And so it begins...

"The University of Texas Medical Branch may stop offering cancer care to indigent and undocumented immigrants in order to cut costs."

The primary motivation for this move is (are you sitting down?): their $1.4 billion [ed: did you say billion, with a b?!] budget included some $12 million specifically for illegals suffering from cancer.

And that just wasn't enough.

And then, of course, we get those who continue to push for "universal care," presumably meaning care for everyone in the, you know, "universe:"

"Any time there's any restriction in access to care, there's pushback from people who are concerned about that."

No kidding.

Remind me again how much illegals pay into the health care system?

Happy Days...

We've spent a lot of time recently discussing the problems inherent in existing nationalized medical schemes, and questioning whether we really want a "universal care" system here. One reason that UC proponents give that our existing system is somehow "broken" is that "the majority of people are dissatisfied with the status quo."

Certainly a reasonable hypothesis, but unfortunately far off the mark:

"National Research Corporation (NASDAQ:NRCI) released today a first-ever National Health Satisfaction Index which rates the quality of healthcare consumers received during their last hospital, emergency room or clinic visit. The Index indicates that 70 percent of Americans surveyed, rate the quality of healthcare they received during their last visit as either, “very good” or “excellent.”

Any Presidential candidate receiving 70% of the vote would be declared a winner by a landslide, so these numbers are quite encouraging to those of us skeptical about the conventional wisdom. Perhaps even more encouraging is that, even with (or perhaps specifically because of) the recent S-CHIP kerfluffle, the Index shows that "Americans have become more satisfied with their healthcare over the last three years."

There are a whole lot of other interesting statistics, with breakdowns by age, household status, even location. Very interesting stuff.

[Hat tip: Jeff Beck]

Ye Olde MVNHS©

Seems the Much Vaunted NHS© is up to some "old" tricks:

"A growing number of people over 50 are being refused treatment on the NHS, according to a new survey...One in six said they had been denied treatment on the NHS on the basis of cost."

On the bright side (such as it is), about half "would be prepared to meet the cost of treatments for diseases such as cancer." Of course, this means that about half wouldn't be.

Ooops.

One of the problems with any health care system is balancing supply and demand. In a nationalized one, this means rationing health care (much the same as we see with our own Medicare system). Problem is, most younger folks have fewer health problems, while seasoned citizens tend to eat up health care like Louie Anderson at a buffet.

Thus, we see a trend toward reducing the health care expenditures on mature Britishers, in an effort to stem the rising cost of their care.

Food for thought.

Edwards Joins the Food Network

With Emeril Live! going off the air after 10 scrumptuous years, the Food Network faced a dilemna: whom to replace the charismatic and entertaining food whiz?

Never fear; TVFN has apparently tapped erstwhile presidential candidate John Edwards (no, not that one) to host a new show centering on decorative food presentations:

"(T)he Edwards plan would empower the federal government to garnish an individual's wages for purposes of collecting "back premiums with interest and collection costs." (emphasis mine)

While I'm not sure how that will play out in prime time, certainly the success of shows like "Unwrapped" and "Have Fork, Will Travel" demonstrate that the gastronomic-themed network isn't afraid to take chances.

[ed: um, perhaps the Edwards campaign meant "garnishee" the miscreants' wages?]

Hunh?

Oh!

Never mind.

In Memorium...

We note the passing of former life insurance agent Robert Craig Knievel, Jr, who passed away today at the age of 69. He represented the Combined Insurance Company for several years; in one week, he sold what may be a record 271 life insurance policies.

Mr Knievel left the insurance business in the 1960's, apparently to pursue other career opportunities.

He leaves behind 10 grandchildren and a great-grandchild, as well as longtime SO Krystal Kennedy-Knievel.

Rest in Peace, Robert.

VERY Long Distance

As previously noted, we do get quite a bit of email from various folks ("regular" readers, home office critters, and sometimes even trolls), but the other day I received a phone call from a distant land, one which poses some interesting challenges. I post it here in the hopes that one or more of our readers will have some solutions to share.

