Thursday, April 09, 2009

M*A*S*H Meets Mac

Every once in a while, we're asked to review a product or service. We've reviewed a book, for example, and a ground-breaking excercise in transparency. Recently, I received an email from a company called Healthagen touting a new iPhone app called iTriage.
[ed: I actually own an iPod Touch, which is essentially an iPhone sans camera, microphone and, well, phone.]
I decided to give the app a whirl, and downloaded it from the iTunes store (paying, I might add, full retail; no swag for me!). The purpose of iTriage is to act as a sort of, well, triage unit for helping one decide the nature and severity of one's symptoms, and to help one decide if and where to go for help. The iPhone's built-in GPS and phone capability enable the program to, for example, dial 9-1-1 if appropriate, or find the nearest ER or pharmacy.
To "enable" the software, one must create an account, supplying an email address and zip code, as well as one's insurer. The first two I understand, but why the insurer? And how is this program a "step-up" from, say, WebMD?
Those questions, and a few others, prompted me to seek an interview with one of the program's developers. What I got, though, was perhaps even better: Healthagen's Chief Medical Officer, Dr Wayne Guerra. Dr Guerra, and his business partner Peter Hudson, are both emergency medicine physicians and collectively have taken care of over 50,000 patients. Having watched their patients struggle to make difficult medical decisions with only limited information, and they were motivated to develop iTriage to empower their patients. The point is to narrow the information gap that currently exists by giving patients medical information, transparency around price and quality, and access to healthcare facilities at the point of care [ed: all major themes here at IB]. Users need this information when they are having, for example, abdominal pain, or when they have just injured their ankle. The most useful method of providing this information was with a mobile device. Dr Guerra says that implementing all the features of iTriage was not possible until the iPhone 2.0 OS was released.
For our readers who may not be familiar with the app, I asked how iTriage differs from something like WebMD? After all, many folks have 'net access on their phones, or have other portable computing devices available to access such resources. so what sets iTriage apart?
Dr Guerra replied that "iTriage starts where other content sites like WebMD stop," by providing “actionable data”. This is information that calls for a decision to be made, perhaps whether more information is needed, to ask for advice, or assist in finding a medical facility at which one may obtain medical care.
By way of example, Dr Guerra gave a rather common symptom: abdominal pain: "Let’s say you have lower abdominal pain. You search this symptom and iTriage produces the possible causes. You select appendicitis and read the description, common symptoms, standard work-up and expected treatment. After this information you can decide to use the search the web for more information including images and videos, get advice from a nurse or a doctor, or decide to find an appropriate treatment facility. If you choose to obtain medical care iTriage will only list appropriate healthcare facilities from its proprietary lists of over 6,000 emergency departments, 5,000 urgent care facilities and 1,000 retail clinics. Only an emergency department can treat appendicitis and iTriage will geo-locate the phone and list the closest emergency departments enabling the user to call or get a map to the facility. iTriage helps users select a facility by enabling them to buy a HealthGrades quality report through the phone and by learning about the hospital’s specialty services through text or videos." It even helps with the financial aspect by connecting with the bill negotiation services of Coalition America.
Before one can begin using iTriage, one must create an account. This involves supplying an email address and zip code, and also the name of one's insurer (if applicable). There's no personally identifiable info (save for, perhaps, the email). I was puzzled as to why the app wanted to know the name of my carrier.
According to Dr Guerra, the current version of iTriage "uses the medical insurance information to provide users with the appropriate nurse advice number. In the future, iTriage will be able to recommend treatment facilities based on network data; this will enable users to obtain the most cost effective healthcare solutions."
Finally, I asked what's in store for the future. Cuurently, Dr Guerra, et al are "developing a web based and .mobi version of iTriage, and expect to launch these functions in May of 2009. This implementation will greatly expand the reach of iTriage and enable those without an iPhone to use the services. iTriage has established partnerships with TelaDoc, HealthGrades and Coalition America. Healthagen, the parent company of iTriage is pursuing other partnerships to bring our users more granularity around pricing, and other features that will help them make better medical decisions."
That's certainly something to look forward to.
A warm InsureBlog Thank You to Dr Guerra for his time and participation, and to Alicia Verity for alerting us to the product and helping to arrange the interview with Dr Guerra.

