IB @ 5

Hard to believe, but InsureBlog turns 5 today. Along the way, we've become a go-to source for COBRA/ARRA and health care "reform," a Lexis-Nexis Top 50 blog, consistently ranked in the Top 20 in the Wikio Health category, and enjoyed a steady growth in regular readership.

Of course, we're most pleased and proud about that last: it's our readers that drive us, and we're grateful to all of you.

Thanks!!

Better late...Cavalcade of Risk Edition

I've been away for a few days, and apologize for my tardiness. Please pop over to Wenchy's site for the latest edition of the Cavalcade of Risk.

As usual, Wenchy does a masterful job of presenting varied and interesting (and, of course, very interesting) risk-related posts.

Cart-Horse. Or is that Horse-Cart?

Back in the day - oh, say, a year or so ago - it used to be that Congress would write a bill, Congresscritters and we of the unwashed masses would read it, and then there'd be a vote on it.

That is to say, in the dark middle-ages of - oh, say a year or so ago - the electorate and its representatives would actually know what was in a bill before deciding whether or not it merited passage.

Heck, they even wrote a song about it.

But that was then - oh, say, a year or so ago - and this is now:

"Mr. Axelrod also issued a warning to Democrats who were reconsidering their support for the health care measure.

“As a political matter, the foolish thing to do would be for anybody else who supported this to walk away from it ... people will never know what’s in that bill until we pass it, the president signs it and they have a whole new range of protections they never had before.” [emphasis added]

Did I hear (or rather, read) that right? Pass a bill before knowing what's in it?

Are you kidding me?

I'm thinking of an old Yiddish proverb.

[Hat Tip: James Taranto]

LOL Grand Rounds (Featuring Teh Kittehs)

I have no idea how or where the whole LOLKitten meme got started, but Nurse Kim harnesses their cloying cuteness to good effect with this week's edition of Grand Rounds.

Drop by for the kittens, stay for the great medblog posts.

Zombies in CA

Golden State politicos have turned a deaf ear to their Bay State cousins, who last week roundly rejected ObamaCare by sending Scott Brown to DC. The folks in Sacramento think that a state-run health care system is the way to go, proving that, like the undead, the concept of gummint-run health care is difficult to put down:

"A key legislative committee in California revived a bill Thursday to create a government-run health care system in the nation's most populous state ... Creating a single-payer system would cost California an estimated $210 billion in its first year."

Surprisingly, though, I rather like this idea. As we've previously noted, experimenting at the state level makes a lot of sense: in a worst-case scenario, only one state's citizens are put at risk, rather than the whole country. On the other hand. if any part of it is successful (it could happen!), there may be ways to translate that to other states. At the very least, we can learn from one state's mistakes, or successes.

Of course, at a time when California's budget is deep in the red, it may be difficult to push this through. It's not clear whether, given the rejection of ObamaCare by an overwhelming majority of American's, this will pass the state's Senate. Stay tuned.

Roll of the Dice: Insurance or Lotto?

[Welcome Industry Radar readers]

One of the very first lessons in Insurance 101 is that insurance is risk management, not gambling. I never quite bought into that, especially as regards indemnity-based products (such as health or home insurance). Life insurance is, almost by definition, something of a gamble as well: the fact of one's mortality is a given, the when, however, remains uncertain. I don't really see a contradiction here: after all, risk management and gambling are really just two sides of the (ahem) same coin.

Some scientific folks, though, wonder if there's a connection between buying insurance and playing the numbers:

"It's all in the genes, contends a team of economists and molecular geneticists from the Hebrew University of Jerusalem and two Asian universities."

It's an interesting look inside the decision making processes we employ, and how they're influenced by our genetic and psychological makeup. It's a safe bet you'll find it intriguing.

[Hat Tip: FoIB Holly Robinson]

Knee Deep? Neck Deep?

Or up to our eyeballs?

Doc's Behaving Badly: The Note on the Door

So my primary care doc decided to retire, but declined to announce this decision to his patients. Before (apparently) skipping town, he and his (former) practice posted a letter to that effect on the front door. The practice (which continued on) also decided not to notify its patients of this material and substantial change to their health care equation.

This, of course, creates a number of problems:

First, by failing to notify its patients, the practice puts their insurance coverage at risk. As most professional agents counsel their clients, just because one doc in a practice is in-network doesn't automatically mean that they all are.

