Major Thanks and Belated Blogiversary

Without a doubt, I have the best co-bloggers on the 'net. As regular readers may have surmised, I was on vacation this week, with extremely limited web access. But Bob and Mike filled in handsomely, and Bill was instrumental in implementing our first ever April Fool's Day post.

Thank You!!

And I was remiss in failing to note that, a few months ago, we passed a major milestone: our 4th Blogiversary. We've certainly come a long way in those first 4 years, and look forward to many, many more.

Cavalcade of Risk #75: Call for Submissions

John Leppard hosts next week's Cavalcade of Risk. Submissions are due by Monday the 6th, and Cav goes live on the 8th. John asks that you include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

And 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.

Massachusetts. Ho? Or Hum?

[Welcome Industry Radar readers!]

This article contains some of the news. Whether it’s all fit to print is another matter.

As is common in NYTimes articles, the best stuff is often found down near the end. That is, after all the stuff that editors with an agenda think is more important.

Check out the 4th from the last paragraph. Aw heck, here it is:

“Really controlling costs requires just stopping spending,” said Stuart H. Altman, a professor of health policy at Brandeis University.

Really, professor?

Now read the next-to-last paragraph:

“It forces us to look in the mirror and say, ‘What do we do about health care spending?’ ” said Jon M. Kingsdale, executive director of the agency that administers Commonwealth Care.

My opinion? These experts are pushing EXACTLY the wrong solution. Their focus on spending leads to worse results for people, not better results.

Why is that?

Because the problem is the cost of health care. Fix that, and the spending problem is solved. Fail to fix the problem of cost, and the spending problem will be with us forever - no matter how politicians try to hide it. The Massachusetts program clearly demonstrates the truth of this statement. A focus on “spending” inevitably leads to rationing and ham-fisted ways to reduce what the government pays for health care, by reducing the supply of health care (think of Canada or Britain) or by restricting the public access to it (think of the same countries, again). That is not a solution. That is running thru Hell in gasoline pants.

Bob and Yogi

Please take a gander here, at Health Access, this week's host for Health Wonk Review. Bob Vineyard, one of InsureBlog’s own Health Wonks, is featured at about (i.e., exactly) the 11th paragraph, ruminating on the pros and cons of insurance companies eliminating medical underwriting.

A treat indeed from top to bottom, this week’s Review is peppered with the sayings of Yogi Berra, which you’ll not want to miss.

And while you’re enjoying the read - and you will enjoy the read - remember that Yogi also said “I never said half the things I said”.

Introducing the International Institute for Health Care Policy Analysis

Longtime IB readers know that we used to be hard-nosed, unthinking, inflexible free market flunkeys. That is, we rejected the very notion that government-run health care, and government sponsored health insurance, could be highly efficient and, indeed, desirable.

One can't, however, read the daily barrage of helpful, insightful emails we get from various organizations, clearly and intelligently framing the issues, and offering viable, attractive solutions to the obvious crisis we now face without being moved. It is in that spirit, then, that we decided to pull up short, take stock, and recommit ourselves to a new system of fairness, efficacy and well-being.

To that end, we've pulled together many of the excellent and well-crafted suggestions we've gleaned from all these missives, and decided to launch our own initiative, to be administered by the newly minted International Institute for Health Care Policy Analysis.

The IIHCPA's core principles include:

■ A shared vision of the kind of health care system that will meet the needs of 21st century America.

■ Administrative inefficiencies associated with a fragmented healthcare financing and delivery system create more paperwork, redundant care, and increases medical errors.

■ Human rights principles require that we treat health care as a public good.

Our overarching goals will be:

■ Focus on controlling spiraling health care costs by implementing a rapid diffusion of Information Technology.

■ Health care should be publicly financed and administered.

■ Based on human rights principles, health care must be financed in a way that is accountable to the people and responsive to health needs, rewarding quality, appropriate care and improved health outcomes.

Won't you join us? Membership is easy, inexpensive and ultimately rewarding, as you help re-shape the shape of health care in the 21st Century.

[Thanks to Bill Halper]

InsureBlog on the Road

InsureBlog posts are often found in the MOST interesting places. Here are two this week - -

1. Carnival of Personal Finance, hosted by Wide Open Wallet, features a classic post from InsureBlog’s own Bob Vineyard. How would feel about a $1 surcharge to your bill to help your waiter buy health insurance?

