Zap!

Everyone knows what happens if you get behind on your car payment.

The repo man comes along and takes the car back. Heck, we even had an insurance carrier get into the "take back" game by repossessing a bionic arm.

But now the car lenders have a new device to protect their interest should you decide to stop making payments.

They zap your car so it won't run.

A light on the plastic box flashes when a payment is due. If the payment isn't made and the resulting code punched in to reset the box, the vehicle won't start. The next step is a visit from the repo man.

This is not good.

So what does this have to do with insurance?

Nothing really . . . yet . . .

But let's just say . . . you have a medical emergency and require immediate care. The ER, hospital & docs are obligated to treat you regardless of ability to pay under EMTALA guidelines.

You do not have insurance.

The providers agree to bill you and even work out payments.

Then something comes along and rather than making payments on a medical bill you decide instead to buy a new SUV.

Then the light on your body begins to flash. Unless you catch up your payments the hospital sends out the repo man to take back the pacemaker . . .

OK. Maybe a bit far-fetched but hey, it could happen.

Read More

Zap!

Everyone knows what happens if you get behind on your car payment.

The repo man comes along and takes the car back. Heck, we even had an insurance carrier get into the "take back" game by repossessing a bionic arm.

But now the car lenders have a new device to protect their interest should you decide to stop making payments.

They zap your car so it won't run.

A light on the plastic box flashes when a payment is due. If the payment isn't made and the resulting code punched in to reset the box, the vehicle won't start. The next step is a visit from the repo man.

This is not good.

So what does this have to do with insurance?

Nothing really . . . yet . . .

But let's just say . . . you have a medical emergency and require immediate care. The ER, hospital & docs are obligated to treat you regardless of ability to pay under EMTALA guidelines.

You do not have insurance.

The providers agree to bill you and even work out payments.

Then something comes along and rather than making payments on a medical bill you decide instead to buy a new SUV.

Then the light on your body begins to flash. Unless you catch up your payments the hospital sends out the repo man to take back the pacemaker . . .

OK. Maybe a bit far-fetched but hey, it could happen.

Read More

Oh, Do Behave!

[Welcome Industry Radar readers!]

In his Austin Powers films, Mike Myers often jibes the Brits for their lack of emphasis on dental hygiene. While some may consider that a bit of a stretch, consider this:

"Health service dentists have been forced to go on holiday or spend time on the golf course this month despite millions of patients being denied dental care."

Play to pay?

MVNHS© dentists are given strict quotas about how many patients they can treat, and once that's met, it's off to the golf course. We tend to think of health care rationing in terms of MRI's, chemo and surgical procedures, but it obviously extends to dental, as well:

"Patients have been told they must either pay privately or return in April when the new work year begins. People suffering from toothache have been advised to go to hospital."

And of course, we know that the MVNHS© hospitals are overcrowded and understaffed already, so this will merely exacerbate that problem.

Maybe an ice pack?

Read More

Oh, Do Behave!

[Welcome Industry Radar readers!]

In his Austin Powers films, Mike Myers often jibes the Brits for their lack of emphasis on dental hygiene. While some may consider that a bit of a stretch, consider this:

"Health service dentists have been forced to go on holiday or spend time on the golf course this month despite millions of patients being denied dental care."

Play to pay?

MVNHS© dentists are given strict quotas about how many patients they can treat, and once that's met, it's off to the golf course. We tend to think of health care rationing in terms of MRI's, chemo and surgical procedures, but it obviously extends to dental, as well:

"Patients have been told they must either pay privately or return in April when the new work year begins. People suffering from toothache have been advised to go to hospital."

And of course, we know that the MVNHS© hospitals are overcrowded and understaffed already, so this will merely exacerbate that problem.

Maybe an ice pack?

Read More

The Carnival of Personal Finance is now online...

Blain Reinkensmeyer of Stock Trading to Go hosts this week's edition of the Carnival of Personal Finance. There's scads of interesting posts on everything from debt management to taxes (pretty timely, that).

SVB (the Silicon Valley Blogger) has an in-depth post on strategies to avoid identity theft. Recommended.

Read More

The Carnival of Personal Finance is now online...

Blain Reinkensmeyer of Stock Trading to Go hosts this week's edition of the Carnival of Personal Finance. There's scads of interesting posts on everything from debt management to taxes (pretty timely, that).

SVB (the Silicon Valley Blogger) has an in-depth post on strategies to avoid identity theft. Recommended.

Read More

13,700,000 Uninsured

[Welcome Industry Radar readers!]

We keep hearing about 45, 46, 47 million uninsured. But the press rarely gives us details.

Readers of InsureBlog know that this is an issue addressed almost ad nauseum. But sometimes it is worth repeating.

Six years ago, Evelyn Reinthaler’s face smacked against the windshield of her Geo Prism during an Interstate collision. The accident sent her to the hospital, where she racked up an $18,000 bill.

This winter she broke into tears when she was hit with a $100 bill for flu medication.

The 25-year-old Omahan, a part-time student, is among the more than 13 million young adults nationally who lack health insurance.

Even though older Americans often are the focus of concerns about health care costs, people ages 19 to 29 are one of the fastest-growing groups without insurance, according to a report by the Commonwealth Fund.

A small percentage of my business is comprised of people in this age bracket. Most have plans selected by and paid for by their parents.

Even though they comprise just 17 percent of the under-65 population, young adults account for 30 percent of the nonelderly uninsured

Carriers are introducing new plans to appeal to this generation but the marketing effort is falling on deaf ears.

Read More

13,700,000 Uninsured

[Welcome Industry Radar readers!]

We keep hearing about 45, 46, 47 million uninsured. But the press rarely gives us details.

Readers of InsureBlog know that this is an issue addressed almost ad nauseum. But sometimes it is worth repeating.

Six years ago, Evelyn Reinthaler’s face smacked against the windshield of her Geo Prism during an Interstate collision. The accident sent her to the hospital, where she racked up an $18,000 bill.

This winter she broke into tears when she was hit with a $100 bill for flu medication.

The 25-year-old Omahan, a part-time student, is among the more than 13 million young adults nationally who lack health insurance.

Even though older Americans often are the focus of concerns about health care costs, people ages 19 to 29 are one of the fastest-growing groups without insurance, according to a report by the Commonwealth Fund.

A small percentage of my business is comprised of people in this age bracket. Most have plans selected by and paid for by their parents.

Even though they comprise just 17 percent of the under-65 population, young adults account for 30 percent of the nonelderly uninsured

Carriers are introducing new plans to appeal to this generation but the marketing effort is falling on deaf ears.

Read More

Georgia on my Mind

[Welcome Industry Radar readers!]

The Georgia legislature is looking at ways to make health insurance more affordable by providing tax breaks to employers & individuals who buy HDHP (high deductible health plans).

As a Georgia resident and agent, this is something that is now on my radar.

In addition to exempting these plans from premium taxes, there are tax breaks.

Small employers under the bill would get a $250 tax credit per enrolled worker, and individuals buying them would get a tax credit.

