Government Experiments on Poor

In an effort to overcome double digit inflation and flowing red ink, the state of Georgia has decided to experiment with their poorest citizens. By forcing those on Medicaid to move to a more structured HMO the state achieved their goal.

But all is not well in the Peach State.

Consumer health advocate Linda Lowe said, "There are widespread reports of children with serious conditions being denied therapies while their medical providers jump through arbitrary authorization hoops."

Widespread reports . . . denied therapies.

Sounds like rationing of services.

The state believed the HMOs "could do a better job managing the care of our members" and save taxpayers money,

The plan worked. In the last fiscal year the state saved the taxpayers of Georgia $78,000,000.

Since the HMO startup, a number of doctors, aggravated by what they call slow and reduced pay from HMOs, have limited the number of patients they will accept from the government programs. Dr. Richard Wagner, a Sandy Springs pediatrician, is one who has cut his Medicaid/PeachCare patient load. The HMO experience, he said, "has been a mess.''

And based on lower fees and more administrative hassles, Dr. Mark Ritz, a Homerville dentist, says he and other dentists are re-evaluating their participation in the government programs.

It would appear that medical providers don't want any part of this program that covers approximately 900,000 Georgians.

What good does it do to have a taxpayer funded program for the poor if they are denied access to services?

A lingering problem involves gaps in the HMOs' doctor networks. Beth Sullivan, a family doctor in Commerce, said a 5-year-old patient had to be driven more than 100 miles to Augusta for an orthopedist willing to treat his broken wrist under his HMO.

That's a two hour drive.

Of course, had it been an emergency care could have been administered closer to home.

At least, that's the theory.

Adding to the chorus of criticism are complaints from many hospitals that say they're losing money on the government programs. "It has been an administrative nightmare," said Tish Towns, vice president of government relations for financially strapped Grady Health System, which operates Grady Memorial Hospital in Atlanta. "I think there's a tremendous amount of work to do to get this right.''

So doctors aren't the only ones threatening to pull out.

"Several rural hospitals have faced near-failure to make payroll, and most rural hospitals are in a cash-flow crisis" because of reimbursement problems

What does this tell us about the future of government managed health care?

Georgia has an estimated 4.6M citizens. About 900,000 of them are on Medicaid. If the state can't do a better job of managing care for 20% of their citizens, then how well would they do if they were to cover 100%?

Right now the state is experimenting on the poor. People who have few, if any choices. If this type program were instituted to cover 100% of our citizens, how many with the means to pay would simply cross state borders, seeking care from private practitioners willing to treat on a cash basis?

Sicko Was Editedo

It seems that "Sicko" was editedo.

Yeah, I find it hard to believe too.

The Main family of Port Charlotte, Florida was supposed to be in Michael Moore's movie but somehow got left out.

Tom Main, a self-employed electrician making about $40,000 a year, had no health insurance and did not qualify for the Florida KidCare state insurance program after moving here from Colorado.

He joined the National Association for the Self-Employed, making him eligible for health coverage. In December 2005, an agent from MEGA Life and Health Insurance Company sold them a family policy at $227 a month.

That's a low price for a family of 4. No one questioned it?

The policy they bought is a limited benefit plan that caps the payout to providers.

Did they read and understand the policy limits?

According to the carrier:

"Mr. Main indicated that he understood the policy and at no point expressed that he had been told anything different about the policy by the agent who sold the policy, or express dissatisfaction with his coverage and benefit selections," Ledbetter said in an e-mail.

Uh-huh.

So Mr. Main clearly understood what he was buying, right?

An ambulance took Kenny to All Children's Hospital in St. Petersburg, where he was diagnosed with acute lymphoblastic leukemia.

When Tom Main handed over his insurance papers to the administration office he was prepared for the $5,000 deductible, but surprised when he was told the policy would not be adequate.

In all fairness, insurance policies can be written in language that might as well be in a foreign tongue to the untrained eye. That is why one should never buy a policy, even from a carrier you know, without first asking a disinterested third party to review the details.

You can start by asking your doctor if they take assignment of benefits from that carrier. If the answer is no, then go no further.

Your next call should be to the business office of your local hospital. Ask them the same question. Better to know up front than after the fact.

If Mr. Main had done this before his child became ill perhaps much of this could be avoided.

This is not casting blame, but when you buy a plan that is designed to provide you with a virtually unlimited line of credit when you need it most, it is better to find out IN ADVANCE is this is the plan you need.

In October, a film crew accompanied Hesper Main and Kenny in the family minivan on the drive to St. Petersburg, filming inside the van, at All Children's and then back at their home, where they treated the family to pizza.

When they were cut from the film, Hesper Main said that the production assistant they had been dealing with felt so bad that she offered to push their story to a companion piece running in "People" magazine.

The family's story made it into the July 23 issue, with Harry Potter on the cover.

This is a situation that even a wizard can't cure.

Do yourself a favor. Stop what you are doing right now and get your policy. Read through it paying particular attention to policy limits. Next call your doc and your local hospital. Ask them what they know about the carrier or the policy you have. It might even be worth your time to buy a cup of coffee for someone in the business office of the hospital.

Better to spend a few bucks now than losing your home later.

Drink up!

Health Wonk Review

HWR is up, this week hosted by Health Care Policy and Marketplace Review. There are 15 entries including a point/counter-point review of the recent Rand study on health insurance prices and willingness to purchase.

The post from Colorado Insurance Insider is a must read! Here is the tease . . ."Dealing with health care providers without the assistance of an insurance company is like dealing with the mafia."

Enjoy!

Cheesy Insurance

It seems the folks who give us great cheese and football now have an idea on how to solve the problem of the uninsured.

This comes in the form of universal, single payor health insurance funded with (what else?) . . . taxpayer dollars.

The Democrats control the cheese state's Senate and are considering bypassing GO and forgetting about the $200 by going directly to a full blown "cover everyone" plan. No baby steps for these folks. Going directly to "free" insurance for everyone.

So how much does "free" cost?

The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker.

So, assuming their numbers are correct (and we have a history of politicians UNDER estimating costs) that means doubling the current tax revenue base and then some.

Sweet.

Employees and businesses would pay for the plan by sharing the cost of a new 14.5% employment tax on wages. Wisconsin businesses would have to compete with out-of-state businesses and foreign rivals while shouldering a 29.8% combined federal-state payroll tax, nearly double the 15.3% payroll tax paid by non-Wisconsin firms for Social Security and Medicare combined.


Out of state competition for business? Surely that won't happen!

How dare companies in IL, IA, MI and other neighboring states EXPLOIT the people of the great state of Wisconsin by undercutting prices (since THEY don't have to pay the 14.5% tax) costing jobs for Wisconsinites.

And let's not forget the folks that say guv-ern-mint can do a much better job, more efficiently, for less money.

So where will savings come from? Where they always do in any government plan: Rationing via price controls and, as costs rise, waiting periods and coverage restrictions.

Seems to me the folks need to keep what they do best. Turn out some really good cheese and a good football team.

