Are WE Stupid, Too?

[Welcome Industry Radar readers!]

Recently, I noted that doctors demonstrate a remarkable lack of intelligence and sense. But I also wonder why the public at large believes that health care reform included in the Spendulus is going to have a happy ending.

As we've repeatedly noted here at IB, unless we're able to contain health care costs, our likelihood of controlling health insurance costs is a pipe-dream. And we can look at real world examples to ascertain the truth of this.

One such example, often cited as a model of health care efficacy by those in favor of such systems, is Medicare. Unfortunately, it fails miserably on all counts:

"An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn't work, a government-contracted study found."

Got that? A "government-contracted study." Not an insurance company or doctor's association. For many seniors, chronic illness is a way of life; the challenge is to manage it cost-effectively. Unfortunately, this gummint-run system has demonstrated no such ability:

"Most of the patients had serious, but common, age-related illnesses...Programs were set up at 15 centers...Only two cut the number of times these patients were hospitalized...None saved Medicare any money." [emphasis added]

One of the primary problems (and again, one we've mentioned many times) is that many folks have behaviors that can be changed, but too often remain unchecked: weight, excercise, smoking, etc. Without more personal responsibility, there's very little hope of change, the power of the gummint notwithstanding:

"The only way you can really do it is by changing patients' behavior and by changing physicians' behavior, and both things are really hard to do," according to the study's author, Randall Brown.

No kidding.

Stupid Mommy Tricks

Several years ago, we caused a kerfluffle with a series of posts explaining why IVF (In Vitro Fertilization) should not be covered by insurance. At the time, it never occured to us that we should have added "or by the taxpayer."

Ooops:

"A big share of the financial burden of raising Nadya Suleman’s 14 children could fall on the shoulders of California’s taxpayers."

Turns out, the young "lady" (who had already spawned 6 children) has been receiving gummint subsidies, at least in part because she is unemployed. For some reason, this rocket surgeon decided that having a slew of additional mouths to feed would be appropriate, and that it would also be appropriate for thee and me to pay for their care.

Perhaps the hardworking taxpayers of the Golden State (or should that be "Goldbrick" State?) had other plans for those dollars; alas, those tireless workers weren't consulted, only forced to pay up.

But wait, it gets better!

"(T)he hospital where the octuplets are expected to spend seven to 12 weeks has requested reimbursement from Medi-Cal, the state’s Medicaid program, for care of the premature babies, according to the Los Angeles Times. The cost has not been disclosed." [emphasis added]

Oh, great: a blank check!

The good news is that Ms Suleman "doesn’t consider the public assistance she receives to be welfare." Well good on her! After all, it's only important to consider what one calls it, not that one is expected to pay for it.

Surprisingly, "bloggers rained insults on Suleman." Gee, I wonder why?

Cavalcade of Risk #71 Now Up

Once again, Julie Ferguson presents an outstanding edition of the Cavalcade of Risk. From peanut butter to lightbulbs, medical errors to radiation risks, you're sure to find something to interest (or scare) you.

Do check it out.

And consider hosting your own Cav; we're scheduling for Spring '09. Just drop us a line to snag yours.

Doctors are Stupid (Updated)

[Welcome Industry Radar readers!]

[ed: File this under "great" (?) minds think alike - before I had the chance to push the "Go!" button on this post, my colleague Bill Halper had his take on the Spendulus Package. Please be sure to read it. And it appears that Bob will also be sharing his thoughts on it a bit later.]

Yup, that's what I said: as a group, doctors are stupid.

That bears repeating: as a group, physicians are stupid.

And on what do I base this?

Well, let's look at the headlines on the front page of the AMA website:

■ AMA Cheers New Law to Get Kids Health Coverage

■ AMA Wins Legal Victory for Physicians in Privacy Court Case

■ AMA Wins Victory with Record-Breaking Settlement in case against insurer

Not one word on the Spendulus package, which contains even more pieces of a nationalized health care system As Bloomberg News' Betsy McCaughey reports:

"The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system."

And:

"One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective."

So let's review those AMA headlines in this new context, shall we:

■ AMA Wins Legal Victory for Physicians in Privacy Court Case. Nope, you can kiss that privacy goodbye. After all, the gummint's proven so adept at keeping private information private.

