On Being Dumb...

Over the past few months, a number of high-profile "medbloggers" (we'll come back to that) have left the building. About a month ago, I observed that "doc's often use their blogs as sounding-boards, and this can be a problem;" privacy issues, of course, were paramount, but there are others.

It never occurred to me that a fellow medblogger could have his own posts almost literally bite him in the tush. The term "medblogger," by the way, refers to physicians, of course, but also nurses, folks in health IT positions, consultants, even those who write about health care financing (such as, oh, say, insurance).

So why the rather blunt title of this post?

Earlier this year, Dr Flea (an anonymous blogger whose dayjob was pediatrician) won the coveted "Best New Medical Blog" award. A few weeks ago, his blog went, well, blank. There was some speculation as to why that occurred; he was in the middle of "some litigation," and it was posited that he shut himself down. Which, as it turns out, he apparently did.

For a very good reason (h/t Hugh "Blogfather" Hewitt):

" As Ivy League-educated pediatrician Robert P. Lindeman sat on the stand in Suffolk Superior Court this month, defending himself in a malpractice suit involving the death of a 12-year-old patient, the opposing counsel startled him with a question.

Was Lindeman Flea? "

Turns out, he was. And he wasn't doing himself (or his cause) any favors blogging on his own trial:

"In his blog, Flea had ridiculed the plaintiff's case and the plaintiff's lawyer. He had revealed the defense strategy. He had accused members of the jury of dozing."

Ooops.

There are times when, having written a particularly passionate (or critical, or snarky) post, I'll hit the "Save" button, instead of "Publish." A post that's never, um, posted isn't cached in 'Wayback, and can't come back to bite me. But once I hit that publish button, all bets are off.

Now, that isn't to say that I always go back and delete those posts (d'uh! Just do a search here for Stoopid Client or Carrier Tricks). And, as I mentioned in that previous post, very little of what we write actually names names (and when we do, there's a very good, and documentable, reason for it). But as this wonderful world of blogs continues to evolve, we may see a creeping reticence emerge.

Maybe that's a good thing.

Last Minute Nudge

I received some interesting, and helpful, info today from Phil Montgomery, of the LIFE Foundation, a non-profit focused on increasing public awareness of life and health insurance issues. As we noted a few weeks ago, May is (was?) Disability Insurance Awareness Month. Phil asked me to pass along some final thoughts: It is estimated that one out of every three workers will suffer a disability lasting three months or more at some point in their career, yet studies show that most Americans couldn't afford to live without their paycheck for even one month before financial struggles would start to mount.

There's even a helpful video available.

We write a lot about medical insurance, which essentially pays the doctors' bills. But it's important to remember that, if you have a serious illness or injury, you still have mortgage and car payments, light and telephone bills, and all those other monthly expenses to pay. No major medical plan pays those, so do yourself a favor and ask your agent about disability insurance. You'll be glad you did.

Cavalcade of Risk: Special Anniversary Edition

Next week's CoR marks the 1rst Anniversary (by date). So, I'd like to encourage folks to submit their favorite risk-related posts from the past year (if you've already submitted a post, but would rather enter a "fav," just let me know).

Submissions are due this coming Monday (the 4th):

■ Blog Carnival

or

■ Email

We've still got some hot summer hosting slots available, so please sign up soon.

Health Wonk Review is up!

The estimable Richard Eskow, blogging at The Sentinel Effect, hosts this week's outstanding edition of the Health Wonk Review. He presents 20 posts, all with helpful context, and an intuitive flow.

Although we here at IB are unashamedly enthusiastic about consumer driven health care, we also know that it's not without its faults. Our good friend Joe Paduda, of Managed Care Matters, presents what he's coined as a "pre-lash" against some aspects of this phenomenon. As usual, it's timely and insightful.

MassHealth, or MassMess?

We've discussed the new Massachusetts health plan before, pointing out the ginormous cost of the program (exceeding even its critics' worst fears), so it's no real surprise that the Bay State gummint has decided to increase the plans' load: consultant Alan Raymond was contracted to evaluate the program 1 year in, and he finds some disheartening trends:

In theory, Mass Health was supposed to lower the ranks of the uninsured by increased enrollment in Medicaid for those in the lowest income levels, while "encouraging" (requiring, really) all others to obtain insurance through their employers or individual plans.

In reality, according to Dr Raymond, enrollment in Massachusetts' Medicaid program has increased by over 50,000 since last summer. That means that about 54,000 low income folks who had been previously counted as uninsured are now covered. And why not, since the Bay State itself (or, rather, its taxpaying citizens) foot 100% of the tab.

What to do, what to do?