Wednesday, April 08, 2009

Chag Sameach Pesach!

This evening we begin the weeklong holiday of Passover, one of Judaism's most important Festivals. More than anything else, it represents the value and importance of liberation and freedom.
Not to mention lots of fruit in one's diet.
A Joyous Passover to all of our readers!

Need TARP Money?

[Welcome Industry Radar readers!]

Back the truck up, the TARP vaults are opening again. CNNMoney is reporting that TARP funds may be made available to insurance carriers that are also bank holding firms.
Prudential Financial Inc. (PRU, Fortune 500), Hartford Financial Services Group Inc. (HIG, Fortune 500) and Lincoln National Corp. (LNC, Fortune 500) are said to have applied but the Journal's sources said Treasury has not yet decided which applications will be approved.
My question is, given the threats from Washington regarding anyone who receives federal tax dollars, why would any firm subject themselves to additional governance? Herr Geithner and Uncle Barney along with many of their band of merry men (and women) have already threatened to limit the pay of executives in firms who receive taxpayer money. And if they can't limit pay, or fire those they deem unfit, they will just tax the hell out of the money you receive.
Of the original $700 billion allocated for the financial-sector bailout, roughly $135 billion remains. However, that doesn't mean all of those funds would be made available for eligible insurers
Money left over? Sounds like party time.

Toga! Toga! Toga!

Thanks to Wenchy for the tip . . .

Cavalcade of Risk #75 is up!

Talk about your Risky Business! Host John Leppard presents this week's Cavalcade of Risk, cruisin' right along with an outstanding selection of posts.

Kudos, John!

The "No Insurance Club"

[Welcome Industry Radar and Kaiser Network readers!]

With unemployment in Georgia topping 9%, and at least one county over 20%, many are finding themselves without employer sponsored health insurance. Even with the employer COBRA subsidy, paying for group insurance without a paycheck can be a challenge. If the employer drops the group insurance plan, COBRA goes away as well.

This is not just a Georgia problem. Individuals and families everywhere who have had health insurance that is tied to their jobs fall into a trap of believing they can't afford health care unless they have health insurance.

For most, nothing could be further from the truth.

Routine health care usually is affordable for most, it is the catastrophic care that is a problem. But some medical providers in Kansas City think they have a solution. The Briarcliff Medical Associates have started what they call a "No Insurance Club".
For one person to join the No Insurance Club, it cost $480 for the year.

After you sign the contract, you get 12 doctor visits a year that include services like physicals, blood work and flu shots.

For a family, no matter the size, it will cost you $680 for the year. It includes everything that an individual plan does, but ups the number of doctor visits to 16.
Sounds great, right?

But it has drawbacks and can convey a false sense of security.

The idea originated out of Arizona. A visit to their site indicates the No Insurance Club has a participating provider in Georgia. A single, participating provider.

How about Kansas City?

A single, participating provider.

Arizona has about a dozen.

There are some other gotcha's as well.

How about this. Why prepay for a dozen visits when you may only need 3, or none? We think a better approach is to access places like Take Care Clinics where you pay as you go and only for needed services. Most office visits run $40 - $60 and you pay only for services provided. Plus the Take Care Clinics are offering free health care for those who are unemployed.

But say you join the No Insurance Club and use up your 12 visits. What happens then?

According to their site, you prepay for another 12 visits.

So far this isn't impressive. And apparently they are flying under the radar in the handful of states where it operates. Surprisingly, New York is one of those states with (again) a single participating provider.

Apparently the New York Dept. of Insurance has not yet put the No Insurance Club in their crosshairs. But a similar plan is already under fire for operating an unliscensed, unregulated prepaid medical plan.

Even though the plan appears pricey to me, there is some transference of risk and that is the very essence of insurance. Don't misunderstand. I like the idea of individuals and families paying for their own primary care out of pocket rather than overpaying for phantom insurance.

One thing I learned a long time ago is any insurance plan with the word copay is a bad choice. I constantly remind my clients that Bare Bones health insurance is the way to go if they want to stop overpaying for health insurance.

But how does a No Insurance Club create a false sense of security?

