From the P&C Side: A Monstrous Idea...

If you've been to a movie or surfed the web recently, you've no doubt seen the trailer for the new horror flick Cloverfield. Like Godzilla before it, the goal of the monster is to destroy a city (whether it's New York or Tokyo, these guys are pretty destructive). There are often morals to these kinds of efforts: nuclear weapons, global warming, Brittany Spears, etc.

But when that monster is bearing down on your house, you have to ask yourself this question: Am I covered?

Fear not:

Low Margin Patients

Got Medicare?

Love it?

Think everyone should have it?

Might want to reconsider.

Mounting pressure on doctors stemming from Medicare has New Jersey physicians thinking about dropping patients with the federal insurance.

Dropping patients.

That would be . . . rationing of services.

The group says Medicare reimbursements are falling behind the rising cost of running a doctor’s office in New Jersey,

Falling behind.

Scott says spine surgeons and some other specialists have already stopped taking Medicare users, mostly because they can’t afford to see “low-margin patients.”

Low margin patients.

Kind of has a ring to it.

“Doctors need to think of their practice as a business, and they need to come up with creative ways to deal with changing reimbursements,”

Sounds like docs are for-profit practitioners. Some feel that profit and medical care are mutually exclusive terms.

That is mostly coming from low margin patients.

Mama was right

Remember when you had the sniffles as a kid, and your mom brought you some nice, warm chicken soup (maybe with those cool mini-star noodles floating around in it)? She told you it was good for you, and after a few tentative sips, as the warmth flowed through you, you believed it.

Well, she was on to something:

"According to Dr. Weil, the nation's leading doctor turned alternative doctor; chicken soup is indeed healthy for us."

A healthy and comforting thought on a blustery winter's day.

H/T: But You Don't Look Sick.

Throwing Out the Baby with the Bath Water

Seems like most of those railing against the private health care system (and health insurance) want to scrap what is working and start all over. Many favor a "Medicare for all" approach without really understanding, or studying the ailments of Medicare (not the least of which is underfunding).

But here is an idea that has not been given much press. Why not run a tandem system and let the public decide?

competition between a new government plan and private insurance programs, has been overshadowed by the political horse race

Keep the current system. Allow the public to buy the Medicare plan if so desired.

In essence, create a new form of competition rather than insisting on a monopoly controlled by the government.

I like it.

Under the proposals being advanced by Clinton, Obama and Edwards, the government would offer coverage for middle-class workers and their families, with benefits comparable to those now provided for federal employees and members of Congress.

You can buy private insurance, or you can buy the same plan Congress has.

Your choice.

What McClellan and other critics say they fear is that the government plan could underbid private insurers

That is the downside.

Since Congress fails to understand the concept of limited funds, they may opt to siphon off increasing taxpayer subsidies to keep the plan competitive.

Only the government can continue to operate by spending more than they take in without collapsing. Private enterprise eventually has to either come to Jesus or go under.

Moon suggested that a government plan could be used to test ideas for reducing waste and improving quality, such as cutting payments for treatments of dubious value

Cutting payments. Sounds like rationing. Is that part of the deal?

Wanna bet some folks won't like that?

"You could allow a government option as a way of setting a standard, as opposed to issuing lots of regulations that would apply to every insurer,"

Give people a choice.

Buy the government plan that covers IVF (as an example) or the private plan that does not.

Granted, this type of approach has its' downside. Of course the government decided to get into the over 65 health care funding business 40 years ago. Rather than driving carriers out of the business it actually created new opportunities. Carriers are still one of the primary sources for supplemental coverage.

You know, insurance to cover the things Medicare does not cover.

I am not saying I am all for this tandem system, but I do believe it can result in a system that allows the public to see there are no free lunches. Some states, Georgia being one of them, are considering allowing individuals and businesses to buy the same plan offered to state employees.

As long as taxpayer dollars are not used to subsidize the cost, I like it.

Carnival of Personal Finance

Hosted this week at Green Panda Treehouse, this week's C of PF is finally up. It's a large edition, helpfully categorized.

Check it out.

If you love accounting, and you love free stuff...um, if you love free stuff, check out FIRE Finance's cool webfind: Microsoft Accounting, gratis.

Mindless Insurance

Need medical care? No problem. You have insurance. They will pay your bills.

How much does it cost?

You have no idea. The insurance company will pay the bill.

Or will it?

On Aug. 17, my 14-year-old son was kicked in the groin during a preseason soccer match. . . The urologist at our community hospital suggested an ultrasound to make sure there was no internal damage. Since it was late on a Friday afternoon, the doctor recommended that my son go to the hospital's emergency room for the scan. The results, fortunately, were benign and my son recovered quickly.

But a month later, the bills started flooding in: hundreds of dollars from the hospital ER, plus a few hundred more from several ER doctors and the urologist who treated my son. We also owed hundreds more for other medical services my family and I had used. On top of that, we still were obligated to pay hundreds to the orthodontist for my son's braces and several hundred dollars to podiatrists for services not covered by our plan.

By last fall, we owed nearly $3,000 in medical expenses.

ER, ultrasound, braces, podiatrist . . .

Sounds like $3,000 out of pocket is a bargain.

Especially for services that are not covered . . .

The bills had begun accumulating shortly after my husband, a social worker, switched jobs and we were forced to change health insurance from a local Blue Cross plan to a for-profit national plan. My husband was not offered a choice of health plans, and when we signed up it was not made clear that our deductible for the year would be $3,000 (for in-network expenses; $4,500 for out-of-network expenses).

Not made clear.

Was the policy written in Chinese?

Nor did we understand that once we met the deductible (i.e., spent $3,000 to $4,500 of our own money), we would then have to pay co-insurance: 15 percent of every in-network expense we incurred and 45 percent of any out-of-network expenses.

Is English their primary language?

Does anyone bother to read their policy, or do they just sign up for Mindless Insurance and assume anything they want is covered?

Flea-Bitten (Revisited)

This past summer, we explored the strange case of (now former) medblogger Dr Flea. The good doctor, you may recall, was caught blogging about his own patients, and making fun of the attorneys prosecuting a malpractice case involving the death of a teenaged patient. At that time, it was revealed that Dr Flea and the defendant were one and the same. As a result of his "outing," Dr Flea apparently pulled his blog, never to be heard from (at least in the blogosphere) again.

Until now.

As our friend Dimitriy reports in his post at Trusted.MD that the erstwhile Dr Flea (aka Dr. Robert Lindeman) was interviewed in a recent article in the Canadian National Review of Medicine (NRM). Our Friends to the North© were writing about the risks and rewards of medblogging, and asked Dr Flea/Lindeman about his experience.

