CMS and Nursing Homes

Not sure how I missed this, but our friend (and frequent foil) Zagreus, blogging at The Physician Executive, has a post on a new CMS initiative on nursing homes.

It's a thoughtful piece, and one which strikes close to home.

Recommended.

The Schengen What?

[Welcome Industry Radar readers!]

Over the past several years, many (not all) of the EU nations have signed an agreement called the “Schengen Convention" which is scarcely known in the U.S. One of the less prominent articles in the Convention is a requirement that persons seeking an entry visa to a signatory country must have adequate medical insurance of their own.

(Click here for details)

An entry visa will not be issued to anyone who does not provide the required proof of adequate medical insurance.

In other words, without much fanfare or publicity outside Europe, the Schengen countries have REJECTED the notion that their citizens are obligated to pay for medical expenses of foreign visitors - even legally-admitted foreign visitors – via their own nationalized health care systems.

The nationals of 134 countries are presently subject to this requirement - interestingly, not the U.S.

In case you wonder whether the Schengen insurance convention is actually enforced, I assure you that it is. In my most recent position I had responsibility for my company’s worldwide staff health benefits. My office was frequently called upon to to help foreign employees who at the last moment discovered they needed the prescribed Schengen benefits documentation in order to obtain a visa.

Some observers suggest it's likely that illegals would be mandated health insurance coverage under a universal U.S. health care program. I say, not so fast. I say it's at least 50-50 that the debate here will reach the same outcome as in the Schengen Conventions.

Of course, people who hold jobs and pay into a system have a plausible claim to benefit from the system. IMO such a claim is indisputable for people who are citizens, and for people who have legitimate green cards or work visas. It is much less clear whether people who are in this country illegally in the first place should be entitled to the same benefits.

None of this is easy stuff and IMO it is very unlikely that any easy answer will be found – rather the likelihood is that a raucous and divisive debate will ensue whose outcome is very much in doubt.

To summarize:

(1) The Schengen countries have REJECTED the notion that their citizens are obligated to pay for medical expenses of foreign visitors - even legally-admitted foreign visitors - via their own nationalized health care systems.

(2) The design of any U.S. governmental single-payer system must deal with the issue of health care costs for illegal aliens. When the debate over program design commences in earnest, there will likely be a strong and vocal faction advocating rules similar to Schengen.

(3) One possible outcome is that illegals would be mandated coverage under a universal U.S. health program. But I say it's at least 50-50 that the debate here will have the same outcome as Schengen.

Holiday Giving

[Bumped]

This is the time of year when many of us take time to give thanks (as in the holiday just celebrated) and look forward to the upcoming season.

As Hank mentioned in his post, this is a time to think about our children.

Just last week we learned of a situation involving one of my wife's co-workers and I want to impose on the readers of InsureBlog to share this information.

Mary is a special ed teacher, her husband is self employed.

Recently Mary took maternity leave for their second child. Will was born on August 17, 2007 and everything seemed normal except he cried all the time.

Recently they took him to a doctor who then sent them on to Children's Hospital for further testing.

Baby Will has cancer. There is a tumor growing in his abdomen about the size of your fist.

Early results are that the cancer was detected early and the prognosis looks promising at this time.

He has completed his first round of chemo and seems to be tolerating the treatment well. Initial tests seem to indicate it has not metastasized but more tests, including a bone scan, are needed to confirm.

Most likely surgery will be scheduled once the tumor starts to respond to the chemo, but that will be some time off in the future.

Will's immune system is quite fragile at this time and they have to be careful not to expose him to any undue germs.

Mary exhausted her sick leave when she delivered. She is the primary income source for the family.

They have decent health insurance through the school system but there are out of pocket expenses that will have to be paid by the family. There is also travel to Children's Hospital (about 90 miles from their home), lodging, and so forth.

This is creating a financial and emotional strain on the family. Several friends have set up an account to collect donations. In addition to your prayers, if you care to make a contribution, send a check to Security Bank, 4219 Forsyth Rd, P O Box 4748, Macon, GA, 31208-4748. The phone number of the bank is (478)722-6200. Indicate the check is for the benefit of baby Will Senn.

