Carefree Lifestyle? ObamaCare© to the Rescue!

You'll have to watch the PSA to learn what's in it:

Picking and Choosing: The Makena Saga continues...

Does the FDA have the right to selectively enforce its own reg's? Reason I ask is this:

"Responding to the public and political pressure, the FDA said it had no intention of blocking pharmacies from selling their own versions of Makena."

By way of background, Bob reported several weeks ago that the price of Makena (a progesterone synthetic) was set to go from $20 a shot to $1500 a pop. Talk about a rate increase! As usual, though, there was more to the story than first met the eye:

"That's because the drug, a form of progesterone given as a weekly shot, has been made cheaply for years, mixed in special pharmacies that custom-compound treatments that are not federally approved."

Since it didn't need FDA approval, the exorbitant costs associated with gaining that approval didn't apply. Pretty much everything the gummint touches, however, begins to cost more gold, and the price of course skyrocketed.

Now, the technology to actually produce the medication didn't disappear overnight from the local apothecary; it was just that the heavy hand of the government had come down upon it, in the form of a letter from the manufacturer to said pharmacists, "warning them of possible FDA enforcement action if they kept compounding the drug."

This is as much a protection for the consumer as the manufacturer, of course, but fine-wary druggists were understandably concerned that they'd be fried under a Federal microscope.

Never fear, however, because the FDA itself has now publicly folded their hand, announcing that they have "no intention of blocking pharmacies from selling their own versions of Makena."

That's correct: they're going to preemptively cede control to the private sector, and abrogate their legal duty to enforce regulations.

This is unconscionable: once the agency stops enforcing one such regulation, how can they enforce others? Obviously, the neighborhood pharmacy just got an FDAWaiver©.

Quelle surprise.

AARP vs Seniors: The $Billion Story

We've wondered before why AARP would be so willing to throw its membership under the bus. After all, one of the cornerstones of ObamaCare© is draconian cuts in Medicare. On its face, this would seem contra the interests of the folks which AARP ostensibly represents.

Not surprisingly, it's all about the green (and I don't mean windmills or solar panels):

"AARP stands to reap an extra billion dollars in profits from ObamaCare ... Worse, this extra profit is largely BECAUSE of the Medicare cuts."

That bears repeating: due entirely to reductions in Medicare, at the express expense of its members, the "leadership" at the American Association of Retired Peons, er, Persons stands to reap a fortune.

Remind me again, why would anyone voluntarily join this disgraceful organization?

MVNHS© Hates Atheists

Well, how else to explain this:

"Former NHS director dies after operation is cancelled four times at her own hospital"

Seems to me, this is God's way of proving that he exists, and has a wicked sense of humor.

If there's any silver lining to this, of course, it's that the Brits' system is at least "fair:" no waivers for previous Directors.

The truly sad part is that the poor woman was hospitalized for quite some time before her family finally decided to bring her home, concerned that she was becoming "institutionalised" from the extended stay. One wonders, given previous examples of poorly equipped and run "trusts" (the MVNHS© name for "hospitals"), whether the family was also concerned about additional health risks, given her condition.

But remember: the MVNHS© (and its ilk) is so much more efficient than our system (for now).

Health Wonk Review: It's Opening Day!

Jason Shafrin hosts this week's all-star line-up of great health care policy and polity posts. As usual, he hits a homerun.

LTCi in Perspective

As we've mentioned over the years, Bob and I frequently contribute to an online forum answering various insurance questions. Along the way, we met Herman Bruns, a Long Term Care insurance specialist with vast knowledge and a big heart. A while back, Herman graciously provided us with a guest post on when it's appropriate to consider purchasing LTCi.

Now, he's added a tremendous, intuitive way to quantify that decision. It's really just a simple test:

How long can you afford to pay $150-200+/day for your care?

How long can you afford to pay $5/day for your care?

As he explains, "if the answer to the first question is "not very long", but the answer to the second is "forever"....then you have just answered your own question. $5/day will buy many people lots of LTC insurance that pays the $150+/day if you need care. (age/health/benefit dependent of course)."

