Got Milk?

Are you sure you want it? Well, maybe you do:

According to researchers at Stockholm's Karolinska Institute, "(f)ull fat dairy products are more likely to keep you slim than comparable low fat foods." That's because, well, apparently no one really knows why.

On the other hand, maybe you don't want that cool, refreshing glass after all:

According to German researchers, "the relaxing effect of a few cups of ordinary black tea on the arteries is completely wiped out by milk." At least they have (or think they have) a handle on why: apparently, "casein proteins from milk blocked the effect of tea all by themselves."

Now go wipe off that mustache.

Carnival Monday!

Up, up and away! It's the latest edition of the Carnival of Personal Finance, on newstands now (okay, not really: it's at Get Rich Slowly). Host J.D. has chosen a heroic theme, and presents a stunning 78 posts, all with interesting and helpful commentary.

The Carnival of the Capitalists is also up, courtesy of Andrew at Diary of a Startup. With 3 dozen entries, all with useful context, it's a great resource. as well.

Insurance Dispatch...

This week, we look at a recent Kaiser Foundation study which shows that the share of GDP going to health care has been growing faster in many European and Asian countries than it has here.

Available now at The Medical Blog Network.

Governator seeks insurance for all Cal children

From the L.A. Times today, 4 January 2007:

“SACRAMENTO — Gov. Arnold Schwarzenegger will propose that all Californian children, including those in the state illegally, be guaranteed medical insurance as part of the health-care overhaul he intends to unveil next week”

The pro and con for including children of illegal aliens seems to sort out as follows:

Pro - From a public health standpoint, it's smarter to cover all children regardless of immigration. You just don't want unimmunized kids surfing around in the population.

Con - Californians do not want to reward illegal behavior

I lean toward the public health view because I think the additional cost of covering children of illegal aliens will be a relatively small part of the overall package – a likely public health bargain. Besides, I think it would be an error to hold children responsible for the illegal behavior of their parents, certainly insofar as entitlement to a public health care program that affects mainly the poor. Finally I think the possibility that this thing will actually be enacted and presented to the Governator for signature are less than 50%.

The governor vetoed a similar plan in 2005 citing lack of a plan to pay for it. It's not clear why the financing might be different now and in fact the article reports that “the administration has not revealed details of how it would pay for such a program”. The article also states that “Sixty-nine percent of Californian children without health insurance in 2005 were eligible for existing programs but were not enrolled, according to the UCLA Center for Health Policy Research...That was due to a variety of factors, including inadequate funds in some county programs to cover all those who qualified”. One must wonder about the logic of pushing a new program when the state cannot pay for the program it has already.

'07 HSA Changes: A Recap

As we reported last month, a number of (mostly positive) changes are on tap for Health Savings Accounts (HSA’s). Here’s a brief summary:

· Folks can make a one time transfer from their IRA to their HSA.

· They can also make a one time rollover from their FSA and/or HRA.

· In general, the FSA grace period no longer impacts HSA eligibility.

· Maximum annual contribution limitations are more generous, and aren’t based on HDHP (High Deductible Health Plan) deductibles or IRS limits.

· Perhaps the most significant change is that, in most cases, contributions don’t have to be pro-rated when you start an HDHP mid year. This is really helpful for folks who want to make the switch in, say, September, but are intimidated at the major deductible (and paltry HSA contributions allowance) facing them so late in the year.

· Employers can contribute to more to non-highly compensated employees without running afoul of HSA comparability rules.
There are one or two other changes, as well.

On the downside, Vimo (a comparison-shopping portal for healthcare products and services) reports a significant gap between the number of people enrolled in HDHP’s and those who’ve set up Health Savings Accounts. They’re also concerned that the amount of money actually on deposit in these accounts represent half of the potential out-of-pocket exposure. For some reason, Vimo is concerned that these “findings hint at disturbing trends that may jeopardize the Consumer-Driven Health movement."

