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Both health and disability insurance are (like auto and home) based on the concept of indemnification . That is, they are designed on the premise that one can both identify and quantify a given risk, and then offload some portion of that risk to an insurer.Health insurance bases these quantities on the cost of health care; car insurance on the cost of a new vehicle (among other things); and disability insurance is based on one's wages.Not exactly rocket surgery.Most people have health insurance of one kind or another, most folks do not own disability insurance (more's the shame). But most intelligent, reasonably astute folks know the difference: health insurance pays the doc, disability insurance pays me (and, hence, the mortgage).Apparently, our Rocket Surgeon in Chief (RSiC) is unaware of these differences:"During the 2008 presidential campaign, Barack Obama often discussed his mother's struggle with cancer ... fighting with insurance companies that sought to deny her the coverage she needed to pay for treatment."The story (and I stress the term story) became the centerpiece of his push for ObamaCrap.Unfortunately, our RSiC misunderstood the very simple, obvious difference between health insurance and disability insurance:"[ObamaMom]'s compensation for her job in Jakarta had included health insurance, which covered most of the costs of her medical treatment ... [ObamaMom]filed a separate claim under her employer's disability insurance policy." It was that claim, with the insurance company CIGNA, that was denied."So let's get this straight: we are now facing an unprecedented limitation on our economic freedom because the RSiC misunderstood (and consistently misquoted) the difference between health and disability coverage?Wow. Just wow.
Over my 8 years as a medical practice manager I have had my share of patients not on their best behavior. I often have to tell patients no, we cannot do that because of 1) office policies, 2) federal policies, or 3) legality. It is at this point that the abusive language begins and I am accused of no customer service, being mean, and other colorful remarks. (The best question was, “Do you work at Wal Mart?" Still trying to figure out that insult.) Customer Service is not to do everything that the patient/customer wants, but to provide the best service/product at the best price with the best staff/employees. I have had many discussions with patients who are not happy with the answer, but I have never had to call 911 to get an abusive patient out of my office. Well, that streaked ended this week. The Joint Commission released a report June 3, 2010 citing increased violence in the workplace.
After my encounter I found this article, which states that “Nationwide, health care is one of the most dangerous industries to work in, especially if you work in an ER.” What caused this outburst on this particular day? The patient was 15 minutes late for her appointment and by office policy I informed her we could not see her today and that I would be happy to reschedule. The vast majority of all medical offices have a policy that if you are late for your appointment you are rescheduled. Most people are upset that they missed the appointment, but understand, reschedule and move on. I told her we could not see her and I would be happy to reschedule. She would have none of it. She insisted on being seen. I offered three times to reschedule her appointment. After the third time I asked her to leave. I told her if she did not leave, I would call 911. She said go ahead, and I did. I have puzzled over the years why normal people become raging idiots in a physician’s office and I believe I have developed a theory. It is because people have been told for several decades and very recently that healthcare is a right. Thus if healthcare is a right, then people are relieved of the obligation of civility. Healthcare is a service, provided to the general population by educated professionals. We are guided by the ethics of our profession, the legality of our profession, federal guidelines, and general good business practices. Yes, medicine is a business and as such my policies are designed for optimal customer service. In this case, the late patient told me that my response was bad customer service and as such she should be seen. However, there are other customers we service in a day; approximately 50 patients are treated on a daily basis. All the other 49 patients made it to their appointments on time, so it would be poor customer service to allow the late patient disrupt their appointments because she was unable to make it to her appointment on time.I realize that the bad behavior will not stop because I will not be able to accommodate every patient’s desire, needs, and perceived rights. I am able to only do what is ethical, legal, and in the best interests of the business. This is an anathema to the current trend that healthcare is a right, but healthcare is not a right. It is a privilege and as with all privileges patients must be more responsible in regards to their behavior in healthcare settings, or there will be no healthcare because professionals like me will simply leave and go to a less stressful profession, like selling shoes.
It's our pleasure to welcome long-time guest-blogger Kelley Beloff as a regular contributor. Regular readers know her as our resident Medical Office Maven (here, for example, or here); we're looking forward to showcasing her interesting and unique insights on a more regular basis.Her first post as an official blogger is coming up shortly, so stay tuned...