Tax breaks. Gotta love it, right?

So what's the problem?

The premium tax in Georgia is a whopping 2.5% of gross premium. Eliminating taxes paid by carriers on these policies may generate some savings, but not anything noticeable.

Many who are uninsured do not pay taxes. Others (the young invincible's) pay taxes but see no need for buying health insurance.

This is a step in the right direction but like most other proposals, does nothing to control health care costs.

On a scale of 1 - 10, I give it a 5.

Read More

Georgia on my Mind

[Welcome Industry Radar readers!]

The Georgia legislature is looking at ways to make health insurance more affordable by providing tax breaks to employers & individuals who buy HDHP (high deductible health plans).

As a Georgia resident and agent, this is something that is now on my radar.

In addition to exempting these plans from premium taxes, there are tax breaks.

Small employers under the bill would get a $250 tax credit per enrolled worker, and individuals buying them would get a tax credit.

Tax breaks. Gotta love it, right?

So what's the problem?

The premium tax in Georgia is a whopping 2.5% of gross premium. Eliminating taxes paid by carriers on these policies may generate some savings, but not anything noticeable.

Many who are uninsured do not pay taxes. Others (the young invincible's) pay taxes but see no need for buying health insurance.

This is a step in the right direction but like most other proposals, does nothing to control health care costs.

On a scale of 1 - 10, I give it a 5.

Read More

This Sceptered Isle - Part IX

So in the U.K. a “voucher scheme” is next up for the National Health Service.

Under this scheme, “patients will not be given money directly, but will decide themselves how to spend sums normally administered by the NHS.”

The U.K. health secretary notes the generation now reaching retirement expects "more control over chronic health conditions that affect four adults in 10." Of course, there are differing opinions. One source of controversy is that some service providers (who at present are paid directly by the government) fret that patients will not welcome the “extra burden” of deciding for themselves where they prefer to obtain treatment. But overall, this scheme seems to me yet another remarkably original, creative, and imaginative idea from the British National Health office. Don’t you agree?

And yet, reading about this scheme . . . I sense something . . .a presence I’ve not felt since . . .

Oh shucks that sensation is probably just deja vu all over again. Won't it be interesting to see how this scheme plays out, over there?

Read More

This Sceptered Isle - Part IX

So in the U.K. a “voucher scheme” is next up for the National Health Service.

Under this scheme, “patients will not be given money directly, but will decide themselves how to spend sums normally administered by the NHS.”

The U.K. health secretary notes the generation now reaching retirement expects "more control over chronic health conditions that affect four adults in 10." Of course, there are differing opinions. One source of controversy is that some service providers (who at present are paid directly by the government) fret that patients will not welcome the “extra burden” of deciding for themselves where they prefer to obtain treatment. But overall, this scheme seems to me yet another remarkably original, creative, and imaginative idea from the British National Health office. Don’t you agree?

And yet, reading about this scheme . . . I sense something . . .a presence I’ve not felt since . . .

Oh shucks that sensation is probably just deja vu all over again. Won't it be interesting to see how this scheme plays out, over there?

Read More

Losing at SOLItaire: Update

About a year and a half ago, we reported on the disturbing story of two California women who were apparently buying life insurance policies on homeless men, naming themselves as beneficiary, and then doing what was necessary to file a claim. We noted at the time that it appeared that the carriers' underwriters must have been asleep at the switch, since one of the principal requirements of a life insurance contract is insurable interest.

Today, an accomplice of the two "damsels of distress" testified against them at their trial for the murder of two of his "colleagues." Sometimes truth is stranger than fiction; this whole story sounds like a Law & Order plot line.

We'll keep you posted.

Read More

Losing at SOLItaire: Update

About a year and a half ago, we reported on the disturbing story of two California women who were apparently buying life insurance policies on homeless men, naming themselves as beneficiary, and then doing what was necessary to file a claim. We noted at the time that it appeared that the carriers' underwriters must have been asleep at the switch, since one of the principal requirements of a life insurance contract is insurable interest.

Today, an accomplice of the two "damsels of distress" testified against them at their trial for the murder of two of his "colleagues." Sometimes truth is stranger than fiction; this whole story sounds like a Law & Order plot line.

We'll keep you posted.

Read More

Accessing Healthcare: Part 2

They pulled my pin last Friday, so I now sport a new cast (they cut the old one off) and another follow-up appointment. The pain is gone, although I'm beginning to understand what folks with arthritis go through when the weather changes.

The EOB, or Explanation of Benefits [ed: a copy of which is available here], has finally arrived, and we now begin the process of paying for my slippery feet. The good news, one supposes, is that I met my annual deductible early. On the other hand, I still have quite a way to go with regard to the potential maximum out-of-pocket. Still, between the amount with which my wife's employer "seeded" the account and what we've put in (not to mention our premium savings), it's not too bad. Yes, I can certainly think of more entertaining uses for the $2,400. Still, things could have been much worse.

How's that, you ask?

Well, let's take the typical co-pay (non-HSA) plan: $25 for office visits, maybe $1,000 deductible for big ticket items, followed by the ubiquitous "80/20" (plan pays 80% of the next $10,000, insured pays 20%). Between the ER, the ortho and the radiologist, the bills total out to just over $3,400. None of these were "office visits," so they all go to the deductible and co-insurance.

So, the first $1,000 would be mine (deductible), and another $480 for the co-insurance, for a total of about $1,500. Add in my premium savings of some $1,600, and my net out-of-pocket would have been $3,100 (not to mention giving up that $800 HSA "seed money"). So, I'm ahead by about $700 ($3,100 less $2,400).

Not too hateful.

I still have some follow-up and, of course, therapy, so I'll need to keep a running total on those. Once the final bill's been paid, I'll post a recap. Stay tuned.

Read More

Accessing Healthcare: Part 2

They pulled my pin last Friday, so I now sport a new cast (they cut the old one off) and another follow-up appointment. The pain is gone, although I'm beginning to understand what folks with arthritis go through when the weather changes.

The EOB, or Explanation of Benefits [ed: a copy of which is available here], has finally arrived, and we now begin the process of paying for my slippery feet. The good news, one supposes, is that I met my annual deductible early. On the other hand, I still have quite a way to go with regard to the potential maximum out-of-pocket. Still, between the amount with which my wife's employer "seeded" the account and what we've put in (not to mention our premium savings), it's not too bad. Yes, I can certainly think of more entertaining uses for the $2,400. Still, things could have been much worse.

How's that, you ask?

Well, let's take the typical co-pay (non-HSA) plan: $25 for office visits, maybe $1,000 deductible for big ticket items, followed by the ubiquitous "80/20" (plan pays 80% of the next $10,000, insured pays 20%). Between the ER, the ortho and the radiologist, the bills total out to just over $3,400. None of these were "office visits," so they all go to the deductible and co-insurance.

So, the first $1,000 would be mine (deductible), and another $480 for the co-insurance, for a total of about $1,500. Add in my premium savings of some $1,600, and my net out-of-pocket would have been $3,100 (not to mention giving up that $800 HSA "seed money"). So, I'm ahead by about $700 ($3,100 less $2,400).