■AMA Wins Victory with Record-Breaking Settlement in case against insurer. And that goes the way of the dodo, as well: can't sue the gummint. So when the bureaucrats in Washington say "jump," the doc's only response will be "how high, boss?"

These are folks who willingly gave up major chunks of their lives to study, work, even brreathe medicine. many of whom make (very) nice wages for these efforts. Yet they willingly risk throwing all of that away to make, what, a political point?

Okay, that's certainly their right and prerogative.

But it's also proof of my original thesis.

And there's this: If you're a "seasoned citizen," be aware (and beware) that this bill dramatically reduces your choices (and chances), as well:
"In 2006, a U.K. health board decreed that elderly patients with macular degeneration had to wait until they went blind in one eye before they could get a costly new drug to save the other eye."

[ed: as we reported last summer]

According to Ms McCaughey, "seniors in the U.S. will face similar rationing." Talk about an uncertain future.

Carnival, anyone?

Oh, and for Economies With "Performance Issues," there's this:

[Hat Tip: Joe Kristan]

You Want Stimulus? I'll give you stimulus...and everything but the kitchen sink...

I hate to be negative about the Stimulus Bill and the myriad of provisions which will affect all of us, but please read:

Ruin Your Health With the Obama Stimulus Plan

If the Bill passes with the provisions relating to health care still in it, you need to think about how it will affect you. As the article says:

"The bill’s health rules will affect “every individual in the United States” (445, 454, 479). Your medical treatments will be tracked electronically by a federal system. Having electronic medical records at your fingertips, easily transferred to a hospital, is beneficial. It will help avoid duplicate tests and errors." (ed. And how often have you had duplicate tests???)

"But the bill goes further. One new bureaucracy, the National Coordinator of Health Information Technology, will monitor treatments to make sure your doctor is doing what the federal government deems appropriate and cost effective. The goal is to reduce costs and “guide” your doctor’s decisions (442, 446). These provisions in the stimulus bill are virtually identical to what Daschle prescribed in his 2008 book, “Critical: What We Can Do About the Health-Care Crisis.” According to Daschle, doctors have to give up autonomy and “learn to operate less like solo practitioners.”

Read the comments about his book. Daschle will not be a cabinet member, but no doubt a similar thinking individual will be.

Next time your doctor says he can't prescribe what he wants or treat you the way he wants because the government deems the treatment or medicine not cost effective (even if you want to pay for it) you can blame the Stimulus Bill. If you don't have blinders on, you might even blame Sen Reid, Speaker Pelosi, and oh, yes - President Obama.

You might ask what such provisions have to do with stimulating the economy, but don't. Those questions aren't allowed. If the law isn't passed, it will be a catastrophe. Just ask the President.

Gardisil in the Crosshairs (Again)

From the Told Ya So Department:

"There are new concerns about Gardasil, the vaccine that prevents a virus that caused cervical cancer. It's approved for girls as young as nine ... The FDA and its maker insist it's safe. But CBS News investigative correspondent Sharyl Attkisson has exclusive information on some very serious side effects."

Ooops.

Turns out, this questionable med - which costs $120 a pop - is not only unproven, but potentially quite unsafe:

"The National Vaccine Information Center [NVIC], a private vaccine-safety group, compared Gardasil adverse events to another vaccine, one also given to young people, but for meningitis. Gardasil had three times the number of Emergency Room visits ... Reports of side effects were up to 30 times higher with Gardasil."

Major oops.

In fact, the NVIC notes that "there are more reactions and deaths associated with Gardasil than with another vaccine given in the same age group."

And yet, proponents of the vaccine continue to promote its use; in fact, they're also pushing to have it administered to boys who, as I understand it, have a very low incidence of cervixes (cervixi?).

Oh frabjous day!

On The Other Hand: Turns out that the doc who connected the dots between the MMR vaccine and childhood autism may have significantly fudged his numbers:

"The doctor who sparked the scare over the safety of the MMR vaccine for children changed and misreported results in his research, creating the appearance of a possible link with autism, a Sunday Times investigation has found."

One of the hallmarks of good science is replicability; that is, that results can be replicated in subsequent studies. When one deliberately misreports the actual test results, and also refuses to divulge how they were obtained, it renders those results unuseable.

Or at least it should.

Shame on "Dr" Wakefield, and further shame on The Lancet for even accepting the report in the first place.

