Be careful what you wish for...

The other day, Mike posted about the efficiency of Britain's Much Vaunted National Health System©, and made this observation:

"[T]he UK has for years led the US in terms of restrictions on its citizens’ access to specialized medical services and newer technologies.  In many respects, such restrictions make sense where overutilization is known to occur; in many other respects, setting an army of bureaucrats on a mission to "cut medical costs" is a terrifying idea."

He went on to note that we're now "committed to a [similar] path over the next 20 years." To which I would reply: You wish it was that far out:

"More than 300 patient advocacy groups recently wrote Health and Human Services Secretary Sylvia Mathews Burwell to complain about some insurer tactics that "are highly discriminatory against patients with chronic health conditions"

And what's their beef?

"Coverage of expensive drugs tops their concerns."

No kidding.

Here's the very simple Econ 101 response: you can have it good, you can have it fast, you can have it cheap.

Pick any two.

That is, when carriers are forced to accept all comers, regardless of their health and what meds they're on, and to cover any and all pre-existing conditions, something's going to give: astronomical premiums, restricted networks, or lower drug coverage.

Or maybe all three.

The folks behind the complaints clearly understand what's at stake:

"[The Administration] ought to make it very clear that if there is any kind of discrimination against people with chronic conditions, there will be enforcement action"

Or else, what?

It's been clear to many of us for a (long) while now that this is actually by design; that is, the true end goal of the ObamaTax is, in fact, Single Payer. And that is clearly what these "advocates" would prefer: after all, the government, unlike the insurance companies, is compassionate and has access to a bottomless well of money.

Or so they believe.

Perhaps, though, they should look to the MVNHS© to see how that story *really* ends.

Hint: not happily ever after.

[And be sure to check out Bob's take on this, as well]

Yum!

On August 14, the Wall Street Journal carried this op-ed piece by Dr. Scott Atlas of the Hoover Institution at Stanford University (subscription required, sorry).

You’ll find it well worth the time to read. Particularly interesting to me is Atlas’ statement that “NHS insurance costs $3,500 annually for every British man, woman and child.” 

I looked up the corresponding figure for the U.S. in the National Health Expenditure Tables published by CMS each year.  Doesn't everyone know by now that the US per-capita annual expenditures are far higher than the UK’s?  So that’s not the interesting part.

The interesting part is that the annual US per-capita health expenditures were $3,500 back about 1994.   But in 1994, that level of expenditure was accepted in many quarters as conclusive evidence that the US needed single-payer medical care; that the private insurance industry had failed to control medical cost; and even that the American free market system had failed.  And here we are 20 years later observing the same annual $3,500 per capita . . . as evidence of NHS success in UK!  Meanwhile the much higher US cost is still accepted in the same quarters as evidence that the US needs single-payer medical care; that the private insurance industry is failing to control medical cost; and that the American free market system has failed.   

I’d like to suggest a slightly different interpretation.  I suggest the history shows that the UK trails the US on cost by about 20 years.  In other words, UK's cost reached our 1994 level in 2014; and so UK’s cost may well reach what ours is today, in 2034.  This interpretation also suggests the UK is not retarding the growth of medical cost any more successfully than the US.  The US is simply the leading indicator for cost growth over time.  This interpretation also suggests the higher US point-in-time costs arise from other factors.

I would also note that the UK has for years led the US in terms of restrictions on its citizens’ access to specialized medical services and newer technologies.  In many respects, such restrictions make sense where overutilization is known to occur; in many other respects, setting an army of bureaucrats on a mission to "cut medical costs" is a terrifying idea.  But the US now seems committed to a path over the next 20 years at least, that will produce similar sorts of deterioration in hospital services, growing wait times, and other restrictions on specialty and high-tech care as have  plagued NHS.  In this sense, UK is the leading indicator for the US.  Our policy leaders should be paying attention.

Of course, as we learn more about Obamacare, we may find the US is sinking to the more restrictive UK service levels much faster than anyone imagined - but accompanied by increasing, not reducing, cost.  Lower access to medical care - - higher prices - - Yum!

Kliff Diving with Sarah

Recently, longtime foil Sarah Kliff (she who couldn't understand her own Explanation of Benefits) set out to enlighten folks in flyover country on how to negotiate better prices for their health care:

"Earlier this year, I got an unpleasant surprise in my mailbox. A$820.19 surprise, to be exact ... Even as someone who writes extensively aboutAmerica's health care system — who had, coincidentally, recently attended a three-day seminar for a story on the subject — I was stuck."