Me, I don’t see it. First, just because the money isn’t in the HSA doesn’t mean it’s not available. And a lot of folks also use their accounts on a fairly fluid basis, moving funds in and out as claims occur. Finally, it ignores the fact that there were significant limits on the amount of money that could be put into those accounts, which limits are now greatly reduced.

Looks like clear skies to me.

MedBlog Awards

This year's Medical Blogs Award is now open for voting, and we've been nominated in the "Best Health Policies/Ethics Weblog 2006" category. Folks can vote once (per category), and we have some mighty stiff (and deserving) competition.

Please consider voting for IB, and ask your friends, relatives, business acquaintences and the fine folks at the Nigerian Ministry of Finance to vote for us, as well.

Just click here and then on InsureBlog.

Thanks again for your support.

I Spine

A while back, Bob blogged on the phenomenon of physicians "expanding" their practices with non-traditional "extras" in an effort to bolster revenue. For example, one physician added botox injections and hair removal to the list of services she offers, which apparently help to offset decreases in other areas of her practice.

According to the NYT's Reed Abelson, this idea is catching on in other medical specialties, as well:

"Spinal-fusion surgery is one of the most lucrative areas of medicine...But there have been serious questions about how much the surgery actually helps patients with back pain and whether surgeons’ generous fees might motivate them to overuse the procedure."

And that's not all; apparently, these same surgeons invest in the companies which make the "hardware" (screws and plates, for example) which are used in the surgery.

I'm not sure I have a real problem with the latter: is it unethical for me to invest in insurance companies? Or my mechanic to buy some shares in Pennzoil? I didn't think so.

But the "non-story" has legs: "Federal regulators have voiced concerns about the growing popularity of the investment arrangements, which would potentially violate antikickback laws if doctors receive stock or are otherwise compensated to use or recommend certain devices."

This sounds to me a bit more damaging than simply buying stock in a company with which one does business. I suppose it would be akin to me only selling policies from companies whose stock I own, or that mechanic only using Pennzoil when servicing my car. I just don't believe that any one carrier (and/or its products) is always right for every client. In the same way, it's difficult for me to believe that XYZ Corporation's spinal products are always the best choice for every patient.

According to Ms Abelson, many of the almost 100 companies in the spinal devices field are owned (to some degree) by physicians. On the one hand, I'm still not convinced that this is as a priori conflict of interest. On the other hand, though, it does look like there may be a problem.

So what does this have to do with insurance? Well, it seems to me that if this is increasing the cost of health care, then it is increasing the cost of insurance, as well. After all, at least some of the funds being so directed come from insurance (and/or Medicare) reimbursements. If the prices are inflated, or if there's no effort made to hold down costs, then this doesn't bode well.

Cavalcade of Risk #16 is up!

Jason Shafrin hosts this edition, available now at the Healthcare Economist. With 15 well-explained entries, in three categories, it's a great New Year for the CoR.

Please drop by!

And if you'd like to host an upcoming edition, just drop us a line.

Money Monday (on Tuesday!)

Free Money Finance rings in the New Year with 2007's first Carnival of the Capitalists. There are over 30 entries, each with excellent context and commentary.

Joe Kristan, of Roth & Co, has his 2006 Taxpayer of the Year Award nominees. Not to be missed.

John at Mighty Bargain Hunter hosts the year's first Carnival of Personal Finance. He's compiled a list of over 40 entries, and includes context for each.

Ever wondered why gas pumps have that third decimal? Me either, but Money, Matter and More Musings explains why you should.

UPDATE: An explosive edition of Grand Rounds, 2007's first, is up at Distractible Mind. Fellow Medical Blog Network columnist Dr Rob Lamberts hosts, with some 30 entries, all with helpful commentary and categorized. Hint: be prepared for a booming good time.

There were quite a few interesting posts, but my favorite is Dr Charles' entry on (of all things) John Bolton's mustache.

The uninsured as Medicaid failure

In October 2006, the Kaiser Family Foundation Commission on Medicaid and the Uninsured released this Issue Paper:

http://www.kff.org/uninsured/upload/7571.pdf

The Issue Paper cites Federal Census data reporting that the estimated number of uninsured grew by 1.3 million people between 2004 and 2005, and now stands at 46.2 million, or about 17.9% of the under-65 population. This Paper thus provides additional support for the expressions of concern that “one out of every 6 Americans is uninsured”.

