Monday, August 31, 2009

Twitter Insurance?

Our Cousins Across the Pond© seem to have an affinity of late for interesting insurance concepts:
Although approximately 40% of all Tweets (?) are "pointless babble," at least one UK insurer, Legal and General, is contemplating a Twitter surcharge as a result of increased claims that they believe are exacerbated by folks announcing to God and country that they're "on holiday" (BritSpeak for "on vacation").
Actually, this isn't so far out:
"A burglar might look out for alarms or security lighting on any pictures of the home, as well as any photos of pet dogs who might be guarding it."
If we're talking risk management - and we are - then it seems to me that L&G has a legitimate concern. The problem, though, is exactly how do they underwrite for this? Simply relying on folks to volunteer that they're on Twitter, or Facebook or some other social networking site doesn't seem particularly reliable to me. And there's this:
"Just because someone is burgled, you can't prove that it's down to details posted on Facebook."
[Hat Tip: Neal Boortz]

Is Your Health Insurance Making You Sick?

Over the last few months I have come to the conclusion that having health insurance in Atlanta, Georgia will make you sick. This came to me as an observation from talking to quite a few people over the last few months who are losing their employer health insurance plan or COBRA is expiring.

OK, this is not a scientific sampling by any stretch. But having spent the last few years talking to people who are looking to buy health insurance in Atlanta it is fairly obvious that people shopping for medical insurance today are generally sicker than those a year ago.

Most of those who contact me now have had employer group health insurance. There are a lot of nice things about employer health insurance. For one, your employer typically pays a portion of the premium. The first time you have a clue how much health insurance really costs is when you get your COBRA notice.

That is usually when I get the first call.

They really can't believe the health insurance costs $1300 per month for their family when they were only paying $50 per week before. They think their employer is stiffing them.

That is not the case at all.

But the premium subsidy isn't making you sick. What is making you sick is the level of benefits provided under an employer health insurance plan. The usual plan design has something like $15 - $25 unlimited doctor visit copay's, $5 - $40 Rx copay's (and no deductible) and a major medical deductible of $1000.

A lot of these plans also include dental insurance and maybe even a vision benefit.

When I start to gather information to pre-screen their application, I always ask for a list of any medications they are taking. Most people don't know all of the names and they almost never know the strength. The reply usually is along the line of, "I take a white pill in the morning for blood pressure and another white pill for cholesterol. I take a blue pill so I don't get depressed over my job and bank account and then another pill at night so I can sleep. You know, just the usual stuff. It's not like I have anything wrong."

In almost every case, if they can name the medication, it is almost always a high priced brand name drug.

I will ask them if they know how much their drugs would cost if they did not have health insurance.

They never have a clue.

A few weeks ago I talked to a man who owned a company. He had canceled his group medical plan a few months ago because the premium was increasing from $1100 to $1700 just for him and his wife. An agent had convinced him that finding coverage was "no problem".


Seems the husband took 4 pills a day and was overweight while the wife took 3 pills a day. When I asked if he knew how much the medications ran he had no idea but speculated that it "couldn't be more than $250 - $300" since he only paid about $130 in copay's.

I checked, and the discounted price to those who have health insurance was $930 per month.

He all but called me a liar.

He also said there were a couple of medications he didn't really need to take but his doctor suggested them so he does.

I hear this quite often.

Last year I talked to a lady who was "healthy and did not take any medication." Seems that was not exactly the case.

When her application was processed the health insurance company discovered she had filled 17 different prescriptions in the last two years.

So I asked about the discrepancy.

Whenever she had a symptom or pain, real or imagined, she went to her doc. Like a lot of patients she has already done her research and decided not only what her ailment is but which medication she needs to correct the problem.

One of her complaints was hay fever. Rather than trying an OTC medication she went to her doc. He wrote a script for a brand name drug which she filled, took for a few days, then quit because it made her mouth dry and eye's hurt. (Her eyes were having a side effect to the medication which causes decreased tear production . . . resulting in dry eyes).

Back to the doctor who promptly writes a prescription for Restasis for dry eyes.

I am very familiar with this as a family member has a chronic case of dry eye (that has nothing to do with side effects) and she uses this daily. At $160 per month this is not something you use casually.

My client had filled the Restasis prescription but never used it. Once she stopped taking the hay fever medication she no longer had dry eyes or dry mouth.

If she had never had a plan with $20 copay's I doubt she would have gone to the doctor as often and I can almost guarantee most, if not all of those medications would never be filled.

She was promptly turned down by every carrier. This was partly due to the number of medications but also due to the fact she failed to own up to any of them on the application.

If the man who canceled his group medical plan had known how much his medications really cost, and he had to pay for them without the benefit of a copay, I can bet he would have asked the doc for a lower cost alternative.

I can't tell you how many times someone who is on medication for GERD (what we used to call indigestion) or taking an anti-depressant and sleeping pill will tell me they don't really need the medication but they take it because their doc prescribed it.

Situational depression, caused by the death of a loved one, marriage or money issues can sometimes be better managed with medication. But if you are still taking anti-depressants 10 years after your dog died it is time to get off the pill and move on.

So if it weren't for rich benefit plans, especially those provided through your job, I suspect quite a few people would not spend as much needless time in the doctor's office and would learn to "suck it up" rather than buying a medication that is going to sit in the medicine cabinet and never see the light of day.

All too often, people coming off employer group health plans are taking so many expensive medications it becomes almost impossible to find a health insurance company willing to issue coverage. If they do issue coverage the rate is jacked up to cover the cost of the medication.

Most people only need a bare bones health insurance plan, but they think they need one with all the bells and whistles.

A question I always ask is this. Does your car insurance have a copay for tires, brakes and oil changes?

The answer is always, "of course not".

If you don't need a copay for tires brakes and oil changes why do you need a copay to see the doctor or fill a prescription?

They don't, but they think they need a copay because . . . they have absolutely no idea how much it costs to see a doctor or purchase medication. There is no need for them to know because they have a copay.

Eliminate the copay and they suddenly become better shoppers for health care and, a big plus, they save a lot of money in reduced premiums and out of pocket expenses.

If you think your Atlanta health insurance policy is making you sick, we need to talk.

Myths & Facts: Which is What?

