Death Panels take Cannon Fire

As in Cato's Michael Cannon, who heads up a special Cato forum at noon tomorrow (Thursday). Michael is joined by Len Nichols, the Center for Health Policy Research and Ethic's Director (whom we've met before), and a few other "friends."

The forum will discuss the ObamaTax's Independent Payment Advisory Board (IPAB) Death Panels, and takes place at the Institute. For those of us who can't be there in person (and thus will also miss out on lunch), the event is being livestreamed, as well.

Stupid Government Tricks

The latest nail in the coffin of personal responsibility (and common sense) just got pounded in:

"Unclaimed property probes by states have escalated to now include mid-sized insurance companies ... The cost of these settlements are not insignificant."

This past Spring, for example, MetLife paid off settled with regulators in 22 of the 58 states, to the tune of $40 million. And for what? Allegedly, they used different methods to track down annuitants than life insurance beneficiaries.

Here's a clue, "insurance regulators:" of course they used different methods, they're different kinds of policies which promise different things.

Presumably, one buys a life insurance policy to help defray funeral costs, pay off a mortgage, help one's progeny through college, whatever. But if it was important enough to motivate one to buy the insurance, doesn't it stand to reason that it's also incumbent upon one to let people know you bought it in the first place?

Sheesh.

There are really two questions here: is it really the insurer's responsibility to track down its dead policyholders? And exactly how are they supposed to do this? As to the first question, do we really want to give insurers access to our every movement? Because that's the only way they can track us. No one has a problem with that?

As to the second, even the government admits its own record-keeping of deceased citizens is damaged goods.

By the way, MetLife didn't pay that $40 million: its policy- and share-holders did. But does anyone really expect government bureauweenies to "get" that?

The ObamaTax vs The Economy

A year and a half ago, we noted that the ObamaTax specifically encouraged employers to find ways to discontinue (or avoid offering) group health insurance plans. At the time, we predicted a "preference cascade" among employers; that is, once one large company started down that road, others would soon follow.

Are we beginning to see this in action?

You tell me:

"Orlando-based Darden Restaurants has stopped offering full-time schedules to many hourly workers in at least a few Olive Gardens, Red Lobsters and LongHorn Steakhouses ... one of the many things we are evaluating to help us address the cost implications health care reform will have on our business."

The company is quick to point out that there's been "no decision made about expanding" the program, but really, what else can they say at this point?

Something about unringing a bell?

Monday Morning LinkFest

Have you ever driven by a car wreck just as it's happening? Time seems to slow down, everyone and everything appears to be moving in slow motion. Well, that seems to be happening with the ObamaTax. FoIB Elena Marie notes this little gem:

"Five insurers, including two of the nation’s largest, already decided to stop selling health insurance in Indiana, mainly because of the [ObamaTax] edict ... And the American Enterprise Group, citing the medical loss ratio and other regulatory burdens, will stop offering individual insurance in more than 20 states, causing 35,000 people to lose their coverage and create a less competitive insurance market."

But remember, "if you like your health plan..."

Meanwhile, in our nation's capital, the local politicos think they've stumbled on the health insurance panacea:

"A board has required D.C. small businesses and individual buyers to purchase health insurance through the newly minted health exchange."

There's some question as to that Board's authority to enforce the new regs, but it's interesting to note that its chairman, Dr. Mohammad Akhter (doctor of what is left unspecified) opines that "[i]f you have a business license here in the District of Columbia, then you participate through the exchange."

Looks like some folks have a problem grasping that whole "pro-choice" concept.

On the other hand, it looks like actual health care providers are none too pleased with the ObamaTax:

"A new survey shows Mitt Romney with a commanding lead over President Barack Obama among doctors, with Obamacare helping to sway their votes."

Well over half of the doctors surveyed say they favor repeal of the train wreck.

Our last item this morning also comes to us courtesy of Elena Marie.

Seems that the Much Vaunted National Health System© is continuing its crackdown on folks who want to, you know, stay alive:

"Forty-three hospital patients starved to death last year and 111 died of thirst while being treated on wards ... There were 558 cases last year where doctors recorded that a patient had died in a state of severe dehydration in hospitals."

Remember, this is the model for the ObamaTax that we'll soon be living dying under.

UPDATE: Looks like the ObamaTax may have another potentially damaging challenge:

"Tucked inside the Supreme Court's lengthy list of orders ... was an indication that the fight over President Obama's health care law soon could be back before the high court ... Liberty University, a Christian college in Virginia, has been fighting the employer mandate since the law was enacted ...  the Supreme Court ruled that the Anti-Injunction Act did not serve as a barrier to lawsuits challenging the health care law."