A couple of days ago, I received a call from Sweden. The caller was a 37 year old young lady pregnant with her first child. She and her husband plan to move to Florida in the next few weeks, and has been unsuccessful in her quest to find health insurance.

Small wonder.

She kept hitting brick walls until she googled "special risk insurance," and found us.

Very cool.

But also very challenging.

Here are the facts:

Sandra is a 37 year old female, 4+ months pregnant. Dual citizenship (US & Sweden), but her husband is a Swedish national. She works for a Swedish company, and will basically be a manufacturer's rep once she gets here. She could potentially qualify for a one-life group, if she ends up in a state where that's relevant. This past summer, she and hubby bought a home in Florida, but she could also land in either North Carolina or Tennessee.

Hey, if it was easy, anyone could do it!

She may also qualify for Medicaid (based on the pregnancy), but that seems a bit murky. I also directed her to the Coverage for All site (in the sidebar) in the hopes that there might be something relevant there.

But what I'm really counting on is the goodwill and immense knowledge-base of our readership.

Suggestions?

Cavalcade #40: Submissions Due

Just a reminder that submissions for next week's Cavalcade of Risk are due this Monday (the 3rd). Our host, Joe Paduda, 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.

We do have a few hosting slots available. Please drop us a line to reserve yours.

Friday Odds & Ends

■ This past summer, Bob had a series of posts on the TB-infected Atlanta attorney-cum-world traveler who seemed oblivious to the danger he potentially created. According to the CDC, "(t)ests on hundreds of airline passengers show that no one caught tuberculosis" from Mr Speaker.

On the one hand, we're grateful for the positive turn of events.

On the other, it doesn't absolve him from putting other folks' lives in jeopardy.

■ Apparently, the "graveyard shift" is aptly named; turns out, "scientists suspect that overnight work is dangerous because it disrupts the circadian rhythm, the body's biological clock. The hormone melatonin, which can suppress tumor development, is normally produced at night."

This can lead to an increased risk of cancer among those who work such hours.

■ About a year ago, we blogged on the surprisingly low participation in Flexible Spending Accounts. Now, USA Today reports that "la plus ca change:" only 1 in five "of workers in large companies that offer FSAs actually enroll in them."

Unfortunately, it seems to be a simple matter of education; when folks truly understand the tremendous benefits, and relatively low risk, of participating, FSA's become more attractive.

But who, exactly, is going to provide that education?

And some critics (myself included) believe that the major problem with these "use it or lose it" arrangements is that they encourage more health care spending, which in turn drives up costs. Others (myself not included) complain that they "simply encourage overspending on discretionary medical care, at a cost to taxpayers."

Health Wonk Review: The Early Edition

Master wonk Dr Roy Poses hosts this week's edition of the Health Wonk Review. It's chock full of interesting and insightful posts on health care policy and polity, with helpful summaries of each post.

As regular IB readers know, we are major proponents of transparency in health care, including little things like "does this procedure work, and is it really necessary?" Over at Gooznews, blogger Merrill Goozner [ed: what a cool name!] takes a look at the latest cancer screening test being touted by Medicare and the VA, and asks "(d)oes screening actually save any lives?" The answer may surprise you.

Doing Right...

As I've noted before, I have a little sticker on my phone as a constant reminder to always do what I think is in my clients' best interest (not that I need constant reminding, but it keeps me humble). Today I had another opportunity to take it for a spin, and I'd like to share that with you. A caveat, however: the story you're about to read is true, the names have been changed to protect private information, and I share it with you as an example of how I believe most professional agents would handle the same circumstances.

The gentleman who founded this agency almost 40 years ago is semi-retired, but keeps his hand in (mostly so his wife has an excuse to get him out of the house). One of his friends and long-time clients called him with a problem, and he referred this gentleman to me for assistance.