In keeping with his, um, less than circumspect style of prose, he responded that "(n)o wonder when doctors write, they write namby-pamby noncommittal crap...it might get you in trouble someday."

Actually, nothing could be further from the truth.

Don't believe me?

Well, one has only to consider Dr Ford's interesting and often provocative posts. That good doctor isn't afraid to take on "big pharma," or little widgets. He also offers solid advice, without rancor or sarcasm (well, sometimes a little sarcasm, but it's always well done).

Still not convinced?

Well, Dr Zagreus (a 2007 MedBlogger Award Finalist) is nothing if not cutting edge, unafraid to take on some dragons (or even innocent, mild-mannered insurance bloggers). And he does that without resorting to "namby-pamby noncommittal crap," as well.

So Dr Flea's fled, and that's not such a bad thing, after all.

Silly Candidate Tricks: P&C Version

A few months ago, we reported on Sen Edwards' empty threat to strip congressgritters of their elite medical coverage. Lest folks believe that we only ding the Democrats, we bring you the latest goofball idea from the Republican side:

"Rudy Giuliani is trying to edge out his fellow Republican presidential contenders by pledging to make homeowners insurance more affordable in high-risk areas - a key issue in this hurricane belt state."

On the one hand, it's comforting to know that our P&C brethren aren't immune from folks looking for gummint solutions to private sector challenges. But if such schemes are unworkable with regard to health insurance, why would this be a good idea for homeowners cover? After all, they share many characteristics.

Indeed, as we reported back in November, the Sunshine State already has a gummint-run insurance plan. And that one is in the hole by almost $400 billion (with a "b"). So what's Rudy's plan?

"(A) federal "backstop" fund to spread insurance risks associated with hurricanes and other disasters."

Essentially, he's proposing to make the Feds a sort of hyper-reinsurer. There's precedence for this, of course (cf: 9/11 victims fund), but is it a good idea? Yes, this may prove quite popular in Florida, where homeowner's insurance tends to run high, but why (other than for vote-pandering reasons) would someone propose making that a permanent fixture, with untold billions of future liabilities?

Oh, looks like I answered myself.

IB on TV

It never ceases to amaze me that we have become so well-known: among other things, we've been invited to teleconference with a Senator, review books, and even be on TV.

Whoa there....TV?!

Yup. Last spring, some folks from the the Fine Living Channel invited us to participate in the pilot for a new program called "Stop, You're Paying too Much!" We discussed it amongst ourselves, and Mike Feehan volunteered to take the gig. So this past summer, he went in front of the camera, and into the history books (well, TV history, at least). The show aired last month, and we were fortunate enough to have several IB readers volunteer to Tivo it for us. One of those folks is Tom Tullis, who yesterday delivered to me a DVD of the show.

Thanks to the technical wizardry of my eldest daughter (who not only knows how to set the clock on the VCR, but how to make these things playable on my PC) we present for your edutainment our own Mike (aka John) Feehan:

Aetna Repo Man

Miss a few payments on your car? The repo man will hunt you down and take away your car.

Can't afford to continue paying for the big screen TV? The repo man will come and take it away.

Buy the wrong arm? The Aetna repo man will come take it away.

Eric Simpson was strangely calm when the insurance company called last week, saying it was sending a man for his right arm.

The woman on the phone told him he should have known he had only $2,000 of coverage through Aetna for artificial limbs. And the arm, which he'd just received that week, cost more like $37,000.

Whatsa matter? Didn't Eric read his policy limits?

Angelo Russello had the job of taking Simpson's arm. He works for Allied Orthotics & Prosthetics in Northeast Philadelphia.

Nice job.

All week he'd been visiting Simpson at Moss Rehab in Elkins Park, fitting the device, teaching the 32-year-old Germantown man how to flex his muscles to move the thumb and fingers.

"I felt like a fool," says Russello. "I've got to tell you, this has never happened before."

Simpson read his face and said, "Just take it."

Eric Simpson is growing used to being disarmed.

My guess is, moonlighting as a repo man probably wasn't covered during the initial job interview.

So what does Aetna have to say about this?

"A miscommunication," Aetna spokesman Walt Cherniak said yesterday.

Miscommunication?

Perhaps the repo man was told to break his kneecaps too?

Aetna officials had mistakenly considered his new arm medical equipment rather than a prosthetic, which is covered in full. They called Simpson to apologize.

And as for Eric's arm?

And the next day, Friday, Russello returned the arm.

This is really bizarre.

I Like THIS, too...

"Emily Lisker was hesitant to see a doctor, no matter how bad she felt...last winter, when she came down with a bad cough, Lisker immediately called her doctor and immediately got an appointment."

So what, you ask?

Well, it may help to know that Emily is uninsured (by choice), and that she chose to avail herself of an "innovative program called HealthAccessRI."

And what, you may further ask, is HealthAccessRI?

It's a program sponsored by the state of Rhode Island which, for a modest $30 monthly fee, gets her priority access to a primary care physician. What started as a pilot program recently went statewide; it was originally conceived by Dr Michael D. Fine, whose practice became the testing ground for the plan. He must be an IB reader, as well:

"The premise underlying the plan, Fine says, is that primary care is both inexpensive and effective, and for most people, it’s all they need."

Exactly!

He's also quick to point out that this is "not insurance," which is a useful admonition. But it also serves to underscore our long-running contention that health insurance is not the same as health care. That's a critical distinction, and one which it appears that the folks behind HealthAccessRI understand.

Hat Tip: Neal Boortz

Middle-age Nintendo Mutant Surgeons

[Welcome Industry Radar readers!]

(Patient) "Say doc. Just how many of these gallbladder surgeries have you done?"

(Doc) "On real people?"

(Patient) "Well, yeah . . ."

(Doc) "Including you?"

(Patient) "Yes . . ."

(Doc) "One."

Far fetched? Maybe not.

playing certain video games on the Nintendo Wii helps surgical residents to hone their fine motor skills and improve their performance on a serious surgery simulator.

Sounds like a Doogie Howser episode.

Or maybe Revenge of the Nerdy Doctors.

OK, maybe "mutant" was a bit over the top.

Storm Front

Want to smoke?

Buy your own insurance.

Health insurance costs have been a major sore spot for employers over the last several years. It can easily cost a thousand dollars or more per month to insure a family, and much more if a company has sick employees or a particularly generous health plan. In an effort to help cut those costs, employers are turning to their employees who smoke, eat poorly, and are overweight to foot the bill. 16% of employers are now making smokers pay the toll for their bad habit

Great idea.

