Poppin' News

Waaay back in August of last year, Bob reported on an employee in a popcorn manufacturing facility who had won a large judgment against one of his employer's suppliers. He claimed that the additive which provided that "buttery flavor," diacetyl, had ruined his lungs.

Earlier this fall, a Denver physician warned various federal agencies about the dangers of this product, urging them to investigate possible links between the chemical and increased risk of pulmonary disease.

Which brings us to today's news that "ConAgra has removed a controversial chemical from its microwave popcorn that gives the snack a buttery, creamy taste, citing concern for its workers' health." Although the DOL's "Occupational Safety and Health Administration does not have specific regulations regarding" the chemical, it did issue a special bulletin discussing the potential problem.

As for me, I'm still sticking with Alton Brown's method.

Carnival of the Capitalists is up

Rob Sama, one of the originators of the Carnival, hosts this week's edition. Rob took a major scalpel to his version, and we're treated to a simple 15 posts. Rob says (and I agree) "the Carnival has become dominated by sole practitioners offering silly how-to type entries in blogs that have extraordinarily few entries to begin with...and submissions that seemingly have been made to every...carnival under the sun." Hear, hear! Thank you, Rob, for injecting some sanity and common sense back into the CotC.

As a big fan of common sense, I really appreciated Super Saver's post on some simple ways to fix (or at least adjust) our tax code. He takes a look at both major parties' ideas and finds them wanting.

Just the next station on the line . . .

Remember please, the rules are there to help everyone.

UPDATE (from HGS): Mike beat me to the punch on this one, but I'd like to add a couple of my own thoughts:

■ This is but another in a (very) long string of "gotcha's" perpetrated by the MVNHS©.

■ It's been said that our system has inequalities, and that it is therefore "broken." Indeed, one of our "regulars" is on record as stating that such things happen "only in America." And yet we see the British "system" failing its patients time, after time, after time. And because it is nationalized, there are few alternatives left when such egregious failures (such as the plight of Ms Mills) come about.

First do no harm

Recently I came across the following comment on a physician’s health blog. I saved the link, but am not posting it because the specific source is not really important. But the point of view it expresses is important because it is common among physicians. Here is the comment:

"unless the physicians are vigilant in correcting [policy wonks’] fantasies, the absurdities will press on unabated."

This is the beginning of an important insight. But it’s left unfinished.

Meanwhile, and in reality, such absurdities have grown for 40 years and IMO are likely to become even worse.

Let's keep in mind that health care policy wonks do not fall out of the sky. It's trite, but true: nature abhors a vacuum. The policy vacuum in health care sucks in people who become health policy wonks, when otherwise most of them would pursue more useful vocations.

And how have these wonkish folk gained significant control within our "system?" IMO, because physicians have increasingly failed to assert control.

The resulting vacuum of physician leadership has become especially harmful during the past 40 years.

Moses found a way out of the wilderness in 40 years. OK, health care is a more difficult problem. But still . . .

Regrettably physicians by their inaction cede leadership on far too many fundamentals of health care management. If physicians want health care to be managed differently, they must find ways to exert more significant and direct leadership.

Physicians’ attempts to correct others' fantasies won’t work. Physicians' attempts to persuade policy wonks to lead, but in a manner agreeable to physicians rather than to policy wonks, won’t succeed. Physicians’ complaints about others’ poor leadership is not leadership. In fact, none of these behaviors is leadership. What to do? Well, I’m no wonk. I don't know for a fact what will work. If I knew I’d be very rich. But my opinion is that physicians must assert much more direct influence on health care policy and management in this country.

“First, do no harm” is sometimes a call to take action, rather than to refrain from taking action. If now is not one of those times to act – then when?

Cavalcade #41: Submissions Due

Next week's Cav wraps up a tremendous 2007. Please make sure to get your submissions in to our host, Matthew Paulson, by Monday (the 17th). Matthew asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We have slots available for the New Year - just drop us a line to reserve yours.

A Taxing (Health) Problem

Once again, our favorite tax-blogger, Joe Kristan, has indispensable year-end news:

"S corporation shareholders need to make sure that their premiums are included on their 2007 W-2s."

What's the point, you ask?

Simply this: if you own a business, and you want to (legally) deduct your health insurance premiums (usually a non-trivial amount), there are some new rules, and you need to know about them.

Fortunately, Joe has all the sordid details, which he generously shares with those of us who don't count (or even necessarily know) beans.

Check it out.

Health Wonk Review: Final '07 Edition

HealthBlawger David Harlow presents an outstanding EOY edition, successfully integrating his chosen theme (light) with a potpourri of policy posts. I especially like how he creates a kind narrative.

Each HWR seems even better than the last.