FoIB Michael Cannon, the Cato Institute's Director of Health Policy Studies, alerts us to this outstanding video that perfectly illustrates how health care will work under ObamaCare©.I'd say "enjoy," but...well, you'll see:
First, courtesy of UHC, we learn that next year's Health Savings Account contributions and policy regs have been published by the IRS.Some highlights:■ The max annual contribution limit for single coverage is up $50 to $3,100; family max is also increased to $6.250 (a $100 step up)■ The max OOP (out of pocket) limit for underlying High Deductible Health Plans (HDHPs), which includes deductible and co-insurance, goes up to $6,050 for singles and $12,100 for family plans (increases of $$100 and $200, respectively)■ The minimum deductible for singles is $1,200 and $2,400 for families That's the same as this years'.And speaking of HSA's, our own Alternative Benefits gurus as FlexBank point out that "HSAs have rules - LOTS of rules. Technically, it is the HSA owner's responsibility to know and abide by all of the rules. How in the world is this possible without help?"That's where having access to a local, professional practice that focuses solely on these kinds of benefits comes in. Being able to pick up the phone (or get a quick reply by email) is, to coin a phrase, priceless.
As we noted Monday, "you are more likely to die if you are on government insurance than if you have no insurance at all." And, of course, Oregon's health care "system" is an exemplar of this result. Well, Cato's Michael Cannon reports on a yearlong experiment on Beaver State citizens, and the results aren't pretty:"Oregon decided to enroll an additional 10,000 people in its Medicaid program via lottery ... Medicaid coverage led to higher medical consumption."No surprise there: make pretty much anything freely available at low (or no) cost, and odds are you're going to have a lot of customers.But is "free" health care worth what you pay for it?You be the judge:"Though the president has claimed [ObamaCrap] will “save lives,” the [Oregon Health Insurance Experiment] detected no evidence that extending Medicaid to 10,000 adults did so in the first year."Granted, one year is hardly long-term, but shouldn't there have been some indication of improved morbidity (if not mortality) even in the short-run? Michael also points out - and this is important - that "the OHIE extended coverage to the most vulnerable population of uninsured Americans, yet the improvements in health and financial security are so far apparently modest."Talk about damning with faint praise.Barbara Wagner was unavailable for comment.
Celebrate your own independence from the mundane with Notwithstanding's unique take on this great collection of risk-related posts. BONUS: A cool sideshow game featuring the flags of countries with national holidays in July.
One of ObamaCare©'s major pitfalls is the so-called Exchanges. As we've seen with RomneyCare©, these may look good on paper, but their real-life implementation leave much to be desired. We've long been proponents of state-based experimentation, of course, so if the Bay State's happy with them, fine. But that doesn't mean that turning over their basic structure to the likes of HHS Secretary Shecantbeserious portends well:"[T]he Obama administration unveiled standards on Monday for insurance marketplaces that will allow individuals, families and small businesses in every state to shop for insurance, compare prices and benefits and buy coverage."As Bob noted here, putting the gummint in charge of these kinds of efforts leads only to heartbreak. Of course, it's literally "your tax dollars at work," since "[t]he Congressional Budget Office predicts that by 2019, about 24 million people will have insurance through exchanges, with four-fifths of them getting federal subsidies that average $6,400 a year per person." [emphasis added]Let's do some simple math, shall we?Eighty percent ("four-fifths") of 24 million is about 19 million souls. At $6,400 a pop, that's over 12 billion in taxpayer subsidies. Something about "robbing Peter...?"I'd perhaps feel better about how this will all work out if it weren't for the fact that the whole shebang was conceived, and is being implemented, by folks like this.
Our theme this week is "Personal Responsibility" - only posts that address this issue have been included. I was quite impressed with the creativity that potential contributors brought to the table to make sure their posts fit the bill.We like outside-the-bun thinkers.The concept of personal responsibility (or accountability, if you prefer) has been a consistent meme here at IB since our earliest days some 6+ years ago. So it seemed appropriate to use that as the theme for this edition of the venerable Grand Rounds:■
As the Happy Hospitalist notes, "
personal responsibility doesn't have to be only about the patient. It can be about doctors and hospitals, too."
Here's his take on how to hold providers accountable to their patients.■
Ryan DuBosar, the ACP Internist, reports on a new study claiming that "
obesity is filling in for smoking as a cause of death in working class women."
Doc Ryan observes that "
people need to take personal responsibility for their health, even as they drop one bad habit."