However the D.O.L. has a different view.

Any bet's on who wins this battle?

Give Me A Break!

[Welcome Industry Radar readers!]

Ron Norton, a Massachusetts professor, says he cannot afford health insurance under the Massachusetts mandate.

He earns $40,000 per year but his "employer does not provide health insurance" (for 1099 employees).

His wife works for an employer that provides health insurance . . . but her income, combined with his, pushes them above the level where he can get a taxpayer subsidy.

"I'll probably have to quit teaching after this year, even though I love it, and look for a clinical radiology technician job with benefits

So this 40 year old man cannot live his dream because his state requires their citizens to buy health insurance and his employer does not "provide" coverage for him.

Cry me a river.

Carnival of the Capitalists: Requium

The good news is that the Carnival of the Capitalists is (finally) up, hosted by its creator. The bad news is that this seems to be the final CotC, at least in its original format. Out of 43 submissions, only a third made the final cut (our post on insurer audits was among that latter group).

I must say that I disagree with the host, who avers: "Blog carnivals as a concept are dead." It's true that they are changing; indeed, they need to change. Many of them have become unwieldy and off-topic. But change is not death, it is transformation.

Recently, I had some correspondence with Julie Ferguson, the hostess of this week's Cavalade of Risk. In part, I wrote that "The thing is, the caps & personal finance ones have gotten so big, they're sort of overwhelming (and that happens sometimes with grand rounds, as well). I think that's why I like hwr & cor: they're a lot more manageable: I enjoy clicking thru a dozen or so posts; 40 or 50 or 60? Not so much."

[ed: "caps" is Carnival of the Capitalists, "personal" is the Carnival of Personal Finance]

Smaller, more niche-intensive carnivals like Health Wonk Review and Cavalcade of Risk represent, I think, the transformation to which I alluded above. By focusing a more narrow beam, and thus appealing to a more limited audience, such round-ups offer a better "value;" in this case, how much useful, relevant information can I glean in the least amount of time?

We'll definitely revisit the CotC down the road, to see how things are going there.

Something New Here...

I subscribe to the school of thought that short blogrolls are better. That is, a huge laundry list of links is less useful than a shorter, more directed one. So I rarely add to ours.

Segue: There exists a whole community of "patient bloggers" ("patient" as in under the care of a physician, not necessarily easy-going) who write about their experiences. IB frequent commenter Marc is one such. Within the medblog community, though, few are as well-known and respected as Amy Tenderich, who blogs at the award-winning Diabetes Mine.

Amy writes poignant, insightful posts on her experiences as a diabetic, as well as reporting on the latest diabetes research and news. There is no self-pity. Rather, she inspires others to stay strong and positive.

I am proud to add her terrific site to our blogroll. Do check it out.

Cavalcade of Risk #43 is up!

Julie Ferguson, of Workers Comp Insider, hosts this week's Cavalcade. As usual, she does an outstanding job, with a bunch of great posts.

While you're there, be sure to catch Joe Kristan's important post on S Corps and health insurance tax deductions.

We'd love to have YOU host a Cav. It's fun and easy, and a nice traffic bump. Just drop us a line to reserve yours.

The D.O.L. Wants You Fat, Dumb & Happy

[Welcome Industry Radar and Wall Street Journal readers!]

Looks like the D.O.L. is meddling where it does not belong. It seems employer incentives to get you off the couch and into a gym are not in your best interest.

Same goes for stop-smoking incentives, drug & alcohol rehab incentives and health screenings.

The D.O.L. thinks you are better off as an overweight, smoking alcoholic. After all, the carrier is paying the bill for the abuse you are inflicting on your body.

Regulatory guidelines recently issued by the department are likely to curtail the ability of employers to motivate workers to kick unhealthy habits. In effect, the guidelines close a legal loophole that could have allowed employers to make health insurance more expensive for unhealthy workers than for their colleagues.

Loophole.

Nice choice of words.

workers enroll in an employer-sponsored health plan with a high insurance deductible. They can offset the deductible by earning "wellness credits" for meeting certain health benchmarks -- such as for cholesterol count -- issued under a separate supplemental policy.

So healthy people, in effect, are rewarded with lower total health care costs.

Isn't that like offering better interest rates to those who are financially healthy? Or better pay to workers who perform better on the job?

So is the D.O.L. trying to socialize the employer health market? The homogenization of the workforce.

Looks that way.

Proponents liken the rewards to giving a good-driver discount, arguing 70% of health-care expenses are lifestyle-related. Exposure to higher out-of-pocket costs motivates employees to improve their health, which saves employers money.

OK, but doesn't it also save the EMPLOYEE'S money?

Seems that way to me, but who am I to question the D.O.L.?

So the D.O.L. not only wants to promote an unhealthy lifestyle, they want you to pay more for health care and health insurance.

What kind of logic is that?

Oh yeah. This is the gubbermint. It doesn't have to be logical.

A Presidential Grand Rounds

Blogger Alvaro Fernandez, who hosts Sharp Brains, presents a tremendous 'Rounds. It's in the form of a letter to our next President, offering a myriad of ideas, opinions and insights on health care delivery and financing. There are over 3 dozen items from which to choose, all categorized and annotated.

Over at the Health Business Blog, FoIB David Williams discusses new research on (and for) kids with attention deficit issues.

THIS, I like...

Regular IB readers may recall our early piece on "minute clinics," and how impressed we were with the concept. The idea is to move away from traditional (and expensive) delivery models for routine care, and toward more economical, cost-effective ones. Interestingly, the latest breakthrough in this practice comes to us from, of all places, the Bay State:

"Yesterday, the Massachusetts Public Health Council approved a controversial plan to allow pharmacies and other retailers as well as nonprofits to operate medical clinics for certain limited ailments...Now, for the first time in the state’s history, retailers may operate in-store clinics where licensed medical professionals may diagnose, and then treat, bronchitis, pink eye and sinus infections."

It's not clear why such delivery systems would be "controversial," except to those who have a vested interest in the older model. But if those entrenched interests were paying attention, they'd know that:

"In other parts of the country, in-store clinics are a fast-growing business. Since 2000, MinuteClinic has opened 465 clinics in 24 states."

And that's just one "brand." There are others, and the demand is apparently (and unsurprisingly) growing.

What's also interesting to me is that these kinds of service providers dovetail nicely with the burgeoning supply of "mini-med" insurance plans. And that makes sense: if one's health plan reimburses office or clinic visits at, say, $60, then one's out of pocket for such is (at worst) minimal. Are we seeing a natural growth pattern here, one which would anticipate (and perhaps mitigate the need for) gummint-mandated schemes?