Earlier, the 4th Circuit had turned down the case as "premature" since no one had yet been penalized for not paying the Employer Mandate fine tax. The Supremes, though, have just re-opened the door for Liberty to re-file.

We've written before about the ill-conceived Employer Mandate; this seems to indicate that it'll be back on the radar soon.

Shecantbeserious Flails

Well, continues to flail is probably more accurate.

She and her minions still haven't found time to delineate specifics for the "Essential Health Benefits" portion of the ObamaTax. This is a set of core "benefits" that must be included in health insurance plans that want to participate in the Exchanges (yeah, we know) come 2014.

Badger State insurance commissioner Theodore Nickel "now has written to U.S. Health and Human Services (HHS) Secretary Kathleen Sebelius to say that the state needs at least 60 days after HHS issues the final PPACA essential health benefits (EHB) regulations."

While she's dragging her feet on actually doing her job, Ms Shecantbeserious has found time to spread government largesse (ca$h) around to her buddies in the private sector, inking a "deal worth more than $3 million to promote [ObamaTax] “exchanges.” And yes, these are the same Exchanges that she can't be bothered to actually, you know, provide guidance for.

By the way, this is the second such deal for her friends at PR firm Weber Shandwick; back in 2010 they scored a cool $3.4 million contract ostensibly for promotion of Medicare fraud prevention and reporting.

Nice gig if you can get it, right Kathy?

Um, about that 3000% Premium Decrease (Redux)

As we've pointed out before (most recently here), the mythical decrease in health insurance premiums was always a fantasy, concocted by those who pushed to pass the ObamaTax (in order, of course, to find out what was in it). Now, FoIB Holly R tips us to the latest from my own neck o' the woods:

"Workers in Greater Cincinnati and Northern Kentucky will pay an average $4,775 out of their own pockets for health care in 2013, about $400 more than this year and nearly $2,000 more than 2007."

Ooops.

I can't help but notice that Mr Peale joins his journalistic brethren in continuing to conflate health care with health insurance. On the other hand, he at least tries to differentiate between them by noting that "payments include health care premiums through their employer, plus office co-pays and deductibles."

I give it a B-.

A star is born!

Our very own Kelley Beloff was part of an NPR roundtable last night, watching and commenting on the debate:

"Kelley Beloff, who works in the health care industry and leans right, says tax rates are impacting her vote, "I am totally middle class...and the big thing for me was hearing Mr. Romney talk about bringing down our taxes. My husband owns his own business, and we pay those individual taxes, and it is very difficult at times to make those tax payments."

Here's audio:

Musings: An Interview with Dr Rob

Dr Rob Lamberts, one of my very favorite med-bloggers, is making a major career change. He'll still be doctorin', of course, but in a new practice, based on a cutting-edge model of health care delivery. If you've never read any of his work, I heartily recommend that you do so.

After his residency at Indiana University in 1994, Dr Rob went into private practice with another physician (who subsequently went to Africa to do missions work). Their practice was initially owned by a hospital, but by 1996 they'd decided that it was better to leave and do "their own thing."

InsureBlog: What made you decide to chuck it all and re-boot?

Dr Lamberts: I had been frustrated as the other doctors in the practice grew more and more resistant to change. The more partners we had, the more inertia we gained. Since I am not a person to sit still when I think there are solutions to problems, I found it increasingly difficult to stay put because of others' personalities. This created conflict, which led to me looking at my options. Going solo in a practice that dealt with the insurance game and had the same limitations as the old practice was not a good solution for me, so when I found the Direct Primary Care (DPC) model it really appealed to me. In the end, my (now former) partners and I saw this as an irreparable split between us and the decision to split was mutual. They have worked it out so I don't have to draw a paycheck for up to 6 months, which gives me time to build my new practice right. They also gave me access to my patients to tell them about the new practice, which is a really generous thing on their part.

IB: You've mentioned that you may have patients that can't (or won't) follow you to your new practice, can you expand on that?

RL: The DPC model is one in which the patient pays the doctor directly for their care, usually in the form of a monthly "subscription," plus or minus a fee for visits. DPC usually limits the size of the patient pool as well, so I will only be able to take 1/3 of my total patient population even if all wanted to come (I had between 3 and 4 thousand patients in my old practice and will limit it to around 1000). Plus there is the fact that some patients are not going to be willing to pay what they see as an extra fee for care they already could get. Since nobody else in the area is doing this, the only way I can show that the value of the service will be worth the cost is to make it work. Some people will trust me in this, while others won't.