She then goes on to offer five steps one might take to entice the provider to offer a price break.

As someone with many years of first-hand experience actually running medical practices, here's my take on her efforts.

First, Miss Kliff is “surprised” that, after visiting a medical provider, having been provided medical services, and receiving a statement after each visit outlining all the various codes and associated costs, she received a bill that somehow she was not expecting. I have dealt with many, many patients who are just as “surprised” as Miss Kliff that the doctor actually billed them for services rendered, and who actively seek ways to avoid paying their share. There’s nothing inherently “wrong” about asking for a break; the problem is that there are a lot of sound reasons why they’re generally not available.

And as a Medical Healthcare Executive, let me say that this is an extremely selfish attitude to take about your financial responsibility for medical care. The medical provider whose valuable services you received has bills to pay and he/she can only pay those bills by charging individuals for the care they provide. Was Miss Kliff forced to have the medical care or did she enter into a contract with the medical provider to pay for services rendered based on the guidelines of her insurance policy? This is why “negotiating down a medical bill” is nonsensical; by being in an insurance plan the price has already been negotiated down. When I set my fee schedule, I account for a discount based on the contract that I signed with the insurance company to treat their patients. That discount can range anywhere from 5% to 60%, depending on the usual and customary charge set by the provider and the amount negotiated to be paid by the patient/insurance company.

Miss Kliff outlines five steps that I would like to refute:

Step One, “stay in network,” is only viable for primary care. For specialty care, finance should not rule your decision, your medical care should.

Step Two, “negotiate beforehand,” is impossible:  the doctor cannot tell you what he is going to code in regards to your injury or illness until he has examined you and made a diagnosis. He then sets up a plan for care that is reviewed and modified at each appointment during the treatment. A treatment plan is individualized for each patient, so a provider is unable to quote the charge before treatment begins.

As to the suggestion of asking the provider to accept what an insurance company would pay, which insurance company price should apply? Each carrier pays a different amount for any service rendered. I received as little as $33.00 for a 99213 (mid level exam) and as high as $65.00 for the same code. If you want to pay the negotiated insurance price, buy an insurance policy; if not, pay your bill.

Step Three, “check your bill for errors.” If I’ve heard this once I’ve heard it a million times from patients unhappy that they had to pay for their medical care. The most common refrain was “my insurance company said you coded wrong”. In today’s electronic billing to clearinghouses this cannot happen. Any incorrectly coded claim is kicked back to be corrected before it even reaches the insurance company. In my years as a medical practice manager, I can attest that 98% of all problems were the fault of the insurance company, not the provider.

Step Four, “ask for a prompt pay discount.” This does not exist. When you sign a contract for an insurance policy you agree to pay your provider as soon as you are notified of your responsibility, thus you have already agreed to pay promptly. Why should I reward you for following the guidelines of your policy and hopefully the financial statement you signed when you entered into care with your medical provider of choice?

Step Five is “don’t be an asshole.” While this is always good advice, she does admit that, in the end, the doctor does not have to negotiate. In fact, she finally gets to the crux of the article, that “your bill isn't wrong, … you just think it’s too expensive.”

Here’s a news flash, Sarah: medicine is expensive. 

Authentic 404Care.gov gibberish

You really can't make this up:

"[T]hose looking for information about appealing a Marketplace decision are facing a brand new one: nonsense."

Here's 1,000 more words on the subject:

 [Click picture to embiggen]

 

I spent most of yesterday doing my annual Marketplace re-certification training (more on that Monday), so I can relate.

Cavalcade of Risk #215: Call for submissions

Paul Dzielinski makes his CavRisk hosting debut with next week's edition. Entries are due by Monday (the 18th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

We need hosts for Fall Cav's - Please drop us a line to claim yours. It's easy, fun and a nice traffic bump. Thank you! 

Health Wonk Review: Dog Days edition

Brad Wright presents this month's (only) roundup of health care policy and polity. I especially appreciate Brad's narrative style, weaving together several posts to create a storyline.

Nice!

Lists and honors

As one might imagine, we get a lot of self-promoting email here at IB, often in the form of "Top 10" lists and the like, in an effort to drum up links. Usually, these are just slapped together with no real effort to confirm whether all the blogs listed are even still on-line.

