tag:blogger.com,1999:blog-47948950480403883202024-02-21T08:38:26.699-08:00historiaenlauniAnonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.comBlogger500125tag:blogger.com,1999:blog-4794895048040388320.post-28027366137877569432007-07-30T11:36:00.000-07:002014-05-23T10:23:41.218-07:00Government Experiments on PoorIn 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 <span style="font-weight:bold;"><a href="http://www.ajc.com/search/content/news/stories/2007/07/28/hmos.html" target="blank">Medicaid </a></span>to move to a more structured HMO the state achieved their goal. <br /><br />But all is not well in the Peach State.<br /><br /><span style="font-style:italic;">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."</span><br /><br />Widespread reports . . . denied therapies.<br /><br />Sounds like rationing of services.<br /><br /><span style="font-style:italic;">The state believed the HMOs "could do a better job managing the care of our members" and save taxpayers money,</span><br /><br />The plan worked. In the last fiscal year the state saved the taxpayers of Georgia $78,000,000.<br /><br /><span style="font-style:italic;">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.''<br /><br />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.</span><br /><br />It would appear that medical providers don't want any part of this program that covers approximately 900,000 Georgians.<br /><br />What good does it do to have a taxpayer funded program for the poor if they are denied access to services?<br /><br /><span style="font-style:italic;">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.</span><br /><br />That's a two hour drive.<br /><br />Of course, had it been an emergency care could have been administered closer to home.<br /><br />At least, that's the theory.<br /><br /><span style="font-style:italic;">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.''</span><br /><br />So doctors aren't the only ones threatening to pull out.<br /><br /><span style="font-style:italic;">"Several rural hospitals have faced near-failure to make payroll, and most rural hospitals are in a cash-flow crisis" because of reimbursement problems</span><br /><br />What does this tell us about the future of government managed health care?<br /><br />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%?<br /><br />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?Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com1tag:blogger.com,1999:blog-4794895048040388320.post-35353711396204647342007-07-26T04:43:00.000-07:002014-05-23T10:23:41.228-07:00Sicko Was EditedoIt seems that "Sicko" was editedo.<br /><br />Yeah, I find it hard to believe too.<br /><br />The <span style="font-weight:bold;"><a href="http://www.heraldtribune.com/article/20070721/NEWS/707210369" target="blank">Main family</a> </span>of Port Charlotte, Florida was supposed to be in Michael Moore's movie but somehow got left out.<br /><br /><span style="font-style:italic;">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.<br /><br />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.</span><br /><br />That's a low price for a family of 4. No one questioned it?<br /><br />The policy they bought is a limited benefit plan that caps the payout to providers.<br /><br />Did they read and understand the policy limits?<br /><br />According to the carrier:<br /><br /><span style="font-style:italic;">"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.</span><br /><br />Uh-huh.<br /><br />So Mr. Main clearly understood what he was buying, right?<br /><br /><span style="font-style:italic;">An ambulance took Kenny to All Children's Hospital in St. Petersburg, where he was diagnosed with acute lymphoblastic leukemia.<br /><br />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.</span><br /><br />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.<br /><br />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.<br /><br />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.<br /><br />If Mr. Main had done this before his child became ill perhaps much of this could be avoided.<br /><br />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.<br /><br /><span style="font-style:italic;">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.<br /><br />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.<br /><br />The family's story made it into the July 23 issue, with Harry Potter on the cover.</span><br /><br />This is a situation that even a wizard can't cure.<br /><br />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.<br /><br />Better to spend a few bucks now than losing your home later.<br /><br />Drink up!Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-29769410711409062272007-07-26T04:12:00.000-07:002014-05-23T10:23:41.237-07:00Health Wonk ReviewHWR is up, this week hosted by <span style="font-weight:bold;"><a href="http://healthpolicyandmarket.blogspot.com/" target="blank">Health Care Policy and Marketplace Review</a></span>. There are 15 entries including a point/counter-point review of the recent Rand study on health insurance prices and willingness to purchase.<br /><br />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."<br /><br />Enjoy!Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com1tag:blogger.com,1999:blog-4794895048040388320.post-87016362482812016072007-07-25T12:49:00.000-07:002014-05-23T10:23:41.246-07:00Cheesy InsuranceIt seems the folks who give us great cheese and football now have an idea on how to solve the problem of the uninsured.<br /><br />This comes in the form of universal, single payor health insurance funded with (what else?) . . . taxpayer dollars.