Top 100: Again!

Back in September, we reported that IB had been selected by RN Central as one of their top 100 health care policy blogs.

Quite an honor, and we were grateful for that recognition.

This morning, we received word from the Radiology Technician Schools site that we'd been selected by them as a top 100 Best Health Care Policy blog.

And we're quite honored by that, as well.

Swag Gone?

In a trend I'd like to see emulated by other industries (e.g. insurance), "the pharmaceutical industry has agreed to a voluntary moratorium on the kind of branded goodies — Viagra pens, Zoloft soap dispensers, Lipitor mugs — that were meant to foster good will and, some would say, encourage doctors to prescribe more of the drugs."

The new "regs" took effect on the 1st, and have met with both skepticism ("[s]ome skeptics deride the voluntary ban as a superficial measure") and optimism ("proponents welcome it as a step toward ending the barrage of drug brands and logos that surround, and may subliminally influence, doctors and patients").

It seems obvious to me that both positions have merit; that is, it's not likely to directly reduce health care costs all that much, but it's certainly a step in the right direction. The giveways themselves likely cost very little, but if doc's are more inclined to prescribe products whose manufacturers "bribe" them with pretty trinkets than perhaps equally effective generics, there's obviously going to be a drop in the overall cost of health care.

Of course, there are other "freebies" available to physicians; last summer, we noted that the AMA has an issue with vendor-sponsored Continuing Medical Education (CME). I'm still unconvinced that this is a major problem, but perhaps the new ban on tangible freebies will affect the intangible ones, as well.

As we've noted many, many times here, the cost of health care drives the cost of health insurance, and any reduction in either one is likely to be "a good thing."

Blessed Event or Lucky Break: A New Year's Conundrum

[Editor's note: this post is not about abortion, per se, so please refrain from comments pro and con re: abortion rights]

First, Mazel Tov to British couple Gaynor and Lee Purdy on the birth of their son, Kai.

This was not necessarily a certainty:

"Gaynor Purdy was warned her first child could have a fatal chromosome defect and a life threatening heart condition...

Four months into the pregnancy doctors told them that part of their unborn child's heart was narrow and underdeveloped and would mean open heart surgery if the baby was born...

Further tests conducted a few days later on New Year's Eve suggested the baby could also have Edwards Syndrome - the presence of an 18th chromosome - with a life expectancy of only up to four months if birth is survived."

As the parent of two beautiful and healthy daughters, I can only guess at the fear and trepidation felt by the Purdy's as they faced this potentially disastrous outcome. Their doctors repeatedly urged them to abort the baby, which wasn't expected to survive more than a few months anyway.

And yet.

Kai was born a month and a half prematurely, and one side of his heart is somewhat enlarged (corrective surgery is anticipated). Still, he was discharged "from hospital" six weeks after birth, or about the time he would have been "discharged" naturally.

Now, we have the luxury of playing Monday morning quarterback, but I'm curious: in this incredible roll of the dice, and not knowing the outcome as we do now, did the Purdy's make the right choice?

Grady's New Year Resolutions

One of the New Year resolutions for Grady Hospital in Atlanta is similar to what many of us pledge. The difference is, while we resolve to lose weight, Grady resolves to lose less money in 2009.

Not an easy task for a hospital that ended 2007 $67 million in debt plus owing another $63 million in debts, mostly to Emory University & Morehouse University who provide staffing via their medical schools.

Grady has already done quite a few things to stem the flow of red ink. They have eliminated non-emergency clinics that provided things like eye exams. They have cut back over 400 non-essential personnel.

What more can they do?

Well, they could start charging for services.

As the designated "charity" hospital, Grady delivers free or nearly free services to 250,000 individuals every year.

Most of these live in Dekalb or Fulton county.

The total population of Dekalb & Fulton combined is roughly 1.5 million residents. You don't have to be a math major to figure out that 1 in 6 residents in greater Atlanta are receiving services at little or no charge, courtesy of the taxpayer.

But how many of those are truly deserving of financial assistance?

We don't know for sure, but we do know that Grady recently notified 1400 people that they no longer qualify for free or reduced fee services.

Some of those who were "cut off" include . . .

One person receiving discounted care was found to have a $750,000 house, he said. Some students have been receiving free care by only submitting their county address, when they should be the responsibility of their parents, he said. Other people hide the fact that they have insurance.