One post that caught my eye was Dr Adam Fein's on how Medicare Part D is playing out. Regular IB readers know that I'm no fan of the program, but Dr Fein has an interesting take on how it can actually drive down some costs.

S-CHIPping Away

The original intent of the S-CHIP program was to offer affordable health insurance coverage to poor children. Along the way, the definition of both poor and children has blossomed to include middle class adults who would rather rely on the government than take responsibility for themselves (and their families). We saw this with the S-CHIP kerfluffle this past fall, and our fearless leaders in Washington (DC) decided to trot it out again.

President Bush wisely smacked down the latest version, which again included adults. The President summed it up nicely:

"Ultimately, our nation's goal should be to move children who have no health insurance to private coverage, not to move children who already have private health insurance to government coverage."

Hear, hear!

Stupid Carrier Tricks #143

Of all the types of claims we see in the life and health business, a natural death claim on a 20 year old policy would seem to be the least likely to be a problem.

After all, such a policy is well past the contestable period, and there's no foul play (my client died of cancer). It's tailor-made for prompt settlement.

Unless, apparently, the carrier's Time Insurance (aka Hartford Life).

The facts are pretty straightforward: we wrote a universal life insurance policy on a gentleman in 1988, and he died of cancer on October 28, 2007. I contacted the carrier immediately, and they responded to the request for paperwork quickly.

And that was the last thing they did "quickly."

I met with the widow a week or so later, and we submitted the completed paperwork on November 9th. Then we waited.

And waited.

Eventually, I called Kelly Wanovich, the "claim analyst" who had initially responded to our request on October 31st. He told me that it can take up to 10 business days for a claim to be processed and paid. It's now over a month since we filed the claim (for those keeping track at home, that's 20 business days, if we presume that the obviously overworked staff at Time Insurance took off Thanksgiving and "Black Friday"), and still no check. I did receive a call late last week indicating that it was being "processed" and would soon be on its way, but "the check is in the mail" doesn't put food on the widow's table, or make the mortgage payment for a roof over her head.

I even emailed Mr Wanovich last Friday:

"Got your voice mail, and was pleased to hear that the check is (finally) on its way.

I still don't understand why it's taken almost a month (including some 20 business days) for this to happen. I'd like to be able to explain this to [redacted], his widow, as well. Can you help with that?"

Of course, I have yet to receive a response.

There is simply no excuse for such an egregious abuse of the claims process. Trust me, if my client had been a day late with his premium payment, he would have quickly received a "reminder" notice from the carrier. But when it's time to pay, where is that state-of-the-art system to be found? Certainly not in the Claims Department.

It's one thing when there's a legitimate question about a claim; after all, we all suffer when carriers are defrauded. But it is quite another to deliberately withhold money on a straightforward, no-brainer claim such as this.

Unless, of course, you're a carrier, and the term "no brain" fits a little too well.

UPDATE 12/12/07: O Frabjous Day! The death claim check arrived this afternoon, a month after the claim was submitted. On the one hand, this is terrific news for the widow. On the other, it does not mitigate or negate the agregiously long time it took for this to happen.

An Enigmatic Conundrum

Group term life insurance is the ugly stepchild of "real" life insurance. Typically sold as part of a group medical plan, it pays a minimal amount (often multiplied in the case of accidental death) and is owned not but the insured, but the employer (who has the right to cancel or change the plan).

Which is not to say that GTL is a bad or unnecessary thing; simply that it is a poor substitute for personally owned life insurance.

So what brought that on?

Well, even though GTL is not my favorite product, it does serve a very important purpose: for many, it is the only life insurance they own. For these folks, it may actually mean bread on the table for the family they leave behind.

There's one other interesting difference between "regular" (underwritten) life insurance and GTL, as well: terrorism coverage. Almost all* individual life policies have clauses about war and (especially) "acts of war" which could be a problem in the event of a terrorist attack.

Most GTL plans lack this distinction.

Which brings us to the conundrum:

"The industry, in the event of a severe act of terrorism, is vulnerable to insolvency because high concentrations of covered employees work in the same locations, because primary group life insurers do not exclude terrorism risks while most catastrophic reinsurance does exclude such risks, and because a large-scale loss of life would fall outside of actuarial expectations of death.”

At least according to the text of a new terrorism bill being debated in the House. The challenge is that carriers face huge losses, many of which are apparently not reinsured, in the event of another 9/11. By placing the treasury of the United States as a "backstop" against this kind of loss, it lessens the likelihood of any one (or several) carrier from going down the tubes. And that would be important to the beneficiaries, those left behind.

On the other hand, this is the nature of business, and particularly the insurance business: risk management. If the risk of terrorism is of concern (as it obviously should be), then it seems to me that the industry is obligated to come up with solutions on its own. It shouldn't count on the gummint (which is to say, the taxpayer) to bail out carriers who made poor choices.