Of course, there are no "minute hospitals" (yet?), but the basic idea seems promising.

[H/T: Coyote Blog]

ADDENDUM: I'm kinda disappointed that I missed this application myself, but one of the commenter's on Coyote's post points out that this might be a good use for HSA funds, as well. Depending on a given service's cost, a minute-clinic visit may actually be less expensive than even an in-network provider. And if there is no in-network provider nearby, then it may be an even better deal (versus an out-of-network "traditional model" provider).

I just love National Health Care...

[Welcome Industry Radar readers!]

From an article in today's Telegraph.co.uk about the organ shortage in the UK...

The proposals would mean consent for organ donation after death would be automatically presumed, unless individuals had opted out of the national register or family members objected.

The Government will launch an overhaul of the system next week, which will put pressure on doctors and nurses to identify more "potential organ donors" from dying patients. Hospitals will be rated for the number of deceased patients they "convert" into donors and doctors will be expected to identify potential donors earlier and alert donor coordinators as patients approach death.

This sounds like a cross between Jonathan Swift's "A Modest Proposal" and something out of China.

Oy Canada (Part XII)

It's been a while since we last looked in on our Friends to the North©, but Bob sent this along earlier today:

"In the survey of more than 20,000 doctors and doctors-in-training from across the country, 75 per cent reported that inadequate funding of the health-care system and an undersupply of physicians and other health professionals, along with paperwork and bureaucracy, are curtailing the amount and level of care they want to provide patients."

But wait, it gets better (or worse, depending on one's perspective):

"(W)e have community after community with patients who are unable to access a family physician for themselves or for their families."

Ooops.

Turns out, Canada would have to come up with over 26,000 new physicians to meet "global standards" (whatever they are), which doesn't seem, um, likely. Of course, they could simply "import" a few more, but the health system's certification process apparently makes that quite challenging (which may actually be a good thing).

But hey, it's free.

[H/T: Don Surber]

Carnival of Personal Finance

This week's Carnival of Personal Finance is now available at Plonkee Money (cool blog name alert). It is GIGANTIC: including a Top 10, there are over 7 dozen entries, alll categorized, all with helpful context. WoW.

Even with such a plethora of choices, I found a standout: Bob McDonald's thoughtful piece on why one ought to delay going on Social Security. Very interesting.

UPDATE: Bob's updated that post to include the cost of health insurance from ages 62 through 65. This is a critical piece of the puzzle, and if you have a chance, definitely stop by to check out the revised edition.

The Patient No One Wants

[Welcome Industry Radar readers!]

For 248 consecutive days and nights, Ritta Wadawu has lain in a hospital bed in the same room on the ninth floor of Grady Memorial Hospital.

Grady Hospital.

The taxpayer funded, "charity" hospital in Atlanta.

Although she is paralyzed, it's not her condition that's kept her at Grady for eight months. She remains there because she has nowhere to go.

Nowhere to go.

No nursing home or rehabilitation center will take her.

That includes nursing homes and rehab centers that accept Medicaid patients.

She has no official immigration status in the United States. The government allows her to stay for humanitarian reasons – and because the cost of sending her back to Zimbabwe would be too high.

The cost?

An estimated $125,000.

Just to send her back to Zimbabwe.

So how much has her care cost over the last 2 years?

Since the accident that made her a quadriplegic on Dec. 31, 2005, her bills have mounted to more than $1.3 million. There is no end in sight.

What about other options?

At first, Ken Levine, Ritta's immigration lawyer, tried to get her possible deportation dismissed because of her condition. Then he did a U-turn and asked about the possibility of returning her to Zimbabwe to the care of her sister, the nurse. He said he was told the cost of sending her back would be more than the government was willing to spend.

In limbo.

And what about Medicaid payments?

Hospital spokeswoman Denise Simpson said Grady "hasn't been paid a penny" on either of Ritta's hospital bills. "Nothing's come in as far as we can tell," she said.

Even Medicaid, the taxpayer safety net for health care, has failed to provide.

Let's see a show of hands. Who wants a government run health care system?

Only You Can Prevent the Health Care Crisis

[Welcome Industry Radar readers!]

Remember the old P.S.A. featuring Smokey the Bear? "Only you can prevent forest fires."

Well guess what? The answer to more affordable health care, and, in turn, more affordable health insurance, starts with you.

Consider that one in four Americans eats fast foods each day. Sixty percent of Americans rarely or never exercise. Sixty-six percent of U.S. adults are overweight or obese.

See anyone familiar in this?

More than half of health insurance claims are paid for lifestyle-related illnesses due to smoking, alcohol use, obesity and sedentary lifestyle.


Imagine the kind of impact on health insurance rates if everyone lived a healthy lifestyle.

Just imagine.

(Not So) Foolish Advice

Psst!

Want to save bundles on health care?

The Fools have some suggestions . . .


Part of why having health insurance is valuable is that your insurer usually negotiates with doctors and hospitals to charge less for covered patients. But even if you're not covered, you can negotiate the same deals

When was the last time you asked the cost of a procedure? Or asked your doc if a lower priced medicine or treatment plan is just as effective?

My guess would be . . . never.

by learning what you're being charged for, you can challenge the common mistakes that inflate your bill. Some insurance companies even offer rewards if you find a mistaken charge.

Read your E.O.B.

You don't have to be a rocket surgeon to figure it out.


For non-emergency care, it's smart to call your insurer beforehand to find out whether there will be any problems down the road.

Don't just ASSUME that all providers are in network. That is one of the biggest mistakes people make that can cost them thousands if you are not careful.

Many doctors and hospitals offer free or low-cost screenings and other services from time to time.

Places like Minute Clinic deliver low cost, quality care for around $40.

Bottom line. Take charge of your health care rather than going along for the ride.

A Proper Conversion

[Welcome Insurance Forums readers!]

We write a lot about health insurance here at IB, but we're far from one-trick ponies. Although life insurance is (generally) a much less controversial topic, and the product has fewer moving parts (and, of course, just the one claim), it's no less important, and has its own set of potential pitfalls.

Case in point:

A few weeks ago, I received a phone call from a woman who was referred to me by another agent. She was looking for help in dealing with her father's life insurance.

Years ago, Larry (her father) [ed: not his real name, of course] bought a 15 year level term policy. Like many (most?) people, he knew that he'd only need the coverage until he retired: by that time, of course, his mortgage would be retired, his kids grown up and settled, his 401(k) fully funded, etc.