Writing in today's Wall Street Journal, Jerome Groopman And Pamela Hartzband proceed to fact-check The Won's claims about where we stand and where he'd like us to go regarding health care. The article is chock full of great information; here's a sample:
Americans only receive 55% of recommended care. This would be a frightening statistic, if it were true. It is not ... The statistic comes from a flawed study published in 2003 by the Rand Corporation."
The World Health Organization ranks the U.S. 37th In the world in quality. This is another frightening statistic. It is also not accurate ... The World Health Organization ranks the U.S. No. 1 among all countries in "responsiveness."
No government bureaucrat will come between you and your doctor. If doctors and hospitals are rewarded for complying with government mandated treatment measures or penalized if they do not comply, clearly federal bureaucrats are directing health decisions.
You'll definitely want to Read The Whole Thing™.
[Hat Tip: FoIB Dr Stuart Fickler]

About those "Exchanges"

As we noted regarding abortion coverage, sometimes what isn't said in a particular bill is as important (and perhaps even more so) as what is stated. Which brings us to whether or not illegal aliens would be covered under the America’s Affordable Health Choices Act [ed: nice segue!].
Turns out, not only would they be covered, but they'd be required to buy their insurance from the Exchange mechanism put forth in the bill.
But don't take my word for it; let's see what the non-partisan Congressional Research Service has to say:
On the one hand, this would definitely solve much of the problem of the "uninsured:" since illegals comprise some 20% of that group, forcing them to buy coverage through the taxpayer-subsidized Exchange would ameliorate that problem. On the other hand, of course, forcing them to buy coverage through the taxpayer-subsidized Exchange will further drive costs skyward.
As Bob is fond of asking, doesn't anybody in Obamington think these things through?

Carnival of Personal Finance

This week's edition of The Carnival of Personal Finance is now up at Stretchy Dollar.

Sunday, August 30, 2009

More Questions than Answers from the Dayton Daily News

Our local paper has a front-page story today on health care "reform," part of which recounts the sad tale of a family which faces some major medical bills as the result of some poor decisions. Ron and Mindibeth chose not to use an in-network provider when the latter's ear was severed in a Jet Ski incident. Instead of requesting an in-network plastic surgeon, they settled for one who was out-of-network, because, as Ron puts it "(t)he last thing on my mind was insurance.”
Isn't one of the very first questions one is asked upon admittance to a hospital (or pretty much any other provider) "who's your insurance carrier?" You're already looking at the card (for policy numbers, etc), and it's not as if "network provider" is a new term or concept.
As a result of this decision, "the couple said they had $267,000 in uninsured medical bills that year." It's not clear, by the way, how much of that total was for the surgeon's services and other expenses related to the accident; for all we know, the family just kept on choosing to use out-of-network providers for other services, as well.
How, exactly, is that a breakdown in "the system?" Or is personal responsibility completely irrelevant now?
As the result of another poor decision, their daughter, Amanda, "racked up $1.7 million in bills for medical care." For whatever reason, she chose not to be insured, and unfortunately developed cancer. Obviously, this made it impossible for her to obtain insurance through "normal" means, although the article also fails to mention whether she was eligible for, or even tried to find, alternate means (such as a HIPAA plan or any of the myriad government-sponsored programs).
Again, how is this an indictment of our health care financing system? Shouldn't she have purchased insurance before a problem developed? Health insurance for a young woman in reasonably good health is not terribly expensive, and if she was old enough to join the Air Force (as the story mentions), then she was old enough to take on that relatively modest expense.
That's the problem, really, with so many of these heart-string-pullers: they paint a very sad picture, neglecting to point out that there were (and are) many ways to avoid this kind of outcome, but which require a modicum of personal responsibility. Perhaps there were other reasons why the young lady didn't have insurance, but the article fails to mention them; and, of course, the reporter couldn't be bothered to ask "why didn't she have insurance in the first place?" because that wouldn't fit the meme.
But it's valid nonetheless.
Perhaps the saddest part is that Ron still doesn't get it; he says he's "disappointed in the systems that have put us there.”
No, Ron, you put you there.

Saturday, August 29, 2009

Harrison Bergeron

This story by Kurt Vonnegut is a miniature classic.

It is relevant to everything we talk about at InsureBlog.

Please read and discuss if you like.

You'll be glad you did.


No Tedicare. All is lost?

Fortunately, there is a way to increase insurance company competition in the individual market without a public option. In fact, this can be done by removing some existing government interference.

Individual medical insurance premiums vary a lot by state. They vary by more than per capita medical costs vary by state. This added variation in insurance premiums occurs because of differences in "mandated" benefits enacted by the state legislatures.

But – state legislatures also prohibit insurance companies from selling policies that are not “issued” in their state – that is, policies which do not include all of that state’s legislated benefit mandates. As a result, individuals who live in one state cannot buy a policy issued in another state, even if – and especially if – the premiums in the other state are less. These “state of issue” laws prevent people from shopping for the best deal. These laws restrict competition among insurance companies. Eliminating these laws would allow people to shop in other states where insurance might be much less expensive. That would force more competition on insurers.

This is a clear case where government regulation is driving up costs (mandates), and is also preventing people from shopping in less-costly states (choice restricted to state of issue). So why keep it?

Public Optiony Number 1

No private company "wants" competition. But the public should want companies to compete, because that forces them to innovate and to bring us more useful products at the least possible cost. If a company is not competitive it must improve, or go out of business. That is how competition among private companies serves the entire public. And that is why it is sound public policy to oblige companies to compete.

But it’s not sound public policy for the government to compete directly with private companies. Private companies cannot "compete" with government because government sets the rules that private companies must follow. Governments tend to “compete” by setting rules that drive its competitors out of business – and governments do not have to “improve” to do this. That leaves the entire public with a static, government standard of service rather than the constant improvements brought by competitive private companies. So in this game, the government “wins” even when providing poor service, and the public loses. Imagine the KC Royals vs. the Yankees - and all the umpires and league officials play for the Royals. Not hard to figure out that even the Royals with lesser talent, win most of the time in that game.

Besides, whether some alleged lack of competition among insurance companies is the primary reason for high medical premiums is not at all clear. If the companies are the source of high premiums, why have life insurance premiums dropped so much over the past 20 years? Answer: insurance companies are not the reason medical premiums are high. Medical premiums are high – and rising – because medical cost is high – and rising. Medical cost, not insurance companies, is the problem.

For these reasons, I think the public option promises what it cannot deliver – improvements to the insurance markets through federal "competition". And it does not get at the more fundamental reason insurance is expensive in the first place – that being the cost of medical care.

Friday, August 28, 2009

A conversation with Senator Boxer

Last week, Senator Boxer was on KGO, the largest AM station in the San Francisco area. While disparaging the system, she displayed a remarkable ignorance about California’s health insurance laws and all of the protections that they provide. Since she's one of our two Senators, I felt compelled to call and correct some of her errors…

Misstatement #1: Insurance companies cancel coverage when people get sick
My response: This is flat-out illegal in California. Carriers can only cancel for non-payment of premium

Misstatement #2: Insurance companies raise rates when people get sick
My response: This is also illegal in California. Carriers can only raise premiums based on claims over a large geographic region. Individual claims simply do not count except in a statistical sense.

Misstatement #3: Insurance companies may not cancel policies outright, but effectively do so by raising people’s rates.
My response: Senator, this is illegal in California!

Misstatement #4: Then enforcement must be pretty lax.

Unfortunately, my on-air time ran out at that point. I’m not sure that the carriers that have been fined millions of dollars and been forced to reinstate rescinded policies would agree with her last point.

It was interesting to be referred to at the show wrap-up as a “representative of the insurance industry.”

I do need to clarify a few items…1. I’m really not an industry representative. I’m just a broker helping clients navigate a confusing system and 2. I never said these things “never happen.” I did say that they were illegal.