Second, although I was not a regular fixture at this office, I've been a patient for over 10 years, and the fact that the now-retired physician -- we'll call him Dr S -- is no longer available seems relevant. For example, after much nagging, er, urging by my better half, I (finally!) scheduled a full-scale routine exam. Mind you, I scheduled this exam after Dr S flew the coop, but before I was aware of "the sign on the door." In fact, the only reason I knew about it at all is that one of my clients is (or was) also a long-time patient of Dr S, and called me to find out what I knew about it.

And so I stopped by the office, saw (and read) "the note on the door," and popped in for details. I was told by the very nice young lady behind the glass window that the staff had strongly encouraged Dr S to send out a letter announcing his forthcoming retirement, but (for reasons known only to himself, apparently) he demurred. I nodded, and asked why the other, remaining doc (his erstwhile partner) hadn't felt it necessary to notify her new patients of the change. The young lady replied that they were telling patients as they called in; I quickly corrected her, reminding her that I had made my appointment after the event, but was told nothing.

There really wasn't anything she could say to that, nor did I expect her to. It's not her call to make.

The more I pondered this, the angrier I became; just as in a marriage, the doctor-patient relationship is built on trust: the doc trusts that I will inform him (or her) about symptoms or whatever, and I trust that I will receive appropriate care, or a referral, or whatever. By failing to explicitly notify me of this change, the practice broke that trust.

Obviously, there's nothing to be done about Dr S. He did what he did, and there's really no recourse there. But his (now former) partner abused that relationship, and I wondered if perhaps the Montgomery County Medical Society might have something to say about that.

I called the society and left several voice mails, one of which was eventually returned. I was eventually transferred to a Ms Mahle, who apparently forgot to take her "be nice to people who call in" pills that morning. For one thing, she completely mischaracterized how insurance networks operate, and when I corrected her, she got, well, let's just call it "snippy." She did provide me with the number for the Ohio Medical Board, but then told me she didn't want to talk with me, and hung up before I could reply.

Which was probably just as well.

When I called the Ohio Medical Board, I learned several interesting things:

First, it was obvious that I wasn't the first person to have, um, issues with the Montgomery County Medical Society, but that they weren't at liberty to discuss this in any detail. That's because of the second thing I learned: the "Medical Society" is simply an association of providers who pay dues for, well, whatever the Society does for them. They apparently have no power (nor, apparently, desire) to discipline errant physicians. That's up to the State Medical Board, which is the actual government agency which oversees physicians (and, one presumes) other providers. They do have a formal complaint process, of which I may or may not avail myself.

Needless to say, I won't be using that practice anymore: they've squandered my trust with "a note on the door."

Medical Bill Helper: The Rest of the Story

As promised when introducing the newest member of the "Resources" section of our sidebar, here's what Rick Lifsitz, CEO of Medical Bill Helper, shared with me in an extended phone interview:

InsureBlog: First, thanks so much for taking the time to help our readers understand what your service is all about. Can you tell us about your background? Are you a physician, for example?

Rick Lifsitz: I'm always happy to explain what we do. No, I'm not a physician, I'm a businessman, MBA, with many years of experience starting and running companies. Mostly with technology and how to apply technology to solve business problems.

IB: What was the original motivation for Medical Bill Helper (MBH)?

RL: As a business owner, I'd heard lots of stories, and seen firsthand, how folks with no insurance, or who had to go out of network, were routinely charged much more than the insurance companies paid. They needed the health care, and were stuck with the bills. I didn't think that was right.

For example, I looked at what radiologists were charging in a specific area for a certain test. The exact same test ran anywhere from $300 to $3,000, all from providers all within a few blocks or miles of each other. It just didn't seem to make sense. And it didn't seem fair that people without insurance were having to pay such high amounts. I knew that a lot of these prices could be negotiated, but most people don't know that, or know how to go about it. [ed: This may be particularly helpful when dealing with Hidden Providers]

IB: How is MBH different from, for example, those discount card programs we see advertised so heavily?

RL: Well, for one thing, we don't have any kind of on-going fee arrangement. You sign up and we charge you a percentage of what we save on a claim. There's no monthly "membership fee" or the like. And we don't charge anything if we aren't able to save our client at least 10%. I think that any consumer can go to their doctor and ask for a simple 10% discount, so we don't charge unless we generate a bigger savings than that. And that's also why we don't work with charges under $500; the point is to deal with the runaway costs, not the small ones.

IB: Okay, but that begs the question, just how do you know what the "right" number or charge should be?