<br /><br />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.<br /><br />So how much does "free" cost?<br /><br /><span style="font-style:italic;">The plan would cost an estimated <span style="font-weight:bold;"><a href="http://www.opinionjournal.com/editorial/feature.html?id=110010374" target="blank">$15.2 billion,</a></span> 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. </span><br /><br />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.<br /><br />Sweet.<br /><br /><span style="font-style:italic;">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. <br /></span><br /><br />Out of state competition for business? Surely that won't happen!<br /><br />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.<br /><br />And let's not forget the folks that say guv-ern-mint can do a much better job, more efficiently, for less money.<br /><br /><span style="font-style:italic;">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. </span><br /><br />Seems to me the folks need to keep what they do best. Turn out some really good cheese and a good football team.<br /><br />Wonder what Brett Favre thinks about this?Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-62458066802048379132007-07-25T08:33:00.000-07:002014-05-23T10:23:41.255-07:00Cavalcade #31: Submissions Due<div align="justify"><span style="font-family:arial;">Just a reminder that submissions for next week's CoR are due Monday (the 30th). Our host, </span><a href="http://healthcare-economist.com/"><span style="font-family:arial;">Jason Shafrin</span></a><span style="font-family:arial;">, asks that you PLEASE include:</span></div><div align="justify"><span style="font-family:arial;">■ Your blog's url</span></div><div align="justify"><span style="font-family:arial;">■ Your post's url</span></div><div align="justify"><span style="font-family:arial;">■ The post's trackback URL (if available)</span></div><div align="justify"><span style="font-family:arial;">■ A (brief) summary of the post</span></div><div align="justify"><span style="font-family:arial;">You can submit them via </span><a href="http://blogcarnival.com/bc/submit_339.html"><span style="font-family:arial;">Blog Carnival</span></a><span style="font-family:arial;"> or </span><a href="mailto:jason@healthcare-economist.com"><span style="font-family:arial;">email</span></a><span style="font-family:arial;">.</span></div><div align="justify"><span style="font-family:arial;">We still have Fall '07 hosting slots available. Hosting is fun, easy, and gets you off the "nag" list. Just </span><a href="mailto:cavrisk@hotmail.com"><span style="font-family:arial;">drop us a line</span></a><span style="font-family:arial;">!</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-40302328607312536102007-07-25T05:23:00.000-07:002014-05-23T10:23:41.283-07:00Hole in the HeadPerhaps 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.<br /><br /><span style="FONT-STYLE: italic">David Malleau awoke in hospital with a gaping hole in his skull.<br /><br />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.<br /><br />Once the swelling subsided and he was ready for surgery in March 2005, Malleau was sent home and <span style="FONT-WEIGHT: bold"><a href="http://onthefencefilms.com/blog/index.php?p=394" target="blank">placed on a waiting list.</a></span><br /><br />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.</span><br /><br />Placed on a waiting list.<br /><br />My, my, my.<br /><br /><span style="FONT-STYLE: italic">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.<br /><br />"I've pretty much had to fight for everything," says his wife Pat, a former bookkeeper.<br /><br />"We were taxpayers. Owned our own home. We went from having our jobs, being in the middle class, to nothing." </span><br /><br />Excuse me. I thought it was only in America where people could lose their home due to the health care system we have.<br /><br />Mr. Malleau could have avoided the wait by coming to America...as long as he had the ability to pay.<br /><br />Seems like a Catch 22 situation.Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-26164619930705097432007-07-24T12:06:00.000-07:002014-05-23T10:23:41.295-07:00Yanks to the Rescue<div align="left">With "free" access to health care, why would anyone need to come to the U.S.?<br /><br /><span style="FONT-STYLE: italic">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. </span></div><div align="left"><span style="FONT-STYLE: italic"></span> </div><div align="left"><span style="FONT-STYLE: italic">Our organization was formed in 2003 to help Canadians from coast to coast, to "<a href="http://www.timelymedical.ca/">Leave the queue</a>" and take personal responsibility for their own private medical services.</span></div><em></em><div align="left"><br />An organization to help Canadians with the ability to pay to take charge of their health care.<br /><br />Interesting concept.<br /><br /><span style="FONT-STYLE: italic">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.</span><br /><br />Saving lives.<br /><br />Isn't that what health care is all about?<br /><br /><span style="FONT-STYLE: italic">Few Canadians realize that:<br /><br />• Surgical waitlists in the US are measured in weeks instead of the years which Canadians are often forced to wait.</span></div><span style="FONT-STYLE: italic"><div align="left"><br />• Cutting edge medical procedures and pharmaceuticals which are unavailable in Canada, are readily accessed by American patients.<br /></div><div align="left">• People under 65, who are without resources, are guaranteed by federal law, access to emergency care for serious medical conditions.<br /></div><div align="left">• 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.