The Carnival of Personal Finance now up

Follow the yellow brick road to this week's edition of the Carnival of Personal Finance. Host Brooke of Dollar Frugal has a Wizard of Oz theme that works quite nicely.

Wasteful Government Tricks

No, not that wasteful government trick.

You just can not make this up:

"As he tells it, Randall Hinton is paid $93,803 a year to do nothing...His work agenda involves placing his feet up on his desk, staring out his office window and counting cars on the New York State Thruway. He arrives at 7:30 a.m., leaves at 3:30 p.m., sees no one and talks to no one."

And just what is his (ostensible) job?

Why, he's the "director of investigations for the Insurance Fund." To hear Mr H tell it, he's not allowed to actually investigate anything, though, because he had sued the state for discrimination. Although that suit has long-since been settled, this Investigator-without-Portfolio has been idled, forced to spend long, lonely days staring out the window, perhaps contemplating life "on the outside."

By my reckoning, that amounts to over $50 an hour to twiddle his thumbs, all on the taxpayer's dime. Nice work if you can get it.

And just what is the State Insurance Fund actually for? Glad you asked:

"It exists to provide workers' compensation and disability policies as an insurer of last resort to 190,000 employers statewide."

Hmm. I wonder if Julie knows about this.

The crux of the matter seems to be that Mr Hinton believes that he's being discriminated against for having had the gall to sue a GOP-led administration. This falls apart, of course, since Democratic Governor and Man-About-Town Eliot Spitzer elected to continue the charade.

Meantime, New York taxpayers continue to fork over almost $8,000 a month for this gentleman to, well, you know.

Cavalcade of Risk #71: Submissions Due

Julie Ferguson, proprietor of Workers Comp Insider blog, hosts next week's Cavalcade of Risk. Submissions are due by Monday (the 9th). Please be sure to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

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

You can submit your post via Blog Carnival or email.

It's really easy to host, and a nice bump in traffic. Just drop us a line to reserve yours.

Hiding in Plain Site

The nationalized health care folks have found renewed energy and legitimacy in the latest iteration of the Trojan Horse known as SCHIP:

"A new report, Maximizing Kids’ Enrollment in Medicaid and SCHIP: What Works in Reaching, Enrolling and Retaining Eligible Children, suggests strategies states can use to increase enrollment in Medicaid and the State Children’s Health Insurance Program (SCHIP) based on tested ideas for reaching, enrolling and retaining children who are eligible for public health insurance."

Of course, this is merely the logical result of an effort to push more folks out of the private sector and into the gummint trough. There are a myriad of commercial alternatives for children (very few of whom are uninsurable), but that just won't do. Rather, the NatHealth folks see an historic opportunity to expand gummint-sponsored and -run health care schemes, forcing our children into substandard care.

Of course, our friends at the Robert Wood Johnson Foundation are all for it; after all, it serves to legitimize their own view of health care finance and delivery. And of further course, the National Academy of State Health Policy (whose board consists primarily of beareaucrats and educators, with no evidence of input from the private sector, let alone the insurance industry) is all for this, since it represents more money for state governments.

What's so appalling to me is that we've come to a point where the NatHealth folks aren't even trying to hide or disguise their agenda.

Early February Health Wonk Review now online

David Williams, fresh off of hosting last week's Cavalcade of Risk, once again dons the mantle of Carnival Master, presenting a terrific Health Wonk Review. From primary care to Big Pharma, this one's got it all.

Do stop by.

And by the way, InsureBlog hosts the next edition, slated for the 19th.

Treat-worthy Carrier Tricks

Over the years, we've chronicled numerous examples of carriers' less-than-stellar performances. Sometimes, though, they do the right thing, and we try to document those times, as well.

This is one such time.

Recently, we reported on Anthem's apparently lackadaisical approach to changing policy effective dates. In this particular instance, my client learned that she could retroactively cancel her previous coverage back to January 1, and receive a full refund from the prior carrier. But we'd already nagged Anthem to move the effective date forward, to February 1.

Could we get them to rescind this change, and regain the original (January 1) effective date? I set out to try.

The bad news is that it took two days, several hours on the phone, and numerous blind alleys to get to the person empowered to make the change. I eventually got to the right department, but was told in no uncertain terms that the company will allow only one such change per policy. The lady with whom I was speaking made it clear that she was not empowered to make an exception.

So, of course, I asked to speak to the person who was so empowered.