RL: We have databases with UCR [ed: Usual, Customary and Reasonable] for different procedures and areas, and we have people on staff with many years of experience negotiating these costs for the insurance companies. Even though we actually opened up MBH in 2009, our people have decades of experience in these kinds of negotiations.

IB: One of the challenges with the discount cards is that they typically require payment in full at time of service, or within a very narrow timeframe afterwards; there's generally no "payment plan" arrangement available. Does MBH work pretty much the same way?

RL: Well, by definition there's no requirement for payment at time of service; we only come into the picture afterwards. Our experience is that providers, while the preference is for payment in full, we've also had occasions where there's been a payment arrangement set up. The big issue is that there are really two kinds of people in this situation: those that have no intention of paying, and those that want to but have finance or budget issues. That first group (non-payers) isn't coming to us, anyway; why bother negotiating on something you're not going to pay in the first place? It's that second group that we're trying to help.

IB: Thanks so much for your time, and we'll remind our readers that they can find the MBH link in the "Resources" section of our sidebar. And we'll also point out that that's a direct link to MBH; we don't receive any compensation for folks who find you because of us [ed: darn!].

Cavalcade of Risk #97: Call for submissions

Wenchy hosts next week's Cavalcade of Risk. Submissions are due this Monday (January 25th); please 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.

We need hosts for March and April - please click here to volunteer!

MassCare: No Brownie Points

FoIB Michael Cannon (director of health policy studies for the Cato Institute) has published a new study that shows some major cracks in MassCare. For example, it's significantly reduced the number of private insurer options in the Bay State, and it's cost a lot more than originally advertised (which we've long since noted). All the while failing to actually improve health.

Download the study here.

By the way, that may also explain why " [f]ifty-two percent of Bay State voters who were surveyed as the polls closed [on Tuesday] said they opposed the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing his chief domestic initiative."

Health Wonk Review: What's Your Avatar edition

Health Wonk Review, the biweekly collection of posts on health care policy and polity, continues to get better and better (no mean feat!). For example, the Disease Care Management Blog's Jaan Siderow hosts this week's 'Review, built around the current hit movie "Avatar."

It. Is. Awesome.

Jaan has obviously taken the time to read each and every submission, and offers both excellent commentary and a sly wit to present a screenplay-worthy HWR. Highly recommended.

What a Life!

For the past 15 years, the LIFE Foundation ("a nonprofit organization dedicated to helping consumers make smart insurance decisions to safeguard their families’ financial futures") and Newsweek (the magazine) have co-sponsored a campaign to highlight how life insurance has helped to make a difference in the lives of real people.

Last year, FoIB Nick Perry shared his own family's moving story with us. Perhaps you have a similar experience. Agents can submit their entry for this year's award:

"Agents have until March 31, 2010 to submit a short essay describing how the benefits of insurance, along with their advice and assistance, made a big difference in a client's life at a time of great financial need. An independent panel of judges will select four stories to be featured in a September 2010 special advertising section in Newsweek magazine, seen by nearly 13 million readers. In addition to the Newsweek special feature, each of the award recipients and their clients, along with a guest, will receive an all-expenses paid trip to Seattle, Wash., Sept. 11-14, 2010."

I've asked the folks running this if a consumer can "nominate" his or her agent for services "above and beyond;" we'll let you know if that's an option.

Click here for more details and to submit your nomination.

Rewarding Incompetence: Your Tax Dollar$ at Work

In a preview of ObamaCare, the Indian Health Services folks are in the news again ("Indian" as in Sitting Bull, not Gandhi). Regular readers may recall our warning about the Epic Fail nature of this agency last June:

"On some reservations, the oft-quoted refrain is "don't get sick after June," when the federal dollars run out."

But health care is apparently not the only commodity that the IHS has difficulty keeping track of:

"[The] government-run health agency for native Americans and Alaskan natives, has lost or had stolen millions of dollars worth of equipment over the last several years, but has yet to implement recommendations for improvement."

This kind of irresponsibility should not go unpunished, and of course our ever-efficient gummint is right there to save the day, teaching these rascals a bitter lesson:

"The reward for poor performance was to give bonuses and awards" says "Gregory Kutz, managing director of forensic audits and special investigations for the GAO."

Oh, goody!

But of course, the buck ultimately stops with the one in charge of the wasteful agency, right?