</span><br /><br />No waitlists, cutting edge medical procedures & pharmaceuticals, no rationing of operating room time.<br /><br />Probably just me, but isn't this a BETTER system?<br /><br /><span style="FONT-STYLE: italic">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.</span><br /><br />And this is interesting as well.<br /><br />If Canadians choose to go outside the system and pay for care, they can <span style="FONT-WEIGHT: bold"><a href="http://www.findprivateclinics.ca/" target="blank">go here</a></span> and find private fee for service clinics in Canada and the U.S.<br /><br />With all that "free" care, why would anyone want to come here?<br /><br />Was Michael Moore wrong?</div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com1tag:blogger.com,1999:blog-4794895048040388320.post-8514012334334287622007-07-23T13:44:00.000-07:002014-05-23T10:23:41.305-07:00Grady - A Microcosm of Public HealthI 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.<br /><br /><span style="font-style:italic;"><br />They're receiving care despite cutbacks that crippled the staff of <span style="font-weight:bold;"><a href="http://www.ajc.com/metro/content/metro/atlanta/stories/2007/07/21/grady_0722.html" target="blank">Grady Memorial Hospital's</a> </span>ophthalmology department.<br /><br />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</span><br /><br />One million patients per year.<br /><br />Most without insurance.<br /><br />Almost all receive "free" care courtesy of the taxpayers of Fulton & Dekalb county Georgia.<br /><br /><span style="font-style:italic;">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."</span><br /><br />Delay's.<br /><br />Symptomatic of public health.<br /><br /><span style="font-style:italic;"><br />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.<br /><br />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.<br /><br />A few days later, Wilks was gone — laid off in an additional cutback</span><br /><br />Cutbacks in non-essential personnel.<br /><br /><span style="font-style:italic;"><br />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.<br /></span><br /><br />The more money that comes in, the more that flows out.<br /><br />There is no end.<br /><br /><span style="font-style:italic;">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."</span><br /><br />Aging equipment.<br /><br />Delays in care.<br /><br />Is this any way to run a health system?<br /><br /><span style="font-style:italic;">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.<br /><br />The woman now receives ongoing treatment at Grady.<br /></span><br /><br />Told by her doctor to go to Grady.<br /><br />Because care there is perceived as "free".<br /><br />Even by someone who (should) know better.<br /><br />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.<br /><br />Is this really what the public wants?Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-24015450872223392332007-07-23T11:00:00.000-07:002014-05-23T10:23:41.315-07:00Incredibly Stupid Carrier Trick<div align="justify"><span style="font-family:arial;">[<strong><em><span style="color:#ff0000;">Welcome </span></em></strong><a href="http://www.theindustryradar.com/Home/index.cfm?currentHome=/Accounts/industryradar/layouts/radars_express.xml"><strong><em><span style="color:#ff0000;">Industry Radar</span></em></strong></a><strong><em><span style="color:#ff0000;"> readers!</span></em></strong>]</span></div><div align="justify"><span style="font-family:arial;">As we've <a href="http://insureblog.blogspot.com/search?q=stupid+carrier+tricks">long-chronicled</a>, 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:</span></div><div align="justify"><span style="font-family:arial;">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.</span></div><div align="justify"><span style="font-family:arial;">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:</span></div><div align="justify"><span style="font-family:arial;">a) Remove him from the plan</span></div><div align="justify"><span style="font-family:arial;">b) Refund the premium paid on his behalf for the balance of the month in which he died</span></div><div align="justify"><span style="font-family:arial;">c) Let us know Ethel's (new) premium</span></div><div align="justify"><span style="font-family:arial;">d) Issue a new ID card for Ethel</span></div><div align="justify"><span style="font-family:arial;">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.</span></div><div align="justify"><span style="font-family:arial;">And waited.</span></div><div align="justify"><span style="font-family:arial;">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.</span></div><div align="justify"><span style="font-family:arial;">The good news is that Anthem did stop the automatic withdrawals.</span></div><div align="justify"><span style="font-family:arial;">The bad news (and you just <em>knew</em> there'd be more of that, right?) is that the new bill shows Frank (and reflects <em>his</em> premium) but not Ethel. That's right, the dead guy has health insurance, while his widow doesn't.</span></div><div align="justify"><span style="font-family:arial;">There is simply no excuse for this kind of sloppy "<em>customer no-service</em>." 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.</span></div><div align="justify"><span style="font-family:Arial;"><strong><span style="color:#cc0000;"><u>UPDATE:</u></span></strong> Okay, just spent another hour on the phone with Anthem, and the situation <em>appears to be</em> resolved.</span></div><div align="justify"><span style="font-family:Arial;">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.