The article does not say where this $750,000 home is but you can bet it is not Section 8 housing.

Right now, Fulton and DeKalb county patients who earn less than 250 percent of the federal poverty guidelines —- or $26,000 for one person annually —- can receive free medical care.

That seems rather generous to me. Apparently the board feel likewise because they are proposing changes to the qualificiations.

Under the plan, Fulton and DeKalb patients who earn between 126 percent and 200 percent of the federal poverty guidelines can receive a 60 percent discount on their bill.

Even if these proposals go through, they will still provide free or reduced care to those who are truly in need.

But of course these changes are not without opposition.

State Sen. Vincent Fort (D-Atlanta), a leader of the Grady Coalition, said the proposed changes would hurt uninsured working-class people already struggling to make ends meet. He said the changes will dissuade many from seeking care at Grady.

“If I know there’s going to be a big bill hanging over me, I may not go,” he said.
“People will die for lack of care.”

Vincent Fort has a panache for over-stating the situation.

None the less, Grady is resolving to change the way health care is paid for in Atlanta and it is about time. Heck, my home isn't worth $750,000 so why can't I get free health care?

Some futures aren't much fun to contemplate - IV

I've linked to a story from today's London Daily Mail 31 December. Please read the entire article. I warn you it is not easy reading.

“[The patient’s] daughter-in-law Amanda . . . added: ‘All that he had at the end of his 101 years was his dignity and they took that away from him.”

Also take a few moments to scroll thru the comments left by Daily Mail readers.

No one should conclude that NHS works like this, routinely. But just as clearly this episode happened, none of the hospital staff seeemed particularly concerned about it, and many of the commenters don’t seem surprised either.

Is this, after all, the future we may look forward to in the US as we sail along toward single-payer, government-controlled health care system?

What evidence is there that the answer is anything but “yes”??

It is also eye-opening to read the cold, bloodless, and lawyerly form-letter “apology” from the Hospital. It’s almost as though the hospital is responding to a complaint about late meal delivery or some other trivial service glitch:

‘Some aspects of Brig Platt’s discharge from hospital in 2006 were unacceptable and the trust apologises for any distress that this has caused.’

Some aspects, huh? Of the discharge (and not of Mr Pratt’s mistreatment prior to his discharge?) And the “trust apologises” – well, that’s about as impersonal as one can get. Gahhhh.

Cavalcade of Risk #68: Up and Running!

Louise at Colorado Health Insurance Insider presents the EOY '08 Cavalcade of Risk. As usual, she does a GREAT job, including her own spin on each entry.

Do check it out.

Stress and the CEO

Alert reader Jeff M alerts us to this, um, alert:

Saving lifestyles, one exec at a time.

Nataline a Year Later: Even More Disturbing News

About this time last year, we reported on the sad case of Nataline Sarkisyan. Our post on December 21, 2007, began:

"The family of a 17-year-old girl who died hours after her health insurer reversed its previous decision and said it would pay for a liver transplant planned to sue CIGNA HealthCare, their attorney said Friday."

And it appears that this is, indeed, coming to pass:

"An insurance company that initially refused to pay for a liver transplant for a 17-year-old Northridge girl who died in a hospital should face criminal charges and pay civil damages, an attorney for the girl's family said Friday."

Lead attorney Mark Geragos went on to rant that Cigna HealthCare "literally, maliciously killed" Nataline Sarkisyan."

Well, to be fair, that's what he's paid to say, even if it lacks actual, you know, truth:

"What is often misunderstood is that most health benefit plans, whether public or private, do not cover unproven and experimental treatment related to transplants or other treatments."

Those who doubt that "public" benefit plans withhhold such vital services need only peruse Bob's post on Sabrina Holloway.

And, in fact, Cigna went out of its way to justify its refusal to cover such an experimental procedure. Unfortunately, they did cave, and agreed to pay for the risky surgery, which ultimately failed to keep poor Nataline alive.

As regular reader Matt H points out, that was really Cigna's biggest mistake:

"Cigna should have stuck to the contract. I bet they will have to pay a settlement now because of their change of mind."