Wonder what Brett Favre thinks about this?

Cavalcade #31: Submissions Due

Just a reminder that submissions for next week's CoR are due Monday (the 30th). Our host, Jason Shafrin, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We still have Fall '07 hosting slots available. Hosting is fun, easy, and gets you off the "nag" list. Just drop us a line!

Hole in the Head

Perhaps it is a good thing that Michael Moore gave us Sicko. Otherwise we may never have known as much about the Canadian health care system as we do now.

David Malleau awoke in hospital with a gaping hole in his skull.

The 44-year-old Hamilton truck driver had suffered a devastating car accident in 2004 that forced doctors at Hamilton General Hospital to remove a fist-sized piece of bone from his skull to relieve pressure on his brain.

Once the swelling subsided and he was ready for surgery in March 2005, Malleau was sent home and placed on a waiting list.

Three months passed. Then six. He waited at home, a prisoner unable to leave the house for fear something would hit the exposed side of his brain - for him a potentially fatal incident. In the end, it took nearly a year before he could get skull replacement surgery.

Placed on a waiting list.

My, my, my.

Malleau, after finally getting his skull replacement surgery in January of last year, is paralyzed on his right side and his speech is only now beginning to return.

"I've pretty much had to fight for everything," says his wife Pat, a former bookkeeper.

"We were taxpayers. Owned our own home. We went from having our jobs, being in the middle class, to nothing."

Excuse me. I thought it was only in America where people could lose their home due to the health care system we have.

Mr. Malleau could have avoided the wait by coming to America...as long as he had the ability to pay.

Seems like a Catch 22 situation.

Yanks to the Rescue

With "free" access to health care, why would anyone need to come to the U.S.?

While recognizing that many Canadians believe that we have one of the best health care systems in the world, the founders of Timely Medical Alternatives Inc. also recognize that there are some 875,000 Canadians currently on the waiting list for referrals to specialists or for medical procedures.

Our organization was formed in 2003 to help Canadians from coast to coast, to "Leave the queue" and take personal responsibility for their own private medical services.

An organization to help Canadians with the ability to pay to take charge of their health care.

Interesting concept.

We have helped our clients to regain their mobility, to get relief from chronic pain, to get diagnoses of illnesses and we have, in some cases, helped to save the lives of a number of our fellow Canadians.

Saving lives.

Isn't that what health care is all about?

Few Canadians realize that:

• Surgical waitlists in the US are measured in weeks instead of the years which Canadians are often forced to wait.

• Cutting edge medical procedures and pharmaceuticals which are unavailable in Canada, are readily accessed by American patients.

• People under 65, who are without resources, are guaranteed by federal law, access to emergency care for serious medical conditions.

• Because their access to operating room time is not rationed, an American surgeon 10 years out of medical school, will (all else being equal) be more skilled at his craft than his Canadian counterparts. If a Canadian orthopedic surgeon operates 6 hours per week, he will never achieve the level of practical experience of his America counterpart who might operate 24 hours per week.

No waitlists, cutting edge medical procedures & pharmaceuticals, no rationing of operating room time.

Probably just me, but isn't this a BETTER system?

We believe it is time that Canadians realize that the rest of the developed world is NOT out of step. It is Canada which is out of step with the rest of the world.

And this is interesting as well.

If Canadians choose to go outside the system and pay for care, they can go here and find private fee for service clinics in Canada and the U.S.

With all that "free" care, why would anyone want to come here?

Was Michael Moore wrong?

Grady - A Microcosm of Public Health

I have made reference to our local charity hospital before. The problems of Grady Hospital are not unique. All hospitals, but particularly those who cater to the indigent, suffer tremendous financial burdens.


They're receiving care despite cutbacks that crippled the staff of Grady Memorial Hospital's ophthalmology department.

The eye clinic — a relatively small service in a medical complex serving almost a million patient visits a year — now schedules 60 to 80 patients a day, down from 120 just weeks ago. Many of its patients include those with advanced glaucoma or diabetic eye complications

One million patients per year.

Most without insurance.

Almost all receive "free" care courtesy of the taxpayers of Fulton & Dekalb county Georgia.

Patients without Medicaid or insurance have no choice but to live with the delay, said Annie Tribble, 51, the uninsured glaucoma patient who stays at a women's shelter. Waiting, she said, "is better than not seeing about yourself at all."

Delay's.

Symptomatic of public health.


More than 400 of the health system's 562 eligible employees accepted, about twice as many as administrators said they expected. A third were nurses, nursing assistants, clerks and other workers in patient care, which accounts for 1,500 of the hospital's 5,000 workers, said Kirk Wilks, Grady's vice president for public affairs. Another 13 percent came from laboratories and radiology.

Of the 422 positions vacated by retirees, about 300 have been or will be refilled since no bedside nursing jobs will be eliminated, Wilks said.

A few days later, Wilks was gone — laid off in an additional cutback

Cutbacks in non-essential personnel.


The buyout was an attempt to stem losses at the state's largest public hospital, which has operated in the red every year since 2000. Consultants hired by the hospital's governing board reported $67 million in losses last year and said 2007's deficit could be even higher.


The more money that comes in, the more that flows out.

There is no end.

In a cash-strapped hospital with aging equipment and a largely indigent patient population, "people learn to make things work and maximize resources," Lewis said. In addition, he said, the senior staff "developed long-term relationships. Those are the things you lose."

Aging equipment.

Delays in care.

Is this any way to run a health system?

One uninsured ophthalmology patient who came through the emergency room this summer told doctors she had been sent there by a private physician who told her that, because of the wait for a clinic appointment, she should lie and say she'd been hit in the eye, said ophthalmologist Broocker. His team discovered a tumor.

The woman now receives ongoing treatment at Grady.


Told by her doctor to go to Grady.

Because care there is perceived as "free".

Even by someone who (should) know better.

Sure, this is Grady. Just one hospital in one city. But the issues Grady faces are reflective of what can happen with taxpayer funded, government mis-managed health care.

Is this really what the public wants?

Incredibly Stupid Carrier Trick

[Welcome Industry Radar readers!]

As we've long-chronicled, insurance companies seem bent on making gummint-run programs more appealing. This one, though, may well be the most egregious example of inept, thoughtless incompetence yet:

Several years ago, I wrote health insurance for a nice, middle-aged couple, whom we'll call Frank and Ethel. We used Anthem (BX) because they offered good benefits at a reasonable price, and (at the time) were more liberal in their underwiting (Frank had some health issues). The plan was issued, and all was well.

Until early May, when Frank passed away following a brief illness. As required, we notified Anthem, in writing, that he had died, and would they please:

a) Remove him from the plan

b) Refund the premium paid on his behalf for the balance of the month in which he died

c) Let us know Ethel's (new) premium

d) Issue a new ID card for Ethel

None of this strikes me as particulary challenging; indeed, it's a relatively routine thing (well, for the carrier; I don't have a LOT of insured's dying every month). We sent this a week or so after Frank died, and waited.

And waited.

