Carnival of Personal Finance is up...

Funny About Money presents this week's collection of personal finance tips and insights. I especially appreciated that our host, "vh," opted to present the "miscellaneous" posts first. Shaking things up is good.

Cavalcade of Risk #79 (3rd Anniversary Edition): Call For Submissions

For our 3rd Anniversary, we're back here, where we started. Please submit your recent risk-related post by Mondy (June 1). And remember 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.

NOTE: Due to the massive amount of spam we've been getting, we're working with the hosts of the Health Wonk Review to find an alternative to Blog Carnival. Any suggestions are most welcome (as are offers to design/implement an alternative submission widget).

Health Wonk Review: Now with more "Chowdah!"

Boston Health News hosts this week's roundup of wonky posts. Be sure to stop by for seafood, baseball and thought-provoking insights.

Healthy Living and Insurance: By the Numbers

When it comes to the relationship between healthy lifestyles and insurance costs, we tend towards ambivalence: on the one hand, there's no question that choosing healthy foods and habits is a good thing; on the other, there's scant evidence that this will dramatically reduce insurance premiums.

So of course we'll muddy the waters a bit more, with some news from United HealthCare. UHC recently emailed agents some information on the (potential) relationship of healthy choices and lower premiums. Based in part on the 2009 Employer Survey on Purchasing Value in Health Care (by Watson Wyatt), we learn that two thirds of those surveyed claim their employees' poor health choices are the "biggest challenge to maintaining affordable health care coverage."

Left unremarked in the UHC email was this little tidbit:

"51 percent of companies have a CDHP in place — nearly a 9 percent increase over last year. Enrollment rates in CDHPs are also increasing at a pace of two percentage points per year, rising to 12 percent in 2008."

That's great news for those of us who think that encouraging insureds to be more proactive, and to take a greater role in their health care and insurance, is a good idea.

Another survey, this one by Buck Consultants, found that over half of the surveyed employers intended to "actively pursue a culture of health for the future." It's not clear what that means; one presumes this would include stop-smoking programs, some kind of regular excercise incentive, that kind of thing.

The carrier even included a handy flyer that can be printed out (and distributed) which recaps some of the findings and offers helpful suggestions.

Kudos to UHC for making this information available.

MassHealth: Proving Us Right

We've maintained all along that health insurance "solutions" do nothing to resolve the underlying problem of constantly increasing health care costs. And we've spent the past several years chronicling Massachusetts' (failing) efforts at forcing a government-backed plan on an unsuspecting populace.

But what do we know?

A good bit, as it turns out:

"Massachusetts took a stab at universal care by requiring every resident to buy health insurance, with the state subsidizing the premiums. The annual cost of Commonwealth Care, originally pegged at $245 million, will be $1.3 billion this year. Consequently, the state's health-care costs have spiked 42 percent in three years, and today, health- care spending is 33 percent above the national average." [ed: emphasis added]

And that's just the intro.

It's not just about increasing costs, either: even though The Bay State has more docs (per capita) than any of the other 56, average wait times have burgeoned, and it's become more and more difficult to even see certain specialists (like OB-GYN's, for example). This is apparently due in large part to so many "newly insured" (on the public's dime, of course) suddenly seeking health care. It's a major "be careful what you wish for" moment, of course: when something's free (or nearly so), demand skyrockets (cf: breakfast at Denny's).

And that's the dilemna, really: when the "solution" merely addresses the symptom (cost and availability of health insurance) without regard for the underlying problem (cost and availability of health care), then there is no real solution at all.

UPDATE: On the other hand, perhaps this idea has merit.

COBRA Made Simple

[Welcome Industry Radar readers!]

In addition to Bob's excellent one-stop-COBRA-shop and our own efforts here at IB, Humana's released a helpful video on the subject:

Public Plan or Public Enemy?

One of the favored buzz words in the current debate of health care and how to fund it is the "Public Plan." Simply stated, this would be a gummint-run, alternative system to private insurers, much like some states already use for their employees. On its face, it seems beign enough: offering a government-sponsored plan in competition with "regular" insurers would force the latter toward ever more competitive price points, while maintaining our choice of physicians and level of care.

