Captain Obvious to the Rescue

Okay, I admit it: I listen to the Bob & Tom Show on my way in to work most mornings. For those unfamiliar with B&T and the crew, suffice it to say that they are irreverent, not-quite-obscene, and (usually) hilarious. One of their on-going "bits" is a call-in show whose host, Mr Obvious, has to deal with the same dense, utterly clueless caller every time. From how to cook a Thanksgiving turkey ("first, it must be a dead turkey") to an errant garbage disposer, it's fun to hear his exasperation.

But it's not so fun when we have to actually pay for answers that Mr Obvious could easily have handled for free. Recently, Bryce Edmonds wrote about 10 such studies for MSN. It's a veritable "who's who" of misguided studies that ostensibly rational scientists undertook (and for which they were paid). Among their brilliant findings:

■ "Scientists have proven that, yes indeed, air pollution is bad for you."

■ "In the September Emergency Medicine Journal, researchers reported that traveling longer distances in an ambulance meant you were more likely to die before you got to the emergency room."

And this gem:

■ “It is a matter of common sense that a person is easier to recognize when close than when far away.” (But that didn't stop the National Institute of Mental Health from underwriting a study to test that)

In case your blood pressure is running a little low today, go take a gander.

But if it's on the high side, you should know that "(m)eetings stress out employees," so you should probably skip the next one. Really!

HWR: The Anti-Halloween Edition

You know us wonks and geeks, we just have to be different. So while it seems that every other "carnival" is touting scary monsters and yummy treats, we're oiling up our sliderules and adjusting the paperclips holding our glasses together. November 1 is actually famous for more than just All Saints Day, and (wonk that I am), we'll be exploring its not-so-famous associations.

Before we start, however, there’s some cobwebs I’m motivated to clean up:

First: We got a LOT of submissions from what my pal Julie calls “splogs” (spam blogs). These can be either transparently commercial endeavors, or folks who just submit to every carnival. I deleted them mercilessly.

Second: If you’ve ever hosted a carnival (HWR, etc), you know that there’s a LOT of reading to do. I suspect that I speak for most (if not all) of my fellow hosts when I tell you that if you didn't care enough about your entry to include a summary, I didn't either, and it was zapped.

Third: We all think everything we write is Pulitzer prize-worthy. It’s not. Please don’t submit more than one entry per blog. I was VERY nice this time, and picked the one I deemed most appropriate. Next time I host, I won’t be so generous.

Okay, that’s off my chest (and the axe is out of my skull), so on with the show.

On This Day*:

■ In 1805, Napoleon Bonaparte invaded Austria. And today, Jon Swift presents Fair Game, at his eponymously named blog. Jon opines that what makes conservatives like Malkin and Macsmind different from liberals like (Ezra) Klein is that conservatives would rather struggle and be faced with terrible health care choices than to have no choice at all, which is what would happen under socialized medicine.

■ In the year 996, then-Roman Emperor Otto III issued a deed to the Bishop of Freising. This is the oldest known document using the name Ostarrîchi (Austria in Old High German). This morning, Jimmy Atkinson presents 5 Little-Known Giant Health Care Issues Facing the United States at OEDb: Nursing Online Education Database.

■ In Mexico it’s the Day of the Dead (BOO!). Here at HWR, PatKing presents Getting rid of the dead weight of old regulation. Pat, blogging at Healthcare $$ and Sense, discusses how we keep adding new laws and regs, but rarely delete the old ones.

■ In 1973, at the height ot the Watergate Scandal, Leon Jaworski was appointed as the new Special Prosecutor. Today, David Harlow presents Rhetoric vs. reality, or, the not-yet-ready-for-prime-time universal health plans: Britain's NHS, Medicare (for All), and the FEHBP, presented at the HealthBlawg.

■ Way back in 1512, Michelangelo’s masterpeice, the ceiling of the Sistine Chapel, was exhibited to the public for the first time. In what some might call a modern masterpiece, Jason Shafrin blogs about Therapeutic non-adherence: a rational behavior revealing patient preferences. At the Healthcare Economist, Jason avers that "drugs should be judged not only on their efficacy, but on the degree that patients will comply with the treatment."