And waited. After several weeks went by, we became concerned that this was taking so long. It was especially problemmatic for newly-widowed Ethel, whose finances were, to put it mildy, shaky. So I called down to our service rep, who informed me that Anthem had "lost the letter," and asked if I could resend it. Since I had it in the computer, that was a fairly simple process. The bigger problem, though, was that Anthem had already drafted the June premium, which still included the deceased (who didn't really need the coverage). And now it's July, and guess what, they did it again! We finally sent down another letter, asking to stop the automatic withdrawls, and just send a bill.

The good news is that Anthem did stop the automatic withdrawals.

The bad news (and you just knew there'd be more of that, right?) is that the new bill shows Frank (and reflects his premium) but not Ethel. That's right, the dead guy has health insurance, while his widow doesn't.

There is simply no excuse for this kind of sloppy "customer no-service." It's bad enough that this poor woman has lost her husband, but to be constantly reminded of it (every time she checks her quickly diminishing bank balance) is unconscionable. We're still working our way up the food chain that is Anthem "customer service," and will keep you posted on any progress we're able to make.

UPDATE: Okay, just spent another hour on the phone with Anthem, and the situation appears to be resolved.

Essentially, when Frank died, they cancelled Ethel as well, and moved her to her own policy. The new policy has the same benefits and premium; it's really an internal mechanism resulting in her being assigned a new policy number as of the date of Frank's death.

Unfortunately, they didn't get around to accomplishing this until about 10:00 this morning (seriously!). Thus, it appeared on their records that Ethel had also died. As an aside: what a great deal for Anthem; they get the premiums, and dead folks file few claims.

In the event, Anthem proposed to credit the amounts Ethel was dinged in May, June and July to future premiums; I demurred, emphatically. Eventually, we arranged for Frank's premiums to be deposited directly back into Ethel's checking account, they would move her premiums from the old policy to the new, and she would begin August with a clean slate, a new policy number, and an appropriate premium.

I'd like to say that "all's well that end's well," and indeed, Ethel has mentioned several times how pleased she's been with how Frank's claims have been handled throughout this ordeal.

But the fact remains, the company fell down on this, big time, rarely returned calls, prevaricated in their answers and generally made a sad situation worse. That it took almost 2 ½ months to get this relatively simple transaction resolved is unacceptable, even for an insurance company.

Let the Games Begin

Fat Dragon may sound like an entree at a Chinese restaurant, but it's really the home of tabletop gaming icon Fat Dragon Games. In just two years, the company, run by an entrepreneur with a unique vision, has garnered widespread industry praise.

So much so that FDG has been nominated for two Ennie Awards, and we'd like to help them win at least one of those, the coveted Best Miniature Product award. All it takes is a few moments of your time, and a couple of mouse-clicks; no fees, registration or hassles.

Just click here (and scroll down to Best Miniature Product, select E-Z Dungeon's for #1).

Your support is appreciated, and we'll let you know how things turn out.

Another Carnival Monday!

This week's edition of the Carnival of Personal Finance is hosted by George, proprietor of Fat Pitch Financials. He presents over 4 dozen posts, all with helpful context, and all categorized. Nice!

I was very glad to see Big Honkin's guest post at No Credit Needed. He explains, by way of an expensive personal lesson, why it's important to have an emergency fund. Right now.

How much is 5Q + 5Q ?

Why, 10Q.

You’re welcome!

Now that we're talking about Q’s, let’s talk about health care queues.

Do governments deliberately manage the cost of their health care and single-payer insurance systems by restricting budget expenditures, thereby restricting capacity and forcing people to queue up and wait for health care services?

Persistent patient queues are evidence that the answer to this question is “yes.”

Many people claim that there are no meaningful queues in countries such as Canada and the U.K. That claim is false. The Canadian Supreme Court ruled in 2005 that "delays in the public health care system are widespread and that in some serious cases, patients die as a result of waiting lists for public health care."

In the U.K., complaints about waiting times for services continually comprise more than 25% of procedural complaints (i.e., excluding clinical complaints).

Many other people claim that there are no such problems in waiting for access to health care in the U.S. That claim is equally false.

Well, now, does that mean the objections to single payer because of waiting lines, are invalid because there are waiting lines in the U.S., too? Whoa, whoa, not so fast.

Two media reports just in the past week point to a major cause in the U.S. for people having to wait in line for health care. Irony of ironies, that cause is government-financed health insurance.

The first report appeared in the Wall Street Journal on July 19. This front-page article was about Medicaid, under which physician reimbursements are set so low that doctors say they lose money for most Medicaid services they perform. More and more doctors refuse to see Medicaid patients. Fewer participating doctors = waiting longer for an appointment.

The second report says that more than 25% of mammography centers in New York have closed since 1999, causing almost a tripling of wait times for appointments. Reason? Medicare pays only about 2/3 of the cost of a mammogram, and the centers are exiting that business. Fewer mammography centers = waiting longer for an appointment.

Is there any reason to believe either Medicare or Medicaid would do a “better” job if the government controlled 100% of health insurance in the U.S? I say no.

I think there are good arguments for single-payer, and there are good arguments against it. As a nation we are really not very close to resolving this debate on any rational basis. (We may be close to resolving it on some irrational basis – that’s a subject for another day). Meanwhile the queues in Canada and U.K. persist, and waiting lines are growing in Medicare and Medicaid. These events suggest that, while government-financed health insurance systems can be effective at reducing their budgets, they are much less effective at reducing health care costs. Accordingly, their strategy of reducing budget expenditures has the principal effect of reducing health care capacity. Less capacity = waiting longer for an appointment. Anyone think that's a solution? Not me. It's my idea of running thru Hell in gasoline pants. (thank you, Nipsey Russell).

This blessed plot, this earth, this realm, this England

On Friday July 20, the Wall Street Journal ran an article about automobile congestion in cities. The article described the solution in London - charge a “congestion fee”. Within the congestion zone and during business hours, everyone who drives a car (except people who live in the zone) is charged a fee. The charge is around $10. The fine for not paying the charge is about $100. So what? I mean, what does this have to do with health care? Well maybe nothing, but check this out:

The zone was recently expanded to include one of London’s largest hospitals, Chelsea & Westminster. And what happened? “Suddenly, the hospital’s emergency room was busiest just after 6 p.m. – when the zone stops operating – instead of at 4 p.m.” The chief executive of the hospital remarked that “maybe the ER patients are not as urgent as they thought they were.”

The article further reports that “People who can prove they drove through the zone for a genuine medical emergency can get a refund but that doesn’t include women in labor” to which a woman who recently had a baby at this hospital and paid the fine for driving there commented: “it wasn’t worth contesting because they really do not care.”

Stiff upper lip, you blokes. See, medical care in the sceptered isle is still free.

Coulda Worked in the Home Office, Too

Based on some of the Stupid Carrier Tricks® we've chronicled, the plight of this poor gentleman, who works for the French version of the IRS, may be more widespread than previously thought:

"A French civil servant has been found to have a huge cavity filled with fluid in his head -- yet lives a completely normal life."