How about a new, even more encompassing state-run plan: Commonwealth Care. This program debuted in January, for folks who make 200% to 300% of the federal poverty level. Now, these folks have to ante up a bit to participate. It doesn't take a Carnac to divine what's happened with this plan: less than 20% of those eligible have opted in.

Quelle surprise!

Now, what could top both of those? You guessed it: The Commonwealth Choice program, set for a July rollout, will purportedly help "higher-income" residents buy "unsubsidized" (i.e. non-taxpayer-funded) private coverage.

Any guesses on how that'll turn out?

Capital!

For the first time in some months, one of our posts is featured in the Carnival of the Capitalists (Yay!). The uniquely named Marketing Whore (sorry) hosts this week's star-studded edition, with 16 entries, almost all with helpful (indeed, copious) context.

In the insurance biz, trust is a precious and jealously-guarded commodity. Charles Green, blogging at Trusted Advisor, explains why trust is so important, and so easily abused.

Carnival Time!

Ben at Money Smart Life hosts the 102nd edition of the Carnival of Personal Finance. Replete with interesting (if sometimes obscure) musical references, this compendium of almost 70 posts is music to the eyes. I have but two quibbles: only a few posts had any kind of context, and some links didn't work at all.

Still, I did find the Silicon Valley Blogger's post on valuing Moms (both Stay at Home and otherwise) to be pretty darned insightful (and it's not just because my better half sometimes drops by here). Recommended.

We Get Mail!

We do, indeed, get quite a bit of email here at IB; some's good, some's interesting, some's spam (or worse). We endeavor to answer all our (legit) email promptly, especially when it comes to claims or coverage issues.

Recently, we received this from one of our readers:

"I have always had a horrible fear of the dentist. I am 46 years old and though it is a tad better, I still tolerate long appointments better with nitrous. At my age, evidently I am all into the "crown stage"...either that or I am paying up someone's college fund.

My insurance will not pay one dime towards nitrous. Why? Medically unnecessary? They'll pay for one or two little pills if the dentist chose to try one of the anti-anxiety drugs (they don't work)."

First off, I am not a big proponent of (individual) dental "insurance:" in almost every circumstance, one is, at best, trading dollars with the insurance company. Think I'm off base? Do the math: waiting periods for anything more involved than a simple cleaning (and sometimes those, too!), deductibles and co-insurance for "major" claims, and an annual cap in the low $1,000's. Insurance companies miss very few tricks. Group dental is also a dollar-trading affair, but may make sense if some/most/all of those dollars are your employer's (if you buy into the theory that employers actually pay for insurance).

Be that as it may, our correspondent raises an interesting question: why is N2O not considered an eligible expense in this scenario? After all, novacaine is okay when you're having a tooth filled, and nitrous is approved for extractions, so why not here?

The easy answer is: because dental insurance is regulated very differently than medical coverage, and carriers can exclude a whole lot more in the former than the latter. Since a benefit that's excluded doesn't cost the carrier anything, there's an incentive to keep as much as possible off the "covered" list.

The more accurate answer is, as the email mentioned, "medical necessity." That is, "treatment which is required to treat or care for symptoms of an illness or injury or to diagnose an illness or condition that is harmful to life or health.” I might add that the industry has often expanded this definition, to include certain obvious comfort-making processes (i.e. anaesthesia for surgery, etc). One can readily see that, although our correspondent may well experience heightened anxiety when visiting her dental practitioner, this does not in and of itself constitute medical necessity.

One possible alternative for folks contemplating dental coverage is to look into an HSA compliant medical plan, and funding dental (and a host of other eligible) expenses through the tax-advantaged Health Savings Account. In this way, Uncle Sam is helping to subsidize your out of pocket, including the aforementioned N2O. And if you're able to shed some anxiety, the money then stays in your account, instead of going to the insurer.

A rather toothsome win-win.

Grand Rounds!

With over 4 dozen interesting posts, the 2nd year medical student who blogs at (of course) From Med Skool hosts this week's Grand Rounds. It's easy on the eyes, and easy to follow, as well, with helpful context and useful categories.

In a rare case iof synchronicity, David Williams (of the Health Business Blog) discusses medical tourism with the author of a new book on the subject. A very interesting read.

A Safe & Enjoyable Memorial Day Weekend

Bob, Bill, Mike and I would like to wish all of our readers a wonderful weekend. Please find the time to thank a vet or active duty military person for their service to our country. It's their efforts that enable us to remain " the land of the free and the home of the brave. "

And if you're planning a big cookout on Monday, stick with the steak and veggies:"The FDA issued a warning Thursday that some imported monkfish may actually be puffer fish, which contains a toxin called tetrodotoxin than can cause serious illness or death."