That sounds about right:

Had they simply stuck to their guns in the first place, the outcome wouldn't have changed (Nataline wouldn't have survived), but they also would have a compelling defense. As it stands, by backing down in the name of PR, they face an uphill battle. My guess is that the case will be based on the simple question of timing: if Cigna had agreed to cover the surgery immediately, the argument will go, then Nataline would surely have survived. By "dithering" (i.e. actually following the correct process) Cigna reduced her chances of survival.

We'll never know, obviously, whether that would have been the case, but I think that Cigna erred in succumbing to public pressure. Had they stood their ground, such a lawsuit likely would have had little chance of success. As it stands, I think Cigna will be paying out quite a few more dollars.

If there's any silver lining, it's that perhaps other carriers will learn the correct lesson from this unfortunate event.

[Hat Tip: Reader Matt H]

UPDATE: In the comments, Chad asks a very good question:

"Why is there no condemnation for the doctors and hospital that withheld this supposedly vital, lifesaving treatment for want of payment?"

Indeed.

I made a similar observation in my original post last year:

"(T)he actual choice belonged solely to the parents and the provider."

Government Inefficiency

There are many social programs, funded by the taxpayer, and mismanaged by government administration. The story of Sabrina Holloway is just one of those.

Sabrina is a 39 year old mother of 8 covered by Medicaid. But "covered" isn't exactly true.

Therein lies the story.

Holloway is covered by Medicaid, the insurance program for the poor and disabled. But unlike other states’ Medicaid programs, Georgia’s does not cover an intestinal transplant for patients 21 years old and older.

Such transplants are covered for younger patients, but not someone older. Wonder why?

Without the surgery, Holloway likely would have died within two to three years, Katz had said.

Is the Medicaid system heartless?

The federal government gives state Medicaid programs leeway on which transplants to approve. Other states’ Medicaid programs —- which have their own coverage rules —- approve intestinal transplants for people Holloway’s age.

So federal health care programs allow each state to decide the level of treatment. So much for "universal" coverage.

Without the surgery, Holloway was fed intravenously at an estimated annual cost of $150,000.

So how much does the surgery cost?

The operation generally costs $200,000 to $400,000, doctors said recently. But Dr. Douglas Farmer, head of the intestinal transplant program at UCLA, said in June that a transplant could be less expensive for the state in the long run. He added that intestinal transplants can cost less than $200,000.

So how was it that she received the transplant?

It seems she relied on the charity of others at the Cleveland Clinic.

The Cleveland Clinic last week declined to disclose the cost of Holloway’s surgery and postoperative care. Officials there said they “made every attempt to obtain coverage from Georgia Medicaid.”

It begs the question.

If government run health care is so great, why do patients have to rely on charity?

This Sceptered Isle - Part XI

Didn’t believe me about compulsory health care, eh?

Well then, now read this:

NHS chiefs are planning to order a massive 40 per cent increase in weight loss surgery for dangerously obese patients from Yorkshire.

After getting our attention with this lead paragraph the article goes on and on, but curiously never gets around to these two questions:

1. How exactly will NHS chiefs decide who will be ordered to undergo surgery?

2. What is the penalty if one should refuse the order?

Oh well, maybe these questions aren't so important. After all, Brits have every reason to trust that Her Majesty's government will always do the right thing.

Cheerio!

Alternative Health Care

Folks in Canada (and many other countries as well) have free health care. So why would they have a need for an alternative?

Timely Medical Alternatives is a firm that arranges private medical care for Canadians.

Why does TMA exist?

Timely Medical Alternatives is able to expedite most types of private medical services from diagnostics to virtually all types of surgery, including procedures not available within the Canadian healthcare system. Wait times for our clients are measured in days rather than in months or years.

How long will I have to wait for services under the Canadian system?

Private Health Care is increasing in demand across Canada more than ever before. The public health care system in Canada has a waitlist in every province and surgery dates are often cancelled or bumped due to a more urgent case arising or a shortage of beds being available.

Click on a Province to view waitlist numbers and options for private medical care in that area.

Will I get in trouble for using a private system?

Inmates in Federal prisons and politicians (among others) routinely jump the queue and we agree that this practice is outrageous. Jumping the queue occurs when convicted criminals and politicians are given preference over the rest of us.

So there is preferential treatment for inmates & politicians.

I suppose if you can't get elected the next best thing is to get arrested.

A Christmas Story: MVNHS© Style

"A pregnant woman in the U.K. was left unattended for hours and had to give birth on a hospital floor despite her desperate appeal for a bed."