Sometimes, though, one will pop up that's actually worthwhile, well-researched and actually well-written. Such is the case with the Best Medical Assistant Program blog. They've just published their take on the Top 100 Health Care Blogs; I was pleasantly surprised to see that it's well-organized and the entries have actually been vetted. And it includes folks that I know are top-flight: Val Jones, Jason Shafrin, David Williams, to name a few.

The list is broken down by category: everything from General Health Care to Nursing, even Health Insurance. And speaking of which,. guess which blog took top spot in that category? Anyway, it's a badge we'll wear with honor. Thanks, Mae Rulona!

Back on the Oregon Trail

Readers may recall that, after $300+ million, the Beaver State health insurance Exchange managed to enroll....precisely no one.

The question then becomes: "And whose fault is that?"

Well, it depends. The state blames Oracle, the contractor resopnsible for designing and implementing the Exchange. And so it's apparently decided to withhold payment for services (not) rendered.

Which of course isn't sitting too well with Oracle, which is now suing Oregon for $23 million it says the state owes it. Seems rather gutsy, considering their "success" rate of 0, but that's not how they see it. They're blaming "the state's poor management [which] doomed the exchange."

And how did it do that?

Well:

"The state chose to serve as its own systems integrator, or general contractor, overseeing the project, a task Oracle claims it was not qualified to perform"

One is reminded of the old adage about being one's own lawyer.

Actually, this makes a lot of sense: based on the performiance of the folks in DC who oversaw the 404Care.gov site rollout, it doesn't seem a stretch to believe that the same hubris exists at the state level.

Which isn't at all comforting.

Of course, the other side of that coin is that Oracle may simply be living that other old adage: the best defense is a strong offisense.

To wit:

"Internal state documents show state technology analysts and other contractors on the job had for years been issuing warnings and [sic] Oracle's performance"

[ed: one presumes the author means about Oracle's performance]

He said, she said. Ultimately, the court(s) will decide.

Less for More

During the debate on Obamacare we were promised lower costs, better benefits, and additional consumer protections. These promises have been modified, but continue forward through many of the supporters of the law as well as the Obama Administration.

However, there are a few big secrets they aren't telling you - ones that year after year will negatively impact everyone. They are called actuarial value, cost sharing limits, and indexing. Two of these occur on the benefit side and the other on the premium side. Actuarial value, indexing and cost sharing are wonky words so let me break it down so that even a member of congress can understand.

Actuarial Value and Cost Sharing go hand in hand

The impact of cost sharing is attributed to what CMS describes as "Protecting Individuals from Excessive Out-of-Pocket Expenses". Most would think that this is a good thing ast protects people from catastrophic claims. What cost sharing really does, though,  is to determine what a person's worst case scenario of medical bill costs will be. For 2014 the worst case scenario (out-of-pocket maximum) is $6,350 for a single person and $12,700 for a family. These figures were hard for consumers to swallow. So creating something that protects individuals should help reduce these figures, correct?

In setting the policy standards the cost sharing component must be updated annually. The formula they use to set the maximum is based on average premiums per enrollee based on employer sponsored insurance (not individual!). This data comes from the National Health Expenditure Accounts. They throw these numbers into their magic formula and presto, they have a new percentage. For 2015 it is 4.21%. This results in a new maximum annual out-of-pocket limit of $6,600 for singles and $13,200 for families. Wait, what? HHS is protecting consumers from "Excessive Out-of-Pocket Expenses" by increasing our potential costs by $250 a year? Yep, they are.

Which brings us to Actuarial Value (AV). We've covered this several times before (here and here to name two). AV is a method HHS uses to determine how much of your medical costs an insurance plan must pay versus the amount you must pay. This is commonly referred to as Metal Tiers. Basically there are four tiers. Platinum, Gold, Silver, and Bronze. The better the metal the better the benefits. So why is this relevant to the cost sharing requirement?

Every year CMS updates a calculator that determines if an insurance plan meets the strict requirements of what Obama considers "good" insurance. Once again they use a crazy formula that only us health nerds can come close to understanding. Here's the rub: if the out-of-pocket maximums increase and other factors stay the same that means that a plan that has good benefits this year will not have good benefits in the future. Why? Because as one variable grows it means that other outputs must also change. The result is that the best plans available on the market today will have to increase their out-of-pocket maximums in order to stay in the "good" insurance range.