I certainly don’t expect a Senator to know the nuances of the California Insurance Code. But these aren’t subtle details. They’re part of her key arguments for health insurance reform. And they’re just wrong.

Incidentally Senator, the next time someone calls into a radio station and tells you that they have breast cancer, their COBRA is ending and they’re scared, you might tell them about the guaranteed issue policies mandated under HIPAA. It’s a FEDERAL law that you voted for...

Who's Afraid of the Truth?

Well, ABC for one:
Which may well be true.
Giving it away, however, poses no problem.
Not that there was anything "partisan" there.
So what, exactly, is ABC so afraid of?
Judge for yourself:
Nothing there we haven't already covered here at IB:
Medicare cuts? Check [ed: updated link].
MVNHS© on the ropes? Check [ed: updated link].
Rationing in Canada? Check.
So it appears that, by ABC's (Guiding) Lights, it's only "partisan" if the truth hurts ObamaCare.

The Ultimate Tax Authority

I believe that creating a government mechanism that has the legal power to deem people not fit to receive medical care, is a very dangerous business. And that is what rationing would be – a legal means to withhold medical care from some, so others can have it. The ultimate tax authority, one might say.

Isn’t it ironic that people agonize over the death penalty for even the most heinous criminal, yet many advocates for a single-payer medical system seem enthusiastic about institutionalizing another sort of death penalty for ordinary citizens simply because they need medical care?

Discussions of rationing medical care can sound repellent, even if presented as a purely academic exercise. Example: some of Dr Ezekiel Emanuel's work.

Describing his "complete lives" theory of allocating medical resources, Dr. Emanuel wrote that it:

"empowers us to decide fairly whom to save when genuine scarcity makes saving everyone impossible."

He correctly identifies the nasty part of rationing - who can be allowed into the lifeboat, who will be pushed back into the ocean?

If I and I alone were empowered to make these decisions, I would agree that Emanuel's system is fair. See, I trust myself - but I don't trust all you others. I expect everyone else feels the same way about me, making decisions about whether to save you or your relative. So that presents a practical problem - who will run this thing? Emanuel only says "us." Questions I have for the good doctor are - who do you mean by "us" exactly? And who will appoint "us" to this job? And who defines or limits the power that "us" will have? What assurance can there be that the powers of "us" won't be expanded ad infinitum? And who decides if "us" made a fair decision? And what happens if someone disagrees with "us"? There are many more such Q's, but you get the idea. O brave new world that hath such people in it as "us".

Emanuel also wrote that his system

"prioritizes younger people who have not yet lived a complete life - and also incorporates prognosis, save the most lives, lottery, and institutional value principles".

Well, that's nice. No one could possibly object to a system that is fair and saves the most lives. Oh, well, maybe you would, if you're not invited.

And what's that part about a lottery? Emanuel explains that

"lotteries could be used when making choices between roughly equal recipients."

Heads or tails, ma?

Thursday, August 27, 2009

But it's NOT KennedyCare...

The good Senator would have never have been on this plan. Like all of the other Senators, he was and would have continued to be covered by the Federal health care system.

The marketing geniuses in Washington strike again.

(Just wondering...are cost-benefit and treatment efficacy considered factors for approval in the Federal system? And how would aggressive brain cancer in a 77 year-old be treated under ObamaPelosiWaxmanBoxerEtcCare?)

Medicare on Life Support

The newly christened Kennedycare is trying to gain new life. Not to speak ill of the dead, but if Obamacare wasn't such a great idea then why should the same plan with a new name be any better?

But this isn't about Kennedycare, or Obamacare. This is about a plan that has been around since 1965. Medicare was part of sweeping legislation signed into law by LBJ to provide health insurance for seniors.

For the last 40+ years Medicare has limped along with only a few changes.

So how well is the government doing at managing the financial side of Medicare?

Not to well according to US Government Spending.

In fiscal year 2008 the federal government spent $391 billion on health care for seniors. That's about $10,000 per senior covered under Medicare.

That same fiscal year the federal government took in $194 billion in Hospital Insurance taxes.

That's a paid loss ratio of 200%.

Expressed another way, Medicare paid out $2 in benefits for every $1 they took in by way of taxes earmarked for Medicare.

How about the Social Security side?

It did much better but nothing to write home about.

In FY 2008 the federal government collected $658 in Social Security taxes and paid out $669 in benefits. At least it came close to breaking even.

So they have a retirement plan that has been in place for 70+ years and it is around a break even point (not including unfunded liabilities) and a health care plan that is slightly more than 40 years old and spending money two years worth of budget in a year.

And they want to take over health insurance for everyone.

How long has Medicare been losing money like this?

In 1998 they spent $193 billion on Medicare and took in $120 billion in HI taxes.

In 1990 the collected $69 billion in HI taxes and spent $98 billion on Medicare.

I could go back further, but why bother?

OK, just for chuckles and grins, let's look at 1970. Medicare is 5 years old at the time. They collected $5 billion in HI taxes (dang that number seems small) and paid out $6 billion in Medicare benefits.

So it would seem that Medicare has never paid for itself and continues to run up a deficit, year after year.

I challenge you to find a single health insurance company in business during that time period that continually paid out more than it took in.

Of course some would say this is proof we need to let the government run a health insurance scheme for everyone. They can do it for less money than a profit driven insurance company.

But here is one difference.

If the insurance company continually loses money they eventually get out of that line of coverage, and many have. When they do, another carrier steps in to take their place.

Those losses do not become an undue burden on the taxpayers for generations to come.

I can't say the same for Medicare.

iTriage App: Update

This past Spring, we interviewed iTriage CMO Dr Wayne Guerra, who explained what the SmartPhone application does and how it works. The new features include "zip code and GPS search capabilities, enhanced navigation and user interface, distances to facilities, integrated mapping within the application, landscape view, the addition of more diseases and symptoms, “Tell a friend” feature to share iTriage information with your contacts, and further integration with HealthGrades® quality information for purchasing reports, reviewing physicians, and accessing provider profiles within the application."
It's a great little app; I just wish someone would buy me an iPhone so I could use the GPS function.

Your tax $$ @ Work

Are there no depths to which President Oy!Bama won't sink?
And to what, exactly, is our correspondent referring? Well to this, silly:
"Backed by the full weight of President Barack Obama’s call to service and the institutional weight of the NEA [National Endowment for the Arts] ... to push an agenda other than the one for which it was created ... to initiate, organize, and tap into the art community to help bring awareness to health care."
That's right: PresBo has decided it's appropriate to use our tax dollars to advertise his legislative agenda. I found the NEA's mission statement at its website, and it says that the agency is "dedicated to supporting excellence in the arts, both new and established; bringing the arts to all Americans; and providing leadership in arts education."
See anything about health care in there?
Me, either.