Find Bob by scrolling down to Budgeting and Saving - and while you're there, read the whole thing.

2. Grand Rounds is hosted by Running a Hospital - this one is grand and it’s certainly round – as in fully-packed. The theme: transparency in the delivery of clinical care. It is a looong and thought-provoking Grand Rounds and once again InsureBlog is a contributor:

InsureBlog's Henry Stern tells the true story of the Italian doc whose dedication to his patient overrode his own immediate health crisis.

Scroll down to Hank’s entry and, as above, enjoy your read along the way.

Off Topic: Another Ethics Question

No, "ethics" isn't OT here at IB, but the specific subject of this conundrum is:

"In a cash-strapped Idaho high school where signs taped near every light switch remind the staff to save electricity, an enterprising teacher has struck a sponsorship deal with a local pizza shop: Every test, handout and worksheet he passes out to his students reads MOLTO'S PIZZA 14" 1 TOPPING JUST $5 in bright red, inch-high letters printed along the bottom of every page."

As in many places, the economy has taken a toll on Pocatello High School. Teachers still need to teach, of course, and many (most?) are willing to dig into their own pockets to fund special projects. Still, when even paper for tests and handouts is in short supply, creative, out-of-the-box thinking is called for.

Or is it?

"It crosses a line," said Susan Linn, a Harvard psychologist and director of the Campaign for a Commercial-Free Childhood. "When teachers start becoming pitchmen for products, children suffer and their education suffers as well."

Do they?

I'd like to know what our readers think of this novel approach to education.

Medicare vs Social Security: The Untold Story

[InsureBlog Exclusive!]

[Welcome YahooNews readers!]

As noted recently, the unlikely (but unfortunately true) story of how opting out of Medicare can adversely affect one's Social Security payments is heating up (for background, click here and here). Briefly, a group of fellow citizens has filed suit against the Fed's because Social Security officials claim that folks must forfeit their Social Security benefits if they withdraw from (or choose not to enroll in) Medicare. This seemed like a fairly important story, yet seems to have flown completely under the MSM radar.

Which is where we come in:

I had a very helpful conversation the other day with lead attorney Kent Brown. Mr Brown's been practicing law for some 35 years, focusing primarily on fighting government meddling in the health care industry. Not coincidentally, he was also the lead attorney in the case to force open then-First Lady Hillary Clinton's closed-door health care task force.

I asked Mr Brown how he came to be associated with this case, and he told me that he was initially contacted by Brian Hall, a gentleman who chose to opt out of Medicare coverage once he became eligible. Mr Hall was told that he could, of course, choose to do so, but at the cost of his Social Security benefits. This didn't seem fair, and so he approached Mr Brown to see if there was any legal recourse. The case has snowballed, and there are now five plaintiffs (including Former House Majority Leader Dick Armey).

Why, though, would someone choose to forgo health coverage for which one has already paid? Opting out of Medicare may be legal, but is it smart? Mr Brown explained that there are many reasons why someone might choose to decline it, including the desire to make one's own health care decisions without government intervention. Folks see what's happening in England, for example, and want no part of that.

Basically, it comes down to choices: some (many?) folks want no part of a system that allows the government to dictate their health care alternatives. Then, too, there's the matter of privacy, which is also a concern for many of these folks.

So why was the Social Security Administration telling Mr Hall that it was all or nothing? Is there something in the original Medicare legislation that dictated this? Surprisingly, the answer is no. Social Security states that one who is 62 years old and otherwise eligible "shall be entitled to" Medicare [ed: this was obviously added after the initial legislation, which of course predates Medicare]. Nothing in the Social Security or Medicare statutes state that one must take Medicare in order to receive Social Security payments (or vice versa). There are explicit conditions set forth under which one might lose Social Security benefits, but lack of a Medicare card isn't among them.

So how did this come about? Well, according to Mr Brown, there are three provisions in the Social Security Program operating manual that bear on this subject; it's important to note, though, that these are not laws or even regulations. This came about not by statute, but by bureaucratic fiat. The first two of these provisions were inserted in August of 1993 [ed: interesting timing, no?], and the last one in 2002.