Not too hateful.

I still have some follow-up and, of course, therapy, so I'll need to keep a running total on those. Once the final bill's been paid, I'll post a recap. Stay tuned.

Read More

Doctor Web

Do you trust your doc?

Most do.

And we believe most docs are competent.

But are all docs up to speed on all medical situations and treatment?

Not necessarily.

After all, even specialists treat multiple patients and multiple conditions and each treatment protocol is different.

So what is a patient to do?

Consult Dr. Web.

14 years ago Todd Small was diagnosed with M.S. (multiple sclerosis).

For 14 years Todd took a daily 10mg dose of Baclofen. His doc told him that was the maximum dosage.

Granted, that was years ago and perhaps when Todd first started on Baclofen 10mg was the maximum.

To Todd's surprise, he discovered patients taking up to 80mg daily.

There are a little more than 7,000 Todd Smalls at PatientsLikeMe, congregating around diseases like Parkinson's, multiple sclerosis (M.S.) and AIDS, all of them contributing their experiences and tweaking their treatments. At first glance, the Web site looks like just any other online community, a kind of MySpace for the afflicted. Members have user names, post pictures of themselves and post updates and encouragements. As such, it's related to the chat rooms and online communities that have inhabited the Internet for more than a decade.

There are plenty of resources available to anyone with internet access. As the Yellow Pages used to say, let your fingers do the walking.

Read More

Doctor Web

Do you trust your doc?

Most do.

And we believe most docs are competent.

But are all docs up to speed on all medical situations and treatment?

Not necessarily.

After all, even specialists treat multiple patients and multiple conditions and each treatment protocol is different.

So what is a patient to do?

Consult Dr. Web.

14 years ago Todd Small was diagnosed with M.S. (multiple sclerosis).

For 14 years Todd took a daily 10mg dose of Baclofen. His doc told him that was the maximum dosage.

Granted, that was years ago and perhaps when Todd first started on Baclofen 10mg was the maximum.

To Todd's surprise, he discovered patients taking up to 80mg daily.

There are a little more than 7,000 Todd Smalls at PatientsLikeMe, congregating around diseases like Parkinson's, multiple sclerosis (M.S.) and AIDS, all of them contributing their experiences and tweaking their treatments. At first glance, the Web site looks like just any other online community, a kind of MySpace for the afflicted. Members have user names, post pictures of themselves and post updates and encouragements. As such, it's related to the chat rooms and online communities that have inhabited the Internet for more than a decade.

There are plenty of resources available to anyone with internet access. As the Yellow Pages used to say, let your fingers do the walking.

Read More

Who's Your Daddy?

[Welcome Industry Radar readers!]

Finding "baby Daddy" is a staple of daytime talk shows. I am still amazed at the number of folks willing national TV and reveal what most would consider deep, dark secrets.

So if you are not into public humiliation (although I have yet to see any signs of embarrassment), help is on the way.

For $30 plus another $119 to process the results, you can know the father without a live audience whooping and hollering "you, you, you, you . . .".

What fun is that?

The kit costs $29.99. It contains cotton swabs for taking cells from inside the mouth. The swabs are sealed in plastic bags and sent with a consent form and a $119 fee to a lab. In three to five days, results can be accessed online. Rite Aid has ordered 10,000 more for all its stores except those in New York, where state law requires a court order or medical prescription.

So what's to stop New Yorkers from crossing state lines to buy the kit?

Nada.

Sure beats hearing Maury say, "You ARE the daddy"!

Read More

Who's Your Daddy?

[Welcome Industry Radar readers!]

Finding "baby Daddy" is a staple of daytime talk shows. I am still amazed at the number of folks willing national TV and reveal what most would consider deep, dark secrets.

So if you are not into public humiliation (although I have yet to see any signs of embarrassment), help is on the way.

For $30 plus another $119 to process the results, you can know the father without a live audience whooping and hollering "you, you, you, you . . .".

What fun is that?

The kit costs $29.99. It contains cotton swabs for taking cells from inside the mouth. The swabs are sealed in plastic bags and sent with a consent form and a $119 fee to a lab. In three to five days, results can be accessed online. Rite Aid has ordered 10,000 more for all its stores except those in New York, where state law requires a court order or medical prescription.

So what's to stop New Yorkers from crossing state lines to buy the kit?

Nada.

Sure beats hearing Maury say, "You ARE the daddy"!

Read More

Dirty Little Secrets

Do you wanna know a secret? Do you promise not to tell?

OK. That was cheesy.

But the WSJ has revealed something I have known for some time. Some folks who work for the federal government do not have health insurance.

I have several clients who are employed by government agencies who either have no health insurance, or have a very limited benefit plan.

A few weeks ago a lady from the CDC called. She was referred by a co-worker who is also a client. Seems she had emergency surgery a few months ago and the health insurance paid less than $1000 on a $14,000 bill.

Covering the uninsured is a central issue in this year's political campaign. Yet while politicians debate how best to cover the growing ranks of the uninsured, the federal government -- by outsourcing service jobs -- quietly is adding to those numbers.

Outsourcing jobs.

To save money.

Considering it is taxpayer money, such moves are commendable.

The problem is, the contract workers are offered health care benefits that are akin to putting a patch on an old pair of jeans. Many of these workers are semi-skilled and usually do not understand how poor the benefits are . . . until they need to use them.

By then it is too late.

Under a 1965 law, called the McNamara-O'Hara Service Contract Act, most contractors with service contracts of more than $2,500 are required to pay locally prevailing wages, plus fringe benefits or the cash equivalent -- $3.16 an hour this year, under a government formula.

$3.16 per hour for fringe benefits.

That's $526 per month per employee working 40 hour weeks.

Seems adequate.

But not all contract employers offer health insurance as part of the package. If they do offer health insurance, it is usually a limited benefit plan.

By diverting all or some of the $3.16 to wages, they are able to offer employees a wage that is higher than the "prevailing market wage" and attract workers.

And some contractors don't even comply with the law, and pocket the government allowance.

"A lot of contractors are playing games," says Al Corvigno, a Smithfield, Va., consultant who trains contractors and Labor Department employees on the McNamara-O'Hara Act. He estimates that 40% of service contractors may not be providing the required benefits or cash, or paying the right amount.

No government oversight or accountability meets greed.

Yeah, I am shocked too.

In fiscal-year 2007, the Labor Department initiated more than 650 investigations under the statute and found that in 80% of those cases, the employer failed to pay proper wages or benefits or both. Employers who violate the law may be required to make cash payments to employees and may be barred from government contracts for as many as three years.

80% failed to comply with the law.

Looks like contracting with the federal government is Easy Money.

Read More

Dirty Little Secrets

Do you wanna know a secret? Do you promise not to tell?

OK. That was cheesy.

But the WSJ has revealed something I have known for some time. Some folks who work for the federal government do not have health insurance.

I have several clients who are employed by government agencies who either have no health insurance, or have a very limited benefit plan.