But wait a minute. Statements like that only reflect the average. Even an accurate average says nothing about the distribution of the population. It is accurate to say that "one out of 5" persons on the face of the earth is Chinese but that does not tell you how many Chinese live on your block. Fact is, the overwhelming majority of Chinese live in China. Similarly the uninsured don't simply comprise "one out of every 6 Americans". Fact is, the odds of being uninsured are hugely driven by poverty.

The Issue Paper confirms this fact, which prior surveys have also consistently found. And it stands to reason - - the very poor tend not to have regular, full-time jobs that offer employer-based group insurance; they often don't sign up for employer-based insurance even if eligible, because of the cost; and they can't afford to purchase individual insurance.

Table 1 in the Issue Paper shows that people below 2X's the federal poverty level comprised about 65% of all uninsured, non-elderly Americans in both 2004 and 2005. For people below 2X’s the FPL, the rate of uninsurance was 32.3% in 2004 and 33.3% in 2005. This raises some questions for Medicaid. Why is Medicaid failing to meet the needs of so many of our most impoverished citizens??? Aren't these exactly the people that Medicaid was created to serve?? How can Medicaid be falling so far short of meeting the goals for which it was established??? The KFF Commission on Medicaid and the Uninsured does not comment on these questions in the Issue Paper.

If all the nonelderly below 2X’s the federal poverty level could be enrolled in Medicaid, the proportion of uninsured Americans would fall from 17.9% to about 6% of the total population under age 65. (Enrolling everyone below 4X’s the federal poverty level into Medicaid would reduce the uninsured all the way down to 2%).

Seems to me that Medicaid is failing in its purpose as a governmental safety net for the poor, and that public pressure must be brought to bear on the new Congress to fx it within e.g. 100 days of their taking office in January.

OT Bleg: We're in the running for a MedBlog Award, and would appreciate your vote (just click here, select "InsureBlog" and press "Vote"). Thank you!

Insurance Dispatch

In this week's column, we discuss wellness programs, which just got a nice boost from the Fed’s.

Available now at The Medical Blog Network.

Submissions Due...

For next week's CoR (#16!), hosted by Jason Shafrin, the Health Care Economist.

Please submit your entries (or one you like from someone else's blog) by Monday (the 1st):

■ via email

or

■ at Blog Carnival

PLEASE include:

► Your blog's url
► Your post's url
► The trackback url (if applicable)
► A (brief) summary

NB: We're still looking for hosts. If you'd like to host a future edition, just drop us an email.

Introducing Mr Mike...

Mike Feehan, that is, the newest member of Team IB. A graduate of Washington University in St Louis (both Bachelors and Masters), Mike’s worked for 3 major insurance carriers, from entry-level to Senior VP. He’s also been a benefits consultant, and manager of benefits for a plan that included some 30,000 employees, over half of whom are outside the US.

Most importantly, however, he is a lifelong Cardinals' fan, and sold beer at Busch Stadium for several years.

Mike’s resume includes stints as an Aetna VP, as Chief Underwriter for Empire Blue Cross, and as a benefits consultant for Willis of New York. It’s really too bad that he can’t seem to hold down a job.

He currently works for a prominent international organization, which must remain nameless (you read about it every day and wouldn't have any trouble guessing its identity). One thing we can tell you, though, is that Mike brings a wealth of information and insight to our blog, as well as a new perspective: Bob, Bill and I are all agents; it’ll be nice to have a knowledgeable and experienced viewpoint from someone who’s got a different outlook. And being in the Northeast, Mike helps us round out our geographic diversity, as well.

We’re looking forward to working with Mike, and wish all our readers a Happy, Healthy and Prosperous New Year!

UHC Takes a Hit...

Our friend Joe Paduda is no fan of UHC’s executive stock plans, and since he’s on vacation this week, we’ll take up the slack. The Securities and Exchange Commission (SEC) has now launched an official investigation into UHC’s stock option plans. The company says that it’s cooperating with the Fed’s, which should set everyone’s mind at ease.