Talk about putting a damper on the festivities.

Girls & Boys...

One of the conditions that give insurance underwriters much trouble is diabetes. This is due, in part, to the "elastic" nature of the condition: adult vs juvenile onset, insulin vs diet control, "stick" vs oral, and now (apparently), boy vs girl:

[Graphic courtesy of Employee Benefit News]

According to Medco Health, "(n)ew research suggests that adolescent girls may be at increasing risk for several physical and psychological health problems." They seem to have found a a link between diabetes meds and sleeping aids, antipsychotics, and treatment for ADD/ADHD. This "linkage" is much more pronounced in young ladies than gentlemen.

One phenomenon which may be driving this disparity is the finding that so many young women are taking anti-psychotic meds: over the past 5 years, the number of girls 10-19 years old who are on these meds has grown by almost 120%, while young mens' usage has gone up just over 70%. That's a pretty wide gulf. Also disturbing is the use of sleeping aids; 80% more young girls use them now than just 5 years ago. I'd sure like to know why; seems to me that adolescence has always been a pretty stressful time, perhaps especially for girls. Couple that with the growing number of that demographic who are now on ADD/ADHD meds (up almost 75% for the girls), and it's not a recipe for positive long term results. Granted, more boys are on these meds than girls, but the gap is apparently shrinking.

One bright spot: "The slowing of growth in pediatric utilization of ADHD drugs, antipsychotics, and sleep medications from 2005 to 2006 may be a reflection of the concerns raised by reports such as (this)."

Gee, I would hope so!

Transparency Growing Up

When we discuss transparency in health care (and/or health insurance), we often focus exclusively on the costs (in dollars) of a given procedure or treatment. Sometimes, as with HealthcareFacts, other information (such as outcomes, complications, etc) are available. The challenge is finding non-insurance sources for this information.

Why?

Well, for one thing, a lot of folks are (understandably) reluctant to trust health insurance companies when it comes to their health care. For another, a lot of these are proprietary systems, so they may be of lesser value to those not insured by a given carrier.

The good news, according to USA Today, is that more and more providers are now making more and more information available.

What kinds of information?

"Click on the "Quality Reports" tab at the top of the virtual file drawer and look up coronary artery bypass graft surgery. You'll learn that the hospital's death rate is 2.3%, a shade below the national average of 2.5%. The length of stay is 7.2 days, a tenth of a day longer than the national average, and the charges will total about $75,000, roughly $49,000 for the hospital and $26,000 for doctors."

And that's just for one hospital!

And various states are getting into the act, as well; California's HealthCare Foundation (in partnership with a number of related entities) has a web portal one can use to rate a given hospital's quality of care. The Ohio Hospital Association maintains a website where one can search for specific facilities, or by geographic area, for outcomes and charges. Even Georgia's hospital association has a web presence, where one can compare facilities, costs and quality.

The Fed's have also been busy in this arena: Medicare's website boasts a number of search tools, among which is "Hospital Compare," which enables beneficiaries to identify how well a given hospital is performing. Costs and quality measurements are both available, and one can even print off a handy hospital check list of questions to ask before care is rendered.

It's encouraging to see these tools becoming more sophisticated and available to us consumers. As consumercentric health insurance plans continue to evolve, these kinds of tools are becoming more critical. Timing is everything.

Cavalcade of Risk #26 - Now Up!

You'll find this week's Cavalcade over at Colorado Health Insurance Insider. Jay's done an outstanding job, pulling together almost 2 dozen relevant and timely posts.Thanx, Jay!

Jay will tell you that hosting's fun, fairly easy, and highly rewarding. Why not give it a try yourself?

Insurance going to the dogs (and cats)?

It's been a while since we visited the world of Pet Insurance, and after the recent pet food scare it seems timely to revisit the subject.

Thanks to The Industry Radar, we're now aware of the Top 10 Reasons we take our pets to the vet: Skin allergies and ear infections top the list for our canine friends, while our feline companions' favorite travails are urinary tract infections and upset tummies.

Most folks don't have pet insurance, so the cost to treat these maladies is 100% out of pocket (and after taxes). According to the American Veterinary Medical Association, "only a small percentage of pet owners carry health insurance for their animals." The American Animal Hospital Association reports that about 3% of pet owners have purchased this cover. By contrast, almost 10% of Canadian owners, and about 2% of cat owners, bought this coverage (what, no national pet insurance plan?).

Our cousins across the pond are snarfing it up, though: in the UK, about 12% of cat owners, and an astounding 18% of dog owners, bought pet insurance, according to the latest figures.