</span></div><div align="justify"><span style="font-family:Arial;">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 <em><u>great</u> <u>deal</u></em> for Anthem; they get the premiums, and dead folks file few claims.</span></div><div align="justify"><span style="font-family:Arial;">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.</span></div><div align="justify"><span style="font-family:Arial;">I'd like to say that "<em>all's well that end's w</em>ell," and indeed, Ethel has mentioned several times how pleased she's been with how Frank's claims have been handled throughout this ordeal.</span></div><div align="justify"><span style="font-family:Arial;">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.</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-58739957334112421642007-07-23T09:30:00.000-07:002014-05-23T10:23:41.324-07:00Let the Games Begin<div align="justify"><span style="font-family:arial;">Fat Dragon may sound like an entree at a Chinese restaurant, but it's really the home of tabletop gaming icon <a href="http://www.fatdragongames.com/">Fat Dragon Games</a>. In just two years, the company, run by an entrepreneur with a unique vision, has garnered widespread industry praise.</span></div><div align="justify"><span style="font-family:arial;">So much so that FDG has been nominated for two <a href="http://www.ennieawards.com/">Ennie Awards</a>, and we'd like to help them win at least one of those, the coveted <a href="http://www.enworld.org/ennies/voting.php">Best Miniature Product</a> award. All it takes is a few moments of your time, and a couple of mouse-clicks; no fees, registration or hassles.</span></div><div align="justify"><span style="font-family:arial;"><a href="http://www.enworld.org/ennies/voting.php">Just click here</a> (and scroll down to Best Miniature Product, select E-Z Dungeon's for #1).</span></div><div align="justify"><span style="font-family:arial;">Your support is appreciated, and we'll let you know how things turn out.</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-63102329328529627502007-07-23T05:53:00.000-07:002014-05-23T10:23:41.358-07:00Another Carnival Monday!<div align="justify"><span style="font-family:arial;">This week's edition of the <a href="http://www.fatpitchfinancials.com/610/welcome-to-the-110th-carnival-of-personal-finance/">Carnival of Personal Finance</a> is hosted by George, proprietor of <a href="http://www.fatpitchfinancials.com/">Fat Pitch Financials</a>. He presents over 4 dozen posts, all with helpful context, and all categorized. Nice!</span></div><div align="justify"><span style="font-family:arial;">I was very glad to see Big Honkin's guest post at <a href="http://www.ncnblog.com/">No Credit Needed</a>. He explains, by way of an expensive personal lesson, why it's important to have an <a href="http://www.ncnblog.com/2007/07/20/guest-author-big-honkin-speaks-the-value-of-having-an-emergency-fund-and-the-tragedy-of-not-having-one/">emergency fund</a>. Right now.</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-74241982881927220192007-07-22T16:42:00.000-07:002014-05-23T10:23:41.399-07:00How much is 5Q + 5Q ?<span style="font-family:trebuchet ms;">Why, 10Q.<br /></span><br /><span style="font-family:trebuchet ms;">You’re welcome!<br /></span><br /><span style="font-family:trebuchet ms;">Now that we're talking about Q’s, let’s talk about health care queues.<br /></span><br /><span style="font-family:trebuchet ms;">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?<br /></span><br /><span style="font-family:trebuchet ms;">Persistent patient queues are evidence that the answer to this question is “yes.”<br /></span><br /><span style="font-family:trebuchet ms;">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 "<a href="http://www.nytimes.com/2005/06/09/international/americas/09cnd-canada.html?ex=1275969600&en=2961143a9462abb5&ei=5088&partner=rssnyt&emc=rss">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</a>."<br /></span><span style="font-family:trebuchet ms;"></span><br /><span style="font-family:trebuchet ms;">In the U.K., <a href="http://www.thestar.com/printArticle/175394">complaints about waiting</a> times for services continually comprise <a href="http://www.ic.nhs.uk/">more than 25%</a> of procedural complaints (i.e., excluding clinical complaints).</span><br /><br /><span style="font-family:trebuchet ms;">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.<br /><br /></span><span style="font-family:trebuchet ms;"></span><span style="font-family:trebuchet ms;">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.<br /></span><br /><span style="font-family:trebuchet ms;">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.<br /></span><br /><span style="font-family:trebuchet ms;">The first report appeared in the Wall Street Journal on July 19. </span><span style="font-family:trebuchet ms;"><a href="http://online.wsj.com/public/article/SB118480165648770935.html">This front-page article</a> 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.<br /></span><br /><span style="font-family:trebuchet ms;">The second report </span><span style="font-family:trebuchet ms;">says that more than <a href="http://www.nypost.com/seven/07222007/news/regionalnews/dem_eyes_breast_test_wait_woe_regionalnews_heidi_singer.htm">25% of mammography centers</a> 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.<br /></span><br /><span style="font-family:trebuchet ms;">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.<br /></span><br /><span style="font-family:trebuchet ms;">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, <a href="http://www.survivinggrady.com/nipsey.jpg">Nipsey Russell</a>).