You may recall that, a few months ago, United’s Dr. William McGuire resigned as Chairman of the Board following a review of his stock options. The company itself also took some financial hits as a result.

Greed, of course, is not the exclusive province of insurers, but this time of year, with so many employers facing double-digit renewals, it sure looks bad when the carrier exec’s get caught with their hands in the cookie jar.

Does She or Doesn’t She…

Well, I don’t know about her hair, but I can make a pretty good guess about her insurance: nope.

Okay, let’s go back to the beginning, and work our way forward.

I occasionally receive calls from distraught folks who are unhappy with their insurance coverage (generally, it’s because they think it’s too expensive; sometimes it’s because they got bad service). Such was the case today, when Melody called with a problem: she’s had an HSA for several years now (well, it started life as an MSA, but evolved along the way). Her agent has left the business (a not unusual occurrence), and the carrier’s home office staff has been, according to Melody, less than helpful. In the meantime, her premiums have increased to unacceptable levels, and she’d like to switch.

Hey, we’re here to help.

So I ask the normal questions (height and weight, tobacco use, some health questions). She seems fine, if a bit plump (not that I should talk, of course). Nothing that should cause a problem though, so I start asking her questions about her plan, what she likes and what she doesn’t like about it. I then suggested a certain carrier, and she quickly (and firmly) told me not to bother with them: they declined her several years ago.

Um, I thought you told me that there were no health issues?

There aren’t, Melody reassured me, just a rare genetic blood condition.

Oh, is that all? Golly, that shouldn’t be too much of a problem; after all, your current carrier took you.

You what?

You don’t think they asked if you’d ever been turned down for insurance, and why?

I see. And you didn’t bother to tell them?

Uh hunh.

Well, I happen to represent that carrier as well, and I can assure you that they did, in fact, ask if you’ve been declined. So you submitted a fraudulent application. Well, let’s see if we can get you back on the right side of the track now, with a carrier that knows your complete history. As it is, you don’t really have insurance now, so it seems a shame to pay even more for it.

I beg your pardon? You do have insurance now; if you break your leg the blood part doesn’t matter? Okay, well, it’s really not my job to argue with you, so I’ll check around, see if there’s any carriers that will offer you coverage, and get back with you as soon as possible.

Happy Holidays to you, too, ma’am, and PLEASE stay well.

LinkFest Tuesday

This week's Carnival of the Capitalists is hosted by Elisa Camahort at Worker Bees. She actually posted it a day early, but I missed it (for shame!!). It's a good one, too, with almost 3 dozen posts, each one with helpful context.

Grand Rounds instigator Nicholas Genes presents this week's edition. Over 30 bloggers submitted their favorite posts, and explained what made them so special.

UPDATE: The Carnival of Personal Finance is now up over at My Personal Finance Blog. The host has pulled together more than 60 entries, in a half dozen categories. Nice job!

Insurance Dispatch

While we're all celebrating the joyous Holiday Season, it's important to remember that not everyone is "naturally" so joyous.

In this week's column, we learn that cough medicine isn’t just for coughs anymore. Are your kids safe?

Available now at The Medical Blog Network.

Thursday News Briefs…

As we’ve written about more than once, so-called “health discount programs” can create more problems than they solve. And because they are NOT insurance products, the Department of Insurance (well, the Ohio DOI) has been powerless to stop them.

Until now, that is:

Ohio has joined a growing number of states which have empowered Insurance Departments to impose – and enforce – new rules on these plans. The Ohio House has passed, unanimously, their version of Senate Bill 5, which sets requirements for discount medical plans, including minimum marketing standards.

Unfortunately, SB 5 also includes enabling language for so-called “Healthcare Purchasing Alliances,” which have their own problems. We’ll have more on this soon.

While we’re on the subject of “ways to make insurance more expensive:” the Ohio House has also passed a mental health parity bill, which would require insurance companies to cover mental illnesses as they cover physical ones. Another word for this is “premium increasing mandate;” lame duck Governor Taft hasn’t announced yet whether or not he’ll sign it into law.