■ In 1920, when Joe Paduda was still a young man, the American fishing Schooner Esperanto defeated the Canadian Schooner Delawana in the First International Fishing Schooner Championship Races in Halifax. Legend has it that Joe lost almost $5 betting on the Canooks. Today, though, he presents The Faux Canadian. Observing that there's lots of good info out here in the blogosphere, but that there’s also lots of misinformation, Joe deconstructs and debunks [ed: we call that “fisking"], an email from an alleged Canadian, one who is none too fond of their health care system.

■ And in 1755 , the terrible Lisbon earthquake nearly destroyed that fair city, killing between sixty and ninety thousand people. Daniel Goldberg discusses a modern day “healthquake” in his post ON MRSA & Prevention.

■ Dateline: Desert Rock, Nevada. In 1951, American soldiers were involuntarily exposed to an atomic explosion for training purposes. And today, David Williams presents the latest developments in the Avastin/Lucentis saga. Over at his Health Business Blog, David had asked "did the FDA really force Genentech to withhold Avastin from compounding pharmacists?"

■ In 1886, the Ananda College, a leading Buddhist school in Sri Lanka, was established with 37 students. Although he wasn’t one of them, Zagreus Ammon has some thoughts on the concept of Alternative Medicine for Underserved as a Public Health Problem.

■ In 1957, Michigan's Mackinac Bridge, the world's longest suspension bridge between anchorages at the time, opened to traffic. Today, Lisa Emrich, blogging at Brass and Ivory, continues the alt.med theme. Her own experience with drug interactions forms her thesis about the value of what she calls "integrative medicine."

■ The first medical school for women opened in Boston, Massachusetts, on this day back in 1848. And over at the HealthBeat blog, Maggie Mahar thinks that The Bay State is a terrible venue to try out Universal Heath Care coverage.

■ In 1970, a fire at a dance hall in France killed 144 young people. Today, fires are raging in California, and Michael Millenson (President of Health Quality Advisors LLC in Highland Park, IL.) is guest-blogging at Matthew Holt’s place. Mr Millenson thinks he’s found a connection between the California fires and health care reform.

■ November 1, 1955 saw the The Famous Flames, a band featuring James Brown, record "Please, Please, Please" at a radio station in Macon, Georgia. Today, New York attorney/blogger Eric Turkewitz comments on an article in the Archives of Internal Medicine which claims that communication is a major cause of medical malpractice, especially among staff in training.

■ In 1963, The Rolling Stones' released their first single: 'I Wanna Be Your Man.’ And rockstar health-blogger Dr Roy M. Poses looks into some potential conflicts of interest surrounding PBS’s recent series on “the Mysterious Human Heart.

■ The worst rapid transit accident in US history occurred under the intersection of Malbone Street and Flatbush Avenue, Brooklyn, New York City on this date in 1918. But Michael Cannon thinks that’s nothing compared to the dangers of Universal Coverage.

■ In 1876, New Zealand's provincial government system was dissolved, which led to some major disruptions. Workers Comp Insider Julie Ferguson discusses the initial impact of the Southern California fires on businesses and suggests that employers prepare to deal with post-traumatic stress reactions from employees who suffered their own major losses and disruptions.

■ And finally, on November 1, 1941, iconic American photographer Ansel Adams took a picture of a moonrise over the town of Hernandez, New Mexico. It would become one of the most famous images in the history of photography. Which has nothing to do with my post, but Mr Adams is a fave of my eldest daughter. My post, on what I call Open Source Health Care, is about whether we're using the wrong models in determining how best to finance health care.

Thanks for playing along, and be sure to join us on November 15 at Maggie Maher’s place.

*Factoids courtesy of Wikipedia.

Helpful Resources: IB to the Rescue!

One of the great links on our blogroll is courtesy of our own Bob Vineyard: Bob collected and organized his Patient Assistance Programs roundup as a way to help his own clients, and has graciously shared them with us.

The PAP is a compendium of links that "provide assistance to low income individuals & families when it comes to medical care."