Wednesday, August 26, 2009

A Trip with Mr Peabody and Teddy

As fellow connoisseurs of 60's Saturday morning television may recall, Mr Peabody was the canine-genius behind the WayBack Machine. Along with his trusted (if dim) sidekick Sherman, he would gallivant back in time to keep us on the straight-and-narrow.
Imagine, if you will, Mr P setting the dial to 1971. Still in his first term, President Richard Nixon proposes sweeping health care reforms, including "a mandate, which would require that employers cover their workers, with a Medicaid-like program for poor families, which all Americans would be able to join by paying sliding-scale premiums based on their income."
Mr P and his pal look on in shock as a young Senator Ted Kennedy, all dried off now, moves to block that legislation, which could have helped us avoid many, if not most, of the health care problems we face today.
Troubled and confused, the intrepid pair flash forward almost 40 years, popping directly into the Senate Visitor's Gallery, where they are stunned to see that same Nor'eastern Senator pushing passionately for... wait for it ... employer mandates and increased government spending to insure more people.
Finally regaining his voice (if not his credulity), the determined doggy whispers "it's deja vu all over again!"

Playing Chicken with Health Insurance

Health insurance policies have "grace periods" to accomodate for late-payers. Generally, these are 30 days; that is, one has 30 days to get the premium in to the carrier in order to keep coverage in force. If there's a claim during that time, it's put "in limbo" until that premium's received.
I'm not a big fan of playing chicken with them, but occasionally there's a good reason to take a bit of a chance. For example, if one is switching carriers, and the new plan isn't through underwriting yet, sometimes I'll recommend holding off payment for a few days to avoid double-coverage or waiting for a refund. I'm a bit leery of this, but for a few days, I haven't found it to be a big deal.
But that is quite different than what one client is proposing:
John and his family are clients, and I have them with an individual plan with XYZ Mutual. John's wife has started a new job which includes group coverage for the family; that coverage is set to "go live" on October 1. John is considering not paying the September premium (recall that September has 30 days), and taking his (and his family's) chances that no claims will arise. If they do, he figures, he can always send in the September payment, and everything will be hunky-dory.
As an aside, HIPAA requires that there be no break in coverage longer than 63 days, so the 30 days "bare" isn't likely to be an issue on that score.
In the event, I have strongly recommended against this strategy. Why, you ask?
Simply this: let's say that everybody's fine all the way to the end of the month, and on September 29th, John has a massive heart attack. There is simply no way for them to get the premium into XYZ Mutual before the GP is up, and so he's completely uninsured for that claim (and if the wife's not actively at work come October 1, it's likely that the group plan won't go into effect then, either). So he's completely on his own with regard to all the ER and ICU services, any ambulance and/or EMT services, nursing care, the whole nine yards. And since he's uninsured, he's not eligible for the insurance company's negotiated (discounted) rates, either, which means he pays full retail for everything.
There is no "up" side to this, save for the comparatively few dollars the September premium represents. I've explained all these issues, so it's out of my hands. Obviously, it's more likely that they'll be fine than not, but why take that chance? After all, isn't that what insurance is for?

Cavalcade of Risk #86: Rate-This-Post edition

Political Calculations' Ironman reprises his patented "Contributed Blog Post Rating System" for this no-holds-barred edition of the Cavalcade of Risk.
It's interesting, fun and interactive - what more can you ask for?
BTW, we're scheduling Fall editions, please drop us a line if you'd like to host.

Affordable Lab Work

Do you need a blood test but don't know how much it will cost? Maybe your doctor has ordered a test but you are wondering if you can afford it.

Perhaps you suspect a problem, but don't have a doctor, or can't afford to see a doctor and pay for testing.

How much is a PSA test or cholesterol test? Maybe you want to know if you have chlamydia, herpes or other STD.

Georgia Insurance Shop and Patient Charity have found a resource for low cost lab tests. You can use the power of the internet to find pricing and locate labs in your area.

Lab fee's are discounted up to 80%. All work is performed by CLIA certified labs. You do not need a doctor's order to have the lab work performed. Confidential results are usually available in 24 - 48 hours.

Perfect for those who do not have health insurance, or you have health insurance with a high deductible. Most Atlanta health insurance plans require you to pay for lab work separately from your office visit copay.

Direct access to lab testing for consumers interested in making smart decisions on health care and seeking the best pricing.

Affordable lab work at direct to consumer pricing.

Tuesday, August 25, 2009

Mandates: Busted! [UPDATED & BUMPED]

[Update below vid]
Ever wonder how much those state mandated benefits add to your premium, and why they even exist? Well, wonder no more:
UPDATE: In the comments, reader Andrew Garland tips us to this video on how "government healthcare and sausages are being made:"

Alphabet Soup Under the Bus?

In our coverage of the swine flu vaccine, we mentioned in passing that it may be eligible for reimbursement under what we call "flex ben" plans (HSA's, HRA's and FSA's). In researching that post, my "guru" for all things flex mused about the fate of what he calls "the alphabet soup" under "health care reform." There seems to be a lot of speculation, but not much hard evidence regarding how these plans will fare.
So, of course, we'll add to that speculation:
First, I could find no mention of any of these plans in the "American Health Choices Act." The only item that remotely touches on them is the requirement that new plans must be "qualified," and I doubt very much that an HSA plan would, um, qualify. Of course, "absence of evidence is not evidence of absence," so it may well be that some enterprising bureaucrat, tasked with actually implementing the bill, would see fit to throw flex plans out under one or more such criteria.
So-called "cafeteria plans" are one benefit of group based coverage; this is a system where a (usually larger) employer offers an array of products from which the employee can choose. Since one of the funding mechanisms for "reform" is a tax on "richer" plans, we may well see those go away, reducing choices and, perhaps, availability of cafeteria plans altogether.
One thing that appears certain is that reimbursement for over-the-counter med's will go away; that is, they will no longer be considered an eligible expense. I'm not convinced that this is a horrible thing: it's a relatively new benefit to begin with, and it's unclear how many people even know about it, much less take advantage of it.
Since one of the primary stumbling blocks facing "reformers" is how to pay for their plans, a number of insurance products are in the crosshairs (e.g. Medicare Advantage); it seems reasonable to presume that doing away with tax advantaged programs like HRA's and FSA's would be a quick and easy way to raise funds. Since these aren't insurance products in and of themselves, getting rid of them may be an easier sell to the public, most of whom don't utilize them anyway.
It's difficult to find credible information about the fate of these benefits, so we'll keep looking, and update as appropriate.

Old School Grand Rounds

Dr Charles hosts this week's edition of Grand Rounds. Head over for a nostalgic look at the far away world of 2004.

Monday, August 24, 2009

The Uninsured

The numbers aren't changing.

We have looked at this for years, and there is little shift, if any at all, in who are the uninsured.
According to the New York Times, the 47 million break down something like this.
The Kaiser Family Foundation estimates that about two-thirds of the uninsured — 30 million people — earn less than twice the poverty level, or about $44,000 for a family of four.
The solution is simple.

Expand Medicaid by allowing those making more than 100% of the FPL to buy in on a sliding scale. That eliminates two thirds of that number overnight and you don't have to unravel a system that works to accomplish that feat.
About nine million uninsured people, according to census data, come from households with incomes of $75,000 or more.
If you can afford health insurance, and someone earning $75k+ should certainly meet that criteria, then buy it. A mandate seems to make sense here.