(Term insurance has been likened to "renting;" that is, one buys pure protection, with no cash accumulation and a limit on how long the premiums stay the same)

A few years ago, he re-financed his house (better rates, don't you know) and bought a new car. Again, he bought into the conventional wisdom, and assumed that, worst case, he'd simply buy another 15 year policy "down the road."

One of our colleagues (and a frequent commenter here) is fond of pointing out that "we buy most things with our money, but we buy insurance with our health."

How true:

Four years ago, Larry suffered a series of strokes, each one worse than the last. He also suffers from COPD, high blood pressure and cholesterol and (of course!) he still smokes the occasional cigar. Next month, the 15 year lock-in goes away, and he is faced with paying quickly escalating annual renewable term premiums (that's what happens at the end of the level term period). Now age 67, with a litany of physical impairments, what are his choices?

Yes, there are carriers that specialize in these cases, and we looked into those. As one might expect, the offers that resulted were, um, less than appealing.

Which left, what?

You guessed it: the much-maligned and oft-overlooked conversion privilege. This is a clause (usually included at no extra charge) that guarantees one the right to change (convert) one's policy to a permanent form of insurance if one so chooses. This is sort of "insurance on the insurance," assuring that one can keep some affordable coverage even if one's health declines.

After consulting with the carrier (which, happily, I also represent), we determined that we could convert much of his existing coverage to a permanent (I prefer whole life, others UL) plan, with guaranteed premiums and coverage.

Because life is full of surprises.

Cavalcade #43: Submissions Due

Julie Ferguson, of Workers Comp Insider, hosts next week's Cavalcade. Please make sure to get your submissions in by Monday (the 14th). Julie requests 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 have slots available for the New Year - just drop us a line to reserve yours.

Health Wonk Review: New Year edition

Bob Laszewski hosts this year's first HWR, and it's a doozy! This may be the biggest one yet (with almost a dozen and a half posts), and every entry is worthwhile. Take a gander and savor each one.

Having said that, I was really intrigued by one of my favorite med-policy bloggers, Roy Poses. His Health Care Renewal blog is always interesting, and this post, on the scuzz-bucket (my term, not Roy's) who ran the Institute for Cancer Prevention is a case study in greed (and, ultimately) stupidity.

It's Your Body

Sadly, more people take better care of their cars than they do their body. They tend to ask more questions before getting a repair than they do before beginning treatment for an illness or injury.

While many Web savvy patients today can ask a doctor about minute details of their circulatory system or cancer treatment, when it comes to asking the really tough, personal questions, they often clam up.

The web can be a great resource, or it can be filled with myth and misinformation. I imagine all too often docs spend as much time correcting patient impressions as they do explaining treatment protocol.

An informed patient can be a boon or a bane.

Ronda Collier, a 43-year-old Ann Arbor, Mich., marketing professional, consulted several surgeons prior to having brain surgery a few years ago, but she recalls being too worried about seeming offensive to ask whether a doctor had a good safety record or used recreational drugs or alcohol.

Frankly, these are questions I never thought to ask.

Until now . . .

So tell me doc, when was the last time you inhaled?

The linked article has many useful sites including Spine Universe, the American Society for Dermatologic Surgery, and the American Board of Medical Specialties.

This article is a must read.

Getting Ugly

While our own health care system has its problems, those hankerin' for a gummint takeover of it may want to take a step back and consider some potential problems.

The MVNHS© is seeing an unintended (one hopes) consequence of long lines and limited services:

"One in three doctors has been physically or verbally attacked at work in the last year...One in 10 was physically attacked, including being stabbed, kicked, punched, bitten or spat on. Of these, a third suffered minor injuries but one in 20 was seriously hurt."

I must admit, as ardent an opponent of such systems as I am, I had never suspected that the Brits would trade in their stiff upper lips for doctors' fat lips.

And things aren't much better for our brethren North of the Border, either:

"Faced with an aging population requiring increasingly complex care, overwhelmed Canadian doctors are feeling more and more frustrated by their inability to properly serve their patients' health needs...75 per cent reported that inadequate funding of the health-care system and an undersupply of physicians and other health professionals...are curtailing the amount and level of care they want to provide patients."

One of the points we've repeatedly made here at IB is that such systems don't really contain costs, they just limit access to ever-increasing ones. Let's just hope that the Canucks don't start high-sticking their doctors.

More Mythbusting

Back in December, we learned that turkey doesn't necessarily make you sleepy, or that reading in the dark will make you go blind. According to Gwen Schoen (food writer for the Sacramento Bee), there are few other food myths that we've always bought into:

■ Think ground beef is all bad? Think again.

■ Do you believe that dieting and pizza are mutually exclusive? Wrong.

I just love playing with my food(pyramid)!

A Troubling Conundrum

We've written before on the imposition of religious practices on health care delivery. In those two instances, the issues were (over-)sensitivity to patients' religious needs, and didn't impact their actual care.

A while back, Dr Ford had a sobering post on the future of euthenasia, and the ethical issues that surround letting patients die (or even encouraging them to do so).

What happens when theological considerations directly impact not only the type of care, but active euthenasia?

Such is the problem facing the Canadian health care system:

On one side, Winnipeg's Grace General Hospital, a 100 year old, 270-bed institution serving a diverse community.

On the other side is Samuel Golubchuk, an 84 year old Orthodox Jew currently on a respirator, and whose prognosis isn't particularly hopeful.

Because of his apparently failing health, Grace General wants to detach him from the respirator to save precious health care dollars by hastening his death.

Okay, that's probably not fair. How about: Because of his apparently failing health and advanced age, Grace General wants to detach him from the respirator in order to maximize the (limited) resources at its disposal to make them available to younger and potentially more viable patients.

This is called "rationing."

It's also at the center of a controversy about where the state's authority (after all, it's a nationalized system) and one's religious beliefs meet. You see, according to Orthodox practices ("halacha"), "removing a feeding tube from a patient who has any brain function is active euthanasia, equivalent to murder."

And there's this: Mr Golubchukhas signed an advance directive (living will) that specifically requests that he be kept alive. Thus, the state is impinging on both his religious beliefs and his autonomy as a Canadian citizen.

We may argue all day long about the value and benefit of spending untold dollars to prolong the life of an octogenarian, but one thing that should send chills down the spine of anyone who still thinks that a gummint-run health care system is a good idea:

"A Grace General Hospital lawyer told the court that doctors "have the sole right to make decisions about treatment - even if it goes against a patient's religious beliefs."

Indeed.

MedBlog Awards Update

Congratulations to our friend Dr Zagreus, whose The Physician Executive blog garnered two(!) finalists spots (Best New Medical Weblog & Best Health Policies/Ethics Weblog).