It seems that this gentleman, we'll call him Tom, has a 55 year old daughter, Susan. Susan was widowed some 20 years ago, and raised her two children by herself. The eldest has recently married and moved away to another city, and the youngest is in college away from home, as well. She has found herself becoming more and more depressed, and has found (as so many have) solace in a bottle. This has reached the point that her employer had to let her go this past summer, but continued to pay for her health insurance through the end of this year. At that time, she's on her own; worse, because of her health history (which include the alcoholism and other issues), she is uninsurable in the "regular" market.

I would like to point out that she chose to adopt that bottle, and that most of her other issues stem from that decision. We are all responsible for the decisions that we make.

In the event, I agreed to meet with her, primarily because of that sticker, but also out of loyalty to the retired gentleman. I was also intrigued by some of the side issues, which included an employer exemption from COBRA compliance. Something not widely known is that some organizations aren't required to offer COBRA continuation even though they might otherwise fit the requirements. She had worked for one such, so COBRA was not an option.

Believe it or not, there were others.

One was the state-mandated guaranteed option route. This is the same plan one would buy once one had exhausted COBRA (were it available and elected). The benefits of this plan were the low qualification threshold (doesn't get much easier than "guaranteed issue") and the fact that it would cover her pre-existing conditions. On the down side, it's rather mediocre coverage, but it is expensive. For Susan, the rate would be well over $1,000 a month.

I understand and believe in the value of insurance. But I also try to live in "the real world." So I absolutely understand if someone says "12 thousand dollars a year?! Plus deductibles and co-insurance? Are you kidding?!" So I can certainly understand someone who decides to roll the dice. And I can't say that I blame them, or even disagree.

Heresy!

Not at all. Insurance is about risk assessment ("I'm uninsurable") and risk management ("this stuff is expensive!"). If one can't justify the premium based on the cover, then that's a legitimate conclusion.

So I also proposed a limited benefit (or mini-med) plan as an alternative to the state-mandated one. My thinking was that it would serve to mitigate the damage should there be a large claim. Again, it's a question of risk management.

Finally, I also printed out the Ohio grid from Coverage for All (on our sidebar). The idea was that, even if she decided not to buy any insurance to offset her increased risk, at the very least I could help her find some way to soften the blow as she received the treatment she needs.

This is a sad situation, with no real "happy ending." But I was awfully proud to have been able to help in some small way.

Now that's a good day.

What if?

Okay, I need to work on that title, but here's the gist: If we agree that health insurance has more in common with Property/Casualty than Life insurance, then perhaps we can learn a lesson from our friends in the Sunshine State:

"Last January, Floridians decided they'd had enough of rising homeowners' insurance rates. Tallahassee allowed a state-run company called Citizens Property Insurance to expand its coverage of private homes and businesses against damages from hurricanes and other disasters."

And that's worked out pretty well: Citizens is now the biggest writer of property insurance in Florida, eclipsing even our friends The Good Neighbors.

In fact, Citizen's has become so successful that it currently has over $400 billion (yes, billion with a "b") in liabilities. Which is only a problem insofar as it's currently collected something like $3 billion in premiums.

Ooops.

But that's not really a problem, you see, because -- worst case scenario -- if there is a devastating storm that wipes out Citizens' (and you just have to love the irony of that name here) meager assets, all they have to do is go back to the actual citizens (note the lower case "c") and make them pony up. They can do that, you see, because they've got the power of the government behind them.

Sweet.

Until you start calculating the costs: "Andrew, in 1992, caused $23 billion in damage," or about 7 years worth of premiums. And that was 1992 dollars. Do the math.

Now, what does this have to do with health insurance? Well, it seems to me that this P&C scheme quite accurately models what we've seen proposed in the way of gummint-run health insurance (and please note the very purposefully chosen terms). That is, the government decides what's (and who's) covered, sets the premiums, and (if they're too low), comes back for more (see Bob's post below). With the power of the federal government. And what happens if (or when) there's a major problem (MRSA, anyone?)?

Hey, I'm just supposin'.

A Generic Update

[Welcome Industry Radar readers!]

About a month ago, Mike wrote about the disconnect between reality and prescription drug co-pays. Under Mike's current health plan, if a med costs $10, and the co-pay is $15, he actually has to part with the extra $5 if he uses his card. So of course, he simply says "nope" when asked about insurance, and gets that med for $10. He (and apparently lots of others) have also found the $4 deals (WalMart, Target, etc) to be a boon in this regard, as well.