If you plug a current benefit design into the AV Calculator from 2014, then do the same benefits into the new 2015 updated version, you will see that the percentage drops. Over time, plans that have a very low out-of-pocket will no longer be offered because good insurance doesn't equal "Obamacare good" insurance. These tiers aren't designed to change, so as time goes on the health insurance plans people like, even the Obamacare compliant ones sold today, will no longer be available. Think about that for a moment: Obamacare increases your out-of-pocket maximums and calls that "better" insurance.

Indexing of Premium Contributions

Every year the IRS will update a crazy formula to determine how much people will have to pay for their health insurance. The results of the formula are updated into the Applicable Percentage Table. This is what the table looks like for 2014.

This isn't a surprise as it reflects what Obamacare deems "affordable" and has been since we first started learning what was in the bill. What is a surprise though, is that these figures are going up. The variable percentages for these payments relative to income are adjusted to reflect any percentage by which premium growth exceeds income growth. For 2015 here is the new table.

As long as premium growth exceeds income growth (high probability) consumers will pay a greater percentage of their income EVERY YEAR! Wait, it gets worse. In 2019 if subsidies are greater than 0.5% of GDP - which many predict will happen - then an additional adjustment will kick in based on premium growth minus inflation. This is called secondary indexing. The impact here is that when this threshold is broken the amount of federal subsidy will decrease, causing consumers to pay even more of their income for premiums.

These three things above are going to cause you to pay more to get less. For those of you who still think this is going to cost less and give you more should remember these lyrics to the old 80's song by Naked Eyes: You made me promises, promises. Knowing I'd believe promises, promises. You knew you'd never keep. Promises, promises. Why do I believe?

Anthem Update

So, our (nearly) month-long saga has come to an end. Mostly:

"We received confirmation today that the member’s $1200 accumulator has been transferred to the new ACA plan."

Translated: my client's pre-ACA-plan expenses will count toward her new ACA-compliant one.

Which is great news indeed.

Now, given that, why the "mostly" qualifier?

Well, it would be nice to know:

■ Why did this take so long to resolve?

and

■ Is this just a special accommodation for my client, or is this true for other policyholders in similar binds?

One presumes that the answer to the latter is that it's universal, but we don't know for sure.

I've reached out to our rep, asking for an answer. Stay tuned...

Shortsighted Agency Tricks

Perhaps you've seen this story:

"An insurance company settled a lawsuit with a Los Angeles man by dropping off buckets full of thousands of quarters, nickels, dimes and pennies"

Aside from the fact that the firm is misidentified as an insurance company, the story is at least credible on its face.

But we know from years of experience that the Mainstream Media has a very poor track record when it comes to getting insurance-related stories correct. So we reached out to Adriana's for comment:

■ via email, which has gone unanswered
■ via phone (neither of the numbers on her website are correct)
■ and via "chat"

That last was pretty interesting: I visited the agency's site and got a pop-up "chat" box. I jumped at the opportunity, and was soon texting with CSR3. I introduced myself and explained that I was looking for their side of the story.

This was what I got:

"We do apologize about what is being reported in the media. At this time, I cannot comment on this matter but I can assure you the company will release an official statement soon. Adriana’s Insurance has been in business well over 20 years, and we value your opinion, we regret to see this being transmitted in the way it is by the media."

And then he/she "hung up" (exited the chat).

This is stupid. A story like this gets "legs" very quickly (especially when the victim is the quintessential Grandpa). And perhaps a major reason that it's "being transmitted in the way it is by the media" is because the agency is making no effort to get out in front of it; indeed, they're turning away opportunities to do so, further damaging their brand.

In this age of alt- and social-media, you really can't do that and expect to do well.

'Tis a shame.

Messy Client Trick

Have you reviewed you own life insurance coverage lately? Do you know who owns it? Who's the beneficiary? Who can tap the cash value?

Here's a story about the dangers of assuming:

One of our agency's clients - we'll call him Steve - called the other day looking to withdraw some cash from his life insurance policy. The good news is that there's plenty of it available. The bad news is: it's not available to him.

Hunh?

Turns out, the policy is owned by his father's (former) company; Dad bought coverage on Steve, paid for it, and named himself and Steve's wife as the primary beneficiaries.

There are, in fact, several messes in play here:

First, since Dad owns the policy, only he can access the cash values. And, only he can change the beneficiary. And why would he want to do that? Because, as it stands now, if (when?) Steve dies, the insurance company is going to cut one check, payable to both Dad and Wife, and they can try to figure it out from there.