I recently had the pleasure of "sitting in" (virtually, of course) on a panel discussion of this topic sponsored by the Heritage and New America Foundations and the Lewin Group. The panelists included representatives from all three "think tanks:" Stuart Butler (Heritage's VP of Domestic & Economic Policies), Len Nichols (New America's Director of Health Policy) and Lewin's John Sheils (Senior VP). Julie Appleby, Senior Correspondent for Kaiser Health News, moderated.

In this first of a two-part post, I'll recap some of the points made by the various panelists; in Part 2, we'll take a look "under the hood" to see what this plan is really all about.

John Sheils took point, explaining that the whole Public Plan (PP) idea is modeled on Medicare [ed: which is itself set to implode in less than 10 years.] The plan sets payment rates for providers much as Medicare does. Mr Sheils believes that Medicare currently pays about 68% of what private insurers pay for hospital expenses, and about 81% of private insurance rates for physicians.

He went on to explain that, unlike commercial insurance plans, Medicare doesn't require pre-certification for various procedures. He also stated that private insurers' admin expenses currently top out at about 13.4% [ed: we've long since debunked this particular canard, but the nature of the call was such that I could only listen, not respond]. Mr Sheils than talked about projected pricing levels for the PP.

Mr Sheils then explained that there are really two scenarios of how a PP could be implemented: a) for individuals (including the self-employed) and small firms or b) for all employers. He then went on to explain how each of these might work out for providers, but never really addressed the conundrum of "price" vs "cost (a consistent IB theme).

We then heard from Len Nichols, who opened by expressing concern over imposing Medicare pricing on all providers and care. The fundamental problem, he said, was that Medicare generally pays below cost [ed: no kidding?!]. He then blurted out that "people don't trust private insurance," but failed to provide any evidence for this assertion. Mr Nichols then picked up on the various states' plans, which are based on ERISA, which allegedly provide a "level playing field" because they must compete based on payment. Unfortunately, he failed to address the underlying problem of cost control, but we'll discuss this in Part 2.

Finally, we heard from Stuart Butler, who began by asking how each model would likely play out over time. He was particularly concerned over what he called "the down the road,"and wondered if government should manage health care. He said that the PPO option supposedly leveled the playing field, but that it is inherently unstable.

Mr Butler then turned to what he felt was a classic case of "bait-and-switch:" the Feds "wall of separation between the market and the Public Option couldn't hold," that Congress would eventually intervene [ed: cf: mortgages, cars], and that there's an inherent and insurmountable conflict of interest because, as he put it, "the government assumes the roles of both umpire and team manager."

He expressed further concern that what the electorate heard wasn't really what was said: that if one is already insured, for example, that wouldn't change. Of course that's not true, but we often hear what we want to hear. He also said that cost-shifting would increase the costs of private insurance [ed: something we've documented here at IB as regards Medicare]. He feared that the government would "cheat" later, and asked if the public was ready for a health system run by the same folks who brought us the Post Office, the DMV and the IRS. His greatest concern was that once we open the doors to congressional "oversight" there would be no "level playing field" as they required more and more benefits at lower and lower costs. He also dismissed the notion that one could argue that state and federal are comparable: no states are as powerful as the Feds. He argued that the Public Plan would control costs by controlling how much is paid.

In Part 2, we dissect what was said, and explain why the PP option isn't really about choice at all, but simply another name for government-run health care.

[Hat Tip: Elizabeth Carpenter]

Grand Rounds is up

Hosted this week at See it First, don't miss this great collection of posts focusing on the realities of health care.

Memorial Day, 2009

In Flanders Fields

By: Lieutenant Colonel John McCrae, MD (1872-1918)

Canadian Army

In Flanders Fields the poppies blow

Between the crosses row on row,

That mark our place; and in the sky

The larks, still bravely singing, fly

Scarce heard amid the guns below.

We are the Dead. Short days ago

We lived, felt dawn, saw sunset glow,

Loved and were loved, and now we lie

In Flanders fields.

Take up our quarrel with the foe:

To you from failing hands we throw

The torch; be yours to hold it high.

If ye break faith with us who die

We shall not sleep, though poppies grow

In Flanders fields.