A few weeks ago a lady from the CDC called. She was referred by a co-worker who is also a client. Seems she had emergency surgery a few months ago and the health insurance paid less than $1000 on a $14,000 bill.

Covering the uninsured is a central issue in this year's political campaign. Yet while politicians debate how best to cover the growing ranks of the uninsured, the federal government -- by outsourcing service jobs -- quietly is adding to those numbers.

Outsourcing jobs.

To save money.

Considering it is taxpayer money, such moves are commendable.

The problem is, the contract workers are offered health care benefits that are akin to putting a patch on an old pair of jeans. Many of these workers are semi-skilled and usually do not understand how poor the benefits are . . . until they need to use them.

By then it is too late.

Under a 1965 law, called the McNamara-O'Hara Service Contract Act, most contractors with service contracts of more than $2,500 are required to pay locally prevailing wages, plus fringe benefits or the cash equivalent -- $3.16 an hour this year, under a government formula.

$3.16 per hour for fringe benefits.

That's $526 per month per employee working 40 hour weeks.

Seems adequate.

But not all contract employers offer health insurance as part of the package. If they do offer health insurance, it is usually a limited benefit plan.

By diverting all or some of the $3.16 to wages, they are able to offer employees a wage that is higher than the "prevailing market wage" and attract workers.

And some contractors don't even comply with the law, and pocket the government allowance.

"A lot of contractors are playing games," says Al Corvigno, a Smithfield, Va., consultant who trains contractors and Labor Department employees on the McNamara-O'Hara Act. He estimates that 40% of service contractors may not be providing the required benefits or cash, or paying the right amount.

No government oversight or accountability meets greed.

Yeah, I am shocked too.

In fiscal-year 2007, the Labor Department initiated more than 650 investigations under the statute and found that in 80% of those cases, the employer failed to pay proper wages or benefits or both. Employers who violate the law may be required to make cash payments to employees and may be barred from government contracts for as many as three years.

80% failed to comply with the law.

Looks like contracting with the federal government is Easy Money.

Read More

Cavalcade of Risk #48 is up!

Jim Strebing hosts this week's edition of the Cavalcade, available now at Insurance Yak.

We really need hosts for May and June, so please reserve yours now.

Read More

Cavalcade of Risk #48 is up!

Jim Strebing hosts this week's edition of the Cavalcade, available now at Insurance Yak.

We really need hosts for May and June, so please reserve yours now.

Read More

Told Ya So...

One of our mantras here at IB is that health care costs drive health insurance costs, which is one reason why we espouse transparency and accountability, and frown upon benefit mandates. We look at utilization as one measure of health care cost; that is, how often, and under what circumstances, a given procedure is used.

The prototypical example of this is hysterectomies: back in the day, there was quite a controversy regarding elective versions of this procedure. Part of the problem was that it was a fairly simple yet lucrative process, and so held great appeal to a certain segment of the physician community.

More recently, we learn that carriers are cracking down on what they perceive to be a similar burgeoning case of over-utilization: medical scanning technology. This would include PET and MRI scans, for example, as well as CT and even x-rays. The tech for these has dropped in cost, and as a result, we have a lot of these machines that need to be paid for. I understand, for example, that we have more MRI machines here in Ohio than in all of Canada. Is that necessarily a bad thing? Of course not, but then one must ask: "who pays for this tech?"

The answer, of course, is that we all do.

But that may be changing:

"Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there’s emerging evidence that these scans are being over-prescribed."

Buying, maintaining and operating all this equipment isn't free, and the cost is reflected, in part, in increased insurance premiums (see, health care costs more, thus health insurance does, too). In order to rein in some of these costs, insurers are starting to take a closer look at whether they're justified, and justifiable.

Folks who've bought into Consumer Driven Health Care (CDHC) already know this: it's their own money that pays for MRI's instead of x-rays, for example. So it's no real surprise that carriers have begun to second-guess their use, as well.

And there's this:

"Insurers fear some patients are being exposed to dangerous radiation levels from having repeated CT and PET scans, which use many times the radiation of a regular chest X-ray...Doctors, too, are concerned about patients getting excessive radiation exposure when they receive scans that aren’t needed or are ordered as “defensive medicine” to protect against possible lawsuits."

Not to mention the conflicts of interest when physicians also own the "imaging facilities" to which they refer their patients.

O Brave New World, indeed.

(Hat Tip to Holly Robinson)

Read More

Told Ya So...

One of our mantras here at IB is that health care costs drive health insurance costs, which is one reason why we espouse transparency and accountability, and frown upon benefit mandates. We look at utilization as one measure of health care cost; that is, how often, and under what circumstances, a given procedure is used.

The prototypical example of this is hysterectomies: back in the day, there was quite a controversy regarding elective versions of this procedure. Part of the problem was that it was a fairly simple yet lucrative process, and so held great appeal to a certain segment of the physician community.

More recently, we learn that carriers are cracking down on what they perceive to be a similar burgeoning case of over-utilization: medical scanning technology. This would include PET and MRI scans, for example, as well as CT and even x-rays. The tech for these has dropped in cost, and as a result, we have a lot of these machines that need to be paid for. I understand, for example, that we have more MRI machines here in Ohio than in all of Canada. Is that necessarily a bad thing? Of course not, but then one must ask: "who pays for this tech?"

The answer, of course, is that we all do.

But that may be changing:

"Insurance companies are taking a harder look at advanced medical scans like CT scans, citing spiraling costs and safety concerns. And some doctors agree there’s emerging evidence that these scans are being over-prescribed."

Buying, maintaining and operating all this equipment isn't free, and the cost is reflected, in part, in increased insurance premiums (see, health care costs more, thus health insurance does, too). In order to rein in some of these costs, insurers are starting to take a closer look at whether they're justified, and justifiable.

Folks who've bought into Consumer Driven Health Care (CDHC) already know this: it's their own money that pays for MRI's instead of x-rays, for example. So it's no real surprise that carriers have begun to second-guess their use, as well.

And there's this:

"Insurers fear some patients are being exposed to dangerous radiation levels from having repeated CT and PET scans, which use many times the radiation of a regular chest X-ray...Doctors, too, are concerned about patients getting excessive radiation exposure when they receive scans that aren’t needed or are ordered as “defensive medicine” to protect against possible lawsuits."

Not to mention the conflicts of interest when physicians also own the "imaging facilities" to which they refer their patients.

O Brave New World, indeed.

(Hat Tip to Holly Robinson)

Read More

Grand Rounds is up!

Monash Medical Student Jeffrey Leow presents a stark but compelling edition of Grand Rounds. His own interest in surgery is evident in the haunting photos interspersed throughout. And, with over 2 dozen intriguing posts, it's hard to choose a favorite.

Over at Distractible Mind, Dr Rob muses on a case gone horribly wrong, and the lessons painfully learned from it. Recommended, but heartbreaking.

Read More

Grand Rounds is up!