Please take a moment to go vote for him.

Medicare Out of Control

Amidst the cry of "Medicare for All" comes a disconnect that begs the question. If Medicare can't control health care costs then why foist a system that pays providers 30 - 40% less than private carriers on the American public?

Medicare is the largest single provider of health care coverage in the United States. As such, they are in a position to say what is covered, what isn't and what they are willing to pay.

Medical providers who treat Medicare patients must be willing to accept the lowest reimbursement of any payor, except for the uninsured who usually pay almost nothing for care.

So how much per beneficiary did spending increase for 2006?

In all, Medicare spending increased at the fastest pace since 1981 -- nearly 19%, to $401.3 billion in 2006 from $338 billion in 2005.

So how is the government going to control health care costs and make coverage more affordable?

They aren't.

Phantom Insurance and Other Ways to Waste Dollars

It seems that consumers everywhere are complaining about the cost of health care and health insurance.

At the same time they are throwing away dollars like there was no tomorrow, buying phantom insurance and other ways to waste their money.

Here are a few examples.

A lady called looking for health insurance. Her current plan was increasing to over $600 per month. Among her health issues was high cholesterol. Every year her doctor ordered a lipid panel test as part of her physical exam. He also had her on an expensive cholesterol reducing med.

I suggested a carrier that would insure her but would not cover her cholesterol med or her lipid panel.

The premium was $280 less than her renewal.

The med would run $140 per month. The lipid panel around $80, once a year.

She opted to keep what she had and pay the higher premium.

She believes she has coverage but all she really has is phantom insurance. The cost of the phantom insurance is over $2500 per year.

A man asked me about options, should he leave his current employer plan and purchase individual insurance. He was entertaining a job offer that would increase his current salary by $80,000 per year but did not offer health insurance.

His current plan was quite rich with $20 copays and a $500 major med deductible. His cost was $100 for him and his wife.

He looked at plans with a $1000 deductible and $25 copays for $700 per month. I suggested a plan with a $5000 deductible and a $300 premium.

He asked what the difference was in the $700 plan and the $300 plan.

With the $700 plan you have something similar to your current coverage. So what do you get for the $400 difference?

You get to forfeit $5000 of your raise. Money you will never see again.

He said he wanted to weigh his options but felt "more comfortable" with the lower deductible plan.

He wanted phantom insurance.

A man called about HSA plans. His wife was a reluctant participant in the decision. She really liked the copays.

We finally resolved all of her issues after several weeks of hashing out issues. But there was one final stumbling block.

"Her doctor" was not in the network of the proposed carrier. Another carrier had an identical plan but the premium was $160 per month more.

She was willing to pay $1800 per year in additional premiums to see her doctor once a year.

She wanted phantom insurance.

In case you haven't figured it out, Phantom insurance isn't insurance at all. It is additional premiums paid for coverage that does not exist and a complete waste of money.

When consumers stop buying phantom insurance they can pocket more of their hard earned money and stop padding the coffers of the carriers.

Grand Rounds is up!

Hosted this week by Trent McBride, proprietor of pathtalk blog. Trent has 3 dozen interesting med-posts, all with helpful context.

Those who've been following the exploits of the MVNHS© should click over to Interested Participant's post on that service's "creative" use of death certificates.

No wonder the Wolverines are Blue

As the father of a rabid Buckeye's fan, I'm a little more sensitive than most to the shenanigans that Wolverines are accused of playing. Most of the time, it's just game-day jitters, or disagreements in judgement with the ref's.

Seemingly unrelated, one of our most popular features here at IB is our Stupid Carrier Tricks series. If for no other reason than size, Blue Cross tends to bear the brunt of more than a few of these.

Okay, so what's my point?

Glad you asked:

"Introduced by Rep. Virgil Smith, Jr. on October 11, 2007, to establish a Blue Cross Blue Shield guaranteed issue high-risk health insurance pool whose maximum premium price would be capped, and levy a fee on other health insurance companies to recoup the cost of insuring individuals in the BCBS pool."

That's right, Michigan is about to essentially hand over the individual medical market to one carrier. No matter how much one may admire the work that BX has done over the years (and they do have their fans), this is an outright gift to them.

How so?

Heartland Institute Research Fellow Jeff Emanuel explains that because of BX's unique status it looks like a not-for-profit tax-exempt entity. And it's taxed that way, too: that is, not at all. But it somehow manages to actually rake in siginificant dollars; its tax-exemption grants it a substantial competitive advantage. Because of the way 4 new mandates are worded, it's unlikely any other carrier would be able to price plans to compete with the Blues.

This would be a terrific deal for Blue Cross, of course, but once other carriers fold up their tents (and they will), Michiganders (?) will be stuck with fewer choices, less accountability and (ultimately) higher premiums.

As we've noted here before, we're all for each state trying out new methods and concepts. But if the idea is to increase choice and access, it's hard to see how this would do either.

IB In The News

Our own Bob Vineyard is featured in this month's issue of Heath Insurance Underwriter magazine. As a nationally-recognized expert on Health Savings Accounts, he was asked to share some insights on these cutting-edge products.

Kudos, Bob!

Carnival of the Capitalists

Nikole Hunter Gipps, who hosts the Small Business Essentials blog, presents 2008's first Carnival of the Capitalists. She winnowed the almost 50 submissions to 26 that "made the cut" (among them, our own Mike Feehan's post on retiree health benefits).

What do stinky cheese and mortgages have in common? You might be surprised: over at the Three Star Leadership Blog, host Wally Bock makes the connection.

Market Conduct Report

[Welcome Industry Radar readers]

If you have health insurance through Mega Life, Mid-West National of Tennessee, or Chesapeake, this is a must read.

Just a few of the findings:

In certain situations, the Company changed the diagnosis code or CPT code in the course of adjudicating a claim.

the Company did not have a claims manual or written claim procedures.

The Examiners found instances where the Company did not adjudicate claims in the correct insurance entity

Provider Misinformation

My wife and I are blessed in many ways, not the least of which is our health. We don't have many of the health issues that plague most people our age. We are not on medication for hypertension or elevated cholesterol. We do not use anti-depressants or sleeping pills.

The only health issue is my wife, who has dry eye syndrome. While this may seem like a lame medical condition I can assure you some of the issues associated with the condition are not pleasant.

But this is not about her condition so much as it is her doctor.

One of the treatment plans for dry eye are punctal plugs. In dry eye syndrome the glands on your eye either produce low quality tears, or the volume of tears is decreased. Punctal plugs are like tiny drain stoppers that are professionally inserted in the tear ducts to trap tears in hopes of fully lubricating the surface of the eye.