And our West Coast contributor, Bill Halper, braved the flames to bring us a link to the Foundation for Health Care Coverage Education. At Coverage for All, "you'll find options for free or low cost health coverage," as well as other valuable and helpful tools. We've just added CFA to the blogroll.

Thank You Bob and Bill!

When I recently told a friend about these resources, he was surprised, and a little angry, that this information wasn't more widely publicized. It's really not a deep, dark secret, but I do agree that the industry could do a better job of making people aware of these tremendously helpful programs.

We're just doing our part.

And Mike has pointed out that, regardless of one's insurance plan, it may well be worthwhile to take advantage of the new generic offerings at such retailers as Walmart, Target, Kroger's and others. For some, this will be an obvious savings (i.e. those whose plans include a minimum generic co-pay, usually far in excess of $4), while for others the savings may not be as large (those without such restrictions).

Again, it's all about consumer empowerment and transparency:

How much more empowered can one be than to have so many choices? And how much more transparent can we get than "$4" in blazing neon?

UPDATE: And Faithful IB Reader Fred sends us this helpful link, which has a whole round-up of low and no cost government sponsored health care programs. Thanks Fred!

The Ratings Race Heats Up

Recently, we looked at Wellpoint's new provider survey courtesy of the folks at Zagat. While imperfect at best, it represents a move in the right direction, i.e. provider transparency.

Now the folks at Cigna, in cooperation with NY AG Andrew Cuomo, have one-upped the WP effort:

"Cigna agreed to make public how it ranks doctors, won't evaluate its physicians on cost alone and will allow an independent national standard-setting organization to review its efforts every six months."

And this won't be based on office decor or smiles-per-member, either. The rankings will take into account more critical metrics: cost and quality will figure more prominently in these measurements.

Bravo, Cigna!

For the Children: Redux

Last week, we brought you a brilliant vidclip perfectly illustrating the twisted logic behind Congress' funding of S-CHIP. Well, the mysterious nicolai1951 is at it again, with further visual commentary on our legislators' hypocrisy.

Enjoy:



h/t: Redstate

Doing the Right Thing

We're pretty quick to take insurers to task here at IB, but sometimes they get it right:

"UnitedHealthcare, PacifiCare® and SecureHorizons® are concerned about the well-being and livelihoods of those affected by the ongoing wildfires. We want to ensure affected members receive the care they need without any delays or disruptions."

So begins an email I received this morning from UHC. A link embedded in the email takes us to a 2 page summary of measures the carrier is taking to ensure that its' members' health care needs aren't too disrupted by the Golden State's blazes.

Perfect? Of course not. But it's a realistic response to a horrendous situation.

A Cold Carnival Monday

Well, cold as in our Fall southwest Ohio temps. But HOT Carnival news:

The Carnival of Personal Finance is up at Millionaire Mommy Next Door. Along with a potentially mind-numbing 92 entrries, she's running a contest, complete with prizes. As has become de rigeur lately, she starts off with a Top 10 list, and then links to the other entries.

I thought Paid Twice's post on financial incentives and health insurance was both timely and well-written. We've blogged on this subject before, but this was from the insured's POV, which is different, and helpful.

And the Start Up blog hosts this week's Carnival of the Capitalists. The SU blog is new, so it's pretty exciting to see them jump into hosting so quickly (and well). Our hosts present 43 entries, starting with a Top Five list, and then the rest broken out into 5 helpful categories.

Mine Your Own Business talks about, believe it or not, Bad Ideas. Really! But it'd be a good idea to read it.

The New Medical Tourism

It's a fairly common story these days:

"Thousands of "health tourists" are going as far as India, Malaysia and South Africa for major operations – such is their despair over the quality of health services."

But they're not leaving Hoboken or Kokomo, or even LA:

"The first survey of Britons opting for treatment overseas shows that fears of hospital infections and frustration with NHS waiting lists are fuelling the increasing trend."

What's interesting is that we see "medical tourism" here, as well, but it's all about price. There are no waiting lines, and few concerns about quality of care. Americans are famous bargain hunters, and medical care doesn't seem immune.