Monash Medical Student Jeffrey Leow presents a stark but compelling edition of Grand Rounds. His own interest in surgery is evident in the haunting photos interspersed throughout. And, with over 2 dozen intriguing posts, it's hard to choose a favorite.

Over at Distractible Mind, Dr Rob muses on a case gone horribly wrong, and the lessons painfully learned from it. Recommended, but heartbreaking.

Read More

2 Cool Monday

■ Last week, Cato's Mike Cannon participated in a debate about the pros, cons and effects of individual health insurance mandates. This is important, fascinating stuff, and I highly recommend the video to our readers.

■ Longtime readers may recall our guest post from Medical Office Manager Kelley Beloff. Her practice has truly embraced health care transparency, and even makes its "menu" available to their patients. With Kelley's permission, this intriguing look "behind the scenes" is available for download here. Enjoy!

Read More

2 Cool Monday

■ Last week, Cato's Mike Cannon participated in a debate about the pros, cons and effects of individual health insurance mandates. This is important, fascinating stuff, and I highly recommend the video to our readers.

■ Longtime readers may recall our guest post from Medical Office Manager Kelley Beloff. Her practice has truly embraced health care transparency, and even makes its "menu" available to their patients. With Kelley's permission, this intriguing look "behind the scenes" is available for download here. Enjoy!

Read More

Still Don't Believe?

Zack Dunlap and his family might disagree.

For more than six hours on Monday, the Oklahoma Highway Patrol classified Zack Dunlap as the state's 610th motor vehicle fatality of the year.

Troopers removed Dunlap's name from the list the same day after learning he showed signs of life shortly before his organs were to be harvested for transplant.

This is a truly amazing story no matter what your faith may be.

For an update on Zack's recovery, click here.

Read More

Still Don't Believe?

Zack Dunlap and his family might disagree.

For more than six hours on Monday, the Oklahoma Highway Patrol classified Zack Dunlap as the state's 610th motor vehicle fatality of the year.

Troopers removed Dunlap's name from the list the same day after learning he showed signs of life shortly before his organs were to be harvested for transplant.

This is a truly amazing story no matter what your faith may be.

For an update on Zack's recovery, click here.

Read More

Do You Believe in Miracles?

Many do and perhaps a lot more don't. We have so much information available to us it is easy to be a skeptic and look for ways to explain the inexplicable.

Some will read this account and say it is just another coincidence. Others will define it as luck.

But some who want to believe in miracles will see this story in a different light.

If you don’t believe in miracles, then you didn’t read of Greg Bugher’s heroism on the front page of this section. The Russiaville man and his family witnessed the horrific accident on Interstate 465 Easter morning – the one that took the lives of Joy Edwards and a motorist who was driving the wrong way on the highway.

Bugher risked his life to save those of Branden, Courtney and Kristin Wade, and their friends, Alex Stang and Chase Parker.

After the violent impact, Edwards’ van was on its passenger side. Fire burned from the engine.

Bugher first pulled Courtney from the wreckage and ran back to the burning van.

“I looked over at my wife and Courtney and, at that moment, I realized I might not be coming back,” Bugher told us last week. “My family, I knew they were safe and God was going to protect them. But, if I don’t go do something to help the kids in the van, they weren’t going to live.”

One by one, Bugher and a passer-by extricated the children – even as the fire crept closer to the van’s fuel cell.

“When Branden came out, the flames were at the second seat,” Bugher said. “Thirty or 40 more seconds and he would have been burning. By the time we got him away and turned back, it was engulfed and there was nothing anyone could do to stop it.”

It is a miracle those five children were saved.

It is a miracle that Joy Edwards veered to the right just before the impact, saving the life of Courtney, who was sitting up front.

It is a miracle that selfless folks like Bugher and his wife, Dianna, were there to help.

It is a miracle the Bughers were even on the road.

“I’m in the passenger seat and was just starting to fall asleep,” Greg Bugher said. “[Dianna] asked if I wanted to get gas at this exit. I said no, go to the next one.”
As children, many of us are taught that God has plans for us – that our lives have purpose.

Easter morning, Greg and Dianna Bugher fulfilled a bit of theirs.


Peace and blessings.

Read More

Do You Believe in Miracles?

Many do and perhaps a lot more don't. We have so much information available to us it is easy to be a skeptic and look for ways to explain the inexplicable.

Some will read this account and say it is just another coincidence. Others will define it as luck.

But some who want to believe in miracles will see this story in a different light.

If you don’t believe in miracles, then you didn’t read of Greg Bugher’s heroism on the front page of this section. The Russiaville man and his family witnessed the horrific accident on Interstate 465 Easter morning – the one that took the lives of Joy Edwards and a motorist who was driving the wrong way on the highway.

Bugher risked his life to save those of Branden, Courtney and Kristin Wade, and their friends, Alex Stang and Chase Parker.

After the violent impact, Edwards’ van was on its passenger side. Fire burned from the engine.

Bugher first pulled Courtney from the wreckage and ran back to the burning van.

“I looked over at my wife and Courtney and, at that moment, I realized I might not be coming back,” Bugher told us last week. “My family, I knew they were safe and God was going to protect them. But, if I don’t go do something to help the kids in the van, they weren’t going to live.”

One by one, Bugher and a passer-by extricated the children – even as the fire crept closer to the van’s fuel cell.

“When Branden came out, the flames were at the second seat,” Bugher said. “Thirty or 40 more seconds and he would have been burning. By the time we got him away and turned back, it was engulfed and there was nothing anyone could do to stop it.”

It is a miracle those five children were saved.

It is a miracle that Joy Edwards veered to the right just before the impact, saving the life of Courtney, who was sitting up front.

It is a miracle that selfless folks like Bugher and his wife, Dianna, were there to help.

It is a miracle the Bughers were even on the road.

“I’m in the passenger seat and was just starting to fall asleep,” Greg Bugher said. “[Dianna] asked if I wanted to get gas at this exit. I said no, go to the next one.”
As children, many of us are taught that God has plans for us – that our lives have purpose.

Easter morning, Greg and Dianna Bugher fulfilled a bit of theirs.


Peace and blessings.

Read More

Cavalcade #48: Submissions Due

Jim Strebing hosts next week's edition of the Cavalcade, scheduled for Wednesday the 26th. Please make sure to get your submissions in by Monday (the 24th). Jim asks that you PLEASE include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

You can submit them via Blog Carnival or email. We have slots available for April and May, so PLEASE drop us a line to reserve yours.

Read More

Cavalcade #48: Submissions Due

Jim Strebing hosts next week's edition of the Cavalcade, scheduled for Wednesday the 26th. Please make sure to get your submissions in by Monday (the 24th). Jim asks that you PLEASE include:

■ Your blog's url
■ Your post's url
■ The post's trackback URL (if available)
■ A (brief) summary of the post

You can submit them via Blog Carnival or email. We have slots available for April and May, so PLEASE drop us a line to reserve yours.

Read More

Stupid Government Tricks

[Welcome Industry Radar readers!]

Seems the folks in Massachusetts are at it again. So much so we just had to blog on it. They are such an easy target . . .