Picking up a substitute one isn't moving the ball forward.■ Can interpersonal communication help us understand our relationships and the social world in new ways? Will Meek thinks it can, and makes the case that "
when we have this knowledge we can be more responsible in how we interact with others."
A potentially great first step towards personal accountability.■ Continuing the Happy Hospitalist's point that personal responsibility also rests with providers, Bob Coffield avers that "
health care providers and staff have a “personal responsibility” under HIPAA to not snoop in the records of patients not under their care."
But he goes even further, making a great case that "
health care lawyers have a personal responsibility to understand how their health care clients are implementing and using social media tools in health care."
These include Twitter and Facebook (and, presumably, blogs and bloggers).■
The always entertaining (and enlightening) Dr Roy Daviss asks "
should patients take personal responsibility for how their health information is shared and with whom?"
In answering the question, he notes the "
risks and benefits of your data going through a Health Information Exchange (HIE)."
And don't miss the lively conversation in the comments.■ Glenn Laffel provocatively suggests that "
folks with chronic diseases would tend, all things being equal, to take care of themselves somewhat better than ‘healthy’ folks, since they have been taught the tough lesson that their behavior is indeed linked to poor health outcomes."
One would think so, notes Glenn, but "alas, that’s just not the case."■ Our colleague Louise Norris observes that "
health insurance is not where personal responsibility ends."
She backs this up by noting that, oftentimes, "
a large claim on a health insurance policy can be the result of a chronic condition or one that will need extensive long-term treatment."
One might well have coverage at the outset, but what happens if that changes during the course of the condition?■ So how to avoid (or at least mitigate) such chronic conditions? Dr Ed Pullen suggests that "
choosing a healthy hobby is one of the things we can all do to take personal responsibility for our own health,"
and even offers some helpful suggestions on which ones to consider.■ Private practice cardiac electrophysiologist [ed: try saying that 10 times fast] Dr John Mandrola believes that "
wellness requires more ownership,"
and laments that this message seems to be (increasingly) falling on deaf ears.■ I confess to a guilty pleasure: DrRich (not a typo) is my favorite President of the Future Old Farts of America (FOFA). This is a lot more prestigious than it sounds: as of this writing, total membership in the FOFA exceeds zero. In this post, DrRich discusses what other OF's need to know about "
Medicare as we know it,"
and their responsibility to ensure and/or prevent its demise.■ Dr Charles offers us this Ode to Dads, and their child-feeding responsibilities.■ Meanwhile, Dr Paul Aurbach offers this "
brief introduction to helping persons with a medical disability safely enjoy an outdoor adventure experience, which may come with more than the "usual" amount of risk."
Since assessing and managing risk is most definitely a matter of personal responsibility, this one's spot on.■ So, should folks in Glass Hospitals stow thrones? Or ban smokers? University of Chicago's general internist and medical educator Dr John Schumann likes the idea that employers have the "
right not to hire smokers."
He notes that this is already the case at the Cleveland Clinic. But he's also concerned that it's a potential "
slippery slope, and that all of us, especially those of us in the health care workplace, have a responsibility to set a good example."
■
Over at Calling the Shots, breast cancer survivor Beth Gainer knows better than most the value and importance of personal accountability. Her post "
focuses on ordinary people who did the extraordinary,"
helping her through her "
medical crisis of breast cancer because they felt a personal responsibility to do so."
Talk about True Heroes.■ e-Patient Dave [ed: gotta love that handle!] continues the cancer-survivor theme, offering this post that "
articulates the best framework I've ever seen for what constitutes patient engagement."
It's about 4-time (!!!) cancer survivor Jessie Gruman, whose recent address to the Institute for Clinical Systems Improvement recounts her own struggles and triumphs.■ From Canada's West Coast, Carolyn Thomas wonders why "
some heart attack survivors remain emotionally wounded for life as they relive and re-experience their catastrophic cardiac events again and again."
She thinks it has to do with the fact that anyone who's undergone such a traumatic event can't help but be transformed, and then points out ways in which those most successful in moving on are those who understand best their own role in their recovery.
■ The Health Business Blog's David Williams brings us full circle, noting that providers also need to take a bit more personal responsibility. In this case, it's pretty simple: take the time to find out how much things cost [ed: sing it, brother!].■ Finally, our own Bob Vineyard has the touching/disturbing story of a gentleman who took personal responsibility (perhaps) a bit too far.Next week, please stop by Dr. Elaine Schattner's place for another romp through the medblogosphere.
