The Much Vaunted National Health System© kills a child...

And then the British justice system convicts his doctor.

Seems legit:

"The good that doctors do is oft interred by a single error ... The most merciless expert witness was none other than Dr. Bawa-Garba herself."

This is as much a story of EHR failure as it is a health care system that is overworked, underfunded and understaffed.

But hey, free health care.

Seriously, a compelling, disturbing story. Recommended.

More from Up North and Across the Pond

Perhaps you've heard the horrific story of the Canadian couple and their Caribbean Vacation from Hell:

"Young couple contracts hookworms in feet at Punta Cana beach resort"

Well, turns out that the worms weren't necessarily the worst part of the story:

"Canadian Couple Forced To Travel To U.S. To Treat Parasitic Worms ... Health Canada denied them a prescription."

That's the trouble (well, a major factor, anyway) with "free" health care: you get what you pay for.

Not to be outdone, the Much Vaunted National Health System© once again says "Hold my pint, mate." Sally Pipes reports:

"The United Kingdom’s government-run, single-payer healthcare system is so inept that something as mundane as flu season can cause a national crisis ... One Portsmouth resident, 88-year-old Josephine Smalley, died on New Year’s Day after spending five hours in an ambulance and another two waiting on a gurney at Queen Alexandra Hospital."

Now to be fair, this season's flu situaton is taxing **our** system, as well (heck, I had a client die recently from it); the lesson here is that the clam that socialized medicine is somehow superior is, well, hokum.

[Hat Tip for first item: @transitfok]

From the "You Can't Make This Up" Department:

We already knew that fake people were being signed up for health "insurance" on the 404Care.gov site, so why am I not surprised to learn that:

"Some 2015 HealthCare.gov Subsidy Applicants Were Dead"

Here's the part that I don't understand: if they're already dead, why weren't they enrolled in Medicaid (and hence not subsidy-eligible)?

[Hat Tip: FoIB Jeff M]

Sketchy Campaign: Counterpoint

FoIB and long-time LTCi Guru Randy Gallas offers his take on last week's post critical of a questionable (to me) Long Term Care insurance awareness effort:

"I agree that the State of Ohio needs to be more engaged in LTC awareness. I have contacted the Department of Insurance (DOI) on many occasions and their answer was always "we'd like to do more but we don't have the budget for sending out brochures or explaining  Ohio's LTC  Partnership program."

However they did in 2008 and these trifold brochures were available through the Ohio Department of Jobs and Family Services.  A very informative planning brochure that was available to all licensed insurance agents. They are no longer printed. 

By sourcing this out to the 3in4NeedMore  has the appearance  of a lead generation program that might be sold to a brokerage that may or may not even be in the State of Ohio.   I would advise anyone who would like more information on LTC planning to contact their local insurance agent/agency.

As always, our 18 years of knowledge and claims experience is something that we enjoy passing along to anyone interested in long-term care planning."

Thanks, Randy!

Something different (and potentially quite helpful!)

Long time readers know that, for many years, I participated in a healing prayer group. One basic tenet of that effort was that the folks for whom we prayed had to know that we were doing so (and had given us their permission, as well). The reason for this was that we truly believed (and of course, this was not exclusive to our efforts or faith) that one's attitude plays a great role in how well (or even if) we heal.

Likewise, dressing up in a suit and tie (or nice dress and stockings) usually engenders a greater level of self-confidence. Perhaps Fernando had it right, after all.

Which brings us to this wonderful news item sent along to us by FoIB Holly R:

"Why do hospitals bare butts when there are better gowns around?"

Turns out, there's been an on-going effort to upscale those ubiquitous (and generally less-than-flattering) hospital gowns patients are issued. While they do have obvious practical advantages, one can't help but think that they interfere, in at least some small measure, with the patient's own attitude and self-image, which in turn may hinder the healing process.

That may be changing, however:

"[H]ospitals are increasingly paying attention to patients’ experience, and that includes what they wear," says Bridget Duffy, whose company consults with providers on health care operations and the like.

Of course, only time will tell, but even the simplest of healthcare tools can play a pivotal role.