One of our faithful readers took issue with Mike's assertion that he'd have to pay the full co-pay even if the med actually cost less. This reader (who wishes to remain anonymous, but for whom I can vouch credibility) wrote to let us know that his company, United Healthcare, generally doesn't ding their members in this way:

"I have now confirmed that UnitedHealthcare (my employer) IN FACT DOES only assume member responsibility up to the contracted cost of a covered service for BOTH medical and pharmacy claims. In short, we do not attempt to charge members a full copay for covered services like those involving $4 generic drugs at Walmart and Target when the contracted rate is less than the copay on covered services."

He adds that their most recent pharma contract language says:

"For Prescription Drug Products at a retail Network Pharmacy, you are responsible for paying the lower of:

• The applicable Copayment and/or Coinsurance or

• The Network Pharmacy's Usual and Customary Charge for the Prescription Drug Product."

Which would seem to indicate that under those plans, if the scrip was $10, you'd pay $10.

Of course, these all apply to commercial, insured plans, not ERISA (self-funded) ones. Generally, ERISA plans can include pretty much any language the employer wants, which means that the minimum co-pay amount charge could be required in such a plan.

I'd really like to Thank our anonymous source, and would challenge other carriers (we know you read us!) to chime in.

A Truly Grand Rounds

Dr Prudence, writing at her eponymously named blog, presents an outstanding 'Rounds this week. This marks her debut hosting GR. She starts with her five favorite (and, we're proud to say, our entry claims the Top Spot), and then another 28 entries, all are categorized and include helpful context.

Regular readers of IB know that we are major proponents of personal responsibility. So it's especially gratifying to read ER Nursey's post that begins "I think there are too many people who don't have anything to do every day but sit and think about their problems." Read the whole thing.

Carnival of Personal Finance is up...

And it's a doozy! Host Blain Reinkensmeyer, blogging at Stock Trading To Go, has this week's passel of personal finance posts, all helpfully categorized and summarized. There's even an interesting factoid for each category (did you know that Bill Gates makes $30 million every night - in his sleep?!).

This week's Carnival offers a Top Five, and our friend SVB from The Digerati Life has a helpful and timely post on how to be a safe, careful consumer. Some good advice, especially at this time of year.

Happy Thanksgiving!

[Photo courtesy Lake Junalaska]

Bob, Bill, Mike and I extend to all our readers and guests a wonderful, joyous, and safe Thanksgiving.

And building on Bob's post below, there's a concrete way to say Thank You to those who spend the holiday guarding the freedoms for which we're so grateful: most cell phone companies are participating in the Giving Thanks Campaign, through which you can text your own, personal Thank You to our men and women in uniform. Just text your message to 89279 and bring a smile to a soldier's face.

Cavalcade of Risk #39 is up!

Jay Norris hosts the Thanksgiving edition of the the Cavalcade of Risk. Please be sure to check it out.

We're now scheduling for early 2008. If you'd like to host, just drop us a line.

Mass Ooops

Previously on IB: Massachusetts implements a new mandatory health insurance scheme. It is projected to cost $(fill in the blank), and to (eventually) cover everyone in the state.

Fast forward to reality...er, today:

"Enrollment in the state's new subsidized health plan is growing so quickly that the state could face a funding gap as large as $147 million by the end of the fiscal year, according to a state projection."

Well why not? When "someone else" (i.e. the taxpayer) is picking up the tab, it's not too difficult to see the attraction. But that $147 mil is only the beginning; we have to wait for the second page of the article to learn that the true liability is over $600 million, more than 4 times the current shortfall.

And since the plan does absolutely nothing to control the cost of health care, expect those numbers to climb even (ever?) higher.

One bright spot: by treating the various states as independent laboratories for these experiments, we're able to contain the damage, yet still learn a little bit more about which kinds of plans will work, and which ones not so much.

Monkey See...