The state's new subsidized health insurance program will cost "signficantly" more than the $869 million proposed in the governor's FY2009 budget just two months ago, the state's top financial official said today.


Oops!

In case you missed it, the Massachusetts plan has been a favorite target at InsureBlog. You can find our refresher course by clicking here.

The budget gap looms despite steps taken today to hold down state costs -- approval of a tough contract with insurers, and increased premiums and copayments for about half of the 176,000 people enrolled.

Budget shortfalls in spite of increased premiums and copays.

The premiums will go up 10 percent on average. For example, people with incomes between $21,000 and $26,000 who are now paying $70 per month, will pay $77

$77 per month. About $2.50 per day. Yeah, I can see how this is a burden.

This is what happens when lawyers decide to meddle in something where ignorance of the dynamics of risk management is rampant.

Read More

Stupid Government Tricks

[Welcome Industry Radar readers!]

Seems the folks in Massachusetts are at it again. So much so we just had to blog on it. They are such an easy target . . .

The state's new subsidized health insurance program will cost "signficantly" more than the $869 million proposed in the governor's FY2009 budget just two months ago, the state's top financial official said today.


Oops!

In case you missed it, the Massachusetts plan has been a favorite target at InsureBlog. You can find our refresher course by clicking here.

The budget gap looms despite steps taken today to hold down state costs -- approval of a tough contract with insurers, and increased premiums and copayments for about half of the 176,000 people enrolled.

Budget shortfalls in spite of increased premiums and copays.

The premiums will go up 10 percent on average. For example, people with incomes between $21,000 and $26,000 who are now paying $70 per month, will pay $77

$77 per month. About $2.50 per day. Yeah, I can see how this is a burden.

This is what happens when lawyers decide to meddle in something where ignorance of the dynamics of risk management is rampant.

Read More

Health Wonk Review is now online...

Joe Paduda, founder of HWR, hosts this week's edition. As always, it's chock full of interesting and insightful posts on medical tech, polity and policy. With over a dozen and a half wonky posts, you're sure to find at least a few items to pique your interest.

One of the great things about HWR is the opportunity to find previously undiscovered blogs, and this edition is no different. David Hamilton runs VentureBeat, and has some cool news from Aetna, which now offers some new web-based care management tools. Recommended.

Read More

Health Wonk Review is now online...

Joe Paduda, founder of HWR, hosts this week's edition. As always, it's chock full of interesting and insightful posts on medical tech, polity and policy. With over a dozen and a half wonky posts, you're sure to find at least a few items to pique your interest.

One of the great things about HWR is the opportunity to find previously undiscovered blogs, and this edition is no different. David Hamilton runs VentureBeat, and has some cool news from Aetna, which now offers some new web-based care management tools. Recommended.

Read More

Racial Differences

Politics has focused our attention on race. Now a study says race (or more precisely, ethnicity) affects how we perceive health care delivery.

91% of whites rated their care as excellent or good. That percentage fell for most ethnic groups, with the lowest ratings recorded among Chinese-Americans, 74%; African-Americans born in Africa, 73%; and Vietnamese-Americans, 72%.

Note the differentiation for blacks. "African-Americans born in Africa."

This would seem to indicate the dissatisfaction has more to do with culture and/or language.

When it came to getting an appointment, about 63% of whites were able to get an appointment on the same day or the next day after they became sick or injured. That percentage dropped to 42% for Cuban-Americans and 39% for African-Americans born in the Caribbean.

Again note the separation. "African-Americans born in the Caribbean."

This distinction is not referenced for Asians or Cuban-Americans, only blacks.

About three-quarters of whites reported that their doctor listened carefully to them. That percentage fell to 62% for Korean-Americans and 58% for those from Central America or South America.

So the conclusion is?

the Harvard study also showed that there are steps that health care providers can take to improve patients' perceptions, such as resolving language barriers. She said health care providers should incorporate translation services into their practice.

So doctors should pay to have a translator on staff.

Why can't those for whom English is not their primary language bring along a translator?

Read More

Racial Differences

Politics has focused our attention on race. Now a study says race (or more precisely, ethnicity) affects how we perceive health care delivery.

91% of whites rated their care as excellent or good. That percentage fell for most ethnic groups, with the lowest ratings recorded among Chinese-Americans, 74%; African-Americans born in Africa, 73%; and Vietnamese-Americans, 72%.

Note the differentiation for blacks. "African-Americans born in Africa."

This would seem to indicate the dissatisfaction has more to do with culture and/or language.

When it came to getting an appointment, about 63% of whites were able to get an appointment on the same day or the next day after they became sick or injured. That percentage dropped to 42% for Cuban-Americans and 39% for African-Americans born in the Caribbean.

Again note the separation. "African-Americans born in the Caribbean."

This distinction is not referenced for Asians or Cuban-Americans, only blacks.

About three-quarters of whites reported that their doctor listened carefully to them. That percentage fell to 62% for Korean-Americans and 58% for those from Central America or South America.

So the conclusion is?

the Harvard study also showed that there are steps that health care providers can take to improve patients' perceptions, such as resolving language barriers. She said health care providers should incorporate translation services into their practice.

So doctors should pay to have a translator on staff.

Why can't those for whom English is not their primary language bring along a translator?

Read More

Mandatory Insurance: Are We There Yet?

[Welcome Industry Radar readers!]

I've been thinking about one of the "givens" in the universal coverage debate, and wanted to share some of that with our readers. We operate under a few assumptions here at IB and, although we obviously don't think in "lock step," I'm pretty comfortable in stating that, for the most part, we all agree that:

■ Health insurance costs rise primarily because health care costs do
■ Mandatory benefits impact premiums
■ Personal responsibility and accountability are desirable

None of the legislative initiatives currently on the table substantively address these issues. Which is not to say that there's nothing of value to be gleaned from them.

But first, a slight digression (which I'll then tie back in):

So-called "mandatory insurance" simply posits that citizens be required to purchase (and maintain) health insurance coverage. Leaving aside underwriting considerations (we'll get to those), the question arises: is this a good idea?

One of the arguments that proponents of mandatory coverage espouse is that health insurance should be treated like auto insurance; that is, one is required to have some kind of insurance in order to operate a car. We've touched on this before: health insurance is indeed similar to Property/Casualty in that both are based on the concept of indemnification. Mandatory auto insurance requires some minimum amount of liability cover. The idea is that this protects those whom one may injure in an at-fault accident; it does not, however, pay for repairs to one's own vehicle (that would be "physical damage").

Nor does that "physical damage" coverage (a.k.a.comprehensive/collision) pay for routine maintenance, blown tires, gas, and the like. Those are solely the owner's responsibility. As Bob would say, "there's no co-pay for new windshield wipers."

But the state (the "public") is well served by requiring drivers to protect the interests of others, so there's a net positive social benefit to mandatory auto insurance. Could the same argument be applied to health insurance?

I'm beginning to believe so.