</span>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-60167207474965876752007-07-21T15:01:00.000-07:002014-05-23T10:23:41.411-07:00This blessed plot, this earth, this realm, this England<span style="font-family: trebuchet ms;">On Friday July 20, the Wall Street Journal <a href="http://tinyurl.com/2yuxk5">ran an article</a> 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:</span><br /><br /><span style="font-family: trebuchet ms;">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.”</span><br /><br /><span style="font-family: trebuchet ms;">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.”</span><br /><br /><span style="font-family: trebuchet ms;">Stiff upper lip, you blokes. See, medical care in the sceptered isle is still free.</span>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-40028965410536799022007-07-20T12:39:00.000-07:002014-05-23T10:23:41.425-07:00Coulda Worked in the Home Office, Too<div align="justify"><span style="font-family:arial;">Based on some of the <a href="http://insureblog.blogspot.com/search?q=stupid+carrier+tricks">Stupid Carrier Tricks</a>®</span><span style="font-family:arial;"> 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:</span></div><div align="justify"><span style="font-family:arial;">"<span style="font-family:times new roman;"><em><a href="http://www.theneweditor.com/index.php?/archives/6592-Tiny-Brain-No-Problem-for-French-Tax-Official.html">A French civil servant has been found to have a huge cavity filled with fluid in his head -- yet lives a completely normal life.</a></em></span>"</span></div><div align="justify"><span style="font-family:arial;">It's actually a pretty interesting article, and one can't help but sympathize with the man, but the comparison was just too tempting.</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-76702789105339867432007-07-20T06:00:00.000-07:002014-05-23T10:23:41.434-07:00"SAS" (and we don't mean Special Forces)<span style="font-family:arial;">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 <strong><em>I</em></strong> need a break, too. But this can be taken to extremes; according to Kronos ("<span style="font-family:times new roman;"><em><a href="http://www.kronos.com/About/pr_seasonal_absence_may29.htm?rss=&ACT=&DES=">a global provider of human capital management solutions</a></em></span>"), some 40% of employees will call in sick this summer, even though they're actually quite fine.</span><br /><br /><span style="font-family:arial;"><img id="BLOGGER_PHOTO_ID_5073416680237652146" style="DISPLAY: block; MARGIN: 0px auto 10px; TEXT-ALIGN: center" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgklBZtktJzwuPWVE_xIMuLz_sEj7hewvKTUGA5CJJOCGz57lyHl1kA9NiOgFfbqggUWUNCowSCotV-CGq3mnRErQXjqLoY42TUZousX3AgtEyuwbU4r5WdX8Mygw_y2DgCJMb6zpBdu_8/s400/seasonal+absence.jpg" border="0" /></span> <div align="right"><span style="font-family:arial;"><strong><span style="font-size:78%;">[Graphic courtesy of </span></strong><a href="http://www.benefitnews.com/"><strong><span style="font-size:78%;">Employee Benefit News</span></strong></a><strong><span style="font-size:78%;">]</span></strong></span></div><div align="justify"><span style="font-family:arial;">Kronos calls this "taking a Bueller," a nod to the popular <a href="bueller:http://www.imdb.com/title/tt0091042/">1986 comedy</a> [<em>ed: hard to believe that film is old enough to drink</em>]. So, with help from Harris Interactive, they surveyed almost 1,100 "<a href="http://hr.blr.com/news.aspx?id=76003">employed adults</a>" to see how many folks really do this (and/or would admit to it).</span></div><div align="justify"><span style="font-family:arial;">While taking the occasional "unscheduled" day off may seem harmless enough, it appears that there may well be a <a href="http://tinyurl.com/qhmhv">dark side</a>: 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.</span></div><div align="justify"><span style="font-family:arial;">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 <a href="http://insureblog.blogspot.com/2007/05/taking-time-off-that-is.html">Paid Time Off</a>, giving folks flexibility in the days they work can also help mitigate this problem.</span></div><div align="justify"><span style="font-family:arial;">I've got more to say about this, but it's Friday, and I'm not feeling so well....</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-67791621209525046932007-07-19T13:16:00.000-07:002014-05-23T10:23:41.442-07:00More Bad Math<div align="justify"><span style="font-family:arial;">There's an old saw about beating a dead horse, and since we recently wrote on the topic of the <a href="http://www.businessandmedia.org/articles/2007/20070718153509.aspx">mysterious 45 million</a>, 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.</span></div><div align="justify"><span style="font-family:arial;">There is no crisis.</span></div><div align="justify"><span style="font-family:arial;">A crisis is defined as "<span style="font-family:times new roman;"><em><a href="http://www.m-w.com/cgi-bin/dictionary?va=crisis">an unstable or crucial time or state of affairs in which a decisive change is impending</a></em></span>." Now, if there were truly 45 million people without health insurance (which, as we've explained <em>ad nauseum</em>, is <u>not</u> the same as lacking access to health <strong><em>care</em></strong>), then perhaps we'd have a crisis.