Thanks again, Herman!

Are you ready for some *Real* Death Panels?

Much has been made of the Death Panels enabled by ObamaCare©; last we looked, they had morphed into “end of life counseling” programs. Or so we thought.

Unfortunately, there's new news on this front:

"(T)he Independent Payment Advisory Board (IPAB), will face heat in the coming months from Congress and from the courts ... the IPAB is the “real death panel” in the health care law."

Quite so.

For those who may not be aware, the IPAB is an unelected, unaccountable panel whose job it is to dole out (ie "ration") health care dollars to Medicare beneficiaries. One can see, by the way, why there are those who would wish to opt out of such a system. The board's criteria is based not on need or efficacy, but cost alone.

And here's where it gets really scary: this process is every bit as transparent as the ObamaWaiver©'s. That is, unelected officials will be in charge, with no oversight, determining who lives and who dies, potentially based on political affiliation and support.

What could possibly go wrong?

But hey, it's only money!

Remember how the bill we had to pass to learn what's in it was going to save us boatloads of dollars?

Turns out, not so much:

"In particular, the provisions related to expanding health insurance coverage were projected to increase the deficit between 2012 and 2021 by $1.04 trillion ... they are now projected to increase the deficit by $1.13 trillion over that period."

That's an 8% increase in one fell swoop. And that's only the beginning:

"The estimated cost of the coverage provisions ... is a good deal larger over the 2012-2021 period than over the 2010-2019 period."

Why is that, do you suppose?

Well, it's really by design (such as it is): by "frontloading" the costs and then tacking on the "benefits" down the road, the actual impact on the deficit is delayed, but not gone.

Never let it be said, though, that the CBO lacks a sense of humor:

"As we have noted repeatedly, our projections of the budgetary impact of last year’s major health legislation are quite uncertain because assessing the effects of making broad changes in the nation’s health care and health insurance systems requires assumptions about a broad array of technical, behavioral, and economic factors."

More succinctly: "we have met the enemy, and he is us."

[Hat Tip: Bob Vineyard, CLU]

Grand Rounds is up

Family doc Mike Sevilla (formerly known as Doctor Anonymous) hosts this week's great collection of interesting medblog posts. Do check it out.

Use it vs Lose it

The major benefit of Flexible Spending Accounts (FSAs) is that contributions go in pre-tax, and eligible withdrawals come out tax-free. The major downside is that money left in the account at the end of the year is forfeit, which can discourage folks from participating in them.

A new bill, HR 1004, seeks to ameliorate this problem by allowing folks with unused balances to "cash out" at the end of the year (albeit with some tax penalties, which is fair).

Since ObamaCare© caps the amount at risk (ie the maximum contribution) at $2500, the sponsors of the bill believe that more folks will be willing to take a chance, driving up participation levels.

What say you?

[Hat Tip: National Underwriter]

Goodwin's Law Prevails

No, not Godwin's Law, Goodwin's, as in Wayne Goodwin, the Tar Heel State's Insurance Commissioner. In some ways, it's old news:

"The settlement arose out of a routine Department of Insurance, DOI, market exam of the company that began in 2005 and looked at the years 2002-04."

Settlement? What settlement?

This one:

"Cigna Healthcare of North Carolina will pay a $600,000 fine and customer refunds and credits totalling $637,974.98"

That's north of $1 million in fines and restitution, all because of sloppy record keeping and premium calculations, not to mention a consistent failure to process "claims in a timely fashion and ... failing to send acknowledgment letters within three business days for member grievances."

The aforementioned refunds were actually paid out late last summer, but the fines are due now. Incidentally, said fines will be "distributed to the state public school system."

Talk about lessons learned.