IB: I know a lot of practices are being gobbled up by hospitals eager to grow their ACO's [ed: Accountable Care Organizations]. Was this ever an option for you?

RL: Not really. If we were able to work out our differences in the old practice I would have been part of a primary care ACO that is being formed by a local IPA (group of independent primary care physicians who have allied together to do this). Primary care is quite independent in Augusta, and has recently done quite well in organizing and working together for their best interest (without risking collusion, despite what the hospitals may say). I could be part of an ACO in that setting if I wanted. In truth, however, I have grown less and less enamored with these models, as they are more driven by data and processes built around meeting care standards than they are built around good patient care.

We had been working on "Patient Centered Medical Home" in our practice, and I found that it was anything but patient-centered; it was data-centered, and took my attention away from the patients. Finally, I simply don't think the hospitals are the means to truly affect meaningful change in health care. They are the businesses that have been built on over-spending on health care, on unnecessary procedures, and on consumption of medical resources. The goal of most hospitals for my patients is 180 degrees from mine: their financial gain is built on people getting procedures, going to the ER, and being hospitalized, while mine is to help them avoid all of the above. [Continued below the fold]

Quote of the Day

"Fathom the hypocrisy of a government that requires every citizen to prove they are insured... but not everyone must prove they are a citizen."

Now add this, "Many of those who refuse, or are unable, to prove they are citizens will receive free insurance paid for by those who are forced to buy insurance because they are citizens."

[ed: incorrectly attributed to the great Ben Stein - but spot on nonetheless]

[Hat Tip: FoIB Debbie C]

Cavalcade of Risk #167: Now online!

Russell Hutchinson presents this week's Cavalcade of Risk and, as usual, does an outstanding job. As he notes, "whatever the conditions, I usually find at least one writer in each Cavalcade offers something interesting that is written well."

Take his advice and check it out.

Alzheimer's News

It's been a little while since we've written about Alzheimer's; two recent news items on the subject caught my attention.

First, it appears that researchers at the "Barcelona Biomedical Research Institute have hailed a natural hormone linked to the sleep cycle as an important new weapon in the fight against" Alzheimer's. Combined with an active lifestyle (exercise), melatonin seems to be effective in slowing deterioration of the brain.

Nothing conclusive yet, but it seems promising.

The second item relates more to those providing care to folks already suffering from the disease. As we've noted, a major problem for family members as caregivers is that they can "cost themselves major chunks of their own nest-eggs; giving up their ability to contribute to 401(k)'s and the like means that there's less available to them when they need it."

That's the financial side, which is pretty important, No less important, though, is the physical toll this can have on these selfless folks. And that's where "the Hebrew Home at Riverdale's ... ElderServe at Night" comes in. The program offers "a structured series of singalongs, crafts and therapy sessions that lasts until dawn." and is available to folks suffering from dementia. That's the good news.

Here's the bad:

"While many nursing homes offer temporary "respite care" so caregivers can catch up on sleep or go on vacation, the overnight-only program at the Hebrew Home fills a niche. But costs are high, and such programs are rare. An official at the Alzheimer's Association said she knew of no other."

Here's hoping that the phenomenon takes off.

ObamaDentalTax

Dr Kim Henry is a dentist (and friend of Bob's) who practices in Hapeville, Georgia. He's also a veteran (Navy) who served alongside Marines in Lebanon in 1983. Having been in practice for over 3 decades, he's seen a lot of changes in health care. Recently, he penned this post for his own FaceBook page, and has graciously allowed us to re-post it here:

"We were told by the former House speaker that we should “Pass the health care bill so we could find out what is in it.” Slowly we are finding out what is in it, and much of it really stinks.

Beginning January 1, 2013, a new 2.3% federal excise tax will be added to all dental lab work- crowns, dentures, bridges, everything. Bet you thought something called the “Affordable Care Act” was supposed to make health care cheaper, not more expensive, right? Well, I am sure it’s not the first time you have been lied to by politicians.

In June, our US House of Representatives voted to kill this provision, by 270 to 146. Unfortunately, there is not the interest in the more liberal US Senate to back up the House action.

When government makes operating costs of dentists go up, guess what happens to dental fees? Think they will be more “affordable?”

I could write a whole book on how government raises the cost of health care. Unfortunately, class envy demogogues want you to believe it is greedy health care professionals who are responsible.