Tivo Bleg

Our own Mike Feehan makes his cable TV debut this Sunday, in a 1 hour special on the Fine Living channel. The show -- called Stop! You're Paying Too Much -- airs for the final time this Sunday morning (the 9th) at 11:AM (Eastern). We would really appreciate it if any of our readers would tape/Tivo/DVR it for us (especially Mike's insurance tips segment).

Thank you!

The New S (for "Strip")-CHIP

Finally, a government-sponsored health care financing scheme I can get behind. Indeed, I can immediately see through the layers of thinking that went into recent Lone Star State legislation:

"The new fee...is set to take effect on Jan. 1. It's expected to raise about $40 million to be dispersed for sexual assault prevention programs and health care for the uninsured."

Granted, this seems an unusual pair, of issues; nevertheless, it seems to me that the $5 fee is modest enough. Specifically, it's a surcharge for consumers of certain entertainment venues. Since no one is forcing folks to frequent these facilities, this seems fair.

Of course, there are the usual nay-sayers, folks with an axe to, er, grind:

"The Texas Entertainment Association and Karpod, Inc., the operator of an Amarillo club, filed the lawsuit Wednesday in Travis County against Texas Attorney General Greg Abbott and Comptroller Susan Combs."

These ne'er-do-wells claim that the surcharge is actually a new tax (as in "sin tax" perhaps?) which would apparently be unconstitutional under current Texas law. It appears that in this case, the state's constitution is bumping up against a popular mandate.

I just hope that the politicians won't keep dancing around the issue.

Drugs Don't Work

An odd thing is happening and has recently come to the attention of former U.S. Surgeon General C. Everett Koop. Drugs don't work . . . unless you take them.

I don't think a lot of money was spent to come to this conclusion, but I could be wrong.

only about half of people with chronic health conditions continue to take medication as directed.

Half stop taking meds.

Must be just those who cannot afford their meds, right?

Doctors say the problem cuts across all socioeconomic groups,

Drug costs sometimes can be a problem, but even at Kaiser Permanente and Veterans Affairs medical centers, where co-pays are minimal, "there's still a high percentage who don't routinely fill their medications," Ho says.

Apparently not.

Heart attack survivors don't take their medicine for high cholesterol or high blood pressure. Epilepsy patients skip their anti-seizure drugs. Breast cancer patients stop taking pills that reduce their risk of a recurrence. Osteoporosis patients forgo medication that will be able to reduce their risk of a fracture.

Patients stop taking meds for any number of reasons.

part of the problem is misconceptions about medications, says Gbenga Ogedegbe, an internist at Columbia University. "Patients have all kinds of crazy beliefs about how medications can be poisonous."

Someone must be spending way too much time on the internet.

Irish researchers reported 22% of the breast cancer patients they had studied stopped taking tamoxifen by the end of a year, even though they had been told to take the drug for five years. By the end of 3½ years, more than a third of the women had stopped taking their tamoxifen.

Wonder how much this affects survival rates as is widely reported in the MSM?

Strangely, I have encountered people on a regular basis who tell me they were taking a certain med, but no longer take it.

Why would someone buy meds and then not take them?

I have some exercise equipment in the basement that hasn't been used in years. Wonder if that is why my clothes are getting smaller?

Alternative Treatment for the Uninsured

Recently the Ford Motor Company closed their automobile assembly plant in Atlanta (actually, Hapeville) and laid off the most of the remaining crew. Some took early retirement while others were offered jobs in other Ford locations.

All were given severance packages of cash and, in some cases, continuing medical coverage.

Apparently some have either had their benefits expire or did not qualify for extended medical coverage.

We have been made aware of one Chris Thaney who is a former Ford worker and is uninsured.

Apparently Mr. Thaney has multiple symptoms which cause him distress. He feels he cannot seek proper medical treatment due to lack of insurance.

While we certainly empathize with Mr. Thaney, we feel his attempt at self diagnosis and possible treatment is a bit unorthodox and should be avoided by others who are in a similar situation.