Well, not so much:

When asked "last week what measures have been taken to amend these problems and whether the agency has taken measures to ensure individual accountability...Dr. Yvette Roubideaux, the director of the Indian Health Service ... [responded that] “We’ve done a lot to address the property issue, and I’d be happy to talk with you with an interview to address that issue. I want to keep the focus today on H1N1 which is the most important thing that we have to talk about today.”

Of course, of course.

Tens of millions of taxpayer dollars lost or stolen, but gotta get right on that flu vaccine.

In January.

After the big scare.

Gee, I can't wait 'til these folks are in charge of everyone's health care!

Now THERE's a Recommendation!

“The Senate bill is better than nothing”

- - House Majority Leader Steny Hoyer

1000 Words...

Introducing Medical Bill Helper

Just as HamburgerHelper© makes it easier to stretch your food budget, a new service called Medical Bill Helper makes it easier to stretch your health care budget. Put simply, MBH helps folks negotiate their medical bills. Unlike discount cards, though, there's no monthly fee or charge; in fact, you only pay them if they save a certain percent off your bill.

This is a service that seems tailor-made for insured folks who've used non-network providers, as well as those who are currently uninsured and need help minimizing their costs.

MBH was recommended to us by one of our long-time readers, and I'll be posting an interview with its CEO shortly. In the meantime, check them out here; we've already added them to our Resources list in the sidebar.

BlogBurst for Haiti

We've been asked by fellow MedBlogger Dr Lisa Marcucci (proprietress of the InsideSurgery blog) to help spread the word that "the American College of Surgeons ... the American Academy of Orthopedic Surgeons ... are requesting help from the medical blogosphere in disseminating information that might be helpful to those deployed, deploying and wishing to volunteer in some way."

The idea is to let people know how they can help, whether it's donating money, or food, or time, or expertise (or some combination of those). We'll try to help by publishing (and updating) links for folks who can help in one or more of those ways. Here are two to get the ball rolling:

■ Sponsored by the American College of Surgeons, Operation Giving Back is "a comprehensive resource designed to help surgeons find volunteer opportunities best suited to their expertise and interests, whether across town or across the world."

■ Crudem "is the largest private hospital in the North of Haiti ... the 73 bed hospital has provided uninterrupted service for 23 years. This premier Haitian healthcare facility has been a beacon of hope for the people of Northern Haiti."

A Delicious Grand Rounds

Dr John Lapuma serves this week's menu, er, collection of great medblog posts featuring Food as Health Care.

Bring a napkin!

Our Runaway Congress

And now this: "The White House and Democratic Congressional leaders, scrambling for a backup plan to rescue their health care legislation if Republicans win the special election in Massachusetts on Tuesday, have begun laying the groundwork to ask House Democrats to approve the Senate version of the bill and send it directly to President Obama for his signature."

I’m not one who says that the government should never become involved. And I do not feel our health care system is running fine. But while change is needed, that does not mean ANY change will do.

Our health care delivery and financing systems clearly have significant problems. Why haven’t the House and Senate focused on them? Why haven’t the leadership of the House and Senate steered toward solutions to THESE problems instead of creating the monstrous fraud of health care “reform” they are trying to foist off on America?

I think the answers are that this Congress is only pretending to reform health care. It is not reforming medical care. It’s not even reforming health insurance. Those are just fig leaves hiding the real substance. The real substance is deals. Deals that will get a bill passed enabling the majority party to extend its power to control 17% of the entire economy.

How is Congress forging these political deals? The promise of transparency has been discarded like the worthless lie it always was. The real impact of the House and Senate bills is carefully hidden behind a curtain of thousands of pages of arcane verbiage that even the legislators haven't read. The intent is to ram a deal thru before the people or anyone else might actually read it and figure out what has happened.

At the same time, the political bribery is out in the open. The Senator from Nebraska? Bribed for his vote. The Senator from Louisiana? Bribed for her vote. Big Labor? Bribed for its support. How can anyone believe other similar bribes haven't also been doled out behind the curtains?

If none of this were so, the unequal taxation of employer-sponsored and individual insurance wouldn't be permitted to continue. If none of this were so, the fraud and waste in Medicare and Medicaid wouldn't be ignored (except as a means to “fund” the administration’s proposals.) If none of this were so, cross-state purchase of individual insurance wouldn't be ignored. If none of this were so, tort reform wouldn't be ignored. If none of this were so, the CBO scoring of the administration’s proposals wouldn't be ignored. If none of this were so, the emerging will of the people wouldn't be ignored.

And the will of the people is being ignored by our runaway Congress.