[Hat Tip: FoIB Jeff M]

POMS and ObamaCare© [UPDATED]

All those naysayers who pooh-pooh the idea that ObamaCare© will deprive Americans of the basic freedom to choose appropriate health care certainly got an eye-opener this week:

"Judge Rosemary Collyer has ruled that Americans have a legal obligation to accept subpar government health benefits."

But surely, Henry, you must be quoting selectively; there's no way a Federal Judge can force people into such a system.

Actually, I'm being kind, and to understand why, it's necessary to rewind a bit, back to October of 2009:

"Under existing rules, if one elects not to be covered by Medicare, one is also ineligible for Social Security benefits ... The judge went further than just denying the feds' request, though: she explains that these POM's are not supported by the statute. In short, they're making their own law (which is a no-no)."

[ed: POMS are Program Operations Manuals used by the Social Security Administration]

In effect, Judge Collyer said that the POM's were clearly extralegal, and allowed the plaintiffs to proceed against the Feds.

But that was then, and this is now:

"The Medicare Act is very clear that persons entitled to Social Security retirement benefits, i.e., of an age and work history and application therefore, are immediately and automatically entitled to Medicare Part A benefits upon their 65th birthdays"

She goes on to note that the plaintiffs are "trapped in a government program intended for their benefit... and wish to escape."

Seems reasonable enough.

But then, she turns this completely on its ear by ruling that there's "no loophole or requirement that the secretary provide such a pathway."

So what caused this 180-degree shift into bizarro-world?

We went back to the source, Kent Masterson Brown, the plaintiffs' attorney who's been leading the charge. Mr Brown (whom we'd interviewed several times a few years back), graciously shared his time and observations with us, Since his appeal is currently pending, he was constrained in what he could tell us, but he was equally stunned that Judge Collyer could do such an about-face with no new facts presented.

In effect, he told us, her 2009 ruling that the POM's were out of bounds has become a confirmation that the agencies can, in fact, deny his clients basic freedom of choice. Somehow, as he understands the ruling, the idea that one is entitled to a benefit now means one must accept it, regardless of one's wishes.

And he draws a straight line directly to ObamaCare©: the same (kinds of) folks who wrote the POM's will be writing these new reg's. Why would anyone believe these will be any less onerous?

The case now heads to the Appeals Court, where, in effect, Judge Collyer will be arguing with herself. Should be interesting, to say the least.

[A Special InsureBlog Thank You to Mr Brown for his time and expertise]

UPDATE: Mr Brown has written a piece for today's Washington Post, in which he warns that the decision "would allow the "health reform" law to become even more Orwellian than it already is, without any action from Congress ... More immediately, whether they want it or not, seniors will now be forced into Medicare, a program that even Judge Collyer asserts "may bankrupt all of us."

Definitely read it all.

ObamaFail©

So the bill we had to pass to see what's in it, touted as the solution to the critical problem of the uninsured, turns out to be a colossal failure?

No kidding:

"(T)he percentage of U.S. residents under age 65 who were uninsured increased to 16.3%, from 15.4%."

I'm shocked, shocked I tell you!

Midweek Link-Fest

For your edification and edutainment pleasure:

First up, it's the one year ObamaVersary©, and the Pioneer Institute hosted a debate on the financial impact of this train-wreck. Courtesy of Josh Archambault, the Institute's Director of Health Care Policy, here's the highlight reel:

2011 Hewitt Health Care Lecture from Mike Dean on Vimeo.

The full debate's available here.

Next, Jane Sanders has put together a pretty alarming graphic about the specific costs of obesity. Here's an excerpt:

Get the rest of the big picture here.

And finally, FoIB Jeff M reports that public employee benefits-cut fever has arrived in North Carolina, where state workers "would pay more for health insurance but get fewer benefits" under a new budget proposal. On the one hand, the proposed changes "scrap a provision that pushed cigarette smokers and those who were very obese into less-generous coverage until they quit puffing or lost weight" (see item above).

On the other hand, the proposal would impose onerous new contribution requirements on said employees, forcing "all active state employees and those retirees in a more-generous plan to pay monthly premiums of between $11 and $22 a month." [emphasis added]

Oh, the humanity!