Rachel's doctor has been pushing this treatment for some time and she finally agreed to have the procedure.

She has decent insurance through her work and punctal plugs are a covered expense. The procedure is considered outpatient surgery, subject to the deductible and coinsurance.

Last week during a follow up visit, we decided to move forward and have the plugs inserted. We tried to find out the cost of the procedure in advance to no avail. While sitting in the examining room Rachel asked the doctor how much the procedure would be since his front office staff was no help. He had no idea, so his medical assistant was dispatched to collect the codes and pricing.

She returned and announced the plugs were $471 . . . and the bill for professional services would be $440 . . . per eye.

The doctors reaction?

"You're kidding!"

The assistant tried to minimize everything by saying insurance companies never pay full price, they discount everything.

Rachel persisted and asked how much the discount would be. The assistant said we would probably pay $50 if that.

I am in the room.

We have a deductible of $500.

It is January 4th.

There is no way this is going to cost us $50.

Rachel looks at me and I nod that we go ahead with the procedure.

There are 6 docs in this practice and I have no idea how many PA's and support staff. I am sure someone in there could have given us the network discounts but we didn't press the issue. We had figured before going that we would be out of pocket the deductible and probably a bit more.

I will point out that Rachel and I had researched treatment options, including punctal plugs, and had decided we were ready to move to the next level regardless of the expense. We had a general idea of the cost but were looking for something specific from our doctor.

Our doctor was no help.

This points out the disconnect in the medical community regarding the cost of treatment and how insurance works. Doctors are quick to promote a treatment plan without regard to cost . . . especially when a carrier is paying for it.

The same happens with patients . . . especially when a carrier is paying for it.

No one really knows how much health care costs because no one really pays for health care.

By the way, Rachel has noticed some improvement since her outpatient procedure which is what we hoped to achieve. As soon as the EOB is posted to our account I will provide the break out of billed pricing vs. carrier allowances.

That should be interesting.

This just in . . . the EOB for Rachel's visit has been posted. We owe $200.28.

Amazing.

Sceptered Isle sniffs need for more NHS regulation

Here is a report on a government-backed Natural Healthcare Council to be established this year in the U.K. The new Council will apparently function in, or with, the NHS and will regulate certain alternative medical therapies.

“Only mainstream alternative therapies such as traditional Chinese medicine and acupuncture are to be the subject of statutory regulation.”

Uh, “mainstream" alternatives? Well, never mind that. Anyway, "mainstream" alternatives apparently include aromatherapy, reflexology, massage, nutrition, shiatzu, reiki, and others. Who knew?

The purpose of the Council is reportedly two-fold:

(1) strike off errant or incompetent practitioners.

(2) set minimum standards for practitioners

Of course, “minimum standards” must be laid down before the government can admit anyone to the privilege of paying licensing fees. One must also have “minimum standards” before one can go round striking off those people from the registry. In this way, the new Council will AT LONG LAST provide NHS with the protection of best practices in . . . aromatherapy.

The report also states

“dealing with misconduct by therapists it will be almost as robust as statutory regulation . . . Suspension from the register will be the ultimate sanction.”

So let’s summarise. NHS creates a council to set up new laws that are weaker than existing laws, in order to create a register, so that practitioners of “mainstream" alternatives can be placed on the register, pay licensing fees, and then struck from the register if they violate existing law?

Is this really a better solution than not paying for treatment in the first place that is of unknown or unproven efficacy? Well, never mind that, either. In a government system, you see, nothing is ever denied. It is only regulated.

Sounds ever so worthwhile to me. How 'bout you?

Are health insurance and health care really different?

Here is an article that actually distinguishes health care from health insurance. And some very interesting results emerge.

Based on 722 responses to a recent survey of low-income Oregon families regarding barriers to health care:

“Families reported 3 major barriers: lack of insurance coverage, poor access to services, and unaffordable costs. Disproportionate reporting of these themes was most notable based on insurance status. A higher percentage of uninsured parents (87%) reported experiencing difficulties obtaining insurance coverage compared with 40% of those with insurance. Few of the uninsured expressed concerns about access to services or health care costs (19%). Access concerns were the most common among publicly insured families, and costs were more often mentioned by families with private insurance. Families made a clear distinction between insurance and access, and having one or both elements did not assure care. Our analyses uncovered a 3-part typology of barriers to health care for low-income families.”

[Me again] It appears that regular people make a clear distinction between insurance and health care access. In other words, the people who can least afford to consider their problem as some theoretical or academic issue, have the good sense to see insurance and health care access as two different factors. The survey also found “disproportionate reporting” based on insurance status (gee, surprise) and that concerns about access to health care or about health care costs arose more frequently from the insured respondents than from the uninsured. Now THAT is interesting. Why might the uninsured be less concerned with costs and access? If you are not asking that question - - well dang it, you should be. Maybe a subsequent survey will probe that finding.

The survey is reported here (registration required – try the link anyway, and read the whole article if you can).

UPDATE: Found a working link (no reg required).

Audited lately?

No, I don't mean by the Infernal Revenue Service, but by your boss.

Hunh?

A brief primer: when putting together a group plan, carriers require a rather strict accounting of eligible employees. They want to make sure that everyone who's on the plan is eligible, and that all those who are eligible are on the plan or have appropriate waivers.

But there's another kind of accounting that comes into play, as well:

Many employer groups don't subsidize dependents' coverage; in fact, a lot of groups are dropping dependent coverage altogether. Not only that, but there's a significant movement towards requiring working spouses to opt for coverage under their employer's plan instead of electing dependent coverage.

Those that have retained that option are becoming more proactive in making sure that dependents are truly eligible for coverage. That is, requiring an employee to prove that they're really married, or have children, or both. Absent such proof, "the dependent loses coverage."

According to those "in the know," as many as 12 percent of covered dependents aren't really eligible for coverage. That's a lot of people who may not be as financially secure as they think.

In a way, this is a good thing: my experience has been that dependent coverage on group plans is much more expensive than comparable cover in the individual market (assuming reasonably good health). And by opting off the group, those dependents have a lot more choices in plan design. And it also makes that coverage portable: no need to elect COBRA, since you already own the plan.

Something to think about as we begin the new year.

MVNHS©: ID Ooops!

Great Minds Think Alike Dept: While this may seem like piling on, I actually wrote this post a week or so ago, but stockpiled it in favor of more urgent matters. Meantime, of course, Mike ran across a similar article and blogged on the same subject. Herewith is my take on the issue:

Well, the good news is that, according to the Associated Press, our cousins across the pond are covered by "Britain's free health care system" (although the English taxpayer may balk at that characterization).