It's actually a pretty interesting article, and one can't help but sympathize with the man, but the comparison was just too tempting.

"SAS" (and we don't mean Special Forces)

I have a client/friend who occasionally has too much time on his hands, so he calls to "chew the fat." I really don't often mind, because he's an interesting fellow, and sometimes I need a break, too. But this can be taken to extremes; according to Kronos ("a global provider of human capital management solutions"), some 40% of employees will call in sick this summer, even though they're actually quite fine.

[Graphic courtesy of Employee Benefit News]

Kronos calls this "taking a Bueller," a nod to the popular 1986 comedy [ed: hard to believe that film is old enough to drink]. So, with help from Harris Interactive, they surveyed almost 1,100 "employed adults" to see how many folks really do this (and/or would admit to it).

While taking the occasional "unscheduled" day off may seem harmless enough, it appears that there may well be a dark side: too many people taking too many "Buellers" could have some negative consequences in the workplace. For one thing, it means that there more honest co-workers are left to pick up their slack. For another, it encourages those who haven't indulged to do so, which sets up a precedent, and a vicious cycle.

One way to nip the problem in the bud is to go proactive: much as "Casual Fridays" ruled the 90's, identifying "Summer Fridays" (closing shop early at the end of the week, for example) could be just the firewall that's needed. And, as we saw with Paid Time Off, giving folks flexibility in the days they work can also help mitigate this problem.

I've got more to say about this, but it's Friday, and I'm not feeling so well....

More Bad Math

There's an old saw about beating a dead horse, and since we recently wrote on the topic of the mysterious 45 million, this may seem a bit insensitive. But facts are stubborn things, and when we debate the nature and severity of the "health insurance crisis," it's helpful to define and quantify it.

There is no crisis.

A crisis is defined as "an unstable or crucial time or state of affairs in which a decisive change is impending." Now, if there were truly 45 million people without health insurance (which, as we've explained ad nauseum, is not the same as lacking access to health care), then perhaps we'd have a crisis.

But there aren't:

■ The number of the uninsured who aren’t citizens is nearly 10 million on its own

■ The Census “underreported” the number of people covered by health insurance – meaning that more people have insurance than the report suggests

■ The Census also underreported the number of people covered by Medicare and Medicaid

■ (A)ccording to the same Census report, there are 8.3 million uninsured people who make between $50,000 and $74,999 per year and 8.74 million who make more than $75,000 a year

Thus, "(s)ubtracting non-citizens and those who can afford their own insurance but choose not to purchase it, about 20 million people are left – less than 7 percent of the population." So how can we seriously discuss a "crisis" when over 93% of the relevant population is covered?

But that's another old saw.

Stupid Carrier Tricks Numbers 236, 237, 238 . . .

From time to time we showcase carriers who do stupid things such as here and here (just to list a few). Seems we have been holding back and can't take it much longer.

So here are some new ones you may know.

Stupid carrier trick #236. Blue Cross of Georgia decides to roll out a new product. Actually, it isn't new but rather imported from their parent company in California. Seems Tonik has been a hot seller in California so now it is time to introduce young Georgian's to it.

On Monday 11/20/2006 an email goes out to all brokers announcing the new product and inviting brokers to the kick off & training session.

So what's the problem?

Monday, 11/20/2006 is 3 days before Thanksgiving.

The meeting is on Tuesday 11/21/2006.

Next comes Coventry with their new individual product. They have been active in the group market for some time (operating under various names) and decided to introduce a new individual major med product to Georgia. This plan is suppose to compete handily with the much entrenched Blue Cross plans. The new Coventry plans are almost a carbon copy of the Blue plans but with more bells & whistles and a lower price. They feature quick turn around in underwriting, fast issue . . . everything you would want.

The product is approved for sale for April 15th effective dates.

The kick off meeting is never officially announced to the brokers but by way of the grapevine I find out the kick off meeting is to be held on 4/19/2007 . . . four days after the product could officially be offered.

Despite a less than auspicious start the product has been well received. In fact, too well.

They have so many applications they cannot get the policies out the door until weeks after the effective date. Letters are sent out informing a client they are approved for coverage yet when those clients call customer service it seems the enrollment department has no record of the underwriting approval issued 3 weeks earlier.

Of course since enrollment has no record of the individual, no premiums have been drafted.

Nice.

Next comes Humana. (Might as well spread it around. No need to just limit it to one carrier.)

They roll out new products in Colorado and are well received. A few months later they are introduced to AZ, IL, MI, LA, OH & TX.

So how is the announcement handled?

With a write up in a business newspaper.

And the brokers?

Not a word . . .

In case you are wondering, most carriers get 85 - 90% of their new business from brokers.

Not direct to consumer advertising.

Not from home office captive agents.

From independent brokers.

Now comes one of my favorite carriers.

No, seriously.

Last year about 60% of the business I wrote went with United HealthCare (AKA Golden Rule).

They are a great company with very good customer service, competitive products and a strong network. Their forte' is the HDHP (high deductible health plan) coupled with a seamless HSA (health savings account).

UHC owns Exante Bank. When a client buys the health insurance from UHC and opts to let Exante handle the HSA they can also let UHC draft directly from the HSA to pay providers.

The way this works is neat.

You see your doc, give them your card, and when you leave you do not pay. The doc files the claim with UHC on your behalf. About 2 weeks later the claim is processed and adjudicated by UHC and the lower, negotiated rate structure is applied. UHC then drafts your HSA and pays the provider for you.

Seamless.

This system works so well that I asked UHC if they would be willing to do the same for their other high deductible plans that are not HSA compliant. What could be more simple? The carrier already has the ability to perform a service to their client, allowing them to access providers without making a payment at time of service.

Granted, the HSA is a tax qualified plan but you can also have a non-qualified HSA. All the same benefits EXCEPT the tax favored transactions.

UHC has the system in place to draft directly from Exante Bank accounts.

UHC owns Exante Bank.

Simple request, huh?

The response is . . . "UHC will not be introducing new products with this capability".

What new product?

Same product you have now. The only change is performing a CUSTOMER SERVICE by drafting from an account OWNED BY UHC, funded by the policyholder and paying the provider directly.

No dice.

This stupid carrier trick tops my list.

At least for now . . .

Take a Number

According to the Brooking's Institute, health care in the U.S. consumes almost 15% of the GDP. They further speculate that by 2040 health care will consume fully one third of the GDP unless something changes.

Perhaps the U.S. can do what the Brit's have done and ration health care.

One approach, used in Britain for many years, is rationing. This brief examines many of the issues involved with rationing health care by applying its principles to radiology, using examples from the budgetlimited British health system. There, policymakers and medical providers routinely grapple with two difficult and value-laden questions: How much should be spent on the expensive but life saving technology? And how much should be spent on very costly research to evaluate that investment?

An argument that appears quite often is the amount spent on health care in the U.S. as a percent of GDP when compared to other countries. This report (albeit from 2001) shows the U.S. spending 14% of GDP compared to 9.5%, 9.7% and 7.6% respectively for France, Canada & the U.K.