No easy answers.

*I'm not aware of any that don't, but there may well be.

An Aesthetic Grand Rounds

First time GR host Dr G C George presents a gorgeous collection of interesting posts from around the medblogosphere. He presents the 20-plus entries as a sort of Caribbean cruise, somplete with marine flora and fauna. It's both visually and intellectually appealing.

Prudence, MD has an interesting post on the relationship of religion and health. Her backdrop is a rather disturbing recent episode in the Philippines which saw a fundamental clash between providers concerned about the spread of AIDS, and a religious hierarchy vehemently opposed to safe sex education.

HSA News: Breaking

CPA Extraordinaire Joe Kristan has some interesting news for those who either itemize their medical expenses or (more likely) participate in Qualified Alternative Benefits (FSA/HRA/HSA).

While some of the changes affect a broad spectrum of participants, those who are pregnant (or think they might be) definitely need to "read the whole thing."

Carnival Monday!

The folks at Money $mart Life present a tremendous Carnival of Personal Finance, complete with an introductory YouTube preview. Very unique, very cool. And there are almost 70 interesting submissions, all neatly categorized and annotated.

Kudos!

Paid Twice has an interesting post on how our priorities and measures change as we mature. It's a very timely reminder.

UPDATE: A tad late, but welcome nonetheless, Jay at Blogblivion hosts this week's edition of the Carnival of the Capitalists. With some 28 posts, all celebrating the capitalist system, you're sure to find something helpful.

Ever eaten a square watermelon? With a post that's truly "outside of the box," take a taste of Financial Hack's report on a great solution to a vexing problem.

CMS and Nursing Homes

Not sure how I missed this, but our friend (and frequent foil) Zagreus, blogging at The Physician Executive, has a post on a new CMS initiative on nursing homes.

It's a thoughtful piece, and one which strikes close to home.

Recommended.

The Schengen What?

[Welcome Industry Radar readers!]

Over the past several years, many (not all) of the EU nations have signed an agreement called the “Schengen Convention" which is scarcely known in the U.S. One of the less prominent articles in the Convention is a requirement that persons seeking an entry visa to a signatory country must have adequate medical insurance of their own.

(Click here for details)

An entry visa will not be issued to anyone who does not provide the required proof of adequate medical insurance.

In other words, without much fanfare or publicity outside Europe, the Schengen countries have REJECTED the notion that their citizens are obligated to pay for medical expenses of foreign visitors - even legally-admitted foreign visitors – via their own nationalized health care systems.

The nationals of 134 countries are presently subject to this requirement - interestingly, not the U.S.

In case you wonder whether the Schengen insurance convention is actually enforced, I assure you that it is. In my most recent position I had responsibility for my company’s worldwide staff health benefits. My office was frequently called upon to to help foreign employees who at the last moment discovered they needed the prescribed Schengen benefits documentation in order to obtain a visa.

Some observers suggest it's likely that illegals would be mandated health insurance coverage under a universal U.S. health care program. I say, not so fast. I say it's at least 50-50 that the debate here will reach the same outcome as in the Schengen Conventions.

Of course, people who hold jobs and pay into a system have a plausible claim to benefit from the system. IMO such a claim is indisputable for people who are citizens, and for people who have legitimate green cards or work visas. It is much less clear whether people who are in this country illegally in the first place should be entitled to the same benefits.

None of this is easy stuff and IMO it is very unlikely that any easy answer will be found – rather the likelihood is that a raucous and divisive debate will ensue whose outcome is very much in doubt.

To summarize:

(1) The Schengen countries have REJECTED the notion that their citizens are obligated to pay for medical expenses of foreign visitors - even legally-admitted foreign visitors - via their own nationalized health care systems.

(2) The design of any U.S. governmental single-payer system must deal with the issue of health care costs for illegal aliens. When the debate over program design commences in earnest, there will likely be a strong and vocal faction advocating rules similar to Schengen.

(3) One possible outcome is that illegals would be mandated coverage under a universal U.S. health program. But I say it's at least 50-50 that the debate here will have the same outcome as Schengen.

Tivo Bleg

Our own Mike Feehan makes his cable TV debut this Sunday, in a 1 hour special on the Fine Living channel. The show -- called Stop! You're Paying Too Much -- airs for the final time this Sunday morning (the 9th) at 11:AM (Eastern). We would really appreciate it if any of our readers would tape/Tivo/DVR it for us (especially Mike's insurance tips segment).

Thank you!

The New S (for "Strip")-CHIP

Finally, a government-sponsored health care financing scheme I can get behind. Indeed, I can immediately see through the layers of thinking that went into recent Lone Star State legislation:

"The new fee...is set to take effect on Jan. 1. It's expected to raise about $40 million to be dispersed for sexual assault prevention programs and health care for the uninsured."