The good news is that I did connect with that person, a supervisor (of course!), who listened politely to my plea and rationale, asked a few questions, and agreed to make the non-change. I'm sure it helped that I had also asked my client whether they'd had any claims since January 1 (which they hadn't), and if they understood that they'd still have to pay Anthem's January premium (which they did).

So, kudos to Anthem for making things right, and for being flexible enough to understand why they should.

Insurance and the Hive(mind)

According to the American Family Association, our esteemed political class has apparently invented a whole new kind of insurance: catastrophic Apis mellifera cover.

For those without a Latin-English dictionary, that would be bee insurance:

"Pg. 102 of Senate Appropriations Committee report: "The Secretary shall use up to $ 50,000,000 per year, and $150,000,000 in the case of 2009, from the Trust Fund to provide emergency relief to eligible producers of livestock, honey bees, and farm-raised fish to aid in the reduction of losses due to disease, adverse weather, or other conditions, such as blizzards and wildfires, as determined by the Secretary")"

That buzzing sound you hear may be a previously uninsured hive stopping by to bind coverage. Or it could just be the innocent taxpayer getting stung again.

Knockin' Wood

The Robert Wood Johnson Foundation, that is. As is typical of such endeavors, when the facts don't support one's preconceived conclusion, just change the subject.

In this case, the Urban Institute doesn't much like free market solutions to health care and/or health insurance issues, so they decided to pick on the one product that is generally perceived to be the most useful in both reining in costs and insuring more people: consumer driven health care plans.

Here's how they characterize consumer-centric health care:

"This RWJF-supported study by the Urban Institute indicates that HSA and HDHPs are likely to be attractive to people with high incomes and those with expected low use of health care services, but they are unlikely to decrease significantly the number of uninsured."

As we've already demonstrated here at IB, none of these conclusions are valid.

Let's take them one at a time:

Fallacy #1: "attractive to people with high incomes." While this may be true (certainly folks with money are likely to want to keep more of it), it implies that folks with lower incomes don't find these plans attractive. As we've previously noted, "75% of its HSA enrollees have an income of $50,000 or less, with 27% reporting a net worth of less than $25,000.” Those folks aren't exactly "high rollers."

Fallacy #2: "those with expected low use of health care services" Again, it's obvious that those who have few health care needs have little use for needlessly expensive health insurance, so of course they'd find HDHP's attractive. But as Bob has repeatedly pointed out, those who have moderate to even heavy use of health care also benefit from plans which eschew costly "extras."

Fallacy #3: "unlikely to decrease significantly the number of uninsured" Of course, this one's the silliest of all, since high deductible plans have lower premiums than their expensive co-pay counterparts, so are more affordable to those who are uninsured, and since the plans have higher deductibles, it seems more likely that those with more health problems (up to a point, of course) will be more likely to make it through underwriting.

As the highly-regarded Heritage Foundation puts it, "(m)ore than 6 million Americans are enrolled in HSA-eligible health plans. And the popularity of these plans is growing, in no small part because patients can determine how much of their money to spend today, or save for tomorrow, for health-care expenses. In short, HSAs allow patients to make prudent decisions for themselves."

Catch that? "HSA's allow patients to make prudent decisions for themselves." That's the whole crux of the matter: the liberal vision assumes that the gummint is best suited to make those decisions for us. The pragmatic, sensible vision is that we are the ones best suited to make them for ourselves.

We Get Results

First there was this: "Mr. Daschle, meet Dartmouth"

Then there was this: "(T)he gentleman in question isn't known for thinking things through"

And now we have this: "Tom Daschle has withdrawn his nomination for health and human services secretary"

Coincidence?

I think not.

Grand Rounds is up

The Samurai Radiologist marks his first blogiversary by hosting this week's Grand Rounds, and does a fine job of it.

Do check it out.

Outrageously Stupid Carrier Tricks: AA Edition

It's difficult, really, to decide which carrier is more incompetent. I'll lay out the facts, and encourage readers to draw their own conclusion.

First up, we have the curious case of Aetna, which doesn't seem to know how to actually underwrite individual medical insurance. I only recently began writing business with them; until a short time ago, their individual policies had a "poison pill" which made them unacceptable. They did away with the offending verbiage, and I was pleased to see what appeared to be well-designed plans with reasonable rates.