Sketchy Marketing "Campaigns"

Or, "How Not to Run One."

Case in point:

The other day's mail brought this exciting, somewhat alarming item:

[click to embiggen]

It certainly implies two things:

One, that the State of Ohio endorses the 3in4 campaign (more on that in a moment), and two, that the Partnership Program is new (it's far from it).

More pointedly, if the offer is simply for a pamphlet explaining how the Partnership Program works, why does it need my date of birth? Are they really going to personalize these brochures for every sucker person that replies?

Then there's the "Privacy Access Code." I 'get' that they'd like to track specifically who's replying, but why would they need this? If you're at the site, you're interested. Why isn't that good enough, without pinpointing individuals?

The site itself specifically says "The nonprofit 3in4 Association is dedicated to providing information to the public about senior issues, and does not underwrite or sell insurance."

Which is likely true, but notice that it doesn't say "and will not sell this information to agents who do."

And lo and behold, a quick Google yields this little gem:

3in4 Need More - Long Term Care Leads

We are proud to be associated with and the direct mail provider for the 3in4 Need More campaign. Place your order below or learn more about the 3in4 Association and TargetLeads®."

Which nicely answers my previous questions.

Thanks but no thanks.

#FakeCampaign

Whack Whack Cadillac

Kicking the can down the road is very bipartisan. Especially when the can is going to be used to fill full of our tax dollars. This has become a key feature of Obamacare. Nothing has been kicked further than the Excise Tax on employer sponsored plans - commonly referred to as the Cadillac Tax.

The Caddy Tax imposes a 40% tax on employer plan premiums that exceed a certain threshold. Originally, this tax was to be implemented beginning in 2013. According to that CBO score the government would have generated $149 billion dollars between 2013-2019. In fact, under the original score $85 billion would already have been generated under the law.

However, with unions and other business lobbyists turning up the pressure, Democrats in the House pushed a reconciliation bill that included an amendment to the Caddy Tax pushing the start date to 2018. (Note: it also increased the threshold substantially) Because of the shoddy way this bill was passed then addressed through a one party railroad, the end result was revenue on paper. Revenue that unions knew would never, ever be collected.

Under the reconciliation bill the new Caddy Tax revenues were to begin this year and generate $12 billion with another $20 billion next year. At least that is what was supposed to happen based on 2010 scoring. Instead we saw a bipartisan agreement in the 2015 spending bill that pushed the Caddy Tax another two years out with a new start date of 2020.

The latest installment came this past week with the government shutdown and subsequent passage of a short term spending bill. Once again we have bipartisan agreement of an additional two year delay pushing the Caddy Tax out to 2022.

The Caddy Tax has now been delayed almost ten years. One would think that such bipartisan support of postponing a tax that is despised by so many would be easy to repeal. Many groups like Fight The 40 have been working to do just that.

But here's the truth. Congress needs the Caddy Tax. They need it for the revenue on paper. When CBO scores in ten year windows it shows an accounting sleight of hand that many of us don't know. It shows as revenues - whether collected or not.

Having IOU's is how they trick us in to believing that they are good stewards of our tax dollars. Sad truth is they simply don't care about spending your money. They care about you voting to re-elect them. Which is why kicking the can down the road is the avenue of choice for those we elect in DC.

Potential Good News

Our friend Jeff M tips us that Gem State citizens may soon have the option of buying non-ACA compliant plans:

"Idaho says no Obamacare needed for some new insurance plans ... on Wednesday revealed a plan that will allow insurance companies to sell cheap policies that ditch key provisions of the Affordable Care Act."

While this is indeed good news (because it means that at least some lawmakers "get it"), it's a far cry from a done deal:

First, as folks in medical-marijuana states have come to learn, Feds trump states. So, any such plans are going to be subject to the ObamaTax (at least for now). Which isn't necessarily an insurmountable impediment, but something to keep in mind.

Second, which carrier's going to put in the time, manpower and - critically - money to develop and price a plan available in only one state (and the 39th in terms of population, at that)? In general, insurance companies are reluctant "first adopters."

On the other hand, if this actually happens, it would represent the first effective argument I've seen for "sales across state lines."