So, no worries, we transfer the ownership from Dad to Steve. No harm, no foul, and Steve can then tap the cash and make his wife the sole beneficiary.

Wait - did I say "no harm, no foul?"

Oops.

Here's the harm and the foul:

Dad owned and paid the premiums on the policy for 20+ years. When he signs over ownership to his son, all that sweet, sweet cash value money is taxable.

Whoa there, Henry: I learned in Insurance 101 that only the gain (or profit) in the cash value is taxable. What gives?

Ah, padawan, that is only a part of the story: you are quite correct, if you're talking about Dad cashing in the policy. But he's not: he's transferring ownership to Steve, and thus the entire cash value (equity, if you will) is taxable to Steve.

Now, is this a big deal? Maybe not: we're talking $15,000 here, not $150,00. But still, this needs to be considered.

Now, I had started to propose this alternative:

Why not have Dad withdraw $10,000 from the policy and gift that to Steve, leaving just the remaining $5,000? That way, he's cut his tax liability by two thirds.

NB: I am NOT an accountant (nor do I play one on TV, nor did I stay in a Holiday Inn Express last night).

Anyway, most of this mess might have been avoided had Steve asked some questions after his father retired and ostensibly left him the policy, and addressed these issues then.

So, have you checked your policy lately?

All aboard the Exemption Train

Remember back in the day, when we had over 40 million uninsured folks, and we had to completely upend the existing health care delivery and finance systems to get them coverage?

Ah, the good ol' days:

"The CBO report ... also finds that about 30 million Americans are currently without health insurance"

Wait, what?

That can't be right: we've got this state-of-the-art enrollment website, comprehensive health care plans with low, affordable premiums (thanks in part to easily understood and verifiable subsidies), and the threat of substantial penalties for failing to buy a plan.

Right?

Right??!!

Turns out, not so much: that same CBO report projects that "the number of those who don’t have to pay fines to opt out of Obamacare — the exempted class — is going to hit 25 million by 2016."

Hunh.

Part of the problem, of course, is that the fine penalty tax is pretty much pre-empted for millions of people who have been given (illegal) waivers by the Obamastration. And it's only going to get worse as this year's Open Enrollment season spins up this Fall, and folks start to see their January renewals nuking their bank accounts, even as their subsidies begin to dry up.

Wait a second there, Henry: what do you mean about those subsidies "drying up?"

Oh, sorry, got ahead of myself:

"People who decide to stick with the coverage they've already gotten through Obamacare, rather than switching plans, are at risk for some of the biggest premium spikes anywhere in the system."

At issue is the so-called "auto-renewal" process (about which Pat has written), which allows folks who've bought ObamaPans to just set-it-and-forget-it; rather than face again the frustration of the 404Care.gov site and all its machinations, one can simply step back, do nothing, and one's current plan is "good" for another year (although that process may be short-lived as the Actuarial Value catastrophe beckons).

Problem is, there's a pretty good chance - bordering on a likelihood - that one will then face not one but two rate increases: an explicit one ("Thanks for choosing Amalgamated Health Insurance, your rate increase for the coming year is 10%") but also an implicit one:

"[M]any of those consumers will find that their subsidies don't go as far next year, even for the same plans ... The size of each person's subsidy is tied to a "benchmark" plan ... But as those plans raise their rates and new options come to the market, they'll often lose their benchmark status to cheaper competitors"

Bet you didn't know that.

Don't feel bad: most folks don't, and that's likely by design. Carriers don't want you to move, and the government certainly doesn't want you to know the true cost . But that doesn't make the problem go away: as new carriers enter the market (and they will - having sat out the initial season to get a feel for how things play out, they're more likley to want to jump in this year). And since they don't have last year's losses to make up, they can offer plans at lower rates, which then become the benchmarks, which then cause a lot of auto-renewers to lose even more ground.

Sweet deal, no?

Bob G hits the Big Time (Again)

Our good friend Bob Graboyes has an interesting article in this week's US News and World report:

"Repeal and replace" is a misguided strategy for getting past the Affordable Care Act ... It is hopelessly utopian, strategically suicidal, emotionally deadening, operationally hollow, and needlessly partisan"
And then he gets feisty.

Seriously, really great analysis from an acknowledged expert.

Rascally insurance conundrum

So here's a thought:

Aside from some zero's and commas, what's the difference between a Rascal and a Tesla? After all, they both have wheels and an electric motor, and can operate on city streets and in store parking lots.