Hackles and Meds

In recent posts, we've explored the rising costs and potential supply problems of "specialty meds" such as Makena and immune deficiency therapies. Fellow medblogger Lisa Emrich is deeply concerned about the increasing volatility of MS (Multiple Sclerosis) medications:

"It is expected that Gilenya will net more than $3 billion in annual sales. When the pricing of Gilenya was announced in September, members of the MS community were outraged. I was disappointed to say the least. $4000 per month for any medication is outrageous."

Almost $50 thousand a year to treat this condition, most of the cost of which is borne by insurance companies (and thus, thee and me). And even this number is suspect because, as Lisa points out, "you will note that the numbers quoted vary from source to source. Such is the nature of the pharmaceutical business. Patients do not have easy access to information such as wholesale price."

I urge you to read the whole thing for some thought-provoking insights.

Cavalcade of Risk #127 now online

Making his hosting debut, Irwin Jacobs presents this week's Cavalcade of Risk. It's a (not very) dangerous job, but someone's gotta do it.

Birthin' and such

Did you know that we spend over $50 billion a year for child-birth related expenses? I didn't, either, but FoIB Kate H sent us the link to an interesting infographic with all kinds of birth-related info. Some, like the aforementioned costs, are more interesting than others (such as predominant hair colors). The graphic itself was apparently put together by the folks at Ultrasound Technician.

The graphic leans heavily on information gleaned by researchers at "Giving Birth Naturally," which provides more than ample citations to back up its findings.

I also found this statistic rather telling: an "[u]ncomplicated delivery ... costs anywhere from $8,000-$10,000 (which) doubles for a C-section." Group medical plans generally cover both eventualities; individual plans generally cover only unplanned C-sections. Come 2014, of course, all of these expenses will be covered under all (non-waivered) medical plans, so look for premiums to sky-rocket based on that provision alone.

One place the graphic fell short was its claim that "America ranks 29th in the world for its infant mortality rate." We've debunked this canard before, of course, but it never hurts to stress how completely screwy it is. In fact, more recent information skewers this claim even more. For example:

"France, the Netherlands, and other European countries don’t count as live births babies who weigh less than 500 grams or had less than 22 weeks of gestation. They are, instead, counted as stillbirths ... in this country, we actually try to save premature and low-birth-weight babies rather than just chalk them up to stillbirths to make our numbers look good."

Spot on.

Quakes, Tsunamis and Reinsurance

The recent disasters in Japan will likely send financial shockwaves across the P&C side of the insurance industry.

A M Best reports that "Swiss Re is estimating claims costs of about US$1.2 billion, net of retrocession and before tax, from the March 11 earthquake and tsunami in Japan" and that AIG "expects to incur a pretax insurance loss of US$700 million for its nonlife subsidiary Chartis Inc. from the March 11 earthquake and tsunami."

When both the wholesale (Swiss Re) and retail (AIG) markets are reeling, one can expect substantial price increases on related lines of coverage (such as homeowners, business and the like). The basic structure of insurance is, of course. "spreading the risk," which translates to "spreading the cost of the risk based on actual losses."

And so our wallets take another hit.

Baby Joseph Update: Still with us (for a little while)

Reader Patrick P alerts us to this terrific development in the story of Baby Joseph Maraachli:

"Baby Joseph," the dying Canadian infant whose medical care sparked a national controversy, arrived at a St. Louis hospital [last week] night for treatment ... Ontario's London Health Sciences Centre ... said it doesn't perform a tracheostomy for patients who have no hope of recovery."

Which is interesting in and of itself, but becomes even more disturbing with this news:

"Doctors report he is resting comfortably ... His parents will soon be able to take him home, which was their initial wish."

The bottom line remains that Baby Joseph will likely die soon regardless; it's a question of how, not if.

An Emotional Grand Rounds

Dr Val presents this week's collection of medblog posts organized by various emotions. Provocative and effective.