The MVNHS© - At it Again

This summer, we reported on the brilliant decision of the Scottish wing of the Much Vaunted NHS© which forbade health care workers from eating at their desks during Ramadan. The powers that be were fearful of upsetting (and/or offending) Muslim co-workers and patients. I opined at the time that this seemed, well, unseemly, never imagining that it could get worse.

Silly me:

"OVERWORKED nurses have been ordered to stop all medical work five times every day to move Muslim patients’ beds so they face towards Mecca."

Believe it or not, it actually gets even worse:

"The lengthy procedure...also includes providing fresh bathing water."

I really don't want to go there.

One presumes that this is for the Muslim patients' foot-baths, not daily (weekly?) bathing, per se.

Currently, only patients being treated in a few hospitals are privy to this over-the-top medical care, but that's slated to expand next year.

Again, I have no objection to patients being afforded a certain degree of comfort, but this puts actual, sick folks at risk, as well as representing a significant additional drain on an already strained health delivery system. If Muslim patients want to pay for this themselves, fine, have at it. But it seems to me that it's not the business of health care providers to render this sort of treatment. That's what volunteers (and paid private nurses) are for.

Of course, this is a nationalized health care system, so what the gummint says, goes. There's really no option for health care providers to demur, since the state has determined what's covered, and what's not.

Gosh, don't you wish we had such a system, too?

Cavalcade of Risk #40 is now online!

This week's edition is hosted by Joe Paduda, at Managed Care Matters. And it's a big 'un, including some new (to us) blogs.

If you'd like to host a Cav, we'd love to have you. We're now scheduling for early 2008, so drop us a line to schedule yours.

Welcoming Chanukah

We Jews like to do even the obvious things a little differently. Case in point: our holidays (or, if you prefer, Holy Days) run from sundown to sundown, rather than day to day. Thus, tonight is the first night of Chanukah this year (yes, that's different, too, but it's also another post), while tomorrow is the first day. In all, we'll celebrate the Festival of Lights for eight nights, each evening adding another candle to our menorahs.

And because we live in a predominently Christian country (life's tough, Penelope), we've absorbed some of the ambiance of the season, so there's a lot of gift-giving that goes on, despite the fact that there's no religious compulsion to do so. As with our Christian neighbors, we Jewish parents walk that difficult path between "too much" and "not enough" with regards to the commercialization of our holiday.

I am blessed to have a number of Christian clergy among my clients, and this time of year I often hear them wish for "putting the Christ back in Christmas." Of course, putting the "Chan back in Chanukah" only works on a certain (gastronomic) level, so we look for other ways to imbue the "spirit of the season" in our progeny.

Now, I'm going to make what may appear to be an abrupt transition here, but bear with me and you'll be rewarded.

In Judaism, the concept of "charity" is expressed in the Hebrew term "tzedakah." But this word actually translates more accurately as "righteousness." In fact, it is closely related to the word "tzaddik" or "righteous one." One of the most famous of biblical scholars, Moses Maimonides (more commonly known as "the Rambam") postulated 8 levels of tzedakah (as there are eight days of Chanukah; we'll come back to that). In fact, even those who receive "charity" themselves "must also give tzedakah to another."

And now we come full circle:

If you stop to think about it, our children are (perhaps) the neediest of all. They depend on us for the very necessities of life: food, clothing, shelter. Yet they are required to observe tzedakah, as well. As noted in this morning's USA Today, "many Jewish families are highlighting the spiritual side of Hanukkah by devoting at least one of the holiday's eight nights to tzedakah."

This is critically important: for many American Jews, it's the only time they really spend celebrating Judaism in their homes (Shabbat, the Sabbath, is actually the original home-based holiday, but is often left unobserved in modern Jewish homes). With so much attention focused on the "eight crazy nights," it's actually an ideal time to discuss what tzedakah really means, and its importance to Jewish life.

Eight levels of giving, eight nights of light: coincidence?

I think not.

Happy Chanukah!

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.