But for our cousins across The Pond, it's quite obviously not about price (after all, it's "free"), but the very real lack of care, both in quantity (waiting lists) and quality (lack of sanitation, for example).

"More than 70,000 Britons will have treatment abroad this year – a figure that is forecast to rise to almost 200,000 by the end of the decade."

That's a lot of "tourists."

On the Health Front: Good News & Bad News

■ First, the Good News:

Many of us count on roasted (and, often, salted) peanuts for a quick "pick-me-up." They are yummy, but also less than optimally healthful: the salted ones are high in, of course, salt, and the roasting process can destroy many of the beneficial compounds that the treats originally contained.

According to a study in next Wednesday's edition of the American Chemical Society's Journal of Agricultural and Food Chemistry, "(b)oiling is a better method of preparing peanuts in order to preserve these phytochemicals."

"Boiled Peanuts." Ask for them by name!

■ Now, the Bad:

Judy Mazel, who wrote the 1981 best-selling Beverly Hills Diet, has succumbed to complications from peripheral vascular disease.

The book itself enjoyed its well-deserved "15 minutes," as did its author.

"After studying for several months with a nutritionist, Mazel came up with a theory about food enzymes and the digestive system that she formulated into a complicated weight reducing plan."

Rest in Peace, Ms Mazel.

■ And then the Sublime:

As we've noted before, the Much-Vaunted NHS continues its downward spiral:

When 6-year-old Chantelle Hill's father, David Hill, contracted lung cancer, the compassion-impaired NHS decided that the contractor really didn't need (deserve?) the life-saving med's that are available at no cost in SCotland, because in England, they're apparently not "an effective use of NHS resources."

And so, the brave little girl has been raising money to pay for her father's chemo; thus far, she's raised enough for about 2 months of treatment by putting up posters asking for help.

Ah, socialized medicine.

Is there anything it can't do?

Got generics?

This being enrollment season for group insurance participants, I was helping my son review his medical plan the other day when I experienced a little epiphany. I noticed his Rx benefit pays 70% with copay limits of $10 for generics, $35 for formulary brands and $50 for non-formulary brands. Ho-hum I was thinking until I noticed this: the $10 for generics is a minimum copay. Let's say he gets a generic drug that costs $8. 30% of $8 is $2.40. But he won't pay $2.40 - he'll pay $10. That's interesting, I thought.

Then I looked at my own plan. Whaddya know, same feature except the minimum on my plan is $15.

So what's the epiphany?

Buy my medications at Wal-Mart but tell them I have no insurance.

Because at Wal-Mart each generic costs $4, period. Even I don't need insurance for that. In fact, if I tell them I'm insured, Wal-Mart will file the claim for me and, presto, collect the $15 minimum copay. I'm presently taking two (generic) medications so my copays have been running $30 per month. Not any more. At Wal-Mart, I pay $4 each, saving $22 a month.

Read your plan - maybe you can save, too.

Health Wonk Review is coming...

We'll be hosting the November 1 edition of HWR here at IB. The Health Wonk Review is a "specialty carnival," focusing on:

Health policy, funding, insurance, managed care, infrastructure, IT, the uninsured, economics and trends ... We avoid things clinical in nature.

If you blog on any of these subjects, please feel free to submit your favorite (relevant) post from the past two weeks. Just click here.

Entries are due by next Wednesday (but please feel free to submit earlier!).

Hot Insurance Tales - Update

Almost exactly 2 months ago, we reported that AIG's Private Client Group policyholders rate extra protection, courtesy of their insurer. This was at the time of the "Castle Rock Fires" in Colorado.

According to ABC news, the same services have been made available to AIG clients in the path of the horrendous California fires. Homes and landscaping are being treated with fire retardant chemicals, at a cost of about $1,000, in an effort to stave off the flames.

This special service seems to work: according to AIG, "(s)ince the program was launched in June 2005, three homes have been saved directly as a result." Not a bad trade-off, considering the homes insured under this program average a cool (or is that hot?) $2 mil apiece.