There will be more Obamacare surprises to come, I guarantee you."

Thanks, Dr Henry, for sharing your succinct - and spot on - thoughts with our readers.

Will Obamacare figure in the debates that start this week?

I think not much. Why not? 

Obama may not want to bring up this law because, despite the Supreme Court decision, it remains widely unpopular.

Romney may not want to bring it up either.  That’s because the Obama campaign would very likely not respond on the issue, but instead would respond by claiming "Romneycare" in Massachusetts was the model for Obamacare.  That’s false; Romney’s actual proposal was less intrusive and less expensive than the law that was ultimately enacted in Massachusetts.  But, nevertheless:

(1) the explanation is complicated, and would not sway many votes.  That’s because most voters would ignore it just because it’s complex.

(2) Worse, it would be a diversion, taking limited debate time away from focusing on Obama’s main governing failures – his wretched economy and his wretched foreign policy.

For these reasons, neither candidate may see much use in bringing up Obamacare; in fact both candidates may see potential harm in doing so. That’s why I think Obamacare will not figure importantly in the debates.

Additional info is here and here.

Among other things, the first linked article reports

The Romney proposal included an employer mandate that required only catastrophic coverage, not the comprehensive and expensive "Cadillac plan" coverage that was ultimately included in the Massachusetts law, and in ObamaCare. 

So, clearly, the Obama plan did not follow the Romney “model” in this feature – a feature important enough that it was disputed all the way to the Supreme Court.  There's more:

Romney's successor, Governor Deval Patrick, greatly increased the mandated level of coverage while implementing the law

Deval's tinkering resulted in much higher costs not contemplated in the original law, and those costs still adversely affect the state’s finances.  Yet the whole thing is tagged as “Romneycare”.  Go figure.

A further insight, which both the linked articles report:  On the day that Romneycare was signed into law, Romney line-item-vetoed eight elements changed in or added into the final draft of the bill . . .  After the signing ceremony, though, the Democrat legislature returned to the State House and overrode all eight vetoes. (in fact, during 2006 alone, Romney's last year as Governor, Romney issued 250 vetoes, every single one of which was overridden.)

. . .  see how easily an Obamacare discussion leads away from the economy and foreign policy?  My bet -  Romney won't go there - and neither will Obama.

Assinine Industry Tricks

Back in the day (2 months ago), I could get competitive quotes from several carriers using the application of just one. Apparently, the carriers think the new ObamaTax Exchanges are preferable to (icky) agents, though, because that's now a thing of the past.

Professional agents "pre-screen" groups so that the quotes have some basis in reality. If a carrier has no medical (underwriting) information, then they're just going to use their "book" rates without adjusting for folks who are, for example, pregnant or diabetic (or both!). These quotes are worse than useless, because they will never reflect what the actual rate will be. By using one carrier's application to obtain quotes with several carriers, we could provide meaningful quotes to our clients.

Well, that used to be the case.

Now, if I want (need) competitive quotes, I can no longer use just one carrier's application. Sure, some carriers will still accept (for now) another carrier's application for rating purposes, but this number is quickly dwindling.

Of course, I can pay an extra fee to a 3rd party to collect that information for me, which is (one supposes) convenient. But what with MLR and carriers looking to cut costs, this is hardly an economically viable alternative to those of us in the (soon to be gone anyway) small group market.

It's almost as if the carriers want to be marketing through the ObamaTax Exchanges.

Gee, I wonder why?

Sarah P and The MVNHS© [UPDATED]

If you want to see how the system on which the ObamaTax was modeled really works, you have only to pick up a British newspaper:

"Cost-cutting NHS chiefs are routinely assigning just one family doctor to districts that stretch over hundreds of square miles ... Patients are still put at unacceptable risk by apparently negligent practices.’"

As we've pointed out before, such provider shortages are looming on our own horizon, as well. And no wonder: more folks with insurance seeking care from fewer and fewer doctors results in the text-book definition of rationing.

It's ironic that former Vice Presidential candidate Sarah Palin made this call years ago. It's even more ironic that her banner's been picked up by erstwhile auto bailout maven Steven Rattner:

“We need death panels ... unless we start allocating health care resources more prudently — rationing, by its proper name — the exploding cost of Medicare will swamp the federal budget."

Gee, ya think?