Buy it or pay a 14% of gross income penalty.
Some 13 million young adults between the ages of 19 and 29 lack coverage.
Same here.

Buy it or pay a penalty tax.
Some 11 million of the poorest people, mostly low-income children and their parents, are thought to be eligible for public insurance programs but have failed to enroll
Whose fault is this?

They are eligible for free health insurance paid for by taxpayers, but not enrolled. Sounds like the government is not doing their job.

Yeah, I know. Shocking . . .
Some 9.7 million of the uninsured are not citizens; of those, more than six million may be illegal immigrants, according to informed estimates.
Why even count these folks if you are not going to insure them?

I'm not saying we should pay for their health insurance, but that makes the 47 million figure bogus.

If you are keeping score, it seems the NYT calculator wasn't plugged in.

When you add 30 + 9 + 13 + 11 + 9.7 (call it 10) you get 73 million uninsured.

But who is counting?

Results Matter: "I Drank What" Update

Does the WH read IB? Who knows, but apparently those of us who sounded the alarm about the Obamistration's decision to renew shilling for veteran's to fall on their swords has struck a nerve:
Unfortunately, this simply means they've pulled in their horns a bit, since we also learn that "(t)he document still exists in another spot on the site." Still, one small victory at a time.

Laudable Carrier Trick, Swine Flu Edition

"Even a blind squirrel finds a nut now and then" goes the adage, and once again, we have a case of a carrier "doing the right thing." From email:
"UnitedHealthcare will provide coverage for the administration of the H1N1 (swine flu) vaccine for all members covered by its fully insured plans.
We intend to process all self-funded member claims as a covered service unless clients explicitly direct us otherwise. If your client's plan does not currently cover the administration of the vaccine, and you notify us of your client's intent not to cover the vaccine in the future, UnitedHealthcare will reimburse the cost of the administration of the vaccine. The federal government has said that the vaccine will be provided at no cost to health care providers."
The note goes on to say that UHC will be working with appropriate authorities to make sure as many folks as possible have access to the vaccine.
The reference to self-funded (aka ERISA) plans is interesting, as well. Most folks don't know this, but ERISA plans are pretty much free to cover and exclude benefits as they see fit. So if a plan either doesn't specifically cover, or if it specifically excludes, the cost of these vaccines, the carrier (UHC in this case) really has no justification for paying or reimbursing for that expense. If you work for a company which has such a plan, it'd be worth your while to check with HR about how (or even if) the vaccine is a covered expense.
Whether or not it is, if you have an HSA, FSA or HRA plan, my Flexible Benefits Guru Pete Deist says that the cost is "probably" reimburseable under that, so your own out-of-pocket may be reduced. The reason for that qualifier, by the way, is that it's not specifically mentioned as either eligible or ineligible, so we really don't know for sure.

Singin' the Arizona Blues

Several weeks ago, we brought you the odd tale of how an Arizona woman, having survived breast cancer, was rebuffed by Anthem when seeking a simple blood test. Throughout her initial ordeal, Anthem seemed to have no problem covering expensive and ultimately successful treatments, but in its aftermath deemed some inexpensive blood work unnecessary.
After exhausting the carrier's appeals process, Heather Toplak turned to TV reporter Carey Peña for help. Ms Peña went to bat for Heather, and they successfully lobbied Anthem to both cover the lab work, and to change how they would deal with this issue in similar cases going forward.
Good news.
The initial post raised some additional questions, however, and Ms Peña graciously agreed to forward my request for further information on to Ms Toplak; she has replied to my request, and given me permission to post this interesting (and hopefully useful) information. She writes:
"As of today, I have a clean bill of health. I still have a panic attack every three months before my check-ups, but I guess it can be expected.
I honestly think there are many more people with the same plan dealing with the same issue. Before my first chemo treatment last year, my oncologist ordered the standard bloodwork to be taken. A few weeks later, I received an invoice from [the lab] stating there was a balance due of $77 dollars for a CEA test. I checked my explanation of benefits statement...and there it was...denied. As so the saga began.
Hours on the phone with BC/BS, numerous letters from myself and from my doctor and three levels of the appeals process...once again left me with "denied."
What amazed me the most was that, during my conference call with the Appeals Board, my doctor told them this test is recognized by Medicare as being the standard for testing during breast cancer treatment. Their comment was it was a "gray area". The doctor said "There is no gray area...this is the standard for breast cancer treatment under national guidelines."
That is when I took the story to Channel 3. It was not a dollar factor. I felt they were denying preventative care.
Many oncologists insist on PET scans, ports, etc. These generate extremely high costs to the insurance companies. I have great veins, so no port was needed and my doctor felt a PET scan at that time was not necessary. They can have too many false positives. Great!! One less surgery and one less bill to the insurance company. I was approved to have a PET scan if needed. My course of preventative care is blood work every three months.
When you look at most insurance policies, they have a cap at about two million dollars. Two million dollars seems like a large amount to most Americans, but if you need re-occuring treatment, it adds up fast.
In comparative speaking....Lets buy the 3 million dollar plane, new condo and a few vacations and then ask for the bailout plan!"
I'll just add a few thoughts. Ms Toplak refers to the policy maximums, and she is quite correct (although many plans now have a $5 million limit). This is an issue with which most folks aren't familiar, but each time one has a covered expense under a given policy, the amount paid for it is deducted from that policy's lifetime max. Obviously, a few doc visits and flu shots aren't going to make much of a dent in that amount, but chemo, radiation and the like definitely will. Just something to keep in the back of our minds.
I'd like to thank Heather Toplak for sharing her story, and Carey Peña for covering it, and wish Heather continued good health.

The REAL Talking Points of Obamacare

Amid all the barbs and rhetoric, most people have completely missed the true points of health care, or more precisely, health insurance reform. That is probably because very few have read the bill known as HR 3200.

I have read through it but admittedly not line by line. But I have read enough to become familiar with what should be the REAL talking points and things that are truly frightening if they come to pass.

Those of you who want to play along at home can by clicking the link above and searching for the notated section. Feel free to offer your own take. I promise not to pull a Barney Frank and say that arguing with you is like talking to a dining room table.

So here goes.

Section 101 requires that coverage be affordable. That is well and good but salient points of the bill do just the opposite.

Section 102 says you can keep your current coverage. So far that tracks what the president has said but here is what he has not said.

You may keep your current coverage, including employer based coverage. But if the plan changes after "Y1" (the year when these provisions go into effect) you must change to a new, QUALIFIED health plan that meets the guidelines of HR 3200.

For those concerned, I am not going to hit every section of the bill, so don't think you need to get popcorn and a beer. This will be long, but not that long and slightly more entertaining than Ishtar.

I have no idea what happened to sections 103 - 110 (which are inexplicably missing from HR 3200), but it certainly appears they want to stuff more goodies in this bill.

Section 111 addresses banning the practice carriers have of excluding coverage for pre-existing medical conditions.