UPDATE: Not all such solutions are insurance-based.

"As the Witch Creek fire raced through some of San Diego County's priciest neighborhoods and crept to the edge of others north and east of Rancho Santa Fe, not a single home in the five subdivisions that have implemented the strategy was lost, fire authorities said."

And what strategy (or, if you prefer, "strategery") was that, you may ask?

It seems that certain areas have implemented draconian zoning codes that require sprinkler systems, special landscaping and other measures designed to allow homeowners to ride out the fires if they're trapped "behind the lines." It's controversial, but it seems to work.

Not so Well(care)

One of our commenters, Cary, noted this morning that the Feds have "raided" a well-known Medicare/Medicaid health plan provider. According to their website, Wellcare (WC) "has been a leading provider of government-sponsored health plans including Medicare Health Plans, Medicare PDP, Medicaid, State Children's Health Insurance Programs and others."

S-CHIP, too, hmm?

Interesting.

Even more interesting for some is the connection to noted financier George Soros, who provided substantial funding to WC back in the early 90's. According to the St Pete Times' story, the company has bestowed some $105,000 to Republican candidates so far this year, and a measly $5,000 to Democratic candidates. Unfortunately, the Times' seems to have missed the $15,000 WC donated to the Democratic National Committee last year (according to opensecrets.org). So it appears that their political largess is a bit more non-partisan than one might believe from the news story.

As Mike noted in the same comments section, "Carroll [Thomas Carroll, analyst with Stifel Nicolaus in Baltimore] suspects the raid is potentially the result of a lawsuit in which an employee brought a matter to the attention of authorities."

So is it all smoke and mirrors, or is there something truly amiss?

Time will tell.

UPDATE: PharmaFraud blog has more.

Cavalcade of Risk #37 is up!

Spencer Hill, blogging at Hill's Personal Finance, presents this week's edition of the Cavalcade of Risk. Please be sure to check it out.

And please consider hosting a Cav yourself: it's fun & easy, and a nice traffic bump (just ask Spencer!).

To host, just drop us a line.

Wednesday Mini Link-Fest

■ Over at Roth & Co, FoIB Joe Kristan has some disturbing news about Section 419 plans (no, not that kind of 419).

In the life insurance field, Sect 419 plans are (or rather, were) a way to deduct life insurance premiums from income taxes. Joe reports that the IRS is cracking down on these plans, and the folks who implement them, in a big way.

■ From time to time, we like to highlight new (to us) blogs that pique our interest. IB commenter Tiffany has one such, which she's titled, eponymously, Tiffany Insurance. She's particularly proud of this post, which discusses why she thinks health insurance should be dealt with on a state by state basis.

Do check it out.

■ From the "Heartwarming Health Stories Dept:" Kevin Connolly, now a 22 year old college senior, was born without legs.

Now, though, you can catch him zipping around Bozeman (MT) on his skateboard. When he's not 'boarding or studying, he talks about his amazing adventures. Recommended.

Open Source Health Care

Okay, call me a geek.

Or a nerd.

Just don't call me late for dinner.

I've been noodling something new:

As regular readers of IB have no doubt ascertained, I'm an enthusiastic supporter of Consumer Driven Health Care. The basic premise of CDH is that, when consumers have "skin in the game," they're more likely to make informed, rational, effective health care decisions.

My friend Dmitriy Kruglyak, editor of Trusted.MD, proposes an alternative: People Powered Health(care).

Okay, freeze-frame.

Recently, I had the privilege of addressing a large group of local medical practice managers (and some of the doctors whose practices they manage). Since my reputation as an expert in CDH preceded me, that's the subject on which I spent the most time. As I was researching my presentation, though, something began to bother me:

Is that all there is?

Okay, I admit it: I am a geek. Whenever family members or friends need help fixing their PC's, I'm the first one they call. And I've begun learning about things like Linux, which is part of a (relatively) new movement collectively known as "Open Source Software."

OS Software is defined as "a development method for software that harnesses the power of distributed peer review and transparency of process. The promise of open source is better quality, higher reliability, more flexibility, lower cost, and an end to predatory vendor lock-in."