Since these other countries supposedly have better results by spending less then the solution seems simple.

Either we ration care like they do in the U.K., or we use 40% fewer medical services, or simply persuade the medical providers to accept 40% less than they do now.

Seems simple enough.

Next!

Cavalcade of Risk #30 is up!

You'll find this week's jam-packed edition at The Sentinel Effect. Our host, Richard Escow has a terrific line-up of of risk-related posts.

As Richard will tell you, it's fun & easy to host, and the little traffic-bump is nice, too. Interested? Just drop us a line!

Doc-in-a-(Bigger)-Box

Over at Trusted.MD, Philippa Kennealy has an interesting article on the burgeoning [ed: what's with that word?!] world of neighborhood retail clinics. These are more than Urgent Care Centers, less than hospital ER's, and often boast more hours than one's family physician. Dr Kennealy quotes from an article she found online, which posited that "when you talk about customer convenience, these clinics have it all over your doctor's office." That author goes on to castigate the AMA for attempting to legislate such establishments away; the theory, one supposes, is that the "medical establishment" feels threatened.

Perhaps they're justified in feeling that way, but I suspect that such legislation, if it ever does come to pass, is akin to putting the toothpaste back in the tube. These kinds of providers are popping up all over the place: not just in the neighborhood strip mall, but in WalMarts and other retailers, as well.

Abraham Lincoln once famously suggested that one should keep one's friends close, and one's enemies [ed: or perceived enemies] closer. Seems to me that "regular docs" could take a page from the upstarts, and begin to assess their own business models. This may well have the effect of reducing the cost of medical care, without a lot of unnecessary (and burdensome, and expensive; the list goes on) government intervention.

The Price is Right (Not)

Bob's pointed out that insurer's profits really have little impact on premiums (indeed, cutting out a carrier's profit altogether does little to affect the final rates). And Mike's pointed out that health insurance is expensive because health care is expensive. One might then argue that, if the cost of health care declined, the cost of health insurance might, as well.

Maybe so, but it doesn't matter.

Why not, you may ask?

Turns out, there are a lot of folks who really don't care how much health insurance (or health care) costs, they ain't buyin'. Need proof? Here ya go:

"A 50% cut in health insurance premiums would only reduce the number of uninsured Americans by 3%, estimates a Rand study out Monday, which suggests that incentives and government tax cuts won't lead to universal coverage."

That's pretty hardcore, and seems to me to put a whole new light on the nature of the "health insurance crisis." After all, is it really a crisis when 97% of the folks affected by it don't care?

And then there's the whole issue of gummint subsidies; these are touted as a way to make insurance premiums more affordable. But according to that same study, "subsidies that cut health insurance premium prices in half for people without insurance would reduce the number of uninsured Americans by just 3 percent."

That's interesting, isn't it? That "3%" keeps cropping up. In fact, it's a number that could easily reflect the actual margin of error in the study itself, which resulted from a survey of some 19,000 "new individual health care policy subscribers from January 1997 through the fall of 2001."

A Rand spokescritter, Susan Marquis, opined that "a federal requirement that all people have insurance may be the only way to achieve such a goal." That's a great idea [ed: um, no, it's not], but hardly practical: what about folks who want insurance, but don't qualify (admittedly, this is a very small subset)? Who sets the policy requirements? How does one enforce such a law, absent an actual government-run program (still dubious? Then explain to me why I need to buy uninsured motorists coverage)?

Okay, Prof, what about making policies more attractive?

I'll let Ms Maquis take that one: "(C)utting by 20% the amount of the annual deductible, which is what policyholders pay before benefits begin, would increase the likelihood of uninsured purchasing the policy by less than half a percent."

Oh.

Back to the ol' drawing board.

The article concludes with this little tidbit: "Researchers concluded that newer types of individual plans with very high deductibles may be attractive to healthy people, but are unlikely to help reduce the total number of people without health insurance."

Really? Based on what, exactly? The release offers no substantiation for this silliness, as if it's just, well, obvious. But of course it's not, and goes against other studies which show just the opposite. Those other studies were not without flaws either, of course, but at least offered some evidence. The Rand folks just toss it out there for consumption, with no critical analysis or numbers.

Seems sloppy to me.

Grand Rounds...

Just keeps on getting better and better. This week's host, 22 year old Canadian Medical student Vitum Medicinus takes an interesting approach: not content with including helpful context and a thoughtful layout, VM explains why each post is a "must-read," and even hands out "awards" based on a post's topic.

There are almost 3 dozen excellent choices, so you really can't go wrong with any of them. That said, I was particularly intrigued by Ad Libitum's post on various privacy and HIPAA issues arise when one writes about a patient or client; equally interesting, what if you're the patient or client?

Tranny Deduction

Consumer driven healthcare has generally been about price transparency and patient empowerment. We've talked about various tax advantages inherent in "alternative benefit plans" like FSA's and HSA's. These advantages flow from an IRS document (213d) which delineate what's "kosher" for such reimbursements.

Obvious expenses include prescription med's, non-reimbursed office visits, even orthopedic hosiery. Obviously non-eligible expenses include hot tubs* and ski trips to Aspen.

But what about sex-change operations?

[ed: Hunh?]

Well, hip replacement surgery is okey-dokey, as is breast-reconstruction following a cancer-related mastectomy. Wouldn't it follow, then that gender-realignment procedures would be eligible for consideration?

Well, according to those neanderthals at the IRS, the answer is "no:"

"(A) 57-year-old suburban Boston man underwent a sex-change operation. Then she [he?] wrote off the $25,000 in medical expenses on her [his?] taxes.

But the IRS disallowed the deduction — ruling the procedure was cosmetic, not a medical necessity — in a potentially precedent-setting dispute now before the U.S. Tax Court."

And there it stands; the gentleman, er, lady in question has sued the IRS, seeking to have the substantial cost of the surgery made eligible for special tax treatment. The IRS maintains that this is elective, cosmetic surgery; the plaintiff argues that it's medically necessary.

Should make for some fascinating Court TV.

[*See comments for an update]

Late-Breaking Carnival Monday

A jam-packed edition of the Carnival of Personal Finance awaits you at MintCN blog. There's an amazing 70 entries, lots of helpful categories and context, and a twist: along with each post actually submitted, the our host includes a link to the very first post on that blog. Very cool.

The Silicon Valley Blogger has an unusual post: we've all heard of discrimination based on race, or religion, or sexual orientation. But based on your name? It's for real.

55+ Health Insurance

The HR Policy Assocation has an idea that may work. Early retirees looking for health insurance run into two challenges.

Insurability and affordability.

Now it appears the HR Policy Association in conjunction with Aetna is preparing to offer coverage with few strings attached.

Under the Retiree Health Access program, no retiree could be turned down for coverage, regardless of prior medical conditions. Specifics of the plans will vary by employer, but a typical plan will have an annual deductible between $500 and $1,100 and a monthly premium between $400 and $1,200, depending on how much an employer chooses to contribute.