UPDATE: Turns out, it's not just us laypeople who are worried. The folks on the front lines, who will be called upon to actually render care to all these extra 10's of millions of new "patients" aren't exactly thrilled, either. Dr. Marc Siegel, an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center, weighs in:

"President Obama and Congress should have checked with the country’s physicians before passing a law that relies on our efforts to handle health insurance expansion to more than 30 million more people ... Perhaps most disturbing, more than half of doctors surveyed by The Physicians Foundation revealed that they will cut back on patients (including Medicare) or reduce patient access to their care over the next three years."

So, more demand, fewer resources, what could possibly go wrong?

Fraud or Hero?

We've touched on "stranger owned" life insurance and annuity plans many times in the past (most recently: here). While there are legitimate uses for these kinds of plans, they are often of dubious legality.

Recently, Joseph Caramadre (a Rhode Island financial planning guru) decided to try his hand. Believing that the Ocean State's insurable interest requirement was weak, he decided it'd be a good idea to entice seniors (and folks knocking at death's door) to purchase variable annuities which he would then either keep for himself or sell off to rubes investors.

Acting as a "charitable organization," he's created a furor in Rhode Island, but may not have done anything illegal.

Time will tell.

Meantime, our friends at LifePartners (about whom we initially wrote here, with subsequent updates) appear to have dodged any number of bullets:

"Life Partners Holdings, Inc. has been cleared of allegations by Texas state securities officials that it did not register life settlement transactions as securities under state law."

The court basically told Lone Star State authorities to pound sand, clearing the way for LP to continue on its merry way.

Heh.

Cavalcade of Risk #167: Call for submissions

Russell Hutchinson hosts next week's Cavalcade of Risk - Entries are due by Monday (the 1st).

To submit your risk-related post, just click here to email it.

You'll need to provide:

■ Your post's url and title
■ Your blog's url and name
■ Your name and email
■ A (brief) summary of the post

PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like). And please only submit if you are willing to link back to the carnival if your submission is accepted.

Thanks!

Thursday Morning Linkage

■ FoIB Holly R tips us to this potentially helpful news for dog-owning diabetics:

"Diabetes alert dogs have become a burgeoning industry in which highly-trained golden retrievers go for as much as $20,000. But some trainers are now trying to harness the lifesaving potential of the family pet."

Old dogs, new tricks, lives saved. Sounds like a win-win.

■ In a surprising move, Minnesota's Democrat Governor Mark Dayton has shifted responsibility for setting up his state's ObamaTax Exchange from the Insurance Commissioner to the Minnesota Management and Budget office:

"[The Gov] cited conflict of interest issues between the State Insurance (Commerce) Department and the exchange as the reason ... Dayton raised the possibility that the discussion of removing insurance regulators from overseeing exchange management could occur in other states as well."

Uh-hunh.

■ As we wrap up LIAM, maybe it's best to begin at the, um, beginning:

On Forgiveness: Yom Kippur 5773

A close friend told me that William Shakespeare once wrote (in King Richard II, Act 5, Scene 3) "If thou do pardon, whosoever pray, More sins for this forgiveness prosper may." Which is a fancy way of observing that forgiveness increases sin. I mention this in relation to the Jewish concept of "t'shuvah," or "turning." It's not enough to regret our transgressions, nor even to vow not to repeat them. Our job is to reflect on them, to learn and grow from them, and then to avoid repeating them.

Yom Kippur is a "fast day" (no, not that kind of fast). Frankly, I've always found that term to be the textbook definition of an oxymoron. I used to say to my fellow participants "may you have an easy fast." I no longer do that: after all, if it was "easy" then what's the point? Now I wish them a "meaningful fast."

I think that's much better.

Grocery Insurance? [UPDATED]

One of my very favorite IB posts was actually an extended comment by Mike (writing under a pseudonym). Unfortunately, it's been lost in the mists of the intertubes [ed: see update below], here's a taste:

"[Mike] proposed a "national, single-grocer plan ... many people go hungry because wholesome groceries cost too much."

It appears that at least some Home Office Critters are fans of Mike's work, because we received this announcement via our friend Holly R:

"As one of the country’s largest health-insurance companies, Humana regularly has a say in where its members seek care. Now it wants sway over what groceries they buy. Humana announced a new partnership with Wal-Mart on Wednesday that will give the more than 1 million members of its wellness program, HumanaVitality, a 5 percent discount on healthy groceries."

On the one hand, this carrot-vs-stick approach is attractive, and it is voluntary. But does anyone else find it creepy that one's insurer is micro-managing our diet?

UPDATE: Thanks to Mike for providing us his original Single-Grocer proposal (available here).