The more I consider this, the more applicable it seems to become to the future of health care (and the financing thereof). What if, instead of focusing on "consumer driven" or "people powered" health care, we turned our efforts instead to "Open Source Health Care?"

So what would OSHC look like?

I'm not really sure. But it seems to me that it would encompass all that's "good" about CDH (consumer empowerment, personal responsibility, transparency and outcomes) and what Dimitry likes about PPHC (peer-to-peer support networks, emphasis on wellness programs, online resources) while encouraging personal responsibility and provider (and carrier) information management.

Not bad, but how would it work?

Well, let’s start with some basic premises:

1) I have a visceral distrust of gummint-run health care systems. OTOH, my own industry has to be pulled, kicking and screaming, into making things "work."

2) As much as I advocate CDH, it's slow in "taking off." Part of that is our cultural reluctance to take personal responsibility, but a part is also that we lack both the tools and the incentive to empower ourselves.

3) Dimitry's PPH relies on tech & wellness programs, but seems to emphasize the provider angle.

4) What we need is a catalyst: something to drive us forward, to give people an incentive to make changes in lifestyle, care delivery AND funding (insurance) choices.

5) It occurs to me that we're using outdated models for all of these things. We should be looking at what's currently driving our economy and society: information. And how do we access that information? Computers. But it's not about Windows and Mac's. The real action is in the Open Source community.

Why? Because there's a synergy there: folks share info and code, try out new ideas (some of which flame out, but some of which stick). The bottom line is, they're driving information delivery tech forward.

What’s appealing about Open Source Software is that emphasis on sharing: new ideas, new tech, new code. Seems to me, Open Source Health Care could emphasize sharing, too: resources, information, outcomes and pricing. The culture of OS is one which embraces and encourages change, not for its own sake, but for a specific purpose.

Could we co-opt that culture, and apply it to health care delivery (docs, hospitals, pharma, etc) and funding (insurance)? You’ll have noticed that I’m not proposing any specific ways in which this could be implemented; right now I’m primarily interested in whether the concept makes any sense.

Well, dear readers?

For the Children...

On the one hand, it's tempting to put the whole S-CHIP kerfluffle behind us.

On the other...

What's the Point?

The other night, my better half took me out to dinner to celebrate my birthday (my 29th, in fact) [ed: riiiight!]. We only recently welcomed one of those Brazilian Steak House places to our community, and I had been looking for an excuse to gorge myself on meat. Had I been so inclined, I might have headed to Zagat, which rates restaurants on such things as quality, service, price, and value.

Now, wouldn't it be nice if such a service existed for medical providers?

Well, they do, and we've discussed some of them. Today's USAToday brings news that WellPoint (aka Blue Cross/Blue Shield) has enlisted the services of the aforementioned rating giant, in an effort to better serve their policyholders. WP seems quite pleased with itself for having pulled off this amazing coup.

So what kinds of information will we be treated to? Surely we'll learn the prices of different services, as well as the success rates of given providers, right?

Wrong (and please don't call me Shirley):

"Instead of Zagat's four categories for restaurants...the ratings guide will consider trust, communication, availability and office environment."

Office environment?! Are you kidding me? Yes, it's always nice to be greeted by a smile, but isn't the whole point of health care to provide, you know, care? What possible difference does it make how friendly the staff is, if the doc is mediocre and the equipment sencond-rate?

Granted, there has been some controversy surrounding provider ranking, but instead of confronting and resolving those issues, WP has chosen "the easy route." The good news is, the service, just now coming on-line, is free.

The bad news is, you get what you pay for.

Scary Good Carnival of Personal Finance

The Dough Roller presents this week's outstanding CoPF, with a dizzying array of helpful posts, and some cool illustrations, to boot!

We've talked about ID theft before, but nothing like Art Dinkin's take at Moment on Money. Recommended.

Cavalcade #37: Submissions Due

Just a reminder that submissions for next week's CoR are due this Monday (the 22nd). Our host, Spencer Hill, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

Don't forget: we still have hosting slots available. Please drop us a line to reserve yours.