We remember.

Carnival of Personal Finance - Memorial Day Edition

Lisa at Greener Pastures hosts this week's roundup of all things financial.

More on BlogSwag

As we've noted before, we don't "do" paid advertising here at IB. This was a conscious decision I made when we began: I believed then, as I believe now, that having paid ("click through") advertising would present potential conflicts of interest, and I really had no stomach for that. Over the years, we've received several offers of products or services for review, and have taken advantage of exactly one (our one and only book review). I also received an (unsolicited) package from the Minnesota Blue Cross touting their (then new) transparency efforts.

Of course, there have been other offers, but we've shied away from them. Even my review of iTraige was based on my having paid full retail (almost $2!) for the privilege.

So what's my point? Well, BlogSwag is about to come under a rather significant microcope, "under a coming set of Federal Trade Commission guidelines designed to clarify how companies can court bloggers to write about their products."

On the one hand, I'm skeptical that the FTC has the manpower to actually police, let alone enforce, any such "guidelines." And I'm not really sure that they have the authority to do so (although I'd welcome any light that may be shed on that by our more legally astute readers). On the other, I certainly think that, as readers and consumers, we're entitled to know whether or not a given blogger has a vested interest in "pushing" a particular product or service. I don't have any particular issue with bloggers posting glowing reviews, but if credibility is our sole asset, it seems to me that how we obtained that which is being reviewed is relevant.

Credit, Taxes and (the new) Law of the Land

With the blitz of radio and TV plugs for debt relief, and the new credit reg's recently passed in DC, folks may be engaging in some premature celebration.

As Taxblogger Extraordinaire Joe Kristan points out, "Angela Bibb-Merritt ran up over $112,000 in credit card debt ... hired a debt-relief outfit and got $10,888 of the balance forgiven ..." and thus may owe some major taxes.

Read the whole thing.

What's EMTALA? A Chevrolet?

The doc at M.D.O.D. had a pretty good response for Hugh Hewitt, and he almost convinces me – but no.

Let’s start by asking: was this doc engaged in health care policy leadership during the 40 years that preceded EMTALA? I'd guess not. Were most other physicians engaged? No.

I believe that physicians, by their failure to effectively assert leadership in health care policy, allowed what this doc calls “professional arguers” to gain control of it. I also believe that, up to just a few years ago, physicians were mostly content with this arrangement because they were left alone to charge fee-for-service based on U & C.

Let’s now ask whether the government suddenly overthrew private medicine? Or did the government come in on little cats' feet, step by step, year by year, always with a promise of doing something good for the people? Yeah, you know the answer. And so gradually government insurance types - and private insurance types for that matter – filled the vacuum of health care policy and administrative control that was being ignored by physicians. Nature truly does abhor a vacuum.

And there are consequences for inaction.

Physicians find they don’t like taking policy direction from the administrators who filled the vacuum that physicians largely created.

So yes, I think it’s an excuse - not to mention a fig leaf over the past - for this doc now to suggest that he and other physicians were simply swept along as passive victims of professional arguers, until one day they were ambushed by EMTALA - the final outrage. And after wandering around in their wilderness of inaction for 40 years, this doc now suggests that physicians believe it’s too late for action. Too late! Resistance is futile! So the better course is to “muddle through to the inevitable” which I gather means toss in the sponge and take the John Galt exit off the Hippocratic Highway. Yeah, sounds like a pity-party to me.

I have hoped and advocated for years for physician leadership in health care policy. I still think that is what the country needs. I hope for it – but encountering continual physician excuses for physician inaction makes me doubt it will ever happen.

And so we will get our government health care controlled by politicians and so docs will slowly turn into government drones and so the government will declare a great victory for the people. And the people will rejoice. Remember that, in the end, Winston Smith decided that he loved Big Brother.

Oh yeah, and there will be political patronage jobs in health care until the end of time.

So let it be written, so let it be done.

I can scarcely contain my enthusiasm.

Maybe Doctor's AREN'T So Stupid...