Finally.

Some Quit Hits

■ Medical marijuana and your health insurance:

"It is our job to responsibly manage around $6 billion of our members’ and employers’ money ... How on earth could we involve them in this chaos by covering marijuana, medical or otherwise, at this point?"

Great points.

■ We've been following the Penn Treaty LTCi kerflufle for a long time (here, for example). What's the latest?

Well:

"Connecticut OKs 69% Penn Treaty Unit LTCI Rate Hike"

That's a big deal for the folks who own one of the 500 or so policies still in-force in the Constitution State.

■ A thousand words (or so) from FoIB Rich W:

Its working! The ACA is working!! And better than expected.

Health Insurance Premiums Rising as High as 265 in Virginia This Year https://t.co/llaWD6eYfs #NewsandPolitics via @pjmedia_com

— Rich Weinstein (@phillyrich1) January 2, 2018

MVNHS© Pole Vaults Shark

From the You Can't Make This Up Department via co-blogger Mike:

Believe or not, it gets worse:

"However men living as women are being invited for cervical smear tests even though they do not have a cervix"

Ya think?

Go read the whole thing over at Powerline.

But for goodness' sake, finish whatever you're eating and/or drinking first.

Let's talk Gummint-Care

Last month, we reported on the latest CanuckCare news, and it wasn't pretty:

"Waiting for treatment has become a defining characteristic of Canadian health care ... waiting times for medically necessary treatment have in-creased since last year."

Turns out, it's even worse than we'd thought:

Canadian Health Care is "Free" But Rationed by Long Wait Times, e.g., a 4.5 YEAR estimated wait time to see a neurologist in Ontario! #Insanity pic.twitter.com/UHljzjvhNX

— Mark J. Perry (@Mark_J_Perry) January 21, 2018

That's right, a four-and-a-half year wait to see the neurologist. But hey: it's free!

To which Britain's Much Vaunted National Health System© says "Hold my pint:"

"NHS 'haemorrhaging' nurses as 33,000 leave each year ... one in 10 now leaving the NHS in England each year, figures show."

This represents a pretty significant problem, since it means the service is now "upside-down" with regard to nurses:

"[T]here are now more leavers than joiners."

Sustainability, indeed.

But hey, free health "care."

DPC vs HSA: Interesting Twist

DPC, of course, being Direct Primary Care, about which we've written extensively over the years (here, for example). My primary criticism of the model (and really the only substantive one from my perspective), is this:

"As long as ObamaCare remains the law of the land, there is never going to be a good *economic* rationale for DPC." [emphasis in original]

But that may be changing, if only a little.

There's a movement gaining steam proposing that DPC fees be made eligible for reimbursement from one's HSA (Health Savings Account):

Dear @RepMarkMeadows and Freedom Caucus: Use your leverage over CR vote to let patients to use HSAs for #DPC. cc @RepDaveBrat @RepAndyHarrisMD @DesJarlaisTN04 @RepGosar @RandPaul #HR365 pic.twitter.com/WqP1y2JAlL

— AssocAmerPhys&Surg (@AAPSonline) January 17, 2018

I think this is a great idea, and I would suggest only that it doesn't really encompass the full value of such a change.

And what's that, Henry?

Well, in the Alternative Benefits field, we talk a lot about HSAs, but also HRAs (Health Reimbursement Arrangements) and FSAs (Flexible Spending Accounts). Seems to me that whatever magic necessary to make DPC fees HSA-eligible would, by definition, render them kosher for HRAs and FSAs, as well.

I suspect that there are a lot more FSAs (and, perhaps, HRAs) out there than HSAs, specifically in the group market (where employers' financial liability is much favorable to the former two).

In any case, a hopeful sign, and perhaps a welcome change

[Special IB Thanks to Jennifer C at FlexBank]

From the Mailbag: Muddy P&C

Last week, FoIB Jeff M and I were chatting and the subject of the (horrific and now deadly) California mudslides came up. We wondered if (and/or how) one would be covered if one's house (literally) went downhill.

Eventually, we turned to Co-blogger Bob, who's a regular participant in an agents' forum, and asked him to research there for this on our behalf.