The case is moving along; the most recent development is the one which caught my eye earlier this week: the government has filed a routine motion to dismiss, and Mr Brown has countered with one for summary judgment. The judge has set a May 22nd date to hear arguments regarding the motion to dismiss; if that motion is quashed, the government will be given time to respond to the motion for summary judgment. That will probably be in late summer.

I had to ask, and so I did: what happens if the judge grants the government's motion to dismiss? Mr Brown quickly replied that they'd go right to the Appeals Court; the plaintiffs are totally committed to this fight. He also noted that the judge is quite well versed in the subject area, and has her own wry sense of humor (and irony). We agreed that a quote from her would be just the thing with which to conclude this post:

"It is passing strange that the Social Security Administration would insist on individuals being forced to enroll in one bankrupt program in order to be in another one that overruns its budget."

Oy Canada?

Did Canada's National Healthcare System "kill" Natasha Richardson?

That's the question raised by the New York Post. For the record, let us note that we are truly sorry for her family's loss, and wish to score no "points" from this tragedy. Still, it may be worth examining the premise of the allegations to see if those who advocate that we should adopt such a system are justified.

First, Canada's gummint-run system isn't too keen on high tech health care:

"About three hours after the accident, the actress was taken to Centre Hospitalier Laurentien, in Sainte-Agathe-des-Monts, 25 miles from the resort ... But Sainte-Agathe-des-Monts is a town of 9,000 people. Its hospital doesn't have specialized neurology or trauma services. It hasn't been reported whether the hospital has a CT scanner, but CT scanners are less common in Canada [than in the US]."

I read some years ago that there were more MRI machines in Ohio than in all of Canada; I don't know whether that's still the case. But a system that relies on government largesse is unlikely to be profligate with "the tech."

And there's this:

"Quebec has no helicopter services to trauma centers in Montreal. Richardson was transferred by ambulance to Hospital du Sacre-Coeur, a trauma center 50 miles away in Montreal -- a further delay of over an hour."

That hour might have been key: after a certain interval, it seems that a less-than-optimal outcome is essentially inevitable. According to the Post, she didn't receive necessary care until some six hours after the incident, which drastically reduced her chances of survival.

For once, though, I'm willing to cut "CanCare" a break: it appears that, immediately following the initial incident, she was conscious and ambulatory, and appeared to be okay. I'm told that this is fairly common with this kind of head trauma (it helps to have a surgeon in the family). Obviously, just appearing to be okay was deceiving, but what else were those on the scene to do? She was a grown woman, not a child, and presumably able to make decisions regarding her own care.

Hard to believe, but I'm going to give Our Neighbors to the North© a pass on this [ed: how noble of you].

Shattering Myths (Again)

We've busted the "Myth of the 46 Million" (or 47 million, or, well, pick a number) many times here at IB, but we're always happy to keep kicking that particular canard as many times as necessary. In 2007, according to the Census Bureau, there were some 46 million folks here in the States without health insurance. Of course, as we've also pointed out countless times, being without health insurance does not mean being without access to health care.

But I digress.

The problem with that number is that it's meaningless: for one thing, almost 10 million of those folks (over 20%) aren't even citizens. That leaves something like 36 million Americans who are uninsured.

Or does it?

An even closer look reveals some amazing perfidy:

"As even the authors of the Census Bureau report themselves acknowledge, "health insurance coverage is likely to be underreported" in the Current Population Survey from which the health insurance data is derived."

That is, the survey takes place in February, and has no way to adjust for the fact that many (most?) of these folks will have coverage in place sometime in the next 10 months. Or, they might reply that, although they're currently covered, they were uninsured at least part of the previous year and, voila, they're "uninsured."

And of course there's the issue of why they're uninsured. Many folks believe, erroneously, that they can't afford even catastrophic health coverage. And finally, there are those folks who qualify for government coverage (Medicare/Medicaid) who for whatever reason opt out (or are unaware of the availability).

But wait, there's more good news:

According to CNN (not exactly rightwing shills), most insured Americans (80% of them!) are actually satisfied with their health care, and about 75% are happy with their insurance coverage, as well.

They're also less than thrilled with the cost of health care, which continues to escalate (but that's another post).

[Hat Tip: American Spectator]

GPMS

That's an amalgam of two seemingly disparate acronyms; this bleeding edge technology is designed to help those of the "Y Chromosome" set more effectively and pleasantly interact with those who sport the "Double X." Specifically:

"PMSbuddy.com, a free Internet-based service that tracks the monthly cycles of a subscriber's significant other and offers e-mail reminders about the impending deadlines."