</span></div><div align="justify"><span style="font-family:arial;"><a href="http://www.businessandmedia.org/articles/2007/20070718153509.aspx">But there aren't</a>:</span></div><div align="justify"><span style="font-family:arial;">■ </span><em><span style="font-family:times new roman;">The number of the uninsured who aren’t citizens is nearly 10 million on its own</span></em></div><div align="justify"><span style="font-family:arial;">■ </span><span style="font-family:times new roman;"><em>The Census “underreported” the number of people covered by health insurance – meaning that more people have insurance than the report suggests</em></span></div><div align="justify"><span style="font-family:arial;">■ </span><span style="font-family:times new roman;"><em>The Census also underreported the number of people covered by Medicare and Medicaid</em></span></div><div align="justify"><span style="font-family:arial;">■ </span><span style="font-family:times new roman;"><em>(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</em></span></div><div align="justify"><span style="font-family:arial;">Thus, "<span style="font-family:times new roman;"><em>(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.</em></span>" So how can we seriously discuss a "crisis" when over 93% of the relevant population <strong><em>is</em></strong> covered?</span></div><div align="justify"><span style="font-family:arial;">But that's <a href="http://www.urbandictionary.com/define.php?term=throwing+the+baby+out+with+the+bathwater">another old saw</a>.</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-4105346032943728312007-07-19T05:44:00.000-07:002014-05-23T10:23:41.451-07:00Stupid Carrier Tricks Numbers 236, 237, 238 . . .From time to time we showcase carriers who do stupid things such as <span style="font-weight:bold;"><a href="http://insureblog.blogspot.com/2007/03/stupid-carrier-tricks-what-327.html" target="blank">here</a></span> and <span style="font-weight:bold;"><a href="http://insureblog.blogspot.com/2007/02/double-secret-phi.html" target="blank">here</a></span> (just to list a few). Seems we have been holding back and can't take it much longer.<br /><br />So here are some new ones you may know.<br /><br />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.<br /><br />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. <br /><br />So what's the problem?<br /><br />Monday, 11/20/2006 is 3 days before Thanksgiving.<br /><br />The meeting is on Tuesday 11/21/2006.<br /><br />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.<br /><br />The product is approved for sale for April 15th effective dates.<br /><br />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.<br /><br />Despite a less than auspicious start the product has been well received. In fact, too well.<br /><br />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.<br /><br />Of course since enrollment has no record of the individual, no premiums have been drafted.<br /><br />Nice.<br /><br />Next comes Humana. (Might as well spread it around. No need to just limit it to one carrier.)<br /><br />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.<br /><br />So how is the announcement handled?<br /><br />With a write up in a business newspaper.<br /><br />And the brokers?<br /><br />Not a word . . .<br /><br />In case you are wondering, most carriers get 85 - 90% of their new business from brokers.<br /><br />Not direct to consumer advertising.<br /><br />Not from home office captive agents.<br /><br />From independent brokers.<br /><br />Now comes one of my favorite carriers.<br /><br />No, seriously.<br /><br />Last year about 60% of the business I wrote went with United HealthCare (AKA Golden Rule).<br /><br />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).<br /><br />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.<br /><br />The way this works is neat.<br /><br />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.<br /><br />Seamless.<br /><br />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.<br /><br />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.<br /><br />UHC has the system in place to draft directly from Exante Bank accounts.<br /><br />UHC owns Exante Bank.<br /><br />Simple request, huh?<br /><br />The response is . . . "UHC will not be introducing new products with this capability".<br /><br />What new product?<br /><br />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.<br /><br />No dice.<br /><br />This stupid carrier trick tops my list.<br /><br />At least for now . . .Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-75309881376487067012007-07-19T05:00:00.000-07:002014-05-23T10:23:41.460-07:00Take a NumberAccording to the <span style="font-weight: bold;"><a href="http://www.brook.edu/comm/policybriefs/pb147.htm" target="blank.">Brooking's Institute</a></span>, 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.<br /><br />Perhaps the U.S. can do what the Brit's have done and ration health care.<br /><br /><span style="font-style: italic;">One approach, used in Britain for many years, is rationing. This brief examines many of the issues involved with <span style="font-weight: bold;"><a href="http://www3.brookings.edu/comm/policybriefs/pb147.pdf">rationing health care</a> </span>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?</span><br /><br />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. <span style="font-weight: bold;"><a href="http://content.healthaffairs.org/cgi/content/full/23/3/10" target="blank">This report</a> </span>(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.<br /><br />Since these other countries supposedly have better results by spending less then the solution seems simple.<br /><br />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.<br /><br />Seems simple enough.<br /><br />Next!Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-11852751486555941962007-07-18T12:00:00.000-07:002014-05-23T10:23:41.469-07:00Cavalcade of Risk #30 is up!