Sounds good to me. Read more here.

Cavalcade #30: Submissions Due

Just a reminder that submissions for next week's CoR are due Monday (the 16th). Our host, Richard Eskow, asks that you PLEASE include:

■ Your blog's url

■ Your post's url

■ The post's trackback URL (if available)

■ A (brief) summary of the post

You can submit them via Blog Carnival or email.

We still have Fall '07 hosting slots available. Hosting is fun, easy, and gets you off the "nag" list. Just drop us a line!

Health Wonk Review

Fellow insurance blogger Jay Norris presents a terrific HWR. Chock full of interesting posts and helpful context, it is, as Jay notes, "the cream of the crop of recent entries in the ongoing US health care policy discussion."

Unfortunately, Jay's site (the Colorado Health Insurance Insider) is experiencing some tech problems, so the HWR seems to come and go. Hitting the "refresh" button sometimes helps; we'll let you know when it's running at 100%.

UPDATE: Well, it seems that Jay's got some of the tech issues resolved, and I was able to look through the 17 entries. They all looked interesting (and indeed, I would encourage folks to read all of them when they have the time), but Roy Poses' item on DTC goes Door-to-Door is a must-read.

Joinin' the Club...

Cato Institute Fellow Michael Cannon has a new project, and we're pretty excited to be a part of it. The Anti–Universal Coverage Club "is a list of scholars and citizens who reject the idea that government should ensure that all individuals have health insurance. It exists to challenge the idea that “universal coverage” is the best way to protect and promote health."

We were invited to join early on, and we did; it seems like a good way to judge the depth of interest on this side of the debate.

The underlying principles of the AUCC are:

■ Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.

■ “Universal coverage” could be achieved only by forcing everyone to buy health insurance or by having government provide health insurance to all, neither of which is desirable.

■ In a free society, people should have the right to refuse health insurance.

■ If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”

Seems pretty straightforward to us, and apparently to quite a few others: in addition to IB, members include such diverse folks as the Illinois Policy Institute, big time econblogger Arnold Kling, even Andrew Sullivan (that one stopped me cold).

We'll have more on the 'Club as details become available.

[A big Thank You to Tom Tullis for the terrific graphic]

Low Cost Health Insurance

Everyone is talking about changes in health care coverage that must come about if our society is going to survive. There are calls to get rid of insurance companies. Their huge profits and excessive salaries are the cause of the high cost of health care. People are clamoring for the government to do something to save us.

Heck, there is even a film about how bad health care is in this country . . .

Well I decided to do a little searching on my own and guess what I found. There is a plan that covers everything for less than $2000 per year.

So what do you get for that kind of money?

Just about anything you need.

Complete coverage for everything including medicine. Most pre-existing conditions are covered after a waiting period.

There are some downsides such as asking you to provide a urine sample in a mayonnaise jar, having to wait in line to see a doctor, waiting in line to have X-rays or lab work. If you have an unanticipated medical need (but non-emergency) in the middle of the day you will be lectured about why you didn't show up at 7:30 in the morning. Eventually you will be seen.

Almost everyone who has a job receives coverage at no charge to them.

So what's the catch?

You may have to travel a bit to receive coverage. You will be required to use state run facilities if you want to receive full benefits. And it helps if you speak Spanish.

Want more details?

Look here, here and especially here.

Bueno!

Lying with Numbers...

Over the years, we've had our own doubts about that ubiquitous "45 million uninsured." For one thing, "uninsured" doesn't mean "without access to healthcare." For another, that number has always been a "snapshot:" it's never the same (alleged) 45 million folks from year to year (or even month to month).

And now, thanks to Junk Yard Dog blog, we learn that the number itself is (no real surprise to IB readers), ahem, "inflated:"

"According to the U.S. Census Bureau, almost 45 million Americans have no health insurance...Oops, they counted non-citizens. So, what do I mean about 45 million not being 45 million? Well, the number originally came from the Census Bureau's 2005 Current Population Survey (CPS) Annual Social and Economic Supplement (ASEC), which was corrected last year to 44.8 million people without health insurance. If you read the report, however, you'll find that 9.2 million of the uninsured are not citizens of the United States."

"Ooops" for sure.

What that means is that even if we take that "45 million" at face value (which is dubious, at best), less than 80% of those are actual, real Americans. The rest are simply skipping out on the healthcare available in their own countries.

That's a big "Oops."

(More here)

Hypothetically Speaking...

We've blogged before about ethical conundrums and issues, and we've talked about how important it is to be truthful when applying for insurance.

And I believe fervently that doing the right thing is always the best choice.

One thing I would never do, for example, is encourage or condone any client misrepresenting facts when completing an insurance application. For one thing, in this age of EMR and other tech, it's just too darned easy to get "caught out," particularly when answering questions about one's own health.

Okay, Prof, so where's this heading?

Life insurance applications have always (or almost always) asked about family history: are your folks still alive? If not, when and how did they die? That kind of thing. Recently, at an online forum to which I occasionally contribute, a respected colleague discussed a recent case of his:

"So far, this person qualifies for Super Preferred. The kicker, his father passed away at age 57 of a heart attack. Now, many carriers have moved him from Super Preferred all the way down to Standard. However, there are still a few carriers that will offer Preferred and be much less expensive than the standard rates."

I've known this, of course, but for some reason I started really considering the implications:

1) What if the client had been adopted? He'd have had no way of knowing, really, whether his father was even still alive, dropped dead of a heart attack at age 32, or whatever. Does that mean he could never get super preferrred rates from certain carriers?

2) How could a carrier ever really check this? It's not like they'd have access to his father's death certificate or medical records. What if he did lie ("Dad? Oh, he was killed in a train wreck at age 92")? How would an underwriter know?

My point isn't to suggest or condone lying on an application. Rather, it's to underscore the futility of even asking the question. Yes, it's relevant (to a point): if Dad died of a stroke at age 49, then that may indicate some genetic predisposition to heart problems.

Or not.

This is one of those "gray" areas that agents (and applicants) abhor, and which carriers might be well-advised to review (and revise).

Grand Rounds

Tara Smith, Assistant Professor of Epidemiology at a university in Iowa (although she's originally from here in the Buckeye State), hosts this week's Grand Rounds. And it's truly grand: she's provided interesting categories, helpful context and gorgeous photos; who could ask for anything more? Oh yeah, and there are 3 dozen posts from which to choose.

I actually had two favorites from this crop:

Here at IB, we're all about transparency in health care (okay, that's a bit of an exaggeration, but we do spend a lot of time promoting it). The oft-unstated "other side of the coin" is the subject of Emergiblog's Kim muses on patients' responsibilities in the exchange.

And over at the Health Business Blog, David Williams has some serious questions about the relatively new, but burgeoning, "concierge" model of health care practices. He asks if some of these medico-entrpreneurs aren't using a bit of "fuzzy math" in their calculations.