The challenge has always been balance; that is, the inherent conflict between personal responsibility ("you should carry health insurance") and the public good ("you must carry health insurance"). From a practical standpoint, the analogy between auto and health breaks down over what the requirements are. As noted, mandatory auto coverage is pretty simple, and relatively modest: bodily injury and property damage, usually with very low thresholds. So the question becomes: can we fashion a health insurance plan with just a few moving parts (i.e. a minimum of mandatory coverages), thus rendering it more affordable?

The second piece goes to underwriting (see, I told ya we'd get to that): good drivers pay less for insurance than those with (for example) multiple DUI's and speeding tickets. Could we fashion a "minimum" health plan that mimics that (i.e. takes folks' health history into account)?

It seems to me that we can do both, by using a model that's already beginning to find more widespread acceptance: limited benefit ("mini-med") plans. These are relatively inexpensive, and can take into account a more diverse range of underwriting classes. By setting the "minimums" at a realistic level (drug discounts into of co-pays, for example), it seems to me that these could be made readily available, and affordable, to a large percent of the chronically uninsured. And just as folks with Jaguars can "upgrade" their policies to include rental reimbursement and GAP coverage, those who want "more bang for the buck" can opt instead for regular major medical plans (although I certainly hope that more folks will at least consider HSA's).

Is this a "perfect" solution? Of course not. But it's pretty well established that Americans prefer incremental changes to drastic and immediate ones, and this seems to me to be a more "doable" solution.

By the way, I'm not the only one who's giving this some thought of late: both Jason Shafrin at the Healthcare Economist and Amy Tenderich at Diabetes Mine have some intriguing ideas on the subject, as well.

Read More

Mandatory Insurance: Are We There Yet?

[Welcome Industry Radar readers!]

I've been thinking about one of the "givens" in the universal coverage debate, and wanted to share some of that with our readers. We operate under a few assumptions here at IB and, although we obviously don't think in "lock step," I'm pretty comfortable in stating that, for the most part, we all agree that:

■ Health insurance costs rise primarily because health care costs do
■ Mandatory benefits impact premiums
■ Personal responsibility and accountability are desirable

None of the legislative initiatives currently on the table substantively address these issues. Which is not to say that there's nothing of value to be gleaned from them.

But first, a slight digression (which I'll then tie back in):

So-called "mandatory insurance" simply posits that citizens be required to purchase (and maintain) health insurance coverage. Leaving aside underwriting considerations (we'll get to those), the question arises: is this a good idea?

One of the arguments that proponents of mandatory coverage espouse is that health insurance should be treated like auto insurance; that is, one is required to have some kind of insurance in order to operate a car. We've touched on this before: health insurance is indeed similar to Property/Casualty in that both are based on the concept of indemnification. Mandatory auto insurance requires some minimum amount of liability cover. The idea is that this protects those whom one may injure in an at-fault accident; it does not, however, pay for repairs to one's own vehicle (that would be "physical damage").

Nor does that "physical damage" coverage (a.k.a.comprehensive/collision) pay for routine maintenance, blown tires, gas, and the like. Those are solely the owner's responsibility. As Bob would say, "there's no co-pay for new windshield wipers."

But the state (the "public") is well served by requiring drivers to protect the interests of others, so there's a net positive social benefit to mandatory auto insurance. Could the same argument be applied to health insurance?

I'm beginning to believe so.

The challenge has always been balance; that is, the inherent conflict between personal responsibility ("you should carry health insurance") and the public good ("you must carry health insurance"). From a practical standpoint, the analogy between auto and health breaks down over what the requirements are. As noted, mandatory auto coverage is pretty simple, and relatively modest: bodily injury and property damage, usually with very low thresholds. So the question becomes: can we fashion a health insurance plan with just a few moving parts (i.e. a minimum of mandatory coverages), thus rendering it more affordable?

The second piece goes to underwriting (see, I told ya we'd get to that): good drivers pay less for insurance than those with (for example) multiple DUI's and speeding tickets. Could we fashion a "minimum" health plan that mimics that (i.e. takes folks' health history into account)?

It seems to me that we can do both, by using a model that's already beginning to find more widespread acceptance: limited benefit ("mini-med") plans. These are relatively inexpensive, and can take into account a more diverse range of underwriting classes. By setting the "minimums" at a realistic level (drug discounts into of co-pays, for example), it seems to me that these could be made readily available, and affordable, to a large percent of the chronically uninsured. And just as folks with Jaguars can "upgrade" their policies to include rental reimbursement and GAP coverage, those who want "more bang for the buck" can opt instead for regular major medical plans (although I certainly hope that more folks will at least consider HSA's).

Is this a "perfect" solution? Of course not. But it's pretty well established that Americans prefer incremental changes to drastic and immediate ones, and this seems to me to be a more "doable" solution.

By the way, I'm not the only one who's giving this some thought of late: both Jason Shafrin at the Healthcare Economist and Amy Tenderich at Diabetes Mine have some intriguing ideas on the subject, as well.

Read More

Cannon Fodder

FoIB (and MedWonk Biggie) Michael Cannon has an interesting article in this month's Forum for Health Economics & Policy journal. In it, he proposes his solution to the health insurance issue:

"The creation of tax-free health savings accounts presents a new opportunity to reduce the distortions created by federal tax preferences for health-related expenditures that ultimately could help eliminate those distortions."

What he's talking about here are so-called "Large HSA's" with deductibles starting at $8000 ($16,000 for familes). His contention is that these plans, with ultra-low premiums, will allow employers to funnel more cash away from insurance carriers and into their employees' pockets.

A laudable goal, to be sure, but I have some issues with it. Last year, Michael was kind enough to share with me the "white paper" on which this was based. I found the idea intriguing (after all, I am a major proponent of CDHP and HSA's), but had some reservations, which I shared with him at the time.

I am absolutely thrilled for Michael to have been published in such an august journal, and hope (and presume) that his piece will spark a much-needed discussion.

I'd also like to share with our readers my response to Michael last year. Hopefully, this too will help move the ball forward:

1) I've always been a believer in "rising tides raise all ships" (paraphrase): when folks talk about the inequity of the employer write-off, they always talk about deleting or capping it. I've always wondered why it wouldn't make more sense to expand it; that is, enable everyone who buys their own cover to deduct it. I see that you've taken some of that with your bigger/better HSA idea, and that's a good thing.

2) Your idea about basically taking the whatever the e'er/e'ee pay for h/c insurance and running the whole thing thru an HSA is intriguing. Seems to me that this is a variation on (expansion of?) "cafeteria plans." I really like that.

Putting those two together (plus whatever else I haven't gotten to yet), I can see where there would be some significant progress. My only reservation is one of pragmatism: how likely is it that the class-warriors would embrace this (or even consider it at all)? Obviously, that's not a reason not to pursue it, but do you have a strategy in mind for dealing with the inevitable obstructionists?