And finally, as long as we’re here in the Buckeye State (home of Heisman Trophy winner Troy Smith), there’s some interesting life insurance news, as well: Western-Southern Life has introduced an unemployment rider, available on many of its term plans.

The rider, which adds about 3% to the premium, is a waiver of premium benefit which is expected to help those who’ve lost their jobs keep their insurance.

UPDATE FROM BOB: Scam alert - Phony health coverage.

Cavalcade of Risk #15...

When we started the CoR a little over 6 months ago, it seemed a calculated risk that we'd last this long. We've got hosts scheduled up through mid-February now (hey, that reminds me, how would you like to host an upcoming edition?), which seems to mean that that risk paid off.

So, take a break from that last minute shopping, sit back, and enjoy the show. And a great big Thank You to everyone who submitted, and a few who didn't (but got included anyway):

■ You’ve heard of soft water, but how about Hard Money? Joshua Dorkin, blogging at Real Estate Investing For Real, explains how some lenders use an imaginative technique to help folks secure loans.

■ Joe Kristan, of Roth & Company, explains some of the “useful changes to the HSA rules." Using them can help reduce your risk of spending too much on health care.

■ The PC-Doctor prescribes a dose of common sense: reusing passwords can be dangerous to your (computer's) health!

■ Think you’re paying too much to insure your car? Chuck Russell has 15 ways to help you lower your car insurance.

■ The folks at VitaBeat warn that young men face a greater risk of high blood pressure than their female counterparts. As a former teen-age boy myself (a LOOONG time ago!), I'm tempted to say "dunh!"

■ Klik Money reports that something as simple as a health risk assessment can help lower your medical bills. Good advice!

■ The unfortunate plight of CNET editor James Kim has some lessons for the rest of us. Pro Bargain Hunter’s Yan has some helpful tips on preparing for the worst.

■ Think your identity is safe? Do you get credit card offers in the mail? Wenchypoo warns that if the answer to both of those are “yes,” you may have a problem.

■ Last week, she hosted the Health Wonk Review; this week, Rita Schwab has some pointed questions about the redundancy of the current physician credentialing system in the US. Don’t miss the comments.

■ Great news! If visions of (chocolate covered) sugarplums are dancing in your head, Mombian reports that chocolate may reduce the risk of miscarriage.

■ What’s a modern day Jack the Ripper got to do with risk (other than the obvious, if you’re in a certain line of work)? Renthusiast wonders why the ubiquitous London surveillance cameras weren't a show-stopper.

■ Hedge Funds are mysterious, and potentially risky, vehicles. Find out why Mister Juggles loves ‘em.

■ Since it's such a hot topic these days, here's one more on identity theft. The Identity Theft Fixes blog has a cautionary tale about a simple printing error that could have dire consequences.

■ No need to grab a shovel: Paul’s Tips has some advice about cutting your losses.

■ Jon Coppelman at Workers Comp Insider has a great post on navigating the hazards of the ADA (no, not that ADA!)

■ And finally, Yours Truly responds to a commenter’s puzzlement over the difference between luck and risk.

Our next host will be Jason Shafrin, the Healthcare Economist, on January 3rd. You can find the new Winter Schedule (and any changes) at the Cavalcade homepage.

Carnival Monday!

I'm ambivalent about this week's Carnival of Personal Finance: on the one hand, it's simply a list of posts, with no clue (other than titles) as to content. OTOH, I'm empathetic to the folks at A Penny Saved (after all, this week's Cavalcade of Risk is here at IB); still, I wonder if there isn't some happy compromise available.

In the event, you can't go wrong with Joe Kristan's tax-oriented guide to gift giving.

Happily, Jeff Cornwall has an outstanding, Christmas-themed Carnival of the Capitalists. With over 40 posts, including summaries and some (cute) comments, this makes a great gift.

Happily, Wenchypoo has a thought-provoking article on those ubiquitous year-end bonuses.