<div align="justify"><span style="font-family:arial;">You'll find this week's jam-packed edition at </span><a href="http://sentineleffect.wordpress.com/"><span style="font-family:arial;">The Sentinel Effect</span></a><span style="font-family:arial;">. Our host, Richard Escow has a terrific line-up of of </span><a href="http://sentineleffect.wordpress.com/2007/07/18/cavalcade-of-risk-come-to-the-carnival/"><span style="font-family:arial;">risk-related posts</span></a><span style="font-family:arial;">.</span></div><div align="justify"><span style="font-family:arial;">As Richard will tell you, it's fun & easy to host, and the little traffic-bump is nice, too. Interested? Just </span><a href="mailto:cavrisk@hotmail.com"><span style="font-family:arial;">drop us a line</span></a><span style="font-family:arial;">!</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-44986116564223814172007-07-18T07:57:00.000-07:002014-05-23T10:23:41.478-07:00Doc-in-a-(Bigger)-Box<div align="justify"><span style="font-family:arial;">Over at <a href="http://trusted.md/">Trusted.MD</a>, Philippa Kennealy has an interesting article on the burgeoning [<em>ed: what's with that <strong>word</strong>?!</em>] world of <a href="http://trusted.md/blog/philippa_kennealy/2007/07/14/retail_clinics_mushroom_can_your_entrepreneurial_practice_compete">neighborhood retail clinics</a>. 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 "<span style="font-family:georgia;"><em><a href="http://www.healthleadersmedia.com/view_feature.cfm?content_id=90775">when you talk about customer convenience, these clinics have it all over your doctor's office.</a></em></span>" 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.</span></div><div align="justify"><span style="font-family:arial;">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 <a href="http://insureblog.blogspot.com/2005/11/marcus-welby-meets-jiffy-lube.html">neighborhood strip mall</a>, but in WalMarts and other retailers, as well.</span></div><div align="justify"><span style="font-family:arial;">Abraham Lincoln once famously suggested that one should keep one's friends close, and one's enemies [<em>ed: or perceived enemies</em>] 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.</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-91128803039093931942007-07-17T12:18:00.000-07:002014-05-23T10:23:41.486-07:00The Price is Right (Not)<div align="justify"><span style="font-family:arial;">Bob's pointed out that insurer's profits really have <a href="http://insureblog.blogspot.com/2007/07/sicko-profits.html">little impact on premiums </a>(indeed, cutting out a carrier's profit altogether does little to affect the final rates). And <a href="http://insureblog.blogspot.com/2007/07/michael-and-me.html">Mike's pointed out</a> that health <em><u>insurance</u></em> is expensive because health <em><u>care</u></em> is expensive. One might then argue that, if the cost of health care declined, the cost of health insurance might, as well.</span></div><div align="justify"><span style="font-family:arial;">Maybe so, but it doesn't matter.</span></div><div align="justify"><span style="font-family:arial;">Why not, you may ask?</span></div><div align="justify"><span style="font-family:arial;">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:</span></div><div align="justify"><span style="font-family:arial;">"<span style="font-family:times new roman;"><em><a href="http://www.usatoday.com/money/industries/health/2007-07-16-uninsured_N.htm">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.</a></em></span>"</span></div><div align="justify"><span style="font-family:arial;">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?</span></div><div align="justify"><span style="font-family:arial;">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, "<span style="font-family:times new roman;"><a href="http://www.rand.org/news/press.07/07.16.html"><em>subsidies that cut health insurance premium prices in half for people without insurance would reduce the number of uninsured Americans by just 3 percent.</em></a>"</span></span></div><div align="justify"><span style="font-family:arial;">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 "<span style="font-family:times new roman;"><em>new individual health care policy subscribers from January 1997 through the fall of 2001.</em></span>"</span></div><div align="justify"><span style="font-family:arial;">A Rand spokescritter, Susan Marquis, opined that "<span style="font-family:times new roman;"><em>a federal requirement that all people have insurance may be the only way to achieve such a goal.</em></span>" That's a great idea [<em>ed: um, no, it's not</em>], 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)?</span></div><div align="justify"><span style="font-family:arial;">Okay, Prof, what about making policies more attractive?</span></div><div align="justify"><span style="font-family:arial;">I'll let Ms Maquis take that one: "<span style="font-family:times new roman;"><em>(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.</em></span>"</span></div><div align="justify"><span style="font-family:arial;">Oh.</span></div><div align="justify"><span style="font-family:arial;">Back to the ol' drawing board.</span></div><div align="justify"><span style="font-family:arial;">The article concludes with this little tidbit: "<span style="font-family:times new roman;"><em>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.</em></span>"</span></div><div align="justify"><span style="font-family:arial;">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 <a href="http://insureblog.blogspot.com/2005/08/doi-vs-cdhc-part-2.html">show just the opposite</a>. 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.