Modeled after other social networking sites (e.g. Twitter, FaceBook, etc), this may be the ultimate expression of MySpace. And it's certainly swelling: enrollment topped 150,000 last month, of which almost 15,000 are of the aforementioned "Double X" persuasion (although those numbers may be padded).

Although the service started off using email technology, founder Jordan Eisenberg has upped the ante by introducing a phone-based PMSsaging system, as well. The purported demographic for the site is men aged 20 to 40. But as mentioned above, a lot of females are using it, too; Eisenberg warns, though, that this method isn't for tracking fertility.

Cavalcade of Risk #74 now online

Wenchy hosts this week's roundup of all things risk. And to show our gratitude, we'll pass along her bleg for swag (you'll have to click over to her Cav to get that).

On a personal note, this may be the best Cav yet: Wenchy's obviously read each post, and she offers her own insights into them, as well. Kudos!

Italian Medico: True Dedication

Sometimes, it's the little things that mean a lot.

Take, for example, Naples-based neurosurgeon [ed: a real brain surgeon, not a "rocket surgeon?" Yes.] was performing a delicate operation to remove a tumor, when he had his own little medical problem.

Well, not so little, after all:

"An Italian surgeon had a heart attack while performing a brain cancer operation but carried on until he had removed the patient's tumour."

Now, an ordinary surgeon might have stepped aside, and tended to his own immediate medical needs. Not Dr Claudio Vitale (no apparent relation):

"I couldn't leave him at such a delicate moment ...I'm not a hero, I only did my duty."

I think most of us would beg to differ. There's a big difference between a headache and a heart attack, and one could easily be forgiven for immediately addressing the latter. Dr Vitale, though, was having none of that:

"Vitale suffered chest pains while he was halfway through the brain op but refused his team's efforts to persuade him to get emergency treatment."

The good news is that both the surgeon and his patient are "already on the mend."

AIG Update: Vindication [UPDATED]

Last week, I noted that the the punitive-tax bill targeting bonus-receiving AIG execs was "clearly unconstitutional." At least one commenter took exception to that; at the time, Rick had an ally in left-leaning Harvard (Constitutional) Law Professor Lawrence Tribe. Professor Tribe opined that "the goal is not to punish corporate executives generally, but is simply to ensure the appropriate use of government funds," and thus was not a Bill of Attainder.

But that was then, and this is now:

"Harvard professor Laurence Tribe, who advised Obama during the campaign ... says he’s leaning towards seeing the new House bill to tax back all the AIG bonuses as unconstitutional."

Score one for IB (et al).

I also made the point that were such a bill to become law, it would be challenging (to put it mildly) to find competent executives to help right the listing ship of industry; after all, "who wants to take that job for free?"

Lo and behold, no less than the administration itself "has concluded that it needs the private sector to play a central role in fixing the economy. So over the weekend, the White House worked to tone down its Wall Street bashing and to win support from top bankers for the bailout plan."

Score 2 for the good guys.

Okay, enough with the "atta boy's." Back to work.

UPDATE - And thus it begins: I suspect that this is merely the first in what will be a litany of (now former) AIG execs who have "had enough:"

"It is with deep regret that I submit my notice of resignation from A.I.G. Financial Products...Most of those responsible [for the CDS's at the root of the meltdown] have left the company and have conspicuously escaped the public outrage...Many of the employees have, in the past six months, turned down job offers from more stable employers, based on A.I.G.’s assurances that the contracts would be honored."

Read the whole thing.

And remember it when the gummint has a hard time finding competent folks to rebuild the devastated companies; you own more than one.

MVNHS©: Out of this World (And Into the 3rd)

Those that favor a gummint-run health care system, ala the Brits' NHS (known to IB regulars as the MVNHS©) generally gloss over the many failings of such schemes. We've been pointing them out for years, focusing primarily on issues of cost control and rationing of services. There's now growing evidence that, rather than elevating health care, such systems actually demean those who need it:

"Appalling standards of care that may have contributed to the deaths of at least 400 patients at a hospital trust were missed repeatedly by managers and regulators...A report by the Healthcare Commission into death rates at Mid Staffordshire NHS Foundation Trust found that receptionists were given responsibility for carrying out medical checks and patients were left screaming in pain for hours."