It's Cool to be PC (P&C, that is)

A while back, I stumbled on a P&C (property and casualty) related blog, run by fellow insurance agent Aaron Wallrich of Wisconsin. I've been following it for a while, and find it just fascinating: a fellow cynic when it comes to carriers, with a quirky, pleasant sense of humor and self-deprecation ("Very interesting stuff for an insurance nerd like me").

If you've got an interest in seeing the P&C side of "the biz," Swift Rate is the place to go.

Carnival Monday

This week's Carnival of Personal Finance continues the trend I've grown to like: Jennifer Lynn presents a (relatively) short list of "Editor's Choice" items, followed by a list of the other submissions (most of which included helpful context).

Although I consider myself a "geek," I haven't rushed out to buy an iPhone. For one thing, I really just want my cell to make and receive phone calls, not play music, or shoot video, and I already have a Palm Pilot (all right, it's really a Clie, but I call all PDA's "Pilots"). So I really appreciated The Money Well's take on our need for "instant gratification," with the iPhone being his springboard. Interesting.

And the Carnival of the Capitalists is also up, hosted this week by The Married Cook Guy (now there's a fellow foodie!). Like the CoPF, our host chose a handful (10) of posts to highlight. While I'm pleased that we made the cut (ours is, in fact, the top post), I was disappointed that the posts that didn't weren't linked in any way. Still, that's the host's prerogative.

Since my industry seems to take a lot of grief in the profit-motive department, I found The Time and Money Group 's comparison of profit margins in different industries quite eye-opening.

Michael and Me

I haven't seen all of Sicko, just enough to make a few comments. Yeah, the production looks good technically but basically, I think the movie should be no more relevant than, say, Hunt for Red October to an intelligent discussion of the issues of health care and health insurance. Why do I say that?

Because the undeniable fact is that insurance is expensive because health care is expensive, not the other way around. Does Moore say that? No he does not. The cost of insurance is rising because the cost of health care is rising. Does Moore say that? No, he does not. The high cost of insurance is a symptom of the deeper problem of health care costs – and if our nation cannot solve the deeper problem, we will never be rid of the symptom. Does Moore say that? No, he does not. He’s pecking around the fringes, not facing the problem itself. Worse he does not clearly articulate the problem as either health care or health insurance. Sorta like some people in Colonial times, he’s stuck a feather in his cap and called it macaroni. Of course what one sees is nonsense on stilts. But it is what it is.

So Moore confuses the difference between health care and health insurance – I think deliberately, since Moore is not a stupid man. Confusing these two hides the real problem. It ends up feeding people’s fears that they cannot afford “health care” because they can’t buy insurance when the truth is that most of us can’t afford health care because HEALTH CARE costs so freakin much!

IMO, what Moore is selling will screw us. And because I think he knows exactly what he is doing, I see him less as an advocate and more as a pimp. By pushing confusion about the deeper problem, Moore in fact is an impediment to understanding. That is why I say, the movie should be irrelevant to an intelligent discussion. Should be. But won’t be. Won’t be irrelevant because the discussion is driven by naivete, ignorance, fear, and cynical politics.

It is a natural human temptation to minimize the importance of facts one doesn’t want to be true, especially when the facts reveal problems that are very difficult to solve. In this case, I believe that the people who are most pleased with Moore’s movie don’t want certain facts to be true. Think about our government's biggest existing health insurance programs - Medicare and Medicaid. Facts are, these programs are rapidly being crushed by the cost of health care (Medicare alone has a $60 Trillion unfunded liability) and are far from effective in meeting the needs of the elderly and poor populations because of fraud, waste, federal budget politics, political corruption, organizational inflexibility, bureaucracy, and the massive amount of law & regulation that governs everything they do. Add to that the health costs driven by our own unhealthy behaviors; we are becoming a population that refuses to take responsibility for our own health except as it can come in a pill-bottle or operation that we demand someone else pay for.

Is there a single reason to suppose that these problems would go away - that our government could do a "better" job with health insurance - if only the government controlled all of it? I think the answer is obvious. No, it could not.

Many of the same people who prefer not to talk about the very real problems in our present government insurance programs, also don’t want to take seriously the problems and occasional failures in other countries’ health insurance schemes. As though if they were to admit there might be a problem elsewhere, the cause of attaining the universal health care in this country would be derailed. Is universal health care such a fragile patient that it cannot stand an honest examination?

IMO, an unwillingness to consider forthrightly the problems that all governmental insurance systems do have is a major obstacle to designing a plan that has a chance of being a “solution”. It is an obstacle because it gets in the way of clear analysis. Instead we hear far too many ad hominem attacks, or appeals to false authority, or fallacious logic, or the old chestnuts “everyone knows” and “this is a no-brainer” not to mention the usual litany of complaints about the cost of insurance, all the while ignoring the cost of health care that is responsible for the high cost of insurance.

BTW, I favor universal health care. I also favor universal health insurance to help pay for health care. There is a lot of work to do because wishing does not make it so. I do not confuse health care with health insurance. I believe that the linkage of group health insurance with one’s employment, while a useful tactic for decades, has outlived its usefulness and it’s time to re-think. At the same time, I believe that any universal insurance scheme whether public or private CANNOT succeed in this country, unless the costs of health care can be reduced and the annual rate of growth in those costs is brought under meaningful control. I favor a substantial role for the private insurance sector in any universal health insurance scheme - as in France, or Germany, or Chile or other countries. IMO, a basic public insurance plan that can be supplemented by private insurance is a reasonable approach and a preferable alternative to the enormous bureaucracy that results within a fully-centralized health care and insurance system such as in the U.K. And, of course, I think that Moore’s movie should be irrelevant to an intelligent discussion of the issues with either health care or health insurance in this country.

Walking Down Memory Lane

Here are a few oldies but goodies . . .

More Equal Than Others.

One of the most prolific, and tenacious, canards cited by those who advocate a nationalized health care system here is the (demonstrably) false assertion that such a system saves more lives than ours.

Basic Economics

Let’s play a game. Roll time forward a bit…universal healthcare has arrived and you are now a Regional Head of the Healthcare System. You have an annual budget that you absolutely can’t exceed. The medical expenses for your region have been increasing and this year you’re going to exceed your budget. What do you cut? Medical staff? Drug expenditures? Or do you defer maintenance and maybe cut back on some housecleaning?

Some Future's Aren't Fun

“The National Health Service in England faces a shortage of nurses and family doctors over the next four years, according to a leaked government planning document seen by the Health Service Journal” and NHS “also predicts an oversupply of 3,200 hospital consultants [i.e., specialists], the medical weekly reported on Thursday.”

More from Across the Pond…


As we’ve noted before, the British National Health System (NHS), while touted as far superior to our own flawed efforts, continues to prove its proponents wrong. For example, Britain's Royal College of Obstetricians and Gynaecology is now urging doc’s to do away with sickly infants, which “can disable healthy families.”

No Tickee, No Chemo…

“Thousands of prostate cancer sufferers in Scotland are facing a "postcode lottery" over a new treatment for the disease.

