

While I take each email (and, for that matter, each comment) seriously, I think that sometimes folks let their imaginations run a bit wild. It may well be that this person has had a bad experience, and I will try my best to help resolve it. But the M.I.B. isn't the enemy.

Darned if you do, or don’t...

Recently, my mother was hospitalized for a week, the victim of a prolonged headache that just wouldn’t quit. Turned out to be an inflammation of an artery, and not (as feared) something worse, such as a tumor.

In many such cases, folks start thinking about their own (and/or their parents’) long-term prospects, and the thought of Long Term Care eventually surfaces. Thankfully, Mom’s condition is (relatively) easy to treat, and she should be fine soon. ‘Course, I am concerned that she found the hospital food superior to her own home cookin’, but that’s a discussion for another day.

All of this by way of introduction to an interesting, if disheartening, study undertaken by the John Hancock (okay, you purists will have noted that I used “the,” a throwback to “the old days.” I also put an “e” at the end of envelope, and spell dilemna with an “n.”), which shows a startling disconnect between what we know to be true, and how we choose to deal with the truth.

To wit: even though we know about the graying of our population, and we know that health care costs keep escalating, we choose to ignore the connection. According to the JH study “Americans are less worried today than they were roughly a decade ago about needing and paying for LTC.” This is stupid. We know that gas prices have risen, and we grumble about those. We know that mortgage rates are on the rise, and we worry about that. But we can choose a smaller house, or a more fuel-efficient vehicle; what is the alternative to living longer?

I know, trick question.

Here's what's weird: while over half of those surveyed were concerned about the cost of care, that's still a 12 point drop from folks 10 years ago. On top of that, compared with the '97 study, fewer people were concerned that they'd even need long term care.

OTOH, almost 2/3 of the respondents thought they'd make it to (at least) 85, and that the cost of LTC would have a substantial (and negative) impact on the post-retirement financial position. This concern, by the way, is an increase over the old study.

And so, we have a population that is ageing, that believes that it will get even older, that believes that there is a greater likelihood that they'll need more (and more expensive) care, and yet aren't really worried all that much about it.

I have a picture in mind.

Something else I found interesting is that, after a decade of sales pitches, advertisements, promotions, news articles and studies, most of those surveyed had no more knowledge about the nature and cost of long term care than their counterparts did 10 years ago. That’s a bit scary, no?