As is so often the case, these are items of interest which don't seem to merit their own, dedicated post. Still, we'd hate to miss mentioning them:■ Buckeyes Buck BambiCare©?Maybe so:"More than 540,000 voters in the state have signed petitions in favor of a ballot initiative to amend Ohio’s state constitution to directly conflict with Obamacare’s individual mandate."Assuming those half-a-million-plus signatures prove valid (and sufficient), there's a good chance that we'll see this on the ballot in a few months. The initiative is doubly-interesting: in addition to contesting the (Evil) Individual Mandate, it's worded to prevent the state from passing its own version of the federal train-wreck. Not that there's any great rush to do so: just check out our last item (below).■ One of the major "accomplishments" of ObamaCare© is to move more folks off of their own private (and group) health plans and onto Medicaid. Whether or not that's such a great idea economically is, of course, a matter of great debate. What's not so debatable, though, may be whether or not it's good for our physical health:"[S]tudies that show big mortality impacts from being uninsured show even bigger mortality impacts from being on Medicare and Medicaid, even after controlling for age and income: you are more likely to die if you are on government insurance than if you have no insurance at all." [emphasis added]Ooops!■ Clunkers and InsuranceGovernment Motors has added a new "service;" in addition to selling, servicing and financing your new car purchase, they'll even throw in free insurance:"To spur sales, General Motors is offering a year's worth of car insurance along with any new GM car purchased in the states of Washington or Oregon ... The insurance ... includes both liability and physical damage coverage."I'm reminded of an old saying.■ Slow and Easy Does It (Not)Whether or not Ohio voters are successful in blocking implementation of ObamaCare© here, at least one piece is facing an uphill battle in at least a few of the other 57 states:"State insurance exchanges are not being set up fast enough to meet the 2014 deadline set by the healthcare law ... a number of state legislatures are at risk of handing over the central component of the reform effort to the federal government."If your state hasn't set up its version of the notorious Exchange by '14, HHS Secretary Shecantbeserious is set to do so, like it or not. How that would play against any state-specific law barring such a move I'll leave to the lawyers to ponder.
As previously noted (here and here), very few weeks go by without at least one of us having to help a client deal with the consequences of ObamaCare©. This time, it's an old friend of mine whose family is quickly exhausting their COBRA coverage, and who need to find a place to land once it's gone later this summer.Fred and Ethel are in their early 50's, and both have health issues serious enough to earn them declines in the open market. Their 13 year old daughter, in perfectly good health, is ineligible for her own plan because neither Mom nor Dad are insurable.Or is she?Bob recently pointed out two potential plans that might work: the first is a Short Term Medical, the other is a quasi-limited benefit plan. Both are from the same carrier, which has apparently decided that it will continue to offer child-only plans in these configurations.So what's my beef?First, the Short Term Medical plan is, well, only good for a short term (6 months at a time, to a maximum of two years in Ohio). And, it excludes coverage for pre-existing conditions (including those that develop during a previous STM's term). On the other hand, it's inexpensive and it does provide some coverage.The other plan, which we'll call HA, may cover pre-existing conditions (depending on whether they were disclosed and underwritten), and doesn't have a built-in time limit. It's basically a limited benefit plan with some additional bells and whistles. It, too, is relatively inexpensive.Fred and Ethel, though, are basically SOL: once COBRA runs out, their only real option is a (so-called) HIPAA Plan. This is expensive, mediocre coverage, but it does cover pre-existing conditions. Another option might have been the richer benefits and lower premiums of the ObamaPool©, but they're ineligible for that because they actually played by the rules and made the responsible decision to remain insured.Oh, Brave New System.
Next Tuesday, InsureBlog hosts Grand Rounds, the prestigious compendium of the best the medblogosphere has to offer.Also: a great way to learn about blogs you've never heard of (but should get to know).Our theme will be "Personal Responsibility" - only posts that address this issue will be included (BUT: feel free to reach back into your archives - any relevant 2011 post will do). Submissions MUST be received no later than Sunday (7/10/11) to be considered.Potential contributors can submit their entries to insureblog (at) mail (dot) com, and please include the following:■ Your post's url and title■ Your blog's url and name■ Your name and email■ A (brief) summary of the postThanks!