Alas, you get what you pay for:

"Personal information about patients in [that free system] has been lost, the Department of Health acknowledged Sunday — the third loss of data about the public by a government service this year."

Now, one may argue (correctly) that our own privileged health information is also at risk, and certainly there've been any number of data thefts here in the States. And some of those thefts include loss of personal health data.

So what's the difference, you ask? Simply this: under our system, the keepers of that information are subject to strict penalties (including fines) for such losses. They can also be sued in civil court, and assessed damages.

And how, exactly, does one sue the MVNHS©?

OK Diet

Anyone notice how the talk shows and commercials are mostly about losing weight? Probably just a coincidence.

Apparently the mayor of Oklahoma City is getting in the act. He has challenged the residents to lose 1,000,000 pounds during 2008.

Over 2600 have registered to participate.

You can track their progress here.

Oklahoma City ranked 15th in a 2007 survey of America's fattest cities conducted by Men's Fitness magazine

No word on who beat them out for the other 14 positions.

The Oklahoma Legislature designated an official state meal in 1988. The menu also includes fried okra, squash, barbecue pork, biscuits, grits, corn, strawberries and black-eyed peas.

A state meal? Sounds like legislators have way too much time on their hands.

"In Colorado, you ski, you climb, you run ... something," . . . In Oklahoma we're spectators."

Wonder if the Man Girdle could catch on in OK?

The Man Girdle

Wacoal launched a men's girdle that touts its stomach-flattening ability. In January, it expects to start selling a version that goes a step further. The stretchy underwear, called the "ex walker," is made of specially woven nylon and polyurethane that the company says is designed to actually tone the thighs and hips, not just hold them in shape temporarily.

Wonder if they will have matching fishnet stockings and spike heels as well?

Wacoal won't disclose its advertising budget or the price of the ex walker, saying it is negotiating with the health-insurance groups.

Fat chance.

Long Overdue . . . but with a Catch

A panel of the 4th District Court of Appeals in Santa Ana, Calif., last week ruled unanimously that health insurers are responsible for reviewing applications before issuing policies and should not wait until beneficiaries run up large medical bills,

Carriers have created too much ill will by rescinding coverage after the fact. This phenomena has received more press in California, but there have been incidences in other states as well.

The court also ruled that insurers cannot rescind a health insurance policy unless they show that the policyholder willfully misrepresented his or her health or that the insurance company had investigated the application before issuing coverage.

The good news is, this SHOULD reduce rescissions.

The bad news is, longer time in underwriting from the time the application was submitted until issue. Some carriers turn around an application in a few days while others routinely take a month or longer.

a company cannot continue to "collect premiums while keeping open its rescission option if the subscriber later experiences a serious accident or illness that generates large medical expenses."

Many times a known pre-existing condition does not come to light until after the policy has been issued. An applicant may be aware of symptoms but does not see a medical professional for a diagnosis until after the new coverage is in place. This is particularly true where an individual is without coverage now and makes application.

This happens with some frequency. Several times each month I will be contacted about health insurance to cover anything from pregnancy to extensive testing and possible surgery.

As this ruling reverberates through the market there are several things that can happen in addition to longer underwriting time frames.

Fewer policies may be issued, particularly to people who are not currently insured.

Some policies come with 30 day waiting periods for illness. Expect this to become more prevalent and possible longer waiting periods.

Carriers may be unwilling to issue coverage when minor symptoms are revealed on the application.

Fraud is an issue, but so is carrier abuse. I have had a few clients experience rescission, but fortunately this is not a regular occurrence. One individual made a deliberate choice to withhold information from the application. Two months later she was back in the hospital, receiving treatment for a pre-ex condition. The carrier investigated and rescinded coverage retroactive to the effective date.

In another situation a carrier attempted to rescind a group plan after the risk letter had been issued. I intervened on behalf of my client and got the carrier to reverse their decision and issue the policy.

Rescissions are never popular but sometimes they are a necessary tool to protect the carrier against willful fraud. It will be interesting to see how this plays out.

MVNHS©: Jumping the Shark

One of our favorite memes here at IB is consumer empowerment. Generally, we mean that folks should be more proactive in their healthcare choices, such as considering Health Savings Account plans, and speaking more frankly with their providers. We've never recommended that such empowerment should take the form of self-medication or diagnosis, because that would be stupid.

Alas, our cousins Across the Pond must have taken our crusade a bit too seriously:

"Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a Government plan to save billions of pounds from the NHS budget."

M'kay (to quote my daughter).

The thing is, our approach is more subtle: make informed decisions, based on research and conversations with providers. Apparently, the Much Vaunted National Health System (MVNHS©) is facing a major shortage of cash...

As an aside: how come we never hear about these little problems from proponents of nationalized health care? Is it because they also know that such systems do nothing to rein in costs, but end up rationing -- and denying -- care?

...and is looking to cut a few corners:

"Instead of going to hospital or consulting a doctor, patients will be encouraged to carry out "self care" as the Department of Health (DoH) tries to meet Treasury targets to curb spending."

Now, in this instance, "self-care" doesn't mean such mundane activities as breast or prostate self-exams. Nor does it mean making sure to finish that antibiotic prescription even though you already "feel much better." No, it means that one must literally provide one's own health care. Thus, blokes suffering from chronic conditions will now be:

■ Monitoring their own heart activity, blood pressure and lung capacity

■ Administering their own drugs and other treatment to "manage pain"

■ (A)ssessing the significance of changes in their condition (!)

Of course, this is being sold as a "self-care agenda...increasing patient choice and "personalised" services." (emphasis added)

"Personalised" indeed.

Cavalcade of Risk #42 is now online!

Jonathan Pletzke presents a great Cav to kick start the new year. He's got 19 interesting entries, all tucked into 4 helpful categories.

If you'd like to host a Cav, we'd love to have you. We have slots available for early Spring, so drop us a line to get on the schedule.

How Emergency Medical Services SHOULD Work

At the risk of enlightening our female readers as to the truth about us Y-chromosomers, we present a vision of how EMS should handle dire emergencies:

New Year's Grand Rounds

The very first 2008 edition of Grand Rounds is now up at Other Things Amanzi. Our host, a general surgeon in South Africa, presents a visually stunning and helpfully annotated collection of med-related posts.

With all the serious and sobering stories about health care here and around the globe, I really appreciated this over-the-top look at an Aussie ER's Christmas experience. Enjoy!

Happy New Year!

Mike, Bill, Bob and I wish all of our readers, and their families, a joyous and healthy 2008.