Oh yeah, sign me right up!

One shudders to think.

But it actually gets worse:

"Families have described Third World conditions at the trust, with some patients drinking water from vases and others left on trolleys for hours without medication."

This is not the MVNHS© we thought we knew.

Also keep in mind that this hospital was repeatedly cited as a model of health care, lauded for its "elite foundation status and [continuing] to receive positive annual reports." Which begs the question: if this is the expected level of care at an elite facility, what must it be like at "normal" ones?

Tell me again why such a system is preferable to our own?

Grand Rounds is up!

Code Blog hosts this week's collection of medposts, presented as a narrative covering a lot of ground.

Social Security vs Medicare: Update

Previously, we learned that "opting out of Medicare benefits also means opting out of Social Security benefits, as well." Not that this made any sense, but there you go.

Today's email brought an update from the group that's challenging this rather strange legal loophole:

"The plaintiffs ... urged the court late last week to reject government efforts to have the case dismissed ... the plaintiffs asked the court to grant their request for summary judgment and to issue a permanent injunction barring enforcement of the illegal regulations."

So it appears that the lawsuit is still alive, and plodding forward. I've asked the group's contact person if I could interview one of the folks litigating the suit. We'll continue to keep you posted on this unique, and perhaps important, situation.

World Down Syndrome Day

Just wanted to note that today is World Down Syndrome Awareness Day. This date was chosen for its significance:

"On March 21st, 2009, World Down Syndrome Day will mark the 50th anniversary of the publication of Professor Jerome Lejeune's discovery of the extra copy of chromosome 21 which causes Down Syndrome.

Now known as trisomy-21 because of the third copy of the 21st chromosome, Down Syndrome was first described by the English doctor, John Langdon Down, in 1866 but until Professor Lejeune's publication in 1959, the ultimate cause of Down Syndrome was unknown."

The chromosome abnormality that underlies the diagnosis of Down Syndrome is known as trisomy 21 (hence 3/21).

The condition affects some 350,000 people here in the US, many of whom lead meaningful lives, participate in sports (e.g. Special Olympics, bowling) and hold steady jobs.

About Those AIG Bonuses...

The more I read about this, the more convinced I've become that:

1) The bonuses themselves comprise an inconsequential amount of the total AIG bailout (now approaching the $170 Billion mark)

2) They represent a promise to AIG employees to stay on during a time of extreme turbulence, with little hope of career advancement in the firm or elsewhere (indeed, one might be tempted to forgo mentioning one's tenure at AIG altogether). In fact, the affected employees weren't even in the division of AIG that contributed (caused?) the melt-down.

3) Congress knew of these bonuses well in advance (cf: the Dodd Amendment)

Actually, I'm with Sen Dodd (D-CT) on this: these folks should be well compensated for their service.

Now, these same Congresscritters have passed a clearly unconstitutional bill in an effort to clean up a mess of their own making. This is not just bad law, it is bad business practice: why would anyone take such a job, knowing that the compensation promised to them could be revoked at the slightest whim? This is why CEO's insist on, and get, "golden parachutes:" to entice them to come aboard a potentially sinking ship, in order to try to their best to salvage what they can.

Which brings up the next problem: we now own 80% of a failing financial giant, which is in desparate need of competent, expert helmsmanship, and we've just announced that whatever sucker takes the job can't rely on being adequately compensated for it. That's dangerous and stupid.

What happens when the next AIG falls through the floor? Will we bail them out, too? And how are we going to guarantee whomever is tapped to bring them up to snuff that they're not working pro bono?

I'll reiterate that we should never have bailed out AIG in the first place, but essentially shooting the messengers isn't going to get us out of this mess. We now own 80% of the firm, and the government now has a fiduciary responsibility to the shareholders (that's thee and me, fellow taxpayer) to do all in its power to empower AIG to right itself. That's not going to happen if it can't attract, much less retain, the caliber of executive necessary to turn things around.

As I said in a recent comment, "Hypocrisy, thy name is Congress."

Cavalcade of Risk #74: Call for Submissions

Wench Wisdom hosts next week's Cavalcade of Risk, which goes up on the 25th. Submissions are due by this coming Monday (the 23rd). Please be sure to include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

And 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.