ADDENDUM: In subsequent correspondence, I also pointed out to Michael the feasibility conundrum such a plan would face. Briefly, insurers know that there is an absolute premium "floor," below which they cannot go. These include fixed and administrative costs, morbidity and reserves. In other words, no matter how high the deductible gets, there's really only "so far" the premiums can be trimmed, until there's no savings to be had. That's why, for example, you save (say) $100 going from a $3000 to a $4000 deductible, but only $25 going to the $6000.

The other problem is that, while I remain convinced that HSA's are a potent weapon in the fight against health care costs and consumer apathy, I don't believe that it is the only such. While "Large HSA's" may appeal to some "large employers," I'm not convinced that they'll play well with smaller groups (or in Peoria, as they say).

Nevertheless, Michael's made an impressive beachhead in the ongoing battle to solve the health insurance "crisis," and we applaud him for that.

Read More

Cannon Fodder

FoIB (and MedWonk Biggie) Michael Cannon has an interesting article in this month's Forum for Health Economics & Policy journal. In it, he proposes his solution to the health insurance issue:

"The creation of tax-free health savings accounts presents a new opportunity to reduce the distortions created by federal tax preferences for health-related expenditures that ultimately could help eliminate those distortions."

What he's talking about here are so-called "Large HSA's" with deductibles starting at $8000 ($16,000 for familes). His contention is that these plans, with ultra-low premiums, will allow employers to funnel more cash away from insurance carriers and into their employees' pockets.

A laudable goal, to be sure, but I have some issues with it. Last year, Michael was kind enough to share with me the "white paper" on which this was based. I found the idea intriguing (after all, I am a major proponent of CDHP and HSA's), but had some reservations, which I shared with him at the time.

I am absolutely thrilled for Michael to have been published in such an august journal, and hope (and presume) that his piece will spark a much-needed discussion.

I'd also like to share with our readers my response to Michael last year. Hopefully, this too will help move the ball forward:

1) I've always been a believer in "rising tides raise all ships" (paraphrase): when folks talk about the inequity of the employer write-off, they always talk about deleting or capping it. I've always wondered why it wouldn't make more sense to expand it; that is, enable everyone who buys their own cover to deduct it. I see that you've taken some of that with your bigger/better HSA idea, and that's a good thing.

2) Your idea about basically taking the whatever the e'er/e'ee pay for h/c insurance and running the whole thing thru an HSA is intriguing. Seems to me that this is a variation on (expansion of?) "cafeteria plans." I really like that.

Putting those two together (plus whatever else I haven't gotten to yet), I can see where there would be some significant progress. My only reservation is one of pragmatism: how likely is it that the class-warriors would embrace this (or even consider it at all)? Obviously, that's not a reason not to pursue it, but do you have a strategy in mind for dealing with the inevitable obstructionists?

ADDENDUM: In subsequent correspondence, I also pointed out to Michael the feasibility conundrum such a plan would face. Briefly, insurers know that there is an absolute premium "floor," below which they cannot go. These include fixed and administrative costs, morbidity and reserves. In other words, no matter how high the deductible gets, there's really only "so far" the premiums can be trimmed, until there's no savings to be had. That's why, for example, you save (say) $100 going from a $3000 to a $4000 deductible, but only $25 going to the $6000.

The other problem is that, while I remain convinced that HSA's are a potent weapon in the fight against health care costs and consumer apathy, I don't believe that it is the only such. While "Large HSA's" may appeal to some "large employers," I'm not convinced that they'll play well with smaller groups (or in Peoria, as they say).

Nevertheless, Michael's made an impressive beachhead in the ongoing battle to solve the health insurance "crisis," and we applaud him for that.

Read More

Lost Your Car Keys?

Perhaps Estradiol will help.

"Women have been telling me this for 25 years," says Elizabeth Lee Vliet, a women's health physician with offices in Tucson, Ariz., and Dallas, Tex., who notes that her patients often speak of feeling "fuzzy-headed." She takes detailed blood tests and typically prescribes 17-beta estradiol, an FDA-approved estrogen replacement. "They come back a couple weeks later and say 'It was like someone turned a lightbulb on my brain! I can think again!'

Like turning in a lightbulb.

Does Estradiol work on blondes?

OK, I am going to hear about that one . . .

Read More

Lost Your Car Keys?

Perhaps Estradiol will help.

"Women have been telling me this for 25 years," says Elizabeth Lee Vliet, a women's health physician with offices in Tucson, Ariz., and Dallas, Tex., who notes that her patients often speak of feeling "fuzzy-headed." She takes detailed blood tests and typically prescribes 17-beta estradiol, an FDA-approved estrogen replacement. "They come back a couple weeks later and say 'It was like someone turned a lightbulb on my brain! I can think again!'

Like turning in a lightbulb.

Does Estradiol work on blondes?

OK, I am going to hear about that one . . .

Read More

Grand Rounds is up...

With a decidedly Western feel, I half expected to see Doc sauntering down the streets of Dodge. But Dr Scott, blogging at Polite Dissent, presents a laid-back and visually attractive compendium of the best of the medblogs. I particularly appreciate the shorter version, a nice break from the massive linkfests that often characterize the 'Rounds.

Do you own you, or do you belong to the gummint? In a somewhat lengthy essay, Sandy Szwarc discusses this intriguing (and disturbing) question.

Read More

Grand Rounds is up...

With a decidedly Western feel, I half expected to see Doc sauntering down the streets of Dodge. But Dr Scott, blogging at Polite Dissent, presents a laid-back and visually attractive compendium of the best of the medblogs. I particularly appreciate the shorter version, a nice break from the massive linkfests that often characterize the 'Rounds.

Do you own you, or do you belong to the gummint? In a somewhat lengthy essay, Sandy Szwarc discusses this intriguing (and disturbing) question.

Read More

Concierge Battle Brewing

[Welcome Industry Radar readers!]

Primary care physicians are battling to save their practices by looking at new ways to increase revenues. Some have converted to cash only services, other are peddling nutritional supplements. And a few have gone to concierge services.

Doctors who charge an annual fee to patients in exchange for customized care including house calls are drawing the ire of some health insurance companies.

Now it seems that some carriers are rebelling against the concierge docs.

But United Healthcare and Cigna both say the concierge model violates their contracts, and United Healthcare is dropping four Texas physicians because of the practice. Insurers say that doctors may charge patients for co-payments or co-insurance, but not additional fees

I tend to agree with the carriers.

MCO contracts signed by physicians prohibit the doc from balance billing for covered services. In other words, once the patient pays their portion the provider is prohibited from charging more.

To do otherwise defeats the concept of the copay (or coinsurance).

It seems this practice may be running afoul of the TX DOI as well.

Jennifer Ahrens, the Texas Department of Insurance's senior associate commissioner for life health and licensing programs, said Texas law is explicit for health maintenance organizations and preferred provider organizations. Physicians associated with HMOs or PPOs agree to discount the fees they bill insurers for specific patient services, but doctors who enter into these discounted-fee contracts can only charge patients related co-payments or co-insurance and not additional fees.

Concierge services is still a new concept so this battle may take a while to come to a head if it ever does.

Still, it is something worth noting.

(Thanks to Matt Horn for the tip on this story line).

Read More