Primary care is not where the big dollars in health care are spent. Roughly 80% of claim dollars go to cover catastrophic health care and almost 20% of those dollars are for prescription drugs.

The No Insurance Club does nothing to address Rx costs or catastrophic coverage.
One thing the No Insurance Club does not cover is a visit to the emergency room or if you are required to stay in the hospital. It also does not cover a specialist.
$480 per year is no bargain when you have a $50,000 claim. (Warning, shameless plug follows). I have quite a few clients who have solid, catastrophic coverage for $500 - $1000 per year in premiums.

Which makes more sense? Paying $480 per year for 12 doctor visits or paying about the same for a plan that will cover office visits, Rx, hospital, surgery, E.R. visits and more up to $5,000,000?

To me, this decision is a no-brainer.

Tuesday, April 07, 2009

DI PDQ ASAP

Do you know your PDQ? No, not "Pretty Darn Quick:" your Personal Disability Quotient. A few weeks ago, we learned about a new online tool that can help us calculate our life expectancy, which is nice if we're talking about quantity . But it's also important to consider quality of life, and that's where another new tool comes in.
The Council for Diability Awareness has designed a tool for folks to calculate how likely it is for one to become disabled. The PDQ Calculator is pretty easy (and fast) to use, and not particularly intrusive. You're asked about height and weight, age and whether or not you smoke, what kind of work you do, that kind of thing. After you've input that data, the app kicks out your odds of becoming disabled.
If you care to, you can then input some financial info, which allows the program to calculate the dollar amount that's at stake; at no time does it ask for personally identifying information . At the end, you can even print out a report with all the information neatly laid out.
Very cool, and very useful.

"Fannie Med"

Every once in a while an article from another health care blog will cross my desk and it will catch my eye. Richard Scott's post Patient-based Health Reform or "Fannie Med?" at The Health Care Blog really resonated with me.

His insight, as well as his analogy to the mortgage meltdown which was created by government intervention in the free market, is spot on.

He also outlines his reasoning for the conflict between "universal care" and "patient rights" in a way that almost everyone will nod their head in agreement.
Anything that interferes with an individual's freedom to consult their doctor of choice to make health care decisions defeats the purpose of meaningful health care reform.
He further states what he terms the "four pillars" of health care reform as it relates to patient rights.

True health care reform must involve choice, competition, accountability and responsibility.

He rejects the idea of what amounts to a health care tribunal where bureaucrats decide what is best for patient care and interfere's with the doctor-patient relationship.

With regard to competition, he has this observation.
eliminating state regulations on health insurance would allow for broader competition and lower prices for consumers.
Currently each state regulates all insurance products, not just health insurance. The result is, what is covered under a Georgia health insurance policy may not be covered in Ohio and vice versa. Sometimes it seems lawmakers at the state OR federal level have nothing better to do than dream up more laws to justify their position and find ways to spend money they don't have.

We have addressed some of the problems associated with mandates before including black & white and blind ambition post just to mention a few.

Mr. Scott also addresses accountability which goes without saying. If no one is held accountable for their actions then reform is a free-for-all. That didn't work, so let's try this.

Kind of like your doctor saying "oops" in the middle of a tedious procedure.

His last pillar is personal responsibility . . . something that seems to be lacking across the board including our current system. It seems as if no one wants to pay for anything and expects carte blanche treatment.

What are they smoking?

He also warns us of problems that exist in other countries where "universal care" has been the norm for some time.
Because of budget constraints, regulators in the United Kingdom dropped pap smears for women under 25. The result - young women are dying of cancer that could have been treated if the cancer was discovered in its early stages. Many Canadians have to wait months for diagnostic tests to determine whether their tumors are malignant, giving cancerous tumors time to worsen, spread and progress to an irreversible stage.
Somehow Michael Moore and the main stream media never wants to report that. Wonder why?

And here is an eye-opener.
Worse, the danger of Washington's recent willingness to spend inordinate sums of money on anything deemed to be a problem, is that we are conditioning ourselves to believe that our government has unlimited resources - and that any problem can be solved by simply spending vast amounts of cash. What politician wants to be in office when it comes time to admit we can no longer spend for services we have come to expect?