Earlier this month, 36 year old Lynne Neilson arrived at Edinburgh's Royal Infirmary, and was forced to wait in an "assessment room" for hours. About 7:30 in the morning on December 5th, they got to the hospital as Mrs Neilson was experiencing labor pains. After they began to subside, the Neilson's were sent home with instructions to return when her contractions got closer.

Which, of course, they did.

Some 12 hours later, they returned to the hospital, but were told to wait. The contractions began coming closer -- and harder -- and Mr Neilson began pleading for help. Eventually, a midwife was called in, just in time to "catch the baby, who had the umbilical cord around her neck."

Whew!

Of course we're thrilled that the baby seems no worse for the experience (although that was certainly not a sure thing), but one wonders why Mr Neilson's repeated requests for help apparently fell on deaf ears. Meantime, the MVNHS© is "investigating the complaint and has apologized to the woman."

Oh, goody.

Cavalcade of Risk #68: Call for Submissions

Our 2008 EOY Cavalcade of Risk is hosted next week by Colorado Health Insurance Insider's Jay Norris. Submissions are due this coming Monday (the 29th), and Jay reminds you to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).

You can submit your post via Blog Carnival or email.

Thanks!

We have hosting slots available for early '09 - just drop us a line to reserve yours.

The Wisdom of the Magi

One of the great, all time stories of Christmas is from O Henry. The Gift of the Magi is a love story about a woman who sells her long tresses to raise enough money to buy a watch fob for her husband.

The surprise comes when she discovers he has sold his watch to buy silver combs to place in her hair.

Each has made a sacrifice, with good intention, as a way of expressing their love for the other.

The Magi were rumored to have traveled from afar bearing gifts for a new born king. Their gifts of gold, frankincense and myrrh were just as appropriate for the recipient as the watch fob and combs were in O Henry's story.

Gold was a traditional gift for royalty.

Frankincense had many uses including medicinal properties for calming and restoring peace. It was also burned by priests as a way of carrying the prayers of the faithful to heaven.

Myrrh was used to treat wounds due to its' antiseptic qualities. It was also used by Egyptians as an embalming ointment. The significance of myrrh is probably lost on many who read the story of the wise men. This tiny baby was born to be a king but would only do so through death 33 years after his birth.

Gifts exchanged at this time of year are only one way of expressing love. The true gift is not the physical item but the thought that goes with it.

Della put a lot of thought into the gift of a chain for her husband's watch. She purchased it by putting her husband ahead of vanity. In turn, Jim expressed his love for Della by sacrificing something dear to him to in order have the money to purchase his gift for her.

Christmas is a time to think of others and putting their needs and wishes ahead of our own. Blessings on you and yours during this season of love.

Have Yourself A Merry Little Christmas

This season, give thanks to those you love, and who love you.

This season, give thanks to those who protect us, risking their lives in the process.

This season, be sure to give thanks to the One who made it all possible.

We wish you and yours enjoy a wonderful (and safe) Christmas.

Stark Raving

In this interview the Wall Street Journal provided California Congressman Fortney Stark an opportunity to blither about "health overhaul" and repeat that his overhaul idea is "a Medicare-like program” anyone could buy.

In other words, there are problems in health care so let's do something about insurance.

Real logical, Congressman.

Health care? Health insurance? The same things, right? No, they are not and unfortunately Stark is not the only one who ignores the difference between health care and health insurance.

Besides, what exactly is Stark's idea for insurance reform? Enroll more people in something “like” Medicare! How . . . creative! But practical?

Medicare’s financial problems are exceedingly well-documented. Its yearly expenditures are projected to exceed its income within the next few years. Medicare is financed on the notorious pay-as-you-go basis, and its unfunded liability is estimated to be $60 trillion (20X's the current U.S. annual budget). I understand that there are some like Stark who apparently believe that any program so hopelessly in debt as Medicare is a successful program because it is a government program. I differ.

What evidence is there that this Medicare financial train wreck will miraculously jump back on the rails if only EVERYONE were enrolled in it? The answer is, none.

And there ain’t gonna be such evidence unless something is done to improve the effectiveness and reduce the cost of the health care delivery system we have now. And that won’t happen until the cost of insurance is understood as a symptom of the underlying cost of health care delivery, not misunderstood as a disease itself. That is, not until the health care system becomes the primary emphasis for reform. Until then, expanding Medicare will just throw more of our tax money into a system that has shown neither the ability nor the inclination to control its costs.