Unfortunately, the "2 out of 3 rule" came into play: alas, they have no clue how to underwrite plans. Case in point: a client who completed an online application in early January, requesting a mid-month effective date. This client had some very minor health issues, but that didn't stop Aetna from dragging its feet.

They conduct "phone interviews" with prospective clients; unfortunately, they kept calling mine at his home. During business hours. When I called them to point this out, I was told he could call it in himself. So I passed along the contact number, and he did, in fact, call in. They requested additional information, which he promptly got from his physician. We actually sent this twice, since Aetna couldn't be bothered to keep track of it.

I was told by Aetna that this was all that was needed, so I presumed that all would be fine. What they neglected to inform either myself or my client was that apparently this fax, from the physician, wasn't enough - they needed to talk with him again. Again unfortunately, they neglected to communicate this to either my client or myself, with the result being that they've now closed the case.

This will become a major component of at least one future Continuing Education class.

Anthem doesn't fare much better: on another recent case, they took so long to underwrite and issue that the effective date came and went. Ordinarily, this wouldn't be a major problem, but in this case, the client had paid a semi-annual premium to his current carrier, and we couldn't get a partial refund. So, we asked to move the effective date forward one month.

No big deal, right?

Not so fast: it took well over two weeks, numerous phone calls and emails, and I finally received word that the date had been changed to February 1.

I got that information today: February 2.

We may be able to resolve this with the current carrier, but why should it take so long to make a very simple change? It isn't as if we're asking them to retroactively issue a policy so as to cover a new condition. Actually, they're off the hook by one month, which would be a reason for them to honor the request quickly. There just isn't any acceptable reason to put my client through this aggrevation and stress.

So there you have it.

UPDATE: Poll's closed, here are the results:

Firing a Cannon at SCHIP

FoIB and Cato Institute wonk Michel Cannon has a fascinating and insightful article in the latest edition of the National Review Online. In it, he argues pursuasively that although the program has enjoyed modest success, it has done so at an unjustifiable price.

Here's a taste:

"It’s not even clear that SCHIP’s method for improving children's health—expanding insurance coverage—is the right one. The New England Journal of Medicine reports large gaps between the quality of care children receive and what they should receive, even if the children have insurance. That study’s authors conclude, “Expansion of access to care through insurance coverage, which is the focus of national health care policy related to children, will not, by itself, eliminate the deficits in the quality of care.”

Note well that last caveat about "quality of care." How come *that's* never addressed by those who favor socialized medicine?

As they say, read the whole thing.

Fixing Gender Discrimination in California

Great Scott! In California (of ALL places) there is a state law that would “force women to pay more than men” for individual health insurance. Who knew??

California already has a law forbidding gender-rating of group insurance. Somehow, the legislature forgot about individual policies, and the City Attorney of San Francisco has filed suit to remedy that error.

He will probably succeed. Remember, this is California.

The inconvenient truth remains that insurance premiums reflect the underlying cost of the insured liability. In this case, health insurance premiums for women are greater than for men, because the cost of health care for women is greater than the cost of health care for men.

But never mind that! Because this is another wonderful opportunity for California politicians and other self-serving “public” servants to grab publicity for some self-serving comments about some alleged discrimination against women.

And the consequence of their political showboating? Why, mainly that women will pay less than their cost, while men will be required to pay more than their cost to make up the difference. But will anyone pay attention? I expect not. Not in San Francisco or Sacramento, anyway.

Oh, and one more thing. The fact that insurance prices reflect the underlying cost of the insured liability also explains why life insurance rates for women are significantly LESS than for men.

But life insurance premiums never seem to result in any gender-discrimination lawsuits or grandstanding by these very same politicians and public servants.

Funny, that.

Deeper and Deeper: Too MUCH Transparency?

File this under things I probably didn't want to know [ed: take deep breaths, Henry]:

"Tom Daschle, tapped to be President Obama's health czar, was paid more than $200,000 by the health-care industry in the past two years."

As Bob previously noted, the gentleman in question isn't known for thinking things through, but is that really a good qualification for this job? After all, he's now going to be responsible (at least in part) for much of our nation's health care system. Does the term "conflict of interest" ring any bells?

We've noted before the inherent problem of folks who accept "gifts" from those whose products and services they're responsible for recommending; how bad is it when the gummint's health care czar-to-be accepted, in just two short years, almost a quarter of a million dollars from the folks he's charged with regulating?

Hope and change, indeed.