On the surface this seems great but Congress has not asked the CBO to price these provisions as well as most other benefit enhancements. This provision alone will increase CURRENT premiums by 50 - 100%. That does not meet my definition of "affordable". Since the CBO has not priced Section 111 you won't find those figures in the $1 trillion plus budget amounts that have been discussed.

Section 113 (see, I told you I would not address every section) sets premium limits. This is what is commonly referred to as community rating and currently exists in the small group health market and a handful of states for the individual market. To an extent, it also is used in many risk pools as well as HIPAA plans. Limiting the premium span to 2x the rate may sound great but unfortunately you don't know what that lower rate will be. Using 2x a single rate of $300 might not seem that bad if you are taking a medication that costs $3,000 per month. Even boosting the starting rate to $600 is still a bargain for the $3,000 per month pill poppers but those who are healthy will not be willing participants at $600.

Therein lies one of the problems. The more sick people you want to cover under this plan and the more restrictions that are placed on premium caps the higher the base premium goes which drives off the healthy ones.

Section 114 isn't getting much play, but mental health parity is a mine field. Simply put, health insurance plans can no longer refuse to cover or limit treatment for any mental health condition, including drug and alcohol abuse. If you have a mental health problem you are entitled to the same level of benefits as someone with cancer or a heart condition. That is one expensive benefit. Add at least 15 - 20% to base premiums on top of the 50 - 100% you have increased current rates for Section 111 (non-discrimination of existing medical conditions).

If you are keeping score, take your current premium and increase it by 65 - 120% just to cover Sections 111 & 114.

Section 122 requires health insurance plans issued once HR 3200 goes into effect to cover all preventive care at no charge to the individual. In addition to your annual exam, there is a litany of diagnostic tests that will be available at no charge to the patient. Newborns are covered from birth to age 21 for preventive care, dental, vision, and hearing at no charge. This will add about 20% to current premiums for children's premiums.

How are you liking this so far?

We haven't even touched on the new layers of government oversight and bureaucracy, public options, health insurance exchanges, reductions in Medicare. I think I will save that for later.

But in case you haven't been keeping track, the benefit mandates up through Section 122 will increase your individual premiums by 65% - 120% over current levels and if you have children add another 20% minimum to cover them for new benefits. Did I mention there are over 3000 sections and 1100 pages in this bill and we are just getting started.

Maine Points of Obamacare

Proponents of health care reform say one reason for a public option is that it will introduce competition in the market place which will result in lower premiums.

On the surface, the argument seems to have merit. More companies offering more plans means more choice and lower pricing.

The problem is, they picked Maine to make their point.
Several studies show that in lots of places, one or two companies dominate the market. Critics say monopolistic conditions drive up premiums paid by employers and individuals.

Wellpoint Inc. accounted for 71 percent of the Maine market, while runner-up Aetna had a 12 percent share, according to a 2008 report by the American Medical Association.
Wow! One carrier has 71% of the market.

Wonder how that happens?
"There is a serious problem with the lack of competition among insurers," said Republican Sen. Olympia Snowe of Maine, one of the highest-cost states. "The impact on the consumer is significant."
Could it be because the legislature in Maine decreed that health insurance companies would not be allowed to refuse coverage to anyone at any time due to pre-existing health conditions? In other words, if you apply for health insurance the company must issue a policy and cover your conditions, no matter how sick you are or how expensive it is to treat your condition.

Any health insurance company who wishes to write health insurance in Maine must "guarantee issue" all plans to all people at all times.

Maine is also a community rating state, which means there are upper limits on how much a health insurance company can charge for coverage.

Both guaranteed issue and community rating are key points of HR 3200, commonly known as Obamacare.

Both provisions drive up the cost of health insurance for everyone and drive away carriers who may want to compete in a free market.

Don't you find it disturbing that Olympia Snowe has no clue why there are so few health insurance competitors in her home state of Maine? Not only does it have very few competitors, but also has some of the highest premiums in the country.

And the linked article mis-states the problem. Maine is not a high cost area for health care. There is nothing to indicate doctors and hospitals in Maine charge any more than in neighboring states.

But the repressive health insurance regulations result in some of the highest premiums in the country.
Proponents of a government plan say it could restore a competitive balance and lead to lower costs. For one thing, it wouldn't have to turn a profit.
This is true.

A public plan, like Social Security, Medicare, Medicaid, Cars for Clunkers, etc. are never required to turn a profit. In fact, they can lose money month after month, year after year, and never worry about turning a profit or even breaking even. They can run a deficit year after year until the taxpayers run out of money to fund these plans.
"Right now, there's no incentive for insurers or big hospital groups to negotiate with each other, because they can pass higher payments on through premiums," said economist Linda Blumberg, co-author of the report. "A public plan would have the leverage to set lower payment rates and get providers to participate at those rates."
Where did Linda Blumberg study economics? It appears she did not earn a passing grade in her studies.

The incentive for carriers to negotiate lower provider fee structures is to lessen the amount they pay for health care. When you can get health care at a lower price than your competitors, you can pass those savings along in the form of lower premiums.

What part of that is lost on Ms. Blumberg?

A public plan, such as Medicaid, does have leverage. When you have 39,000,000 individuals on a health insurance plan paid for by taxpayers you have leverage. So much leverage that you can name your price and providers have to take it if they want your plan participants.

Of course medical providers lose so much money on Medicaid and Medicare patients that they cost shift those losses to private pay patients . . . those who have health insurance. But if the public plan eliminates the private health insurance market will health care providers abandon their profession? How much money do they have to lose before they say "enough"?

Smaller cars, bigger health insurance, Poppa Washington.

Sunday, August 23, 2009

Death Panels Made Simple

Not to (you should pardon the expression) beat a dead horse, but one of the reasons that "Death Panels" struck such a resounding chord is because of CARS.
We've all watched the past few weeks while the gummint's ill-advised (and even more poorly implemented) program to turn perfectly serviceable older vehicles into new car sales has itself been traded in. Of course, no one called the program by it's actual name: the Consumer Assistance to Recycle and Save Act of 2009 (CARS). No, we immediately glommed onto the completely unauthorized and unofficial term "cash for clunkers." I defy any reader to find that term in the enabling legislation.
I'll save you some time: it ain't in there.
But that didn't make the program any less well-known or "successful." The reason it became such a joke is precisely because that new title became an unstoppable meme, with the added bonus that it happened to be spot-on accurate.
And that is exactly why "Death Panel" was effective: it accurately summarized the insidious nature of the bill, its intent and implementation, in a way that was instantly understandable and recognizable to the citizenry. They saw how the government viewed serviceable vehicles creeping past their prime, listened to Ezekiel Emanuel (Rahmbo's brother, and an advisor to the president) when he wrote that "health care should be rationed in a way that “promot[es] and reward[s] social usefulness,[<- 6/30/10: new, working link] and that age could play a factor in determining who can and cannot access health-care resources."
It's really a very small and valid leap from there to "Death Panels."
Of course the term itself never shows up in the bill; what boots it? There were no shadowy, hooded figures coming out to announce "sorry, Mr Smith, you're denied." Such verbiage was unnecessary: all that was necessary was to pass the concept (just as the term "cash for clunkers" is nowhere to be found in HR1550).
And just how has C4C worked out? Well, it's run out of money (even with an extension) and is due to be shut down in a few days. In the meantime, it's left in its brief wake thousands of now useless vehicles (which can't even be scavenged for parts or donated to charity), thousand of dealers who have no idea when (or, perhaps, even if) they'll be paid, and a public which sees first-hand how ObamaCare can be expected to perform.
Not a pretty picture.