Granted, this seems an unusual pair, of issues; nevertheless, it seems to me that the $5 fee is modest enough. Specifically, it's a surcharge for consumers of certain entertainment venues. Since no one is forcing folks to frequent these facilities, this seems fair.

Of course, there are the usual nay-sayers, folks with an axe to, er, grind:

"The Texas Entertainment Association and Karpod, Inc., the operator of an Amarillo club, filed the lawsuit Wednesday in Travis County against Texas Attorney General Greg Abbott and Comptroller Susan Combs."

These ne'er-do-wells claim that the surcharge is actually a new tax (as in "sin tax" perhaps?) which would apparently be unconstitutional under current Texas law. It appears that in this case, the state's constitution is bumping up against a popular mandate.

I just hope that the politicians won't keep dancing around the issue.

The MVNHS© - At it Again

This summer, we reported on the brilliant decision of the Scottish wing of the Much Vaunted NHS© which forbade health care workers from eating at their desks during Ramadan. The powers that be were fearful of upsetting (and/or offending) Muslim co-workers and patients. I opined at the time that this seemed, well, unseemly, never imagining that it could get worse.

Silly me:

"OVERWORKED nurses have been ordered to stop all medical work five times every day to move Muslim patients’ beds so they face towards Mecca."

Believe it or not, it actually gets even worse:

"The lengthy procedure...also includes providing fresh bathing water."

I really don't want to go there.

One presumes that this is for the Muslim patients' foot-baths, not daily (weekly?) bathing, per se.

Currently, only patients being treated in a few hospitals are privy to this over-the-top medical care, but that's slated to expand next year.

Again, I have no objection to patients being afforded a certain degree of comfort, but this puts actual, sick folks at risk, as well as representing a significant additional drain on an already strained health delivery system. If Muslim patients want to pay for this themselves, fine, have at it. But it seems to me that it's not the business of health care providers to render this sort of treatment. That's what volunteers (and paid private nurses) are for.

Of course, this is a nationalized health care system, so what the gummint says, goes. There's really no option for health care providers to demur, since the state has determined what's covered, and what's not.

Gosh, don't you wish we had such a system, too?

Cavalcade of Risk #40 is now online!

This week's edition is hosted by Joe Paduda, at Managed Care Matters. And it's a big 'un, including some new (to us) blogs.

If you'd like to host a Cav, we'd love to have you. We're now scheduling for early 2008, so drop us a line to schedule yours.

Welcoming Chanukah

We Jews like to do even the obvious things a little differently. Case in point: our holidays (or, if you prefer, Holy Days) run from sundown to sundown, rather than day to day. Thus, tonight is the first night of Chanukah this year (yes, that's different, too, but it's also another post), while tomorrow is the first day. In all, we'll celebrate the Festival of Lights for eight nights, each evening adding another candle to our menorahs.

And because we live in a predominently Christian country (life's tough, Penelope), we've absorbed some of the ambiance of the season, so there's a lot of gift-giving that goes on, despite the fact that there's no religious compulsion to do so. As with our Christian neighbors, we Jewish parents walk that difficult path between "too much" and "not enough" with regards to the commercialization of our holiday.

I am blessed to have a number of Christian clergy among my clients, and this time of year I often hear them wish for "putting the Christ back in Christmas." Of course, putting the "Chan back in Chanukah" only works on a certain (gastronomic) level, so we look for other ways to imbue the "spirit of the season" in our progeny.

Now, I'm going to make what may appear to be an abrupt transition here, but bear with me and you'll be rewarded.

In Judaism, the concept of "charity" is expressed in the Hebrew term "tzedakah." But this word actually translates more accurately as "righteousness." In fact, it is closely related to the word "tzaddik" or "righteous one." One of the most famous of biblical scholars, Moses Maimonides (more commonly known as "the Rambam") postulated 8 levels of tzedakah (as there are eight days of Chanukah; we'll come back to that). In fact, even those who receive "charity" themselves "must also give tzedakah to another."

And now we come full circle:

If you stop to think about it, our children are (perhaps) the neediest of all. They depend on us for the very necessities of life: food, clothing, shelter. Yet they are required to observe tzedakah, as well. As noted in this morning's USA Today, "many Jewish families are highlighting the spiritual side of Hanukkah by devoting at least one of the holiday's eight nights to tzedakah."

This is critically important: for many American Jews, it's the only time they really spend celebrating Judaism in their homes (Shabbat, the Sabbath, is actually the original home-based holiday, but is often left unobserved in modern Jewish homes). With so much attention focused on the "eight crazy nights," it's actually an ideal time to discuss what tzedakah really means, and its importance to Jewish life.

Eight levels of giving, eight nights of light: coincidence?

I think not.

Happy Chanukah!