Fannie Mae's and Freddie Mac's failed experiment to improve home ownership for "low and middle income families" should be a wake-up call to those who believe more government involvement in American healthcare will help "low and middle income families". These two initiatives resulted in politicians being accused of receiving favored treatment, low and middle income families being forced out of their homes and a federal bailout that could cost taxpayers as much as $2.5 trillion. We never envisioned politicians receiving favored treatment, the housing meltdown caused by the expansion of these programs, nor the unbelievable number of low and middle income families being evicted from their homes with their life savings depleted. It's not difficult to imagine similar results under a national health care system.
This is something I have been saying for months. Perhaps Mr. Scott has been reading my posts or maybe we are channeling each other.

I particularly liked his "Fannie Med" term. I think I might just steal that, especially since we are already in sync on so many other things.

Monday, April 06, 2009

Miami (Not) Nice

[Welcome Industry Radar readers!]

Finding health insurance in Georgia is usually not that difficult, if you know the rules. Most people, including the bulk of agents, do not. I have a reputation for taking on challenging cases and almost always finding a good offer. That's because I know the rules of engagement.

John Dorschner of the Miami Herald isn't playing nice. His ignorance of risk management coupled with publishing (on the web) a carrier guide that is clearly marked "Confidential & proprietary" makes one question his ethics. His article subitled "How health insurers secretly blacklist those with certain ailments" while based in truth shows his ignorance.
Trying to buy health insurance on your own and have gallstones? You'll automatically be denied coverage. Rheumatoid arthritis? Automatic denial. Severe acne? Probably denied. Do you take metformin, a popular drug for diabetes? Denied. Use the anti-clotting drug Plavix or Seroquel, prescribed for anti-psychotic or sleep problems? Forget about it.

This confidential information on some insurers' practices is available on the Web -- if you know where to look.
So for the price of a newspaper, Johnny boy is going to spill the beans.

Any idea how much gallbladder surgery runs? About $4800 according to Out of Pocket.

How about a popular RA drug such as Enbrel? Try $1500 for a 30 day supply. Plavix ($565) or Seroquel ($126) are a bit more reasonable but these meds are just a small portion of the cost of treating such illnesses.

Johnny Reporter apparently doesn't own a calculator or know how to use it.
What's more, you can discover that if you lie to an insurer about your medical history and drug use, you will be rejected because data-mining companies sell information to insurers about your health, including detailed usage of prescription drugs.
Is Johnny suggesting you should perjure yourself in order to secure coverage? Isn't this like the liar loans that led to the mortgage crisis?

Where is this guys moral compass?
``Basically, they're taking only the healthy so they can get the fattest profits. If you really need insurance, then you can't get it.''
Kind of like, if you really need a loan, you can't get it. Unless of course you applied for a mortgage in the last 10 years or so. We know how that one ends.

Sorry, but refusing coverage to someone who is knowingly going to "bust the bank" is not about profits. Approximately half a dozen states have mandated guaranteed acceptance health insurance and guess what? Carriers are allowed by the Dep't of Insurance to charge roughly 3x the premium for similar coverage in non-guaranteed acceptance states and still make a profit.

The reason some carriers will deny coverage is because the risk of accepting that individual is so high that an adequate rate would exceed the amount allowed by the state Dep't of Insurance.

In other words, the GOVERNMENT, not the carrier, is limiting the rate and controlling access to the market. If the GOVERNMENT did not restrict the carriers from charging an adequate premium anyone could find coverage for any pre-existing condition, treatment plan or medication.
Sandra Foertsch, who sells individual policies, says the fundamental concern of insurers is clear: ''They don't want to buy a claim,'' meaning that they would start to collect $500 monthly premiums from a person and quickly pay out more than that to doctors and other providers.
Sandra Foertsch is an example of an agent without a clue. She is someone who needs to find a job asking folks if their order is for here or to go.
Searching the Web, The Miami Herald found underwriting guidelines for Coventry Health Care, which owns Vista; Wellpoint; Assurant Health; and Blue Cross Blue Shield of Nebraska.