Knee deep? Waist deep? Neck Deep?

The cost of medical care in the U.S. is the real reason medical insurance costs so much.

Because the care is expensive and its cost is growing, the insurance is expensive and its cost is growing. As a result, there are more and more Americans whose access to medical care is limited because they are uninsured.

Very high quality medical care is delivered in Western Europe and in places all over the world, at much less cost vs. the U.S. Why can’t that be done here? That is the key question – and please note this is a medical cost question, not an insurance cost question.

Achieving real economies in medical cost should be a central objective of reform. But the administration doesn't seem to be looking there.

In fact, the administration can't seem to explain in straightforward terms, what it is trying to accomplish and why. First we were told it was health care reform. Now they say it's health insurance reform. First the motivation was to help the uninsured – plus or minus 15% of the population. Now we see Congress intends to control 100%. First we’re told we can keep the coverage we have. Now it appears we cannot. First we have Section 1233 of HR3200 that no Congressman or Senator or administration official could explain. Now the administration promises to pull Section 1233 from the Bill (as if that will change anything). First Obama told us his proposals were necessary to save the economy. Now CBO has shown that all the bills currently being discussed will increase the deficit. So now the economic argument for reform is set aside in favor of a moral and ethical imperative. First Obama demanded a bill be passed by August - a deadline that foreclosed meaningful Congressional debate. Now we are told that the public is obstructing debate in the Town Hall meetings - as though the administration suddenly decided on July 31 that debate is worthwhile. And of course this administration assured us from the beginning that it will unite us around hope and change we can believe in. Now we see the leaders in this administration descending into ugly name-calling and vilification of ordinary citizens for exercising their right to speak up and speak out.

What do you see? I see an administration and Congress who have failed to figure out what they want, or to to explain to us what they are trying to do in any but highly generalized and uninformative terms. Nevertheless, the administration and Congress seem less interested in listening to the public, and more determined to discredit public opinion, while they doggedly forge ahead with their plans anyway.

We’re knee-deep in the big muddy but the big fool said to push on.

Saturday, August 22, 2009

Why we need real physician leadership

Physicians for a National Health Program, or PNHP, is self-described as “a non-profit research and education organization of 17,000 physicians, medical students and health professionals who support single-payer national health insurance”.

I recently went to the PNHP site. I read their mission statement. Now I feel sick.

In their mission statement, here's what PNHP says guides them:

“The U.S. spends twice as much as other industrialized nations on health care”

Yes, the problem is medical care spending. The high cost of medical care is why medical insurance is expensive – but don’t expect PNHP to tell you that.

“Yet our system performs poorly in comparison”

And that, too, is a medical problem. Question: who is responsible for medical care in your home town?

“and still leaves 45.7 million without health coverage”

Kaiser Family Foundation released a study a couple years ago that revealed 65% of the uninsured have incomes below 2X’s the Federal Poverty Limit.

Why has Medicaid failed to protect the poor? Medicaid is the government program expressly established to provide adequate medical insurance for the poor. Why is it not doing so? Why has our government left so many of the poor without access to medical insurance? I think that is a scandal. PNHP won’t tell you this, because PNHP advocates government-controlled medical care for EVERYONE, not just the poor.

Medicaid’s failure is not speculation, it's real. What is speculative is to believe, despite the evident Medicaid failure, that the government would truly manage a universal, single-payer public plan as its advocates promise.

“This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar.”

One of my former jobs was chief of benefits for a very large employer. If I mentioned the name, everyone would instantly recognize it. We worked with Aetna and Blue Cross. Their administrative overheads amounted to about 5% of our annual claim volume. Why is this relevant? Because the 31% number that organizations like PNHP like to throw around is a cherry-picked number – and PNHP presents it dishonestly. It may be the right number for individual insurance. But in my experience it is clearly not the right number for group plans – where most insured Americans are covered. and besides, it defies logic for PNHP to blame the problem of high medical costs on insurance. In fact, the reverse is true.

“Streamlining payment through a single nonprofit payer would save more than $400 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

Think carefully about this statement. PNHP is not saying any “savings” would be returned to the public. PNHP is saying that such "savings" would be paid to physicians. Aside from increasing physician incomes, this means that the public would pay even more for the expensive medical care we now have.

So PNHP presents nothing that will help solve our principal problem - the high cost of medical care. The public has every right to expect physicians to help solve that problem, not simply to demand more money from us. Sadly, PNHP barely acknowledges that problem, and offers no solution – just more spending.

And this is why we need real physician leadership on health policy.

Friday, August 21, 2009

Two-wheeled Risk (You Want Fries With That?)

[Welcome Industry Radar readers!]
While not strictly an insurance issue, this story does pose some interesting risk-management questions:
[ed: we'll table the discussion about the seeming contradiction between eschewing a car for a bike but ordering a cheeseburger instead of a salad]
The gist of the story is that this particular chain, known for its "green policies," banned bike riders from using the drive-through, citing safety concerns. Other national chains also do this, but Burgerville has decided, as a result of Ms Gilbert's experience and response, to delete (or at least modify) that policy. One supposes that's good news, at least for the bicyclists.
But is it sound risk management?
Here's why I ask: if you're on a bike going through the drive-through, aren't you at greater risk of being run-over than if you simply parked the bike out front and walked on in? I don't know the answer to that, and I spent quite some time Googling around trying to find stats to prove the case either way.
No luck; perhaps one of our resourceful readers has access to this info and would be willing to share it?
Of course, this same principle would apply to drive-up ATM's [ed: and BTW, what is it with braille markings on drive-up ATM's? Isn't that oxymoronic?], and I didn't see any stats on that either.
While I understand how riders must feel when they find themselves barred from the drive-up, how big is that lawsuit going to be the first time one gets creamed by a Caddy? Which also begs the question: is this policy driven by insurance company rules as much as common sense?
It's funny how things snowball: when I began to write this post, I had two questions that were still unanswered: one, stats on bikes and drive-throughs and two, whether or not insurance carriers played a role in the "no bike" rule. Since this falls under the general aegis of "P&C," I called on my colleagues in that field. There seems to be a mixed bag of answers: it doesn't appear to be a general industry rule that Wendy's et al post and enforce a "no bikes" rule. There may well be carriers which include that verbiage, but it doesn't seem to be a standard policy clause.
One colleague suggested that it may have to do with the inherent risk of letting people walk up to the window: if they pull a gun and ask for money, they can be gone pretty quickly. If they're in a car, they're likely blocked front and rear (and, of course there's the license plates). There's also a slippery slope here: in my research, I noted that there were at least a few incidents where folks on "Rascals" (motorized wheelchairs) were also turned away, presumably for the same "safety concerns" as the bikers. If Burgerville lets bikers use the drive-through, what can they say to Granny in her Rascal. Or Joe in his "regular" wheelchair?
The other concern regarding safety is this: at drive-through speeds, if my Honda hits your Buick, there are some scrapes and dents, but no one's getting care-flighted. But if my Ford hits you on your Schwinn, there could be some major injuries.
The bottom line, such as one exists here, is that this really isn't as cut-and-dried as it might at first appear. Risk management means taking into account all the variables (or at least as many as possible), and sometimes we don't like the answers.