Most of the plans available here are based on an indemnity model; that is, reimbursement up to a certain, scheduled amount. They're comparable, for example, to the now ubiquitous mini-meds on the "human" market. And the plans seem to be reasonably priced; I've even seen some offered in corporate cafeteria plans [ed: dog insurance, cafeteria plans; are you sure you're not talking about Korea?].

Just some (dog) food for thought.

Taking Time (Off, that is)

Generally speaking, we use the term "benefits" to describe various things covered by insurance policies. But that's by no means an exhaustive definition; retirement plans, for example, are benefits, and flex-time hours certainly qualify, as well.

Perhaps the newest of these non-traditional "benefits" is "Paid Time Off." According to World At Work "(p)aid time off (PTO) banks help companies increase productivity and lower costs by reducing unscheduled absences." Basically, an employer "deposits" a certain value in an employee's benefit bank, against which the employee can draw; the benefit is that such time off is characterized not as "vacation" or "sick leave," just "time off."

In the event, according to Employee Benefit News, more companies are now installing such banks, and there's an increased interest in implementing them:

[Graphic courtesy of Employee Benefit News]

Who knew a simple day off could become such a big deal?

Carnival Monday

FIRE Finance blog hosts a very cool Carnival of Personal Finance, with eye-catching (and relevant) illustrations, and helpful context for each of the 50+ entries. It's even categorized for readers' convenience.

For a while now, my daughter and I have had a standing (well, sitting, really) date for Friday nights: House (the doc ) on USA Network. It's always a hoot to watch the title character arrogantly bully his way toward a solution (kind of a medical Sherlock Holmes). I had never considered the show as a place for financial advice, though, until Flexo pointed out some interesting lessons to be inferred.

Cavalcade #26: Submissions Due [UPDATED!]

A big round of applause to Colorado Health Insurance Shopper's Jay Norris, who has bravely & graciously stepped in to host this week's Cav. Here's updated submission info (posts due Monday, the 21st). You can submit your (or someone else's!) risk-related post via:

Blog Carnival

or

Email

Please include:

■ Your blog's url

■ Your post's url

■ The trackback url (if applicable)

■ A (brief) summary

PS We're scheduling hosts for Early Summer '07, so don't wait too long to sign up!

ZPL ("Zero Premium Life") Update

As we recently reported, Zero Premium Life is the latest something-for-nothing scheme making the rounds of agents' in-boxes. Today I received this from one of our sources:

The product was supposed to have been approved in six states (CA, GA, NC, SC, PA & VT), but the Departments of Insurance for these states have NOT approved it, and many have posted warnings on their websites:

■ North Carolina

■ Georgia

■ South Carolina

■ Idaho

■ Ohio continues to be asleep at the wheel (as is California, but they have an excuse)

The product's roll-out date was supposed to be May 1st, but has apparently been pushed back a month. FWIW, agents are being charged a $10 contracting fee, yet the names of the carier and the investment group are both being withheld.

NAIFA, ACLI and AALU have published a joint STOLI ALERT [ed: STOLI, or Stranger Owned Life Insurance, was supposed to be dead and buried. Guess not].

We'll keep you posted.

The Golden Years, Redux?

Just a few months ago, we reported that a lot of folks worried that they'd be working even after they'd formally "retired." Turns out, many of them underestimated their own nest eggs.

The survey on which that report was based was conducted by the Pew Research Center; the Employee Benefit Research Institute recently did its own Retirement Confidence Survey, with interesting results:

[Graphic courtesy of Employee Benefit News]

■ Almost 1 in 5 believe they'll retire before they hot 60

■ A few more than 1 in five plan to bail out between 60 and 64

■ And just about a quarter of those surveyed think they'll hang it up at 65

The survey results conclude that employees are still playing catch-up with all the retirement plan options available to them. Perhaps more disturbing: about half of them are pretty skeptical about their company sponsored pension plans, yet they're not really taking advantage of all the personal opportunities now extant (IRA's and Roth IRA's, for example).

In a nod to a recurring theme here at IB, most workers currently approaching retirement are ill-prepared for a long term care claim; a lot of them think they're covered, but most probably aren't.

It's not a pretty picture.

Health Wonk Review is up...

Must be "early bird week," 'cuz Bob Laszewski has this week's terrific HWR already posted. It's got a kind of folksy feel to it, which makes it even more fun to read. And each post benefits from that; it's obvious that Bob read each and every entry carefully.

One of my favorite things about the medblogosphere is how folks can take away something completely different from the same data. Jane Hiebert-White of the Health Affairs blog looks at the same USA Today article as I did, and draws completely different conclusions. Viva la difference!