A few months ago, we raised eyebrows (and hackles) with our assertion that physicians are, as a group, stupid. Thanks to Blogfather Hugh Hewitt, I found this post, by a "semi-young, semi-burned out Emergency Physician," that lays the blame squarely on EMTALA:

"I believe that after EMTALA was crammed down our throats in 1986 we all saw the writing on the wall and have simply been trying to muddle through to the inevitable."

While the post runs a bit long, it's worth every minute.

UPDATE: Mike has a very different take on the good doctor's diatribe. Upon further reflection, I think his is much more defensible.

Cavalcade of Risk #78 is up!

Richard Eskow hosts this week's edition, dodging a myriad of "spamvertisements" to bring us a well-focused collection of risky posts.

Thanks, Richard!

Sen Kennedy: Good News and Bad News

First the good news: Sen Kennedy's brain cancer appears to be in remission. Regardless of how one views his politics (let alone lifestyle), it's always a blessing when folks are able to beat back their illness.

Now the bad: Under the health care plan that Sen Kennedy and his colleagues would impose on us, such an outcome would be unlikely. That's because the centerpiece of their party's plan is the use of cost/benefit analyses, which bodes ill for the sickest among us.

As we've seen time and again, those most at risk in such a system are the ones least likely to be approved for treatment. Of course, if the idea is to ration health care, this makes sense; if you're dying, there's probably no real incentive to bother getting out to vote.

Something to consider if you're leaning toward supporting such a scheme.

[Hat Tip: RedState]

HSA News: "When and How Much" edition

Nothing dramatic, but two recent items may be useful for readers. The first, for those who reside in the Beehive State, clarifies that the “establishment date” of an HSA (the "account" portion of a Health Savings Account plan) is the "first day that an account holder is covered by a high-deductible health plan (HDHP). Previously, an HSA wasn’t considered established until the account was both open and funded." In other words, one had to actually "activate" the account (by depositing money into it) before it was considered "live."

This was a problem for folks who use their accounts on a "revolving door" method (waiting for an actual expense before funding the account). That dilemna is now resolved, at least for those in Utah.

The second item is news that 2010 will see increases in both the amount one may contribute to the HSA and the minimum deductible required for a plan to be HSA-compliant. For singles, the max contribution will go to $3050 (an increase of $50, or about 2%); for families, it'll be $6150 (up $200, or a bit over 3%).

On the other hand, the minimum deductible for single cover increases from $1150 to $1200 for singles (over 4%), while the minimum family deductible goes to $2400 (also about 4%). While these numbers aren't large, they are significant: the percentage increase in minimum deductibles is almost twice that for tax-advantaged contributions to help pay them. That's disturbing.

Grand Rounds: Special Edition

Health Care Technology News hosts this week's edition of health care posts, with a special emphasis on Health Care Reform.

Carnival of Personal Finance is up

Debbie Dragon hosts this week's roundup of finance-related posts, with a "Pay it Forward" theme.

Ve haf vays . . .

[Welcome Industry Radar readers!]

For those who don’t like the free health care that is already, er, freely available, you will really not love the health care planned for delivery to you by crusaders such as the new head of the CDC, Thomas Frieden:

. . . an infectious disease specialist who is known mainly as an enthusiastic advocate of New York's strict smoking ban, heavy cigarette taxes, trans fat ban, and mandatory calorie counts on restaurant menu boards . . .

It's true that unhealthy behaviors affect the government's cost e.g. Medicaid; CHIP; benefits for employees of the City of NY; etc. That means these behaviors raise the tax burden. Hmmm, so as long as we're raising taxes, the thinking goes, why not instead raise taxes to finance "programs" designed to eliminate these behaviors? This motive is couched in benevolence - after all, it's "for your own good," is it not?

And when the government is financing all of "health care", just imagine all your behaviors it can think of to regulate, to save taxpayer money, "for your own good."

The entire linked article is worth thinking about. Thanks be to Jacob Sullum at Reason Hit & Run.

If this topic piques your interest I also highly recommend this short story - if you can find it. Hint: it seems like SF, but is actually a parable of a possible future. Certain characters in this story are truly trying to bring “wellness” to humankind. Their mission is benevolent and they carry it out out with integrity. Yet the result is . . . well, you read it. Worth your time - if you can find it.