So we received the following email:

"We would like invite you to participate in a study of health bloggers, "From My Experience to Yours: Taking the Pulse of Health Care Blogs in the Blogosphere," administered by Brown University. The study assesses the use of blogging in the area of health and medicine."

They're targeting "health-related" bloggers; of course, if they truly understood the genre, they'd call us "medbloggers." Still, it's interesting that they're trying to quantify our little corner of the blogosphere.

The survey's hosted by a site called, of course, "SurveyMonkey." It was pretty well done (took me about 5 or 6 minutes to do). They asked questions about how long I'd been blogging, and (more importantly) why. What they didn't ask was also interesting: no questions about blogging for money, or awards, for example. There were some demographic questions (age, household income, etc). They specifically asked if I was Hispanic (I'm not, but my daughter's in Honors Spanish).

At the very beginning, they said this:

"This survey is part of a research study at Brown University of health-related blogs, covering such topics as health policy, research and news, specific illnesses or diseases, and personal experiences of doctors, students, and patients. Our research examines the ways in which blogging has impacted discussion of health topics, information dissemination, and community-building."

The email promised me "a summary of the responses." One supposes that this is remuneration enough.

IB: Legal

Legal information biggie Lexis-Nexis has dropped us a line:

Gentlemen:

I am happy to let you know that your blog has been selected to be included in the "Top Blogs" section of LexisNexis' Insurance Law Center.

We take pride in associating with the best talent in the legal world, so we are thrilled to include you as part of this dynamic new platform that features commentary from experts, and gives visitors to the site the ability to interact with the content and one another. Also featured on the site is real-time insurance news, blogs from internal teams at LexisNexis, news about attorneys, firms and insurance companies, plus several delivery options, including RSS feeds, Podcasts and email alerts.

The selection of your blog was made by insurance editors at Matthew Bender and LexisNexis Mealey's Insurance publications as one that can be relied upon to provide its readers with timely review and analysis on insurance and insurance related topics.

We are thrilled and honored to be selected, and just a bit stunned, as well. Thanks to our readers for helping to move us "up a notch."

Moron or Fraud: Update and Conclusion

Last week, we discussed the curious case of the gentleman who submitted multiple applications to the same carrier, both of which contained fraudulent information. I spoke this morning with the underwriter, and then with the Department of Insurance.

The underwriter is well aware of the facts in this case, because he is the underwriter for both myself and the other agent. We had a rather lengthy conversation, wherein I reiterated that the only correct course of action was to decline both applications for material misrepresentation. He disagreed, but offered no rationale for that decision. He is going forward with the underwriting.

I told him that I had no intention of withdrawing my application, and he responded that it didn't really matter, because the applicant was providing the other agent with an Agent of Record letter. This is a means by which an insured can specify his "official" agent in these matters. At that point, I begged off the conversation before I said something regrettable.

I really had only one option at that point, which was to contact the Department of Insurance, Fraud Division, and discuss this with them. After laying out the whole story, the gentleman from the DOI explained that there really wasn't anything that they could do, and that I had done my due diligence in this matter. Since I had informed the carrier of the fraud (actually, they already knew, I simply confirmed it), there was nothing more for me to do. If the carrier was so inclined, they could notify the state, but that was entirely in their hands.

I explained to the DOI rep that in addition to selling insurance, I'm also a licensed CE provider, and even teach a course on ethics. To which he replied (correctly) that I teach agent ethics, not consumers'. That's really only half right: the course also includes carrier ethics (an oxymoron, of course), but I didn't think that bringing this up would move the ball forward.

At this point, there's really nothing more for me to do with this case. I will not withdraw the application, but I won't pursue it, either. Of course, I now have to rethink my relationship with Carrier C. I have printed out a copy of both these posts and added them to this client's file; in addition, I've sent a note to the underwriter confirming the facts of the case (a copy of which is also in that file).

There are a number of issues that follow from this, of course, and perhaps these would be worth exploring in the comments section. In the meantime, I'll consider the matter closed, and try to move on (although I'm not really sure that I can).