</span></div><div align="justify"><span style="font-family:arial;">Seems sloppy to me.</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-30905553142042968102007-07-17T05:14:00.000-07:002014-05-23T10:23:41.494-07:00Grand Rounds...<div align="justify"><span style="font-family:arial;">Just keeps on getting <a href="http://blog.vitummedicinus.com/2007/07/official-grand-rounds-volume-3-number.html">better and better</a>. This week's host, 22 year old Canadian Medical student <a href="http://vitummedicinus.blogspot.com/">Vitum Medicinus</a> takes an interesting approach: not content with including helpful context and a thoughtful layout, VM explains <em><u>why</u></em> each post is a "must-read," and even hands out "awards" based on a post's topic.</span></div><div align="justify"><span style="font-family:arial;">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 <a href="http://ad-libitum.blogspot.com/">Ad Libitum</a>'s post on various <a href="http://ad-libitum.blogspot.com/2007/07/from-hippocrates-to-hipaa.html">privacy and HIPAA issues</a> arise when one writes about a patient or client; equally interesting, what if <strong><em>you're</em></strong> the patient or client?</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-49027534029544188022007-07-16T18:10:00.000-07:002014-05-23T10:23:41.501-07:00Tranny Deduction<div style="text-align: justify;"><span style="font-family:arial;">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 (<a href="http://rapidshare.com/files/35228319/213d_2007.pdf.html">213d</a>) which delineate what's "kosher" for such reimbursements.<br /><br /></span></div><div style="text-align: justify;"><span style="font-family:arial;">Obvious expenses include prescription med's, non-reimbursed office visits, even orthopedic hosiery. Obviously non-eligible expenses include hot tubs<strong><em>*</em></strong> and ski trips to Aspen.<br /><br /></span></div><div style="text-align: justify;"><span style="font-family:arial;">But what about sex-change operations?</span></div><div style="text-align: justify;"><span style="font-family:arial;"><br />[<span style="font-style: italic;">ed: Hunh?</span>]</span></div><div style="text-align: justify;"><span style="font-family:arial;"><br />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?</span></div><div style="text-align: justify;"><span style="font-family:arial;"><br />Well, according to those neanderthals at the IRS, the answer is "no:"</span></div><div style="text-align: justify;"><span style="font-family:arial;"><br />"<a href="http://www.msnbc.msn.com/id/19793815/"><span style="font-style: italic;font-family:times new roman;" >(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.</span></a></span></div><div style="text-align: justify;"><span style="font-family:arial;"><a href="http://www.msnbc.msn.com/id/19793815/"><br /></a><a href="http://www.msnbc.msn.com/id/19793815/"><span style="font-style: italic;font-family:times new roman;" >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.</span></a>"</span></div><div style="text-align: justify;"><span style="font-family:arial;"><br />And there it stands; the gentleman, er, <span style="font-weight: bold; font-style: italic;">lady</span> 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 <a href="http://insureblog.blogspot.com/2005/10/medical-necessity-vs-ivf.html">medically necessary</a>.</span></div><div style="text-align: justify;"><span style="font-family:arial;"><br />Should make for some fascinating Court TV.</span></div><div style="text-align: justify;"><span style="font-family:Arial;"><br />[<strong><em>*</em></strong><a href="http://www.haloscan.com/comments/hgstern/3610943970316361851/#182395">See comments </a>for an update]</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-26646061337411591922007-07-16T10:19:00.000-07:002014-05-23T10:23:41.509-07:00Late-Breaking Carnival Monday<div align="justify"><span style="font-family:arial;">A jam-packed edition of the <a href="http://www.mint.com/blog/updates/70-tidbits-and-tips-on-personal-finance-the-109th-carnival-of-personal-finance-first-post-edition/">Carnival of Personal Finance</a> awaits you at <a href="http://www.mint.com/blog/">MintCN</a> 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 <em><u>very first</u></em> post on that blog. Very cool.</span></div><div align="justify"><span style="font-family:arial;">The <a href="http://www.thedigeratilife.com/blog">Silicon Valley Blogger</a> has an unusual post: we've all heard of discrimination based on race, or religion, or sexual orientation. But <a href="http://www.thedigeratilife.com/blog/index.php/2007/07/02/name-discrimination-how-it-affects-job-and-career-choices-life-status-overall-success/">based on your name</a>? It's for real.</span></div>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0tag:blogger.com,1999:blog-4794895048040388320.post-3731254372199927312007-07-16T06:25:00.000-07:002014-05-23T10:23:41.516-07:0055+ Health InsuranceThe <span style="font-weight:bold;"><a href="http://www.hrpolicy.org/" target="blank">HR Policy Assocation</a> </span>has an idea that may work. Early retirees looking for health insurance run into two challenges.<br /><br />Insurability and affordability.<br /><br />Now it appears the HR Policy Association in conjunction with Aetna is preparing to offer coverage with few strings attached.<br /><br /><span style="font-style:italic;">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. </span><br /><br />Sounds good to me. Read more <span style="font-weight:bold;"><a href="http://www.hrpolicy.org/members/downloads/2007/NYT%20RHA%20Freudenheim_06.23.07.pdf" target="blank">here.</a></span>Anonymoushttp://www.blogger.com/profile/05787775308649013392noreply@blogger.com0