NotWithStanding blog hosts next week's CavRisk. Entries are due by Monday (the 11th).NB: We're now using this submission tool: The BC WorkAroundOnce there, you'll be asked to provide:■ Your post's url and title■ Your blog's url and name■ Your name and email■ A (brief) summary of the post ("Remarks")At the bottom of the form, you'll see a drop-down menu; simply select "Cavalcade of Risk" then press "Submit" and you're good to go.And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
I have a long-running dispute discussion with a colleague regarding the argument that driving while talking on the cell is the same as drunk driving.[ed: We have no disagreement vis: texting and driving - we both agree that this warrants the immediate application of the death penalty]My take is that talking on the phone using a hands-free device is no more risky than listening (and talking back) to the radio, or to one's spouse in the passenger seat. Bill thinks that pretty much any use of the cell while driving is inherently more dangerous than either of those two activities.So, who's right?Well, score one for the good guys me:"A comprehensive study on distracted driving has found there is no conclusive evidence that hands-free cell phone use while driving is any less risky than hand-held cell phone use ... there is no evidence that cell phone or texting bans have reduced crashes."Is this dispositive? No, not really: the study itself contained enough contradictory findings that the case is still open. But it does recommend that states without such bans hold off a while before enacting them, which also tells you something.
CORRECTION: Bill M begs to disagree: He thinks that the study actually proves his point that there's really no difference between hand-held and hands-free in terms of risk, and that the study actually supports his position.
What say you, dear readers?
(Yeah, we're old school like that)Just two months ago, we noted a study of 4,000 Continentals and their intake of salt. The surprising results?"People who ate lots of salt were not more likely to get high blood pressure, and were less likely to die of heart disease than those with a low salt intake ... The findings "certainly do not support the current recommendation to lower salt intake in the general population."Now, one might be tempted to discount those results as a "one-off," but one would be wrong to do so. Researchers at Exeter University took a peek at "seven published studies involving 6,489 people. Some had high blood pressure, others had normal blood pressure and they had all been put on salt-reduction diets." Their results mirrored those of the one we cited in May:"[T]he authors found that there was no evidence that cutting down reduced deaths or heart disease in either group."In fact (and as noted in that previous study), folks who did cut back on their salt intake were actually more likely to die prematurely than those who didn't alter their diet.Bon appetit!
On July 1, the Wall Street Journal reported that Medicare had decided to cover Provenge, a new drug for treatment of advanced prostate cancer.
According to the article, men with advanced prostate cancer and treated with Provenge in clinical research lived a median of about 26 months, or about four months longer than patients who received a placebo.
Translated into English, this says half the Provenge patients lived at least 4 months longer than patients treated with sugar water. The other half lived fewer than 4 months longer.
The punch line is the cost--about $93,000 per course of treatment. (Not a typo.)
I have a question. Why shouldn't Medicare allow patients a choice between Provenge - and a cash payment of $50,000?
Why ask? Well, for starters because this drug delivers minimal benefit, patients might not want it especially if another option were available; the cash option might be a much more welcome way for the federales to help families cope with the loss of a loved one; having no choice means taxpayers will shoulder much higher costs; there's no telling WHAT Medicare was really thinking anyway; and the only party that clearly benefits seems to be Dendreon, the drug manufacturer.
So - is this drug worth it? Is it rationing if the answer is "no" ?
■ First up, FoIB Jeff M tips us to some cancer-related good news/bad news:"A group of new drugs is promising to prolong the lives and relieve the symptoms of men with advanced prostate cancer, but could also add billions of dollars to the nation’s medical bills."In a sense, this is sauce for goose/gander, since we've already seen how politicized the battle over breast-cancer treatment Avastin became. These are, of course, valid and important debates to have, but we mustn't lose sight of the very real bottom line: peoples' lives are at stake.■ Next, we consider the case of Dr. Susan Rutten Wasson. Is she a "renegade" or just ahead of the curve:"[She's] a throwback to a time before HMOs, electronic health records and hospitals with fountains in their lobbies. She sees patients the same day they call if ... and usually charges only $50 for a consultation. She takes cash or check, but no insurance — and sometimes accepts gratuities of a dozen fresh eggs or a pie."■ Finally, RandCorp's Lisa Sodders alerts us to a new Rand study on Medicare's new reporting thresholds:
"Effective January 1, 2012, Medicare will require insurers and self-insured companies to report settlements, awards, and judgments to a Medicare beneficiary to the Centers for Medicare and Medicaid Services."
Big Brother, or Concerned Agency?
You be the judge.
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