Unintended Consequences

One of the problems with having so many, um, "undocumented" immigrants is the strain on our health care system. Many (most?) of these folks have no health insurance, nor the means to pay substantial health care bills. And yet, out of compassion or necessity or law, continue to provide them with neeeded health care.

The problem, of course, is that someone has to pay, and that "someone" is often the greater community, because the providers are forced out of business:

"A small group of nurses and community members gathered outside Southern Hills Medical Center on Monday morning to protest the hospital's decision to discontinue labor and delivery services — a move they say will be particularly hard-felt in a community known for its high population of immigrants and patients who are uninsured or without prenatal care."

While it's tempting to lay the blame for this on the health insurance system, it's really the fault of politicians and activists who refuse to acknowledge the not-so-hidden costs of a policy that tacitly (and not so tacitly) encourages such folks to make their home here, without the tedious process of doing so legally.

The result?

"Nearly 600 babies were delivered at Southern Hills Medical Center each year before the hospital suspended its obstetrics services Sept. 1...Southern Hills suspended obstetric services following the resignation of our largest group of obstetricians."

It's really not difficult to divine just why Southern Hills took a pass: after all, how long can they afford to render free services?

And what's the community's response?

If you said "well, obviously they're going to try to reduce the number of illegals straining the system," you're not paying attention:

"The nurses and healthcare activists hope that a new nearby Spanish-language billboard reading "Nosotros Merecemos" or "We Deserve" will raise awareness among residents to protest the hospital's decision and will force the facility to reopen the doors to its labor and delivery unit. " [ed: emphasis added]

And just how does one force a doc to deliver babies for free?

Aye, there's the rub.

UPDATE: And adding insult to injury, The Volunteer State's not the only commonwealth to feel the pain of footing the cost of illegals' health care:

"Healthcare for illegal immigrants cost the Texas government and local hospital districts $678 million in a year...The study...estimates that $597 million of the total was spent by 94 public hospitals during fiscal 2005-06.

The remainder, about $81 million, went to the state’s contribution to emergency Medicaid"

Ouch.

The Lone Star State's Health and Human Services Commission compiled these figures to bolster their plea for increased dollars from the Fed. But not everyone's on board:

"Rep. Lon Burnam, D-Fort Worth, said looking just at the cost of illegal immigrants doesn’t take into account the money they pump into the state."

Perhaps Rep Burnam should heed the lesson of the broken window.

Grand Rounds is up!

Biochemist/molecular biologist Walter Jessen, blogmaster of Highlight Health, presents this week's collection of great medblog posts, with a holiday theme.

151A Update

Last week, we reported on regulators' efforts to change how Equity Indexed Annuities can be sold. Up 'til now, they were considered "fixed" products, meaning that any appropriately licensed life insurance agent could sell them. There was much concern, however, that these products were closer to "variable" ones (i.e. market-based returns) and should require special licensing and training to be sold.

There was much discussion of this in our comments section, for which we are very grateful.

In the end, the regulators won out:

"During an open meeting on Dec 17th the Securities and Exchange Commission adopted Rule 151A, which calls for the SEC to take over regulation of index annuities. This was opposed at the local, state and federal government levels as well as by many industry organizations including the NAIC, ACLI, NAIFA & NAFA."

[ed: this from an email I received this morning; no link as yet]

Of course, it will take some time for all the final pieces to come together, so folks who don't have their Series 6 may continue to sell Indexed products for a little while, at least. Long term, of course, the landscape will change, perhaps dramatically. The rules aren;t set to go into effect for another two years: it'll be interesting to see what impact this will have on production numbers between now and January 12, 2011.

Chanukah Cheartburn

Now that Chanukah's underway, a lot of familiar traditions seem to be getting a 21st century makeover. For example, I recently downloaded a (free!) app that turns my iPod Touch into a dreidl.

But this is literally over the top:

"Man eats 7 pounds of latkes to win N.Y. contest.

A 23-year-old mechanical engineering student downed 46 of the potato pancakes in eight minutes to win a contest at a Long Island deli."

Now don't get me wrong: I love latkes (and make them every year). But seven pounds of these "crispy crepes?"

I don't think so.