Cavalcade of Risk #86: Call for submissions

The Political Calculations blog hosts next week's edition. Submissions are due this Monday (the 24th). PC requests that you include:
■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post
And PLEASE remember: ONLY posts that relate to risk (not personal finance tips and the like).
You can submit your post via Blog Carnival or email.
HOSTING: We're scheduling fall Cav's now, please let me know if you'd like to host one.

Thursday, August 20, 2009

Late Breaking Wonkery

Health Business Blog's David Williams hosts this week's Health Wonk Review. Today's edition of this bi-weekly compendium of all that's wonky is a bit late out of the gate but well worth the wait.
Do check it out.

ObamaCare 2011

We now return you to regularly scheduled blogging.

AARP and the Gray Panthers

AARP has found itself smack in the middle of health care/insurance reform debates. Some 60,000 or so of their members have expressed dissatisfaction over AARP's position by voting with their feet.

The Washington Post offers some questions from members and AARP's response. Here are just a few.
Q. As a breast cancer survivor, I could not buy health insurance at any price.

A. About 1 of every 4 60-year-olds can't even get insurance because of a pre-existing medical condition -- and we agree with you that this must change.

I certainly understand the position of the individual who could not find health insurance. But I also know the other side of the coin.

While it is noble to talk about ending the practice of underwriting medical conditions it is also very costly to do so. A true "guaranteed issue" policy when implemented across the board is priced about twice as high as medically underwritten policies. This is illustrated in states that have prohibited carriers from medically underwriting new applicants.

A few states, Kentucky and New Hampshire, flirted with guarantee issue then later abandoned those laws when the number of carriers willing to participate declined, premiums skyrocketed and so did the number of uninsureds.

The idea of affordable health insurance and full coverage for pre-existing conditions are mutually exclusive ideas.
Q. Disabled and under age 65 - What is AARP's position here with the new proposals?

A. For those under 65, as you know, some disabled persons are eligible for Medicare. This will not change, and we support the current coverage. For those not eligible for Medicare, we strongly support doing away with insurance company practices that prevent those with a existing medical condition from getting insurance.

Why impose new rules on insurance carriers that will increase premiums for everyone? Why not just support legislation that allows those with pre-existing conditions to buy in to Medicare?

We already have a system that will cover some people through Medicare. Why not simply expand it for anyone with a pre-existing condition?
Q. Prescription Drug Coverage - Many of the disabled (like myself) reach the "doughnut hole" gap in Q1 of each year. Then no more medicine. It was better before Part D as the Drug Companies offered accommodating PAP. What is AARP's position?

A. For those with high drug costs, we strongly support closing the so-called doughnut hole (or coverage gap in part D)

AARP seems to think this can be done at no cost.

Again, why increase premiums on everyone when the solution would be to either allow those who have higher needs to buy more coverage, or simply suggest they drop Part D and go back on PAP's.
Q. Why is AARP supporting a program that MUST take from Medicare to provide insurance for other groups?

A. AARP opposes any cuts to Medicare benefits. We do support savings in the Medicare program that will help lower costs, such as those changes that will weed out waste and inefficiency in the program.

This begs the question, why do people think we need an overhaul of the current health care system to eliminate fraud and waste? If you know there are abuses in the Medicare system, attack them rather than waiting on some mythical reform legislation to compel you to do the right thing.

Some seem to think the solution to what ails us is to scrap everything, including things that work, and start all over from scratch. Using that logic we should scrap all cars and trucks, not just the clunkers, and use horse drawn carriages and wagons.

We have an energy crisis and a global warming crisis (at least according to some). But I don't hear anyone saying we need to live like Laura Ingalls.

Are You on "God's Team?"

PresBo wants you to be:
Yes, our Spiritual Leader in Chief© really said that in a conference call with some 1000 Rabbis, as he urged them to supplement his bully bimah with their real ones. As an aside, whatever happened to that much vaunted proscription from the left regarding "separation of church and state?"
Or is that only on the right side of the equation?
This little pep talk was especially inappropriate when one considers the overarching Torah commandment to "choose life." This is, of course, in direct contravention to the proposed cuts in Medicare, the rush to rationing, and the inclusion of abortion coverage in the House bill.

Wednesday, August 19, 2009

Alzheimers? You're Not Really Sick . . .

[Welcome LGF readers!]

The NHS, Britain's version of Medicare for all, says Alzheimer's is a social condition and does not qualify for benefits.

Is this a medical breakthrough? Does the NHS believe folks with Alzheimer's just pretend to be forgetful in order to gain attention?
NHS Worcestershire ruled that Judith Roe, 74, did not qualify for NHS funding because her condition was a "social" rather than "health" problem, even though she was so ill she could not make a cup of tea and regularly left the stove on.

She was forced to sell her £200,000 home to pay her £600-a-week nursing home fees, which would have been funded if she had been categorised correctly.
They can't be serious.

Sure smacks of denying the claim to save money.
Her son, Richard, 40, urged other families in a similar situation to fight for the care they are entitled to.

"They told me I should count myself lucky because there are people that are more ill than my mother, which was an outrageous thing to say.
So the NHS does triage in order to make sure those who are really ill get care.

Under English law, elderly people must pay for their own residential care unless their needs are deemed health-related.

She was assessed but her needs were regarded to be social rather than health, meaning she did not qualify for funding.
"The NHS doesn't want to admit elderly people have health issues because then it falls to them to pay for their care."

He added: "We made the difficult decision to sell her home because we were under the assumption that older people sell their houses to pay for care.

Only in America do folks have to sell their home to pay for health care. That doesn't happen in countries where the government takes care of everything.
Paul Bates, chief executive of NHS Worcestershire, said: "Decisions around eligibility for continuing NHS care are extremely complex and difficult even though we have national guidance to assist us.

"The line between the need for healthcare and social care is a very thin one indeed, but the impact for the individual is the difference between free care and care which is means tested.
Means tested.

Seems like that is one of the talking points of HR 3200. If the care does not meet certain standards it won't be covered.
Andrew Harrop, Head of Policy for Age Concern and Help the Aged, said: "The system for deciding where the line is drawn between free NHS Continuing Care, and paid for social care has been a mess for years.

"We are still very concerned that older people may wrongly be forced to pay for their care when it should be free.
Well of course it should be free.

And that is what Obama wants for us as well. Free health care.

FWIW, the family prevailed in court and won a judgment of 130,000 pounds.