Among the health problems that the guides say should be rejected: diabetes, hepatitis C, multiple sclerosis, schizophrenia, quadriplegia, Parkinson's disease and AIDS/HIV.
Again, Johnny Reporter shows his ignorance about risk management and his apparent disdain for legal disclaimers that the information is proprietary.

Beyond that, let's face it. Carriers are not the federal government who can write checks without having money in the bank and do so to the tune of trillions of dollars.

I wonder if the Miami Herald has access to unlimited funds and is able to pay for reporters without regard to their ability to understand basic economics or legal disclaimers? Perhaps Johnny Reporter is a graduate of the College of Community Organizing and firmly believes anything can be solved by simply throwing more money at it.

Johnny Reproter is showing his ignorance in a starring role in Miami Not Nice. It's pretty difficult to take this guy seriously, but apparently some do.

Folks looking for health insurance don't have to deal with people like Sandra Foertsch or take advice from Johnny Reporter. Clients of Georgia Insurance Shop with apnea, type II diabetes, gallstones and other ailments can often find the coverage they need.

Clash of the (Wonky) Titans

FoIB Michael Cannon of the esteemed Cato Institute takes to the pages of McPaper today, offering a vehement contradiction to Dr Kevin Pho's recent op-ed in the national daily. The subject is "comparative-effectiveness research," which seeks to analyize which medical processes work best.
Both are worth reading, if only to get a sense of how two very bright guys differ on matters of both health policy and implementation.

Friday, April 03, 2009

Wikio Rankings - InsureBlog Exclusive

Audrey Fleury, Account Manager at Wikio, sent me a heads up on April's Wikio Rankings, on which we've move up a few notches (Yay!). I must admit, it's quite heady (and a bit intimidating) to be ranked up there with the likes of Kevin, MD and Health Care Renewal; Drs Pho and Poses are both highly regarded in their fields.
And, of course, it's nice to be back in the Top 20.
And as a MOTT, the number 18 also holds special significance for me. Thanks, Audrey!
1Kevin, M.D. - Medical Weblog
2Highlight HEALTH
3GoozNews
4In the Pipeline
5The Carlat Psychiatry Blog
6The Covert Rationing Blog
7DB's Medical Rants
8Her Bad Mother
9The Doctor Is In
10Health Care Renewal
11Diabetes Mine
12Healthcare Economist
13Junkfood Science
14Schwitzer health news blog
15Six Until Me.
16Musings of a Dinosaur
17Fight Aging!
18InsureBlog
19ScienceRoll
20Disease Management Care Blog
21Brain Blogger
22Doctor Anonymous
23StevePavlina.com
24Pallimed
25retired doc's thoughts
26The-F-Word.org
27Caustic Musings
28Autism Vox
29John Goodman's Health Policy Blog
30Beyond Meds
31Weighty Matters
32Cranky Fitness
33Eye on DNA
34Adventures in Autism
35Dr. Deb
36AlexShalman.com
37CancerDiva
38The Urban Monk
39Brass and Ivory
40The Last Psychiatrist
41Autism News Beat
42The Independent Urologist
43Autism Street
44HD BizBlog
45Global Health Policy
46Digital Doorway
47Feed Me!
48Jung At Heart
49The Trouble With Spikol
50soulful sepulcher
51Women's Bioethics Project
52Big Fat Deal
53All 4 My Gals
54MSSPNexus Blog
55Aging Fabulous
56John McManamy's SharePosts
57PixelRN
58Capital Health WW-MD's Notes
59Alzheimer's Notes
60How To Use The Law Of Attraction
61The Rotund
62Natural Variation - Autism Blog
63Stayin' Alive
64Teen Health 411
65The Voyage
66lend4health [beta]
67The Change Blog
68ReunifyGally
69You Already Know This Stuff
70fat fu
71Pinwheels
72Take A Bite
73Bump on the Road
74Facing Autism in New Brunswick
75Slow Down Fast
76...salted lithium.
77Andrea's Buzzing About:
78Tech Medicine
79Medical Marginalia
80Fat Man Unleashed
81A Nurse Practitioner's View
82hospital impact
83ByronKatie.com
84Fighting Fatigue
85One Dad's Opinion
86Herbal Connection
87TomographyBlog.com
88Kidney Notes
89Big Blueberry Eyes
90Plasmetic.com
91Medicine for the Outdoors
92Med Law Blog
93Healthy Children
94Heal Pain Naturally
95Postpartum Progress
96Lovely and Amazing
97Mauzy's Musings
98Monk at Work
99AIDS.gov blog
100Sleep Disorders

Ranking by Wikio.