We were not disappointed.

The two most helpful replies:

"Most HO policies exclude flood and earth movement. The NFIP forms define what "mudflow" is. DIC policies may cover mudslides and earth movement, but if it's in an area blighted by wildfire, availability and affordability could be an issue for a DIC policy."

And:

"Hello! Here's what I heard back from our underwriter @ Safeco... I am based at CA.

'No coverage for mudslide, only possibly covered under Flood coverage depending on the % of water in it (a mudflow). There is no coverage for hotel/food etc. under the home policy either if evacuated due to the mudslide. Mudslide is covered under EQ if a result of an earthquake.'"

Thanks, Bob (and IF folks)!

WooHoo - New Wonk Review!

Health Wonk Review co-founder (and all-around mensch) Joe Paduda gets the first 'Review of 2018 and hits it out of the park.

From  rx cost sharing in Germany to expanded association plans to industry corruption, and lots more. Enjoy!

Breaking: Goodbye Good Sam

It's been just a couple of weeks since we learned that Premier Health and United Healthcare had buried the proverbial hatchet; now we learn that the former is cutting loose what seems to have become quite the financial albatross:

"Good Samaritan Hospital, the fourth-largest hospital in the Dayton region, will close."

Premier Health appears to be streamlining its facility offerings, in line with its self-proclaimed "2020 strategic plan." The company says that Good Sam's services will still be available, just moved over to Miami Valley Hospital (about 5 miles, or 14 minutes, away). How that will work out is, of course, anyone's guess.

Stay tuned...

[Hat Tip: FoIB Debbie C]

Can’t say I’m surprised. You?

According to Gallup, “After four years of Affordable Care Act implementation, the percentage of adults with no health care insurance has hit 12.2 percent”

So is that an increase or a reduction? The linked article continues:

“In the last quarter of 2016, the percentage of uninsured hit a record low of 10.9 percent. A year later, in the last quarter of 2017, the percentage of uninsured increased by 1.3 points—the largest single-year increase Gallup has seen since it began tracking the measure in 2008.”

Based on US population of approximately 320 million, each 1-percentage point increase to the uninsured rate is about 3.2 million people. Do the math.  The number of uninsured Americans increased by more than 4 million just at one enrollment - 2017!  (For any progressives who may struggle with math, 3.2 x 1.3  = 4.1). Don't forget the premiums for 2017 were set B.T. - Before Trump.  

Also note that after 4 years of Obamacare, and despite the “mandate”, Americans age 26-34 have the highest  uninsured rate = 20.1%.   Can’t say that’s a surprise either.

Data, Data, Who owns the data? Part #3,624

So here's an interesting (if tragic) scenario:

"An Afghan refugee named Hussein Khavari is being accused of raping and murdering 19-year-old medical student Maria Ladenburger, disposing of her body in a river."

He has since confessed to the crime, but is disputing some of the details that were obtained once the police were able to access his iPhone's health/activity data for the date of the crime. It seemed to confirm his guilt, but has raised some interesting questions (some of which we've seen echoed here: the Sam Bernadino tragedy comes to mind):

"Sean O’Brien, a researcher at Yale Privacy Lab [believes that it] would be much better... not to collect such surveillance data at all. Such data is best kept locally on devices whenever possible. If it is collected, those who handle it have a deep responsibility to defend the privacy of their users.”

It seems to me that there are (at least) two issues in play here:

First, as we've asked more than a few times before, who actually owns your data? It's not as clear-cut as one might think:

"Hugo Campos has [an ICD] buried in his chest to help keep him alive. But he has no idea what it says about his faulty heart."

The information the device accumulates is stored in a proprietary format, inaccessible to Hugo (or anyone else, for that matter). The iPhone data is also, after a fashion: the owner must either give up the password or the authorities must (try to) use brute force to unlock it themselves. And of course here there are significant 4th Amendment issues at play here (not so much in Germany).

On the other hand, the data can be prove useful in other ways, (alleged) crime-wise:

"Further investigating – including a review of a Fitbit activity tracker – showed the scene was staged and 43-year-old Jeannine Risley knowingly filed a false report."