The drug Zometa, has not been approved for use in Scotland, despite being available in England and other EU countries.”

The Dark Side of Universal Health Care

Multiple Sclerosis is “an autoimmune disease that affects the central nervous system (CNS)...In MS, myelin is lost in multiple areas, leaving scar tissue called sclerosis. These damaged areas are also known as plaques or lesions.” It is a debilitating disease, one that robs its victims of their health and, sometime, life.

It is also, generally, treatable and manageable. Medications and protocols exist that help those with MS function, contribute, and enjoy life.

And that concludes today's review. Any or all of these may appear on your final exam.

Sicko, Michael Moore and Karl Marx

I watched Sicko today, mostly as a result of a dare.

It was not what I expected.

The movie is well done. Michael Moore is not waving his arms and screaming into the camera like some protester or street evangelist. Instead, his narration is done in a voice one would expect if telling a story to a small child. Almost a Fred Rogers kind of tone.

His focus is not so much on the uninsured in this country as it is on the insured. He also spends a great deal of time talking to people in other countries about how well their care works and how little they pay.

He uses the word "free" a lot.

In fact, there is nothing free about health care regardless of where you live.

I suspect his posse also believes there is such a thing as free health care, free housing, free police & fire protection, free education.

I did find it interesting that he paraphrased Karl Marx by stating health care is paid for in other countries by "asking those who have the ability pay to take care of those who have the need ."

That is not a direct quote from the movie, but close enough.

I don't recall any government anywhere making taxes voluntary. There is no asking people to pay taxes, rather it is a mandate.

Karl Marx of course penned the Communist Manifesto and felt that capitalism should be replaced by socialism which would then become communism.

One would deduce from the movie that other nations are more charitable about health care where here in the U.S. health care is all about profit.

More on the profit motive can be read here.

The idea that Americans are not charitable is bogus. In 2001 the estimated total for uncompensated care was $35B according to a Kaiser report. Even though the report says that 85% of that total is "covered by the government" it ignores one thing:

The government doesn't have any money. It all comes from taxpayers.

Allowing "free" and (mostly) unfettered access to health care regardless of ability to pay sounds charitable to me, but not so to Michael Moore.

You would think after watching Sicko that everyone, everywhere has better health care than we do and there is no downside to health care in Canada, Great Britain, France or even Cuba.

If so, then why do Canadians cross the border into the U.S. to receive treatment? Why do Brit's have to get in the queue and have treatment for certain conditions denied? Why is it Cubans can apparently get the best in health care yet 75% of them are illiterate, almost no one owns land and unemployment is rampant. Cubans may have excellent health care, yet many die each year from curable diseases for lack of medicine.

Wonder how Sicko missed this fact?

So is health care perfect here? Of course not. But neither is it perfect in these other countries.

In Canada, Britain, France and Cuba people still suffer, they still die and (in some cases) are denied care. For all the good these health care systems have done, they have not managed to banish heart disease, cancer or other serious illness from their country.

While the system here has its flaws, it is neither uncharitable nor is it costly because of profiteering. Free comes with a price. The question is, do we really want to trash the current system in favor of a Katrina Health Plan?

Flooding across the Pond

From time to time, we like to dabble a bit in the P&C (property and casualty) side of "the biz." This includes items like auto, home and liability insurance, as opposed to our regular fare of life and health.

About two years ago, we participated in the blogosphere's efforts to help victims of Hurricane Katrina (which project, apparently, was more successful than our own gummint's). And while that was a terrifically satisfying endeavor, we never underestimated the vast reserves and dedication of the P&C "cat" teams who slogged through the devastation, dispensing help and, more importantly, cash.

At the other end of the spectrum, Britain's NHS (National Health System) has been the target of more than a few of our posts, and rightly so. But our English cousins haven't (yet) nationalized their P&C industry, which is now trying to cope with floods that compare to that which we saw in NOLA. Apparently, the Brits' carriers are up to the task, but an interesting question arises:

"So why do one in four people, almost a third in Scotland and London, take a risk and not insure their contents?"

That's a lot of uninsured folks, many of whom now face financial ruin, displacement and worse. Some, of course, are just natural risk-takers, and we have many of our own of this ilk here in the 'States. For others, it's a matter of economics: if you can barely afford to eat, then insurance premiums are probably not high on your list of necessary purchases. I'm not sure I entirely buy that: the premium quoted in the Times article, £200 (about $400) a year, works out to less than $10 a week, which doesn't seem overwhelming.

Which gives rise to the real questions:

"Should we save them when the floodwater rises? Or do we stand purse-lipped at their lack of providence, as the loss adjuster with his clipboard sanctions our new suite?"

Tough choices. What was that about stiff upper lips?

Katrina Health Plan

With all the fuss about how insurance carriers waste dollars that could be used to deliver health care coverage at a lower cost, I felt this article was appropriate. It seems there are some who feel the government does a better job at administering almost everything.

Let's see.

Two Years After Katrina, $1 Billion Missing and 11,000 Complaints

$1B missing. In the big scheme is $1B much money? I mean, we are talking about the federal government that spends money in the TRILLIONS.

What is $1B in all that?

Of the nearly $7 billion spent on Katrina victims, an estimated $1 billion was either stolen or wasted.

$1B out of $7B!!!

Where did the money go?

anger might be directed at someone like Walter Ray Stall. Stall claimed he lost everything in New Orleans. Federal workers gave him $2000 – but it turns out he actually lives in Texas.

$2k to a guy who lived in TX at the time Katrina hit.

Wonder who would get my meds under a Katrina Health Plan? Somebody in KS probably.

"The reaction of the government was to throw as much money as you can as quickly as possible and don't worry about it if these people really deserve it or need it,"

Sounds like the way some people want to treat health care. Just throw more money at it and don't worry where the money lands or who benefits.

The Justice Department defends its efforts saying 700 people have so far been convicted.

700 convictions.

11,000 complaints.

Then there is this.

The two audits found that up to 900,000 of the 2.5 million applicants who received aid under FEMA’s emergency cash assistance program — which included the $2,000 debit cards given to evacuees — were based on duplicate or invalid Social Security numbers, or false addresses and names

900,000 out of 2,500,000 willing to commit fraud for $2000 in free cash. Wonder what they would do for free health care?

Duplicate payments were made to about 5,000 of the nearly 11,000 debit card recipients who received Katrina aid, first with debit cards and then again via electronic bank transfer.

"Yes Mr. Jones. I realize we have already removed one kidney. But hey, the second one is on us."

FEMA may have bought too many temporary homes — 24,967 manufactured homes obtained for $857.8 million and 1,295 modular homes at $40 million — resulting in 10,777 such homes sitting empty in Hope, Ark., in sinking mud without proper storage. “It was unclear how the decision was made,” the Homeland Security audit stated.

26,262 homes bought.

10,777 sit empty.

Sounds like they are ready to run a more efficient health plan.

I can hardly wait. Wonder if Canada has a place for me. I hear they have a wonderful health plan there.