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.

Musical Marijuana

[Welcome Industry Radar readers!]

Musical legend Carlos Santana wants President Obama to legalize pot.
"Legalize marijuana and take all that money and invest it in teachers and in education. You will see a transformation in America."
Invest marijuana profits (or taxes on the sale and/or profit) to invest in education. Interesting concept. Since Congress is adding a tobacco tax to fund the SCHIP health care plan, why not legalize pot and tax it for education?

Maybe he is on to something.
"I really believe that as soon as we legalize and decriminalize marijuana we can actually afford a really good governor who won't keep taking money away from education and from teachers and send him back to Hollywood where he can do 'D' movies and we can get an 'A' governor," continued Santana, referring to former movie star and current California Gov. Arnold Schwarzenegger.
Here in Georgia we legalized gambling (state run lottery) and used that tax to fund education. Of course we are still 48th or so in the nation but imagine where we would be if not for the lottery tax on the poor?

More is Less?

Georgia health insurance is no different from any other part of the country. The GAO (Government Accounting Office) says that the small group market is concentrated, with only a few carriers competing for business.
The GAO report analyzed 39 states' health-insurance markets and found that in 34 of the markets, the top 5 insurance carriers accounted for more than 75% of the small-group market, compared with 26 states among 34 analyzed in 2005 and 19 among 34 states in 2002. What's more, the median market share of the largest small-group insurer in each market increased to 47% in 2008, up from 43% in 2005 and 33% in 2002.

The worry, of course, is that more concentration leads to less competition and will only exacerbate price increases for small companies.
So having fewer carriers means less competition and higher prices. Of course some folks are calling for a "single payer" system, which of course is is less than a few carriers.

And there is this.

No doubt when one entity is the dominant or only player prices can become sticky. Of course when the government is the only player they can name their price and play by rules that apply to them and not to anyone else. That is why Medicare reimbursements to providers are below market and Medicaid even lower.

It is also why so many medical providers refuse to accept Medicaid patients and Medicare providers limit the number of patients they are willing to treat.

So this begs the question.

If less competition is bad (according to the GAO) and single payer (as in Medicare, Medicaid) is worse, how will the GAO (or any other government entity) encourage more competition?

Small business owners looking for Georgia health insurance have at least a dozen major carriers and easily double that number when minor players are factored in. If we are to believe the GAO, those carriers operate in a vacuum and there is no incentive nor market forces that prohibit them from overcharging.

If the GAO had a clue (and nothing indicates they do) they would know that the DOI regulates the prices carriers can charge and LIMITS the rate up that can be applied for adverse health conditions. I have several small groups where the monthly claims easily exceed monthly premiums and has done so from the start.

So how will introducing more carriers change this?

It won't.

Many of these clients are getting a 100% return on investment on their premium dollar. For every $100 they pay in premiums they receive $200 in benefit.

Would the GAO have us believe this is bad for the consumer?

Democratic Representative Nydia Velazquez offers this observation.
"Americans across the country know our healthcare system is broken, as millions find themselves on the growing rolls of the uninsured each year, while those with health insurance see costs skyrocket," said Velázquez. "Meanwhile, small firms are grappling with how to pay for rising premiums, while continuing to offer their employees coverage. It has become clear that our current healthcare system is not only morally indefensible, it is also economically unsustainable."
Define broken?

Most of those "millions on the growing rolls of uninsured" are there by choice. Roughly 15 % of the uninsured are "young invincible's" who choose to spend their money on iPhones rather than health insurance. Another 15 - 20% are illegal aliens. About 20% are children, many of whom qualify for taxpayer funded plans such as Medicaid or SCHIP.

But yet our current health care system is "morally indefensible" and "economically unsustainable".

So are trillion dollar deficits . . .

One bright spot in Ms. Velazquez' epistle is this.
Unless the fee cut problem is addressed permanently, many small providers could have no choice but to turn away Medicare beneficiaries.