Admittedly, only one is required to be licensed by the state, and its operator insured against potential liability. But where's the fairness in that?

Such is the question posed, albeit less benignly, by the Farm Bureau and State Farm insurance companies:

"They’re insisting that the drivers of motorized mobility scooters should be required to get the same insurance as car and truck owners."

This is in response to a case in Michigan that involves a paralyzed man, zooming innocently along on his motorized wheelchair, hit by an SUV. Apparently, he had no license to operate a motor vehicle, nor did he have automobile insurance coverage. 'Course, he didn't need to:

Wheelchairs, motorized or not, aren't considered motor vehicles under the law, nor could the gentleman have bought auto coverage if he'd wanted to: it's not available for Rascals, at al.

Now, if he owned a home or rented an apartment, his homeowner's policy would most likely have covered him (assuming that he had such a policy). I reached out to the PIA's Ted Kinney (whom we've met before) for his take. Ted told me that:

"I can’t speak for all policies but I know that the ISO homeowners policy provides both property and liability coverage for vehicles designed to assist the handicapped. I don’t know any auto insurer who will cover them on an auto policy. hese vehicles are not subject to motor vehicle registration.

It’s possible that this case might cause insurers to look at this issue if they think they can charge for coverage on an auto policy that a homeowners policy provides for free."

The key criteria here is "[t]hese vehicles are not subject to motor vehicle registration." Absent that, auto insurance just isn't available. Now, is it possible that some enterprising carrier will comeup with a special Hoveround policy? Maybe, but until then, it seems like the two carriers ought not to "bet the Farm" on winning their way.

[Hat Tip: FoIB Holly R]

Cavalcade of Risk #214: Bottom Line edition

Jaan Sidorov once again brings his considerable talents and sense of style to bear as he hosts this week's collection of outstanding risk-related posts. The coolest part? He highlights the key concept of each post to ensure that you know what you're getting into.

Great job, Jaan!

Mostly Harmeless Carrier Trick

So this pops up on FaceBook:

MassMutual does some really outstanding insurance outreach and awareness work, and deserves credit for that.

And I realize that posting a status on FB is relatively low-cost (aside from the no-doubt miniscule stipend earned by the intern tasked with composing and posting it).

But really: what is the point of this exercise? How does it raise industry awareness, or even move would-be customers to consider MM as a potential carrier?

And it's actually self-reinforcing, since it ultimately directs the reader not to an agent or even the home office, but a Pinterest page.

Way to move the ball forward, MassMutual.

No Care For You!

We've long chronicled the difference between health insurance and health care, and noted that simply having the former does not guarantee access to the latter.

Now, Alert Reader (and FoIB) Jeff M tips us that:

"Obamacare plans have shrunk payments to physicians so much that some doctors say they won’t be able to afford to accept Obamacare coverage"

That's not news to regular IB readers, but this may be: Connecticut internist Dr. Doug Gerard concludes that "I cannot accept a plan [in which] potentially commercial-type reimbursement rates were now going to be reimbursed at Medicare rates"

In English, this means "we can't afford to stay in business accepting only ObamaTax plan reimbursement rates."

But don't just take my word for it; as co-blogger Kelley observed just a few months ago:

"At a patient load of 7,200 patients that is $125.00 for a 15 minute appointment. This is great pay. But remember also that 80% of that total goes to pay the staff salaries and benefits, rent, utilities, as well as such government mandated programs like Electronic Medical Records and all other costs needed to keep a business running."

And when those reimbursements fall even lower, the doc has a simple decision to make: can he afford to keep seeing those patients?

Increasingly, that answer is likely to be "No."

Trending: Disability stats

Thanks to our friend Andy Linneman, we learn that:

■ More than 30 million Americans between the ages of 21 and 64 are disabled

■ 44% of employees say they have about a 1% chance of becoming disabled during their working years.

■ 60% of consumers are concerned about their ability to support themselves if they were to become disabled and unable to work

I just met with a client who, as the result of a recent stroke, has lost 95% of her hearing. She's struggling to make ends meet, and we even had to tap into her life insurance policy to help pay bills until Social Security Disability kicks in (if it ever does).

One surefire way to have prevented some of this would have been a disability insurance plan, either through work or individually.

What's in your disability plan?

Cavalcade of Risk #214: Call for submissions

Jaan Sidorov hosts next week's Cav. Entries are due by Monday (the 4th).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.