Two steps forward....

This Sceptered Isle - Part MMXVIII

Britain’s NHS is seeking to charge co-pays for certain patients.  Up to now, NHS has always claimed to be “free” for everyone . . . Free at the point of service, anyway. (I suggest you read the entire linked article.  Its headline is a bit misleading.)

While charging of co-pays would be a departure, it should come as no great surprise.  In the first place, NHS financial problems have been public for quite a while.  And, after all, NHS is just another insurance company - albeit a giant, national monopoly. Aside from the political control of its management and budgets, NHS behaves very much like private insurance companies around the world. Specifically, NHS has a large bureaucracy that determines what medical services are reimbursed, and under what terms.  Also, NHS is financed by premiums that must must cover its costs - although NHS “premiums” are disguised as taxes.

And now - co-pays?

What next?  Refusal to cover services of non-approved physicians and hospitals?

Will NHS end up a British HMO?

And The HIT Just Keeps on Coming

Obamacare imposes a "fee on insurance companies" for fully insured plans that is referred to as the HIT (Health Insurance Tax). Last year this tax was in a one year moratorium thanks to Congressional relief. But this year it is back in full effect.

The tax on health insurers is non-deductible, meaning for every $1.00 in taxes the insurer will need to take in $1.54 (assumes 35% corporate tax rate). For 2018, the amount this tax must generate is $14.3 billion - meaning insurers must generate $22 billion of additional premiums to pay for it. Insurers have to pay their portion based off of market share so the larger presence they have the greater the amount they have to charge. This also makes it a moving target from year to year.

The tax applies to all fully insured coverage including:

• Individual On Exchange
• Individual Off Exchange
• Small Group Fully Insured - Both ACA and Pre ACA
• Large Group Fully Insured - Both ACA and Pre ACA
• Medicare Advantage
• Medicare Part D
• Medicaid Managed Care

To offer transparency, many insurers are breaking out these taxes on renewals for consumers to see. But, for most employer plans - where a large amount of this revenue is generated - this tax isn't transparent to employees.

Employers offer a total compensation package to employees. Wages and benefits are the biggest drivers of what makes up an employee's compensation. The HIT hurts employee wages and benefits while providing zero value to the business.

How bad does the HIT hurt employers? For my clients it's extremely painful. Reviewing my January 2018 renewals I found the average cost per employee is $356.50. That doesn't seem like much right?Until we do the math and show that this tax averages a cost of $0.17 per hour.

This puts an employer in a tough position. Do they give a $0.25 an hour raise but increase premium contributions by $0.17 an hour? Do they cut benefits by $0.17 an hour? Or, do they decline to expand, cut overtime, or reduce staff to pay the tax? These are tough decisions employers have to make that are all done behind the scenes.

Employees see these decisions to increase the amount deducted from their paychecks, higher deductibles, higher copays, more restrictive provider networks, and higher prescription costs as if the employer or the insurer is screwing them.

The reality is Obamacare's HIT is causing the problem. It's been screwing employees since 2014 and every year it will get worse.

The next time someone says Obamacare doesn't impact employer sponsored insurance remember the HIT. It's the sucker punch that keeps on coming.

Sharing, Caring and Talking

So Politico's Paul Demko reached out to me yesterday to ask about Health Care Sharing Ministries (HCSM), and specifically about whether or not I'd decided whether or not to market them. He was also interested in connecting with any (former?) clients who'd made the leap from Major Med to HCSM.

I was intrigued, and we agreed to speak this morning. In the meantime, I contacted several folks I knew who'd gone that route, especially hopeful that one in particular will respond.

Why her?

Well, because she was actually referred to me by a mutual friend at our synagogue. We had looked into ACA major med plans for her, but she ultimately chose a Ministry. Since these tend to be church-based I was intrigued, and Paul thought that would be really interesting to hear more about, as well.

Ultimately, we had a very nice conversation, and I told him that I'd let him know if I was able to connect with any of these folks so that I could send them his way (if they agreed that would be a good idea).

I don't know when (or even if) this article will be published, but will post a link to it here once it is.