"Many smaller medical practices are small businesses and are responsible for expenses like rent, payroll, employee health insurance and malpractice insurance," said Velázquez. "Until the Medicare physician fee cut is permanently addressed, smaller providers will face difficulty making long term investments in their practices. Even worse, the projected cuts to Medicare could create a situation where small practices stop admitting Medicare patients."
So government run health care isn't the answer either.

Especially when it is underfunded.

Excuse my skepticism, but I haven't seen evidence that more government is the answer to ANY problem. Individuals and private business cannot continue to operate year after year by spending more than they take in. Eventually even the government will run out of money and will be forced to reduce services, raise taxes, or both.

Seems to me like the cure is worse than the problem.

The USPS is a "quasi-government" entity. Almost every year they raise prices and deliver less service. Fannie Mae and Freddie Mac also operate as quasi-government entities but yet they led us down the road to economic collapse in the mortgage market.

Not very promising, huh?

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.

Thursday, April 02, 2009

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”.

How Many Texans Does It Take to Fill the E.R.?

No, this is not a joke. Abuse of Emergency Rooms is a growing problem that cost's everyone. For many, the E.R. is their PCP (primary care physician).

In Texas the E.R. seems more like an old friend to some.
In the past six years, eight people from Austin and one from Luling racked up 2,678 emergency room visits in Central Texas, costing hospitals, taxpayers and others $3 million
Nine people, 2,678 E.R. visits, $3,000,000.

Who are these people?
All nine speak English; three are homeless; five are women whose average age is 40, and four are men whose average age is 50. Seven have a mental health diagnosis and eight have a drug abuse diagnosis.
That last statistic is significant.

At one time, many with mental health issues were confined in state run facilities. Budget cuts and "patient rights" advocates changed all that.

According to the report, the average E.R. visit cost's taxpayers about $1,000. The total spent on these 9 people average $55,000 per year.

That's $55,000 in "free" care that is borne by taxpayers, insurance policyholders and those who are financially responsible for their own medical bills.

The group who collected this data has information on 750,000 uninsured and "underinsured" people. The database includes 900 repeat offenders . . . people who visited an ER six or more times in three months - had 2,123 preventable visits in 2007.

A preventable visit is one that could have been treated in a non-emergency care facility such as a doctors office or clinic.

The cost of preventable visits?

More than $2,000,000.

If we want to control health insurance premiums, and taxes that go to entitlement programs such as Medicaid & SCHIP, then we need to find a more effective way of controlling health care cost. Identifying repeat offenders and finding more efficient ways of dealing with their medical issues is a step in the right direction.

Wednesday, April 01, 2009

Stupid Government Tricks

Life insurance proceeds are, with few exceptions, received free of any income tax. But that may change if the Oregon taxer's get their way.
"Oregonians who purchase life insurance and annuity products to assure the financial security of themselves and their loved ones would be hit with a tax that undermines their carefully-made financial protection, long-term savings and retirement income. H.B. 2854 would impose a tax on the life insurance benefits received by Oregon families suffering the death of a loved one. It would also impose a new tax on savings through life insurance and annuities.
Sorry your spouse died. Here is a check, less the state's cut. We need it more than you do.
Good public policy encourages financial security and self-reliance. This is especially so today when Oregon is facing 11 percent unemployment and struggling through a financial crisis that has drained the savings of so many of its citizens. Yet, H.B. 2854 goes in the opposite direction, taxing already beleaguered savings plans and penalizing families when they suffer a loss.
Is there no end to the money grabbing taxer's? Just one more example of stupid government tricks.

Ballpark Diet

Buy me some peanuts and a 4 pound burger, I don't care if I never get back.

4800 calorie burger

Just when you thought it was safe to have a fun time at America's sport, this happens.

It's not bad enough that you pay $10 to park, another $14 to sit in nosebleed seats, $8 for a beer and $7 for a hot dog, now you have a 4800 calorie burger to deal with.
The four-pound, $20 burger features five beef patties, five slices of cheese, nearly a cup of chili and liberal doses of salsa and corn chips, all on an eight-inch sesame-seed bun.
How about I leave off the bun?

Enjoy!

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]